• 한국임상수의학회지
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• 제30권3호
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• pp.166-171
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• 2013

본 연구는 개에서 난소자궁절제술과 난소절제술의 실시가 동물의 통증행동과 스트레스에 미치는 영향을 비교하고, 임상적용 가능성을 평가하기 위하여 실시되었다. 13 마리의 건강한 암컷 중 (4.2-5.5 kg) 6 마리의 개에서 난소절제술이 행하여졌고, 7 마리에서 난소자궁절제술이 이루어졌다. 술 후 두 그룹 간에 수술 시간, 마취 시간, 복벽의 절개 길이를 비교하였다. 또한 술 전과 술 후 1, 2, 4, 6, 12, 24 시간째에 Short form of composite measure pain scale (CMPS-SF) 를 사용하여 통증 점수를 측정하였고 혈중 glucose 와 creatine kinase 그리고 cortisol 수치를 측정하였다. 난소자궁절제술을 시행한 그룹에서는 난소절제술을 시행한 그룹에 비해 유의적으로 (p < 0.05) 긴 수술 시간, 마취 시간, 복벽 절개 길이를 나타내었다. Two-way ANOVA test 결과 CMPS-SF에 의한 통증점수가 두 그룹 간에 유의적 (p < 0.05) 차이를 보였으며 술 후 1, 2, 4, 6 시간째 난소절제술을 행한 그룹에서 유의적으로 낮은 수치를 나타내었다. Glucose 의 경우 난소자궁절제술을 행한 그룹에서는 술 전과 비교해 유의적 (p < 0.05) 농도 증가가 술 후 1 시간째에 나타났으나 난소절제술을 행한 그룹에서는 술 후 전체 관찰기간 동안 유의적 농도 증가가 관찰 되지 않았다. Creatine Kinase 의 경우 난소자궁절제술을 행한 그룹에서는 술 전과 비교하여 술 후 1, 2, 4, 6, 12 시간째에 유의적 (p < 0.05) 농도 증가를 나타내었으나 난소절제술 그룹의 경우 술 후 4, 6, 12 시간째에만 술 전과 비교하여 유의적 (p < 0.05) 농도 증가를 나타내었다. Cortisol 의 경우 두 그룹 모두 술 후 1, 2 시간째에 유의적인 (p < 0.05) 농도 상승을 나타내었다. 본 연구 결과 난소절제술을 이용한 암캐의 중성화 수술 방법은 난소자궁절제술에 비해 짧은 복벽 절개, 수술 시간, 마취 시간을 요하며, 적은 술 후 통증과 스트레스를 유발하므로 난소절제술을 시행하는 것이 환자에게 바람직할 것으로 판단된다.

• 대한치과의사협회지
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• 제48권1호
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• pp.38-44
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• 2010

Nowadays, medically compromised patients who could not receive dental treatments in the past are able to go through minor oral surgeries with adequate preoperative measures. Thorough understanding of the systemic disease and its complications is needed as well as the management them. Frequent complications of surgical procedures are bleeding, infection, delayed healing, systemic reactions by stress and they can be aggravated due to the patients' systemic conditions. Therefore, understanding of the systemic disease of patient visiting dental office and treatment modification according to the systemic status is needed. Also consultation to the medical doctor is imperative, through which perioperative risk and complications can be reduced. Among the high frequency complications of dental treatment of medically compromised patients, bleeding, infection, delayed healing, systemic reactions by stress will be discussed with the management of each one.

• Journal of Korean Neurosurgical Society
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• 제61권2호
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• pp.277-281
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• 2018

Objective : Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. Methods : A 53-year-old male patient applied to outpatients' clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation.The patient underwent C0-C3-C4 (lateral mass) and additional C0-C2 (translaminar) stabilization surgery. Results : In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound.When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system.Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. Conclusion : We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.

• The Korean Journal of Pain
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• 제11권2호
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• pp.235-240
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• 1998

Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of CNS and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative intravenous morphine could affect postoperative pain and change plasma cortisol and serum glucose levels. Methods: Thirty eight patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. Control group (n=11) did not received intravenous morphine, preoperative group (n=13) received intravenous morphine (0.1 mg/kg as a bolus 10 min before operation and followed by 1.5 mg/hr for 10 hours), postoperative group (n=14) received the same doses and method of intravenous morphine of preoperative group postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative visual analogue scores (VAS), analgesic requirement (first request time, total amounts used), side effects, plasma cortisol and serum glucose levels were compared. Results: VAS were different between control group and the other two goups, but were not different between preoperative and postoperative group. Total amounts of used fentanyl were not different among groups, but first request time were significantly delayed in the preoperative group compared with the other two groups ($66.2{\pm}33.9$ vs $39.0{\pm}15.4$ and $45.0{\pm}14.9$ min respectively, p<0.05). Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Above dosage of preoperative and postoperative morphine has analgesic effect, but could not block surgical stress induced plasma cortisol and serum glucose increase.

• Archives of Plastic Surgery
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• 제51권3호
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• pp.304-310
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• 2024

Background Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. This study aimed to assess impact of a psychiatric diagnosis on patients treated for HS. Methods Patients with HS were retrospectively identified at a single institution from 2010 to 2021. Cohorts were stratified by the presence of a psychiatric disorder. Demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the procedural interventions and emergency department (ED) visits. Financial distress was assessed via the COST-FACIT Version 2 survey. Results Out of 138 patients, 40 (29.0%) completed the survey of which 19 (47.5%) had a preexisting psychiatric diagnosis. No demographic differences were found between cohorts. Mean follow-up was 16.1 ± 11.0 months. The psychiatric cohort had a higher median number of surgeries received (7.0 vs. 1.5, p < 0.001), a higher median number of ED visits (1.0 vs. 0, p = 0.006), and a similar hospital length of stay (p = 0.456). The mean COST-FACIT score of the overall study population was 19.2 ± 10.7 (grade 1 financial toxicity). The psych cohort had a lower mean COST-FACIT score (16.8 vs. 21.3, p = 0.092) and reported greater financial hardship (3.3 vs. 1.7, p < 0.001). On multivariate analysis, a psychiatric diagnosis was predictive of lower credit scores, more ED visits, and a higher number of surgeries. Conclusion Preexisting psychiatric conditions in patients with HS are associated with increased health care utilization and surgical intervention with substantial financial distress. Plastic surgeons should be cognizant of such comorbid disorders to facilitate holistic care addressing all patient needs.

• 대한핵의학회지
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• 제33권3호
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• pp.273-281
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• 1999

목적: 우리는 비심장 수술 환자에서 수술전후의 심장사건의 위험도를 평가할 때 미국 순환기학회/미국 심장학회(이하ACC/AHA)에서 제시한 임상적 여러 지표에 더하여 심근관류 SPECT가 도움되는지 연구하였다. 대상 및 방법: 1997년에 비심장 수술을 시행한 118명(혈관수술 18, 비혈관수술 100)을 대상으로 수술 전에 휴식 T1-201/부하 Tc-99m MIBI 심근관류 SPECT를 시행하고 중한 심장사건과 경한 심장사건의 발생을 조사하였다. 임상적 지표, 운동능력, 수술 종류에 따라 분류한 것의 심장사건 예측률과 심근관류 SPECT 소견을 가역관류감소, 지속관류감소, 정상으로 나누었을 때 심장사건 예측률을 조사하였다. 임상적 지표들에 대해 심근관류 SPECT가 부가 효용이 있는지 다변량 로짓 회귀분석을 하였다. 결과: 심장사건은 전체 환자의 21%에서 발생하였으며 심근관류 SPECT에 가역적 심근관류 이상이 있는 경우에 심장사건의 발생빈도가 높았다. 임상적 분류와 수술 종류도 사건 발생을 예측할 수 있었으나 다변량 분석에 수술 종류(p=0.0018)와 심근관류 SPECT 소견(p=0.0001)이 유의한 예측지표이었다. 심근관류 SPECT 결과가 수술 종류에 따른 위험 예측을 더욱 계층화할 수 있었다. 결론: 비심장수술 환자에서 수술 종류에 더하여 심근관류 SPECT가 심장사건 발생을 예측하는 유용한 지표이었다.

• Asian Spine Journal
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• 제12권6호
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• pp.1092-1099
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• 2018

Study Design: In-vitro biomechanical investigation. Purpose: To evaluate the biomechanical effects of the degeneration of the biodegradable cervical plates developed for anterior cervical discectomy and fusion (ACDF) on fusion and adjacent levels. Overview of Literature: Biodegradable implants have been recently introduced for cervical spine surgery. However, their effectiveness and safety remains unclear. Methods: A linear three-dimensional finite element (FE) model of the lower cervical spine, comprising the C4-C6 vertebrae was developed using computed tomography images of a 46-year-old woman. The model was validated by comparison with previous reports. Four models of ACDF were analyzed and compared: (1) a titanium plate and bone block (Tita), (2) strong biodegradable plate and bone block (PLA-4G) that represents the early state of the biodegradable plate with full strength, (3) weak biodegradable plate and bone block (PLA-1G) that represents the late state of the biodegradable plate with decreased strength, and (4) stand-alone bone block (Bloc). FE analysis was performed to investigate the relative motion and intervertebral disc stress at the surgical (C5-C6 segment) and adjacent (C4-C5 segment) levels. Results: The Tita and PLA-4G models were superior to the other models in terms of higher segment stiffness, smaller relative motion, and lower bone stress at the surgical level. However, the maximal von Mises stress at the intervertebral disc at the adjacent level was significantly higher in the Tita and PLA-4G models than in the other models. The relative motion at the adjacent level was significantly lower in the PLA-1G and Bloc models than in the other models. Conclusions: The use of biodegradable plates will enhance spinal fusion in the initial stronger period and prevent adjacent segment degeneration in the later, weaker period.

• 대한정형외과스포츠의학회지
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• 제9권1호
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• pp.16-21
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• 2010

최근 스포츠 활동 증가로 인한 하지의 과사용증후군인 만성 구획증후군 및 스트레스 골절의 빈도가 늘어가고 있다. 만성구획증후군은 운동 중 근육의 부피 증가와 이로 인한 구획압 증가로 야기된 가역적인 허혈상태로, 보존적 치료로 호전되지 않는 경우 근막절개술 등의 수술적 치료를 고려할 수 있다. 스트레스 골절은 정상적인 골에 비정상적인 스트레스가 가해져서 발생하는 피로 골절과 비정상적인 골에 정상적인 스트레스에 의해서 발생하는 부전골절로 분류할 수 있으며, 대부분의 스트레스 골절은 하지, 특히 경골부에 호발한다. 운동선수에서 피로 골절은 훈련 방법의 변화에 기인할 수 있고 진단은 일차적으로 단순방사선 촬영을 시행하며, 자기공명영상을 통해 확진 할 수 있다. 대부분의 경우 휴식 및 단기간의 고정 등을 통한 보존적 치료만으로 증상의 호전 및 운동 복귀가 가능하나, 경골의 신연부에 발생한 경우 수술적 치료를 요할 수도 있다.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1997년도 춘계학술대회
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• pp.374-378
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• 1997

Operative procedures such as core drilling with and without fibular bone grafting have been recognized as the treatment methods for osteonecrosis of femoral head(ONFH) by delaying or preventing the collapse of the femoral head. In addition, core drilling with cementation using polymethylmethacrylate (PMMA) has been proposed recently as another surgical method. However, no definite treatment modality has been found yet while operative procedures remain controversial to many clinicians In this study, a finite element method(FEM) was employed to analyze and compare various surgical procedures of ONFH to provide a biomechanical insight. This study was based upon biomechanical findings which suggest stress concentration within the femoral head may facilitate the progression of the necrosis and eventual collapse. For this purpose, five anatomically relevant hip models were constructed in three dimensions : they were (1) intact(Type I), (2) necrotic(Type II), (3) core drilled only(Type III), (4) core drilled with fibular bone graft(Type IV), and (5) core drilled with cementation(Type V). Physiologically relevant loading were simulated. Resulting stresses were calculated. Our results showed that the volumetric percentage subjected to high stress in the necrotic cancellous region was greatest in the core drilled only model(Type III), followed by the necrotic(Type II), the bone graft (Type IV), and the cemented(Type V) models. Von Mises stresses at the tip of the graft(Type IV) was found to be twice more than those of cemented core(Type V) indicating the likelihood of the implant failure. In addition, stresses within the cemented core(Type V) were more evenly distributed and relatively lower than within the fibular bone graft(Type IV). In conclusion, our biomechanical analyses have demonstrated that the bone graft method(Type IV) and the cementation method(Type V) are both superior to the core decompression method(Type III) by reducing the high stress regions within the necrotic cancellous bone. Also it was found that the core region filled with PMMA(Type V) provides far smoother transfer of physiological load without causing the concentration of malignant stresses which may lead to the failure than with the fibular bone graft(Type IV). Therefore, considering the above results along with the degree of difficulties and risk of infection involved with preparation of the fibular bone graft, the cementation method appears to be a promising surgical treatment for the early stage of osteonecrosis of the femoral head.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제37권
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• pp.14.1-14.11
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• 2015

The aim of this article is to review temporomandibular joint symptoms as well as the effects of orthognathic surgery(OGS) on temporomandibular joint(TMJ). The causes of temporomandibular joint disease(TMD) are multifactorial, and the symptoms of TMD manifest as a limited range of motion of mandible, pain in masticatory muscles and TMJ, Joint noise (clicking, popping, or crepitus), myofascial pain, and other functional limitations. Treatment must be started based on the proper diagnosis, and almost symptoms could be subsided by reversible options. Minimally invasive options and open arthroplasty are also available following reversible treatment when indicated. TMD manifesting in a variety of symptoms, also can apply abnormal stress to mandibular condyles and affect its growth pattern of mandible. Thus, adaptive developmental changes on mandibular condyles and post-developmental degenerative changes of mandibular condyles can create alteration on facial skeleton and occlusion. The changes of facial skeleton in DFD patients following OGS have an impact on TMJ, masticatory musculature, and surrounding soft tissues, and the changes of TMJ symptoms. Maxillofacial surgeons must remind that any surgical procedures involving mandibular osteotomy can directly affect TMJ symptoms, thus pre-existing TMJ symptoms and diagnoses should be considered prior to treatment planning and OGS.