• Archives of Plastic Surgery
• /
• 제49권2호
• /
• pp.174-183
• /
• 2022

Management of traumatic skull base fractures and associated complications pose a unique reconstructive challenge. The goals of skull base reconstruction include structural support for the brain and orbit, separation of the central nervous system from the aerodigestive tract, volume to decrease dead space, and restoration of the three-dimensional appearance of the face and cranium with bone and soft tissues. An open bicoronal approach is the most commonly used technique for craniofacial disassembly of the bifrontal region, with evacuation of intracranial hemorrhage and dural repair performed prior to reconstruction. Depending on the defect size and underlying patient and operative factors, reconstruction may involve bony reconstruction using autografts, allografts, or prosthetics in addition to soft tissue reconstruction using vascularized local or distant tissues. The vast majority of traumatic anterior cranial fossa (ACF) injuries resulting in smaller defects of the cranial base itself can be successfully reconstructed using local pedicled pericranial or galeal flaps. Compared with historical nonvascularized ACF reconstructive options, vascularized reconstruction using pericranial and/or galeal flaps has decreased the rate of cerebrospinal fluid (CSF) leak from 25 to 6.5%. We review the existing literature on this uncommon entity and present our case series of n = 6 patients undergoing traumatic reconstruction of the ACF at an urban Level 1 trauma center from 2016 to 2018. There were no postoperative CSF leaks, mucoceles, episodes of meningitis, or deaths during the study follow-up period. In conclusion, use of pericranial, galeal, and free flaps, as indicated, can provide reliable and durable reconstruction of a wide variety of injuries.

• The Korean Journal of Pain
• /
• 제26권2호
• /
• pp.191-194
• /
• 2013

Pseudoaneurysm of the abdominal wall is a possible but very rare clinical entity. It is a known complication of surgery, trauma, or arterial puncture, but it is rarely spontaneous. Even though it can usually present with a wide range of local symptoms, it can cause referred pain via spinal cord, which is cross-excited with afferent sympathetic nervous system. We report a case of right arm pain which was referred from a small abdominal pseudoaneurysm like a referred pain from gall bladder. This rare entity should be considered in the differential for pain management in case that the pain does not resolve with medication or interventional pain management.

• Investigative Magnetic Resonance Imaging
• /
• 제22권4호
• /
• pp.249-253
• /
• 2018

Superficial siderosis of the central nervous system (CNS) is a progressive and debilitating neurological disease manifesting sensorineural hearing loss, cerebellar ataxia, and pyramidal tract signs. Chronic extravasation of blood into the subarachnoid space results in the accumulation of hemoglobin derivate in the subpial layer of the CNS, which is toxic to the neural tissues. Craniopharyngioma is a benign third ventricle tumor, which rarely presents with tumor bleeding. We report a rare case of superficial siderosis associated with craniopharyngioma with intratumoral hemorrhage in a patient with no history of prior trauma or CNS surgery.

• 대한두개안면성형외과학회지
• /
• 제25권2호
• /
• pp.99-103
• /
• 2024

Because facial nerve injuries affect the quality of life, leaving them untreated can have devastating effects. The number of patients with traumatic and iatrogenic facial nerve paralysis is considerably high. Early detection and prompt treatment during the acute injury phase are crucial, and immediate surgical treatment should be considered when complete facial nerve injury is suspected. Symptom underestimation by patients and clinical misdiagnosis may delay surgical intervention, which may negatively affect outcomes and in some cases, impair the recovery of the injured facial nerve. Here, we report two cases of facial nerve injury that were treated with nerve grafts during the subacute phase. In both cases, subacute facial nerve grafting achieved significant improvements. These cases highlight surgical intervention in the subacute phase using nerve grafts as an appropriate treatment for facial nerve injuries.

• 감성과학
• /
• 제7권2호
• /
• pp.179-186
• /
• 2004

중추신경계는 일단 손상이 되면 손상된 세포의 재생, 손상된 수초의 회복, 신경계의 정상적인 연결 등의 제한성 때문에 그 회복이 매우 힘들다. 이러한 중추신경계의 중요한 손상으로는 다발성 경화증, 뇌졸중, 척수손상, 외상, 축삭의 탈수초화 등이 있다. 이전 연구들은 많은 발생빈도를 보이고 있는 척수손상에서 실질적인 척수의 기능적인 회복을 위해 손상된 척수신경의 재생과 축삭의 재수초화가 중요한 요인이라고 전하고 있다. 최근에는 이러한 척수손상에 대한 치료적 접근으로서 세포이식 기술이 하나의 해결책을 열어주고 있다. 따라서 본 논문에서는 척수손상의 특성을 살펴보고, 척수손상에 의한 기능장애에 대해 세포이식이 기능의 회복을 증진시킬 수 있다는 증거를 논의하고자 한다.

• Archives of Pharmacal Research
• /
• 제27권3호
• /
• pp.314-318
• /
• 2004

Microglia are the major inflammatory cells in the central nervous system and become activated in response to brain injuries such as ischemia, trauma, and neurodegenerative diseases including Alzheimer's disease (AD). Moreover, activated microglia are known to release a variety of proinflammatory cytokines and oxidants such as nitric oxide (NO). Minocycline is a semi-synthetic second-generation tetracycline that exerts anti-inflammatory effects that are completely distinct form its antimicrobial action. In this study, the inhibitory effects of minocycline on NO and prostaglandin E$_2$ (PGE$_2$) release was examined in lipopolysaccharides (LPS)-challenged BV2 murine microglial cells. Further, effects of minocycline on inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expression levels were also determined. The results showed that minocycline significantly inhibited NO and PGE$_2$ production and iNOS and COX-2 expression in BV2 microglial cells. These findings suggest that minocycline should be evaluated as potential therapeutic agent for various pathological conditions due to the excessive activation of microglia.

• Archives of Plastic Surgery
• /
• 제42권5호
• /
• pp.626-629
• /
• 2015

Peripheral nerve injuries remain a challenge for reconstructive surgeons with many patients obtaining suboptimal results. Understanding the level of injury is imperative for successful repair. Current methods for distinguishing healthy from damaged nerve are time consuming and possess limited efficacy. Confocal laser endomicroscopy (CLE) is an emerging optical biopsy technology that enables dynamic, high resolution, sub-surface imaging of live tissue. Porcine sciatic nerve was either left undamaged or briefly clamped to simulate injury. Diluted fluorescein was applied topically to the nerve. CLE imaging was performed by direct contact of the probe with nerve tissue. Images representative of both damaged and undamaged nerve fibers were collected and compared to routine H&E histology. Optical biopsy of undamaged nerve revealed bands of longitudinal nerve fibers, distinct from surrounding adipose and connective tissue. When damaged, these bands appear truncated and terminate in blebs of opacity. H&E staining revealed similar features in damaged nerve fibers. These results prompt development of a protocol for imaging peripheral nerves intraoperatively. To this end, improving surgeons' ability to understand the level of injury through real-time imaging will allow for faster and more informed operative decisions than the current standard permits.

• Clinical and Experimental Pediatrics
• /
• 제64권6호
• /
• pp.251-259
• /
• 2021

Psychogenic nonepileptic seizures (PNES) is a neuropsychiatric condition that causes a transient alteration of consciousness and loss of self-control. PNES, which occur in vulnerable individuals who often have experienced trauma and are precipitated by overwhelming circumstances, are a body's expression of a distressed mind, a cry for help. PNES are misunderstood, mistreated, under-recognized, and underdiagnosed. The mind-body dichotomy, an artificial divide between physical and mental health and brain disorders into neurology and psychiatry, contributes to undue delays in the diagnosis and treatment of PNES. One of the major barriers in the effective diagnosis and treatment of PNES is the dissonance caused by different illness perceptions between patients and providers. While patients are bewildered by their experiences of disabling attacks beyond their control or comprehension, providers consider PNES trivial because they are not epileptic seizures and are caused by psychological stress. The belief that patients with PNES are feigning or controlling their symptoms leads to negative attitudes of healthcare providers, which in turn lead to a failure to provide the support and respect that patients with PNES so desperately need and deserve. A biopsychosocial perspective and better understanding of the neurobiology of PNES may help bridge this great divide between brain and behavior and improve our interaction with patients, thereby improving prognosis. Knowledge of dysregulated stress hormones, autonomic nervous system dysfunction, and altered brain connectivity in PNES will better prepare providers to communicate with patients how intangible emotional stressors could cause tangible involuntary movements and altered awareness.

• 혜화의학회지
• /
• 제15권1호
• /
• pp.125-140
• /
• 2006

Study of east & west medical science documentary records of Hip joint pain lead to following conclusions. 1. Easten medicine classify hip joint pain with terms "Bi-chu-tong", "Bi chu in tong" "Bi-chu-choong-tong". 2. Easten medicine asorts cause of hip joint pain with external factor, such as exogenous energy, six yin evil energy and intrinsic factor, which are weakness caused by prolonged deasease, warm-heat evil. 3. In western medicine, causes that trigger hip joint pain are trauma, fracture, dislocation,and bacterial infection. 4. Treatment of hip joint disorder in western medicine, physiotherapy concerning conservative treatment, and pain control with drug treatment, kinesitherapy are used, and concernig fracture, operation is used. 5. In Eastern medicine, principle of treating hip joint pain, sung-juk-sa-ji(盛則寫之), hu-juk-bo-ji(虛則補之), yul-juk-jil-ji(熱則疾之), han-juk-yu-ji(寒則留之), ham-ha-juk-chim-ji(陷下則沈之), bul-sung-bul-hu(不盛不虛), yi-kyong-chui-ji(以經取之) is presented. This priciple of treatment was descended through ages and is now applied to treatments such as Acupuncture, Herbal, physical treatment based on so-san-eo-hyul(消散瘀血), seo-kun-tong-rak(舒筋通絡), so-ri-kwan-jul(疏利關節) principle. 6. In Eastern medicine, meridians used to treat hip joint pain are The Chok yangmyung wi Kyong(足陽明胃經), Chok taeum bi Kyong(足太陰脾經), Chock soyang dam Kyong(足少陽膽經), Chock guelum gan Kyong(足厥陰肝經). In conclusion, hip joint pain should be considered in relationship with internal organs and whole body system. Western & Eastern point of view should be carefully inspected and connected and intensive study of nervous system and meridian is required, in order to adopt best treatment for the patients.

• 대한의용생체공학회:의공학회지
• /
• 제25권6호
• /
• pp.611-615
• /
• 2004

본 연구는 외부 전원 없이 광다이오드만을 이용하여 생성한 광전 자극을 통해 신경계를 효과적으로 자극하는 방법에 대한 것이다. 광을 통한 전류원 생성 및 전달은 생체 내에 집적된 광소자를 삽입하고 외부에서 광을 통해 신호와 전력을 전달을 한다. 이 기술은 특히 '눈' 이라는 광학적인 연결통로를 이용할 수 있는 인공망막과 같은 시스템에 매우 효과적이다. 그러나 광전 소자를 내부 전원 없이 구동시키는 경우, 광전류가 생체 저항에 직접적인 영향을 받게 되므로 자극에 충분한 전류를 생성할 수 없다. 무 전원 광다이오드를 통해 생성되는 광전류를 신경 자극에 적용하기 위해서는 생체 저항의 크기에 관계없이 활동 전위 생성에 충분한 전류 공급을 할 수 있는 안정된 전류원이 필요하다. 이를 위해서 본 연구에서는 병렬 저항을 도입하였다. 병렬 저항 추가 시 생체 저항을 포함한 전체 저항 값이 낮아지므로, 광원의 세기에 따라 최대의 광전류에 근접한 값을 얻을 수 있게 된다. 그러나 병렬 저항 값의 크기를 낮출수록 자극에 쓰이지 않는 전류량이 늘어나므로, 자극 전류량의 극대 값을 찾기 위해서는 병렬 저항 값의 최적화가 필요하다. 실험을 통해 측정된 실제 자극 전류량이 최대가 되는 병렬 저항 값의 범위는 500Ω∼700Ω 이고, 이때 전류량은 580uA∼860uA 이며 전류 효율은 47.5∼59.7%이었다. 자극의 크기와 빈1도를 변화시키면서 쥐의 좌골 신경을 자극하여 눈으로 확인 가능한 떨림 현상을 확인하였으며, 다채널 기록기를 이용해 활동 전위를 측정하였다. 이를 통해, 인공 망막에서의 광 자극 가능성을 확인할 수 있었다.