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

• Journal of Chest Surgery
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• 제52권5호
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• pp.372-375
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• 2019

A 55-year-old man was admitted to the trauma center after a car accident. Cardiac tamponade, traumatic aortic injury, and hemoperitoneum were diagnosed by ultrasonography. The trauma surgeon, cardiac surgeon, and interventional radiologist discussed the prioritization of interventions. Multi-detector computed tomography was carried out first to determine the severity and extent of the injuries, followed by exploratory sternotomy to repair a left auricle rupture. A damage control laparotomy was then performed to control mesenteric bleeding. Lastly, a descending thoracic aorta injury was treated by endovascular stenting. These procedures were performed in the hybrid-angio room. The patient was discharged on postoperative day 135, without complications.

• 대한영상의학회지
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• 제84권2호
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• pp.332-344
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• 2023

비촉지성 유방 병변의 발견이 늘어나고 유방암에서도 유방 보존 수술이나 선행항암화학요법이 증가하면서, 유방 병변의 진단과 처치에 있어서 초음파 유도하 중재 시술은 갈수록 그 역할이 중요해지고 이용이 늘어나고 있다. 본 종설에서는 유방 초음파 유도하 중재 시술 중 가장 많이 쓰이는 조직검사와 조직 마커 삽입, 수술 전 위치결정술에 대해 종류와 시술 방법, 적응증, 장단점 등을 알아보고 실제 진료 현장에서 시행하는 데에 도움을 주고자 한다.

• The Korean Journal of Pain
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• 제29권4호
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• pp.217-228
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• 2016

The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.

• 대한정형외과 초음파학회지
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• 제3권2호
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• pp.54-58
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• 2010

목적: 만성적으로 경추 동통을 호소하는 환자의 통증의 근원은 대부분 후관절인데, 증상을 일으키는 관절의 정확한 위치 확인의 어려움과 합병증 및 위약효과의 가능성으로 인해 임상에서의 적용에 의구심을 가지게 된다. 본 연구에서는 만성 경추 동통을 호소하는 환자에서 후관절 동통의 유병율을 평가하고 진단 및 치료적 목적의 초음파를 이용한 후관절 차단술의 유용성에 대해 보고한다. 대상 및 방법: 만성적이면서 비특이적인 경추 동통을 6개월 이상 호소하는 환자를 대상으로 하였다. 방사통을 동반한 추간판 탈출 관련 통증을 호소하는 환자는 그 대상에서 제외되었으며, 물리 치료나 척추 교정 요법, 약물 치료 등의 보존적 치료 요법에 실패한 환자 160명을 대상으로 하였다. 경추 동통에 대한 진단적 후관절 차단술은 1% 리도카인(lidocaine)을 사용하여 시행하였으며, 리도카인에 양성 반응을 보인 환자에 대해서는 2주 뒤 0.25% 부피바카인(bupivacaine)을 사용하였으며, 후관절 차단술 시행 이후 경추 운동시 75% 이상의 통증 감소를 보일 경우를 양성 반응으로 고려하였다. 결과: 만성 경추 동통을 호소하는 환자 160명 가운데 리도카인을 이용한 후관절 차단술에 96명, 60% 양성반응을 보였으며, 리도카인에 음성반응을 보인 환자 64명 가운데 부피바카인에 48명, 75% 양성반응을 보였다. 리도카인에 양성반응을 보였으나 부피바카인에 음성반응을 보인 가양성 환자는 48명, 50%에 해당하였다. 총 160명의 환자들의 시술 전 VAS는 평균 8.5이었으며, 2주 추시시 2.7 (p=0.001), 4주 추시시 3.6 (p=0.001)로 감소하였다. 초기 시술로 증상의 호전이 만족스럽지 않았던 8명과 경과 관찰 도중에 악화되었던 3명은 4주째 후관절 차단술을 추가적으로 실시하여 통증의 완화를 보였다. 결론: 만성 경추 동통을 호소하는 환자에 대해 초음파를 이용한 단일 차단술은 가양성 반응이 높아 진단적 가치가 상대적으로 낮으며, 후관절에 시행한 두 번의 차단술은 만성 경추 동통 환자의 중재적 통증 조절에 유용한 방법으로 사료된다.

• 한국방사선학회논문지
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• 제16권7호
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• pp.935-942
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• 2022

초음파 유도 하 중재적 시술 시 먼저 초음파 장비로 병변의 위치를 파악하며 angio needle을 삽입한다. 이때 실제와 초음파 상 병변의 위치 또는 바늘의 투과 깊이의 차이가 클수록 인체의 주요 혈관이나 조직에 손상을 일으킬 수 있는 위험이 있다. 그러므로 우리는 초음파 장비 업체와 연식에 따라 성능의 차이가 나는지, 이것이 시술의 정확도에 얼마나 영향을 끼치는지 의문이 들어 이를 연구 주제로 삼았다. 본 연구에서는 임의의 초음파 5대의 장비를 사용하여 초음파상 주사침의 길이와 실제 길이를 비교하여 왜곡에 영향을 주는 요인을 분석하고자 하였다. 초음파 유도 하 돼지고기 투과 시 각 연식과 업체가 다른 다섯 대의 초음파 장비로 실제 소시지의 깊이와 바늘의 투과 길이를 영상에서의 값을 측정하여 오차율을 비교하기 위해 spss 22 통계 프로그램의 단일 표본 T 검정을 이용하였다. 그 결과 모두 통계적으로 유의한 범위의 수치가 나왔고, 장비의 연식과 업체만으로 성능을 평가하는 것은 옳지 않다고 판단하였다. 그러므로 초음파 정도 관리를 정기적으로 실시하고 시술자의 숙련도를 높여 실제 시술 부위와 영상에서의 오차율을 줄여야한다고 결론을 내리는 바이다.

• Journal of Trauma and Injury
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• 제25권3호
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• pp.67-71
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• 2012

Purpose: Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard. Methods: The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department. Results: There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively. Conclusion: Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.

• Clinics in Shoulder and Elbow
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• 제20권2호
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• pp.84-89
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• 2017

Background: Common and effective treatments for calcific tendinitis involve needling procedures. However, it has been widespread practice to refer patients with calcific tendinitis, which is a predominantly orthopedic condition, to radiology department. The purpose of this study was to compare clinical and radiological outcomes after ultrasound-guided needling for calcific tendinitis between the orthopedics and radiology department. Methods: Seventy-seven shoulders (Group 1) and 38 shoulders (Group 2) treated in the radiology and orthopedic department, respectively. A fellowship-trained orthopedic surgeon and a musculoskeletal radiologist each performed the procedure of ultrasound-guided needle decompression with subacromial steroid injection. Clinical outcomes was evaluated using the visual analogue scale for pain (pVAS) and the American Shoulder and Elbow Surgeons (ASES) shoulder score before treatment and at each follow-up. The pre- and postneedling size and shape of the calcific deposits were compared between the two groups. Results: We analyzed a total of 56 shoulders for Group 1 and 32 shoulders for Group 2. The mean age and sex ratio of the patients no significantly different. We found that the mean decrease in the diameter of calcification between pre- and post-needling was 9.0 mm for Group 1 and 13.1 mm for Group 2; the difference was significantly larger in Group 2 than in Group 1. Both groups showed improved pVAS and ASES scores after needling but the extent of these improvements did not differ with the type of operator. Conclusions: Needling decompression performed by orthopedic surgeons could a viable option for the treatment of calcific tendinitis.

• 대한족부족관절학회지
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• 제20권3호
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• pp.135-139
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• 2016

Purpose: Modified Mau and Akin osteotomy for hallux valgus is followed by moderate to severe postoperative pain. Ultrasound-guided sciatic nerve block can be an effective option for pain control. We attempted to evaluate the efficacy of the ultrasound-guided sciatic nerve block in controlling postoperative pain. Materials and Methods: The charts of 59 consecutive patients were retrospectively reviewed between December 2014 and August 2015. Twenty-eight patients (the patient group) has received the ultrasound-guided sciatic nerve block after surgery, and 31 patients (the control group) has not received such procedure. The primary outcome was the satisfaction scale for postoperative pain control and postoperative visual analogue scale (VAS) score. Results: The VAS score at postoperative day one was significantly lower in the patient group than in the control group. The satisfaction scale for pain control for postoperative 1 day was significantly different between the two groups. In patient group, most patients have rated positively ('strongly agree' 42.9%, 'agree' 42.9%); however, in the control group, the rating scales were distributed relatively negatively ('strongly agree' 9.7%, 'agree' 22.6%, 'neutral' 29.0%, 'disagree' 25.8%, 'strongly disagree' 12.9%). The number of postoperative rescue analgesics injection was significantly lower in the patient group than in the control group. Conclusion: Postoperative ultrasound-guided sciatic nerve block was effective for pain relief after hallux valgus surgery.

• The Korean Journal of Pain
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• 제33권3호
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• pp.258-266
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• 2020

Background: The genicular nerve block (GNB) is demonstrated from several reports to alleviate pain and improve knee functionality in patients with chronic knee osteoarthritis (OA). Ultrasound (US)-guided GNB has been the most used imaging method. This study aimed to compare the effectiveness of US-guided versus blind GNB in the treatment of knee OA. Methods: This prospective, randomized clinical trial included patients with knee OA based on American College of Rheumatology diagnostic criteria. The patients were evaluated for clinical and dynamometer parameters at the baseline, 4 weeks after treatment, and 12 weeks after treatment. The patients underwent blind injection or US-guided injection. Results: When compared with the baseline, both groups showed significant improvement in pain, physical function, and quality of life parameters. Significant differences were observed between the groups for clinical parameters (30-second chair stand test, 6-minute walk test) in favor of the US-guided group. On the other hand, blind injection was more significantly effective on some parameters of the Nottingham Health Profile. There wasn't any significant improvement in isokinetic muscle strength for either group. Conclusions: This study demonstrated that both US-guided and blind GNB, in the treatment of knee OA, were effective in reducing symptoms and improving physical function. GNB wasn't an effective treatment for isokinetic muscle function. US-guided injections may yield more effective clinical results than blind injections.