• 대한소아치과학회지
• /
• 제35권3호
• /
• pp.556-561
• /
• 2008

신경섬유종증은 상염색체 우성 유전성 질환으로, 17번 염색체의 장완에 위치한 종양 억제 유전자의 변성에 의해 발생한다. 이는 두가지 형이 있으며 신경섬유종의 발생은 제1형 신경섬유종증의 임상적 진단 기준 중 하나이다. 신경섬유종증의 임상적 증상으로는 피부병소, 골변형, 중추신경계의 종양 등이 있으며 환자의 25%가 구강내 신경섬유종을 보인다. 악골내 신경섬유종은 드물며 방사선학적으로 하악공, 하악관, 이공을 포함하고 단방성으로 잘 경계된 방사선 투과성으로 나타난다. 신경섬유종은 하나 또는 그 이상의 병소에서 신경육종으로 전이된다는 점에서 임상적으로 중요하며 현재 특이한 치료법은 없으나, 외과적 절제술이 좋은 치료법으로 여겨지고 있다. 본 증례는 제1형 신경섬유종증 진단을 받은 환아로, 구강내 신경섬유종의 외과적 절제 후 양호한 결과를 보여 이를 보고하는 바이다.

• Clinics in Shoulder and Elbow
• /
• 제5권1호
• /
• pp.47-54
• /
• 2002

Purpose : We evaluated clinical result of arthroscopic and open Bankart repair in anterior shoulder instability to identify factors iuluencing operative result and prognosis. Materials & Methods . We reviewed 24 patients of anterior shoulder instability treated with arthroscopic Bankart repair in 16 cases and open Bankart repair in 8 cases. Average age was 26 years old and involved in dominant arm in 15 cases. Patients were suffered instability for 3.1 years before operation and mean follow-up was 2 year 9 months ( 1 you 9 months -4year 10 months). Results : Post operative pain was subsided in 2 weeks in arthroscopic surgery and 3 weeks in open surgery. The final range of motion after arthroscopic repair were flekion in 168" , external rotation in 54" , and internal rotation in 79, and after open repair 168" ,49" , and 78 respectively. In arthroscopic surgery,2 cases (13%) were redislocated, and 4 cases(25%) showed mild instability. In open case,1 case (11%) showed mild instability. According to function- al result by Rowe grading scale, satisfactory results were 12case (76%) in arthroscopic repair and 7 cases (88%) in open cases. Conclusions Both arthroscopic or open Bankart could get good results in the treatment of anterior instability of shoulder. In arthroscopic repair, perioperative morbidity was lower than open repair, but it needs careful rehabilitation program to prevent redislocation and to return to sports activity.

• Clinics in Shoulder and Elbow
• /
• 제1권2호
• /
• pp.160-166
• /
• 1998

The purpose of this study was to assess the results of arthroscopic subacromial decompression in patients with chronic impingement and to evaluate the results according to the rotator cuff pathology. We evaluated the clinical results of treatment for chronic impingement syndrome in 28 patients from Feb 1996 to Feb 1997. There were twenty men and eight women in age from 24 to 72 years (mean age 51) with dominant arm involvement in sixteen patients. Follow up evaluations averaged 15(range 12-24)months. The average duration of symptoms were 15(range 6­60)months. The final diagnoses which were based on the physical examination, plain radiographs and arthroscopic findings, were stage II impingement in 16 patients and stage ill impingement in 12 patients. We excluded the patients with acromioclavicular arthritis or glenohumeral instability in this study. All patients were managed non-operatively a minimum of six months. During the operation we performed contouring and smoothing the acromial undersurface and only resecting of the anterolateral band of the coracoacromial ligament. The clinical results were quantitated using UCLA shoulder rating score. Satisfactory results were obtained in 23(80%) patients. Unsatisfactory results were obtained in 5(18%) patients with posterior cuff tear. The average UCLA pain score showed significant improvement from 2.8(constant pain) to 7.2(present during heavy activities) at final follow up. The function and active forward flexion scores also increased from their preoperative value. There was no significant differences according to the surface and severity of tear and NeeI' stage (P>0.05). These results compared favorably with those reported following open acromioplasty. While arthroscopic subacromial decompression is a demanding technique with a learning curve, it is a reliable treatment for chronic impingement syndrome. A less aggressive approach to subacromial decompression and preserving the posteromedial band of the coracoacromialligament does not appear to compromise results.

• 한국운동역학회지
• /
• 제15권3호
• /
• pp.51-59
• /
• 2005

To examine the influence of aging on the mechanism of muscle fatigue, we compared the magnitude of central and peripheral fatigue in young and old women before, during and after a sustained submaximaI isometric contraction of elbow flexor muscles. Twelve women (6 young. $20.7{\pm}1.2$ years and 6 old, $68.8{\pm}29$ years) performed a contraction at 20% of maximal voluntary contraction (MVC) torque with their non-dominant arm. The old women were weaker than the young women, however their endurance time for the 20% contraction was longer compared with the young women ($1822{\pm}444$ vs. $1061{\pm}678$ sec, P <. 05). Both groups had a similar reduction in voluntary activation ratio (VA) during and after the fatiguing contraction. However, the old women showed much greater variability in VA before and after the contraction ($91.61{\pm}4.54%$ and $76.70{\pm}19.55\;%$ range of $79{\sim}99$ to $87{\sim}99%$ respectively) compared with the young women ($95.71{\pm}1.86\;%$ and $83.46{\pm}7.57\;%$ range of $39{\sim}75$ to $69{\sim}90%$, respectively). Furthermore, the EMG activity of the elbow flexor muscles and triceps brachii was greater for the old women compared with the young women throughout the fatiguing contraction, indicating different activation strategies with age. Indices of peripheral fatigue including twitch properties, showed that fatigue within the muscle was more rapid for the young women compared with the old women. These results suggest that although old women are weaker than young women, they have greater endurance due to mechanisms within muscle. Furthermore, old women showed great variability in their ability to optimally activate all muscle fiber compared with young women for an isometric contraction.

• Archives of Plastic Surgery
• /
• 제38권5호
• /
• pp.679-682
• /
• 2011

Purpose: Neurofibromas of neuroectodermal origin are commonly found in Von Recklinghausens disease or neurofibormatosis type 1. It is an autosomal dominant disease caused by mutation of the long arm of chromosome 17. It can present from small nodules to disfiguring giant tumor. Plexiform neurofibroma is benign in most cases, but it could be transformed into malignant tumor, which requires surgical excision. To cover the defects after the excision, a number of surgical correction methods are available. This study is to report a surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap for extensive defects after surgical excision of neurofibrona. Methods: Data of five neurofibroma patients with an average age of 39 including medical history, physical examination, computed tomography, and magnetic resonance imaging were checked. No disease other than neurofibroma were detected. Biopsy on the excised tissues was performed. The follow-up period was 7 to 27 months. Results: The average size of defects after complete excision of neurofibroma was $13{\times}10{\sim}25{\times}15$ cm. Defects were covered by anterolateral thigh free flap, while donor sites were covered by local flap, split thickness skin graft and regional flap. Throughout follow-up, there were no complication, relapse, or any abnormalities. Conclusion: Despite various surgical correction methods are applicable to defects after excision on disfiguring plexiform neurofibroma, coverage of massive defects is still challenging in plastic and reconstructive surgeon. We have made five successful cases of surgical correction of disfiguring plexiform neurofibroma using anterolateral thigh free flap.

• Archives of Plastic Surgery
• /
• 제36권5호
• /
• pp.555-558
• /
• 2009

Purpose: The high success rate of free flap transfers is well documented in previous literature, and is possible due to the early detection of vascular compromise and timely reoperation. We specifically analyzed the operative results of immediate and delayed reconstruction with free transverse rectus abdominis musculocutaneous(TRAM) flap respectively in order to reveal its distinctive features on timing and causes of vascular compromise. Methods: The senior author operated on 158 patients, 161 cases of free TRAM flap for breast reconstruction. 51 patients underwent delayed reconstruction, whilst immediate reconstruction was performed in the other 107 patients. All patients were monitored every 3 hours for the first 3 days. We reviewed medical records of all patients, and tested statistical significance with the Fisher's test. Results: Reoperation was performed in 20 cases, but the cases include hematoma with bleeding focus and arterial anastomosis site rupture due to abrupt arm abduction. We performed reoperation in 15 cases of suspicious vascular compromise. Flap compromise was noticed mostly within 24 hours, but not longer than 72 hours. Venous compromise was dominant by 11 cases (73.3%). There was difference in the timing of flap compromise between immediate and delayed reconstruction. All the cases of delayed reconstruction did not show signs of vascular compromise after 12 hours postoperatively. On the other hand, cases of vascular compromise were observed until 72 hours postoperatively in cases of immediate reconstruction. Conclusion: Delayed reconstruction showed vascular compromise within 12 hours postoperatively, while immediate reconstruction showed compromised until the 3rd postoperative day. If more aggressive monitoring is maintained during this period, we believe salvage of flaps may be increased with more efficiency.

• Clinics in Shoulder and Elbow
• /
• 제25권1호
• /
• pp.49-56
• /
• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• Clinics in Shoulder and Elbow
• /
• 제26권2호
• /
• pp.148-155
• /
• 2023

Background: Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. Methods: The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. Results: At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°-120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. Conclusions: Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions.

• 영어영문학
• /
• 제56권6호
• /
• pp.1047-1065
• /
• 2010

English inversion constructions are not only hard for non-native speakers to learn but also difficult to teach mainly because of their intriguing grammatical and discourse properties. This paper addresses grammatical issues in learning or teaching the so-called 'predicate inversion (PI)' construction (e.g., Equally important in terms of forest depletion is the continuous logging of the forests). In particular, we chart the grammatical (distributional, syntactic, semantic, pragmatic) properties of the PI construction, and argue for adata-driven teaching for English grammar. To depart from the arm-chaired style of grammar teaching (relying on author-made simple sentences), our teaching method introduces a datadriven teaching. With total 25 university students in a grammar-related class, students together have analyzed the British Component of the International Corpus of English (ICE-GB), containing about one million words distributed across a variety of textual categories. We have identified total 290 PI sentences (206 from spoken and 87 from written texts). The preposed syntactic categories of the PI involve five main types: AdvP, PP, VP(ed/ing), NP, AP, and so, all of which function as the complement of the copula. In terms of discourse, we have observed, supporting Birner and Ward's (1998) observation that these preposed phrases represent more familiar information than the postposed subject. The corpus examples gave us the three possible types: The preposed element is discourse-old whereas the postposed one is discourse-new as in Putting wire mesh over a few bricks is a good idea. Both preposed and postposed elements can also be discourse new as in But a fly in the ointment is inflation. These two elements can also be discourse old as in Racing with him on the near-side is Rinus. The dominant occurrence of the PI in the spoken texts also supports the view that the balance (or scene-setting) in information structure is the main trigger for the use of the PI construction. After being exposed to the real data and in-depth syntactic as well as informationstructure analysis of the PI construction, it is proved that the class students have had a farmore clear understanding of the construction in question and have realized that grammar does not mean to live on by itself but tightly interacts with other important grammatical components such as information structure. The study directs us toward both a datadriven and interactive grammar teaching.

• 대한소아치과학회지
• /
• 제38권2호
• /
• pp.187-193
• /
• 2011

신경섬유종증(neurofibromatosis)은 골조직, 신경계, 연부조직, 피부 및 내분비계 장애를 수반하며 상염색체 우성을 보이는 유전질환으로 제17번 염색체의 장완에 위치한 종양 억제 유전자의 변성에 의해 발생한다. 임상적으로 진단에 도움을 주는 특정적인 소견들 중 가장 중요한 것은 신경섬유종(neurofibroma)이고 그 외에 밀크 커피색을 띠는 밀크 커피색 반점(cafe-au-lait spot)과, 홍채결절(Lisch nodule)이 있다. 신경섬유종증이 비교적 구강 내에서 발현하는 비율은 비교적 낮은 것으로 알려져 있고, 대부분의 경우 단독 혹은 다수의 신경섬유종이 존재하는 연조직 변화와 관련되어 있다. 최근 전북대학교 병원에서 제1 형 신경섬유종증으로 진단받고, 치아우식증 치료를 위해 본원 소아치과에 내원한 만 4세의 남아와 그의 아버지에게서 제1형 선경섬유종증의 특징적인 치과적 소견을 발견하였기에 치료 경과와 함께 보고하는 바이다.