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CARE OF RECURRENT TEMPOROMANDIBULAR JOINT DISLOCATION IN CEREBROVASCULAR ACCIDENT PATIENT : REPORT OF A CASE (뇌졸중 환자에서 재발성 턱관절 탈구의 관리 : 증례보고)

  • Oh, Ji-Hyeon;Yoo, Jae-Ha;Kim, Jong-Bae
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.11 no.2
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    • pp.62-66
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    • 2015
  • Temporomandibular joint dislocation causes considerable pain, discomfort, and swelling. The anatomic construction of the articular fossa and the eminentia articularis may predispose to dislocation, and weakness of the connective tissue forming the capsule is believed to be a predisposing factor. The capsule may be stretched and, more rarely, torn. Dislocation may be unilateral or bilateral and may occur spontaneously after stretching of the mouth to its extreme open position, such as during a yawn or during a routine dental operation. Manual reduction with the patient under muscle-relaxing condition or anesthesia is recommended method. After the reduction of an acute dislocation, immobilization of the jaw is recommended to allow the stretched and sometimes torn capsule to heal, thus preventing recurrence. A Barton's bandage may be applied for 2 to 3 weeks to prevent the patient from opening the jaw too wide. But, it results in recurrent dislocation in the neurologically disabled patient, because of loose intermaxillary fixation. This is a case report about management of recurrent temporomandibular joint dislocation by multiple loop wirings and intermaxillary elastics in cerebrovascular accident patient.

ON THE "TERRA INCOGNITA" FOR THE NEWTON-KANTROVICH METHOD WITH APPLICATIONS

  • Argyros, Ioannis Konstantinos;Cho, Yeol Je;George, Santhosh
    • Journal of the Korean Mathematical Society
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    • v.51 no.2
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    • pp.251-266
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    • 2014
  • In this paper, we use Newton's method to approximate a locally unique solution of an equation in Banach spaces and introduce recurrent functions to provide a weaker semilocal convergence analysis for Newton's method than before [1]-[13], in some interesting cases, provided that the Fr$\acute{e}$chet-derivative of the operator involved is p-H$\ddot{o}$lder continuous (p${\in}$(0, 1]). Numerical examples involving two boundary value problems are also provided.

Arthroscopic Medial Plication using Pull-out Suture for the Treatment of Acute or Recurrent Patellar Dislocation - Technical Note - (급성 또는 재발성 슬개골 탈구의 치료에 있어서 견인 봉합술을 이용한 관절경적 내측 관절막 중첩술 - 수술 술기 -)

  • Ahn, Jin-Hwan;Kim, Jae-Hoon;Ha, Hae-Chan
    • Journal of the Korean Arthroscopy Society
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    • v.10 no.2
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    • pp.214-218
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    • 2006
  • Purpose: We describe a new technique of arthroscopic medial plication using pull-out suture with consideration of anatomical location of medial patellofemoral ligament for the treatment of acute or recurrent patellar dislocation. Operative technique: Under arthroscopic examination, sutures are passed through the medial capsule, at which medial patellofemoral ligament is located, from outside to inside of knee joint. Three guide wires are inserted from anterior surface of the patella to upper half of its medial border. Intraarticular portions of sutures are pulled out toward anterior surface of the patella through bony tunnels. Under appropriate tension, the sutures are tied after performing lateral retinacular release. Conclusion: As suturing medial patellofemoral ligament, this technique can maximize the effect of medial plication and can correct subluxation and tilt of the patella. It seems to be a minimally invasive, easy and effective method for the treatment of acute or recurrent patellar dislocation.

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Two Cases of Fatal Hypoxemia after Talc Pleurodesis for Recurrent Malignant Pleural Effusion (Talc 늑막유착술 이후 발생한 치명적 저산소증 2 예)

  • Park, Shin Ae;Lee, Han Hee;Kim, Dae Jun;Shim, Byoung Yong;Song, So Hyang;Kim, Chi Hong;Ahn, Myeong Im;Cho, Deog Gon;Cho, Kyu Do;Kim, Hoon-Kyo
    • Tuberculosis and Respiratory Diseases
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    • v.62 no.3
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    • pp.217-222
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    • 2007
  • Talc pleurodesis is a safe and effective treatment for a recurrent malignant pleural effusion. However, acute hypoxemia, pulmonary edema or acute respiratory failure can develop in a small number of patients. We report 2 patients who developed fatal hypoxemia after talc pleurodesis which was necessary the control recurrent pleural effusion. The first case was an 18-year old male diagnosed with Ewing's sarcoma with bilateral lung metastases and pleural effusion. The performance status was ECOG (Eastern Cooperative Foncology Group) grade 3. Fever along with hypoxemia and leukocytosis developed 10 hours after the second talc pleurodesis on the right side for an uncontrolled pleural effusion, The patient died from respiratory failure after 13 days. The second case was a 66-year old female diagnosed with non-small cell lung cancer with a bone metastasis. Two weeks after systemic chemotherapy, she complained of dyspnea, and a pleural effusion was observed on the right side. Her performance status was ECOG grade 3. Talc pleurodesis was performed for recurrent pleural effusion, but hypoxemia developed 6 days after pleurodesis and she died from respiratory failure 10 days after pleurodesis. In conclusion, talc pleurodesis should be performed very carefully in patients with a poor performance status, in cases with repeated pleurodesis, bilateral pleural effusion, recent chemotherapy, radiotherapy and when there are parenchymal metastatic lesions present.

Surgical Treatment of the Funnel Chest by Sternoturnover method (우두흉(漏斗胸)의 외과적(外科的) 치료(治療) (Sterno-turnover 방법(方法)에 의(依)한))

  • Choi, Soon Ho
    • Journal of Chest Surgery
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    • v.9 no.2
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    • pp.143-147
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    • 1976
  • A case of congenital funnel chest which was observed in 6 year old male was reported. The patient represented clinical status of depression of lower sternum, recurrent upper respiratory tract infection, and slight exertional dyspnea. The treatment was carried out by "turnover" method, and it was easy to do viable on sternum, costal cartilage, and intercostal muscles. And it is fit to reimplantation by free autograft when repair was indicated. The plane of the manubrium, an acute hump on the sternum, and asymmetry constitute limiting factors in the cosmetic results.

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Antithrombotic Therapy for Ischemic Stroke (허혈성 뇌졸중에서의 항혈전 치료)

  • Hah, Jung-Sang;Lee, Jun
    • Journal of Yeungnam Medical Science
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    • v.20 no.1
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    • pp.1-12
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    • 2003
  • Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.

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Reconsideration of urine culture for the diagnosis of acute pyelonephritis in children: a new challenging method for diagnosing acute pyelonephritis

  • Lee, Jun Ho;Rhie, Seonkyeong
    • Clinical and Experimental Pediatrics
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    • v.62 no.12
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    • pp.433-437
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    • 2019
  • Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.

Clinical and Pathological Aspects of Filarial Lymphedema and Its Management

  • Shenoy, R.K.
    • Parasites, Hosts and Diseases
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    • v.46 no.3
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    • pp.119-125
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    • 2008
  • Lymphatic filariasis, transmitted by mosquitoes is the commonest cause of lymphedema in endemic countries. Among 120 million infected people in 83 countries, up to 16 million have lymphedema. Microfilariae ingested by mosquitoes grow into infective larvae. These larvae entering humans after infected mosquito bites grow in the lymphatics to adult worms that cause damage to lymphatics resulting in dilatation of lymph vessels. This earliest pathology is demonstrated in adults as well as in children, by ultrasonography, lymphoscintigraphy and histopathology studies. Once established, this damage was thought to be irreversible. This lymphatic damage predisposes to bacterial infection that causes recurrent acute attacks of dermato-lymphangio-adenitis in the affected limbs. Bacteria, mainly streptococci gain entry into the lymphatics through 'entry lesions' in skin, like interdigital fungal infections, injuries, eczema or similar causes that disrupt integrity of skin. Attacks of dermato-lymphangio-adenitis aggravates lymphatic damage causing lymphedema, which gets worse with repeated acute attacks. Elephantiasis is a late manifestation of lymphatic filariasis, which apart from limbs may involve genitalia or breasts. Lymphedema management includes use of antifilarial drugs in early stages, treatment and prevention of acute attacks through 'limb-hygiene', antibiotics and antifungals where indicated, and physical measures to reduce the swelling. In selected cases surgery is helpful.

Maple Syrup Urine Disease : Longterm Diet Therapy and Treatment of Acute Metabolic Decompensation (단풍당뇨증의 식이요법과 급성대상부전의 치료)

  • Lee, Hong-Jin;Bae, Eun-Joo;Park, Won-Il;Lee, Kyung-Ja
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.3 no.1
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    • pp.4-14
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    • 2003
  • Maple syrup urine disease or branched chain ketoacidurias caused by a deficiency in activity of the branched-chain ${\alpha}$-keto acid dehydrogenase(BCKD) complex. This metabolic block results in the accumulation of the branched-chain amino acids(BCAAs) leucine, isoleucine and valine, and the corresponding branched chain ${\alpha}$-keto acids (BCKAs). Based on the clinical presentation and biochemical responses to thiamine administration, MSUD patients can be divided into five phenotypes : classic, intermediate, intermittent, thiamine responsive and dihydrolipoyl dehydrogenase(E3)-deficient. Classic MSUD has a neonatal onset of encephalopathy, and is the most severe ad most common form. Variant forms of MSUD generally have the initial symptoms by 2 years of age. The majority of untreated classic patients die within the early months of life from recurrent metabolic crisis and neurologic deterioration. Treatment involves both longterm dietary management and aggressive intervention during acute metabolic decompensation. We report here our experience of longterm diet therapy and treatment of acute metabolic decompensation of a case of classic MSUD.

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Severe recurrent nocturnal hypoglycemia during chemotherapy with 6-mercaptopurine in a child with acute lymphoblastic leukemia

  • Cho, Eun Mi;Moon, Jung Eun;Lee, Soo Jung;Ko, Cheol Woo
    • Annals of Pediatric Endocrinology and Metabolism
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    • v.23 no.4
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    • pp.226-228
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    • 2018
  • Various endocrine dysfunctions occur during chemotherapy, including hypoglycemia. However, reports of hypoglycemia associated with 6-mercaptopurine (6-MP) are rare. Herein, we report an 8-year-old boy with severe symptomatic hypoglycemia likely due to 6-MP during chemotherapy. He had been diagnosed with acute lymphoblastic leukemia 3 years previously and was in the maintenance chemotherapy period. Treatment included oral dexamethasone, methotrexate, and 6-MP, of which only 6-MP was administered daily. Hypoglycemic symptoms appeared mainly at dawn, and his serum glucose dropped to a minimum of 37 mg/dL. Laboratory findings showed nothing specific other than increased serum cortisol, free fatty acids, ketone, alanine aminotransferase, and aspartate aminotransferase. Under the hypothesis of hypoglycemia due to chemotherapy drugs, we changed the time of 6-MP from evening to morning and recommended him to ingest carbohydrate-rich foods before bedtime. Hypoglycemia improved dramatically, and there was no further episode during the remaining maintenance chemotherapy period. To the best of our knowledge, this is the first report of this type of hypoglycemia occurring in an Asian child including Korean.