• 대한치과마취과학회지
• /
• 제14권1호
• /
• pp.63-71
• /
• 2014

Extension of advanced odontogenic infection from deep neck fascial spaces into the mediastinum is heralded by chest pain, dyspnea, fever, and radiographic demonstration of mediastinal widening. The critical care should be done in a team approach by multiple medical and dental departments, such as, oral & maxillofacial surgery, otolaryngology, anesthesiology, chest surgery, and infection medicine. Especially, fluid & drug therapy, adequate incision & drainage and systemic supportive psychosedation care are important. But, acute hyperventilation can be produced by several distinct causes: severe anxiety, respiratory alkalosis, increased blood catecholamine levels, and a decrease in the level of the ionized calcium in the blood. The orofacial fears about acute pain, trismus, dysphagia, swelling and oral surgical treatment lead to the severe anxiety and increased blood catecholamine level by stress. Therefore, the most dental patient should be cared gently as the stress reduction protocol. In spite of the care, hyperventilation was occurred during psychosedation and local anesthesia for incision and drainage of the masticatory fascial space abscess with deep neck infection & mediastinitis. We suggest that the dental patient with advanced odontogenic infection must be attention for the manifestation of hyperventilation, especially in the medically compromised conditions.

• 대한장애인치과학회지
• /
• 제9권2호
• /
• pp.111-117
• /
• 2013

Some odontogenic infections erode into fascial spaces directly and spread toward lymphatic tissues and blood streams. The principal maxillary primary spaces are the canine, buccal, and infratemporal space, the next secondary spaces are the masseteric, temporal and pharygeal space. As a result of the infection, trismus and orocutaneous fistula may be occurred. Trismus is owing to conditions not associated with temporomandibular joint itself and may be of myogenic, neurogenic, or psychogenic nature. Muscular trismus is due to infection adjacent to the elevator muscles of the jaw. The four principles of treatment of infection are as follows: (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including rest, nutrition and physiotherapy. Jaw physiotherapy is necessary to increase the amount of mouth opening and regain normal muscle tone. If proper care of odontogenic infection could be attained, the orocutaneous fistula will heal and close spontaneously by wound contraction mechanism of natural homeostatic response. This is a case report of the care of trismus and orocutaneous fistula due to fascial space abscess by advanced odontogenic infection in a physically disabled patient.

• 대한장애인치과학회지
• /
• 제9권1호
• /
• pp.30-35
• /
• 2013

The four principles of treatment of odontogenic infection are as follows : (1) removal of the cause, (2) establishment of drainage, (3) institution of antibiotic therapy, and (4) provision of supportive care, including proper rest and nutrition. A separate incision is required to establish drainage, especially in the case of extensive fascial space infections. There are four principle causes for active bleeding in the immediate incision & drainage phase; (1) vascular wall alteration (infection, scurvy, chemicals), (2) disorder of platelet function, (3) thrombocytopenic purpuras, (4) disorders of coagulation (liver disease, anticoagulation drug). If the hemorrhage from incision & drainage site is aggressive, the site must be packed with proper wet gauze and wound closure & drainage dressing are applied. The specific causes of bleeding may be associated with hypoxia, changes in the pH of blood & chemical changes affecting vascular contractility and blood clotting. This is a case report of bleeding control by the circumferential suture & drainage on active bleeding incision & drainage site of temporal space abscess due to advanced odontogenic infection in a multiple medically compromised disabled patient.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제16권1호
• /
• pp.104-111
• /
• 1994

Necrotizing fascitis is a severe soft tissue infection characterized by extensive necrosis of superficial fascia, suppurative fascitis, vascular thrombosis, widespread undermining of surrounding tissues. Associated systemic problems are widespread undermining of surrounding tissues, Associated systemic problems are common, with chronic alcoholism and diabetes being most prominent. Most commonly this disease presents in the extremities, trunk, and perineum. Necrotizing fascitis of dental origing is rare and its fulminating clinical course is not well documented in the dental literature. The present report is a case of necrotizing fascitis following vital extirpation of the pulp in a patient with uncontrolled diabetes mellitus and liver cirrhosis. Originally throught to be caused by hemolytic streptococcus organism or stphylococcus aureus, advances in anaerobic culturing have shown it to be a synergistic bacterial infection involving aerobic and ovligate anaerobes. it is relatively rare in relatively rare in haea and neck regions. If it was not diagnosed and treated in early stages, necrotizing fascitis can be potentially fetal, with a mortality rate approaching 40%. It's treatment requires early recognition, prompt and aggressive surgical debriment and proper supportive cares, such as, antibiotic therapy, fluid resuscitation and correction of metabolic and electrolyte disorder, resolving of the underlying systemic disease. Recently, we experienced two cases of necrotizing fascitis in cervicofacial region, One patient was 60 years old male with uncontrolled Diabetes Mellitus and other patient was 48 years old with steroid therapy during 30 years. Local surgical wound healing was successful but, patients were died after admission, because of lung abscess, gastrointestinal bleeding, septic shock and respiration hold.

• Childhood Kidney Diseases
• /
• 제8권2호
• /
• pp.239-243
• /
• 2004

저자들은 두통, 안면 부종, 고열 및 옆구리 통증 등을 주소로 내원한 5세 여아에서 특징적인임상 양상과 검사 소견 등을 통하여 첫 발병시에 E. coli 감염에 의한 급성 신우신염이 병발한 급성 연쇄상구균 감염후 사구체신염으로 진단하고 치료한 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Pediatric Infection and Vaccine
• /
• 제23권1호
• /
• pp.72-76
• /
• 2016

골화석증은 골격의 경화증이 특징적으로 나타나는 드문 유전 질환으로 뼈 흡수 기전에 손상이 오며 조기 사망하는 질환이다. 반면 거대세포바이러스 감염은 가장 흔한 선천성 감염 중 하나로 빈혈, 혈소판 감소증과 간비장종대, 뇌 석회화 등이 나타날 수 있다. 심한 간비비대, 혈소판 감소증 및 저칼슘혈증과 발달지연으로 내원한 환자에서 두 가지 질환이 함께 있어 항바이러스제 치료 및 대증치료를 시행하였고, 치료 반응이 빠르게 나타나지는 않았으나 지속적인 치료 결과 대부분의 수치가 정상화 되는 것을 확인하였다. 본 증례는 골화석증 신생아에게 동반된 거대세포바이러스 감염의 첫 증례 보고로, 거대세포바이러스 감염에 대한 항바이러스제의 장기 치료로 호전된 사례이다.

• Journal of Chest Surgery
• /
• 제22권4호
• /
• pp.601-608
• /
• 1989

We sought the relationship between the pulmonary artery development and cardiac performance from the analysis of the 36 cyanotic congenital heart disease patients [mainly TOF] who were operated and indwelled the pulmonary artery and left atrial pressure monitoring catheters for the postoperative care at the department of Thoracic and Cardiovascular Surgery SNUH in 1988. They were pre-evaluated of the pulmonary artery index from the cineangiographic films and post-operatively, calculated the cardiac index from the arterial and mixed venous blood gas and also measured the mean left atrial pressure and total inotropic supporting amount after operation. The post-operative cardiac indices were 3.46 * 1.03 1/min/M2 [immediate postoperative], 3.31 [ 1.08 [postoperative 6 hrs], 3.29 [ 1.01 [12 hrs], 3.54 * 1.02 [24 hrs], 3.92 * 1.14 [48 hrs], respectively. We divided the patients the group A and group B from the size of the pulmonary artery index, that is, group A was below 200 mm2/M2 and group B above 200 mm2/M2 of the pulmonary artery index. The cardiac indices and left atrial pressure between the group A and B were not different in the view of the statistical significance but the total post-operative inotropic amount of group A was more than group B and it was significant statistically. We concluded that the smaller the pulmonary artery index is, the more postoperative supportive treatment [for example, inotropics] for the enhancement of cardiac performance is needed, and indirectly, which means that the pulmonary artery index was correlated with the postoperative cardiac performance in cyanotic congenital heart disease.

• 대한한방내과학회지
• /
• 제26권3호
• /
• pp.677-684
• /
• 2005

Objectives : This study was designed to evaluate the effects of oriental herb medicine therapy on a limited stage small ell lung cancer(SCLS) patient. Methods : The medical record of this case of SCLS was researched. The patient had been treated with oriental herb medicine for five months continuously in OPD. Clinical data was analyzed and the mass of small cell lung cancer before and after oriental herb medicine therapy was compared using X-ray and CT scan of the whole body in order to determine metastasis. Result : After 5 months of oriental herb medical treatment, most of symptoms disappeared or improved. The small cell lung cancer patially receeded and improvements were mainly seen in sputum, coughing, insomnia, diarrhea, and performance status. Conclusion : The study suggests that oriental herb medicine therapy effects the tumor size by causing remission and Improving health and relieving symptoms, and also positively effects the quality of life as a supportive or curative therapy for SCLC patients.

• 한국융합학회논문지
• /
• 제11권8호
• /
• pp.131-138
• /
• 2020

본 연구는 난임 환자를 담당하는 간호사의 난임 간호 교육 요구도를 파악하기 위하여 시도된 연구이다. 본 연구의 대상자는 5개의 난임 전문 병원과 1개 보건소에서 난임 환자를 담당하는 간호사 194명이었다. 자료는 난임 질환과 증상에 대한 정보, 난임 대상자의 일상 생활에 대한 정보 제공, 난임 대상자의 지지와 상담 내용을 포함한 자가보고식 설문지를 통하여 수집되었다. 난임 질환과 증상에 대한 정보 요구도의 평균 점수는 3.52점이었고, 난임 대상자의 일상 생활에 대한 정보 제공 교육 요구도는 평균 3.36점이었으며 난임 대상자의 지지와 상담에 대한 교육 요구도는 평균 3.32점이었다. 각 하부 영역중에서는 '난임 치료 과정과 중재', '운동', '배우자와의 지지 체계 형성'이 난임 환자를 담당하는 간호사들의 교육 요구도 항목 중 가장 높은 것으로 나타났다. 본 연구 결과를 통해서 난임 환자에게 효과적으로 교육을 하기 위해서 난임 환자를 담당하는 간호사는 난임 간호 교육에 대한 분명한 개념인식과 목적을 가지고 그들의 신체적, 심리적 요구를 충족시킬 수 있는 전략개발을 할 필요가 있다.

• Journal of Preventive Medicine and Public Health
• /
• 제47권4호
• /
• pp.236-243
• /
• 2014

Objectives: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. Methods: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. Results: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants' compliance with treatment. Conclusions: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.