• 재활복지
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• 제22권4호
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• pp.43-58
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• 2018

영양 섭취와 일상생활 삶의 질에 영향을 미치는 삼킴장애는 신경장애 환자뿐만 아니라 정상 노년층에게서도 적지 않게 나타난다. 본 연구에서는 노인의 삼킴 문제를 조기 선별하여 진단 검사로 연결될 수 있도록 도움을 주기 위한 기초연구로서, 주관적 삼킴장애 평가도구인 삼킴곤란척도(Swallowing Disturbance Questionnaire, SDQ)를 한국인의 정서와 문화에 맞게 번안하여 신뢰도와 타당도를 검증하고, 뇌졸중 환자 105명을 대상으로 하여 그 유용성을 검증하였다. 연구 결과, 한국판 SDQ의 문항내적 일관성 신뢰도는 .601, 검사-재검사 신뢰도는 .97, 공인타당도는 .956이었고, 절단점 8점을 기준으로 민감도가 46.8%, 특이도가 81.6%인 것으로 나타났다. 객관적 삼킴장애 검사인 비디오투시조영검사와 한국판 SDQ 검사 상 관찰된 삼킴곤란 유무와의 비교 결과, 음성예측도(negative predictive value, NPV)는 81%, 양성예측도(positive predictive value, PPV)는 53%로 나타났다. 한국판 SDQ는 뇌졸중 환자들의 삼킴장애 유무를 변별하는데 유용한 검사도구로 활용될 수 있을 것으로 기대되며, 재활전문가에 의한 임상평가가 이루어지기 전에 대상자가 보이는 삼킴곤란을 미리 선별하여 진단검사를 의뢰하거나, 삼킴문제가 없는 뇌졸중 환자를 정확하게 선별하여 잉여적인 추가 검사 노출을 배제하는 차원에서 그 임상적 의의가 크다고 볼 수 있다.

• 대한치과의사협회지
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• 제9권10호
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• pp.607-609
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• 1971

The author has diagnosed and treated the dermold cyst patient in the 41 years old korean man. The dermold cyst in the floor of the mouth had various sign and symptom such as elevated tongue, disturbance of speech and swallowing, and etc. The cyst wall of dermoid cyst was enucleated by using of direct enucleation of cyst wall and primary suture technique. The mass of the enucleated dermoid cyst was 5×5.5×6 Cm.in size.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.97-104
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• 2017

Background: Nasal bone fracture is one of the most common facial bone fracture types, and the surgical results exert a strong influence on the facial contour and patient satisfaction. Preventing secondary deformity and restoring the original bone state are the major goals of surgeons managing nasal bone fracture patients. In this study, a treatment algorithm was established by applying the modified open reduction technique and postoperative care for several years. Methods: This article is a retrospective chart review of 417 patients who had been received surgical treatment from 2014 to 2015. Using prepared questionnaires and visual analogue scale, several components (postoperative nasal contour; degree of pain; minor complications like dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, and headache; and degree of patient satisfaction) were evaluated. Results: The average scores for the postoperative nasal contour given by three experts, and the degree of patient satisfaction, were within the "satisfied" (4) to "very satisfied" (5) range (4.5, 4.6, 4.5, and 4.2, respectively). The postoperative degree of pain was sufficiently low that the patients needed only the minimum dose of painkiller. The scores for the minor complications (dry mouth, sleep disturbance, swallowing difficulty, conversation difficulty, headache) were relatively low (36.4, 40.8, 65.2, 32.3, and 34 out of the maximum score of 100, respectively). Conclusion: Satisfactory results were obtained through the algorithm-oriented management of nasal bone fracture. The degree of postoperative pain and minor complications were considerably low, and the degree of satisfaction with the nasal contour was high.

• 대한후두음성언어의학회지
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• 제27권2호
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• pp.108-113
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• 2016

Background and Objectives : After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. Materials and Methods : Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. Results : Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). Conclusion : The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권4호
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• pp.286-289
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• 2002

In the treatment of mandibular condylar fractures, arthrocentesis, lavage and selective intermaxillary fixation were performed after closed reduction. In this lavage group, the physiotherapy performed for 3-6 months after injury. in control group, continuous intermaxillary fixation was done for 1-3 weeks, and physiotherapy followed in the same method of the lavage group. In the comparative study of the both groups, the following results are shown. 1. Compared to control group, the lavage group had a slightly superior result at range of motion, joint pain and occlusal deviation, from I day after arthrocentesis to 6 months after injury. 2. The significant differences between both groups were seen at range of motion and joint pain in 1 month after injury. 3. At 6 months after injury, the differences between both groups were not significant at range of motion, joint pain and occlusal deviation. From this study, in the mandibular condylar fracture, the arthrosentesis, lavage and selective intermaxillary fixation after closed reduction can improve symptoms such as joint pain and occlusal deviation, also increase range of motion. in this therapeutic way, intracapsular hemarthrosis which can cause TMJ ankylosis or dysfunction can be removed effectively. in addition, patient's discomfort such as swallowing disturbance, speech disturbance and emotional stress can be reduced signuficantly.

• Journal of Chest Surgery
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• 제13권3호
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• pp.301-305
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• 1980

Myasthenia gravis is a disorder that affects neuromuscular transmission in a way that is still poorly understood. some think that myasthenia gravis results from a reduction of available acetylcholine receptors in neuromuscular junctions, consequent to some form of autoimmune injury. Surgical interest in this disease was first aroused in 1939 when Blalock observed that some patients with thymic tumors and myasthenia gravis improved following thymectomy. This report represents two cases of myasthenia gravis. The 14-year-old girl was admitted to Korea Universtiy Hospital with chief complaintment of bilateral ptosis, diplopia, swallowing difficulty, and mastication difficulty, which were relieved by administration of edrophonium (Tensilon) chloride, given intravenously. Myasthenica gravis was confirmed and thymectomy was given. After thymectomy, symptoms were relieved but the administration of neostigmine was contijued to be needed till following 3 months. After that period, she was free from this symptoms without anticholinesterase drugs. Second case is 57 year old male who has the symptoms of diplopia, bilatreal ptosis, walking disturbance, and speech difficulty. He had thymectomy too but in thymic tissue, malignant thymoma was included. He has subjective improvement only, with no major reduction of medication requirements after thymectomy.

• Journal of Chest Surgery
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• 제4권1호
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• pp.35-42
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• 1971

This is a report on four cases of bypass for esophageal stricture due to gastro-esophageal carcinoma in the Department of Thoracic Surgery, Chonnam University Hospital. Bypass was performed intrathoracal esophago-jejunostomy by a segment of jejunum. Three patients received end to end anastomosis and the other one side to end esophagojejunostomy. Postoperative results were as follow; There was no swallowing disturbance with regular diet and the patients appear to be more comfortable by bypass than gastrostomy or jejunostomy. Postoperative condition of all the patients was satisfactory because other organs were intact. However, two patients expired in 12 months and 6 months after operation by wide metastasis and the other 2 cases are living now with regular diet in 4 months and 2 months after operation.

• Journal of Chest Surgery
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• 제3권2호
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• pp.143-148
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• 1970

Bleomycin is known as a antibiotic agent for malignant tumors especially sguamous cell carcinoma. We have treated 2 cases of malignant tumors, each one esophageal and lung carcinoma with bleomycin, 630 mg and 510 mg respectively. In case of esophageal carcinoma. the subjective symptoms such as dysphagea and swallowing disturbance are temporally relieved, but the irregular filling defect is not significantly changed in esophagogram. In case of lung carcinoma, the atelectasis of right upper lobe on chest X-ray was slightly regressed in its size without effective improvement of subjective symptoms. However, following additional radioactive $^60{Co}$ irradiation therapy (5200r), marked regression of tumor density and aeration of right upper lobe was observed. But 2 weeks later of ceasatioil of irradiatio:J, atelectasis of right upper lobe was again developed. Fever, anorexia, headache and eruption were developed during the treatmeat with bleomycin in both cases but the sign or symptoms of hone marrow depression, renal or liver damage were not noted.

• Journal of Korean Neurosurgical Society
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• 제29권10호
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• pp.1396-1401
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• 2000

Although direct surgical treatment of the lesion in the pons may cause severe neurologic morbidity, safe route to minimize injuries of the important structures in the pons should be considered. The authors operated four cases of intrapontine lesions via safe approach route without causing severe neurologic complications. Two cases were intrapontine tumors and other two were intrapontine hematoma. An anaplastic astrocytoma($3{\times}3{\times}3cm$) located bilaterally in the pons was approached via midline of the median sulcus, and a metastatic tumor($1.5{\times}1.5{\times}1.5cm$) located at the left posterolateral aspect in the upper pons was approached via suprafacial space. Two cases of hematoma were evacuated via median sulcus, and supra- and infrafacial spaces. Preoperatively, quadriplegia, swallowing difficulty, diplopia, speech disturbance, and nystagmus were noted in a patient with an anaplastic astrocytoma. A patient with metastatic tumor showed mild right hemiparesis, right hemisensory disturbance, diplopia, and dizziness. Two patients with hematoma in the pons were comatous, and had contracted, fixed pupils. Postoperatively, a patient with an anaplastic astrocytoma recovered and a patient with a metastatic tumor showed temporary hemifacial palsy. Mental status was fully recovered normal even though facial palsy, diplopia, severe ataxia, dizziness, and tremor persisted in both patients with pontine hematoma. Careful operation based on the anatomical knowledge of the floor of the 4th ventricle is of prime importance in appraoching to the intrapontine lesion with minimal injuries of the eloquent structures during surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제32권4호
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• pp.380-383
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• 2006

Tetanus is rare in Korea due to the introduction of vaccination programs and the advancement in public health. Its common signs are trismus, voice disturbance, neck stiffness, and difficulty in swallowing, etc. A 56 years old man was injured by grasping a high voltage electric cable. After the accident, he fell down on a steel plate and had a head trauma. When he visited Emergency Department, there was multiple electric burn wound on left arm and left facial area. He was hospitalized on a department of neurosurgery, because intra cranial hemorrhage was presumed. 12 days later, he was referred to department of OMFS with developed painful masseter spasms and trismus. That night he violently bit his tongue with his denture. Because masseter muscle and temporal muscle constriction was involuntary, tongue was lacerated and denture was distorted. At first we supposed that the symptom was related with neurologic disturbance following head trauma or electric shock. But it was revealed that trismus was caused by tetanus on an electrophysiological test. By using mechanical ventilation and administration of tetanus immunoglobulin, muscle-relaxant, and sedatives at ICU, symptoms had subsided (4-weeks). Because tetanus is rare disease, we rarely suppose tetanus infection to be a cause of a trismus. Especially it is more difficult to diagnose in patient who has head trauma, burn and neurologic problem as in this case.