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경막 외 스테로이드 주사에 반응 없는 추간판성 요통에 대한 추간판 내 시술 효과
신용범,고현윤,손현주,장재혁,박형욱,신명준,김수연 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23
Objective: To determine the effect of intradiscal therapy with discography in patients with back pain of no effect using epidural steroid. Subject and methods: Thirty patients with herniated nucleus pulposus (HNP) who had not have any improvement using repeated epidural steroid were studied. Degree of disc degeneration, provocation pain and intradiscal pressure were evaluated in 41 discs. Intradiscal triamcinolone was injected to degenerated discs and intradiscal electrothermal therapy (IDET) was performed to the patients who had no improvement using intradiscal steroid. Patients were asked to report pain according to a visual analogue scale (VAS). Results: Thirty of 41 discs showed significant degeneration. In 19 of 30 (63.3%) patients, VAS was reduced over 50% after intradiscal steroids. Low intradiscal pressure without provocation pain and ruptured discs were significantly higher in these patients (p<0.05). After IDET, 8 of 9 patients noted over 50% reduction of VAS. Conclusions: In patients with discogenic back pain combined with radicular pain, intradiscal therapy according to discography may be helpful in patients with no improvement using epidural steroid.
신경인성 과반사성 배뇨근에 대한 배뇨근 내보툴리눔 독소 A 주사
고현윤,신용범,손현주,장재혁,이경미,문혜정,하용훈 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23
Local injections of botulinum toxin A have been reported in the treatment of neurogenic bladder dysfunctions including detrusor sphincter dyssynergia and detrusor overactivity. We reports a case of intradetrusor injection of botulinum toxin type A in acervical cord injured patient with neurogenic overactive detrusor refractory to high dose anticholinergic medication. Botulinum toxin A (200 units) was injected cystoscopically into the detrusor in 40 sites over the bladder with sparing the trigone. Urodynamic studies were performed at baseline, and eight days, four weeks, and eight weeks after intradetrusor injection. There was marked improvement of the urodynamic parameters including maximum cystometric capacity and maximum detrusor pressure after intradetrusor botulinum toxin injection.
손현주,김경민,한지의,장재혁,신용범,고현윤 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21
Purpose: Numbers and severity of the injured segments and neurological recovery patterns are both vague and confused following cauda equina syndrome (CES). We evaluated the characteristics of CES according to the causes of the injuries resulting in CES. Subjects and Methods: Thirty-nine cases of CES diagnosed by clinical features and electrophysiological studies were recruited. We investigated segments or roots involved, muscle strength grades of key muscles, external anal sphincter tones, and changing patterns of theses findings. Their characteristics were compared according to the traumatic and non-traumatic lesions. Results: In traumatic lesions, lower segments, such as sacral roots, were involved more frequently and severely (p<O.OOl). In non-traumatic lesions, L5 and Sl roots were more injured and S2,3,4 roots were less injured (p<O.05). However, there was no significant difference of severity among the injured segments in non-traumatic disorders. There was no typical recovery pattern in both traumatic and non-traumatic cases. Conclusions: In traumatic CES, lower segments or roots were injured more prevalently and severely. Relatively, upper segments were more affected in non-traumatic CES.
신경인성방광으로 인한 방광요관역류에서 임계 배뇨근압 및 용량
장재혁,고현윤,신용범,손현주 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23
Purpose: We investigated relationships of detrusor pressure and bladder volume at the onset of vesicoureteral reflux (VUR) with other urodynamic and clinical parameters in neurogenic bladders after spinal cord injury. Materials and Methods: Videourodynamics were performed in 15 patients with spinal cord injury. Neurological levels of spinal cord injuries were categorized as cervical in 6 cases, thoracic in 6 cases, and lumbosacral in 3 cases. The interrelationships of detrusor pressure and bladder volume at the onset of VUR, bladder comp Hanco maximum detrusor pressure, and maximum bladder capacity were assessed. Results: A weak correlation existed between detrusor pressure and bladder volume at VUR (r=0.493, p=0.062). Detrusor pressure at VUR and bladder compliance presented an inverse correlation (r=-0.525, p=0.044). Pressure-volume index at VUR had a strong correlation with bladder volume at VUR divided bladder capacity (r=0.861, p<0.00l). Conclusions: Detrusor pressure and bladder volume at the onset of VUR appeared to have relationships with other factors associated with VUR in neurogenic bladders after spinal cord injury. Further studies acquiring additional patient data and follow-up data about reflux resolution permit to develop the management guide and prognostic factor of the secondary VUR in neurogenic bladders after spinal cord injury.