근근막 통증증후군

문철원 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2

Myofascial pain syndrome (MPS) is a painful musculoskeletal condition produced by myofascial trigger points, which are locally tender when active, with the pain referred through specific patterns to other areas of the body. Myofascial trigger points produce specific regional pain complaints, and refer both tenderness and pain. The referred pain pattern is usually valuable in helping to in identifying the muscles responsible for the myofascial trigger points. Patients with myofascial trigger points usually present with persistent pain, tight or aching muscles, a limited range of motion and general fatigue, or a combination of these. The intensity of myofascial pain ranges from low level, felt as a mild ache, to an excruciating aching or burning pain, or both. Diagnosis of MPS requires a detailed history of the pain problem, the patient's personal and family history, a general physical examination and a systemic search for the myofascial trigger points. Patients complain that the regional aching pain, the onset of which is related to acute, chronic or repetitive muscle overload. The diagnostic findings of myofascial trigger points are painful limitation, a palpable taut band and jump sign. Treatment of myofascial pain syndromes revolves around the interruption of the pain cycle by eliminating the myofascial trigger points. This may be accomplished by penetrating the trigger point with a needle, injecting a local anesthetic, a weak steroid solution, or saline alone, or by spraying the skin overlying the muscle containing the trigger area with a vapocoolant. Elimination of the perpetuating factors permits spontaneous inactivation of the myofascial trigger points.

유리체절제술 후 발생한 낭포황반부종에서 브롬페낙 점안약의 효과

문철원(Cheol-Won Moon),박동근(Dong-Geun Park),사공민(Min Sagong) 대한안과학회 2020 대한안과학회지 Vol.61 No.12

목적: 유리체절제술을 시행한 후 발생한 낭포황반부종에서 비스테로이성 항염증제제 점안약인 Bromfenac의 기능적, 해부학적 효과를 알아보고자 하였다. 대상과 방법: 유리체절제술 후 발생한 낭포황반부종으로 치료를 시행한 53안을 후향적으로 분석하였다. Bromfenac 점안약을 사용한 군(nonsteroidal anti-inflammatory drug [NSAID]군)이 37안이었고, 후테논낭하 트리암시놀론주사술을 사용한 군(injection군)이 16안이었다. NSAID군 중 27안은 유리체절제술과 백내장수술을 동시에 시행한 동시수술군이었고, 10안은 유리체절제술만 실시한 단독수술군이었다. 치료 후 6개월간 최대교정시력과 중심황반두께, 안압 변화를 비교하였다. 결과: 평균 최대교정시력은 모든 경과 관찰 기간 동안 두 군 사이에 서로 유의한 차이가 없었고, 평균 중심황반두께는 injection군에서 4개월까지 유의하게 더 많은 감소를 보였으나 이후 두 군 사이에 차이는 없었다. 안압은 injection군에서 상승이 관찰되었으나(2개월째 p=0.035) NSAID군에서는 나타나지 않았다. NSAID군을 백내장 동시수술 여부에 따라 비교하였을 때 평균 최대교정시력은 모든 경과 관찰 시점에서 두 군 사이에 유의한 차이가 없었고 평균 중심황반두께는 초진 시 동시수술군이 더 두꺼웠으나(p=0.023) 이후 유의한 차이를 보이지 않았다. 결론: 유리체절제술로 인한 낭포황반부종에 Bromfenac 점안약의 사용은 백내장 동시수술 여부와 관계없이 적은 부작용으로 시력개선과 중심황반두께 감소 효과를 보였다. Purpose: To investigate the functional and anatomical effectiveness of bromfenac sodium hydrate ophthalmic solution for the treatment of cystoid macular edema (CME) after pars plana vitrectomy (PPV). Methods: A retrospective chart review of 53 patients was performed. Thirty-seven eyes received topical 0.1% bromfenac sodium hydrate ophthalmic solution (nonsteroidal anti-inflammatory drug [NSAID] group), and 16 eyes were treated with subtenon triamcinolone acetonide injection (injection group). Of the NSAID group, 27 eyes underwent PPV with cataract surgery, and 10 eyes underwent PPV without cataract surgery. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured at baseline and monthly after treatment initiation over a 6-month period. Results: No significant difference in mean BCVA from baseline was found for either group over the 6-month follow-up. The injection group showed significantly greater improvement in CMT than the NSAID group at 4 months; however, there was no significant difference between the two groups at the 5-month follow-up visit. IOP was significantly higher in the injection group (p = 0.035 at 2 months), but not in the NSAID group. In the NSAID group, neither PPV group, with and without cataract surgery, showed any significant difference in mean BCVA from baseline over the 6 months of follow-up. The baseline CMT was significantly greater in the PPV with cataract surgery group than in the PPV without cataract surgery group (p = 0.023). However, at the 1-month follow-up, no significant difference in mean CMT from baseline values was observed in either group over the remaining follow-up examinations, up to 6 months. Conclusions: Topical bromfenac resulted in an improvement in the BCVA and a reduction in the CMT, with a less adverse effect in the treatment of CME after PPV, regardless of whether cataract surgery was performed at the same time.

경북대학교병원 외래환자수술실의 현황

곽경화,문철원,박성식,임동건,박진웅 대한정맥마취학회 2001 정맥마취 Vol.5 No.4

Background: Outpatient surgery has been continuously expanded around the world because of its cost-effectiveness and benefits for patients. Additionally, advances in anesthesia and surgical procedure have facilitated the rapid growth in day surgery. The purpose of this article is to analyze our 2 years' experience in day surgery center and therefore, to improve the management and effectiveness of day surgery center. Methods: We retrospectively analyzed 1,160 patients who were monitored and maintained by anesthesiologist except 6,549 patients who were done under local anesthetics during 2 years from Feb. 1998 to Jan. 2000. Patients were evaluated for ratio of outpatients to total surgery patients, male to female ratio, age distribution, ASA classification, participating departments, anesthetic techniques and aesthesia time. Results: The mean ratio of outpatients to total surgery patients was 4.6%. The sex ratio of outpatient surgery was similar and the age of patients was distributed 34.6 of under 20 years of age, 63.7 of 20-59 years of age and 12% of over 60 years of age. ASA physical status 1 and 2 occupied most of proportion of patients by 77.4 and 21.7% respectively. In our outpatient surgery center, all case was dane under general anesthesia and otolaryngologic surgery (47.5), orthopedic surgery (10.6), cardiac surgery (10.3), gynecologic sugery (10.1) and general surgery (10.0%) in ascending order. General anesthesia using propofol (88.2%) was commonly used and the airway has been kept with endotracheal tube (61.0), mask or manual (22.6), LMA (14.0) and COPA (2.4%). Anesthesia time less than 30 minutes was most common (42.2%), and most of the cases were done in less than 60 minutes (71.2%). Conclusions: The rate of outpatient surgery was very low compared to other countries but continuously has been increased. In this period, I think that the role of anesthesiologist is very important for faclitating outpatient surgery and improving both quantity and quality of outpatient surgery center.

Bioimpedance를 이용한 공기지혈대 사용 전 후의 혈역학적 변화

안치홍,문철원,박진웅 慶北大學校 醫科大學 1997 慶北醫大誌 Vol.38 No.1

목적 : 공기 지혈대의 장시간 착용시 저혈압, 빈맥, 전신적 산혈증 등이 일어 날 수 있다고 보고되어 왔다. 저자는 bioimpedance법을 이용하여 공기 지혈대 착용 전 후의 혈역학적 변화를 관찰하고자 하였다. 대상 및 방법 : 상지나 하지에 공기 지혈대를 착용하여 정형외과 수술을 받을 ASA class Ⅰ or Ⅱ에 해당하는 환자 44명을 대상으로 하였다. 전신마취 하에 공기지혈대를 하지에 착용한 군을 LC군(n=22)이라 하고 상지에 착용한 군을 AC군(n=12)이라 하였으며 척추마취 하에 공기지혈대를 하지에 착용한 군을 LS군(n=10)이라 하였다. Bioimpedanre법을 이용하여 심박수, 좌심 작업 지수, 전신 혈관 저항 지수, 심지수, 심박출 계수를 지혈대 착용 전 후로 순차적으로 측정하였으며 평균동맥압은 Sirecust 1260®를 이용하여 측정하였다. 결과 : 공기지혈대 제거 후 평균 동맥압은 LC군에서, 전신 혈관 저항 지수는 LC군과 LS군에서 감소함을 보였고, 심박수의 증가는 LC군과 AC에서 보였다. 결론 : 본 실험에서는 공기지혈대의 착용 전 후로 유의한 혈역학적 변화가 있음이 관찰 되었고 이는 마취과 의사가 관심을 가져야 할 것으로 사료된다. Background : The hemodynamic changes such as hypotension, tachycardia and acidosis have been reported when pneumatic tourniquet was deflated. The authors evaluated more detailed hemodynamic parameters about cardiac index(CI), left cardiac work index(LCWI), systemic vascular resistance index(SVRI) and ejection fraction(EF) with bioimpedance method. Methods : Forty four ASA class Ⅰ or Ⅱ patients underwent elective orthopedic surgery are divided into 3 groups. Pneumatic tourniquet was applied to patient's lower extremity with general anesthesia (LG, n=22), lower extremity with spinal anesthesia (LS, n=10) and upper extremity with general anesthesia(AG, n=12) respectively. We observed herat rate (HR), CI, LCWI, SVRI and EF to be changed by bioimpedance technique, mean arterial pressure was measured by automated oscillotonometry. Results: After tourniquet deflation, MAP was decreased significantly in LG group, HR was increased signifaicantry in LG and LS group and SVRI was decreased significantly in LG and AG group. Conclusions: we suggest that hemodynamic changes occur after tourniquet deflation. Therfore, these changes can be of clinical importance.

콘택트렌즈 관련 세균각막염에서 배양 양성 여부에 따른 비교 분석: 25년 후향적 연구

손성근,문철원,조찬호,이상범 대한안과학회 2023 대한안과학회지 Vol.64 No.12

목적: 미생물학적으로 확인된 콘택트렌즈 관련 세균각막염(culture positive, CP)의 균주 분포와 임상 특징을 조사하고 배양음성군(culture negative, CN)과 비교하였다. 대상과 방법: 1998-2022년 사이 콘택트렌즈 관련 세균각막염으로 입원치료한 142안을 후향적 분석하였으며, CP 79안(100균주)과 CN 63안이 포함되었다. CP군의 균주 분포 및 CP군과 CN군 사이에 역학, 선행인자, 임상 양상, 치료 결과를 비교하였다. 불량한 치료결과는 최종 최대교정시력 0.5 이하, 치료 후 시력감소, 또는 수술적 치료 시행으로 정의하였다. 불량한 치료 결과에 이르는 위험인자는 two-proportional Z-test를 통해 분석하였다. 결과: CP군에서 그람음성균이 85%였으며, Pseudomonas (27%)와 Serratia spp. (26%)가 흔하였다. CP군과 CN군 사이에 평균 나이(27.0 vs. 33.8세, p=0.009)와 치료콘택트렌즈 사용(13.9 vs. 28.6%, p=0.031)이 차이를 보였다. 두 군 사이에 증상 기간, 이전 점안항생제 사용, 수면 시 렌즈 착용, 상피결손 크기, 전방축농 및 불량한 치료 결과는 차이가 없었다. 전체군에서 불량한 치료 결과의위험인자는 심부기질침윤(Z=2.88), 상피재생 기간 ≥7일(Z=2.30), 초진 시력 <0.1 (Z=2.20), 렌즈 교체주기 초과 사용(Z=2.10) 그리고상피결손 ≥5 mm2 (Z=2.05)였다. 결론: CP군과 CN군 사이에 임상 양상과 치료 결과의 유의한 차이는 없었다. 전체군에서 불량한 초진 소견과 렌즈 교체주기 초과사용이 불량한 치료 결과와 관계 있었다. Purpose: This study investigated the microbiological profile and clinical characteristics of culture positive (CP) contact lens-related bacterial keratitis (CLBK) and compared them to culture negative (CN) cases. Methods: We retrospectively analyzed 142 CLBK patients hospitalized between January 1998 and December 2022. The CP and CN groups consisted of 79 eyes (100 isolates) and 63 eyes, respectively. We investigated the microbiological profile in the CP group and compared the epidemiology, predisposing factors, clinical characteristics, and treatment outcomes between the CP and CN groups. Poor treatment outcomes were defined as a final best-corrected visual acuity (BCVA) ≤ 0.5, worsened BCVA after treatment, or the need for surgical intervention. We evaluated the risk factors for poor treatment outcomes in the entire cohort through two-proportional Z-test analysis. Results: In CP group, gram-negative bacteria accounted for 85%, and common isolates were Pseudomonas (27%) and Serratia (26%) species. There were significant differences in mean age (27.0 years vs. 33.8 years, p = 0.009) and a history of therapeutic bandage contact lens wear (13.9% vs. 28.6%, p = 0.031) between the CP and CN groups. However, there were no significant differences in symptom duration, prior use of topical antibiotics, sleeping with wearing CL, epithelial defect size, hypopyon, and poor treatment outcomes. Significant risk factors for poor treatment outcomes in the entire group included deep infiltration (Z = 2.88), epithelial healing time ≥ 7 days (Z = 2.30), initial BCVA < 0.1 (Z = 2.20), over date use of contact lens (Z = 2.10), and epithelial defect size ≥ 5 mm2 (Z = 2.05). Conclusions: There were no significant differences in clinical characteristics and treatment outcomes between the CP and CN groups. Poor initial clinical findings and over date use of contact lens were associated with poor treatment outcomes in both groups.

외상목동맥해면굴샛길의 색전술 후 지연 발생한 한 눈 가돌림신경마비와 호너증후군

김원제,문철원,김명미 대한안과학회 2019 대한안과학회지 Vol.60 No.9

목적: 외상목동맥해면굴샛길(traumatic carotid cavernous fistula)의 색전술 후 지연 발생한 가돌림신경마비(abducens nerve palsy) 와 호너증후군(Horner syndrome)을 보고한다. 증례요약: 68세 여자가 서서히 심해진 좌안 눈꺼풀처짐과 수평두눈복시로 왔다. 10년 전 교통사고로 좌측 외상목동맥해면굴샛길이발생하여 색전술을 시행받았으며, 치료 결과는 좋았다고 했다. 시술 6년 뒤부터 서서히 좌안 눈꺼풀처짐이 생겼으며, 이후 복시도발생했다고 한다. 좌안은 눈꺼풀처짐과 함께 동공이 축동되었으며, 어두운 조명에서 동공부등은 더 심해졌다. 안구운동검사에서 정면주시 시 30프리즘디옵터의 내사시와 좌안 -4의 가쪽운동장애 소견을 보였다. 뇌 자기공명영상과 자기공명혈관조영술에서 목동맥해면굴샛길의 재발을 의심할 소견은 없었다. 6개월 동안의 경과 관찰에서 내사시의 변화는 없었다. 사시수술을 시행하였고, 복시는 호전되었다. 결론: 목동맥해면굴샛길의 색전술 후 한눈 가돌림신경마비와 호너증후군이 지연 발생할 수 있다. 지연 발생한 뇌신경마비가 자연 호전을 보이지 않으면, 적극적인 사시수술의 시행을 고려할 수 있다. Purpose: We report a patient with delayed-onset abducens nerve palsy and Horner syndrome after endovascular treatment of traumatic carotid-cavernous fistula (CCF). Case summary: A 68-year-female visited our ophthalmic department complaining of gradual-onset ptosis of the left eye and horizontal diplopia. She had undergone endovascular treatment to treat left-sided traumatic CCF after a car accident 10 years before; she had been told at that time that the treatment outcome was favorable. The left-sided ptosis gradually developed 6 years after the procedure, accompanied by diplopia. The left eye exhibited miosis and the extent of anisocoria increased in dim light. An extraocular examination revealed 30 prism diopters of left esotropia in the primary gaze and a -4 abduction limitation of the left eye. CCF recurrence was suspected; however, magnetic resonance imaging with magnetic resonance angiography of brain did not support this. The esotropia did not improve during the 6-month follow-up and strabismus surgery was performed. Conclusions: Delayed-onset abducens nerve palsy and Horner syndrome can develop even after successful endovascular treatment of CCF. Strabismus surgery should be considered in patients whose diplopia does not spontaneously improve.

제왕절개술중 정맥마취약제의 투여가 뇌파스펙트럼 분석에 미치는 영향

백운이,김시오,문철원 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.3

Background: Anesthesia induces the spectral changes in EEG. Attempts to relate these spectral changes to adequacy of anesthesia have been hindered due to the complex waveforms of EEG. The objective of this investigation is to monitor the awareness of patients during cesarean section by means of EEG spectral analysis. Methods: 20 patients for cesarean section aged from 24 to 39 and ASA class I or II, were maintained with O₂(50%)-N₂O(50%)-enflurane(0.8%). And they were administered with midazolam(0.07 mg/kg) in group I(n=6), fentanyl(l ㎍/kg) in group II(n=7), and fentanyl(2 ㎍/kg) in group III(n=7) after birth. The density of each spectral band in EEG (delta 1-3.25 Hz, theta 3.5-7.75 Hz, alpha 8-12.15 Hz and beta 13-31.75Hz) was analyzed to derive total density, delta ratio and median power frequency. Results: The spectral data demonstrated that the alpha rhythm was dominant in pre-induction period and beta rhythm was abundant both in the immediate post-induction period and after birth for all three groupslta ratio and median power frequency decreased after injection of midazolam and fentanyl in all three groups. None of patients could reeall the memory about experience during cesarean section. Conclusions: These findings indicate that EEG spectral analysis is potentially useful to determine the changes of cerebroelectrical activity but difficult to monitor the awareness of patients during cesarean section.

흉강경하 흉부교감신경절단에 따른 심박수 변이도의 스펙트럼 분석

박성식,김석희,김시오,홍정길,문철원,이응배 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2

Background : In general, we know that a thoracic sympathicotomy may have influence an cardiac autonomic nervous activity to change vital signs. The purpose of this study was to analyse preoperative and postoperative heart rate variability to evaluate the influence of a sympathicotomy on cardiac autonomic activity. Methods : We studied 14 healthy patients, ASA physical status Ⅰ and Ⅱ, undergoing an endoscopic thoracic sympathicotomy. A laryngeal airway mask was performed on all patients for tracheal intubation. Intravenous anesthesia was induced by administration of propofol 10 ㎎/㎏, and fentanyl 2 ㎍/㎏ and was maintained with propofol 10 ㎍/㎏/hr and N_2O-O_2 (2 L/min-2 L/min). An electrocardiogram was checked in the supine position with Biopac Student Lab. at an hour before anesthetic induction, after a left and right sympathicotomy and at 3-4 hours after emergence. A spike 2 version 3.0 was used for analyzing heart rate variability and a Fast Fourier Transform was used to yield a power spectrum. Frequency bands were divides to low frequency (0.02-0.09 ㎐) components. Results : There were no significant changes of heart rate, high frequency component, low frequency component and ratio of low to high frequency component. Conclusions : Influence of a thoracic sympathicotomy on cardiac autonomic activity was less in the supine position at rest. However, we think that the response of the cardiac autonomic activity to sympathetic stimulation like position change and exercise after a sympathicotomy may yield different results and studies about this must be done. (Korean J Anesthesiol 2002; 42: 177~182)

경요도 전립선절제술에서 척추마취 시 소용량 Bupivacaine-Fentanyl의 병용투여와 상용용량 Bupivacaine의 임상 효과 비교

곽경화,이수현,전영훈,문철원,백운이 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

Background: The combination of local anesthetics and opioids in the spinal anesthesia has a synergic analgesic effect, Therefore, we compated intraoperative conditions and clinical effects of low dose (5 mg) bupivacaine added with fentanyl versus a conventional dose(10 mg) of bupivacaine in spinal anesthesia for a transurethral resection of the prostate (TURP). Methods: Forty five ASA class 1 and 2 patients scheduled for a TURP were randomly divided into three groups. Group B (n = 15) received bupivacaine 10 mg, group BF (n = 15) received bupivacaine 5 mg added with fentanyl 20 ㎍, and group BFE received bupivacaine 5 mg added with fentanyl 20 ㎍ and 0.2 mg epinephrine. Blood pressure and heart rate were recorded every 5 minutes before and after spinal anesthesia. Sensory blockade was measured by a pin-prick test and motor blockade was evaluated by the Bromage motor scale. Side effects including pruritus, nausea, vomiting, respiratory depression, and intraoperative pain were observed. Results: The duration of sensory and motor blockade in group BF was significantly shorter than in group B and group BFE (P < 0.05). Without statistical significance, hypotension (6.7%) and bradycardia (13.3%) were observed in group B and pruritus (26.7%) and nausea (13.3%) occurred in all patients who received fentanyl. Conclusions: The addition of fentanyl 20 ㎍ to low dose bupivacaine 5 mg resulted in short lasting motor and sensory block, compared with conventional dose bupivacaine 10 mg. Therefore, we concluded that the clinical application of this method could provide adequate analgesia with early discharge and no serious side effects for TURP patients. (Korean J Anesthesiol 2002; 43: 418~423)

백서 척수강내 이식한 부신수질 크로마핀 세포의 진통 효과

백운이,임정옥,김유미,문철원,전영훈,한창규 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4