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다발성 전신질환 장애환자에서 진행성 치성감염에 의한 측두간극농양 절개 배농시 창상주위 봉합과 배농술에 의한 과도한 출혈조절
손정석(Jeong-Seog Son),오지현(Ji-Hyeon Oh),유재하(Jae-Ha Yoo) Asia association of Disability and Oral health 2013 International Journal of Disability and Oral Healt Vol.9 No.1
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.
폐렴을 동반한 턱관절 탈구환자에서 인상채득 중 유발된 급성 호흡장애
손정석,오지현,유재하,김종배,Son, Jeong-Seog,Oh, Ji-Hyeon,Yoo, Jae-Ha,Kim, Jong-Bae 대한치과마취과학회 2014 Journal of Dental Anesthesia and Pain Medicine Vol.14 No.2
Difficulty in breathing can be very disconcerting to a patient who is conscious yet unable to breath normally. The common causes of acute respiratory distress include hyperventilation, vasodepressor syncope, asthma, heart failure, and hypoglycemia. In most of these situations, the patient does not exhibit respiratory distress unless an underlying medical disorder becomes acutely exacerbated. Examples of this include acute myocardial infarction, anaphylaxis, cerebrovascular accident, hyperglycemia, and hypoglycemia. A major factor that leads to the exacerbation of respiratory disorders is undue stress, either physiologic or psychologic. Psychologic stress in dentistry is the primary factor in the exacerbation of preexisting medical problems. Therefore, the most dental patient should be cared gently as the stress reduction protocol. This is a case report of acute respiratory distress with vasodepressor syncope during alginate impression taking of mandibular teeth in a long-standing temporomandibular joint dislocated 93-years-old pneumonic patient.
손정석(Jeong-Seog Son),오지현(Ji-Hyeon Oh),유재하(Jae-Ha Yoo),김종배(Jong-Bae Kim) Asia association of Disability and Oral health 2014 International Journal of Disability and Oral Healt Vol.10 No.1
The general local cause of gingival bleeding is the vessel engorgement and erosion by odontogenic infection. Abnormal gingival bleeding is also associated with systemic causes. Bleeding disorders in which continuous gingival bleeding is encountered include the followings : vascular abnormalities, platelet disorders, hypoprothrombinemia and other coagulation defects. There are classic methods for gingival bleeding control, such as, direct pressure, electrocoagulation, suture, crushing and application of hemostatic agents. If the continuous gingival bleeding is not stopped in spite of the conventional methods, the life of patient is threatened owing to upper airway obstruction, syncope, vomiting and hypovolemic shock. Therefore, the rapid and correct hemostatic method is very important in the emergency condition. This is a case report of continuous gingival bleeding control by primary endodontic drainage & suture in a disabled patient with systemic bleeding disorders.
손정석,오지현,최병호,유재하,Son, Jeong-Seog,Oh, Ji-Hyeon,Choi, Byung-Ho,Yoo, Jae-Ha 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.3
Temporomandibular joint (TMJ) dislocation is an acute paintful condition that causes severe functional limitation. So, manual reduction is the treatment of choice and should be performed as early as possible. Long-term dislocation of the TMJ that has persisted for more than 1 month is comparatively rare. This may include severe illness, neurological diseases and prolonged intensive care hospitalization with oral intubation and sedation. A joint that remains prolonged dislocated undergoes morphological change which is also true for periarticular tissue, especially in ligaments and muscles. Treatment of long-term TMJ dislocation should be different from acute TMJ dislocation, as simple reduction is difficult to achieve and it's likely to redislocate. The prevention of redislocation after reduction should be considered. This is a case report of about manual reduction of temporomandibular joint long-standing dislocation under general anesthesia.
진행성 치성 감염병소에서 부적절한 진정요법과 국소마취 시행하 절개 배농술에 따른 과환기증
오지현,손정석,유재하,김종배,Oh, Ji-Hyeon,Son, Jeong-Seog,Yoo, Jae-Ha,Kim, Jong-Bae 대한치과마취과학회 2014 Journal of Dental Anesthesia and Pain Medicine Vol.14 No.1
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.
뇌졸중 환자에서 항생제 정주 후 유발된 실신과 의식소실: 증례보고
유재하,손정석,김종배,Yoo, Jae-Ha,Son, Jeong-Seog,Kim, Jong-Bae 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.4
The loss of consciousness in the dental office have many causes, such as, vasodepressor syncope, drug administration, orthostatic hypotension, epilepsy, hypoglycemic reaction, acute adrenal insufficiency, acute allergic reaction, acute myocardial infarction, cerebrovascular accident, hyperglycemic reaction and hyperventilation. Patients have fainted during all phases of dental care: during tooth extraction and other surgical procedures, during local anesthetic injections, or during procedures such as venipuncture, on being seated in the dental chair, and even on first entering the dental office. If an elderly patient with known cardiovascular or cerebrovascular problems experiences a syncopal episode, differentiation from cerebrovascular insufficiency of more serious etiology, such as cerebrovascular accident, must be considered. And anaphylactic shock is also suggested during intravenous drug administration. This is a case report of syncope care during venous injection of cephalosporin in patient with cerebrovascular accident.
상악골괴사 환자에서 페니실린 정주 후 아나필락틱 쇼크: 증례보고
오지현,손정석,최병호,이정섭,김지훈,유재하,Oh, Ji-Hyeon,Son, Jeong-Seog,Choi, Byung-Ho,Lee, Jeong-Sub,Kim, Ji-Hun,Yoo, Jae-Ha 대한치과마취과학회 2014 Journal of Dental Anesthesia and Pain Medicine Vol.14 No.4
Generalized anaphylaxis is a most dramatic and acutely life-threatening allergic reaction and may cause death within a few minutes. Differential diagnosis of anaphylaxis is made by clinical signs, such as, mental change, respiratory distress, hypotension, hypoglycemia, urticaria and angioedema. Especially, insulin reaction, myocardial infarction and vasovagal syncope are considered as differential diagnosis. In cases of fatal anaphylaxis, respiratory and cardiovascular disturbances predominate and are evident early in the reaction. This is a case report of the intensive care of anaphylactic shock after intravenous injection of the penicillin in a old medically compromised patient with the maxillary osteonecrosis. The anaphylactic shock symptoms, such as, unconsciousness, respiratory disorder, no pulsation on carotid artery and cardiopulmonary arrest are occurred in intravenous injection of augmentin 1.2 g after the skin test. In spite of immediate emergency cares, such as intravenous injection of epinephrine, endotracheal intubation, cardiopulmonary resuscitation, and continuous intensive care, the patient is expired in 58 hours after anaphylactic shock attack.
외상 후 오랜 시간 지체된 탈락 치아 재식술 시행 시 근관 통한 배농: 증례보고
유재하,김종배,손정석,Yoo, Jae-Ha,Kim, Jong-Bae,Son, Jeong-Seog 대한악안면성형재건외과학회 2012 Maxillofacial Plastic Reconstructive Surgery Vol.34 No.4
From the standpoint of general guidelines of a dentist, the following conditions should be considered before replanting a permanent tooth. The avulsed tooth should be without advanced periodontal disease. The alveolar socket should be reasonably intact in order to provide a seat for the avulsed tooth. The extra-alveolar period should be considered, i.e. periods exceeding. 2 hours are usually associated with marked root resorption. But, the above mentioned regulations are often difficult to keep in the actual situation of the medical emergency room, owing it to the delay of primary medical care in multiple trauma patients. The successful cases have been reported with minimal root resorption in the long-term periods, in spite of extra-alveolar periods of several hours and combined alveolar bone fracture. This is a case report regarding the effect of endodontic drainage in delayed replantation after a prolonged extra-alveolar period of the avulsed teeth with alveolar bone fracture.
윤광로 ( Kwang Ro Yoon ),손정석 ( Jeong Seog Son ),이수진 ( Su Jin Lee ),김영창 ( Young Chang Kim ) 대한임상병리사협회 1994 임상수혈검사학회 발표자료집 Vol.1 No.1
2188 volunteered for blood donation in blood bank of Wonju Christian Hospital during the period from January to December, 1993. Through the performing the physical examination, history, specific gravity of blood, and blood typing, 1781 were found eligible for blood donation and 1706 donated blood. The results obtained were summarized as follows. 1. The donors mainly consisted of 21-29 year-old group(63.7%) and 30-39 year-old group(23.7 %) with male to female ratio of 9.6: 1 2. The occupation of donors was soldier(30.0 %), employee(22.4 %) student(21.3 %), public service personnel(4.9 %), and others(21.3 %). 3. Among the all 2188 candidates, 407(18.6 %)were deferred due to various diseases(47.6 %), abnormal blood pressure(23.1 %) and ABO incompatibility against the directed recipient(l1.8 %) poor vessels(5.4 %), low specific gravity of blood(4.4 %), and underage donor(4.1 %), and other causes. 4. Among the 1,706 donor bloods tested for serological markers, 109(6.4 %) units were discarded due to positive HBsAg(42.6 %), positive anti-HCV(2.7 %), reactive VORL test (9.2 %), elevated ALT level(39.4 %), and simultaneously increased ALT with positive HBsAg(6.4 %). 5. 1552(91 %)were directed donors and 154 were purely voluntary donors. All directed blood units were transfused to the directed recipients as the whole blood. Departements that wanted the directed blood donors were general surgery, chest surgery, internal medicine, pediatrics, and others.
뇌성마비 장애환자에서 함치성 낭종 적출과 매복 과잉치 발치후 창상처치로 배액술
유재하(Jae-Ha Yoo),손정석(Jeong-Seog Son),김종배(Jong-Bae Kim) Asia association of Disability and Oral health 2012 대한장애인치과학회지 Vol.8 No.2
In treatment of dentigerous cyst, complete enucleation, histopathologic examination and postoperative care are important to prevent the potential complications (mural ameloblastoma, squamous cell carcinoma). On the other hand, a maxillary impacted supernumerary anterior tooth are removed surgically, owing to the possibility of the cyst formation in future. After the cyst enucleation and extraction of the involved tooth, the wound area sutured and removable resin plate is then applied. In this operation, the postoperative bleeding and infection is likely to occur owing to postoperative accumulation of hematoma & seroma, psychologic stress and other contaminated factor. So, the authors established the immediate rubber & iodoform gauze drainage into the sutured wound of cyst enucleation & tooth extraction for the prevention of postoperative bleeding and infection. The removable resin splint are not used because of the poor cooperation and economic factor. The results were more favorable without the postoperative bleeding & wound infection in a cerebral palsy patient.