한국인에서 족저 섬유종증의 초음파 소견

안재기,김철,박용범 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.5

Objective: To investigate the sonographic appearance of plantar fibromatosis in Korean adults, thus enabling sonographic diagnosis of the benign, focally invasive fibrous neoplasm. Method: The medical records, pathologic reports, and sonographic reports and image of 42 patient with plantar fibromatosis were reviewed retrospectively. Results: US demonstrated plantar fibromatosis as a fusiform nodular thickening of the plantar fascia oriented according to its major axis. A total of 60 fibromatosis nodules in 42 patient were examined. Thirty-eight (63.33%) of the 60 were elongated. The remaing 22 were rounded or oval. Thirty- five (58.33%) were hypoechoic; fivty-one (85%) were 20 mm long or less. Eight of 9 lesions that had mixed echogenicity were longer than 20 mm. Conclusion: Our results suggest that the lesions of the plantar fibromatosis were characteristically located on the surface of the plantar fascia, longitudinally elongated, most often less than 20 mm long, fusiform and hypoechoic. Lesions longer than 10 mm often exhibited mixed echogenicity. Our sonographic finding was helpful in diagnosing planatar fibromatosis in the Korean. (J Korean Acad Rehab Med 2010; 34: 565-569) Objective: To investigate the sonographic appearance of plantar fibromatosis in Korean adults, thus enabling sonographic diagnosis of the benign, focally invasive fibrous neoplasm. Method: The medical records, pathologic reports, and sonographic reports and image of 42 patient with plantar fibromatosis were reviewed retrospectively. Results: US demonstrated plantar fibromatosis as a fusiform nodular thickening of the plantar fascia oriented according to its major axis. A total of 60 fibromatosis nodules in 42 patient were examined. Thirty-eight (63.33%) of the 60 were elongated. The remaing 22 were rounded or oval. Thirty- five (58.33%) were hypoechoic; fivty-one (85%) were 20 mm long or less. Eight of 9 lesions that had mixed echogenicity were longer than 20 mm. Conclusion: Our results suggest that the lesions of the plantar fibromatosis were characteristically located on the surface of the plantar fascia, longitudinally elongated, most often less than 20 mm long, fusiform and hypoechoic. Lesions longer than 10 mm often exhibited mixed echogenicity. Our sonographic finding was helpful in diagnosing planatar fibromatosis in the Korean. (J Korean Acad Rehab Med 2010; 34: 565-569)

팔꿈치, 팔목, 손 통증의 초음파 유도하 주사치료

안재기 대한임상통증학회 2021 Clinical Pain Vol.20 No.2

Patients with pain, numbness, and weakness in their elbows, wrists, and hands often need proper rehabilitation treatments. Among them, musculoskeletal injection therapy should be performed after a full evaluation of the patient, taking into account history and physical examination leading to clinical diagnosis. General rules such as accurate diagnosis and injection materials selection are used to achieve maximum benefit with minimal side effects. During injection, patient location, aseptic care, penetration techniques, follow-up and follow-up care must be maintained. Specific techniques may vary depending on the type, lesion, and location of the injection therapy. For optimal effectiveness, physician should inject directly into the lesion and avoid the injection of surroundings as much as possible. Therefore, ultrasound-guided injections are needed to accurately inject. These conditions and other conditions of the hands, wrists, and elbows can be effectively diagnosed and treated with diagnostic ultrasound and ultrasound-guided injections.

3차원 초음파에서 관절 조영술 전후 회전근개 파열 크기와 형태의 변화

안재기,김철,박용범 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.3

Objective: To compare to type and size of rotator cuff tear (RCT) in the transverse view before and after arthro-3D sonography. Method: Total 24 cases with rotator cuff tear were diagnosed according to ultrasonographic finding. All of patients were performed by a posterior-lateral approach for sono-guided intra-articular injection and underwent by both before and after arthro 3D sonogrpahy. We measured size (transverse, longitudinal, area) of RCT on the transverse scan in search of the largest lesion and the difference to type and size of RCT after arthrography. Results: 3D ultrasonography detected full-thickness tear in 18 cases, partial-thickness tear in 6 cases before arthro-3D sonograhy. Change in the diagnosis of rotator cuff tear after arthro -3D sonogrphy; 3 partial-thickness tear were diagnosed as full-thickness tear. The size (transverse, longitudinal, area) of RCT was increased significantly after arthro -3D sonography compared with that before arthro 3D sonography. Conclusion: Arthro-3D sonography is useful for evaluation the configuration of RCT. Using this method, we can provide the objective and steric image of RCT. (J Korean Acad Rehab Med 2010; 34: 362-367) Objective: To compare to type and size of rotator cuff tear (RCT) in the transverse view before and after arthro-3D sonography. Method: Total 24 cases with rotator cuff tear were diagnosed according to ultrasonographic finding. All of patients were performed by a posterior-lateral approach for sono-guided intra-articular injection and underwent by both before and after arthro 3D sonogrpahy. We measured size (transverse, longitudinal, area) of RCT on the transverse scan in search of the largest lesion and the difference to type and size of RCT after arthrography. Results: 3D ultrasonography detected full-thickness tear in 18 cases, partial-thickness tear in 6 cases before arthro-3D sonograhy. Change in the diagnosis of rotator cuff tear after arthro -3D sonogrphy; 3 partial-thickness tear were diagnosed as full-thickness tear. The size (transverse, longitudinal, area) of RCT was increased significantly after arthro -3D sonography compared with that before arthro 3D sonography. Conclusion: Arthro-3D sonography is useful for evaluation the configuration of RCT. Using this method, we can provide the objective and steric image of RCT. (J Korean Acad Rehab Med 2010; 34: 362-367)

아마추어 마라톤 주자에서의 마라톤 완주 전후 생화학적 골대사 지표의 변화

안재기 ( Jae Ki Ann ),김철 ( Chul Kim ) 대한스포츠의학회 2009 대한스포츠의학회지 Vol.27 No.1

It has been known that exercise has long-term benefits on bone mass, but acute effects following long distance running likes marathon were not clearly known. The aim of this study was to evaluate the acute effects of bone remodeling following full course running of marathon by measuring biochemical markers of bone turnover in blood and urine. Sixteen healthy, regularly exercising persons who participated in full course running of marathon were studied. There were 11 men and 5 women and their mean age was 35.6 year-old (range 25-45). We collected blood and urine samples in the morning preceding the race, and on days 1, 2 and 7 following the marathon. We measured biochemical bone markers including alkaline phosphates (ALP), serum osteocalcin, parathyroid hormone (PTH), serum ionized calcium, and urinary deoxypyridinoline, and then we analyzed on each times. There were no significant changes in PTH and ALP levels change at any time following the race. The serum ionized calcium levels decreased on the day after race (p<0.01). The serum osteocalcin levels decreased on the day after the race (p<0.01) and it returned to pre-race levels on second day following the race. The Serum osteocalcin levels at 1 week after the race were significantly higher than pre-race levels (p<0.01). The urinary deoxypyridinoline levels increased the day after the race (p<0.01), and then it sequentially decreased on second day after and one week after the race (p<0.01). In marathon running, bone resorption and the inhibition of bone formation occur on one day after the race. The effect of bone formation increases and the effect of bone resorption decreases on second day and one week after the race. We know that there are some changes in bone turnover markers before and after marathon racing.

허혈성 심장질환 환자에서 심장재활 후 운동능력 및 심실 기능의 변화

안재기 ( Jae Ki Ahn ),김철 ( Chul Kim ),방인걸 ( In Keol Bang ),김영주 ( Young Joo Kim ) 대한스포츠의학회 2006 대한스포츠의학회지 Vol.24 No.2

노인에서 발 마사지 후 발생한 발바닥 근막 손상 1예

안재기(Jae Ki An),김철(Chul Kim),박용범(Yong Bum Park),문창진(Chang Jin Moon),최희은(Hee Eun Choi) 대한임상노인의학회 2009 대한임상노인의학회지 Vol.10 No.4

족저 근막(plantar fascia)은 발바닥 전체에 퍼져 있으면서 뛰거나 걸을 때 발바닥에 가해지는 충격을 흡수하는 기능을 하는 막이다. 족저 근막의 손상은 주로 반복적인 사용에 의여 발생하나 평소 체중증가나 무리한 운동이 없이 발 마사지 후 발행한 족저 근막 손상 1예를 경험하였기에 보고하는 바이다. 57세 여자 환자는 2개월 전 지압용 봉을 이용한 발마사지를 받은 이후 발생하여 지속되는 우측 족저부위의 내측 통증을 주소로 내원하였다. 환자는 과거력상 특이 소견은 없었으며 하지 및 발 부위에 외상 및 질환의 병력도 없었다. 증상 발현 초기에 개인병원에서 1개월간 치료를 받았으나 증상이 호전되지 않아서 본원에 방문하였다. 환자는 아침에 일어난 후 첫걸음을 디딜 때 통증이 나타나지는 않았으나, 보행시에 통증을 심하게 호소하였다. 이학적 검사에서 내측 발바닥의 발꿈치뼈 앞 1 cm에서 통증 및 압통이 있었으며 근막을 스트레칭하면서 압박시에 심하게 통증을 호소하였다. 단순 방사선 검사에서 족부의 특이 변형 및 이상소견은 발견되지 않았다. 근골격계 초음파 검사에서 우측 발꿈치뼈 내측 1 cm 전방, 깊이 1 cm 아래에서 약 직경 1.5 cm부위의 족저 근막과 그 주위 저음영성 부종이 관찰되었으며 파워 도플러 검사에서 근막 주위 바닥쪽으로 과다혈관 병변이 관찰되었다. 다른 심부의 손상을 확인하기 위해 시행한 족부 자기공명영상검사에서 T2 영상에서 족저 근막내 조영증강된 소견과 함께 주변 조직의 부종 등이 관찰되었다. 일반적으로 발바닥 근막 손상은 특이한 외상없이 반복적인 손상에 의하여 발생하는 것으로 알려져 있으나 최근 유행하고 있은 발 마시지 후 발생한 발바닥 근막 손상 1예를 경험하였기에 보고하는 바이다. Plantar fascia is the form of fascia that is spread out on the sole and absorbs the shock that is applied to the sole when walking or running. Plantar fasciitis is usually gradual in onset with few cases attributable to a specific inciting event. A plantar fascia injury can however occur with direct trauma or forceful stretching of the plantar fascia in a specific incident. The authors have experienced one case of plantar fascia injury which occurred due to weight gain or repetitive trauma. A 57 year old female patient visited the hospital because of the continuous medial sole pain which occurred after she received foot massage with a stick. There was no specific family history about the particular pain and had no trauma or other diseases in the leg and foot. She received treatment for a month in a private clinic, but she did not see any improvements, so she visited our hospital. The patient did not feel painful when taking a first walk in the morning but she complaint of severe pain when walking. During the physical examination, she felt pain in front of the calcaneal bone. She also complaint of pain when she stretched the plantar fascia. Simple x-ray did not find any foot deformity or gross bony abnormality. During muscular skeletal sonogram, at the front of right medial calceneus and a centimeter deep, edematous hypoechoic lesion and hypoechoic swelling plantar fascia that is about 1.5 cm was found and hypervascular lesion was found around the fascia during the power dopper scan. In the foot MRI, mild thickening with increased intrasubstance signal intensity of plantar fascia, perifascial edema and change in signal intensity of underlying flexor digitorum brevis muscle, mainly involvement of proximal 1/3 of medial part of central segment of plantar fascia finding were discovered. Commonly, it is known that plantar fascia leision occurs due to non-traumatic repetitive overuse, but in this case, plantar fascia injury occurred after the patient received the popular foot massage.

심부전증에서의 심장재활 프로그램의 효과와 안정성

김철,안재기,방인걸,김용진 대한재활의학회 2005 Annals of Rehabilitation Medicine Vol.29 No.1

Objective: This study was performed to investigate the effect and safety of cardiac rehabilitation program in heart failure. Method: 36 patients who suffered from heart failure with decreased left ventricular ejection fraction less than 50% by echocardiogram were recruited for study subject. They took graded exercise test before and after cardiac rehabilitation program. Cardiac rehabilitation program was consisted of 6~8 weeks monitoring exercise according to the result of exercise test. We reviewed the all courses of the program to see the safety and compared the several results to know the effect of the program. Results: During totally 696 exercise-hours with ECG monitoring, 12 abnormal hemodynamic responses were happened,but those were minor in severity. All of them were managed successfully and could complete their exercise program as their schedules. Even in heart failure patients, cardiac rehabilitation program could improve exercise capacity in terms of increased maximal oxygen consumption, maximal exercise time, and maximal myocardial oxygen demand. Submaximal myocardial oxygen demand and rate of perceived exertion were significantly decreased after cardiac rehabilitation program. Conclusion: In case of prudent monitoring and proper management, cardiac rehabilitation program is safe and effective to improve exercise capacity in heart failure patient.

Treatment Effects of Ultrasound Guide Selective Nerve Root Block for Lower Cervical Radicular Pain: A Retrospective Study of 1-Year Follow-up

박용범,안재기,손유경,지혜미,이지혜,김종우,박기덕 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.5

Objective To compare the long-term effects and advantages of ultrasound (US)-guided selective cervical nerve root block with fluoroscopy (FL)-guided transforaminal block. Methods From March 2009 to November 2012, 162 patients received steroid injections for lower cervical radicular pain. A total of 114 patients fulfilled the inclusion criteria. All procedures were performed by using US or FL. We compared the intravascular injections during the procedure with the effects and functional scales at 3, 6, and 12 months after the procedure between the two groups. Successful treatments occurred when patients obtained significant pain reliefs (as measured by >50% improvements in the verbal numerical scale [VNS] score and >40% improvements in the neck disability index [NDI] score) and reported a patient satisfaction score of 3 or 4 points at 12 months after the injection. Image analysis of intravascular injection and chart review were performed. Logistic regression was performed to reveal the correlations between successful treatments and variables (patient’s age, gender, duration of the disease, cause, injection method, and radiologic finding).Results The VNS and NDI improved 3 months after the injection and continued to improve until 12 months for both groups. But there were no statistical differences in changes of VNS, NDI, and effectiveness between these two groups. The proportion of patients with successful treatment is illustrated as 62.5% in US-guided group and 58% in FL-guided group at 12 months. There were no significant differences between the groups or during follow-up periods. Three cases of the intravascular injections were done in FL-guided group.Conclusion The US-guided selective cervical nerve root blocks are facilitated by identifying critical vessels at unexpected locations relative to the foramen and to protect injury to such vessels, which is the leading cause of reported complications from FL-guided transforaminal blocks. On treatment effect, significant long-term improvements in functions and pain reliefs were observed in both groups after the intervention. However, significant differences were not observed between the groups. Therefore, the US-guided selective cervical nerve root block was shown to be as effective as the FL-guided transforaminal block in pain reliefs and functional improvements, in addition to the absence of radiation and protection vessel injury at real-time imaging.

관상동맥질환에서 운동능력 및 위험인자에 대한 심장재활의 효과

김철,안재기,방인걸,이건주,김병옥,소무철,김영주,정인탁 대한재활의학회 2006 Annals of Rehabilitation Medicine Vol.30 No.1

Carbamazepine 사용 중 발생한 약물 유발성 간염 1례 : 증례보고

소무철,안재기,임한석 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Carbamazepine is the one of the widely-used anticonvulsant medications and nowadays it is also applied to various kinds of pain. Besides well-known, dose-dependent adverse drug effects, Carbamazepine can induce an acute, fatal but very rare idiosyncratic syndrome, named as AHS(Anticonvulsant hypersensitivity syndrome) , which includes fever. rash, eosinophilia, pancytopenia, hepatitis. lymphadenopathy. A 32-year old man with the cervical spinal cord injury due to C4 compression fracture developed acute hepatitis with fever, rash. eosinophilia, pancytopenia and elevated liver enzymes 7 days after starting carbamazepine therapy because of a central pain. Discontinuation of carbarnazepine with systemic steroid therapy improved the clinical and laboratory findings within 2 weeks. It is very important for physicians to be aware of carbamazepine-induced idiosyncratic hepatitis because of its diagnostic difficulty.