흉추 5번 압박골절을 동반한 상부흉추(흉추4-6)결핵환자 1예 -증례보고-

심호용,임오경,이하림,박기덕,이주강 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.1

Study Design: Case report Objectives: We report a case of a female patient who had only upper back pain without neurological symptoms and was later diagnosed with spine tuberculosis in combination with a compression fracture. Summary of Literature Review: Spine tuberculosis is the most common type of musculoskeletal tuberculosis. However, the indolent nature of tuberculous bone and joint disease often leads to delayed diagnosis and severe neurologic complications. Material and Methods: A 37-year-old female with only upper back pain for five months was admitted. She had no signs, symptoms or past histories related to tuberculosis. She had taken conservative management, but symptoms persisted. Results: By doing motor and sensory evoked potential studies, we questioned spinal cord jury. Then, we confirmed spine tuberculosis T5with T4 compression fracture by thoracic magnetic resonance imaging and pathologic findings. Conclusions: When a patient presents constant back pain without neurological symptoms, image study and electromyography should be evaluated. 연구 계획: 증례보고목적: 신경학적 증상이 없이 상부 배부통증만을 호소하던 환자에서 압박골절을 동반한 결핵성 척추염을 경험하였기에 보고하고자 한다. 선행문헌의 요약: 척추 결핵은 근골결계 결핵에서 가장 흔히 호발하는 질환이다. 그러나 결핵은 뼈와 관절을 서서히 침범하므로 늦게 진단되며 심각한신경학적인 합병증을 유발한다. 대상 및 방법: 증례는 5개월간 상부배부 통증만을 호소하는 37세 여성이 입원했다. 환자는 결핵과 관련된 어떠한 증상과 증후가 없었다. 입원 이후 배부통증에 대한 보존치료를 시행했으나 통증은 지속되었다. 결과: 체성감각 및 운동 유발전위 검사에서 척수손상을 의심하였고 흉부 자기공명영상검사를 통해 흉추 4번의 압박골절과 흉추 5번의 결핵성 척추염이관찰되어 수술을 통해 얻은 조직검사로 결핵성 척추염을 확진하였다. 결론: 신경학적인 증상이 없는 환자에서 배부 통증이 지속된다면 근전도와 영상검사 등을 통해 통증의 원인을 확인해야한다.

Sciatic Nerve Injury Caused by a Stretching Exercise in a Trained Dancer

심호용,임오경,배근환,Seok Min Park,이주강,박기덕 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.6

Sciatic nerve injury after stretching exercise is uncommon. We report a case of an 18-year-old female trained dancer who developed sciatic neuropathy primarily involving the tibial division after routine stretching exercise. The patient presented with dysesthesia and weakness of the right foot during dorsiflexion and plantarflexion. The mechanism of sciatic nerve injury could be thought as hyperstretching alone, not caused by both hyperstretching and compression. Electrodiagnostic tests and magnetic resonance imaging revealed evidence of the right sciatic neuropathy from the gluteal fold to the distal tibial area, and partial tear of the left hamstring origin and fluid collection between the left hamstring and ischium without left sciatic nerve injury. Recovery of motor weakness was obtained by continuous rehabilitation therapy and some evidence of axonal regeneration was obtained by follow-up electrodiagnostic testing performed at 3, 5, and 12 months after injury.

선박 운항 정보 프로그램 개발의 SQA 프로세스 적용사례

심호용(Ho Yong Sim),이상봉(Sang Bong Lee),이서정(Seo Jeong Lee) 한국항해항만학회 2017 한국항해항만학회 학술대회논문집 Vol.2017 No.춘계

Dropped Head Syndrome (DHS) Combined with Cervical Polyradiculopathy Following Radiotherapy

임오경,심호용,윤진원,이진영,박기덕,이주강 대한근전도전기진단의학회 2014 대한근전도 전기진단의학회지 Vol.16 No.2

We report a 55-year-old man with dropped head syndrome who developed neck extensor muscle weakness. After he was treated with radiotherapy (66Gy) two years ago because of non-small cell lung cancer, he exhibited progressive inability to lift his head with severe neck pain with the dropped head. The electrodiagnostic study revealed left cervical polyradiculopathy and polyneuropathy combined with cervical myelopathy, and localized myopathic change was detected on trapezius muscle biopsy. In his cervical magnetic resonance images revealed cervical spine compression fracture and multiple foraminal stenosis, so we concluded that dropped head posture was caused from radiotherapy induced myopathy of neck extensor muscle and left upper extremity pain and weakness was resulted from compression polyradiculopathy due to prolonged cervical flexion contracture. Although neuropathic pain and the neck movement limitation were treated with physical therapy, cervical orthosis, trigger point injection and medication, the improvement was limited. We suggest that the early diagnosis of dropped head syndrome (DHS) and appropriate rehabilitative management should be considered to prevent severe secondary complications such as myopathy and neuropathy.

외부 간병인에서 나타나는 근골격계 통증

이하림(Ha Lim Lee),심호용(Ho Yong Shim),김정만(Jung Man Kim),박기덕(Ki Deok Park),이주강(Ju Kang Lee),임오경(Oh Kyung Lim) 대한임상노인의학회 2011 대한임상노인의학회지 Vol.12 No.2

연구배경: 외부 간병인력에서 나타나는 신체 부위별 근골격계 통증 양상 및 직무 특성과 대상자의 일반적인 특성에 따른 신체 부위별 근골격계 통증의 차이에 대해 알아보고자 하였다. 방법: 206명이 연구 조사 대상에 포함되었고, 일반적 특성에 대한 문항, 지난 3개월간 주로 간병했던 환자의 기능과 관련한 문항, 근골격계 통증의 위치와 강도, 특정 간병 활동 시 악화 여부 등에 대한 문항으로 구성된 구조화된 설문지를 이용하였다. 결과: 연구에 참여한 조사 대상자는 총 206명으로 전부 여성이었으며, 평균 연령은 56.3±5.3세였다. 전체 신체 부위 중 어느 한 곳 이상에서 통증을 호소하는 간병인은 전체의 85.9% (95% 신뢰구간 81.1∼90.7)였고, 신체 부위별로 어깨 55.8% (95% 신뢰구간 49.0∼62.7), 허리 49.5% (95% 신뢰구간 42.6∼56.4) 부위 통증을 가장 많이 호소하였으며, 그 다음으로 손 또는 손목 34.0% (95% 신뢰구간 27.5∼40.5), 무릎 21.4% (95% 신뢰구간 15.7∼27.0), 목 20.9% (95% 신뢰구간 15.3∼26.5) 부위 순이었다. 통계적으로 유의한 위험 인자로는 간병 경력, 통증으로 인해 일을 쉰 적이 있는지 유무, 환자 처치 업무 중 체위 변경, 침대에서 휠체어로 환자 이동 및 환자 씻기기였다. 결론: 외부 간병인에서 나타나는 근골격계 통증 유병률은 비교적 높은 편으로 확인되었다. 어깨, 허리, 손 또는 손목 등을 포함하여 여러 신체 부위에 걸쳐 통증을 호소하는 빈도수가 높았으며, 대상자의 특성 및 간병 업무에 따라서도 영향을 받을 수 있음을 확인할 수 있었다. Background: To investigate the prevalence of musculoskeletal pain in several parts of the body and how these complaints vary with demographic characteristics, other risk factors in Korea’s caregivers. Methods: Self-reported questionnaires were given to each candidate and two hundreds six women caregivers were enrolled. Questionnaires included questions on location, severity of pain during the previous 3 months, aggravating factors, general characteristics of caregivers and patient's functional status. Results: All participants were female (100%) with an average age 56.3 years (SD 5.3). The prevalence (previous 3 months) of musculoskeletal pain was 85.9% (95% confidence interval [CI] 81.1∼90.7%). The most commonly affected region was the shoulder (55.8%), followed by the lower back (49.5%), wrist or hand (34.0%), knee (21.4%) and neck (20.9%). The statistical significant related factors were working experience, off work due to pain, changing a patient's position, transfering the patient from bed to wheelchair and bathing the patients. Conclusion: The prevalence of musculoskeletal pain in non-standard employed caregivers is high. Not only the shoulder and lower back but also several other regions of the body are frequently affected. The musculoskeletal pain was influenced by demographic factors and daily working tasks.

Epidermal Growth Factor Receptor Mutations and the Clinical Outcome in Male Smokers with Squamous Cell Carcinoma of Lung

박세훈,하승연,이재익,박진희,조은경,신동복,이재훈,이혜원,심호용,김영생,홍준식,홍준식 대한의학회 2009 Journal of Korean medical science Vol.24 No.3

Epidermal growth factor receptor (EGFR) mutations in non-small cell lung cancer (NSCLC) have been reported to be related to certain clinical characteristics (i.e., female, non-smokers with adenocarcinoma) and gefitinib responsiveness. This exploratory analysis was performed to determine the incidence of EGFR mutations in male smokers with squamous cell carcinoma, who were treated with EGFR tyrosine kinase inhibitor, gefitinib. Sixty-nine Korean NSCLC patients were treated with gefitinib in a prospective study. For a subset of 20 male patients with squamous cell carcinoma and a history of smoking, pretreatment tumor tissue samples were obtained and analyzed for EGFR mutations (exons 18 to 21). EGFR mutations were found in 3 (15%) patients, including in-frame deletions within exon 19 (n=2) and L858R missence mutation in exon 21 (n=1). These 3 patients with EGFR mutations responded to gefitinib, whereas only one of remaining 17 patients with wild-type EGFR achieved clinical response. Trend toward longer progression-free (5.8 vs. 2.4 months; P=0.07) was noted in patients with EGFR mutations compared to those with wild-type EGFR. Although male smokers with squamous cell carcinoma have not been considered ideal candidates for gefitinib treatment, significant incidence of EGFR mutations was observed. The molecular markers should be considered to predict clinical benefits from gefitinib.