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Usefulness of Permanent Tracheostoma in Chronic Brain Injured Patients: A Case Series
원유희,배하석,전서영,김한수 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6
Patients with severe neurological deficit, such as hypoxic ischemic injury, cerebral infarction, and traumatic brain injury, often show comatose mental status and requiremaintenance of long-term tracheostomy for pulmonary toileting. However, several complications, which are mostly related to the cannula, invariably occur. Permanent tracheostoma is a short, skin-lined, noncollapsing, self-sustaining openingby suturing the denuded skin lining to the margin of the tracheal stoma. This tube-free method is a useful alternative to make long-term airway without tube-relatedcomplications in chronic diseases, such as obstructive sleep apnea, and laryngealcancer, however, it has not yet been reported in chronic brain injured patients. This case report illustrates 3 cases of vegetative patients in our rehabilitation clinic who underwent successful procedure of permanent tracheostoma. Permanent tracheostomahas some benefits associated with the free of tube-related complications,and can be considered as a useful alternative way for chronic brain injured patients with long-term tracheostomy.
폐쇄성 두부손상 후 발생한 간접 외상성 시각신경병증으로 인한 완전실명 - 증례 보고 -
원유희,김용욱 대한근전도전기진단의학회 2010 대한근전도 전기진단의학회지 Vol.12 No.2
Indirect traumatic optic neuropathy is defined as trauma-induced visual loss that occurs without external or internal ophthalmologic evidence of injury to the eyes or its nerve and it occurs 0.5-5 % after closed head injury. We report a case of a 43-year-old man with bilateral complete visual loss following closed head injury. On initial examination, he can not count finger and see objects clearly with minimal perception of the light. The orbito-facial computed tomography reveals bilateral optic nerve atrophies without evidence of direct trauma to the optic nerve. We perform visual evoked potential with flash stimulation and its result shows no response on both eyes. Further ophthalmologic evaluation discloses bilateral optic disc pallors induced by optic neuropathy. We present a case of indirect traumatic optic neuropathy folllowing closed head injury based on the clinical, radiological, ophthalmological and electrophysiologic findings with reviewing of some literatures.
유희재,김선일,김세중,원일,조대성 대한비뇨기종양학회 2023 대한비뇨기종양학회지 Vol.21 No.1
Purpose: The aim of this study was to evaluate the impact of body mass index (BMI) on survival in patients with nonmetastatic renal cell carcinoma (RCC) treated with radical or partial nephrectomy. Materials and Methods: Between June 1994 and December 2021, 482 patients with RCC underwent radical or partial nephrectomy. Among those patients, 21 patients with lymph node or distant metastasis were excluded. The medical records of the remaining 461 patients were retrospectively reviewed. The prognostic significance of various clinicopathological variables, including BMI, was evaluated in univariate and multivariate analyses. Results: Of the total 461 patients, 171 (37.1%) were categorized as normal-weight, 118 (25.6%) as overweight, and 172 (37.3%) as obese. Forty-eight patients (10.4%) developed local recurrence or distant metastasis, and 26 patients (5.6%) died from the disease during the follow-up period. In the multivariate analysis, BMI (p=0.017), tumor size (p<0.001), T stage (p<0.001), Fuhrman nuclear grade (p=0.016), and lymphovascular invasion (p=0.012) were independent predictors of recurrence-free survival. Furthermore, BMI (p=0.025), tumor size (p<0.001), T stage (p<0.001), Fuhrman nuclear grade (p=0.047), and lymphovascular invasion (p=0.033) were independent predictors of cancer-specific survival. Conclusions: Our results suggest that overweight and obese patients with nonmetastatic RCC treated with radical or partial nephrectomy have a more favorable prognosis. These findings indicate that BMI could be an important factor for predicting recurrence or survival in patients undergoing nephrectomy for nonmetastatic RCC.
유방암 환자에서 액와 림프절 제거술 후 발생한 내측전완피부신경 손상: 증례보고
김다솔,원유희 대한근전도전기진단의학회 2019 대한근전도 전기진단의학회지 Vol.21 No.2
Various complications of breast cancer surgery and axillary dissection have been reported, of which arm pain and sensory abnormality was reported mainly due to intercostobrachial nerve injury. We have experienced a rare case of medial forearm pain and numbness due to medial antebrachial cutaneous nerve (MACN) injury after axillary dissection. A 49-year old woman was consulted to department of physical medicine and rehabilitation for pain and numbness at medial side of left forearm after wide local excision of left breast cancer and axillary lymph node dissection. Sensory examination showed paresthesia and hypesthesia of left medial forearm although manual muscle test of left upper extremity was relatively normal. On sensory nerve conduction studies, the amplitude of left MACN decreased to 30% of right side. The motor nerve conduction studies and needle electromyography showed no abnormal findings. The patient was diagnosed with left MACN injury, and treated with medication and physical therapy.
이형남,원유희 대한근전도전기진단의학회 2018 대한근전도 전기진단의학회지 Vol.20 No.2
Myotonic dystrophy type 1 (DM1) is an autosomal dominant multisystem disorder and one of the most common muscular dystrophies affecting adults. Charcot-Marie-Tooth (CMT) disease, a common hereditary neuropathy, is characterized by atrophy of the distal limbs and peripheral nerve abnormalities. The authors report a rare case involving a 24-yearold female who was diagnosed simultaneously with both DM1 and CMT1A based on the results of a nerve conduction study (NCS). The patient, who had previously been diagnosed with DM1, was admitted for lower extremity pain. Her electrodiagnostic examination continued to reveal severe sensorimotor demyelinating polyneuropathy, and a genetic study was performed to confirm whether she had other hereditary neuropathies, except DM1, that suggested CMT1A, the most common phenotype of CMT. Severe abnormalities in an NCS in a DM1 patient may suggest the incidental coexistence of hereditary neuropathies, and further evaluations, such as genetic studies, should be performed for proper diagnosis.
이장우,원유희,최원아,이순규,강성웅 대한재활의학회 2013 Annals of Rehabilitation Medicine Vol.37 No.6
Low vital capacity is a risk factor for scoliosis correction operation in Duchenne muscular dystrophy (DMD) patients, but pulmonary rehabilitation, including noninvasive intermittent positive pressure ventilator application, air stacking exercise, and assisted coughing technique, reduces the pulmonary complications and perioperative mortality risk. In this case, the patient’s preoperative forced vital capacity (FVC) was 8.6% of normal predicted value in sitting position and 9.4% in supine position. He started pulmonary rehabilitation before the operation and continued right after the operation. Scoliosis correction operation was successful without any pulmonary complications, and his discomfort in sitting position was improved. If pulmonary rehabilitative support is provided properly, FVC below 10% of normal predicted value is not a contraindication of scoliosis correction operation in DMD patients.
Complication of Chronic Lymphedema in an Elderly Achondroplasia Patient: A Case Report
윤주열,원유희 대한노인재활의학회 2022 Geriatric rehabilitation Vol.12 No.1
Chronic lymphedema can cause severe complications such as infection, pain, disability, and secondary malignancy. We introduce a case of neglected chronic lymphedema in an elderly achondroplasia patient. The patient visited the hospital for lymphedema and skin lesion suspected of malignancy, which had been neglected for more than 8 years after breast cancer treatment. The patient quickly confirmed chronic inflammation after biopsy of the suspected malignancy site. After that, taking into account the patient's underlying medical condition and social and economic status, a modified protocol of complete decongestion treatment (homebased) was established as a sustainable therapeutic strategy. Caregivers were educated to ensure proper home treatment, and thus, patient visits to institutions were minimized. At the same time, complete decongestion treatment was simplified to reduce the burden on caregivers and patient to ensure sustainable and appropriate treatment. As a result, successful lymphedema treatment was achieved without treatment abandonment.
Unilateral Phrenic Nerve Palsy Following Blunt Chest Trauma: A Case Report
노충희,원유희 대한근전도전기진단의학회 2021 대한근전도 전기진단의학회지 Vol.23 No.3
Phrenic nerve (PN) injury without a direct injury is unusual and difficult to diagnose. This case report is the first to describe the diagnosis of unilateral PN palsy following blunt chest trauma by fluoroscopic diaphragmatic movement testing (FDT) and electrodiagnostic testing. A 68-yearold man was admitted to the emergency department after a motorcycle accident. Chest radiography showed an elevated right hemidiaphragm. More than 7 months later, he experienced dyspnea on exertion and orthopnea, prompting him to visit the Department of Physical Medicine and Rehabilitation. FDT showed no movement in the right diaphragm during maximum inspiration and expiration, but the left diaphragm was intact. Electrodiagnostic testing showed absent compound motor action potential (CMAP) in the right diaphragm, but normal CMAP in the left diaphragm. We hypothesize that in patients with orthopnea symptoms after blunt chest trauma, electrodiagnostic testing paired with FDT may be useful for diagnosing diaphragm palsy.