당뇨황반부종에서 유리체내 베바시주맙 및 후테논낭하 스테로이드 주입술 병합요법의 효과

김훈동,최경식,이성진 대한안과학회 2009 대한안과학회지 Vol.50 No.11

목적: 당뇨황반부종에서 유리체내 베바시주맙과 후테논낭하 트리암시놀론 주입술의 병합요법을 각각의 단독요법과 비교하였다. 대상과 방법: 당뇨황반부종이 있는 83명, 90안을 대상으로 각 30안씩 무작위로 유리체내 베바시주맙 주입술 (IVB 군), 후테논낭하 트리 암시놀론 주입술(STTA 군) 및 병합요법(combined 군)을 시행하였고, 술 전 및 술 후 1, 3, 6개월의 시력, 중심황반두께 및 안압의 변화를 비교하였다. 결과: 세 군 모두 중심황반두께의 감소가 술 후 3개월까지 유지되다가 6개월째에 다시 증가하였고, 시력 호전은 술 후 3개월까지 유지되 다가 6개월 후에 다시 감소하는 양상을 보였다. 술 후 초기 1개월간 중심황반두께의 감소량 및 시력 호전량은 병합요법에서 가장 크게 나타 났다(p=0.003, p=0.021). 관찰 기간 중 안내염, 망막박리 등의 심각한 합병증은 관찰되지 않았고, 총 3안에서 안압 상승이 관찰되었다. 결론: 당뇨황반부종에서 유리체강내 베바시주맙과 테논낭하 트리암시놀론 주입술의 병합요법은 각각의 단독요법에 비하여 시력 호전과 중심황반두께 감소에 있어 초기 1개월에 높은 치료 효과를 보였으며, 3개월 이후에는 비슷하였다. Purpose: To investigate the outcomes of the combined therapy of intravitreal bevacizumab (IVB) and posterior sutbtenon triamconolone acetonide (STTA) injections as compared to single injections of each in patients with diabetic macular edema (DME). Methods: IVB injection (IVB group), STTA injection (STTA group) and combined therapy injection (combined group) were performed randomly for 90 eyes (83 patients) diagnosed with DME. Changes in central macular thickness (CMT), best corrected visual acuity (BCVA) and intraocular pressure (IOP) were compared among groups prospectively at pre-injection and one, three and six months after injection. Results: Reduction of CMT and improvement of BCVA were maintained for three months after treatment in all groups, but CMT and BCVA deteriorated at six months after treatment. The combined therapy group revealed significant reductions in CMT and improvement of BCVA (p=0.003, p=0.021, respectively) for the first month compared to the single treatment group. Elevated IOPs were found in three cases and there was no endophthalmitis or retinal detachment. Conclusions: The combined therapy injection showed significant early improvements in CMT and BCVA for one month. Additionally, the combined therapy revealed similar outcomes as compared with each single treatment after three months.

전문 음성사용인들의 성대결절에 있어 성대 내 스테로이드 주입술 이후 음성치료의 유용성

이정엽,이재혁,최정임,이상혁,진성민 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.1

Background and Objectives A local steroid injected directly into the vocal nodules has recently come to the forefront as another treatment option, which is reported as useful and effective. However, vocal nodules are caused mainly by excessive voice use, and therefore, even if a marked improvement was shown after injection, recurrence can occur unless the voice abuse habit is changed. We hypothesized that voice therapy after steroid injection would reduce recurrence of vocal nodules in professional voice users. Subjects and Method This prospective study included thirty female professional voice users with vocal nodules treated with vocal cord steroid injection on between May 2010 and March 2011. The experimental group (n=15) received the voice therapy after vocal cord steroid injection, and the control group (n=15) received only vocal cord steroid injection. Videostroboscopy, acoustic voice analysis, and Voice Handicap Index (VHI) were evaluated prior to the steroid injection and 4 and 8 weeks after steroid injection. Results Jitter, shimmer, noise-to-harmonics ratio, and mean VHI improved significantly after steroid injection in both group (p<0.05). There was no significant complication and voice discomfort after steroid injection in both groups. And, there were no significant differences in all parameters between the two groups. However, the experimental group (13.3%) showed less recurrence rate of vocal nodules than the control group (53.3%) after 8 weeks. Conclusion Vocal cord steroid injection was useful treatment option of vocal nodules in professional voice users. And voice therapy after steroid injection would be effective in preventing a recurrence of vocal nodules than only steroid injection. Korean J Otorhinolaryngol-Head Neck Surg 2014;57:32-7

일측성 성대마비 환자에 대한 치료방법 비교

이창윤(Chang Yoon Lee),손희영(Hee Young Son),권순복(Sun Bok Kwon) 한국언어치료학회 2016 한국언어치료학회 학술발표대회 논문집 Vol.2016 No.12

Purpose: The purpose of this study was to analysis the effects of two treatment methods on patients with unilateral vocal fold paralysis by voice therapy and injection laryngoplasty. Methods: Twenty patients were treated injection laryngoplasy and 23 patients were treated voice therapy. results were evaluated by acoustic analysis, electro glotto graphy(EGG), cepstrum analysis before and after therapy. The therapy was conducted by improving the larynx movement and glottal contact, whilst removing hypertension of the supraglottic and use the breathing. Results: Significant improvement was found in the acoustic parameter, cepstrum parameter, and EGG before and after treatment in both groups. There was no significant difference between the two groups when compared before and after treatment to compare the effects of injection laryngoplasty and voice therapy. Conclusions: The initial treatments for unilateral vocal cord paralysis are injection laryngoplasty and voice therapy. Injection laryngoplasty is commonly used in clinical settings, and studies on the effects of voice therapy on patients with vocal fold paralysis are lacking. In particular, the voice therapy method used in this study was to apply the holistic voice therapy method to increase the mobility of the vocal cords while simultaneously eliminating secondary compensation due to vocal fold paralysis and to use breathing together. The results of this study suggest that voice therapy in addition to Injection laryngoplasty at the initial stage is a very useful method to improve voice quality of vocal fold paralysis and improve laryngeal function.

중증 부갑상선 기능항진중에서 부갑상선 결절내 Calcitriol 직접 주입술 및 충격요법 병용치료의 장기간 연구결과

신석균(S. K. Shin),황재하(J. H. Hwang),송현용(H. Y. Song),노현진(H. J. Noh),최규헌(K. H. Choi),임승길(S. G. Lim),이호영(H. Y. Lee) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Severe hyperparathyroidism(i-PTH>1,000pg/ml, dia-meter of nodules>1.0cm, and hypercalcemia) in dialysis patients may be resistant to conventional calcitriol- pulse therapy. To assess the usefulness of direct calcitriol injections in restoring the responsiveness to calcitriol, we performed a prospective study in 23 dialysis patients(mean age 42.3 years, M: F 0.9: 1, CGN 14, hypertension 4, lupus nephritis 2 & others 3, mean duration of dialysis 9.5 years, HD: CAPD 9: 14) who had severe hyperparathyroidism resistant to calcitriol pulse therapy for more than 2 months and had no ectopic gland in Sestamibi parathyroid scan. We three repeatedly injected calcitriol of dose(μg) equal to 3-D nodule volume(cm(3)) under U.S.(Acuson Computa Sono, California, USA, 7MHz probe) for 1 week and concurrently began calcitriol-pulse therapy(0.75-1.0μg/day, t.i.w.) after 3rd injection. All patients were followed up by serum i-FI H(Allegro Intact FPH kits, Nichols Ins.), calcium, phosphate, and U.S. after 7 days, 1 month, 6 months, and 1 year of 3rd calcitriol injection. These combination therapy could significantly decrease i-PTH level and gland volume in patients with resistant secondary hyperparathyroidism on conventional calcitriol therapy and the response were main-tained for one year after start of these therapy. The complete response group was the patients with lower baseline i-FFH levels compared to those with partial and non-response(1001.7±150.2 vs. 1521.8±328.3, 1569.2 ±344.3pg/ml, p<0.05, respectively). The patients with baseline i-PTH of less than l,200pg/ml or gland volume of less than 1.5cm were well responded to the three consecutive direct calcitriol injection and pulse combination therapy(i-PTH; PPV 77.8%, NPV 92.8%, gland volume', PPV 87.5%, NPU 93.3%). No severe adverse effect was observed during this study. In conclusion, direct calcitriol injections into the parathyroid nodules and pulse combination therapy could be useful in secondary resistant hyperparathyroidism patients with conventional calcitriol therapy especially in those with i-PTH of less than 1,200pg/ml or gland volume of less than 1.5cm. However, sugical management may be indicated in patients with higher i-PTEI levels or larger gland volume than these.

Perspective on Intra-articular Injection Cell Therapy for Osteoarthritis Treatment

Gun-Il Im 한국조직공학과 재생의학회 2019 조직공학과 재생의학 Vol.16 No.4

BACKGROUND: Osteoarthritis (OA), the most common arthritis, is one of the most frequently encountered orthopaedic conditions. As a small number of large joints such as knee and hip are affected in OA, OA is an ideal target for local therapy. Although corticosteroid and hyaluronic acid have been traditionally used for joints through intra-articular (IA) injection, IA injection also provides a minimally invasive route to apply cell therapy to treat OA. IA cell therapy has drawn attention because it may provide regeneration of articular cartilage in addition to palliative anti-inflammatory effects. METHODS: Current progress of IA injection therapy and the author’s perspective on this issue are described narratively. RESULTS: It is too premature to have any conclusion on the eventual efficacy of IA cell therapy concerning regeneration of articular cartilage based on current data. Prospective radiological and histological data from larger numbers of patients are needed to prove cost effectiveness of IA cell therapy. CONCLUSIONS: Expanding research in this field will produce further evidences to provide guidance on the eventual effectiveness of IA cell therapy in the future.

Comparison of Extracorporeal Shock Wave Therapy Versus Injection Therapy for Shoulder Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Dajeong Kim,Hyunjoong Kim 물리치료재활과학회 2023 Physical therapy rehabilitation science Vol.12 No.1

Objective: The purpose of this study is to compare the effects of extracorporeal shock wave therapy (ESWT) and injection therapy through qualitative and quantitative analysis by synthesizing randomized controlled trials (RCTs) conducted on patients with various shoulder diseases. Design: A systematic review and meta-analysis of randomized controlled trialsMethods: This review conducted a literature search through international electronic databases in January 2023 to compare the effects of ESWT and injection therapy. Qualitative analysis was performed as a risk of bias tool, and quantitative analysis was synthesized with a random effect model to show the effect size as a standardized mean difference (SMD). Results: Five RCTs involving 298 individuals with shoulder disorders were included in this systematic review and meta-analysis. ESWT showed a moderate effect on pain (SMD=-0.44; 95% CI, -0.95 to 0.06) and a large effect on shoulder function (SMD =-0.81; 95% CI, -1.70 to 0.07) than injection therapy. A significant difference was found in the shoulder range of motion, showing a large effect size (SMD=1.50; 95% CI, 0.58 to 2.43). Conclusions: When considering treatment options for the management of patients complaining of shoulder disorders, it is appropriate to recommend ESWT first rather than injection therapy to increase the range of motion of the joint. In addition, ESWT is safe for pain control and shoulder function improvement, and a positive prognosis could be expected.

맥락막신생혈관을 동반한 광범위한 망막하출혈환자에 대한 삼중치료 효과

유은석,이동원,Eun Seok Yoo,Dong Won Lee 대한안과학회 2011 대한안과학회지 Vol.52 No.4

Purpose: To presents the effect of triple therapy including C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy on patients with subretinal hemorrhage accompanied by choroidal neovascularization. Methods: Twelve eyes of 12 patients suffering from subretinal hemorrhage accompanied by choroidal neovascularization with onset of the symptom within a week prior to three-day prone positioning after C3F8 gas injection were included in the present study. Next, intravitreal anti-VEGF injection and photodynamic therapy was performed. Then, within two months, intravitreal bevacizumab or ranibizumab injection was performed. Results: After stabilization of the submacular hemorrhagic lesion, ten eyes of ten patients showed improved visual acuity, one eye showed no improvement, and decreased visual acuity developed in one patient. LogMAR visual acuity improved after the initial treatment from 1.05 ± 0.43 to 0.74 ± 0.58 and 0.53 ± 0.51 at three and six months, respectively. The improvement was considered to be clinically significant. Conclusions: An appropriate regimen for treating broad submacular hemorrhage accompanied by choroidal neovascularization has not been established. The authors of the patients had obtained positive results from C3F8 gas injection, intravitreal anti-VEGF injection and photodynamic therapy. In the future, additional studies should be conducted. J Korean Ophthalmol Soc 2011;52(4):442-447

만성 중심장액맥락망막병증에서 절반에너지 광역학치료와 베바시주맙 주입술의 12개월간 치료효과 비교

김영승,이영훈,김형석,진선영,이태곤 대한안과학회 2013 대한안과학회지 Vol.54 No.10

Purpose: In this study we compared the effectiveness between half energy photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) injection for chronic central serous chorioretinopathy (CSC). Methods: Forty-five eyes of 42 patients diagnosed as chronic CSC from March 2008 to April 2011 were treated with half energy PDT or IVB injection. The subjects were chosen for a retrospective study and analysis was performed on changes in best corrected visual acuity and existence of subretinal fluid, recurrence rate and changes in central macular thickness. Results: Similar improvement of visual acuity was observed in both treatment groups 1 month after treatment and no meaningful difference was found in each stage for both groups (p = 0.001, p = 0.0012, respectively). However, 6 to 12 months after the treatment, the half energy PDT group showed more improvement in visual acuity compared to the IVB injection group (p = 0.019, p = 0.043, respectively). Nineteen out of 21 cases showed full recovery of subretinal fluid in the half energy PDT group with an average treatment period of 1.3 ± 0.8 months and 7 out of 24 cases showed full recovery in the IVB injection group with an average treatment period of 3.2 ± 2.8 months. There was a single case of recurrence in the half energy PDT group and 4 in the IVB injection group. The half energy PDT group showed a meaningful decline in central macular thickness at 1, 3, and 6 months after treatment (p = 0.001, p = 0.005, p = 0.007, respectively) compared to the IVB injection group and showed numerous cases with decline in central macular thickness below the 2 standard deviation from normal values (p = 0.002). Conclusions: Both half energy PDT and IVB injection were effective for the treatment of chronic central serous chorioretinopathy. However, the half energy PDT group comparatively showed better anatomical and functional outcomes. The thinning of central macular thickness below normal value was also observed, thus careful choice of treatment is necessary for patients with chronic central serous chorioretinopathy.

이상근 증후군 : 증례 보고와 문헌고찰

신규만,조도상,김명현 이화여자대학교 의과학연구소 2008 EMJ (Ewha medical journal) Vol.31 No.1

Objectives : The piriformis syndrome appears to be more common because it is often underdiagnosed and undertreated. This syndrome is caused by compression or irritation of the sciatic nerve by the piriformis muscle as it passes through the sciatic notch. This entrapment neuropathy presents as pain, numbness, paresthesias, and associated weakness in the distribution of the sciatic nerve. In this article. we present the clinical symptoms, anatomy of the piriformis muscle, and the technique and result of the injection therapy with local anesthetics and steroid Materials and Methods : A 72-year-old woman presented with 7 days history of severe pain in the right buttock, hip, numbness of the right thigh. Previous management had included non-steroidal anti-inflammatory drug and physical therapy in local orthopedic clinic. Her past medical history was unremarkable. Her right side buttock was tender and discomfort was increased by right hip flexion, adduction and internal rotation with pain radiating to the anterior thigh. The her leg lenghts were equal, the strenght of right hip abductors and abduction was normal. Also low back range of motion and neurological examination were normal. Radiographs of the lumbosacral spine, pelvis and the hip joint were unremarkable. The she didn't respond to conservative treatment including physcal theraphy combined with the use antiimflammatory drugs, analgesics and muscle relaxants. Results : One week later she received an injection of0.5% mepibacaine HCI 8㏄ and methylpredanisolone(Depomedrol) 40㎎ into the medal right piriformis muscle. She reported that the 3 days after the injection, her right buttock pain had resolved and 7 days after the injection the pain resolved completely and she resumed normal activities and continued pain free. Conclusion : We reviewed the literature on piriformis syndrome and its signs, symptoms and treat-ments. In an isolated piriforms syndrome, the major finding include buttock tenderness from the sacrum to the greater trochanter, piriformis tenderness on rectal or vaginal examination. The patient with piriformis syndrome usually does not have neurologic deficits Through complete history, physical and neurologic examinations, the other causes of low back pain and sciatica should be eliminated. Patients who do not respond to conservative therapy are candidates for local anesthetics and steroid injection. We injected methyl prednisolone 40mg and 0.5% mepibacaine HCl 8cc into the medial right piriformis muscle. 3 days after injection, her pains of right buttock and trochanter had resolved and 7 days after the injection, she resumed normal activites and consumed free. In order to improve the reliability of proper needle placement and allow for definite and treatment, EMG-assisted or MRI guidance may utilize.

Comparison of Extracorporeal Shock Wave Therapy and Ultrasound-Guided Shoulder Injection Therapy in Patients with Supraspinatus Tendinitis

Ho Won Lee,Jung Youn Kim,Changwon Park,Bai Haotian,Geun Woo Lee,Kyu-Cheol Noh 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.4

Background: The present study compared the clinical effect of extracorporeal shock wave therapy (ESWT) with that of ultrasound (US)-guided shoulder steroid injection therapy in patients with supraspinatus tendinitis. We hypothesized that the two treatments would show comparable results. Methods: The inclusion criteria were age over 20 years and diagnosis of supraspinatus tendinitis using US. Ultimately, 26 patients were assigned using blocked randomization: 13 in the US-guided shoulder injection group and 13 in the ESWT group. Treatment outcomes were evaluated using the pain visual analog scale (pVAS), the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 1 and 3 months after the procedure. Results: At 1 month after the intervention, pVAS, ASES, and constant score were significantly higher in the US-guided shoulder injection group than in the ESWT group, but not at 3 months after the intervention. Both groups showed clinically significant treatment effects at 3 months after the intervention compared to baseline. No significance was shown using equivalence testing. Conclusions: US-guided shoulder injection therapy was not superior to ESWT therapy. Considering the complications and rebound phenomenon of steroid injections, interventions using ESWT may be a good alternative to treat patients with supraspinatus tendinitis.