뇌하수체 선종내 출혈의 임상분석

이봉훈,김오룡,김성호,배장호,최병연,조수호 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.5

구조화된 평가척도와 신경심리검사를 이용한 외상성 뇌 손상 환자의 주관적 증상 연구

이종범,김오룡,김진성,서완석,배대석 대한생물치료정신의학회 2003 생물치료정신의학 Vol.9 No.2

본 연구에서는 외상성 뇌 손상 환자의 주관적인 증상의 특성을 알아보기 위하여 그 주관적인 증상의 정도와 관련한 인구동태학적 요인, 뇌 손상의 특성, 신경심리학적 평가결과 및 MMPI 성적을 비교한 뒤 주관적인 정신증상의 정도와 추정된 장애정도와의 일치정도에 따른 특성을 알아보고자 하였다. 1999년 3월 1일부터 2003년 8월 31까지 두부외상 후 정신과적인 증상을 나타내어 진료를 받았거나 자문이 의뢰된 경우 및 후유장애 평가를 위해 내원한 환자 498명 중 배제기준에 해당하지 않는 18세 이상 성인 281명에게 SCL-90-R, K-WAIS, K-MAS, K-BNT 및 MMPI를 실시하였다. 주관적 정신과적 증상 정도에 따른 특성을 알아보기 위해 연구대상자는 SCL-90-R의 표출증상의 문항당 평균점수를 바탕으로 주관적인 정신과적 증상이 경미한 집단(minimal distress group), 경한 집단(mild distress group), 증등도 집단(moderate distress group), 심한 집단(severe distress group)으로 구분하고, SCL-90-R을 수행하지 못한 집단을 불능집단(failed group)으로 구분하여 그 성적을 비교하였다. 그리고 SCL-90-R을 비롯한 신경심리검사 및 MMPI를 온전히 수행한 180명을 대상으로 주관적 증상의 정도와 추정된 장애 정도를 비교하여 주관적 증상의 정도와 추정된 장애정도가 일치하는 집단(no difference group), 주관적 증상의 정도에 비해 추정된 장애정도가 심한 집단(faking good group) 그리고 주관적 증상의 정도에 비해 추정된 장애정도가 약한 집단(faking bad group)으로 구분하여 성적을 비교하였다. 첫 번째, 주관적 증상의 정도에 따라 SCL-90-R의 성적을 비교한 결과에서, 주관적 증상의 정도에 따라 SCL-90-R의 하위척도 및 전체지표에서 유의한 차이(p<.001)가 있음이 확인되었다. 주관적 증상과 추정된 손상정도의 일치정도에 따른 구분에서도 각 집단 간에 하위척도 및 전체지표에서 유의한 차이(p<.001)가 있었지만 공포불안 척도의 점수가 다른 척도 점수에 비해 높은 프로파일 형태를 보이고 있었다. 두 번째, 주관적인 증상의 정도에 따라 신경심리검사 성적을 비교한 결과에서, 지능의 경우 주관적인 증상이 심할수록 사고 후 지능수준이 낮은 것으로 나타났으며, 주관적 증상을 과소평가한 집단은 차이가 없는 집단과 동일하거나 더 나은 지적능력을 유지하고 있는 것으로도 나타났다. 세 번째, 주관적인 증상정도에 따른 기억능력을 비교한 결과 주관적 증상이 심할수록 기억능력이 저하되어 있는 것으로 나타났지만, 주관적인 증상을 과소평가한 집단의 수행이 다른 집단에 비해 우수한 것으로 나타났으며, 한국판 이름대기 검사에서도 이와 동일한 수행성적을 보이고 있었다. 네 번째, MMPI에서는 주관적 증상의 정도 혹은 추정된 손상의 일치정도와는 상관없이 주관적 증상을 경미하게 호소하고 있는 집단을 제외하고는 외상성 뇌 손상 환자들이 기본적인 신경증적인 증상을 경험하고 있었으며, 주관적 증상의 정도가 심할수록 정신병적 증상들을 주로 호소하고 있었다. 본 연구에서는 외상성 뇌 손상의 주관적 증상이 심하던 그렇지 않던 혹은 추정된 손상정도의 일치여부와는 상관없이 이들이 신경증적인 증상을 공통적으로 경험하고 있음이 확인되었으며, 증상의 과대호소를 위하여 주로 정신증적 증상을 사용하고 있었다. 그리고 외상성 뇌손상이 있은 뒤 인지적 기능수준이 나을수록 자신의 정신과적 증상을 과소평가할 수 있음을 확인할 수 있었다. Objectives : To search for the character of subjective symptom among traumatic brain injury patient, we tried to investigate the level of subjective symptoms and the character of the discrepancy between subjective symptoms and suggested disability. The factors such as demographic factors, characteristics of head trauma, the score of neuropsychological test and MMPI were compared for those subjective symptoms. Methods : SCL-90-R, K-WAIS, K-MAS, K-BNT and MMPI was conducted for 281 patients who are suitable for this study with age over 18, out of 498 patients who visited hospital for their psychiatric symptoms after traumatic brain injury or disability evaluation after requesting consult from Mar 1, 1999 to Aug 31, 2003. Subjects were categorized based on the positive symptom total in SCL-90-R as four groups such as minimal distress group to observe character depending on the subjective symptoms level. Mild distress group, moderate distress group, and severe distress group and compared with failed group which couldn't perform SCL-90-R. And 180 patients of all of tests conducted, were divided to the three groups such as no difference group, faking good group, and faking bad group by comparing the level of subjective symptoms to suggested disability and assessed its results. Results : In the result of SCL-90-R depending on the subjective symptom level, there was significant difference (p<.001) in subscale and global index of SCL-90-R. There was also significant difference(p<.001) in the division depending on the discrepancy between subjective symptoms and suggested disability on subscale and global index in each group. However, the score in phobic anxiety scale was high other than subscale score. The result of neuropsychological test depending on the level of subjective symptoms represented more severe in subjective symptoms and lower in intelligence after traumatic brain injury. But, even or better intellectual capability was possessed in faking good group by comparing to no difference group. Memory ability is reduced as subjective symptoms severe and faking good group was superior in its performance. The same result was shown in K-BNT. Regardless of the level of subjective symptoms or discrepancy of the subjective symptoms between suggested disability, traumatic, brain injury patients(except the group appealed minimal distress) experienced basic neurotic symptoms and they appealed psychotic symptoms as the level of subjective symptoms is severe in MMPI. Conclusion : In this research, All the patient commonly have experienced neurotic symptom weather the symptom of traumatic brain injury patients is severe or not. Psychotic symptoms was mainly used for the faking bad of symptom and proved that they underestimated their psychiatric symptoms with better cognitive function level after traumatic brain injury.

비정형 수막종에서 AgNORs와 MIB-1 표지지수의 진단적 의의

서대홍,김동석,김오룡 대한병리학회 1998 Journal of Pathology and Translational Medicine Vol.32 No.11

Neurocognitive Function Differentiation from the Effect of Psychopathologic Symptoms in the Disability Evaluation of Patients with Mild Traumatic Brain Injury

Kim, Jin-Sung,Kim, Oh-Lyong,Koo, Bon-Hoon,Kim, Min-Su,Kim, Soon-Sub,Cheon, Eun-Jin The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.5

Objective : We determined whether the relationship between the neuropsychological performance of patients with mild traumatic brain injury (TBI) and their psychopathological characteristics measured by disability evaluation are interrelated. In addition, we assessed which psychopathological variable was most influential on neuropsychological performance via statistical clustering of the same characteristics of mild TBI. Methods : A total of 219 disability evaluation participants with mild brain injury were selected. All participants were classified into three groups, based on their psychopathological characteristics, via a two-step cluster analysis using validity and clinical scales from the Minnesota Multiphasic Personality Inventory (MMPI) and Symptom Checklist-90-revised (SCL-90-R). The Korean Wechsler Adult Intelligence Scale (K-WAIS), Korean Memory Assessment Scale (K-MAS) and the Korean Boston Naming Test (K-BNT) were used to evaluate the neurocognitive functions of mild TBI patients. Results : Over a quarter (26.9%) experienced severe psychopathological symptoms and 43.4% experienced mild or moderate psychopathological symptoms, and all of the mild TBI patients showed a significant relationship between neurocognitive functions and subjective and/or objective psychopathic symptoms, but the degree of this relationship was moderate. Variances of neurocognitive function were explained by neurotic and psychotic symptoms, but the role of these factors were different to each other and participants did not show intelligence and other cognitive domain decrement except for global memory abilities compared to the non-psychopathology group. Conclusion : Certain patients with mild TBI showed psychopathological symptoms, but these were not directly related to cognitive decrement. Psychopathology and cognitive decrement are discrete aspects in patients with mild TBI. Furthermore, the neurotic symptoms of mild TBI patients made positive complements to decrements or impairments of neurocognitive functions, but the psychotic symptoms had a negative effect on neurocognitive functions.

Peritumoral Brain Edema in Meningiomas: Correlation of Radiologic and Pathologic Features

Kim, Byung-Won,Kim, Min-Su,Kim, Sang-Woo,Chang, Chul-Hoon,Kim, Oh-Lyong The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.49 No.1

Objective: The primary objective of this study was to perform a retrospective evaluation of the radiological and pathological features influencing the formation of peritumoral brain edema (PTBE) in meningiomas. Methods: The magnetic resonance imaging (MRI) and pathology data for 86 patients with meningiomas, who underwent surgery at our institution between September 2003 and March 2009, were examined. We evaluated predictive factors related to peritumoral edema including gender, tumor volume, shape of tumor margin, presence of arachnoid plane, the signal intensity (SI) of the tumor in T2-weighted image (T2WI), the WHO histological classification (GI, GII/GIII) and the Ki-67 antigen labeling index (LI). The edema-tumor volume ratio was calculated as the edema index (EI) and was used to evaluate peritumoral edema. Results: Gender (p=0.809) and pathological finding (p=0.084) were not statistically significantly associated with peritumoral edema by univariate analysis. Tumor volume was not correlated with the volume of peritumoral edema. By univariate analysis, three radiological features, and one pathological finding, were associated with PTBE of statistical significance: shape of tumor margin (p=0.001), presence of arachnoid plane (p=0.001), high SI of tumor in T2WI (p=0.001), and Ki-67 antigen LI (p=0.049). These results suggest that irregular tumor margins, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI can be important predictive factors that influence the formation of peritumoral edema in meningiomas. By multivariate analysis, only SI of the tumor in T2WI was statistically significantly associated with peritumoral edema. Conclusion: Results of this study indicate that irregular tumor margin, hyperintensity in T2WI, absence of arachnoid plane on the MRI, and high Ki-67 LI may be important predictive factors influencing the formation of peritumoral edema in meningiomas.

Atypical Cerebellar Medulloblastoma Originating from Tentorium : Case Report

Kim, Seong-Ho,Kim, Chang-Hwan,Kim, Oh-Lyong,Chang, Chul-Hoon,Kim, Sang-Woo,Choi, Byung-Yon,Cho, Soo-Ho,Hah, Jeong-Ok 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

The extraaxial presentation of a medulloblastoma is rare. This article descibes the case of a 12-year-old boy who presented with severe headache, nausea, and vomiting. The tumor developed in the left tentorium; it was misdiagnosed as a meningima based on the radiology examination. We review the literature and discuss the atypical presentation of medulloblastoma. 수모세포종은 주로 소뇌 충수에서 기원하는 것이 대부분이며, 천막에서 기원하는 경우는 아주 드물다. 본 보고는 심한 두통, 오심, 그리고 구토 등의 증세로 내원한 12세 남자 환자의 경우이다. 자기공명영상 검사 상 좌측 천막에서 기원한 것으로 보이는 종양이 있었으며, 이를 수막종으로 의심하고 수술적 치료를 시도하였다. 병리학적 검사 결과는 수모세포종이었다. 이에 본 저자는 천막에서 기원한 비정형적인 수모세포종에 대한 문헌고찰과 저자가 경험한 증례를 보고하고자 한다.

Long-Term Follow-Up Result of Hydroxyurea Chemotherapy for Recurrent Meningiomas

Kim, Min-Su,Yu, Dong-Woo,Jung, Young-Jin,Kim, Sang Woo,Chang, Chul-Hoon,Kim, Oh-Lyong The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.6

Objective : Meningiomas represent 18-20% of all intracranial tumors and have a 20-50% 10-year recurrence rate, despite aggressive surgery and irradiation. Hydroxyurea, an inhibitor of ribonucleotide reductase, is known to inhibit meningioma cells by induction of apoptosis. We report the long-term follow-up result of hydroxyurea therapy in the patients with recurrent meningiomas. Methods : Thirteen patients with recurrent WHO grade I or II meningioma were treated with hydroxyurea (1000 $mg/m^2/day$ orally divided twice per day) from June 1998 to February 2012. Nine female and 4 male, ranging in age from 32 to 83 years (median age 61.7 years), were included. Follow-up assessment included physical examination, computed tomography, and magnetic resonance imaging (MRI). Standard neuro-oncological response criteria (Macdonald criteria) were used to evaluate the follow-up MRI scans. The treatment was continued until there was objective disease progression or onset of unmanageable toxicity. Results : Ten of the 13 patients (76.9%) showed stable disease after treatment, with time to progression ranging from 8 to 128 months (median 72.4 months; 6 patients still accruing time). However, there was no complete response or partial response in any patients. Three patients had progressive disease after 88, 89, 36 months, respectively. There was no severe (Grade III-IV) blood systemic disorders and no episodes of non-hematological side effects. Conclusion : This study showed that hydroxyurea is a modestly active agent against recurrent meningiomas and can induce long-term stabilization of disease in some patients. We think that hydroxyurea treatment is well tolerated and convenient, and could be considered as an alternative treatment option in patients with recurrent meningiomas prior to reoperation or radiotherapy.

Cerebellar Pilocytic Astrocytomas with Spontaneous Intratumoral Hemorrhage in Adult

Kim, Min-Su,Kim, Sang-Woo,Chang, Chul-Hoon,Kim, Oh-Lyong The Korean Neurosurgical Society 2011 Journal of Korean neurosurgical society Vol.49 No.6

Cerebellar pilocytic astrocytomas (PAs) are benign gliomas predominantly found in the pediatric population. Intracranial hemorrhages are extremely rare in initial presentations of cerebellar PAs. There are no reports in the medical literature of adult cerebellar PA cases presenting with intratumoral hemorrhage. We report 2 cases of adult cerebellar pilocytic astrocytomas with intratumoral hemorrhage. The first case is a 37-year-old woman presenting with severe headache, nausea, and vomitting. Computed tomography demonstrated an acute hemorrhage adjacent to the right cerebellar hemisphere and hydrocephalus. Magnetic resonance imaging (MRI) revealed a cerebellar vermian tumor with the hemorrhage as a mixed isoin-tense area in the T2-weighted image, and as a mixed hyperintense area in the contrast-enhanced T1-weighted image. The second case is a 53-year-old man presenting with headache for 3 weeks. MRI revealed a cerebellar hemispheric tumor with the hemorrhage as a mixed hyperintense area. It had a cystic mass with a heterogeneous enhanced mural nodule in the gadolinium-enhanced T1-weighted image and a fluid-fluid level within the cyst in the T2-weighted image. Both of them underwent radical resections of their respective lesions. Histological examination of the specimens revealed typical astrocytoma, including a hemorrhagic portion. Both patients recovered postoperatively and continue to do well at present. The medical literature on hemorrhagic cerebellar PAs is also reviewed.

Switching biologics for the treatment of psoriasis : A retrospective case review

( Jun-oh Shin ),( Bong Seok Shin ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jungsoo Lee ),( Kihyuk Shin ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Moon-bum Kim ),( Kyunghyung Seo ),( Byung-soo Kim ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: It has become common in clinical practice to switch to subsequent biologics in patients with poor response or adverse events to the first biologics. Objectives: To assess the reasons and effectiveness of switching biologic agents during the treatment of psoriasis. Methods: We retrospectively reviewed all psoriasis patients who were treated with biologics in Pusan National University Hospital (Busan and Yangsan) and Chosun University Hospital from March 2012 to June 2020. Demographics and treatment characteristics (reasons for switching biologics and efficacy of the first and second biologics) were assessed for the study. Results: Of 162 psoriatic patients treated with biologic agents for more than 52 weeks, 35 patients required a switch to another biologic agent. First-line biologic agents were ustekinumab (n=91), secukinumab (n=59), adalimumab (n=12), and second-line agents were secukinumab (n=12), ixekizumab (n=9), guselkumab (n=14). The reasons for switching biologic agents were inefficacy (n=29), adverse events (n=2), and others (n=4). The mean Psoriasis Area and Severity Index (PASI) score was 12.0 at the start of the second biologics, and 3.0 at 14-16 weeks after the start of the second biologics. Conclusion: The most common reason to discontinue biologics was inefficacy. Switching to a different biologic agent may improve clinical outcomes for patients who do not sufficiently respond to the first one.

Nonavalent human papilloma virus vaccine for the treatment of multiple recalcitrant warts

( Jun-oh Shin ),( Dae-lyong Ha ),( Jin-hwa Son ),( Jungsoo Lee ),( Hoon-soo Kim ),( Hyun-chang Ko ),( Byung-soo Kim ),( Moon-bum Kim ),( Kihyuk Shin ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Warts caused by the human papilloma virus (HPV) have a negative impact on quality of life. Recently, studies on warts treated with HPV vaccine have been increased. However, until now, only a few cases of warts treated with nonavalent HPV vaccine were reported. Objectives: To investigate the efficacy of nonavalent HPV vaccine in the treatment of multiple recalcitrant warts. Methods: This study included 38 patients diagnosed as multiple recalcitrant warts who visited Pusan National University Hospital (Busan and Yangsan) from March 2017 to June 2020. Recalcitrant wart was defined as the lesion which persists for more than 1 year and has not responded to more than 2 conventional therapies. Clinical characteristics, therapeutic response, adverse reactions and recurrence were assessed. Results: With respect to therapeutic response, 24 patients (63.2%) showed “complete response”, 4 (10.5%) showed “partial response”, and 10 (26.3%) showed “no response”. Patients older than age 26 years (55.6%) showed less response rate than patients aged 9 through 26 years (90.0%). No recurrence was observed in complete response group. No adverse event after vaccination was noted. Conclusion: Nonavalent HPV vaccine could be a convenient and less painful therapeutic option for warts, especially in multiple, recalcitrant, periungual warts and uncooperative patients.