소아 중등도 두뇌손상환자에 대한 임상적 고찰

송시헌,고현송 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

The authors review the records of 88 pediatric head injured patients whose initial Glasgow coma scale (GCS) scores ranged from 9 to 12 and who were treated at Chungnam National University Hospital over a recent 4-year period. These results are compared with reports from other centers and severely brain injured groups. The results were as follows : 1. The peak age group was between 6 and 8 years and were predominantly males (2.7 : 1 ratio). 2. The most common cause of head injury was as a pedestrian in a motor vehicle accident (72.7% ). 3. The number of patients with abnormalities on cranial computerized tomography (CT) and magnetic resonnance imaging (MRI) was 71 (80.7%) and the most common lesion was brain contusion (20/88). 4. The number of patients with intracranial hematoma was twenty-three (26%). 5. Twelve patients (13.6%) received cranial operation (four for hematoma removal and eight for repair and elevation of depressed fractures). 6. Eighty-three patients (94.3%) showed a good recovery, one patient (1.1%) died and four patients (4.5%) showed moderate or severe disability. 7. There was no relationship between age and intracranial lesions or GCS score and also there was no relationship between skull fracture and intracranial lesions or GCS score.

강직성 뇌성마비 환아를 위한 선택적 척수 후신경근 절단술

송시헌 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

Cerebral palsy is a multifaceted disorder of which spasticity is only one aspect. Selective posterior rhizotomy(SPR) is a well-established treatment for spasticity associated with cerebral palsy and favorable results have been reported from a number of different centers. However, the techniques used in performing SPR to treat spastic cerebral palsy remains controversial. A review of the personal experience of the SPR performed at Chungnam National University Hospital(CNUH) for reduction of spasticity in children with cerebral palsy is presented. The SPR procedure performing in CNUH involves an L1 and L2 laminectomy, followed by the about 60.9% selective section of certain lumbosacral posterior spinal nerve rootlets(Ll-S1 or S2), based on the electromyographic responses to their electrical stimulation. All patients showed markedly relieved or disappeared spasticity on post-rhizotomy neurologic examination. Postoperative physical and occupational therapy are felt to be essential for regaining strength and improving motor function following the SPR.

소아 두개저 골절의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

The purpose of this study is to analyze clinical features of 51 patients, who have admitted Chungnam National University Hospital, from January 1, 1992, to, June 30, 1997, with basal skull fracture in children. The results were as follows: 1. The peak age was 3-12 year-old and occured predominantly in male(1.7:1 ratio). 2. The most common cause of trauma was traffic accident(80.4%). 3. The frequent clinical features, in decreasing order of frequency, were pneumocephalus(72.5%), CSF otorrnea(33.3%), raccoon eye(23.5%), CSF rhinorrhea(21.6%), and facial palsy(15.7%). 4. The basal skull fracture line was detected in only 49% of cases by skull X-ray film. 5. The degree of development of paranasal sinus were poor in 68.2%. 6. CSF leak was noted in 66.75 of cases and among them 79.5% of cases were stopped spontaneously.

소아에 발생한 낭성 핍지신경교종 1 예

송시헌 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

Oligodendroglioma is a relatively rare brain tumor making up to about 5% of all primary intracranial tumors. It's incidence is predominantly in adult, and it is quiet rare in childhood and adolescence. This 9-year-old boy patient presented with 3 months duration of headache, vomiting and I month duration of visual disturbance. Computerized tomography showed large low density and round shaped cystic mass with capsule over frontal lobe that was confirmed by operation. A brief review of oligodendroglioma is presented.

소아 중증 두뇌손상환자에 대한 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

The purpose of this study is to report the outcomes of 73 children, 15 years of age or younger, who were consecutively admitted to Chungnam National University Hospital over a 5-year period with nonpenetrating severe brain injury and to compare these results with reports from other centers in a community with well trained paramedic care and an excellent transfer system. In addition, clinical analysis of the relationship between age, initial GCS score, coma duration, clinical findings, intracranial lesions and outcome have been studied. The results were as follows : 1. The average age was 8.7 years and occured predominantly in males(2.3 : 1 ratio). 2. The most common cause of brain injury was motor vehicle accident (84.9%). 3. The number of patients with intracranial hematoma was 25(34.2%) and patients with acute subdural hematoma showed the poorest outcome. 4. Seventeen patients(23.3%) died, fourty-six patients(63%) recovered functionally and ten patients (13.7%) showed a nonfunctional outcome. 5. A significant relationship was found between outcome, initial GCS score and bilateral pupillary abnormalities. However, the age, duration of coma, other clinical findings and intracranial lesions, except acute subdural hematoma, did not relate to the outcome.

소아 두뇌손상에 대한 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

The purpose of this study is to analyze treatment results of 122 patients who have admitted Chungnam National University Hospital, from January 1, 1991, to June 30, 1993, with various types of craniocerebral injury. In addition, author analyzed correlationship between Glasgow Outcome Scale(GOS) and initial Glasgow Coma Scale(GCS) ; initial blood glucose level ; and value of serum electrolyte (sodium, potassium) respectively. The result were as follow : 1. The peak age was 6-8 year-old and occured predominantly in male(3 : 1 ratio). 2. The most common cause of trauma was pedestrian-motor vehicle accident (65.1%). 3. The frequent types of intracranial lesions seen on CT/MRI were cerebral contusion, epidural hematoma and diffuse brain swelling. 4. One hundred patients(82.0%) recovered completely and nine patients (7.4%) died. 5. A significant correlation was found between the outcome and initial GCS and blood glucose level. However, the serum electrolyte abnormalities did not correlated with the outcome.

Mannitol 및 Glycerol이 고양이의 두개강내압에 미치는 영향에 관한 실험적 연구

송시헌,김윤 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

Although mannitol and glycerol are most commonly used for the treatment of cerebral edema and increased intracranial pressure(ICP), comparative studies concerning the effects of mannitol and glycerol administration on intracranial pressure (especially short term) have not been found. The study was made to compare the effect of mannitol(20%) with glycerol(10%) administration on ICP, serum osmolarity, serum electrolyte, urine volume and mean arterial blood pressure in cats. The results are summarized as follows 1. In all the cases the fall in ICP was prompt, usually reaching around the maximum percent reduction of ICP between 1.5 min. to 20min. after the beginning of drug administration. 2. The larger doses of mannitol or glycerol produced a more significant percent reduction of ICP (p<0. 05 or p<0. 01) and a more singnificant increase of serum osmolarity and urine volume with statistical correlationship. 3. Glycerol administration produced a higher percent, reduction of intracranial pressure than the same doses or equimolar doses of mannitol administration (p<0.05 or p<0.01). 4. In this study, the highest percent reduction of ICP was obtained when a glycerol dose of 2gm/kg had been administered (group 6 : maximum percent reducton of ICP was 54.8±4.1%), but,the values were not significantly different from the values of group 5 (glycerol dose of 1.0 gm/kg). Although there was no significant difference in the percent reduction of ICP between -group 6 and group 5, serum osmolarity of group 6 was very significantly higher than that of oup 5 (p<0.01). 5. There was no significant change in serum Na` and K' concentration following each of the drug infusions except the statistically significant fall of serum Na'concentration within a normal :range in higher mannitol doses. 6. In all the cases there was no appreciable change in mean arterial blood pressure during the period of study.

소아 뇌종양의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

Between January, 1983 and July, 1992, 41 children(aged 15 years or younger) with various types of brain tumors were managed at Chungnam National University Hospital. The results were as follows : 1. Among all the incidences of intracranial tumors, pediatric tumors were 15.1%. 2. The peak age was 6~10 (48.8%). 3. The most common pediatric brain tumor was astrocytoma (31.7%) and primitive neuroectodermal tumor (29.3%). 4. Supratentorial tumor (51.2%) were slightly higher than infratentorial tumors in frequency. 5. Headache and vomiting were the two most common presenting symptoms. 6. Infratentorial timors (85%) were more frequently associated with hydrocephalic change than supratentorial tumors (52.4%). 7. The treatment result was worse in patients with hydrocephalic change than those without. 8. The overall operative mortality (mortality within 1 month) was 7.4%.

소아기 외상성 경막외혈종 환자에서의 보존적 치료

송시헌 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

With the advent of computerized tomography(CT) , an increasing number of patients with only minimal symptoms and signs are found to harbor considerable amount of acute epidural hematomas. Although most of these patients were still subjected to craniotomy because of the neurosurgeon's ingrained fear of delayed deterioration, the initial stable status of these patients warrants some rethinking about conservative treatment. The purpose of this study was to present a 34 pediatric epidural hematoma patients who were treated conservatively at Chungnam National University Hospital over a recent 6 year period and to define the clinical parameters that may aide in the conservative management of patients with epidural hematomas who were in state of clinically stable minimal symptoms and signs. Analysis of the patients revealed that age, sex, Glasgow Coma Scale score of more than 12, an initial size of the hematoma of less than 40cc, the presence of skull fracture and the hematoma locations are not risk factors for delayed deterioration. This study propose that those children with epidural hematoma who initially have a stable neurological status can be successfully selected for close observation and conservative treatment.

신경외과 영역에서 BANAN^(�)(Cefpodoxime proxetil)의 감염치료효과에 대한 임상적 연구

송시헌,김한겸 최신의학사 1994 最新醫學 Vol.37 No.7