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Failed Back Surgery Syndorme(FBSS)의 임상적 고찰
박형천,김영수 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.1
The authors experienced 186 cases of Failed Back Surgery Syndrome(FBSS). which were 2.5% of all admitted patients in authors' clinic from 1983 to 1992 Among them. 173 patients were referred cases from other hospital and 13 patients were authors' cases which was 0.2% of authors' back surgery. About 75% of all was come to our clinic Within 2 years after initial operation. The common cause of FBSS was resulted form inadequate surgery or surgical complications (51%). In these cases incomplete decompression at initial operation was seemed to be a major factor. The next causes was due to inadequate patient selection(26.3%) and the FBSS was more prevalent when the patient had only back pain without leg pain. The other causes of FBSS was post-operative adhesion(8.6%), discitis(4.3%), and inadequate diagnosis(4.3%). So about 80% of FBSS seem to have preventable causes. 66 of 186 cases was performed m p t i o n and 70% of them had improvement
METRx™ 기구를 이용한 후방 경추부 추궁추간공 제거술의 예비 결과
박형천,윤승환,박종운,하윤,현동근,김은영,박현선,임대철 대한척추신경외과학회 2004 Neurospine Vol.1 No.1
Objectives: Posterior cervical microscopic laminoforaminotomy has been a preferred procedure for a posterolateral cervical disc or foraminal stenosis. However, neckpain from wide skin incision and muscle injury are some of disadvantages. The authors performed cervical microscopic laminoforaminotomy with METRx™ tubular dilator system and were compared the results with classical cervical microscopic foraminotomy. Methods: Six patients underwent posterior cervical microscopic laminoforaminotomy using the METRx™ during 6 months. We have selected 10 patients from our institution as a comparison group. Preoperative and postoperative pain score composed of the radicular and neck component was examined and disability score also recorded. Diameters and lengths of laminoforaminotomy on the postoperative CT also were compared with two methods Results: Postoperative pain scores to the radiculopathies were not different but postoperative pain scores to the neckpain on the follow up periods were significantly different. The average vertical and transverse diameters of the laminoforaminotomy defect on the postoperative CT scans were not different between two groups. Average hospital stay of the classical methods was 8.8±7.5 days comparison with 4.5±0.54days of new procedure. Conclusions: Posterior cervical microscopic laminoforaminotomy with METRx™ systems seems to provide similar decompression and clinical results as classical methods compared to classical methods and shows superior results for postoperative neckpain and hospital stays.
박형천,이규창,이규성,서정호,김동익,정상섭,박상근,최중언,김영수 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.4
The authors analyzed 377 consecutive cases of aneurysmal subarachnoid hemorrage admitted to the Department of Neurosurgery at Yonsei University Hospital from 1980 through 1984. The results of analysis were summarized as follows. 1) Mean age of the patients was 48.8 years. Aneurysmal SAH occured more frequently in female (201) than male (176). 2) Incidence of clinical vasospasm was 33.2%(125/377) and of rebleeding was 11.7%(44/377). 3) Surgery was done for 191 patients which accounts for 50.7 % of all patients. Functional recovery was noted in 179 of these 191 surgically treated patients (93.7 %). Operative mortality was 3.7 %. 4) Conservative treatment was done for remaining 186 patients. Among them, 124 patients died or disabled : 40 from initial insult, 59 from vasospasm, 25 from rebleeding. Aneurysm could not be found on angiography in 19 cases. Remaining 43 patients refused surgery. Despite of dramatic improvement of surgical treatment for ruptured intracranial aneurysms, overall mortality and morbidity for ruptured cerebral aneurysm still remain unchanged over the past two decades. As shown in this study, most of the management mortality and morbidity came from the patients who didn't or couldn't receive surgical treatment. The authors suggest several directions to improve overall management outcome in all aneurysmal patients.
박형천,최소래,김범석,이태희,강병승,최규헌,이호영,한대석,하성규 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.6
The angiotensin-converting enzyme (ACE) gene DD homozygote has been suggested to be a significant risk factor for the progression of diabetic nephropathy. We analyzed clinical parameters and ACE genotype distribution between type 2 diabetic patients at the extremes of renal risk, i.e. an end-stage renal failure (ESRF) group (n = 103, group 1) who were on dialysis therapy due to progression of diabetic nephropathy, and a no progression group (n = 88, group 2) who had maintained normal renal function and normoalbuminuria for more than 15 years. There were no significant differences in age, sex, body mass index, HbA1c level, or lipid profiles between the two groups (p > 0.05). Group 1 had a significantly higher prevalence of hypertension [group 1: 82.5% (85/103) vs. group 2: 50.0% (44/88), p < 0.05] and diabetic retinopathy [group 1: 103/103 (100%) vs. group 2: 28/88 (31.8%), p < 0.05] than group 2. Daily urinary albumin excretion was also higher in group 1 than in group 2 [group 1: 2873 ± 2176 mg/day vs. 12 ± 7 g/day, p < 0.05]. The frequencies of the DD, ID, and II genotypes of the ACE gene in group 1 and group 2 were 26.2%, 47.6%, and 26.2%, and 7.9%, 57.9%, and 34.2%, respectively. The ACE genotype frequencies between the two groups were significantly different according to a chi-square test with Bonferroni's correction (p = 0.004). The presence of the DD genotype increased the risk of ESRF 4.286-fold compared to the II genotype [odds ratio 4.286, 95% CI 1.60-11.42, p = 0.005]. The frequency of the D-allele was higher in both male and female patients in group 1 compared to group 2, but reached statistical significance only in males [male, group 1: 50.8% vs. group 2: 35.0%, p = 0.018, female, group 1: 48.8% vs. group 2: 39.5%, p = 0.231]. This study, although limited by sample size, showed that type 2 diabetic ESRF patients more frequently expressed the DD genotype. These findings may substantiate the previously noted relationship between the ACE DD genotype and the progression of diabetic nephropathy in Korean type 2 diabetic patients.