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RISS 인기검색어
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- 저자 : 이자규 (검색결과 10 건)
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이자규,박정율,서중근,정흥섭,이기찬,이훈갑 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.3
During the past decade, internal fixation techniques for stabilization of spinal fracture, correction of spinal deformity and immobilization in degenerative spinal diseases have increased. In general, pedicle screw fixation of the spine provides the three dimensionally rigid grip on each vertebra and minimizes the levels of spinal segment that is needed for proper fixation. But with the increasing use of pedicle screw, there is an increase in incidences of complication. Major complications of pedicle instrumentation are screw malposition, pedicle fracture, latrogenic foraminal encroachment, injury to the facet joints or vessels, and mechanical failure. These complications may be associated with irreversible damage of both vertebral and neural elements. Therefore, full understanding and knowledge of vertebral morphology is essential for proper instrument fixation and avoidance of complications. A total of 500 pedicle measurements wre made from L1 to L5 vertebra. Five morphometric parameters were studied, transverse pedicle width, transverse pedicle angle, depth to anterior cortex, sagittal pedicle width, sagittal pedicle angle. Measurements were done using both spinal computed tomography and simple lumbar X-rays. As for the results, the means of transverse pedicle width is 7.9-16.6㎜, transverse pedicle angle is 8.3-29.1° and depth to anterior cortex is 43.8-47.9㎜. The results were compared with previous data.
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뇌낭미충증과 동반된 수두증 치료후 발생한 Chiari-Malformation
이자규,박정율,정흥섭,서중근,이기찬,이훈갑 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6
Acquired Chiari malformation is a term describing the low lying cerebellar tonsils subsequent to the documentation of a normal hind brain. It is radiographically indistinguishable from Chiari-I type malformation. Ventricular and lumbar shunting are known predisposing factors in patients who develop such tonsilar descent. Managements of acquired Chiari malformations include ventriculoperitoneal(V-P) shunt, ventriculoatrial(V-A) shunt or posterior fossa decompression after removal of lumboperitoneal(L-P) shunt. The authors recently have encountered a patient who developed an acquired chiari malformations after V-P shunt for hydrocephalus associatd with neuro-cysticercosis. This case of chiari malformation is presented as our report, together with pertinent literature review.
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박정율,이자규,박윤관,정홍섭,이기찬,이훈갑 고려대학교 의과대학 1997 고려대 의대 잡지 Vol.34 No.2
The most common cause of head injury in the first two years of life is a fall. This is usually from a low height, frequently onto a soft surface, and is rarely associated with neurological disturbance or intracranial damage. The brain and intracranial compartment undergo a multiplicity of physiologic and anatomical changes which influence the type of head injury and response to such injury, especially for those in first two years of age. Purpose of this study is to retrospectively analyze the clinical result of 68 cases of such age group admitted to our department due to head injuries and to evaluate the various clinical parameters influencing the outcome. The mean duration of admission period was 15 days and mean duration of follow-up period 29.4 months. Most common mode of injury was from stairway injury(32.3%), followed by in-car accident (19.1%). with suspected child abuse being only 2.9%. Cerebral contusion was the most frequent diagnosis being 43 cases(63.2%), followed by skull fracture in 31 (45.6%). For the outcome related to various categories, 5 cases of death were due to diffuse axonal injury or intracranial hemorrhage, but most simple linear fractures were not associated with underlying brain injury. Among those required the operation (18 cases), subdural and/or epidural hematoma were the most common pathology (50%), followed by subdural hygroma and depressed skull fracture. The outcome, however, was not related to type of pathology. Instead, it was rather closely related to the initial PGCS. The PGCS at admission was found out to be the major predicting factor to outcome. In overall, 34/36(94.4%) cases with normal PGCS in these age groups showed good recovery with deaths being 5/7(71.4%) cases of PGCS≤5 at admission. The good recovery in these age groups regardless of causes was 73.5% but the mortality rate was 10.3%. The specific clinical parameters related to bad outcome were hypoxia, shock, anisocoria, and bilateral abnormal light reflex. Parameters such as anemia, hypo- or hyperthermia, hypotension, seizure did not directly influence the outcome.
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초기상태가 불량한 자발성 뇌출혈 환자의 예후 - 70세 이상의 고령환자를 대상으로 -
김주한,이자규,임동준,권택현,박정율,정흥섭,이훈갑,서중근,Kim, Joo Han,Lee, Ja Kyu,Lim, Dong Jun,Kwon, Tack Hyun,Park, Jung Yul,Chung, Hung Seob,Lee, Hoon-Kap,Suh, Jung Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2
Objective : The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. Material and Method : A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. Results : In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. Conclusion : It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.
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두개강내 병소와 동반되는 급성 고혈압의 치료 : 이상적인 항고혈압 치료제의 선택을 중심으로 Focus on Selecting Ideal Antibypertensive Agents
박정율,이자규,이일옥,공명훈,송우혁,정흥섭,이기찬,이훈갑 고려대학교 의과대학 1997 고려대 의대 잡지 Vol.34 No.2
Patients with acute hypertension associated with intracranial pathology often require prompt reduction of elevated blood pressure. But the principal goal here is to ameliorate systemic hypertension while maintaining adequate cerebral perfusion pressure to provide required cerebral blood flow and thereby preventing secondary ischemic brain damage. Although many new antihypertensive agents are now available, the ideal agent along with optimal guidelines for blood pressure reduction still remain controversial in acute hypertensive patients with different types of intracranial pathologies. Object of this study was to first review briefly the cerebrovascular pathophysiology of hypertension in conjunction with management of these patients. Pertinent literature is searched, indexed, and referenced from MEDLINE for this purpose. From this information, along with clinical experiences, authors tried to provide some of basic guidelines for managing these patients in various clinical situations, focusing mainly on selecting ideal antihypertensive agents available at present time. From the present standpoint it is generally agreed that 1- or 1-adrenergic receptor antagonists provide arterial pressure reduction with little or no adverse effect on intracranial pressure within regulatory range. Although many promising calcium-channel blocking agents are now available, their use are often limited by their action to cause cerebral vasodilation and thus increased intracranial pressure. Angiotensin converting enzyme inhibitors can be used for moderate hypertension but have potential to further increase intracranial pressure in patients who already have intracranial hypertension. It has long been known that barbiturates can be adjuvant method in case of resistant or malignant hypertension with intractablly increased intracranial pressure since it decreases both the blood pressure and cerebral blood flow with reduction of oxygen metabolism. The proper management of acute hypertension in the patients with intracranial pathology should be based on sufficient understanding of the pathophysiology of hypertension and cerebral perfusion pressure. Ideal agents would be individually based on their ability to promptly and reliably ameliorate the hypertension and at the same time maintain adequate cerebral blood flow and intracranial pressure.
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