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.

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.

뇌동맥류성 지주막하 출혈에 대한 뇌전산화 단층촬영의 가치

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

Computerized tomographic (CT) scanning is of value in the assessment of cases of subarachn oid hemorrhage (SAH). To determine the localizing, features, rates of detection of SAH due to ruptured aneurysms and to evaluate the correlationship between CT findings, clinical grade, angiographic vasospasm, CT scans, angiograms and clinical records were reviewed in 50 consecutive patients with SAH due to a ruptured aneurysm. In 84 % of all cases, the CT scans showed the presence of SAH. The most common location for an aneurysm was anterior communicating artery. There was somewhat a relationship between the CT grade and the angiographic grade. However, a strict correlation. not only between the CT grade and clinical grade but also between the angiographic grade and clinical grade was not observed.

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.

앙드레 브르통의『전당포(Mont de Piete)』소고(小考)

노시훈 全南大學校 人文科學硏究所 1993 용봉인문논총 Vol.22 No.-

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.

腦脊髓液壓의 臨床實驗的 硏究(Ⅰ)

宋時憲 충남대학교 의과대학 지역사회의학연구소 1980 충남의대잡지 Vol.7 No.2

Lumbar cerebrospinal fluid (CSF) pressure was recorded in 115 outpatients who were not associated with any change in intracranial pressure and without any special disease entities either: of whom 65 subjects (Group I) with a intermittent low back pain used a 18-gauge needle, while for the rest of 50 subjects with mild head trauma who came to the emergency room who used 22-gauge needle (Group II). The CSF pressure was measured in a position of an excessive spinal flexion and then an adequately relaxed spine with the lateral recumbent position maintained all the while. After that Queckenstedt test was performed. And then, CSF pressure recording was done after every 1 cc of CSF withdrawal until the withdrawal amounted to 5cc, the withdrawal rate being 1 cc/min. in both of the groups. In this study, the normal CSF pressure obtained (thus) was compared with undistorted normal physiolgic CSF pressure. The results obtained are as follows : 1. The average CSF pressure recorded under the condition of any possibility to cause any anxiety and tension was 152(±31) mm of CSF in group I and 159(±34)mm of CSF in group II . 2. In group I, for whom a 18-gauge needle was used, a lower value (152±31 mm of CSF) was obtained compared with the group II (159±34 mm of CSF) for whom a 22-gauge was used. 3. The CSF pressure recorded under condition of spinal hyperflexion(160±29 mm of CSF in group I and 184±34mm of CSF in group II) was slightly higher than that recored in comfortable, relaxed state (152±31 mm of CSF in group I and 159±34 mm of CSF in group II). 4. There was not any remarkable difference in CSF pressure above the age of 11. 5. The CSF pressure data obtained on CSF withdrawal amounitng to 5cc gave a linear pressure-volume curve and the amount of decreased pressure was 24 mm of CSF in group I and 21 mm of CSF in group II.

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.

만화를 통한 프랑스 문화 교육 : 『아스테릭스Aste´rix』의 경우 the case of Aste´rix

노시훈 全南大學校 人文科學硏究所 2002 용봉인문논총 Vol.31 No.-

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.