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.

뇌실-복강단 단락수술에 의한 뇌수종 치료의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.2

The ventriculoperitoneal shunt(V-P shunt) has emerged as the preferred diversionary procedure for hydrocephalic patients with various underlying causes. Its major advantages are the relatively benign nature of complications, the ease of shunt placement and shunt revision. This study reviews 37 patients who had the V-P shunt at Chungnam National University Hospital. The major complications of the V-P shunt were infection(9.5%), shunt malfunction (9.5%), subdural hygroma(7.1%) and seizure(2.4%). Of the patients with V-P shunt 83.8% had good improvement. Also, computerized tomographic findings and the causes of underlying diseases were reviewed.

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.

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.

급성 뇌경막외혈종의 임상적 고찰

송시헌 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

The outcome of acute epidural hematoma has been generally unsatisfactory. This study has analyzed the factors influencing the outcome of 99 patients who underwent acute epidural hematoma evacuation. Seventeen patients(17.2%) died and seventy-eight patients(78.8%) had a favorable outcome. A significant correlation was found beteen the outcome and the motor score at preoperation, pupillary response, bleeding point at operation, the degree of midline shifting, hematoma thickness and hematoma density on computerized tomography. However, the patient's age, the mode of injury, the hematoma location and the shape of the hematoma did not correlated with 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.

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.

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.