만성뇌경막하혈종에 대한 임상적 고찰

계종수,서중근,이기찬,주정화 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.1

Chronic subdural hematoma is a relatively common disease which is practically always secondary to severe or minor injury to the head but may occur In connection with blood dyscrasias or cachexia in the absence of trauma. Early diagnosis and proper operative treatment result in complete recovery In most cases, but the outcome without operative treatment is almost invariably fatal. During 1972 to 1975, 28 patients with chronic subdural hematoma were examined and operated in the Department of Neurosurgery, Korea University, and clinical observation and analysis were made particularly of the relationship of age to clinical and pathological findings. Incidence of hematoma was predominated by men and estimated as 71.4% of total cases over the age group of 31 to 40 years and in the group of under 10 years were found in 3 cases. A history of craniocerebral trauma in varying degree was obtained In 23 cases(82%), and remainings had no history of it or any other illness. The average time interval from trauma to operation was 31.7 days and it was shorter in the young patients who had more evidence of increased intracranial pressure. The prevalence of the most commonly encountered symptoms and signs, especially in different age groups were analyzed. Headache was by far the commonest symptom in this series, being present in 20(71.4%) vomiting in vomiting in 15(53.6%), hemiparesis in 13(16.4%) speech disturbance in 5(18%), papilledema in 16(57.2%), and convulsion in 2(7.14%). There was a tendency that young patients had headache more frequent and severe than the older patients, while mental symptoms, such as somnolence, confusion, and memory loss were significantly more frequent in the older age group. Hemiparesis and other pyramidal tract signs were more frequent in the older age group. Leukocytosis in peripheral blood was investigated in 75% of cases and roentgenograms of the skull showed evidence of a linear fracture in 10 of the total cases. Carotid angiograms were of diagnostic value in that they demonstrated a lentiform shaped avascular zone by in 28% and a crescent shaped-one in the remainders by an inward displacement of the terminal branches of the middle cerebral artery. The hematomas were most frequently found in the parietotemporal region. The thickness of the hematomas as measured from angiograms increased with the age of the patient. On]y 1 of 28 cases died of reaccumulation of blood in the subdural space and bleeding in the gastrointestinal tract following the operation. Excellent recovery following operation is obtained in 82% of the cases at the time of discharge from hospital.

좌골신경 주사손상에 대한 실험적 연구

계종수 고려대학교 의과대학 1976 고려대학교 의과대학 잡지 Vol.13 No.1

외상성 척수손상에 대한 Myelotomy의 효과에 관한 실험적 연구

계종수,이기찬 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.1

This study involved 29 adult cats with acute spinal cord injuries produced experimentally in which a myelotomy was performed in 10 cats one hour (]-hour myelotomy group) after and in remaining 9 animals 6 hours (6-hour myelotomy group) after the injury. The remaining 10 animals served as controls and were only subjected to the spinal cord injury. The spinal cord injury with 400 gm-cm blow was inflicted by dropping a 20gm cylindrical weight from a height of 20cm onto the impounder rested epidurally over the entire dorsal surface of the cord at T 10 or T 12 vertebral level. Under the operating microscope, a myelotomy, dorsal midline longitudinal, approximately 1.0 cm to 1.5 cm long, was made at the injury site. The myelotomy extended 4 mm into cord completely through to the anterior surface of the cord. Animals were evaluated neurologically after the injury in time sequence of 4 hours, 8 hours, 2 days 4 days and 7 days after which they were sacrified, and the spinal cord and meninges were removed for pathological study. Acute spinal cord injury produced in this study immediately resulted in total paralysis of both hind limbs in all animals after injury and the weakness lasted throughout whole experimental period. There was no significant improvement in recovery of neurological function in control and in 6-hour myelotomy groups, but there was a significant improvement in recovery of motor function in the group of 1-hour myelotomy animals as compaired with the other groups. Histopathological findings of injured spinal cord were mainly those of hemorrhage, necrosis of cavity formation in the central gray and degenerative changes in the white and gray matters, and of edema and swelling of the spinal cord. In the group treated with myelotomy after the injury, the degree of destruction of the spinal cord was lesser histologically than those in control group, and that, in the group of 1-hour myelotomy, no central cavitation or necrosis were observed. It was observed that the neurological functional deficits tended to correlate with the degree of destruction to the spinal cord, and when the myelotomy was done earlier in the post-traumatic period and extended for the full depth of the cord, the improvemet of neurological function and the prevention of further destruction of the spinal cord were significant. It is well to say that a number of possible mechanism to account for this beneficial effectiveness of myelotomy may be attributed to drainage of blood and necrotic tissue from the injury site. Myelotomy may prevent cavitation of spinal cord, and thus prevent the surviving axons from further damage, and it may reduce tissue pressure.

좌골신경 주사손상에 대한 실험적 연구 : 생리학적 연구 Physiological Study

계종수,이기찬,주정화 고려대학교 의과대학 1976 고려대 의대 잡지 Vol.13 No.1

This experimental study was conducted in order to observe the change and degree of the functional disability of the sciatic nerve following injection of various drugs such as Rheumapyrine, Chloromycetin, Penicillin and physiological normal saline solution. In clinical practice a serious sciatic nerve injury may result from an erroneous injection of commonly used antibiotics and other therapeutic or prophylactic agents into the gluteal region, which can occur at any age, especially common in infants, children and small debilitated patients. Thirty-six normal adult rabbits were divided into four groups depending on injected materials and also divided into two groups of simple exposure and closure of the nerve and of simple puncture of the exposed nerve with injection needle. The drugs were injected into the right sciatic nerve intraneurally and around the left sciatic nerve perineurally. For the functional study in the nerve, needle electrode was inserted into the calf muscle which was pick-up muscle, and nerve potential was recorded on electromyography (EMG) and motor nerve conduction velocity(M. N. C. V. ) was also measured in the calf muscle at intervals of 3,7,10 and 14 days after the injection. In normal control group, electrical activity on E M G was silent in resting state of muscle and was normal motor unit action potential(normal motor unit) in volition state by demonstrating biphasic or triphasic wave patterns. Distal latency averaged 1.1 msec and the amplitude of action potential was average 6.4 mV. Two experimental groups of simple exposure and closure of the nerve and of simple puncture of the exposed nerve with injection needle showed identical E M G findings with those in normal control group. In E M G findings of both normal saline and Chloromycetin injection groups, there were no significant differences in comparison with those in normal control group. Abnormal EMG findings were observed in both Penicillin and Rheumapyrine groups, which showed fibrilliation potential and positive sharp wave in resting state and decreased amplitude or reduced numbers of normal motor unit in volition state, along with delayed M. N. C. V. No abnormal EMG findings were observed in the left side where the drugs were injected around the sciatic nerve perineurally. Two of five cases with penicillin injection showed denervation potentials and delayed M. N. C. V. 10 days after the injection, while all cases with Rheumapyrine injection started t o demonstrate the denervaxion patterns on E M G and delayed M.X.C.V. 3 days after the injection, and these abnormal findings were become more evident and severe to be partial or complete denervation as the time elapsed following the injection. It was postulated that functonal and physiolgical disabilities recorded on E M G were developed after the injection only when there was a severe degree of nerve damages on the basis of histopathological study.

흉추에 발생한 척색종의 치험 1례 : Case report

계종수,최호익,이기찬,주정화 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

Chordomas are congenital tumor which develop from remnant of the notochord. Most of them arise at the clivus Blumenbachii, at the junction of the sphenoidal and occipital bones or sacrococcygeal region. Rarely chordomas arise it the thoracic spine, which compress the spinal cord epidurally and sometimes invade the substance of the spinal cord. The authors report a case of chordoma at T-9-T 10 vertebral level in which the characteristic "physaliferous' cells were found in the slides of operative specimen. The tumor was compressing the spinal cord and extending into body and ?????? of the vertebra, which resulted the patient, 52 year-old Korean male, in paraplegia.

외상적 척수손상에 대한 Myelotomy의 효과에 관한 실험적 연구

계종수,이기찬 고려대학교 의과대학 1981 고려대 의대 잡지 Vol.18 No.1

This study involved 29 adult cats with acute spinal cord injuries produced experimentally in which a myelotomy was performed in 10 cats one hour (1-hour myelotomy group) after and in remaining 9 animals 6 hours (6-hour myelotomy group) after the injury. The remaining 10 animals served as controls and were only subjected to the spinal cord injury. The spinal cord injury with 400 gm-cm blow was inflicted by dropping a 20 gm cylindrical weight from a height of 20 cm onto the impounder rested epidurally over the entire dorsal surface of the cord at T10 or T12 vertebral level. Under the operating microscope, a myelotomy, dorsal midline longitudinal, approximately 1.0㎝ to 1.5㎝ long, was made at the injury site. The myelotomy extended 4㎜ into cord completely through to the anterior surface of the cord. Animals were evaluated neurologically after the injury in time sequence of 4 hours, 8 hours, 2 days, 4days and 7 days after which they were sacrificed, and the spinal cord and meninges were removed for pathological study. Acute spinal cord injury produced in this study immediately resulted in total paralysis of both hind limbs in all animals after injury and the weakness lasted throughout whole experimental period. There was no significant improvement in recovery of neurological function in control and in 6-hours myelotomy groups, but there was a significant improvement in recovery of motor function in the group of 1-hour myelotomy animals as compared with the other groups. Histopathological findings of injured spinal cord were mainly those of hemorrhage, necrosis or cavity formation in the central gray and degenerative changes in the white and gray matters, and of edema and swelling of the spinal cord. In the group treated with myelotomy after the injury, the degree of destruction of the spinal cord was lesser histologically than those in control group, and that, in the group of 1-hour myelotomy, no central cavitation or necrosis were observed. It was observed that the neurological functional deficits tended to correlate with the degree of destruction to the spinal cord, and when the myelotomy was done earlier in the post-traumatic period and extended for the full depth of the cord, the improvement of neurlolgical function and the prevention of further destruction of the spinal cord were significant. It is well to say that a number of possible mechanism to account for this beneficial effectiveness of myelotomy may be attributed to drainage of blood and necrotic tissue from the injury site. Myelotomy may prevent cavitation of spinal cord, and thus prevent the surviving axons from further damage, and it may reduce tissue pressure.

腦硬膜上血腫의 死亡要因에 關한 硏究

桂鐘秀,池善豪 대한신경외과학회 1978 Journal of Korean neurosurgical society Vol.7 No.2

Of all the potentially lethal complications of the head injury, extradural hemorrhage is the most readily diagnosed and remediable, yet the mortality rate remains distressingly high. The authors report on 58 consecutive patients with extradural hematoma. The mortality was 31%. The classical clinical course with a lucidal interval was seen in three patients only. The classical neurological signs of an extradural hematoma, contralateral hemiparesis, and ipsilateral third nerve palsy were seen in 9 patients(15.5%). The main factors associated with increased mortality were concomitant brain injury, rapid development of the hematoma and unconsciousness at the time of operation. In almost half of the fatal cases, there was a delay in the diagnosis and operation. Consequently better results are possible with better organization of the supervision and treatment of brain injured patients.

巨大한 類皮囊腫 1例

桂鐘秀,金潔,池善豪,박병완 대한신경외과학회 1977 Journal of Korean neurosurgical society Vol.6 No.2

The authors describe a case of large dermoid cyst of the scalp which was removed surgically and cosmetically. Dermoid cyst is derived from epiblastic cells predestined to form skin which become detached from their neighbours and included in mesenchyme at about third to the fifth week of fetal life, when the neural tube is closing. The contents of the cyst are thus mixtures of keratin, sebum, and hair, according to the proportionate development of these elements. It is usually a single tumor and may develop almost anywhere in the subcutaneous tissue, being of variable size.

超音波 腦反向圖

桂種秀,李基燦 최신의학사 1974 最新醫學 Vol.17 No.10

大腦半球에 發生한 結核腫 1例

桂鐘秀,金潔,池善豪,金正根 대한신경외과학회 1977 Journal of Korean neurosurgical society Vol.6 No.2

The authors report a case of tuberculoma of the cerebral hemisphere, which has been excised under the operating microscope. With the references reviewed, this case is interesting one in supratentorial location.