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나영신,김영수 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.2
The author has studied 125 patients of degenerative spondylolisthesis at the department of Neurosurgery YUMC Severance and Yongdong Severance hospitals from 1975 to Sept. 1986, and also analized the outcome of 72 operated patients. The results were summarized as followings : 1) Male to female ratio was 1 : 3. mean age was 55.5 years old. 2) On L-spine X-ray study, the "Pedicle-Facet angle" between pedicle and inferior articular facet at the slipping level was significantly widened, compared to the angle at the above and below level. It was 113.8˚ in average at L4-5 level "Pedicle-Facet angle" and the degree of slipping were in directly proportional relationship(Y=0.51X+107.2, r=0.35). The wider the angle is, the more slipping develops. 3) As the results from the above, etiologic factor of pathogenesis in degenerative spondylolisthesis is considered as that the widening of "Pedicle-Facet angle" had been congenital, is more increased when the severe degenerative change of posterior articulation develops as aging process. 4) The most characteristic symptom was neurogenic intermittent claudication(91.2%). There were few neurological abnormal findings. Common abnormal signs were loss or decrease of ankle reflex(81.6%) and limited backward bending(73.6%). The SLR test, characteristic sign of soft disc herniation, was not significant in this degenerative spondylolisthesis. 5) The degenerative spondylolisthesis developed most frequently at L4-5 level (84%), next at L5-S1(6.4%) and L3-4(4.8%). 6) On L-spine X-ray study, the average extent of displacement was about 7㎜, ranging from 5 to 9㎜ in most cases. The average degree of slipping against the A-P diameter of the vertebral body was about 16%, mostly in the range of 11 to 20 %. Almost all the cases (96.8%) fell into Grade Ⅰ category by Meyerding classification. 7) On myelogram, the finding of complete or incomplete block was present in 71 %, and simple indentation of contrast dye column in 29%. Among the patients with incomplete block, the cases in which contrast media passed with lumbar flexion and completely obstucted with extension, comprised 53.3%. 8) Spine CT myelography was most important in the diagnosis of the stenosis of spinal canal, the degree of disc herniation, and the cauda equina compression. 9) The commonest findings on spine CT scan were pseudoherniation of disc and lumbar spinal stenosis. And vacuum facet phenomenon(57.3), hypertrophy of facet joint(50.8%), and osteophyte formation(49.1%) were also found. 10) The prefered method of operation was wide decompressive laminectomy of the adjacent vertebrae at slipping level, medial facetectomy and foraminotomy. And in most cases, vertebral interbody fusion was not needed(90.3%). 11) There were 4 cases(5.6%) of further slipping following laminectomy, and anterior interbody fusion were performed in two of them. 12) The results of surgery were Good to Excellent in 88.9% and Fair to poor in 11.1%.
뇌간 신경교종의 증식형태, 병리 및 예후 : Growth Patterns, Pathology, and Prognosis
나영신,황충진 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.12
A retrospective study of 29 cases of brain-stem gliomas(BSG's) from 1989 to 1993, was performed to determine prognostic factors. Our study also analyzed clinical features, growth patterns, pathologic findings and modalities of treatment in patients with brain-stem gliomas. The patients ranged in age from 6 to 65 years, most commonly in the first decade. The symptom duration prior to diagnosis was ½ to 36 months (mean 1½ months). The most common symptom and sign were cranial nerve palsies, especially 6th or 7th cranial nerve. The growth patterns of BSG's were classified into diffuse tumors(17 patients), exophytic(9 patients), focal(2 patients) and cervicomedullary (1 patient). Twenty three of 29 patients were diagnosed pathologically by means of stereotactic biopsy (13 patients) and open surgery(10 patients). The Pathologic findings were low grade astrocytoma in 9 patients, oligodendroglioma (3 patients), malignant astrocytoma (7 patients), and glioblastoma multiforme (4 patients). A significant correlation between diffuse growth pattern and malignant pathologic finding could be obtained (P=0.05). The methods of radiation therapy for BSG's were conventional (10 patients), hyperfractionated (13 patients), and Gamma knife radiosurgery (6 patients). The median survival time was 12 months. The Poor prognostic factors determined in our study were 1) short symptom duration prior to diagnosis(≤2 months), 2) diffuse growth pattern, 3) malignant pathologic finding, 4) tumor without cystic portion, and 5) tumor without hydrocephalus.
나영신 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.1
Single photon emission computed tomography(SPECT) and positron emission tomograph(PET) are modern imaging techniques that allow for both qualitative and quantitative assessment of hemodynamic changes in cerebrovascular diseases. SPECT has been becoming and indispensable method to investigate regional cerebral blood flow because equipment and isotope are easily available in most general hospitals. Acetazolamide stress SPECT has also been proved to be useful to evaluate the cerebrovascular reserve of occlusive cerebrovascular diseases and to select surgical candidate. PET has gained wide spread clinical use in the evaluation of the hemodynamic and metabolic consequences of extracranial or intracranial arterial obstructive disease despite its complexity and limited availability. PET has been established as an invaluable tool in the pathophysilogy investigation of acute ischemic stroke. The potentials, limitation, and clinical applications of SPECT and PET in various cerebrovascular diseases will be discussed in this article with reviews of literatures. (Korean J Nucl Med 2003;37:1-12)
Xenon-Enhanced CT를 이용한 뇌혈류의 측정
나영신,정태섭,허승곤,서정호,이규창 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6
A non-invasive technique for measuring regional cerebral blood flow by xenon-enhanced CT has been developed with advent of computed tomography and reported extensively in recent years. Inhaled non-radioactive xenon gas can make tissue contrast enhancement on CT scan. Attenuation change from time dependent xenon concentration in brain CT slice are used to derive both partition coefficient(λ) and rCBF. In spite of its limited slice, it appears to be a useful and potentially widely available technique for clinical examination of rCBF in cerebrovascular disease, and it provides blood flow information with relatively high degree of spatial resolution and anatomical correlation. In this report, we present four clinical cases of various conditions and discuss methodology.