뇌졸중의 진단과 치료 ; 뇌졸중의 외과적 치료

송진언 ( Jin Un Song ) 대한내과학회 1977 대한내과학회지 Vol.20 No.5

The Effect of Radiation Therapy on Oligodendrogliomas

윤세철,김성환,정수미,길학준,신경섭,박용휘,강준기,송진언,Yoon Sei Chul,Kim Sung Whan,Chung Soo Mi,Gil Hok Jun,Shinn Kyung Sub,Bahk Yong Whee,Kang Joon Ki,Song Jin Un The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

가톨릭의대 방사선치료실에서는 1983년 4월부터 1989년 4월 사이 6년 동안에 회돌기교종환자 21예를 외부방사선 치료하였다. 전예에 대하여, 연령 및 발병부위별 빈도와 임상증상과 CT소견 그리고 추적 가능하였던 20예의 생존율에 관한 후향적 분석을 하여 다음과 같은 성적을 얻었다. 1. 전예는 원발성 뇌종양으로 방사선치료 하였던 환자(246예)의 약 8%의 빈도를 보였으며, 연령 분포는 5~62세 (중앙값 38세)이고, 남녀의 비는 13:8이었다. 2. 임상주 증상은두통 18예(86%), 뇌운동신경마비 12예(57%), 오심구토 7예(33%), 경련 5예 (24%)등 순을 보였다. 3. 발병부위는 전두엽 10예(48%), 두정엽 10예(48%), 측두엽 7예(33%), 후두엽 2예(10%)그리고 뇌간 및 소뇌가 각각 1예 (5%)씩 이었다. 4. 조직학적 진단은 정위다방향 조직생검이 3예(14%), 종양의 수술적 제거 (부분 전체제거)에 의함이 18예(86%)이었다. 전예에서 전뇌 및 소부위에 3960~6480cGy15~8주 외부방사선 치료를 하였고, 6예 (29%)에서는 항암약물 치료도 병행하였다. 5. CT음영은 저, 고, 혼합 및 등가음영이 각각 13(62%), 3(14%), 3(14%), 2(10%), 예씩 이었고, 낭성종괴 7예(33%), 괴사 및 출혈성 종괴가 각각 1예(5%)씩 이었다. 석회와 음영은 14예 (67%)에서 관찰되었으며, 조영증강 유무는 9 : 12로 나타났다. 6. 평균생존기간은 38개월이었다. From April,1983 through April,1989, we have treated histologically proven 21 patients with oligodendroglioma using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam 51. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated U patients with oligodendroglioma, we analyzed the cerebral location of the involvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to follow up and excluded from survival data. Of the 28 patients, thirteen were male and 8 female. Ages ranged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3900 cGy to 0480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%). Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7,9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting symptoms were headache, cerebral motor, nausea & vomiting and epilepsy in 18,12, 7 and 5 respectively in decreasing order. In CT analysis, low density (02%), cystic mass (33%), calcifiestion (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.

뇌하수체선종

윤세철(Sei Chul Yoon),권형철(Hyung Chul Kwon),오윤경(Yoon Kyeong Oh),박용휘(Yong Whee Bahk),손호영(Ho Young Son),강준기(Joon Ki Kang),송진언(Jin Un Song) 대한방사선종양학회 1985 Radiation Oncology Journal Vol.3 No.1

Twenty-four cases of pituitary adenoma, 13 males and 11 females with the age ranging from 11 to 65 years, received radiation therapy(RT) on the pituitary area with 6MV linear accelerator during past 25 months at the Division of Radiation Therapy, Kangnam St. Mary's Hospital, Catholic Medical College. Of 24 cases of RT, 20 were postoperative and 4 primary. To evaluate the effect of RT, we analysed the alteration of the endocrinologic tests, neurologic abnormalities, major clinical symptoms, endocrinologic changes and improvement in visual problems after RT. The results were as follows ; 1. Major clinical symptoms were headache, visual defects, diabetes insipidus, hypogonadisms and general weakness in decreasing order of frequency. 2. All but the one with Nelson's syndrome showed abnormal neuroradiologic changes in the sella turcica with an invasive tumor mass around supra· and para-sellar area. 3. Endocrinological classifications of the patient were 11 prolactinoma, 4 growth hormone -secreting tumors, 3 ACTH-secreting tumors consisting of one Cushing's disease and two Nelson's syndrome, and 6 nonfunctioning tumors. 4. Eleven of 14 patients, visual problems were improved after treatment but remaining 3 were unchanged. 5. Seven of 11 prolactinomas returned to normal hormonal level after postoperative and primary RT and 3 patients are being treated with bromocriptine (BMCP) but one lost case. 6. Two of 4 growth hormone·secreting tumor returned to normal level after RT but the remaining 2 are being treated with BMCP, as well.

The Effect of Radiation Therapy on Oligodendrogliomas

Sei Chul Yoon(윤세철) , Sung Whan Kim(김성환) , Soo Mi Chung(정수미) , Hak Jun Gil(길학준) , Kyung Sub Shinn(신경섭) , Yong Whee Bahk(박용휘) , Joon Ki Kang(강준기) , Jin Un Song(송진언) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

가톨릭의대 방사선치료실에서는 1983년 4월부터 1989년 4월 사이 6년 동안에 회돌기교종환자 21예를 외부방사선 치료하였다. 전예에 대하여, 연령 및 발병부위별 빈도와 임상증상과 CT 소견 그리고 추적 가능하였던 20예의 생존율에 관한 후향적 분석을 하여 다음과 같은 성적을 얻었다. 1. 전예는 원발성 뇌종양으로 방사선치료 하였던 환자 (246예)의 약 8%의 빈도를 보였으며, 연령 분포는 5~62세(중앙값 38세)이고, 남녀의 비는 13:8이었다. 2. 임상 주 증상은 두통 18예(86%), 뇌운동신경마비 12예(57%), 오심구토 7예 (33%), 경련 5예 (24%)등 순을 보였다. 3. 발병부위는 전두엽 10예 (48%), 두정엽 10예 (48%), 측두엽 7예 (33%), 후두엽 2예 (10%) 그리고 뇌간 및 소뇌가 각각 1예 (5%)씩 이었다. 4. 조직학적 진단은 정위다방향 조직생검이 3예(14%), 종양의 수술적 제거 (부분 전체제거)에 의함이 18예(86%)이었다. 전예에서 전뇌 및 소부위에 3960~6480cGy/5~8주 외부방사선 치료를 하였고, 6예(29%)에서는 항암약물 치료도 병행하였다. 5. CT음영은 저, 고, 혼합 및 등가음영이 각각 13(62%), 3(14%), 3(14%), 2(10%), 예씩 이었고, 낭성종괴 7예(33%), 괴사 및 출혈성 종괴가 각각 1예(5%)씩 이었다. 석회와 음영은 14예(67%)에서 관찰되었으며, 조영증강 유무는 9:12로 나타났다. 6. 평균생존기간은 38개월이었다. From April, 1983 through April, 1989, we have treated histologically proven 21 patients with oligodendroglioma using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam St. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated 21 patients with oligodendrog-lioma, we analyzed the cerebral location of the involvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to follow up and excluded from survival data. Of the 21 patients, thirteen were male and 8 female. Ages raged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3960 cGy to 6480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%) Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7, 9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting symptoms were headache, cerebral motor, nausea & vomiting and epilepsy in 18, 12, 7 and 5 respectively in decreasing order. In CT analysis, low density (62%), cystic mass (33%), calcifica-tion (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.

외상성 뇌경막하 수종에 대한 임상적 연구

지철 ( Chul Jee ),김영 ( Young Kim ),박춘근 ( Chun Kun Park ),김문찬 ( Moon Chan Kim ),김달수 ( Dal Soo Kim ),강준기 ( Joon Ki Kang ),송진언 ( Jin Un Song ) 대한외상학회 1988 大韓外傷學會誌 Vol.1 No.1

Authors represented an analysis on 81 patients with traumatic subdural hygromas who had been ad-mitted from 1983 to 1985. All cases were diagnosed by CT scan. The results were summarized as follows: 1).The main symptoms were: headache, lowered consciousness and neurological plateau. Nine patients (8.6%) did not present any symptom. 2)In 81 cases, 43.2% had not associated head injury (simple subdural hygroma), and 54.3% were diagnosed in subacute stage (2 to 14 days). 3)A lot of patients in subacute type subdural hygroma who had contusion or had no associated head injury were getting worse in their clinical course. 4)The most common interval from trauma to diagnosis was from 2 days to 14 days, but in cases with epidural or subdural hematoma, most of subdural hygroma were diagnosed in chronic stage. 5)In cases with surgical treatment, high proportion of patients, who were over 60 years old and whose subdural hygroma were diagnosed in acute stage, showed plateau, or worsened clinical result. In cases with conservative treatment, such a clinical result was noted in lots of patients who had simple and/or subacute type subdural hygroma between 41 to 60 years old. G)Glasgow outcome scale had not relation to interval from trauma to diagnosis of subdural hygroma, but to age of patient and associated head injury. 7)Improvement in CT finding had not relation to type of treatment and clinical result, but to age of patient.

前交通動脈瘤에 對한 手術成績分析

宋鎭彦,李永根,崔昌洛,姜俊基,宋將成,河榮秀,李春章,金達洙,成台慶,安明洙,許春雄,朱文培,金英鎭 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

The authors attempted to analyse the factors influencing the mortality involved in aneurysm surgery based on 38 cases of intracranial surgery for anterior communicating aneurysms, and obtained the following conclusion. 1. The surgical results are much better when the aneurysm surgery is delayed over one week after the occurrence of aneurysmal rupture, if there is no evidence of intracerebral hematoma. Administration of a massive dosage of epsilon aminocaproic acid in the waiting period prior to aneurysm surgery seems to be effective for preventing recurrence of bleeding from the aneurysm. 2. The direction of the anterior communicating aneurysm should be clearly visualized on a cerebral angiogram so that the most effective aneurysmal approach can be selected in surgery. 3. Microsurgery and hypotension in aneurysm surgery minimize brain damage in the exposure of aneurysm and provide accurate isolation of the aneurysmal neck from the parent vessel in aneurysmal neck ligation. 4. Proximal ligation of the anterior cerebral artery is also an effective procedure to prevent recurrent hemorrhage from anterior communicating aneurysm.

뇌농양(腦膿瘍)

송진언 대한감염학회 1970 감염 Vol.2 No.1

腦動靜脈畸形에 對한 臨床的觀察과 外科的 療法

宋鎭彦,李永根,崔昌洛,姜俊基,宋將成,李春章,河榮秀 대한신경외과학회 1972 Journal of Korean neurosurgical society Vol.1 No.1

We have experienced 19 patients of the cerebral arteriovenous malformations with subarachnoid hemorrhage, who were admitted to the Presbyterian Hospital, Daegu from January 1966 to July 1968, and to the Catholic Medical Center, Seoul from August 1968 to August 1971. All of the patients, who have the cerebral arteriovenous malformations, were proved by cerebral angiography. Since the site of lesions were considered to have close relation to the neurologic deficit and the result of surgery, various analysis of the clinical manifestations and the cerebral angiographic findings were attempted. Of the 19 patients, surgery was performed on 12 patients and its results were analysed correlating to various types of surgical procedure. Followings are the results, 1. From January 1966 to August 1971, there were 100 cases of cerebral vascular anomalies which were proved by cerebral angiography. Among the 100 cases, there were 71 intracranial aneurysms, 19 cerebral arteriovenous malformations, one cavernous angioma, 2 telangiectasis, 5 cerebral rete mirabile, and 2 Sturge Weber-Dimitris disease. The ratio of arteriovenous malformations to aneurysms was 1 : 3.7. 2. Age distribution of the bleeding arteriovenous malformations was ranged from 8 to 54, and 42 per cent of them were in the third decade. 73 per cent of the group had bleeding from the cerebral arteriovenous malformations before the age of 40. The ratio of male to female was 1.9 : 1. 3. The parietal region was most commonly involved by the malformations. There were 8 parietal lesions, 4 temoroparietal lesions, one temporal lesion, one occipital lesion, and one tela chorioidea lesion. Simultaneous involvement of the both hemispheres occurred in one case. In lesions involving the cerebral hemisphere, there was a predominance of the left side. 4. In the past history, convulsive seizure was recorded in two cases and recurrent hemorrhages were reported in two. One patient was recorded to have suffered fourth hemorrhage and the other have suffered third hemorrhage. 5. Meningeal irritation signs were most frequently observed in bleeding arteriovenous malformations. The incidence of weakness of extremities was higher in lesions involving the parietal area. Unconsciousness was occurred in 6 patients at the onset of symptom, of which transient loss of consciousness was seen in 3 patients. Transient hypertension at the onset was observed in two patients. 6. The feeding arteries of the malformations were most frequently seen from the middle cerebral artery and the draining veins from the malformations were into the superior sagittal sinus and internal cerebral vein in many cases. It was evident that the carotid artery of the site of arteiovenous malformations was markedly dilated in 5 patients. 7. Ligation of the vessels feeding the arteriovenous malformations was carried out in 8 patients. One patient had neurologic deficit after the operation. Evacuation of intracerebral hematoma, resection of the anomaly or carotid ligation were carried out in 4 patients. Of the 12 patients who underwent various types of surgery, there was one death after evacuation of a large intracerebral hematoma. 8. In our opinion, the ligation of feeding artery is a choice of procedure to reduce the incidence of rebleeding, if the resection of the lesion was considered to have operative risk by the location of malformations.

神經外科領域에 있어서의 出血에 대한 應急治療

宋鎭彦 대한의학협회 1974 대한의학협회지 Vol.17 No.1

뇌부종에 대한 Corticosteroids요법

송진언 대한의학협회 1976 대한의학협회지 Vol.19 No.5