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의식명료한 경한 두부외상에서 CT촬영의 필요성에 대한 연구 : Is CT always Necessary?
송화식,김갑득 단국대학교 1998 論文集 Vol.33 No.-
We studied retrospectively 721 alert patients with mild head injury who visited to Emegency Medical Center of Dankuk University Hospital during a 18 months period to determined the clinical value of routine initial computerized tomography(CT) of the head and the follow-up CT scanning in alert patients with mild head injury. Variables reviewed were age of patients, symptoms of head trauma(brief loss of consciousness(LOC), amnesia, nausea and vomiting, headache), skull fracture on skull radiology, intracranial lesions, delayedintracranial lesion and operation. All 721 patients underwent CT of the head on the basis of history of symptoms and signs of head injury. Of these 721 patients, 159(22.1%) had skull fracture and 146(20.2%) with intracranial lesions, and 44(6.4%) required neurosurgical operation. Conclussively routine initial CT scanning in patients with linear or basal skull fracture, older than 60 years old or symptoms of head injury has clinical value and is warranted. Also follow-up CT scanning in necessary in patients with linear or basal skull fracture, symptoms of head injury or abnormal findings in initial CT scan.
송화식,김갑득,오성환,강명희 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.2
Background: A skull fracture is an indication of the severity of the head trauma and the physician should be alert to the potential for intracranial injuty , such as intracrnial lesioos and clinical management of patients with head injury. Methods: We evaluated 251 tients with nondepressed closed or basal skull fractures who was admitted to the Einergency Medical Center of Dankuk University Hospital from July 1996 to December 1997 tetroapectively and used x2-test statistical significance. Result: The overall incidence of skull fractures in head injury was 26,1%. Of wbom 78.5% have linear slnill fracture and 21.5% have basal skull frature, Of patients with skull fractures, 63.7% have associated, intracrainal 1esions and 19.5% with delayed intracrmial hematomas. Higher percentage of patients with linear skull fratures have iatracranial lesions, especially epidural bematoma, compered with patients with basal sku11 fratures. Similarly intracrania] lesions are highly associated in Older than 60 years old and multiple and long skull fractures. Epidural hematoma is almost found to be coup injuries whereas with subdural hematoma, contrecoup iajuriea in high percentage(22.4%). Delayed intracrainal hematomas are found in 63.7% of patients with skull fracture, and in 24.3% of patiens without skull fracture. They are also highly developed in patients with multiple or long skull fracture. Conclusion: The presence of a skull fracture is the important predictor of intracranial hematoma and influences mamagment of patient. We recommend the routine skull x-ray studies in all head injured patients. If skull fracture is detedcted, the patients then should undergo initial CT scanning and follow-up CT scanning.
송화식,양정현 中央醫學社 1993 中央醫學 Vol.58 No.11
During the 10-year period between January 1980 and December 1989, 33 cases of advanced breast cancer patients who under vent CMFVP anticancer chemotherapy among 134 breast cancer patients at National Medical Center were analyzed retrospectively with respect to response rate, duration of response and survival. 1. Radical or modified radical mastectomies were performed in 21 cases, simple mastectomy or biospy only were done in 12 cases among 33 patients at initial operation, the cases of metastatic lymph node above 4 in number were 11 cases (61.1 %). 2. The infiltrating ductal carcinoma was 29 cases as the commonest pathologic type. The hormonal receptor status was evaluated in 9 cases, ER or PgR positive cases were 7 cases (77.8 %). 3. There were 62 sites of confirmed metastatic sites among 30 patients. The classification according the recurrence sites were as follows, 17 cases of pulmonary metastasis, 13 cases of osseous metastasis, 12 cases of local recurrence and 7 cases of pleural metastasis. 4. The response rate according to recurrence sites were as follows, 53.8 % response rate in osseous metastasis, 52.4 % in pulmonary metastasis, 66.7 % in local recurrence and 42.9 % in pleural metastasis, respectively. 5. The overall response rate was 51.5 %, the median duration of response was 8 months. 6. The survival span after initial operation to death for advanced breast cancer was 3.8 years among 30 cases of confirmed recurrence cases.