두뇌 손상 환자의 뇌간청각 및 체감각 유발전위 반응소견

이장철,김동원,이정교,임만빈,박영춘,김인홍 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.1

There were 84 cases of brainstem auditory evoked potential(BAEP) and 90 cases of somatosensory evoked potential(SSEP) from the 124 cases of head injury. The studies were performed within the first three days after head injury in most cases and after ten days in emergency operative cases. The results of BAEP and SSEP studies recorded from 67 normal volunteers were used as a control group. The latency, amplitude and wave pattern of the pattern of the evoked potential were examined and a peak or interpeak latency were considered abnormal when it exceeded the corresponding mean ±25D found in the control group. The wave patterns were arranged in BAEP as grade Ⅰ : all waves were normal ; grade Ⅱ : waves Ⅰ, Ⅱ, Ⅲ were abnormal ; grade Ⅲ : waves Ⅳ, Ⅴ, Ⅵ were abnormal ; grade Ⅳ ; all waves were abnormal. In SSEP as grade Ⅰ : all waves were normal ; grade Ⅱ : N_(13) wave was abnormal ; grade Ⅲ : N_(19) wave was abnormal ; grade Ⅳ : all waves were abnormal. The abnormal findings by percentage were : 47.6% in latency of BAEP, 68.9% in latency of SSEP, 49.4% in wave pattern of BAEP and 87.8% in wave pattern of SSEP. The BAEP was superior to SSEP in correlation to clinical parameters including GCS, duration of coma, basal cisterns in initial brain CT scan and Glasgow outcome scale(GOS). As a BAEP criterion, the wave Ⅴ latency and the BCT(Ⅲ-Ⅴ interpeak latency) and as a SSEP criterion, the central conduction time (N_(19)-N_(13))were more correlated to duration of coma and GOS. The appearance of the basal cisterns on initial brain CT is significantly correlated with wave Ⅴ and BCT of BAEP only. Grade Ⅰand Ⅱ were reliable predictors of a good prognosis. Therefore, we concluded that BAEP and SSEP are adjunctively diagnostic tests for determining the outcome of head injuried patients.

경추간판탈출증에 대한 전방경유 골유합술과 미세 전방 경유 추간공 확대술의 치료 비교

이장철,이창영,손은익,김동원,임만빈,김인홍 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.8

요통에서 경막외 Steroid 주입의 효과

이장철,임만빈,김인홍,이창영,강철영,이정구,정정길 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

In order to evaluate the effect of the lumbar epidural steroid injection in the low back pain and/or radicular pain, we studied 66 patients who were treated and followed for an average of 8.6 months. In the initial evaluation, main pain sites were as follows : low back pain in 41 patients, buttock pain in 7 patients, and leg pain in 18 patients. Immediate response and delayed response in the patients were studied. Immediate response within 1 day after injection revealed the following : dramatic improvement in 3.0% ; some improvement in 56.1% ; no improvement in 27.3% ; and more aggravated in 13.6%. Delayed response after 1 month revealed the following : 15.2% continuously maintained improvement ; 9.1% showed progressive improvement ; 36.4% experienced recurring pain ; 27.3% had no improvement ; and 10.6% had aggravating pain. The effect of the lumbar epidural steroid injection was not affected by the severity of pain in the initial evaluation. Better improvements were noted in patients who suffered radicular pain than those who suffered low back or buttock pain. Good prognostic factors were young age and male. Complications that the patients suffered were transient injection pain(6), edema of the face or extremity(10), transient leg weakness(5) and dural puncture(1). The number of patients who wanted to recommend this procedure to others were 22(33.3%). In conclusion, epidural steroid injection was one of the methods in the management of the patients who suffered low back pain and/or radicular pain and had no effect by any other therapies.

내경동맥의 발육부전을 동반한 뇌동맥류

이장철,임만빈,김동원,이정교,김인홍 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.4

The authors report two cases of intracranial aneurysm associated with aplasia of internal carotid artery. The one case showed complete occlusion of left internal carotid artery just above the origin of ophthalmic artery and aneurysm which located at the junction of basilar superior cerebellar artery. The blood supply of the left side anterior cerebral artery came from the right carotid artery through the anterior communicating artery and the left middle cerebral artery came from basilar artery through the enlarged posterior communicating artery. The another case showed marked narrow cervical portion of right internal carotid artery which terminated as a posterior communicating artery just above the origin of ophthalmic artery and large aneurysm which located at the anterior communicating artery. The blood supply of the right side of anterior cerebral and middle cerebral artery came from the left internal carotid artery through the anterior communicating artery. We tried to surgical management of these two aneurysms. We reviewed the literature and discussed the related collateral circulation of this anomaly.

불꽃축제를 활용한 관광자원 개발 가능성 고찰

이장철,안병주,이동수 한국문화산업학회 2017 문화산업연구 Vol.17 No.2

본 연구의 목적은 부산불꽃축제 유료화에 대한 만족도를 분석함으로써 부산불꽃축제를 활용한 관광자원 개발의 가능성을 분석하는데 있다. 본 연구의 구체적인 연구 방법은 (사)부산문화관광축제조직위원회의 관련 자료와 부산불꽃축제 유료화에 대한 언론 보도 자료를 활용하여 분석하였다. 연구 결과를 종합하여 보면, 현재 부산불꽃축제의 만족도는 부산지역에 거주하는 내국인 보다 타 지역에서 축제를 관람하기 위하여 참여하는 관광객의 만족도가 더 높은 것으로 확인할 수 있다. 따라서 부산불꽃축제의 유료화를 안착시키고, 관광자원으로 발전시켜 나가기 위해서는 축제 제반 환경을 개선시키고, 유료화 티켓 구매 절차와 비용에 대한 대응책 마련을 통해 향후 재참여를 촉진하고, 구전 효과를 극대화 시킬 수 있는 마케팅을 통하여 관광자원으로 적극 개발하여야 할 것으로 분석되었다. The purpose of this study is to analyze the satisfaction rate of ticketed Busan Fireworks Festival, and study the possibility of tourism resource development utilizing Busan Fireworks Festival. The research of this study was conducted by analyzing the data related to Busan Culture & Tourism Festival Organizing Committee and the press release data on the ticketed Busan Fireworks Festival. The conclusion we can draw from these results is that, the overall satisfaction of Busan Fireworks Festival was relatively higher among those visiting from outside of Busan city than the local Busan citizens. Therefore, in order to establish ticketing system and actively develop the festival as one of tourism resources, it is necessary to improve overall environment of the festival, promote re-participation of the people by developing more efficient ticket buying procedures, prepare countermeasures for charges, and develop marketing strategies to maximize word-of-mouth effect. 본 연구의 목적은 부산불꽃축제 유료화에 대한 만족도를 분석함으로써 부산불꽃축제를 활용한 관광자원 개발의 가능성을 분석하는데 있다. 본 연구의 구체적인 연구 방법은 (사)부산문화관광축제조직위원회의 관련 자료와 부산불꽃축제 유료화에 대한 언론 보도 자료를 활용하여 분석하였다. 연구 결과를 종합하여 보면, 현재 부산불꽃축제의 만족도는 부산지역에 거주하는 내국인 보다 타 지역에서 축제를 관람하기 위하여 참여하는 관광객의 만족도가 더 높은 것으로 확인할 수 있다. 따라서 부산불꽃축제의 유료화를 안착시키고, 관광자원으로 발전시켜 나가기 위해서는 축제 제반 환경을 개선시키고, 유료화 티켓 구매 절차와 비용에 대한 대응책 마련을 통해 향후 재참여를 촉진하고, 구전 효과를 극대화 시킬 수 있는 마케팅을 통하여 관광자원으로 적극 개발하여야 할 것으로 분석되었다. The purpose of this study is to analyze the satisfaction rate of ticketed Busan Fireworks Festival, and study the possibility of tourism resource development utilizing Busan Fireworks Festival. The research of this study was conducted by analyzing the data related to Busan Culture & Tourism Festival Organizing Committee and the press release data on the ticketed Busan Fireworks Festival. The conclusion we can draw from these results is that, the overall satisfaction of Busan Fireworks Festival was relatively higher among those visiting from outside of Busan city than the local Busan citizens. Therefore, in order to establish ticketing system and actively develop the festival as one of tourism resources, it is necessary to improve overall environment of the festival, promote re-participation of the people by developing more efficient ticket buying procedures, prepare countermeasures for charges, and develop marketing strategies to maximize word-of-mouth effect.

제2경추 골절의 분류에 따른 임상 소견과 치료 결과의 비교

이장철,손은익,김동원,임만빈,김인홍 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.11

저자들은 최근 7년간 치료한 제 2경추 골절 환자 43명을 대상으로 손상 기전에 따라 구분한 Benzel등의 분류에 따라 치상 돌기 골절, 제 2경추제 수평 고절, 제 2경추제 시상 골절, 제 2경추제 관상 골절, 제 2경추제 전방전위 골절 등 5가지로 구분하여 비교하였다. 치상 돌기 골절은 불유합의 가능성이 높아 조기 수술이 요망된다. 제 2경추체 수평 골절은 편측 탈구가 많아 정복시 회전력을 감안하여야 할 것이다. 제 2경추제 시상 골절은 상관절돌기 골절을 동반하였다. 제 2경추제 관상 골절은 전방 전위 골절과 비슷하였으나 상관절돌기 골절 등 다른 복합적인 골절을 동반하여 정복시 어려움이 있었다. 그러므로 이 분류 방식에 따라 발생 기전을 이해하고 치료를 하면 더욱 좋은 결과를 얻을 것으로 예상된다. There are some debates on the best method of treatment of C-2 fractures. Clinical findings and results of treatment were evaluated in forty-three patients with C-2 fractures. These fractures were classified into five types according to the classification by Benzel^(4)) : 1) odontoid fractures (14), 2) horizontal C-2 body fractures (13), 3) sagittally oriented vertical C-2 body fractures (2), 4) coronally oriented vertical C-2 body fractures (8),5) traumatic spondylolisthesis of the axis (6). Primary fusion appears to be justified in odontoid process fractures due to a high rate of non-union. In horizontal C-2 body fractures, unilateral facet dislocation was visible in six patients which was the cause of malalignment in closed reduction. In sagittally oriented vertical C-2 body fractures, combined facet fractures were always visible because the mechanism of injury was axial compression. The choice of management schemes may depend on the mechanism of injury and fracture type defined by Benzel.

거대 뇌동정맥기형의 성공적 처치 : 술전 색전술 및 단단계 수술법에 의한

이장철,임만빈,손은익,김동원,이정교,김인홍,전석길 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.3

The surgery of large cerebral arteriovenous malformation(AVM) may be complicated by the potential for serious brain swelling and hemorrhage during operation and/or postoperative period due to "normal perfusion pressure breakthrough(NPPB)". The authors present two cases of successful management of large AVM which anticipated the development of 'NPP' using hypotension and preoperative embolization. The one case admitted with intraventricular hemorrhage and intracerebral hematoma due to rupture of large occipital AVM. We managed him with one-stage resection, followed by postoperative hypotension successfully. The another case was interesting. He had the history of intracranial hemorrhage about 13 years ago. We treated him conservatively at that time. He also had the another attack of intracranial hemorrhage in 1979. We performed angiogrphy which revealed large AVM around trigon of left lateral ventricle. He also had another one time of intracranial hemorrhage in 1985. In 1986, We decided to treat hem surgically and repeated angiography which showed enlarged AVM compare to size of AVM in previous angiogram of 1979 definitely. We embolized this lesion with Ivalon®(polyvinyl alcohol) and confirmed decreased size of AVM. During waiting the surgical resection, another intracranial hemorrhage occurred and recovered without surgical management. In May 1987, we decided to do operation and performed preoperative angiography, which showed reenlarged of previous embolic obliterated AVM. We resected that AVM successfully and discharged him without any aggravation of previous neurological signs. The pathologic findings of resected embolized AVM revealed infiltration of neurtrophils within vessel walls and foreign body material, surrounded by multinucleated foreign body giant cells, epitheloid cells in the vessel lumen. We reviewed the literature and discussed the enlargement of AVM, the treatment of large AVM, especially in point of view about 'NPPB' and pathologic fingings of embolized AVM with Ivalon®(polyvinyl alcohol).

핍지신경교종의 예후인자

이장철,이선희,임만빈,김상열,손은익,김동원,김인홍,김상표 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.9

In order to find out the prognostically significant factors in the oligodendrogliomas, we investigated the relationship between the clinical and histopathological characteristics and the mean survival time after surgery in 21 cases of oligodendrogliomas which were managed surgically and confirmed pathologically during the 12-year period. The survival analyses were performed on eight possible prognostic factors including age. duration of symptoms, Kornohan grade. mitosis, pleomorphism, endothelial proliferation, cell density, and gliofibrillary oligodendrocyte(GFOC) which wa sdetected by immunohistochemical method. The results rvealed that the tumor grade as classified by the Kernohan. cell density and the GFOC in Kernohan grade Ⅰ&Ⅱ had a prognostic significancy in order of decreasing importance. The best prognosis of the cases was found in the absence of GFOC in Kornohan grade Ⅰ&Ⅱ. The 2-year and 5-year survival rates after surgery were estimated as 62% and 42%. respectively.

금속판 및 나사를 사용한 경추제 융합술의 결과

이장철,김동원,손은익,임만빈,김인홍 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.5

저자들은 1991년 8월부터 1994년 12월까지 퇴행성 경추증 7예, 후종인대 골화증 4예, 결핵성 및 화농성 골수염 5예, 진이성 종양 3예, 외상 40예에서 Caspar 및 TOP 금속판을 사용한 경추부 전방 융합술을 시행한 후 추적 관찰하여 그 결과를 분석하였다. 95%에서 조기 고성의 목적을 달성할 수 있으며, 골 융합은 판정이 가능한 54예 모두에서 성공적이었다. 나사못 이완이 5예로 가장 많은 합병증이었으며 1예의 식도 천공이 있었으며 2예의 연하 곤란, 2예의 나사못 골절이 있었다. 나사못 이완은 금속판의 부정확한 위치, 골다공증, 탈구의 불완전 정복 등이 원이이었다. 전방 금속판의 사용은 골 융합을 목적으로 하는 내고정 방법으로서 대체로 우수하나 숙련된 수기와 세심한 주의가 필요하다. In order to evaluate long term effects of the anterior cervical plating system. we report the results of 59 patients who were treated with anterior decompression. autogenous iliac bone graft. and anterior cervical plate. Operations were performed on 59 patients for a variety of reasons ; 40 for fracture and/or dislocation, 7 for degenerative spondylosis 4 for ossification of posterior longitudinal ligament. 5 for pyogenic or tuberculous spondylitis. and 3 for metastatic tumor. Our study consisted of 41 male and 18 female patients whose ages ranged from 14 to 76 years. immediate fixation was obtained in 56 cases(95%). Satisfactory fusion was obtained in all but five cases of which the result could not be judged due to death of the patients(3 cases of metastatic disease) and removal of the instrument(2 cases of fracture). Specific complications included 5 cases of screw loosening, f cases of screw fracture. 2 cases of dysphagia. and 1 case of esophageal fistula. The anterior plate system is thought to provide a valuable means of treating cervical instabilities.

만성 피낭성 뇌내혈종 : 소위 Chocolate낭종 5례 So Called Chocolate Cysts

이장철,손은익,김동원,이정교,임만빈,김인홍 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5

Five cases of chronic encapsulated intracerebral hematomas(so called "chocolate cysts") presented slowly progressive neurological deficits and hence mimicked brain tumors. The median duration of symptoms was 21 days. The first symptoms were severe headache and vomiting. At one case generalized seizure was noted. Computed tomography almost consistently demonstrated ring shaped lesions with central high density and minimal perifocal edema. Cerebral angiographic studies showed avascular mass lesions. All cases had superficial white matter lesions. Soft, well-encapsulated, organized, large intracerebral hematomas were removed surgically. Arteriovenous malformations were detected in two cases. All cases recovered completely but at one case postoperative brain swelling was noted transiently. Increasing awareness of "chocolate cyst" as a clinical and pathological entity was necessary.