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자발성 뇌실출혈의 원인 및 임상적 고찰 : Etiology and Clinical Analysis
하충건,김재일,정진명 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12
Spontaneous intraventricular hemorrhage(IVH) is divided into primary IVH(PIVH) and secondary IVH(SIVH). PIVH is further divided into primary confined IVH(PCIVH) and primary junctional IVH(PJIVH). To evaluate the difference in clinical, etiological and prognostic aspects on the type, location and extent of IVH, we analyzed retrospectively total 53 cases with IVH diagnosed by brain CT for a period of 3 years. We excluded traumatic IVH and IVH due to germinal matrix hemorrhage in premature infant. The incidence of IVH was 23.9%(53 cases) of total 222 hemorrhagic strokes. PIVH and SIVH were 12 cases(PCIVH 8, PJIVH 4) and 41 cases respectively. Age of onset was more younger in PCIVH. All except 3PCIVH was abrupt in mode of onset. The main initial manifestation was headache in PIVH, and altered mentality in SIVH. Most of them whose mentality had been intact on initial examination or improved during the clinical course was PIVH with relatively small amount of hematoma. Sixteen cases with focal neurologic deficits were all SIVH without exception. Meningeal irritation signs were observed in 30 cases, who all showed presence of blood in the fourth ventricle irrespective of the type of IVH. The etiology of IVH was hypertensive intracranial hemorrhage in 23 cases(PIVH 3, SIVH 20), rupture of aneurysm 16(PIVH 2, SIVH 14), bleeding from arteriovenous malformation 5(PIVH 2,SIVH 3), respectively. Other minor causes were complication of anticoagulation. bleeding tendency due to liver cirrhosis, intracranial metastasis of leukemia and Moyamoya disease, and unknown in 4 cases. Distribution of IVH was lateral ventricle only in 14 cases(PIVH 5), the fourth only 3, lateral and the third 9(PIVH 2), the third and the fourth 2, all ventricle in remainder 25 cases. The better mentality was on initial examination and the smaller amount of hematoma was on CT, the better prognosis was revealed. Patients with PIVH had better prognosis than those with SIVH. But there was no definite difference in prognosis on the etiology of IVH.
이상열,임병훈,하충건 大韓成形外科學會 1991 Archives of Plastic Surgery Vol.18 No.1
The anterior interosseous nerve syndrome is a compressive neuropathy of a motor branch of the median nerve, caused by tendinous bands (deep head of pronator teres, arcade of flexor superficialis, thickened lacertus fibrosus etc, trauma, enlarged bursae, tumors, anomalous muscles such as Gantser's muscle or palmaris brevis. On clinical examination, there is weakness or paralysis of the flexor pollicis longus, flexor digitorum profundus of the index finger, and the pronator quadratus muscles with a history of pain in the proximal forearm. The patients will assume a weakness of pinch or an unusual posture of pinch without sensory deficit because of loss of function of these muscles, hyperextending the interphalangeal joint of the thumb and the distal interphalangeal joint of the index finger. We experienced two cases of anterior interosseous nerve syndrome with typical clinical manifestations, confirmed by electrodiagnostic studies. In both cases causative anatomical structures were released through surgical exploration. A case was caused by a sharp edge of the flexor superficialis arcade, another case by the tendinous portion of deep head of pronator teres muscle and a thickened lacertus fibrosus. Both cases revealed partial recoveries after postoperative 3 months.
이정,하충건,윤창호 대한수면연구학회 2006 Journal of sleep medicine Vol.3 No.2
Acromegaly can cause obstructive sleep apnea syndrome because excessive growth hormone (GH) results in abnormal growth of craniofacial skeleton and parapharyngeal soft tissue. A 46-year-old female patient presented with excessive daytime sleepiness and habitual snoring. Polysomnography and multiple sleep latency test documented moderate to severe degree of obstructive sleep-disordered breathings and excessive daytime sleepiness. Craniofacial characteristics leaded to the endocrinologic study that confirmed excessive GH secretion. Sella magnetic resonance image revealed underlying pituitary macroadenoma. Craniofacial features should be carefully evaluated to find the underlying cause of obstructive sleep apnea.