요추간판탈출증 수술 후 수술 실패와 재발에 관한 임상적 연구

황금철,이승재,이종수,박효일 인제대학교 1990 仁濟醫學 Vol.11 No.4

1980년대부터 1989년까지 만 10년갼 확진된 요추간판탈출증으로 입원 치료를 받았던 2,436명의 환자 중, 수술 치료를 받았던 환자는 1,423(58.4.%)례 였으며, 이러한 일차 수술을 받았던 환자 중 일차 수술 후 상태의 변화가 없었거나 악화된 경우와, 상태가 완전히 호전 치유되었다가 재발한 환자는 82/1,423례(5.76%)였다. 수술 실패(FBSS)는 47/1,423례(3.3%), 재발(Recurrence)은 30/1,423례(2.1%), 타부위의 제2의 신생요추간판탈출증은 5/1,423례(0.3%)였고, 이들 수술실패와 재발례의 재치료 형태는 고식적 치료가 44례(53.7%), 재수술이 38례(46.3%)로서 95.12%가 호전 치유된 만족한 치료 결과였다. 1차 수술후 수술실패와 재발환자의 재수술은 38/1,423례(2.67.%)였다. 수술 실패와 재발의 발빈의 선행적 원인에서, 1차 수술 후 상태의 변화가 없었거나, 악화 또는 수술 합병증에 의한 예가 35/82례(42.7%)였으며, 주된 병인병리학적 소견은 수술실패적 예에서는 보상성 전환 신경증, 수핵의 불완전 적출, 신경근의 지주막염 등의 순위로 주로 수술 적응의 잘못이나 수출기법의 실패에 기인된 것이었고, 재발된 경우에서는 진행되는 퇴행성 변성 병변으로서 노령화현상(Aging process)과 경막외섬유 증식이었다. Lumbar disc surrey was performed in 1,432 patients among the 2,436 patients diagnostically proved lumbar herniated neucleus pulposus during ten years period (Jan. 1980-Dec. 1989) at the Inje University, Paik hospital, Seoul. The initial operative treatment ratio was 58.4%. Through the investigation of these patients, the authors found 82 patients of re-admission and / or re-operated cases because of worsened clinical states and/or recurrences following initial lumbar disc surgery. The prevalence rate of worsening and recurrence following initial lumbar disc surgery was 5.7%. The authors' opinion was that these worsening and recurrence cases following the lumbar disc surgery should be classified into two groups ; one was a case of unchanged or worsening clinical states from the initial disc surgery was failed back surgery syndrome(FBSS) and the other was a case of recured lumbar disc symptoms who had satisfactory symptom free intervals form the initial disc surgery was recurrence. The prevalence rate of FBSS was 3.3% (47/1,423 cases) and that of reccurence was 2.46% (35/1,423 cases) included 5 cases of new disc herniation of other level. In the 82 total FBSS and recurrence cases, 39 cages (46.3%) were underwent to re-operation, and the ratio of re-operation was 2.67% (38/1,423). The major causes of onset of FBSS and recurrence were unchanged or worsening and direct complication from initial surgery, which rate was 42.7% (35/82 cases). The main leading pathologic factors between FBSS and recurrence were quite different characteristically : these of FBSS were inadequate indication of disc surgery and technical failure etc. and these of recurrence were continuation of degenerative changes (Aging process) and epidural fibrosis etc. This study investigated and assessed the main leading pathologic factors, the methods of re-treatment, the techniques of re-operation, the results of treatment, the disability grade of H.N.P. of FBSS and Recurrence more detaily.

척수내 결핵종 1예

황금철,이채혁,고영초,박효일,주미 인제대학교 1998 仁濟醫學 Vol.19 No.2

척수내 결핵종은 매우 드물다. 척수내 결핵종은 항결핵제에 비교적 잘 반응한다고 보고 되고 있고, 수술적 치료는 간혹 요구된다고 하였다. 저자들은 척수내 결핵종으로 항결핵제를 투여하였으나, 임상적으로 호전되지 않고 더 악화되어 수술적으로 제거한 후 항결핵제를 병행 투여하여 좋은 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. Intramedullary tuberculomas are extremly rare. Intramedullry tuberculomas normally respond well to conventional antiturculous medications requiring surgery only occasionally. We report a case of an intramedullry tubercaloma that the lesion unchanged during appropriate medical therapy, and thus reguired surgical excision. Excellent clinical outcome was obtained with combination of medical and surgical mangement.

요추간판탈출증의 통계적 실제와 수술 실패 및 재발의 예방 대책

황금철,이승재 인제대학교 1991 仁濟醫學 Vol.12 No.1

요추간판탈출증의 완벽한 치료는 쉽지 않으며, 통계적으로 5-40%의 불만족스러운 치료 결과를, 5-25%의 수술 실패 또는 재발율, 5∼18%의 재수술율을 보이고 있는데, 수술 실패의 주요 원인은 진단의 잘못, 신중하지 못한 치료 방법의 결정, 시행한 수술 자체의 결함 등이며, 재발의 주요 원인은 신생요추간판탈출증의 발병과 진행되는 변성변화, 즉 노화현상(Aging Process)이였다. 이 요인들은 대부분 의인성(Iatrogenic)이기 때문에 저자들은 수술 실패 및 재발예의 검토와 문헌 고찰을 통하여 수술 실패 및 재발의 예방과 대책에 관하여 정리하였다.

흉수부 경막내 척수내 지방종

황금철,최찬영,황충진 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Intradural lipomas are benign tumors of the spinal cord corresponding to 1% of all primitive intradural tumors and intradural lipoma not associated with spinal dysraphism are very unusual. A case of an intradural intramedullary lipoma in the thoracic region in a 47-year-old male is reported. Surgical decompression with biopsy or subtotal resection is the operative procedure of choice.

송과선 종양 세포주의 세로토닌 유도 세포자멸사에 대한 멜라토닌의 보호작용

황금철,황충진 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Objective : Although the pathophysiology of neurodegenerative diseases and serotonin syndrome has been reported, its mechanism has not been elucidated. In this study, the cytotoxicity of serotonin and protective effect of melatonin is examined by using the pineal gland tumor cell line, which is known to secrete serotonin. Methods : The cell cytotoxicity concentration measurement was performed by 3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide(MTT) assay method. In order to judge the protective effect of melatonin, morphological study and 4.6-diamdi-no-2-phenylindole(DAPI) staining, flow cytometry, and RT-PCR was performed. Results : Serotonin showed about 50% cytotoxicity at a concentration 1mM in the pineal gland tumor cells(PGT-beta). Studies of the morphological changes induced by serotonin revealed cell shrinkage and cytoplasmic condensation and that the affected cells were scattered from the floor of the culture dish. "Rounding up" of the affected cells and morphological features consistent with the morphological definition of apoptosis were observed. Morphological and 4.6-diamdino-2-phenylindole(DAPI) staining analyses of cells pretreated with melatonin revealed that these cells were similar patterns compared to the control. These results showed that melatonin protects apoptosis by serotonin toxicity. Flow cytometric analysis of cells treated with 1mM serotonin showed that these cells had lower G1 peaks compared with cells grown in controls. RT-PCR analyses of apoptotic genes of cells pretreated with 100nM meiatonin showed that expressions of bclx and bax genes in these cells were slightly lower and p53 was similar pattern compared to the serotonin-treated group. Conclusion : This study would provide important basic data on the possibility of the clinical treatment of melatonin in the pathogenesis of not only the serotonin-related neuropsychiatric disorders but also serotonin syndrome.

요추간판 탈출증 수술후 발생한 요통 환자의 임상적 연구

황금철 인제대학교 1997 仁濟醫學 Vol.18 No.1

1980년부터 1955년까지 16년간 요추간판 탈출증으로 입원 치료를 받았던 4,104 명의 환자 중. 수술적 치료를 받았던 환자는 2,754 (67%)명이었고, 수술후 임상 상태의 변화가 없거나, 악화된 경우와 완전히 호전되었다가 재발한 환자를 실패한 요추간판 탈출증 수술 증후군(Failed Back Surgery Syndrome : FBSS)이라고 하며, 그 수는 182예(6.6%)였다. 재치료 형태는 수술적 치료가 102예(56%), 고식적 치료가 80예(44%)였는데 93%에서 만족할만한 치료결과를 보였다. 이 182예를 분석 검토한 결과 병변은 일차 수술과 동일한 곳에서 주로 발생하였고, 일차수술 1년 이후에 증상이 발현된 경우 및 다른 부위에서 병변이 발생한 경우 예후가 좋았다. 주된 병리소견은 척추강 협착증 72예(39%), 잔존 혹은 재발된 요추간판 탈출증 35예(19%), 경막외 섬유증식 32예(17%) 및 유착성 지주막염 14예(6%) 등이었다. 또한 재치료하기전 임상 증상이 심한 환자일수록 수술적 치료를 많이 하였고, 고식적 치료를 시행한 경우보다 예후가 좋았다. Lumbar Disc surgery was performed in 2,754 patients among the 4,104 patients diagnostically proved as lumbar herniated nucleus pulposus during 16 years period (Jan. 1980-Dec. 1995) at the Inje University, Paik hospital, Seoul. The initial operative treatment ratio was 67%. Through the investigation of these patients, the author found 182 patients of re-admis-sign because of low back pain with or without leg pain following initial lumbar disc surgery. The prevalance rate of FBSS was 6.6% (182/2754 cases). In the 182 cases, 102 cases were underwent to reoperation, and the ratio of reoperation was 56%(102/182 cases). The clinical result is affected predominantly by the time interval between the first operation and worsening symptoms and by the main pathological factors. The good result could be achieved among patients after one year following initial surgery. The most common pathological findings were spinal stenosis (72 cases: 39%), recurrent or persistent disc herniation(35 cases:19%), epidural fibrosis (32 cases 17%), and adhesive arachnoiditis(11 cases;6%) The better results were achieved among the patients who were re-operated than who were treated conservatively in the patients with severe symptoms. The adequate bony decompression, complete removal of disc, meticulous bleeding control, autologuous fat graft were considered to be helpful to reduce the chance of reoperation.

뇌교 출혈과 예후 인자에 관한 분석

황금철,최찬영,황충진 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Spontaneous brain stem hemorrhage usually results in higher mortality and morbidity with poorer prognosis than any other intracranial vascular lesion in spite of meticulous medical or surgical treatment. Sixteen cases of pontine hemorrhage who were treated either surgically or conservatively were analysed. Among seven cases treated surgically by suboccipital craniotomy or stereotaxic evacuation showed on Glasgow Outcome Scale(GOS) Ⅰ, one GOS Ⅱ, two GOS Ⅲ, one GOS Ⅳ, two GOS Ⅴ. On the other hand, nine cases who were treated conservatively showed one GOS Ⅰ, one GOS Ⅱ, one GOS Ⅳ and six GOS Ⅴ. The prognosis of primary pontine hemorrhage depends on the size, location, and extent of the hematoma. With regard to the site, three types of hemorrhage are to be considered as the tegmentotectal (Type Ⅰ), the tegmentolateral(Type Ⅱ) and tegmentobasilar(Type Ⅲ). Surgical treatment for the pontine hemorrhage should be reserved for tegmentotectal and tegmentolateral type and we hope to emphasize the efficacy of surgical treatment.

다발성 뇌수막종 1예

황금철,이채혁,고영초,박효일,강윤경 인제대학교 1998 仁濟醫學 Vol.19 No.2

수막종은 두개강내 종양 중 비교적 흔한 종양이나 다발성 수막종은 드물다. 저자들은 65세 남자로 두통과 좌측 편마비를 주소로 모 대학 병원에 입원하여 시행한 단층촬영과 자기공명영상검사에서, 우측 전두부 측격부위와 좌측 두정부 궁융부에 발생한 다발성 수막종으로 진단되어, 좌측 두정부 궁융부의 종양은 완전 제거되었으나, 우측 전두부 측격 부위의 종양이 부분적으로만 제거되어, 본원으로 전원된 후 재수술을 통하여 성공적으로 제거하였다. 병리학적 검사상 우측 측겸 부위는 비정형 수막종이고, 좌측 두정부는 소낭성 수막종이었다. Meningiomas are common intracranial tumor, but the neurosurgiral frequency of multiple meningioma is low. The authors report a case of multiple meningioma of supratentorial region. The patient was 65-year-old male and presented headache and left hemiparesis. CT and MRI revealed multiple meningioma in right parafaxial region and left parietal converxity region. The patient had underwent bilateral frontal and frontoparietal craniotomy with total removal of the left parietal tumor and partial removal of the right parafaxial tumor. He was transferred for the removal of the remanining tumor. The patient was treated sucessfully and these pathological types was different as atypical meningioma in the right parafoxial tumor and microcystic meningioma in the left parietal tumor.

Hybrid Particle Swarm Optimization 기법을 적용한 X-대역 광대역 편파 변환기 설계

황금철(Keum Cheol Hwang) 한국전자파학회 2009 한국전자파학회논문지 Vol.20 No.4

본 논문에서는 미앤더 스트립라인을 이용한 X-대역 광대역 편파 변환기 설계 및 최적화 문제에 대해서 고찰하였다. 편파 변환기에 입사되는 편파를 수직, 수평 성분으로 분리하고 각 편파별로 등가 전송선 모델(transmission line model)을 사용하여 교차 편파 억제율과 편파 변환율을 계산하였다. 또한, 최적화된 파라미터 도출을 위해 유전 알고리즘과 particle swarm optimization에 기반한 하이브리드 알고리즘의 성능을 평가하고 설계에 적용하였다. 최적화된 편파 변환기는 X-대역(8.45~11.38 ㎓)에서 -25 ㏈ 이하의 편파 억제 성능을 보여주고 있으며, 편파 변환 손실은 0.2 ㏈ 이하로 계산되었다. 또한, 이 결과를 상용 시뮬레이션 수치와 비교 분석하였다. Design and optimization of a broadband meander-line twist reflector was performed for X-band application. Based on the equivalent transmission line model, the polarization twist performance was evaluated. Genetic analysis, particles swarm, and hybrid swarm optimizations were employed to obtain the optimized geometrical parameters. The optimized design exhibits low cross-polarization level below -25 ㏈ between 8.45 and 11.38 ㎓. The polarization twist loss was below 0.2 ㏈. Comparison between computed and simulated results was also discussed.

X-Band 모노펄스 추적 레이더를 위한 광대역 도파관 Magic-T 최적화 설계

황금철(Keum Cheol Hwang) 한국전자파학회 2009 한국전자파학회논문지 Vol.20 No.10

본 논문에서는 광대역 X-Band 추적 레이더의 모노펄스 비교기(comparator)에 적용 가능한 도파관 magic-T 설계 및 최적화 문제에 대해서 고찰하였다. 다층으로 구성된 도체 실린더(cylinder)를 이용하여 기존의 X-Band magic-T에 비해 광대역의 임피던스 정합을 구현하였다. 최적화된 파라미터 도출을 위해 유전 알고리즘과 particle swarm optimization을 결합한 하이브리드 최적화 알고리즘을 설계에 적용하였으며, 최적 설계된 도파관 magic-T는 모든 도파관 포트에 대해, 최소 12 % 이상의 대역폭에서 -20 ㏈ 이하의 반사 특성을 나타내었다. 전력 분배손실은 0.2 ㏈ 이하이며 전력 분배 편차 또한 0.1 ㏈ 이하로 우수한 특성을 보여주었다. 또한 측정된 결과는 시뮬레이션 결과와 잘 일치하는 것을 확인하였다. 마지막으로, 적층 실린더의 차수를 증가시켜 5단 및 7단 적층된 구조에 대한 대역폭 성능도 분석하였다. Design and optimization of a broadband waveguide magic-T was performed for X-Band tracking radars. A multistepped conducting cylinder was used to enhance the bandwidth performance of the conventional waveguide magic-Ts. Particles swarm optimization in conjunction with genetic algorithm was employed to obtain the optimized geometrical parameters. The optimized design exhibits low reflection coefficient below -20 ㏈ at all waveguide ports with frequency bandwidth of 12 %. The transmission loss and difference are within 0.2 ㏈ and 0.1 ㏈, respectively. Measured results are also shown to be in good agreement with the simulated results. Finally, the bandwidth performances for five and seven-stepped conducting cylinders are also investigated.