척수내 결핵종 - 증 례 보 고 -

김상우,김성민,심영보,최선길,Kim, Sang Woo,Kim, Sung Min,Shim, Yong Bo,Choi, Sun Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Intramedullary spinal tuberculoma is a rare form of central nervous system tuberculosis. The authors presented a case of 41 years old male with intramedullary and intradural extramedullary tuberculoma of the thoracic spinal cord without systemic involvement. The preoperative diagnosis was a metastatic cancer. Subtotal removal of intradural extramedullary and intramedullary mass was performed and pathological diagnosis was tuberculosis granuloma. We suggest that Intramedullary spinal tuberculoma must be considered in the differential diagnosis of the spinal cord compressive lesions in our country.

중대뇌동맥 동맥류 파열 환자의 출혈 양상에 대한 임상적 분석

김훈,심영보,황형식,최재준,김성민,박용기,최선길,Kim, Hun,Shim, Young Bo,Hwang, Hyung-Sik,Choi, Jae Jun,Kim, Sung Min,Park, Yong Kee,Choi, Sun Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objectives : The rupture of middle cerebral artery(MCA) aneurysm usually cause or is associated with higher incidence of intracerebral hemorrhages(ICH) than any other aneurysmal ruptures. Also, the outcome of patients who had ICH is known to be worse than patients who had subarachnoid hemorrhage(SAH) only. The authors report the bleeding pattern and outcome of ruptured MCA aneurysm patients. Patients and Methods : A total 106 ruptured MCA aneurysm patients who were surgically treated were included and they were divided into 2 groups by the initial brain CT findings according to the presence or absence of ICH over 10cc in amount. The clinical data were analysed retrospectively. Results : The overall mortality was 18.9%. Among 81 patients(76.4%) who had subarachnoid hemorrhage(SAH) only, 68 patients(84%) showed favorable outcome. Twenty five patients(23.6%) had ICH over 10cc in amount with or without SAH, and among them, 11 patients(44%) showed favorable outcome. The ICH was located in temporal lobe(15 patients, 60%), frontal lobe(3, 12%), sylvian fissure(6, 24%) and frontal-temporal lobe(1, 4%). Among 15 patients who had ICH in temporal lobe, only 4 patients(26.6%) showed favorable outcome and all 3 patients who had ICH in frontal lobe showed favorable outcome. Conclusion : ICH was presented in 23.6% of ruptured MCA aneurysm patients and the prognosis of patients with ICH was worse than patients with SAH only. The ICH was located mainly in the temporal lobe and sylvian fissure.

외상성 척수공동증의 치료를 위한 지주막하강 재건술 - 증례보고 -

정대진,김성민,김훈,심영보,박용기,최선길,Chung, Dai Jin,Kim, Sung Min,Kim, Hun,Shim, Young Bo,Park, Yong Kee,Choi, Sun Kil 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

The authors report a posttraumatic syringomyelia in a 30-year-old man who has complained pain, weakness of upper arm and dissociation sensory loss since 2 months before. He was underwent by decompressive laminectomy from T12 to L1, reduction of encroached bony fragments, transpedicular screw fixation from T12 to L2 and posterolateral bony fusion due to burst fracture of L1 at other hospital 3 years ago. Preoperative spinal MRI was highly suggestive of wide-spread, multiseptated syringomyelia from C3 to thoracolumbar junction. We performed wide decompressive laminectomy from T10 to L2 and subarachnoid space reconstrucion composed of microdissection of meningeal fibrosis widely, iatrogenic meningocele formation with lefting the dura mater opened for treatment of spinal-spinal pressure dissociation. Clinical manifestations and radiological findings of the patient were improved after the operation. This technique was thought to be superior to shunting procedures in cases of wide-spread, multiseptated post-traumatic syringomyelia.

다분절 퇴행성 경추질환에서의 전방 금속판 사용 유무에 따른 환자의 예후분석

김상우,김성민,신동익,조용준,심영보,최선길,Kim, Sang Woo,Kim, Sung Min,Shin, Dong Ik,Cho, Yong Jun,Shim, Young Bo,Choi, Sun Kil 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Objectives : The rates of pseudarthrosis for two- and three level fusion have been reported to be 17-63 and 50% without anterior cervical plating. The purpose of this study is to assess the effects of anterior cervical plating in the treatment of multilevel degenerative cervical disease such mostly the additional risks associated with hardware implants and its benefits, fusion rate and radiographic results, and clinical outcomes. Methods : Forty-seven patients who underwent operations between 1993 and 1997 were retrospectively reviewed. The technique for operation was same for both groups(Smith Robinson with autologous iliac bone graft). Group I consisted of 35 consecutive patients treated with anterior cervical decompression and fusion with anterior cervical plate fixation. Group II consisted of 12 consecutive patients treated without plate fixation. We compared clinical outcomes by Prolo score, radiographic results in the rate of fusion, cervical lordosis by Gore angle, disc height by Farfan method, and surgical complications between two groups. Results : The favorable clinical outcomes(excellent and good) by Prolo score were observed with the use of anterior cervical plate fixation(89% vs 75%). The successful fusion rate of multilevel cervical fusion was as seen with anterior cervical plate fixation(97% vs 75%). The overall graft complication rate in multilevel fusions was decreased, with anterior cervical plate fixation, and the hardware related complications were relatively minimal without serious consequences. Conclusion : Anterior cervical plate fixation in the treatment of multilevel cervical disorders is an effective stabilizing method which provides increased bony fusion rate, decreased graft complications, maintained cervical lordosis, early mobilization of the these patients without serious hardware related complications.

미만성 척수 경막외 농양을 동반한 화농성 척추염 - 증 례 보 고 -

김훈,김성민,정대진,심영보,박용기,최선길,Kim, Hun,Kim, Sung Min,Chung, Dai Jin,Shim, Young Bo,Park, Yong Kee,Choi, Sun Kil 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

We report a case of pyogenic spondylitis on L2 and L3 with diffuse epidural abscess up to T4 to L3 and large psoas abscess. A forty-nine-year old male was presented with progressive back pain, left flank pain and ab-dominal distention, weakness of the both legs and voiding and defecation difficulty during last 2 months. Initially multiple coronal hemilaminectomies from T4 to T12 were done for the treatment of diffuse thoracic epidural ab-scess. Then second operation via left retroperitoneal approach was performed for lumbar spondylitis and psoas abscess on third day after initial operation. After removal and curettage of pyogenic psoas and epidural abscess and spondylitis (L2-L3), iliac bone grafting with Keneda instrumentation from L1 to L4 was done simultaneously. Postoperative course has been unevenful without recurrent infection. The literature on diffuse epidural and large psoas abscess with pyogenic spondylitis are reviewed and instrumentation for stabilization of pyogenic spondylitis is also discussed.

화상 후 두피에 생긴 편평 상피세포 종양에 대한 증례 보고 - 증례보고 -

김강산 ( Kang San Kim ),황형식 ( Hyung Sik Hwang ),권흠대 ( Heum Dai Kwon ),문승명 ( Seung Myung Moon ),오석준 ( Suk Jun Oh ),최선길 ( Sun Kil Choi ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1

Marjolin`s ulcer is a rare and often-aggressive cutaneous malignancy that arises in previously traumatized or chronically inflamed skin, particularly after burns. We experienced two cases after burns. Case I involved a forty eight year-old man who had suffered from a flame burn at the parietal scalp area, where had been initially described three years earlier as a full-thickness wound including the pericranium. The man consulted us for a persistent ulcerative and infected wound on the burned lesion during the last 24 months, which turned out on the contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) to be the squamous cell carcinoma with involving the skull and the dura mater. Although the posterior auricular lymph node was enlarged on the ipsilateral side, recent positron emission tomography (PET) CT did not show any metastatic lesion. It was impossible for us to resect the intracranial involvement of the tumor radically, and the postoperative PET CT still showed a focal fluorodeoxyglucose (FDG) uptake around the wall of the superior sagittal sinus. We think that an aggressive combined approach is essential for treatment in early stages for a high success rate, before the intracranial structures are involved because there is no consensus on the treatment for advanced disease, and the results are generally poor. Case 1 also did not involve a radical resection because of the intracranial invasion to the wall of superior sagittal sinus and the possibility of damage to the major cortical veins. He received adjuvant radiotherapy and must be followed periodically. Case 2 involved an eighty six year-old women who suffered from a painful scalp ulcer lesion after flame burns three years earlier. Unlike case 1, neither tumor infiltration into the dura nor lymph node enlargement was observed on the contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) CT. We did a radical resection of the tumor, including the involved bone, and a cranioplasty with bone cement. (J Korean Soc Traumatol 2007;20:52-56)

뇌실 및 뇌표 지주막하강에 유입된 외상성 기뇌

최선길,황도윤 중앙대부설한국의과학연구소 1975 한국의과학 Vol.7 No.7

신경섬유종증없이 마미총에 발생한 다발성 신경초종

최진화,김성민,최진환,안경순,심영보,손진희,최선길 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.6

A case of multiple intradural schwannomas of the cauda equina is reported without evidence of any other manifestations of neurofibromatosis. The patient had symptoms of cauda equina compression. Following a diagnosis of multiple intradural tumors of the cauda equina, based on lumbar spine MRI with contrast enhancement, the tumors at the L1 body, L3 body, L3- L4 intervertebral space level were removed completely, innolving two rootlets. After the operation, the patient is asymptomatic apart from left S3 dermatome hypesthesia.

肺吸蟲症 診斷에 있어서 ELISA법의 應用에 관한 硏究

崔銑吉,李駿商,林漢鍾 고려대학교 의과대학 1984 고려대 의대 잡지 Vol.21 No.1

Human paragonimiasis is one of the common trematode diseases and of very important public health problem in Korea. Although many techniques have been deviced for immunological diagnosis of paragonimiasis, they exhibit low sensitivity and specificity. In this study the enzyme-iinked immununosorvent assay (ELISA) was employed in the diagnosis of human paragonimiasis using Paragonimus VBS(veronal buffered saline) antigen, peroxidase conjugated anti-human Ig G and ortho-phenylenediamine as a substrate by micromethod according to technique of Voller et al. (1979) and McLaren et aI. (1978) with minor modifications. Sera tested were categorized into 106 paragonimiasis, 20 clonorchiasis, 12 taeniasis, 10 toxoplasmosis, 10 hymenolepiasis and 10 non-infected human cases. The results obtained are as follows: 1. In the preliminary study optimal dilutions of conjugate, stock antigen and serum were 1/5,000, 1/400 and 1/400 respectively. 2. The O.D. (optical density) values of the ELISA in the sera of paragonimiasis cases using stock antigen and VBS antigen were 1.291±0.731 and 1.466±0.813, respectively, and the mean O.D. values in the sera of paragonimiasis cases using VBS antigen were not significantly different from that of stock antigen in sensitivity. (p<0.001) Results showed a standard sensitivity in the application of the ELISA in the diagnosis of human paragonimiasis using VBS antigen. 3. The mean O.D. values of the ELISA in 106 sera of paragonimiasis cases were 1.243±0.863 and those of other parasite infection groups and non-infected human group were 0.487±0.549 in clonorchiasis, 0.513±0.521 in taeniasis, 0.158±0.235 in hymenolepiasis, 0.222±0.235 in non-infected human group and that in paragonimiasis was significantly higher than those of other groups. 4. Distribution of the O.D. values of the ELISA, 86 (81.1%) out of 106 paragonimiasis sera, 3 out of 52 other parasite infection group sera and none out of 10 non-infected human group showed highter than that of the positive serum of 1.000 at 488nm) O.D. value. In conclusion, results of this study suggest that the ELISA is more applicable and reproducible in the diagnosis of human paragonimiasis than other immunological tests used especially in seroepidemiological study.

소아 두뇌외상에 대한 임상적 고찰 : Analysis of 481 Cases

최선길,이상철,황도윤,최덕영,강성구,임광세 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.2

Clinical observation and analysis were performed on 481 cases of craniocerebral injuries under 15 years of age those were treated at Chung-ang university hospital during the period from January, 1972 to August, 1975. Following results were obtained: 1. There were 302 males and 179 females and sex ratio was 1.7 : 1. 2. Age incidence of the accidents was greatest at 5 years of age and mostly distributed to the age group between 5 to 7. 3. Seasonal peak of the accidents was at June. 4. The most frequent cause of the craniocerebra1 injuries was traffic accident (277 cases. 57.59%), and the next was fa11 from height (159 cases, 33.06%). 5. No deterioration of consciousness before and after the admission was observed in 176 cases (36.6%). 6. Pupillary change was observed in 28 cases in which unilateral were 21 and bilateral were 7. Babinski sign was elicitable in 91 cases. 7. Early convulsion and vomiting were frequent symptoms in childhood. 8. Skull fracture was observed in 204 cases (40.33%) in which linear fracture was most frequent. The location of the linear fracture was parietal and the predilection sites of the depressed fractures were frontal and parietal. 9. The accompanying rate of skull fracture in intracranial hemorrhage was; epidural 75%, subdural 50% and subarachnoid 17.3%. 10. The overall mortality was 8.32%. In non-surgical group (442 cases), the mortality rate was 7.47% but in surgical group (39 cases), operation mortality was 17.95%.