Retroperitoneal Yolk Sac Tumor in Adult Woman Presenting as Spinal Cord Compression and Fatal Pulmonary Tumor Embolism

Yi, Hyeong-Joong,Bak, Koang-Hum The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.39 No.4

A 35-year-old woman, previously treated for systemic metastases from retroperitoneal yolk sac tumor, presented with progressive painful paraparesis. Preoperative images showed severe cord compression by the metastatic infiltration of the lumbar vertebrae and epidural mass as well as a huge retroperitoneal mass. While performing unremarkable surgery in prone position, the patient abruptly fell into hypoxic insults and circulatory arrest. Intraoperative pulmonary tumor embolism was deemed a cause of death. When planning operative procedure for this dangerous malignancy, scrupulous manipulation is mandated and the possibility of fatal pulmonary tumor embolism should also be addressed and fully discussed preoperatively.

Factors affecting the Poor Prognosis of the Primary Pontine Hemorrhage(PPH)

Yi, Hyeong-Joong,Kim, Kwang-Myung,Kim, Jae-Min,Bak, Kwang-Hum,Kim, Choong-Hyun,Kim, Young-Soo,Ko, Yong,Oh, Seong-Hoon,Oh, Suck-Jun 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.2

원발성 뇌교 출혈 환자의 예후는 일반적으로 극히 불량한 것으로 알려져 있으나 일부에서는 소와 경색처럼 경한 임상증세나 가벼운 후유증만을 남기는 경우도 있고 급격히 악화되어 곧 사망에 이르는 양상을 보이는 경우도 있다. 저자들은 이런 원발성 뇌교 출혈 환자들의 최종 예후에 미치는 인자들을 분석하기 위해 이들의 임상 증세와 방사선 소견(CT)을 최종 예후와 비교 분석하였다. 1997년 1월부터 2000년 12월까지 본원 신경외과에 입원 치료받은 32명의 환자를 대상으로 임상 소견과 CT 소견을 중심으로 후향적으로 분석하였다. 환자들의 최종 예후는 Glasgow Outcome Scale (GOS) 을 기준으로 하여 Mann-Whitney 검정과 다변량 회귀분석으로 평가하였다. 1. 남녀비는 22 : 10이었으며 평균 나이는 51.9세였다. 신경학적 검사에서 의식이 있던 환자는 8명으로 이는 좋은 예후를 보였다. 동공과 운동 장애는 불량한 예후 (GOS 1-3)와 밀접한 관계가 있었으며 궁극적으로 15명 (47%)이 사망하였다. 2. CT 소견에 따른 혈종의 분류 결과 unilateral tegmental, bilateral tegmental, basal-tegmental, massive type 이 각각 17, 5, 6, 4 명이었다. 3. 혈종의 횡단면 직경이 20mm 이상인 경우가 22명이었고 종직경이 10mm 이상인 경우가 23이었다. 이런 CT 소견들은 불량한 예후를 보였던 군에서 현저했다. 원발성 뇌교 출혈 환자의 예후는 내원 초기 신경학적 상태, 혈종의 파급 범위 (횡단면 직경, 종직경, 뇌교 외부로의 파급 정도)와 밀접하게 관련이 있었다. 일측만 침범한 소량의 출혈은 전 예에서 예후가 좋았으나 massive나 양측을 침범한 경우는 예후가 불량하였다. 따라서 저자들은 예후가 좋지 않을 것으로 판단되는 뇌교출혈 환자에 있어서 적절한 치료의 수준을 결정하는데 도움이 되고자 하였다.

Reoperation due to Slippage of Titanium Aneurysm Clip - Case Report -

Hyeong Joong Yi,Kwang Myung Kim,Yong Ko,Suck Jun Oh 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.33 No.5

Aneurysm surgery using titanium clips has been popularized, although confronted by some minor drawbacks and the paucity of long-term clinical results about the safety of these implants. The authors recently experienced an unusual case of postoperative titanium clip slippage in surgery for anterior communicating artery aneurysm in a 38-year-old man. Aneurysm reoperation with implanting of two cobalt alloy clips was followed. We reviewed the mechanical characteristics of the titanium clips and technical considerations in clipping, and then tried to search for solutions to prevent this kind of complication. Key words:Intracranial aneurysm;Titanium clips;Slippage;Reoperation.

A Common Peroneal Nerve Palsy Following Anterior Cervical Discectomy -Case Report-

Hyeong Joong Yi,Seong Hoon Oh,Koang Hum Bak,Suck Jun Oh 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.33 No.4

We describe an immediately developed common peroneal nerve palsy in a 53-year-old slender man who underwent anterior cervical discectomy. Cause of the palsy is uncertain, however, it is presumed to be stretching injury with regard to the patient positioning rather than to be direct compression in operative procedure. He suffered incomplete common peroneal nerve injury for about 8 months. He undertook two times of electromyographic examination suggesting demyelinating injury and received conservative treatment, finally made a favorable although not complete recovery. In this report, we suggest the possible risk factors, preventive measures, therapeutic options and relevant outcome of this unwanted result. Key words:Common peroneal nerve;Palsy;Anterior cervical discectomy.

Threaded Fusion Cage(TFC)를 이용한 척추 전전위증 수술환자에서의 임상 및 방사선학적 소견의 분석

이형중,김광명,김영수,고용,오성훈,오석전,김남규 한양대학교 의과대학 1995 한양의대 학술지 Vol.15 No.1

The indications for surgical treatment of spondylolisthesis are pain unrelieved by conservative treatment, persistent neurologic signs, progression of the slip or slip greater than 50 per cent and a postural deformity or walking difficulty due to tight hamstring muscles. The goal of operation for spondylolisthesis is relieving radiculopathy and low back pain with preventing further progression of the slip through decompression of neural elements and fusion for pseudoarthrosis. The authors performed posterior lumbar interbody fusion by using of Threaded Fusion Cage(TFC) for 23 patients of spondylolisthesis. All patients have been followed from 3 months to 12 months. We studied the clinical and radiological outcomes for all patients and verified the relationship between clinical outcomes and radiological findings. Summaries of the results are as followings. 1) Successful bone fusion was achieved in 20 out of 23 cases (87%). 2) Neurological signs were improved in 20 out of 23 cases (87%) 3) The majority of cases which demonstrated radiologic bone fusion also showed clinical improvement. Posterior lumbar interbody fusion using TFC was useful in treatment of mild degree spondylolisthesis.

폐색전증과 동반된 동맥류 파열에 의한 뇌지주막하출혈

이형중,김동원,고용,김광명,오석전 한양대학교 의과대학 2003 한양의대 학술지 Vol.23 No.1

Threaded Fusion Cage(TFC)를 이용한 척추 전전위증 수술환자에서의 임상 및 방사선학적 소견의 분석

이형중,김남규,이승로,김영수,고용,오성훈,오석전,김광명 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.7

The indications for surgical treatment of spondylolisthesis are as follows : pain unrelieved by conservative treatment persistent neurologic signs. progression of the slip or slip greater than 50 per cent. postural deformity or walking difficulty due to tight hamstring muscles. The goal of operation for spondylolisthesis is to relieve radiculopathy and low back pain. and to prevent further progression of the slip through decompression of neural elements and fusion for pseudoarthrosis. The authors performed the posterior lumbar interbody fusion using Threaded Fusion Cage(TFC) on 23 patients with spondylolisthesis. All patients have been followed for 3 to 12 months. We then studied the clinical and radiological outcomes of these patients and verified the relationship between clinical outcomes and radiological findings. Summaries of the results are as followings. 1) Successful bone fusion was achieved in 20 out of 23 cases(87%). 2) Neurological signs were improved in 20 out of 23 cases(87%). 3) The majority of cases which demonstrated radiologic bone fusion also showed clinical improvement. Posterior lumbar interbody fusion using TFC was useful in the treatment of mild degree spondylolisthesis.

"고지동의"의 이론적 배경과 실행상의 문제점

좌철수,Hyeong-Joong Yi,Tai-Ho Im,Hyun-Jong Hong 대한신경외과학회 2003 Journal of Korean neurosurgical society Vol.34 No.5

Objective:The informed consent, in literal sense, is a medicolegal process that requires full explanation and clear disclosure about the illness, and thorough comprehension and autonomous consent to the respective medical services of the competent recipient. The authors review the theoretical background of the informed consent and investigate pertinent problems encountered in medical practice. Methods : We gathered 153 consecutive cases of written form of the informed consent regarding diagnosis and treatment from Mar 2001 to Jun 2002. The authors evaluate the completeness of the process by looking into the possible omitted components in whole cases and degree of recall for the explained risk by telephone questionnaire in 128 available cases. Results : In a total 153 cohort, 21 emergency operation cases invariably showed structural deficiencies of free-ended discussion due to short of time. Thorough past history taking and physical examination was necessary to perform reoperation for the postoperative hematoma in 3 cases and solid intimate relationship was necessary to treat previously disclosed complication in 7 cases of invasive diagnostic and minimum operative procedures, respectively. Among the available 128 patients, only 33(25%) ones could recall the given risks addressed at the consent approximately 6 weeks later. Conclusion : The informed consent is a process that dictates the free dialogue between the patient and the physician, not a simple paper expressed in published characters. However, to enhance the effectiveness of the consent process, both free discussion and writing down contents are prerequisite. Key words:Discussion;Informed consent;Medical practice;Theoretical background;Write down.

Long-Term Follow-Up Radiologic and Clinical Evaluation of Cylindrical Cage for Anterior Interbody Fusion in Degenerative Cervical Disc Disease

Kim, Su-Hyeong,Chun, Hyoung-Joon,Yi, Hyeon-Joong,Bak, Koang-Hum,Kim, Dong-Won,Lee, Yoon-Kyoung The Korean Neurosurgical Society 2012 Journal of Korean neurosurgical society Vol.52 No.2

Objective : Various procedures have been introduced for anterior interbody fusion in degenerative cervical disc disease including plate systems with autologous iliac bone, carbon cages, and cylindrical cages. However, except for plate systems, the long-term results of other methods have not been established. In the present study, we evaluated radiologic findings for cylindrical cervical cages over long-term follow up periods. Methods : During 4 year period, radiologic findings of 138 patients who underwent anterior cervical fusion with cylindrical cage were evaluated at 6, 12, 24, and 36 postoperative months using plain radiographs. We investigated subsidence, osteophyte formation (anterior and posterior margin), cage direction change, kyphotic angle, and bone fusion on each radiograph. Results : Among the 138 patients, a minimum of 36 month follow-up was achieved in 99 patients (mean follow-up : 38.61 months) with 115 levels. Mean disc height was 7.32 mm for preoperative evaluations, 9.00 for immediate postoperative evaluations, and 4.87 more than 36 months after surgery. Osteophytes were observed in 107 levels (93%) of the anterior portion and 48 levels (41%) of the posterior margin. The mean kyphotic angle was $9.87^{\circ}$ in 35 levels showing cage directional change. There were several significant findings : 1) related subsidence [T-score (p=0.039) and anterior osteophyte (p=0.009)], 2) accompanying posterior osteophyte and outcome (p=0.05). Conclusion : Cage subsidence and osteophyte formation were radiologically observed in most cases. Low T-scores may have led to subsidence and kyphosis during bone fusion although severe neurologic aggravation was not found, and therefore cylindrical cages should be used in selected cases.

"Brain Stunning" Atypical Feature of tPA Thrombolysis Following Aneurysm Embolization

Park, Min-Woo,Yi, Hyeong-Joong,Gupta, Rishi,Horowitz, Michael B. The Korean Neurosurgical Society 2006 Journal of Korean neurosurgical society Vol.39 No.4

"Stunning" represents prolonged contractile depression of any muscular component after alleviation of severe ischemia, as shown in reperfusion following acute myocardial ischemia or ischemic stroke. Clinically, it presents with no or delayed recovery past to thrombolytic therapy but its pathogenic mechanism is not fully uncovered yet. We describe a unique case of a 63-year-old woman, who was undertaken endovascular coiling for the aneurysms, deteriorated several hours later without known cause, and showed delayed clinical improvement over the next 3 days following thrombolysis. Immediate post-thrombolysis magnetic resonance imaging scan showed no apparent abnormality except for high signal intensity within the corresponding hemisphere. Reversible but delayed nature of " brain stunning" can be explained by these images and it seems to be caused by a certain type of reperfusion injury.