퇴행성 요추 병변에서 척추경 나사를 이용한 요천추유합의 결과

김진혁,이상민,정의룡 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective: To evaluate the efficacy of lumbosacral fusion with bilateral bicortical S1 pedicle screw fixation without anterior support on the basis of the fusion levels in degenerative lumbosacral disease. Materials and Methods: Seventy three patients were treated with posterior decompression and posterolateral fusion with bilateral bicortical S1 pedicle screw fixation. Their results were analyzed retrospectively with minimum 2-year follow-up. Postoperative anteroposterior and lateral radiographs were analyzed for S1 screw loosening, fixation failure and lumbosacral fusion. Medical records were analyzed for postoperative low back pain and complications. Results: S1 screw loosening was 1(6.3%) in 2 level fixations, 3(14.3%) in 3 levels, 7(5O.0%) in 4 levels and 13(86.7%) in more than 5 levels. Fixation failure was 1(4.8%) in 3 levels fixation, 1(7.1%) in 4 levels, 5(33.3%) in more than 5 levels. Non-union was suspected in 30 patients(41.1%), 1(14.3%) in mono-level fixation, 2(12.5%) in 2 levels, 8(38%) in 3 levels, 9(64%) in 4 levels and 10(67%) in more than 5 levels. Postoperative sustained low back pain was 1 in 3 levels fixation, 2 in 4 levels and 7 in more than 5 levels. Postoperative complications were detected in more than 3 level fixations ; hematoma in 2, wound infection in 6, progressive kyphosis in 2. Conclusion: Lumbosacral fixation with bilateral bicortical S1 pedicle screw could not provide satisfactory outcome in long level fusion especially in more than 4 levels fusion of degenerative lumbar disease.

후방 도달 반척추 절제술을 이용한 선천성 측만증의 치료

김진혁,이상민,정의룡 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objectives: To evaluate the surgical outcomes of congenital scoliosis with hemivertebra corrected by posterior vertebral column resection after a minimum follow up of 2years. Materials & Methods: Thirty five congenital scoliosis cases(20 males and 15 females) subjected to posterior vertebral column resection and without any previous operative intervention were analyzed. They were analyzed for deformity correction and complications. The mean age at operation was 14.6 year-old(range 2.6~35) and mean follow-up was 3.1 years(range 2.0~4.5). The preoperative index curve was 44.5±15.8° in coronal plane, and 22.7±35.9° in sagittal plane. Results: The total number of resected vertebrae were 36 : 17 in thoracic and 19 in lumbar. The deformity correction was 57.0% with 19.0±10.6° in the coronal plane and 69.0% with 7.0±14.9° in the sagittal plane. Mean operation time was 222.7±54.9 minutes with a total perioerative transfusion of 1992.0 ㎖. Complications were encountered in 3 patients(8.6%) : 1 hematoma and cauda equina syndrome, 1 fixation failures and 1 transient posterior cord syndrome. Conclusion: Posterior vertebral column resection in congenital scoliosis with hemivertebra is an effective method compared to anterior-posterior two stage hemivertebra resection. It could offer satisfactory correction of deformity and restoration of spinal balance.

간내 담석증의 외과적 고찰

배진선,송인상,김제룡 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

The intrahepatic calculi are prevalent in east Asia and are regarded as malignant disease because diagnosis and treatment are difficult and complication and mortality are high. This study is a retrospective clinical review of 47 cases of patient with intrahepatic calculi in the Department of Surgery, Chungnam National University Hospital from January 1994 through December 1998. The incidence of intrahepatic calculi was 8.5% of total biliary calculi. The ratio of male to female was 1:19. The peak incidence was noted at the 6th decade (29.8%) and mean age was 50. 9 years. About the site of stones, left intrahepatic duct (51%)was more prevalent than right intrahepatic duct (19%). 32 cases(70%) of the intrahepatic calculi were associated with GB stone (8%), CBD stone(45%) or both(17%). As to surgical method, choledochotomy with T-tube drainage was performed in 27 cases(57%), choledochoduodenostomy was in 3 cases(7%) and hepatic resection in 17 cases(36%). Among them choledochotomy with T-tube drainage was the most frequently performed procedure. The remnant stones are most commonly founded after choledochotomy and T-tube drainage (70%) followed by 33% after choledochoduodenostomy and 29% after hepatic resection. But, major postoperative complications such as bile leakage and intraabdominal abscess are more frequent in cases of hepatic resection. So we suggest that agressive treatment modality such as hepatic resection is more reasonable than drainage procedure in the management of intrahepatic duct stone by the experienced expert.

척추경 나사 고정 및 후방 유합술만으로 치료한 Andersson 병변 : Andersson 병변 Andersson lesion

김진혁,이상민,정의룡 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

A60-year-old female patient with Andersson lesion is presented. Andersson lesion or spondylodiscitis in ankylosing spondylitis is a rare but well-known condition defined as an erosive and sclerotic process involving the intervertebral disc and adjacent vertebral bodies. The causes of this condition are not well understood. The Andersson lesion is often painful, and needs surgical treatment. The patient underwent segmental pedicle screw fixation and posterior fusion without any anterior procedure. The clinical features are presented with leterature review.

고도 성인 흉부 측만증에서 시행한 후방 척주절제술

정의룡,김진혁,이상민 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.5

Objective : To report the result of one stage posterior vertebral column resection(PVCR) in treating severe adult thoracic scoliosis Materials and Methods : Thirteen patients(average age 30.2 years) with thoracic scoliosis were treated with PVCR. Their results were retrospectively reviewed after a minimum follow-up of 2 years for deformity correction and complications. Etiological diagnoses were neglected idiopathic in 6, congenital in 4 and others in 3. The average preoperative scoliosis was 96°(range: 70∼143) with less than 25% flexibility. The average preoperative trunk shift was 2.Ocm(range: O∼6.0) and the shoulder height difference was 2.1 cm(range: O∼8.0). The procedure consisted of a posterior midline approach, segmental pedicle screw fixation of the index curve, resection of the posterior elements, bilateral rib heads and vertebral bodies with adjacent discs, anterior column reconstruction with a structural graft or chip bones, and correction of the deformity by derotation and cantilever method. Results : Total 17 thoracic vertebrae were resected. The most common resection was T8 in 5 patients. The mean operative time was 387 minutes with an average blood loss of 4864 ml. At latest follow up, the index curve was corrected to 36(range: 15∼78) showing a correction of 63%. The loss of correction was 4%. The trunk shift and the shoulder height difference were improved to 0.4cm(range: O∼1.4) and 0.4cm (range: O∼1.0), respectively. One paraplegia occurred in scoliosis with Beal's syndrome, who had a preoperative neurologic deficit. Conclusion: One stage posterior vertebral column resection could be performed safely and effectively for severe adult thoracic scoliosis, even though technically demanding and involves possible risk for major complications.

심한 척추변형(측만증 및 후만증)에 대한 척추 후방 절제술

석세일,김진혁,이상민,정의룡,이정희,김성수,정락용 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Purpose To report a technique of vertebral column resection through a single posterior approach and its first results in the treatment of severe spinal deformities. ■ Methods and materials Seventy spinal deformity patients treated by posterior vertebral column resection(PVCR) were reviewed. Minimum follow up was 2 years (2 - 3.3 years). There were 34 males and 36 females with a mean age of 27.4 years at the time of the operation. Etiologic diagnoses were adult scoliosis in 7, congenital kyphoscoliosis in 38, and post-infectious kyphosis in 25. The surgery consisted of temporary stabilization of the vertebral column with segmental pedicle screw fixation, resection of the vertebral column at the apex of the deformity via the posterior route followed by gradual deformity correction and global fusion. ■ Results The total number of resected vertebrae were 143; 76 in thoracic and 67 in lumbar. Mean operation time was 4 hours 31 minutes with average blood loss of 2333 ml. The deformity correction was 40o in the coronal plane and 5Oo in the sagiotal plane. Complications were encountered in 24 patients: 2 complete cord injuries in severe adult scoliosis and thoracic kyphosis patient who had significant preoperative cord compromise, 6 hematomas, 4 root injuries (all incomplete), 5 fixation failures, 2 infections and 5 hemopneumothoraxes. ■ Conclusions PVCR is an effective alternative for severe fixed spinal deformities. However, extreme caution must be taken in the patients with preoperative cord compromise who are the high risk of neurological complications.

선천성 거대결장증 진단에 필요한 조직화학염색 : Rapid Acetylcholinesterase Staining

설지영,김제룡,김진만,장일성 충남대학교 의학연구소 2001 충남의대잡지 Vol.28 No.2

Hirschsprung's disease is a congenital absence of ganglion cells in the Meissner's and Auerbach's plexuses of the colon. The definitive diagnosis of the disease can only be based on histologic examination of bowel wall biopsies demonstrating aganglionosis. To distinguish Hirschsprung's disease from other causes of contipation and megacolon, it is helpful to use histologic examination with routine hematoxylin and eosin (H&E) staining and acetylcholinesterase (AChE) special histochemical staining techniques. With H&E staining, the difficulties may arise in the hypoganglionic area of the transition zone, or in hypoganglionosis or neuronal intestinal dyspiasia. The AChE technique provides reliable identification of ganglion cells by staining nerve filaments in close proximity to the ganglion cells. However, the conventional AChE technique takes about 2 hours for the examination of specimens, so it is not suitable for intraoperative examination. Using a rapid AChE histochemical staining technique, it is possible to produce staining of cholinergic fibers in 20 minutes. It should enable the surgeon to use it selectively during operation and to support or refute the H&E findings.

뇌졸중 위험인자를 가진 어지럼 환자에서의 확산강조 자기공명영상

강형구,윤유상,이진희,박인철,이경룡,정상원,구홍두,김승호 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: The management of vertiginous patients is a great challenge to emergency physicians. We evaluated the diagnostic value of a diffusion-weighted image(DWI) in differentiating central vertigo from the peripheral vertigo in patients who presented no neurological symptoms other than risk factors for stroke. Methods: From March 2000 to February 2001, we retrospectively analyzed the cases of 68 patients who visited the emergency department with symptoms of isolated vertigo and who had risk factors for stroke. DWIs, computed tomograms(CT), and medical records were reviewed, and the final diagnose, the DWIs and the CT readings, the risk factors for stroke, and the time it took waiting for a DWI or CT scan were analyzed. Results: Of the 68 patients, 21(30.8%) had central vertigo: 15 vertebrobasilar transient ischemic attacks(VB-TIA), 4 brain stem infarctions, 1 cerebellar infarction, and 1 cerebellopeduncular infarction. The DWI showed a 28.6% sensitivity, a 97.9% specificity, and an 85.7% positive predictive value in diagnosing central vertigo. It also had a 100% sensitivity in detecting infarctions. Conclusion: A DWI had a comparable sensitivity to MRI in detecting central vertigo and small, but potentially, lethal infarctions in our patient population. We recommend clinical application of DWI in the emergency department evaluation of isolated vertigo patients with risk factors for stroke.

간세포암의 고주파 열치료 후 천자침 경로를 통한 전이 1례

조영완,박석주,진한영,김준영,이재익,강명주,박정하,윤정희,박성재,지삼룡,이연재,이상혁,설상영 인제대학교 2006 仁濟醫學 Vol.27 No.-

Radiofrequency ablation(RFA), as a form of minimally invasive therapy for hepatocellular carcinoma, has become an important treatment modality. Because of limitation of surgery, RFA has become standard therapy for hepatocellular carcinoma in some situations. But there are some complications of RFA such as bleeding, infection, hematoma, adjacent organ thermal damage including intestinal perforation, needle track seeding, and so on. There are few reports in the literature that systematically evaluate the incidence of needle tract seeding and its associated risk factors. And only 2 cases of needle tract seeding of hepatocellular carcinoma after RFA were reported in Korea. We report a case of needle tract seeding of hepatocellular carcinoma after RFA.

척수 외상의 자기공명영상 및 신경학적 소견 : Delayed MR Image and Correlated Neurology

박용규,정진명,김은상,김재일,송해룡,한종우,신형진 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.11

19 patients with traumatic spinal cord injuries and associated neurological deficit were examined by delayed(> 1 month) magnetic resonance imaging(MRI), the result of which were correlated with neurologic and somatosensory evoked potential(SSEP) findings. 5 different MRI patterns were observed in these patients : (1) normal signal intensity(SI) on T1-and T2-weighted images(WI)(pattern N/N, n=6), (2) normal SI on T1-WI and high SI on T2-WI(pattern N/Hi, n=3). (3) low SI on T1-WI and high SI on T2-WI(pattern Lo/Hi, n=6), (4) syrinx(n=2), and (5) cord transection(n=2). The neurologic state was determined using Frankel's classification at admission and MRI time. Pattern N/Hi had best neurologic state except pattern N/N, and pattern Lo/Hi showed worst prognosis except pattern transection. SSEP findings relatively well correlated with neurologic findings, but did not exactly. The cause is probably that SSEP shows predominantly the function of ascending sensory systems of the cord, do not reveal motor pathways, directly or indirectly.