Tracer Test에 의한 정수장 플록형성지 수리학적 특성 개선사례

한무영(Han Moo Young),정영균(Jung Young Gyun),김영도(Kim Young Do),강기석(Kang Gi Seok),강창호(Kang Chang Ho),유재오(Ryu Jae O) 대한토목학회 2000 대한토목학회논문집 B Vol.20 No.2B

포도막 흑색종에 대한 감마나이프 방사선수술 - 증례보고 -

김병욱,김무성,심홍보,정영균,이선일,정용태,김수천,심재홍,윤일한,김영일,백광욱,Kim, Byung Wook,Kim, Moo Seong,Sim, Hong Bo,Jeong, Yeong Gyun,Lee, Sun Il,Jung, Yong Tae,Kim, Soo Chun,Sim, Jae Hong,Youn, Il Han,Kim, Young Il,Paik, Koang 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Uveal melanoma is uncommon but life-threatening intraocular malignancy and has been treated by irradiation, local excision and enucleation. Gamma-Knife radiosurgery allows a high dose of radiation to be delivered to an intracranial target with a very high spatial accuracy and has been used for the treatment of ocular melanomas. We have treated two cases of uveal melanoma between October 1994 and December 1999. They include one man and one woman(34, 62 years, respectively). They were followed up for 12 momths. Mean maximal dose was 65Gy. In one case, the tumor disappeared 7 months after gamma-knife radiosurgery. In another case, multiple tumors (uveal, suprasellar and cerebellar tumor) had decreased in size. These results show that single and high dose gamma-knife radiosurgery is may be an option in the local control of uveal melanoma which can spare the eyeball and vision.

신경외과 중환자실 환자의 경장영양 지침서 적용에 따른 영양적 중재 효과

한정희,김영란,이영민,김애리,김호진,정영균,유정하,Han, Jung-Hee,Kim, Young Ran,Lee, Young Min,Kim, Ae Lee,Kim, Ho Jin,Jeong, Young-Gyun,Ryu, Jeong Ha 한국의료질향상학회 2011 한국의료질향상학회지 Vol.17 No.1

Background : Evidence-based guidelines are now used for enteral nutrition(EN) in neurosurgical intensive care unit patients who mostly depend on EN. This study compared and analyzed the nutritive conditions of patients before and after they underwent guideline based nutritional interventions in order to determine whether using these guidelines improved their calorie supply. Methods : Data on the patients' nutritional requirements, maximum calorie supply through EN, serum albumin level, and total lymphocyte count were collected and analyzed using SAS version 9.1.3. All the statistical analyses were performed at a significance level of P<0.05. Result : The maximum calorie supply through EN was $923.1{\pm}359.7$ kcal before the intervention and $1254.4{\pm}196.3$ kcal after the intervention; this difference was statistically significant(P<0.05). The ratio of nutritional requirements to maximum calorie supply through EN was $55.5{\pm}22.4%$ and $74.2{\pm}13.9%$ before and after the intervention, respectively; this difference was statistically significant(P<0.05). This indicates a 19% increase in the ratio after the nutritional intervention. The serum albumin level also significantly increased from $2.7{\pm}0.6g/dL$ before the intervention to $3.2{\pm}0.4g/dL$ after the intervention(P<0.05). The total lymphocyte count slightly increased from $1267.7{\pm}728.2cells/mm^3$ before the intervention to $1801.9{\pm}1211.5cells/mm^3$ after the intervention; this difference was not statistically significant. Conclusion : The results showed that using the evidence-based feeding guidelines for interventions increased the calorie supply and improved the patients' nutritive conditions from moderate malnutrition to mild malnutrition.

흉추부 경막외에 발생한 녹색종

정영균,이선일,정용태,김수천,심재홍 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.7

Granulocytic sarcoma(chloroma) is an uncommon and solid tumor composed of immature cell of the mycloid series usually seen during the course of myelogenous leukemia or myeloproliferative disorders. The common sites for the occurrence of granulocytic sarcoma are soft tissue. periosteum, bone lymphoid tissue, skin, gastrointestinal tract and testic. But extradural presentation of the spine is very rare. We report two cases of extradural granulocytic sarcoma of the spine. Early recognition of the etiology of the paraplegia and the underlying systemic involvement with leukemia resulted in an excellent neurological and hematological outcome.

진행성 뇌경색증 환자에서의 수술적 감압술

황영원,심홍보,정영균,이선일,정용태,김수천,심재홍 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1

■ Objectives Progressive brain infarction may be accompanied in its acute stage by brain swelling although aggressive medical management is performed. Progressive mass effect may prove life-threatening owing to increased intracranial pressure and herniation. The objective of this paper is to evaluate how surgical decompression is effective to prevent more aggravation of clinical state to death. ■ Methods and Materials Author reviewed total 887 patients of cerebral stroke who were treated in the departments of neurosurgery and neurology at Busan Paik Hospital. Inje University from January 1998 to December 2000. Of these, 40 patients of progressive brain infarction were analysed. ■ Results Male to female ratio was 1.86:1. Most of them(77.5%) occured in the fifties and sixties. The most common mentality change was from drowse to stupor in 26 cases. Mean time from attack to worsening was 60.8 hours. Infarcted right to left brain side ratio was 23:17. Medical disorders were associated in 24 patients. Operation methods are as follows; 35 craniectomies, 4 craniectomies with lobectomy. 1 craniectomy with extraventricular drainage. Surgical results according to Barthel Index was as follows: 2 independent. 7 slightly dependent, 8 moderate dependent, and 5 totally dependent. ■ Conclusions Surgical decompression to control increasing intracranial pressure and optimize cerebral perfusion can provide protection of uninvolved brain, patient salvage, and possibly functional recovery.

전신 마취후 일과성으로 발생한 양측성 이하선 종창

김홍범,최완수,정영균,신일우,양우창,강성준,이헌근 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.2

Parotid gland swelling in association with general anesthesia is an unusual complication. Benign postoperative parotid swelling should be recognized as a noninfectious, self-limiting process occurring immediately after surgery. This enlargement is non-tender, rubbery in consistency, without crepitus, and may be accompanied by variable salivation. The mechanism of the occurrence remains unknown, but two factors most frequently associated with this phenomenon appear to be physical stimulation or manipulation of the airway or coughing and/or straining. We report bilateral parotid gland swelling in a middle-aged man after surgery under general anesthesia.

Gamma-Knife Radiosurgery for Large sized Cerebral Arteriovenous Malformation(AVM)

Sun, Woo Sung,Sim, Hong Bo,Kim, Moo Seong,Jeong, Young Gyun,Lee, Sun Il,Jung, Yong Tae,Kim, Soo Chun,Sim, Jae Hong 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1

목적 : 뇌동정맥기형의 치료의 목적은 완전폐색이다. 그러나 큰 크기의 뇌동정맥기형은 수술요법만으로는 완전 폐색은 어려우며, 수술요법, 색전술, 상사선 수술 등의 병합요법이 필요하다. 본 연구는 큰 크기의 뇌동맥기형에서 방사선 수술의 효과를 보기 위함이다. 대상 및 방법 : 본 교실에서는 1994년 10월부터 2000년 2월까지 감마나이프방사선 수술을 816례에서 시행하였고, 이중 112례는 뇌동정맥기형이었다. 큰 크기의 뇌동맥정맥시형은 용적 10cc 이상, Spetzler-Martin 등급 Ⅲ 이상을 정의하였으며, 큰 크기의 뇌동정맥기형은 27례였고, 그중 6개월 이상 추적관찰이 가능하였던 22례를 분석하였다. 평균 용적은 31.5cc, 평균 최대 선량은 38Gy, 평균 변연선량은 18.3Gy, 평균 추적 기간은 20개월(6-55개월)을 추적하였다. 결과 : 추적 검사한 뇌혈관조영술, 자기공명영상 및 자기공명영상 뇌혈관 조영술상 뇌동정맥기형의 완전소실이 4례, 부분소실이 13례, 변화없음이 5례였고, 시술후 출혈이 2례, 낭종형성 1례, 추적자기공명영상 T2 영상에서 부종형성이 4례가 있었으며, 추가로 감마나이프방사선 수술이 2례에서 시행되었다. 결론 : 감마나이프방사선 수술은 큰 크기의 뇌동정맥기형의 치료에 안전하고 효과적이며, 추가로 저용량을 조사하거나 큰 용적에 대해 단계적으로 감마나이프방사선 수술을 시행하는 것이 거대 뇌동정맥 기형에서 시행될 수가 있을 것으로 사료된다. ■ Objectives Complete obliteration is the goal of the treatment of all arteriovenous malformation. In large sized arteriovenous malformation is difficult complte obliteration by operation alone. Combined therapy of surgery, embolizationand radiosurgery have better refult than a siage therapy. The purpose of this study was to evaluate of effect of radiosurgery in adjuvant therapy for AVM. ■ Material and Methods We have treated 816 cases with Gamma-Knife radiosurgery from October 1994 to February 2000. Among them, 112 cases were arteriovenous malformation. Large-sized arteriovenous malformations were 27cases and 22 cases were in follow up. We defined large sized arteriovenous malformations as ones above 10cc or above Spetzler-Martin grade Ⅲ. Mean volume was 31.5cc, mean maximal dose was 38 Gy, mean marginal dose was 18.3 Gy and mean follow-up period was 20 months(6-55 months). ■ Results Imaging studies of cerebral angiography, MRA and MRI showed 4 cases of complete obliteration, 13 cases of partial obliteration and 5 cases of stat onary. Radiosurgical complications were hemorrhage in 2 cases, cyst formation in 1 case and 4 cases of edema formation on T2WI. Booster Gamma-Knife radiosurgery was done in 2 cases. ■ Conclusions Gamma-Knife radiosurgery is safe and effective method for large-sized AVM and booster Gamma-Knife radiosurgery or volume-staged Gamma-Knife radiosurgery is needed in large-sized arteriovenous malformation.

감마나이프 방사선수술 1124례의 경험 : 신경외과 영역에서의 수술적 이용가치 surgical available values in neurosurgical fields

심재홍,심홍보,김무성,정영균,이선일,정용태,김수천 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Objectives: The Leksell gamma knife is one form of stereotactic radiosurgery. Stereotactic radiosurgery is really not surgery at all. The skull is never opened. Gamma knife is a way of treating brain disorders with a special form of radiation. The purpose of this study was to evaluate the surgical results in 1124 gamma knife cases operated in our institution from Oct. 1994 to Dec. 2001. Patients and Methods: The Leksell model G stereotactic head frame was affixed to the patients's head after local anesthesia on the scalp. Dose planning was performed initially on a Micro-VAX workstation(KULA) later on a Hewlett-Packard work-station using gamma-plan software, Radiosurgery was performed using the 201 source cobalt-60 Leksell Gamman Knife model B. Results: We treated 1124 patients with gamma knife radiosurgery from October 1994 to December 2001. Disease entities were vascular disorder 221cases(19.7%), benign neoplasm 549 cases(48.6%), primary malignant brain tumor 177cases(15.7%), metastatic tumor 90cases(8%), functional disorder 12cases(1%), others 75cases. Overall results of gamma knife were good outcome in 85~90%. Conclusion: The some benefits of gamma knife include; no risk of infection or reaction to anesthesia, short hospital stay within 2 or 3 days in most cases, virtually no pain, significantly reduced medical costs and an immediate return to normal activities. Gamma knife radiosurgery can enable to treat surgical inaccessible location, high risk location, old age, and other medical problem combined patient, etc. In the future gamma knife radiosurgery would be more widely applied to various neurosurgical fields.

뇌동맥류 수술 2,335례의 치험 : 2,335 Cases

심재홍,김수천,정용태,이선일,김무성,정영균,심홍보 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1S

■ Objectives The principle role of treatment for ruptured aneurysm has been to obliterate the aneurysmal sac and secure the patient's life from the hazards of rebleeding and vasospasm. The present study was conducted to evaluate the overally surgical results in 2,335 patients with intracranial aneurysms operated in our institution from January 1980 to December 31th, 2001. ■ Patients and Methods Among these, 776 cases were anterior communicating artery aneurysms, 596 internal carotid artery aneurysms, 603 middle cerebral artery aneurysms, 63 anterior cerebral artery aneurysms and 80 cases of vertebro-basilar artery aneurysms, etc. The male to female ratio was 0.7 to 1. Surgical methods were 2,111 clippings, 182 coatings and wrappings, 23 aneurysmorraphy, 19 proximal ligations. ■ Results Incidence of the rebleeding was 5.6% of the early operation group. 17% of the late operation group. Incidence of the clinical vasospasm was 18.6% angiographic vasospasm was 26.2%. The percent of the multiple aneurysms was 9.3%, dissecting aneurysm ; 5 cases(0.2%), "De Novo" aneurysm ; 4 cases(0.17%), lobectomy cases ; 7 cases (0.3%), incidental aneurysms ; 117 cases(5.0%). Overall surgical result was favorable outcome in 86% and mortality in 7%. In early surgery group, favorable outcome was 88%, mortality was 6%. The calcium-channel blocker and "Triple-H" therapy does not improve the postoperative mortality but improve the post-operative morbidity significantly. In old age group, favorable outcome was 85.5% and 8.5% mortality rate, favorable outcome 69.8%, mortality 11.3% in late operation group. In old age group, early operation can reduce vasospasm, rebleeding, medical complications, etc. In complex artery aneurysm, the use of endovascular treatment is increasing. Intraoperative angiography reduced residual aneurysm or remained aneurysm in large, giant aneurysm, and complicated aneurysm, especially in A.com. a. aneurysm. ■ Conclusions In vascular surgery, it is important how we do it for the aneurysm from surgical treatment to postoperative management. The more aneurysm operations, the more difficult.