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흉추부 수질내로 전이한 소세포암 1례 : 증례보고 Case Report
김근회,정용구,주정화 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.7
The incidence of metastasis to the spinal cord in patients with systemic carcinoma has been estimated to be 0.9 to 8.5%. Attempts to aggressively remove intramedullary spinal cord tumor may cause increased neurologic deficits and a worsend outcome. The authors present the case of a multiple intramedullary metastatic spinal cord tumor which had metastasized from the lung to the thoracic spinal level. Pathologic diagnosis of the small cell carcinoma was made from the tumor specimen obtained by stereotaxic-guided neddle biopsy after which the patient was treated with radiotherapy and chemotherapy.
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김근회,정용구,박정율,이기찬,이훈갑 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.5
The authors present a statistical survey of the general incidence. age distribution. and preferential site of 631 tumors of the brain which have been surgically treated at Korea university medical center, department of neurosurgery over the last period of 10 years from 1985 to 1994. Among them 289 cases were males and 362 were females. Of the 631 intracranial neoplasms verified histologically. tumors of neuroepithelial tissue comprised 34%(212 cases), tumors of meninges 23%(148 cases), pituitary adenoma 18%(114 cases), metastatic tumors 8%(50 cases), neurilemmomas 8%(49 cases), germ cell tumors 3%(13 cases), cyst and tumor like lesions 3%(16 cases), and lymphomas 1%(5 cases). Of the 178 gliomas. astrocytic tumors comprised 83%(148 cases), oligodendroglial tumors 11%(20 cases), ependymal tumors 3%(6 cases) and mixed gliomas 1.7%(3 cases). Brain tumors occurred most frequently in the age group of 45-50 years, as seen by an incidence of 63 cases(10%). The male to female ratio was 0.74 : 1. Tumors that showed a definitive preponderance of females over males were meningiomas, neurilemmomas. and pituitary adenomas. Supratentoral and infratentorial cases were 73%(461 cases) and 26%(162 cases). respectively and the remaining cases involed both sites. Of the 114 cases of childhood and adolescent tumors. 60 were male and 54 were female. Supratentorial tumors were 56% and infratentorial were 44%. The tumors in order of frequency were astrocytomas(28%). primitive neuroectoderrnal tumors(2l%). craniopharyngioma(10%) and so on. Meningiomas occured most frequently in parasagittal/falx area(25%). followed by cerebral convexity 23%. sphenoid 14%, posterior fossa 13%. Among pituitary adenomas, prolactinomas(32%) were the most common and followed by null cell adenomas 31%, growth hormone cell adenomas 15%. mixed GH-PRL cell adenomas 11%.
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항암화학요법후 발생한 Leukoencephalopathy
김근회,조태형,박정율,정용구,이기찬,이훈갑 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.3
Increasing vigorous chemotherapy for cancers including primary and metastatic tumors has resulted in prolonged survival. However, there has been an associated increase in neurotoxicity as a result of it. All classes of chemotherapeutic agents contain drugs that are potentially neurotoxic. The authors has studied three cases of leukoencephalopathies developed during adjunctive therapy with 5-flurouracil and cisplatin for adenocarcinoma of the stomach. None of the patients had evidence of metastasis or any previous neurologic diseases. The duration of chemotherapy before onset of neurological symptoms ranged from 8 to 12 weeks, while the third one had two unexplained episodes of loss of consciousness. In all of these patients, magnetic resonance imagings demonstrated prominent periventricular white matter lesions. Cerebral biopsies were performed stereotaxically in 2 patients. The morphological features were active demyelinating disease and edema. All three patients had improved after the cessation of chemotherapy and a short course of corticosteroid therapy, suggesting that these alarming events such as nausa, vomiting, dizziness, dysarthria, and mental change were a toxic reversible side effects from these chemotherapeutic agents. This syndrome may represent the pathological basis for 5-fluorouracil neurotoxicity, however we cannot completely exclude the role of cisplatin in the occurences of the above syndromes.
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뇌허혈후 재관류 손상에서의 Hydroxyl Radical의 생성에 관한 실험적 연구
김근회,전현길,박윤관,정흥섭,이기찬,주정화,이훈갑 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.10
The time course of hydroxyl radid generation in the brain and the intensity of brain hydroxyl radical(OH￣) generation were examined in rat during the first four hours after postischemia reperfusion. Hydroxyl radical production was measured using the salicylate trapping method in which the production of 2, 3-dihydroxybenzoic acid(DHBA) in hippocampus(CA₁) 15 minutes after salicylate administration was used as an index of OH￣ formation. The interstitial concentration changes of salicylate and 2, 3-DHBA were detected by intracerebral microdialysis following the intraperitoneal administration of salicylate(150mg/kg) using high pressure liquid chromatography-electrochemical(HPLC -EC) and -ultraviolet(-UV). Adult Sprague-Dawley rats were subjected to 20 minutes of bilteral carotid artery occlusion(BCAO) in either normotensive or hypotensive state. Serial changes of cerebral blood flow(CBF) were monitored by H₂ clearance method. CBF of normotensive BCAO group(n = 6) was found to be decreased only to 52% of baseline value, and OH￣production after reperfusion did not develop in this group. Rats in the BCAO hypotensive group(n = 10) showed remarkable reduction of CBF to 27% of baseline(p<0.05) and 2~4 folds increase of 2, 3-DHBA/salicylate during the first 40 minutes of recirculation. Hydroxyl radical production in rats died(n = 5) after the insult was significantly higher and lasted longer than that in rats survived(n = 5)(p < 0.05). Concentration of salicylate inperfusate increased during 100 minutes after the peritoneal injection and before reaching to a plateau, which lasted for 3 hours. The changes of cerebral tissue concentration of 2, 3-DHBA differed from those of salicylate. In 2, 3-DHBA, the plateau was reached rather slowly than that of salicylate and lasted for 2 hours. These data indicate that global celebral ischemia could be induced by temporary BCAO only if the systemic hypotenion is accompanied, it can not be induced in normotensive group. The hydroxyl radical produced brain damage is prone to develop early in the reperfusion period and is correlated with the severity of ischemic insult.
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