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보행성 24시간 식도내압검사로 진단된 미만성 식도경련 1례
최명규(Myung Gyu Choi),추교영(Kyo Young Choo),김재광(Jae Kwang Kim),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박수헌(Soo Heon Park),장데레사(Theresa Jang),김백선(Baek Sun Kim),김선명(Sun Myung Kim),한준열(Jun Yeol Han) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of l0 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific, findings on the laboratory hiwi manometry, but DES was diagncwed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry. should always he performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature. (Korean Journal of Gastrointestinal Motility 2000;6:63-68)
장데레사(The Re Sa Jang),김백선(Baek Sun Kim),김선명(Sun Myung Kim),추교영(Kyo Young Choo),오정환(Jung Hwan Oh),현영근(Young Geun Hyun),박수현(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeol Han),김재광(Jae Kwang Kim),정인식(In 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2
N/A Background/Aims : Generally, it is recommended for patients with gastroesophageal reflux disease to sleep with the head of the bed elevated; however, many patients in Korea do not have heartburn symptoms during the night. Methods: We investigated the pattern of acid reflux in patients who were diagnosed as having definite pathological acid reflux on 24-hour pH monitoring. Results : One hundred patients were categorized into 3 groups; upright refluxer (68%), supine refluxer (2%), or combined refluxer (30%). Acid reflux was rare in supine positions but instead, usually occurred in upright positions. Acid reflux was found to occur most commonly after meals. The reflux symptoms occurred during pH monitoring with the average frequency of 5.5 times (total of 254 times) in 46 patients. The acid related symptoms were more common in the upright period and postprandially than the supine period. The presence of an esophagitis, an esophageal motility disorder, or the LES pressure did not make a significant difference between upright refluxer and supine refluxer. Conclusions : Gastroesophageal reflux was found to be rare in supine positions but usually occurred in upright positions. Gastroesophageal reflux occurred most commonly after meals, and was frequently associated with reflux symptoms.
박수현,김재광,정규원,최명규,김선명,선희식,한준열,윤정민,김백선,장데레사,추교영 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.1
A 29-year-old man was admitted because of melena for 5 days. Two years ago, he underwent allogenic bone marrow transplantation for chronic myeloid leukemia and received immunosuppressive agents. Esophago - gastroduodenoscopy showed a picture - multiple scattered deep ulcers and friable pseudomembranes - of highly suggestive of a herpes simplex esophagitis and biopsy revealed multinucleated giant cells and pathognomonic intranuclear inclusion bodies. Esophageal lesions and melena improved after acyclovir therapy.
뇌종양에서 17번 염색체 단완부 소실에 관한 분자유전학적 연구
백선하,김은상,김동규,정희원,김현집,조병규,한대희,이승훈,김종현 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1
With the methods of restriction fragment length polymorphisms(RFLPs) and southern blot analysis, gene deletion of chromosome 17p in 16 cases of brain tumors, was investigated. There were 4 cases of glioblastoma multiforme, 1 case of anaplastic astrocytoma, 4 cases of low grade astrocytoma, 3 cases of oligodendroglioma, and 4 cases of meningioma. Among restriction fragment length polymorphism(RFLP) DNA located in chromosome 17p, p144D 6 and p SNZ 22 were imployed as the probes. In eight of 16 cases(50%) constitutional heterozygosity was observed for p144 D6 probe on the short arm of chromosome 17, and in nine of 16 cases(56%) for PYNZ 22.1 probe. With both probes constitutional heterozygosity was observed in thirteen of 16 cases(81%). And the loss of constitutional heterozygosity was detected in two of 14 informative cases. Although, with the malignant gliomas, including 4 cases of glioblastoma multiforme and 1 case of anaplastic astrocytoma, two of 4 informative cases showed loss of constitutional heterozygosity. None of 9 informative cases showed loss of heterozygosity with the other brain tumors(low grade astrocytoma, oligodendroglioma, and meningioma).
김준수,김은상,이종서,박용규,백선하,박인성,정진명,한종우 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10
To clarify the prognostic factors influencing clinical outcome. the authors retrospectively analyzed 50 cases of thoracolumbar vertebral junctuon fracture treated at our hospital between September 1989 and October 1992. The age of the patients ranged from 23 to 75years(median 49years) and the male-to-female ratio was 33:17. Falling was the major mode of injury(n=27). The kyphotic angle between fractured vertebrae and the ratio of neural canal encroachment was measured in a simple X-ray and a computed tomography(CT) of the thoracic spine. An ANOVA test was performed to evaulate the predicting factors to determine the final outcome. The kyphotic angle and loss of height of vertebral body were not significantly correalted with the neurological status of the patients. However. the ratio of the compromised area of the neural canal was closely correlated with the neurological outcome(p value<0.05). The worst prognosis was found in patients with fracture-dislocation. In conclusion. it is suggested that early surgical intervention must be considered in the neurologically compromised patients whose CT demonstrates neural canal encroachment by bony fragments.
백선하,김은상,김동규,김현집,한대희 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.12
Far lateral disc herniation(FLDH) with compression of the nerve root as it exits through the foramen has been a recognized entity for a number of years. Failure to diagnose and precisely localize these herniations can lead to unsuccessful surgical exploration or exploration of the innocent interspace. If these herniation are diagnosed, they often cannot be adequately exposed by the classic minline hemilaminectomy approach. A partial or complete unilateral facetectomy to expose these herniations can lead to vertebral instability or contribute to continued postoperative back pain. The authors present 5 patients who were diagnosed as having far lateral lumbar disc herniations from 1988 to 1990. Two of these were at L_(4-5) level, two at L_(5)-S₁level and one at L_(3-4) level and all were over 60 years old. High resolution CT scan appeared to be the best study and the paramedian muscle splitting microsurgical approach, done in 3 cases, was found to be the most direct and favorable anatomical route to FLDH for vertebral stability and minimal postoperative back pain.
조병규,백선하,김은상,정영섭,왕규창,한대희 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.12
An encephalocele is defined as a herniation of cranial contents through a defect in the skull. Encephaloceles are classified accroding to their contents and location. Encephalocele is a useful general term to refer to common features of the various forms of anomaly, but considerable differences exist in the pathology, treatment and prognosis of encephaloceles at each anatomical location. Improved neuroimaging facilities, especially MRI, make it easy not only to detect the encephalocele including its contents and location, but also to get preoperative informations. We have reviewed a total of 22 patients with encephalocele whom we have experienced from 1986, July to 1990, June. Twelve were at occipital location, six at cranial vault, three at cranial base, one at frontoethmoidal location. The size of cranium bifidum and herniating sac of the cranial vault and occipital location is larger than that of frontobasal location. The incidence of associated hydrocephalus is in order of occipital, cranial vault, frontobasal form, and its prognosis is also better in frontobasal form than in occipital of cranial vault form.
뇌동맥류 파열에 의한 급성 경막하 혈종이나 뇌내혈종을 동반한 혼수상태 환자에 대한 뇌혈관 조영술을 시행하지 않은 응급수술
황수현,박용규,백선하,박인성,김은상,정진명,한종우 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10
Neurologically based clinical grading scales offer excellent prognostic information for the patient suuffering diffuse subarachnoid hemorrhaging. These grading scales are less applicable to patients with life-threatening intraparenchymal or subdural hematomas after aneurysmal rupture. During 2 and half years. 9 patients(ICH;5.SDH:1. ICH+SDH:3) in a comatose state with brain stem compression syndromes documented by computerized tomographic scans have undergone emergent operation without angiography in our neurosurgical departement. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the detection to operation was 2 hours. The origin of the hematoma was identified as a berry aneurysm of the middle cerebral artery bifurcation in seven patients and a posterior communicating artery aneurysm in two patients. One patient had a good recovery. two patients recovered with hemipardsis and mild cognitive dysfunction. two patients were vegetative and died due to pneumonia. and four patients died due to brain swelling within two weeks postoperatively. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving management in some cases. The delay imposed for diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.