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자발성 척수 경막외 농양 : 증례 보고 Case Report
박신병,이규춘,박용석,이영배,강석 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.4
Abscesses in the spinal epidural space are seen in 0.2- 1.2 patients per 1O.ooO hospital admissions and are much rarer than intracranial abscess. The morbidity and mortality of patients with infections in this location can be high, and most authors emphasize prompt diagnosis combined with appropriate antibiotics and surgical theraphy. Although laminectomy is frequently used for diagnosis and decompression of the neural element it can lead to instability, and there are orther reports emphasizing the importance of anterior decompression with stabilization. We discussed the clinical features. radiologic finding of the case, and reviewed the literatures of this disease.
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박신병,이영배,박용석,이규춘,정찬 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.10
The development of sophisticated diagnostic modalities, most notably computerized tomography(CT), let to an increasing awareness of delayed traumatic intracerebral hematoma(DTICH). But the general prognosis for functional recovery was poor in patients who developed DTICH. The author analysed 95 cases of DTICH admitted to the department of Neurosurgery. Dong-Guk University Hospital during three years from January 1990 to December 1992. The result were as follows : 1) The incidence of the DTICH was 5.1% of all head injured patients. 2) The average age of patient was 43.3 years and the most common cause was traffic accident (61.6%). 3) Of the 95 patients who were diagnosed as DTICH, the clues to undergo follow up CT were divided as routine follow up in 39, changes of the consciousness level in 38, changes of the pupil size in 18 patients. 4) Most of the DTICH formation were related to contusion site of the brain and were more commonly associated with rotational forces. 5) Twenty-one cases of DTICH occurred within 24 hours after trauma and 18 cases at 2 days after trauma. 6) The most common site of hematoma was frontal lobe followed by temporal lobe. 7) The factors affecting prognosis were ① age(p<0.01) ② Glasgow Coma scale(GCS) at admission(p<0.01) ③ time interval between trauma and discovery(p<0.01) ④ hematoma volume(p<0.01). Location of hematoma did not affect outcome, but the patients with multiple hematoma or basal ganglia hematoma showed higher fatality than the others. 8) The overall fatality rate was 40%.
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만성 경막하 혈종 수술후 대측에 발생한 지연성 만성 경막하 혈종 2예
박신병,이규춘,박용석,이영배 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.12
This report illustrates two cases of contralateral chronic subdural hematoma developed after evacuation of chronic subdural hematoma by burr holes. Contralateral hematoma occured in the area of previously existed low density lesion. The possible pathogenic mechanism is briefly dissussed. The reduction of intracranial pressure after the removal of first hematoma and bleeding into undected chronic subdural hematoma were postulated to be the important factor contributing to the formation of the contralateral chronic subdural hematoma.
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김한식,박용석,이영배,목진호,이규춘,박신병 東國大學校醫學硏究所 1997 東國醫學 Vol.4 No.-
두부외상 환자에서 두개강내 병변 발생유무가 환자의 예후에 많은 영향을 미치는 요인의 하나로 조기에 두개강내 병변을 진단하고 이에 대한 적절한 치료를 시행하여야 한다. 그러나 두개강내 병변의 정확한 진단을 위하여는 뇌 전산화 단층촬영(CT)이나 뇌 자기공명 영상촬영(MRI)을 시행하여야 하지만 모든 두부외상 환자에서 뇌CT를 시행할 수는 없으며 선택적으로 뇌CT를 시행하게 된다. 따라서 관례적으로 쉽고 빠르게 시행할 수 있는 두개골 단순 방사선 촬영을 하여 두개골 골절의 유무를 확인함으로서 간접적으로 두개강내 병변의 발생을 예측하고 진단하는데 이용하고 있다. 그러나 일부 보고에 의하면 단순 방사선 사진을 이용한 두개골 골절의 진단은 환자의 치료 및 예후에 별 도움이 안된다고 하며 심지어는 두부외상 환자에서 단순 방사선 사진 촬영은 필요 없다고까지 보고되고 있다. 이에 저자는 1995년 1월부터 1996년 12월까지 동국대학 포항병원에 두부외상후 입원 치료한 414명의 환자중에서 두개골 골절로 진단된 158명(38.2%)중 두개저 골절 환자 및 진료기록이나 방사선 사진 분석이 불가능한 환자를 제외한 80명의 환자에 대하여 임상진료기록 및 방사선 사진을 분석하여 두개골 골절과 두개강내 병변의 발생에 대하여 연구하였다. 골절형태는 선상골절이 54명(67.5%)으로 가장 많았고 복잡골절과 함몰골절이 각각 13명(16.2%)이었으며 골절부위는 측두-두정골이 20명(25.0%)으로 가장 많았고 전두골 및 후두골 골절이 각각 16명(20.0%)이었다. 초기 뇌CT상 두개강내 병변이 발견된 경우가 52명으로 65.0%이었으며 뇌경막상 혈종 23명(29.5%), 출혈성 뇌좌상 22명(28.2%), 뇌경막하 혈종 14명(17.9%), 뇌내혈종 10명(12.8%)이ㅓㅆ다. 추적 뇌CT를 시행한 68명중 새로운 병변이 발견되거나 지연성으로 커진 경우가 26명으로 추적 뇌CT를 시행한 환자의 38.2%에서 지연성 병변을 보였다. 두개골 골절이 없는환자의 경우 뇌CT를 시행한 160명중 46명(28.7%)에서 두개강내 병변이 발견되어 두개골 골절이 있는 경우에 두개강내 병변의 발생빈도가 더 높았다. 따라서 두부외상 환자에서 단순 방사선 사진 촬영을 시행하여 두개골 골절 유무를 확인하는 것은 두개강내 병변의 발생을 예측하고 진단하는데 중요하며 두개골 골절이 동반된 경우 반드시 초기 뇌CT 및 추적 뇌CT를 시행하여 조기에 두개강내 병변을 발견하여 적절한 치료를 하여야 할 것으로 생각된다. A development of intracranial lesions in patients with head trauma is one of the most important prognostic factor and brain CT scanning plays a vital role in early diagnosis of traumatic intracranial lesions. But all patients with head trauma are not evaluated with brain CT scaninning, and skull X-ray have a valuable role as a screening procedure in patients with head trauma. The presence of a skull fracture has been thought to correlate with occult intracranial lesions that may result in delayed neurological deterioration. We have undertaken a retrospective study to evaluate the development of intracranial lesions and the significance of skull fracture in patients with head trauma. A analysis of 80 cases with skull fractures who were admitted to Dongguk University Pohang Hospital from January 1995 to December 1996 was made according to their clinical informations, skull x-ray films, initial and repeated brain CT scans and prognosis. In the results, a linear skull fracture was the most common type in 54 cases(67.5%), and the most common site of fracture was temporo-parietal skull in 20 cases(25.0%). Intracranial lesions were identified in 52 cases(65.0%) on initial brain CT scan and types of intracranial lesions were epidural hematoma in 23 cases(28.8%), hemorrhagic cerebral contusion in 22 cases(27.5%), subdural hematoma in 14 cases(17.5%) and intracerebral hematoma in 10 cases(12.5%). Repeated brain CT scanning was performed in 68 cases and delayed lesions were identified in 26 cases(38.2%). Conclusively, the presence of skull fracture is a important and valuable indicator for development of intracranial lesions and skull x-ray film is a good screening evaluation method in patients with head trauma.
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급성기 두부손상 환자에서 혈액응고기전의 변화에 관한 연구
박신병,정찬,이영배 東國大學校醫學硏究所 1994 東國醫學 Vol.2 No.-
혈액응고이상은 두부손상시 흔히 발생하는 합병증이다. 저자들은 혈액응고 기전의 활성도와 두부손상환자의 의식수준, 임상경과, 신경학적 결손사이의 연관관계를 알아 보았다. 다른 장기에 신한 손상을 받지 않은 두부손상 환자 178명을 대상으로 시행되었으며, 혈액응고이상의 출현여부를 알기위해 출혈시간, 프로트롬빈 시간, activated partial thromboplastin time(APTT), 혈소판 수치, 섬유소원 수치, 섬유소원 분해물 수치 등의 검사를 하였으며, 응고이상의 출현 비율, 응고이상과 의식수준과의 관계, 응고이상 유무 등이 치료결과에 미치는 영향 및 예후와의 관계를 분석하여 아래와 같은 결과를 얻었다. 1. 혈액응고이상의 빈도는 178명중 50명으로 28%였으며, Glasgow Coma Scale(이하 GCS) Score가 3-7인군에서 49.2%, 8-12인 군에서 13%로, 의식이 나쁠수록 혈액응고 이상의 빈도가 높았다. 2. 내원 당시 뇌 전산화단층촬영소견과 혈액응고이상의 비교에서 미만성 축삭손상,급성 경막하 혈종,외상성 뇌내혈종 등 뇌실질 손상이 심한 군에서 혈액응고이상의 출현 빈도가 높았다. 3. 두부손상환자에서 혈액응고검사 이상소견은 내원 당시의 의식상태, 신경학적 이상소견의 유무, 임상경과 등과 아주 의의있는 정도로 비례하였다. 4. 두부손상 환자에서 혈액응고검사 이상소견 특히 섬유소원 분해물 수치의 변화는 뇌실질 손상의 정도를 아는데 도움을 주며 환자의 예후와도 밀접한 관계가 있었다. Abnormal coagulation is a frequent complication in patients with head injury. We evalute the relationship of the activity of blood coagulation with patient's consciousness level, clinical course, neurological deficit in the patient with head injury. Hemostasis in 178 patients with head injuries, not associated with serious systemic injury, were screened using platelet count, bleeding time, prothrombin time, thrombin time, activated patial thrombin time, fibrinogen level, fibrin degradation prodect(FDP). The result were as follows: 1. Frequency of coagulopathy was 28% in all patients. The coagulopathy was more frequently detected in patients with low GCS score on admission than high GCS score. 2. The most common disease associated with coagulopathy was the diffuse axonal injury and followed by subdural hematoma and intracerebral hematoma. 3. The presence of coagulopathy was correlated with the state of consciousness on admission, the patient's clinical course, and neurological deficits(p<0.01). 4. The presence of coagulopathy with value of FDP were proportional to the cerebral parenchymal injury and influenced on poor outcome (p<0.01). 5. We conclude that coagulopathy in patient with head injury was a reliable marker of cerebral parenchymal injury and that coagualtion stadies might have both diagnostic and prognostic values.
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새로운 내부 방사선 치료용 166Ho - Chitosan 착물 및 그 응집입자의 제조에 관한 연구
박경배(K . B . Park),김영미(Y . M . Kim),신병철(B . C . Shin),김재록(J . R . Kim) 대한핵의학회 1996 핵의학 분자영상 Vol.30 No.3
N/A Chitosan is a polysaccharide of natural orgin obtained by full or partial deacetylation of chitin, a very abudant natural polymer, which has the properties of biocompatibilities, bioaffinities, and biodegradabilities. The free amino group of chitosan should be participated in forming chelate with holmium (β-emitter). Ho-166(NO3)3. 5H2O of high radionuclidic purity of upto 99.9% was made by neutron irradiation of naturally occuring Ho-165(NO3)3., 5H2O, and then reacted with the prepared chitosan solution. The effect of pH, reaction time, the concentration and viscosity of chitosan and the amount of Ho-166 on forming Ho-166-chitosan complex (Ho-166-CHICO) were investigated. Ho-166-chitosan macroaggregate(Ho-166-CHIMA) was made from Ho-166-CHICO. Their physical properties such as radionuclidic purity, particle size distribution, stability in vitro and vivo were examined. Their high in vitro and vive stability makes them attractive agents for interna1 radiotherapy by local administeration.
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