의학교육에 있어서의 Tutorial System

박정율(Jung Yul Park),채병국(Byung Kook Chae),유세화(Se Wha You) 한국의학교육학회 1996 Korean journal of medical education Vol.8 No.1

Desmoplastic Fibroma of the Skull;A Case Report, Review of the Literature, and Therapeutic Implications

김주한,박정율,정용구,서중근,김성남,서연림,Kim, Joo Han,Park, Jung Yul,Jung, Yong Gu,Suh, Jung Keun,Kim, Sung Nam,Suh, Yeon Lim The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.8

결합조직형성 섬유종은 드문 골종양으로 조직학적으로는 양성이나 국소적으로 빨리 자라는 질환이다. 두개골에 발생한 결합조직형성 섬유종은 지금까지 9례가 보고되고 있으며, 이 중 8명은 여자에서 발생하다. 이 논문은 남자에서 발생한 두개골 결합조직형성 섬유종을 보고하며, 문헌을 검토하여, 이 질환의 임상양상 및 조직학적소견, 그리고 치료방법등을 보고하고자 한다. 환자는 21세 남자로 두통을 호소하으며, 두부 전산화 단층 촬상 뇌을 침습한 소견이 없는 단일 골용해성 부위가 관찰되었으며, 조직학적 검사상 결합조직형성 섬유종으로 밝혀졌다. 면역조직화학적 염색상, 종양의 에스트로겐과 프로게스테론 수용기는 음성이었다. 정상골을 포함한 종양을 전적출하으며, 35개월간 추적관찰결과 재발소견은 없었다. 다른 부위의 결합조직형성 섬유종과 비교했을 때, 종양의 정상골을 포함한 전적출이 두개골에서 가능하므로, 재발이 없는 것으로 생각되며, 남자에서 발생한 결합조직형성 섬유종을 치험하기에 문헌검토와 함께 보고하는 바이다. Desmoplastic fibroma(DF) is a rare neoplasm of the bone, and is histologically benign but locally aggressive disease. A total of nine cases of DF involving skull have been reported in the literature, and among these eight are females. In this report, the clinical findings and histopathology of a case with DF of the skull in a male patient is presented with a review of the literature with an emphasis on treatment modalities. A 21-year-old man presented with headache. CT scan revealed a solitary and lytic skull lesion without brain invasion. DF was confirmed by histological evaluation. On immunohistochemical staining of the tumor was negative for estrogen or progesterone receptors. After total resection of tumor with wide surgical margin, there was no recurrence during the 35 months of follow-up period. Although longer follow up period maybe needed, treatment of this type of tumor with complete resection of tumor tissue along with a wide margin may provide long disease-free state compare to the high recurrence rates in DF of other sites.

Craniopharyngioma : Comparison of Tumor Characteristics Relevant with Initial Symptomatology between Children and Adults

박동혁,박정율,김주한,정용구,이훈갑,이기찬,서중근,Park, Dong Hyuk,Park, Jung Yul,Kim, Joo Han,Jung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.8

목 적 : 두개인두종은 적어도 일부분이 상부 터어키안에 존재하는 양성종양이다. 그러나 이 종양으로 인한 증상과 징후는 종양의 위치뿐만 아니라 그 크기와 환자의 나이등에 영 향을 받는다고 알려져 있다. 이번 연구에서 본 저자들은 성인과 소아에서 증상과 연관된 두개인두종의 임상적 특징을 후향적으로 분석하였다. 방법 및 대상 : 1990년부터 1999년까지 두개인두종으로 치료를 받은 23명(성인 : 16명, 소아 : 7명)을 대상으로 종양의 크기, 성장양상과 주변조직으로의 침윤정도와 증상과의 연관성을 연구하였다. 분석을 위해 16명의 성인(남자 : 8명, 여자 : 8명, 평균연령 : 43.7세)과 7명의 소아(남자 : 5명, 여자 : 2명, 평균연령 : 10.1세)에게 MRI 및 CT를 시행하였으며 3차원적으로 종양의 부피를 측정하였다. 결 과 : 두개인두종에서 3대 주증상은 두개강 내압상승과 연관된 증상, 내분비 기능 이상, 시력이상이다. 종양의 크기는 소아군에서 성인군보다 컸으며 시력이상, 두개강 내압 상승과 연관된 증상, 뇌수두증도 소아군에서 더 많았다. 그러나 내분비 기능 이상과 시상하부와 시상, 뇌하수체, 전두엽과 다른 피질부위와 연결의 이상으로 인한 신경정신적과적인 증상은 성인군에서 더 많았다. 결 론 : 이번 연구에서 두개인두종은 종양의 크기와 침윤성은 두개강 내압 항진과 연관된 증상 및 시력 증상과 연관이 많으며 소아군에서 더 흔하게 나타났다. 하지만 종양의 성장 양상은 소아군과 성인군에서 주된 차이를 발견하지 못했다. Objectives : The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. Material and Methods: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M : F=8 : 8, mean age : 43.7 years) and 7 children(M : F=5 : 2, mean age : 10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. Results : The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.

Morphine과 Pentazocine의 혈장 Corticosterone 증가작용에 미치는 Naloxone 및 Diazepam의 영향

전보권,박정율,조근행,김수경,Chun, Boe-Gwun,Park, Jung-Yul,Cho, Geun-Haeng,Kim, Soo-Kyung 대한약리학회 1983 대한약리학잡지 Vol.19 No.1

The influences of diazepam and naloxone on the increase of plasma corticosterone level induced by morphine, pentazocine, ACTH, or picrotoxin were investigated in male mice. The results obtained were summarized as follows: 1) The increase induced by morphine or pentazocine of plasma corticosterone level was not affected by naloxone pretreatment but markedly suppressed by diazepam pretreatment. 2) The increase induced by ACTH of plasma corticosterone level was not affected by diazepam or naloxone pretreatment. 3) The picrotoxin markedly increased plasma corticosterone level, and the inceease was not affected by diazepam or naloxone pretreatment. This above results suggest that the increase induced by opioids of plasma corticosterone level seems to be rather related with other than opiate- or GABArerecptor.

Primary Non-Hodgkin's Lymphomas Presenting with Extradural Spinal Cord Compression as the Initial Manifestation

김세훈,임동준,조태형,박정율,정용구,이훈갑,이기찬,서중근,Kim, Se Hoon,Lim, Dong Jun,Cho, Tai Hyoung,Park, Jung Yul,Chung, Yong Gu,Lee, Hoon Kap,Lee, Ki Chan,Suh, Jung Keun The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.10

악성 임파종중에서 Non-Hodgkin 임파종이 척수 압박 증상을 일으키는 경우는 0.1~10.2%정도로 알려져 있으며, 이러한 척수 압박 증세가 임파종의 초기 증상으로 나타나는 경우는 특히 드문 것으로 알려져 있다. 척수 압박은 척추관내에 국한되어 있는 임파종에 의하거나 주변 임파절이나 척추로부터 전이된 경우에 발생하며, 다른 장기로의 침범 소견이 없는 원발성 척수 경막외 임파종의 경우, 조기에 외과적 감압이 이루어지고 보조요법으로 항암 치료 및 방사선 치료가 행해진다면 그 경과가 비교적 양호한 것으로 알려져 있다. 저자들은 요통을 전구 증상으로, 급성 하반신 부전마비 및 배뇨 장애 소견을 보여 본원에 내원후, 응급 감압술 및 조직병리검사 결과 B-세포성 Non-Hodgkin 임파종으로 확인된 두 명의 여자환자를 경험하였다. 수술후 두 환자의 증세는 모두 회복되었으며, 항암 치료 및 방사선 치료후 현재까지 추적 조사중이다. 이에 저자들은 초기 증상으로 경막외 척수 압박을 보인 원발성 Non-Hodgkin 임파종에 관해 문헌 고찰과 함께 보고하는 바이다. Objectives : Spinal cord compression is a rare presentation of non-Hodgkin's lymphoma(NHL), occurring in 0.1% to 10.2% of patients. Primary spinal extradural NHL, i.e. occurring in the absence of any detectable extraspinal lymphoproliferative disorder, has a potentially favourable outcome if diagnosed and treated early. The authors describe two patients with a clinical picture of acute spinal cord compression as the first presentation of NHL. Methods : The patients were 48-year-old female and 27-year-old female. Both presented with back pain followed by acute paraparesis and voiding difficulty. One patient was diabetic. Plain radiographs of the spine were not specific. Thoracic spine magnetic resonance imaging(MRI) revealed evidence of extradural soft tissue mass extending multiple vertebral segments. Results : The patients underwent emergency laminectomy for decompression and tissue diagnosis. Histological and immunohistochemical study revealed B-cell lymphoma, intermediate grade in both patients. Postoperative staging did not reveal any additional lesions other than extradural manifestation of the malignant lymphoma. Surgery with additional chemotherapy and radiotherapy allowed the clinical improvement of both patients. Conclusion : The authors report two patients with a clinical picture of acute spinal cord compression as the first presentation of NHL, and stress that primary spinal epidural NHL should be a diagnostic consideration in the patient without prior history of malignancy who presents with a prodrome of back pain followed by a rapid neurological deterioration.

안와종양 55례의 임상적 분석

김상대 ( Sang Dae Kim ),박정율 ( Jung Yul Park ),정용구 ( Yong Gu Chung ),이훈갑 ( Hoon Kap Lee ),서중근 ( Jung Keun Suh ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.2

Diverse pathological types of tumor are known to occur in the orbital space, although not common. Object of this study was to evaluate and analyze the characteristics of these uncommon tumors that were undertaken operatively in past ten years. Moreover, choice of surgical approaches for various types of tumor was reconsidered. A total of 55 cases operated in our institution from 1988 to 1998 were included in this study. Primary intraocular tumors, e.g., retinoblastoma, and those arising from appendages were excluded. Age distribution, sex ratio, symptomatology, radio- histopathological types, and surgical methods with their results were analysed. Age distribution was 1 to 60 years with average of 29.1 years. Male to female ratio was 26:29. The most common symptom was exopthalmos(40%). Radiologic findings were related to types of pathology. Pseudotumor(16.3%), dermoid(14.6%), meningioma(10.9%), neurilemmoma(10.9%), hemangioma(9.1%) were among more common histologic types. Various surgical approaches were applied according to types and locations of tumors including two-step supraorbital approach. There were 8 cases of recurrence in whom reoperations were necessary. Most of postoperative cosmetic results were acceptable. Wide variety of histologic types of orbital tumors can be seen with recurrences in some cases. Thus, careful selection of surgical plan seems to be mandatory for good functional outcome.

뇌 전이를 동반한 크루켄베르크 종양 - 증 례 보 고 -

권택현,조태형,임동준,박정율,박윤관,정용구,정흥섭,서중근,Kwon, Taek-Hyun,Cho, Tai-Hyoung,Lim, Dong-Jun,Park, Jung-Yul,Park, Youn-Kwan,Chung, Yong-Gu,Chung, Hung-Seob,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Krukenberg tumor has been traditionally defined as gastrointestinal malignancy metastatic to the ovary, and is known to account for 1 to 3% of ovarian neoplasms. The nature and behavior of this particularly virulent tumor still remains unclear. We have experienced a case of Krukenberg tumor with brain metastasis. A clinical description of our case is presented with a review of the literature.

신경교종에서 뇌동맥내 Carboplatin주입후 발생한 안구 합병증 - 3례보고 -

김주한,이장보,정용구,박정율,이훈갑,서중근,Kim, Joo-Han,Lee, Jang-Bo,Chung, Yong-Gu,Park, Jung-Yul,Lee, Hun-Kap,Suh, Jung-Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma : 3, Grade III Astrocytoma : 1, Grade IV Astrocytoma : 5, Gliofibroma : 1, Oligodendroglioma : 1) underwent IAC regimen with carboplatin($300mg/m^2$) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.

초기상태가 불량한 자발성 뇌출혈 환자의 예후 - 70세 이상의 고령환자를 대상으로 -

김주한,이자규,임동준,권택현,박정율,정흥섭,이훈갑,서중근,Kim, Joo Han,Lee, Ja Kyu,Lim, Dong Jun,Kwon, Tack Hyun,Park, Jung Yul,Chung, Hung Seob,Lee, Hoon-Kap,Suh, Jung Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.2

Objective : The prognosis of spontaneous intracerebral hemorrhage often depends on initial neurologic condition, size and location of hemorrhage and associated intraventricular hemorrhage. However, age of patient, coagulation state and other associated vascular diseases may also play a role when present. In recent years, the geriatric population has been increasing. The age distribution of the patients with intracerebral hemorrhages also has been increased, accordingly. However, such patients, especially when associated with poor initial conditions often tend to be managed rather conservatively. The authors analyzed retrospectively on forty-five patients with spontaneous intracerebral hemorrhage over the seventies with poor initial condition to find out whether there exists a difference of outcome between surgery and non-surgery group. Material and Method : A total of 45 patients over seventies with spontaneous intracerebral hemorrhage with Glasgow Coma Scale(GCS) 4-8 treated over last six years were included. The validity of surgical management for these patients as well as clinical variables which might have been operated on the outcome of these patients were evaluated. The Glasgow Outcome Scale(GOS) after three months was used for comparison of outcome. Results : In surgical group(19 cases), mean age was 74.5 years old, mean hematoma volume 67.2ml and mean GCS score 5.7 points. In nonsurgical group(26 cases), mean age was 79.3 years old, mean hematoma volume 32.1ml, and mean GCS score 6.8 points. Mortality rate in surgical group was 47.4%(9 patients), including 2 cases of post-operative rebleeding, while that in nonsurgical group was 46.2%. However, when patients with initial GCS 4-6 points and over 30ml in hematoma volume were regrouped, mortality rate in surgical group was 46.2%, whereas mortality rate in nonsurgical group was 66.7%. Conclusion : It is concluded that the mortality rate is much low in surgery group with initial GCS less than 6 points and hematoma volume over 30cc. There was no significant difference of outcome in patients with basal ganglia and thalamic hemorrhage. However, surgical treatment lowered the mortality and morbidity rate in patients with subcortical and cerebellar hemorrhage.

SAPHO 증후근에서의 신경근병증 - 증 례 보 고 -

한석,조태형,김세훈,임동준,박정율,정용구,서중근,Han, Seok,Cho, Tai Hyoung,Kim, Se Hoon,Lim, Dong Jun,Park, Jung Yul,Chung, Yong Gu,Suh, Jung Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11

SAPHO syndrome is an acronym for an increasingly recognized syndrome of synovitis, acne, pustulosis, hyperostosis, and osteitis. Most of the previously reported case are from Japan and Europe. The authors report a case of SAPHO syndrome in Korean female who presented with extrasternal neurologic symptoms. A 60-year-old female with thoracic and right chest wall pain presented with the sternocostoclavicular hyperostosis, and recurrent aseptic osteitis. Previously, she had hystrectomy and thyroidectomy due to uterine malignancy 25 years ago. Also, she started to take medications for palm and sole pustulosis 7 days prior to admission. Through evaluation of clinical, radiological, serological studies, studies was done along with bone needle biopsy for the biological reassessment. The hyperostosis was found in the pedicles of thoracic 8, 9, 10 vertebrae and sternoclavicular joint. Radio-isotope bone scan showed an accumulation of tracer in thoracic vertebra. The bone biopsy from these site showed increased osseous turnover, thickening of trabeculae accompanied by mild acculuation of granulation tissue and round cell infiltration, compatible with mild chronic inflammation with marrow fibrosis. The patient showed good response to conservative management. The authors report a case of SAPHO syndrome with thoracic radiculopathy. It is considered that SAPHO syndrome is related to spondyloarthropathy, and appears to have benign disease process with good prognosis.