축추-환추간 경관절 나사못 고정술 치료의 결과 및 합병증

최준웅,윤승환,박형천,박현선,김은영,하윤,Choi, Jun-Woong,Yoon, Seung-Hwan,Park, Hyung-Chun,Park, Hyeon-Seon,Kim, Eun-Young,Ha, Yoon 대한신경외과학회 2005 Journal of Korean neurosurgical society Vol.37 No.3

Objective: To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings. Methods: From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 patients. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis. Results: Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. Conclusion: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

중증 뇌손상 환자에서 뇌동정맥 산소함유량차이와 지연성 뇌경색 발생과의 관계

윤승환,조준,문창택,장상근,박형천,박현선,김은영,Youn, Seung-Hwan,Cho, Joon,Moon, Chang-Taek,Chang, Sang-Keun,Park, Hyung-Chun,Park, Hyeon-Seon,Kim, Eun-Young 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : This study was performed to evaluate the relationships among intracranial pressure(ICP), cerebral perfusion pressure(CPP), and cerebral arteriovenous oxygen difference($AVDO_2$) which were used as parameters of adequacy of cerebral blood flow to support cerebral metabolism after severe head injury and also to examine the association between delayed cerebral infarction and outcome. Material and Method : The authors studied the ICP, CPP and $AVDO_2$ before and after treatment on 34 head-injured patients from June 1996 to December 1997 and examined the association with the change of an ICP, CPP and $AVDO_2$ following treatment and the development of delayed cerebral infarction. Sixteen patients underwent craniotomy for hematoma evacuation and eighteen patients received mannitol to decrease ICP. Results : The development of delayed cerebral infarction was demonstrated in 3(42.9%) out of 7 patients in no improvement group and 13(48.1%) out of 27 patients in improvement group with an increased ICP following treatment. Also, the development of delayed cerebral infarction was demonstrated in 8(50%) out of 16 patients in no improvement group and 8(44.4%) out of 18 patients in improvement group with a decreased CPP following treatment. The association with changes of ICP and CPP following treatment and development of delayed cerebral infarction was not statistically significant(p>0.01). However, 11(78.6%) out of 14 patients who demonstrated an increase in $AVDO_2$ and 5(25%) out of 20 patients who demonstrated a decrease in $AVDO_2$ following treatment developed delayed cerebral infarction. No improvement(reduction) in $AVDO_2$ following treatment was significantly associated with the development of delayed cerebral infarction(p<0.01). All of 16 patients with delayed cerebral infarction showed poor prognosis. Conlcusion : The change of $AVDO_2$ rather than those of ICP and CPP was considered more important factor for the development of the delayed cerebral infarction and poor outcome.

Atlantoaxial Rotatory Fixation - 3 례 보 고 -

손문준,임승철,노성우,박형천,Sohn, Moon Jun,Rhim, Seung Chul,Roh, Sung Woo,Park, Hyung Chun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

The atlantoaxial rotatory fixation is a uncommon disease of deformity, occuring much more frequently in children than in adults. Despite of its benign clinical course, delayed recognition or improper management may cause persistent deformity or recurrence. We report three cases of typical atlantoaxial rotatory fixation. Successful reduction was achieved with posterior atlantoaxial fusion in one case and nonoperative treatment in others. We emphasize that it is necessary to perform dynamic CT scan to obtain correct diagnosis and to plan proper treatment for this disease entity.

Bolus Injection 방법을 이용해서 측정한 정상 성인의 뇌척수액 배출저항

김은영,박현선,정종권,진태경,김재중,박형천,Kim, Eun-Young,Park, Hyun Sun,Chung, Chong Kweon,Jin, Tae Kyoung,Kim, Jae Joong,Park, Hyung Chun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objectives : The measurement of resistance to cerebrospinal fluid outflow($R_o$) can clearly delineate cerebrospinal fluid dynamics in patients with ventricular dilatation and can help in selecting patients to undergo shunt placement. With regards to type of infusion method, bolus injection is known to be more practical and safer than continuous infusion. The purpose of this study was to obtain $R_o$ of normal adults using lumbar bolus injection method. Material and Methods : Twenty adults aged 25 to 52 years were studied using lumbar bolus injection method. Fifteen patients with hemifacial spasm and five with cerebral concussion underwent $R_o$ measurement under propofol general anesthesia and local anesthesia, respectively. Results : The mean values of $R_o$ determined 1 minute and 2 minutes after bolus injection were $4.8{\pm}1.7$ and $4.4{\pm}1.6mmHg/ml/min$, respectively. There was no significant difference of $R_o$ between propofol general anesthesia group and local anesthesia group. Two patients showed $R_o$ greater than 6mmHg/ml/min. One patient revealed unexpectedly high level of $R_o$ due to severe spinal stenosis. Conclusion : Mean Ro in this study was higher than that of Shapiro's study. Borderline Ro near 6mmHg/ml/min should be regarded with caution and compared with clinical symptoms and results of other studies. Patients with severe spinal stenosis should be evaluated with caution.

축내 뇌종양으로 오인 된 탈수초성 가성종양

서현성 ( Hyun Sung Seo ),김은영 ( Eun Young Kim ),박인서 ( In Suh Park ),박현선 ( Hyun Seon Park ),박형천 ( Hyung Chun Park ),박종운 ( Chong Oon Park ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

Acute tumor-like demyelination or demyelinating pseudotumor is a variant presentation of demyelinating diseases, such as multiple sclerosis. A 32 years old male developing left side hemiparesis for 4 days and general tonic clonic seizure lasting 2 minutes was admitted to the hospital. Brain magnetic resonance imaging(MRI) taken at other hospital showed a large and irregular well enhancing intra-axial mass in right fronto-parietal area with massive surrounding edema. Craniotomy was planned under the impression of the malignant glioma. The edema and hemiparesis subside by preoperative use of corticosteroid. Therefore we had to rule out lymphoma. Stereotactic biopsy revealed a demyelinating lesion consistent with demyelinating pseudotumor. The patient recovered from hemiparesis by corticosteroid treatment over several weeks. The demyelinating pseudotumor, which usually presents as a well enhancing and poorly defined intra-axial lesion with edema, is very hard to distinguish from intra-axial tumors such as lymphoma and malignant glioma. Neurosurgeons should be aware of the possibility of demyelinating pseudotumor though it is rare.

GM-CSF를 이용한 척수손상의 치료적 접근

최병현 ( Byung Hyune Choi ),하윤 ( Yoon Ha ),박현선 ( Hyeon Seon Park ),윤승환 ( Seung Hwan Yoon ),박형천 ( Hyung Chun Park ),민병현 ( Byoung Hyun Min ),박소라 ( So Ra Park ) 한국조직공학과 재생의학회 2006 조직공학과 재생의학 Vol.3 No.1

전두동골절 수술 후에 발생한 점액낭종에 의한 안구돌출증

김진욱(Jin-Wook Kim),하윤(Yoon Ha),윤성환(Seung-Hwan Yoon),현동근(Dong-Keun Hyun),박현선(Hyeon-Seon Park),박형천(Hyung-Chun Park),박종운(Chong-Oon Park),김은영(Eunyoung Kim) 대한두개저학회 2008 대한두개저학회지 Vol.3 No.1

Mucoceles arise from the gradual accumulation of mucus material caused by obstruction of the sinus ostium. They may enlarge sufficiently to compress orbital or intracranial structures. We present a case of severe exophthalmos caused by frontal sinus mucocele developed after operation for frontal sinus fracture. At initial operation for depressed fracture of the anterior wall of left frontal sinus, all frontal sinus mucosa was extirpated and the space was obliterated with bovine artificial bone. The fractured pieces of the bone were replaced and fixed with titanium mesh and screws. The reason for the delayed development of mucocele in this patient was the unintentionally remained sinus mucosa and blockage of the natural drainage pathway by bone graft. Exophthalmos was relieved after surgical drainage of mucocele, resection of mucosa as much as possible and recreation of drainage pathway by the removal of grafted bovine bone. This case reminds surgeons that natural drainage pathway of sinus should be kept intact whenever possible, otherwise a mucocele may develop even many years after operation.

종양내 출혈을 동반한 선천성 교모세포종 -증례보고-

김형중 ( Hyoung Joong Kim ),김세혁 ( Se Hyuk Kim ),김순기 ( Soon Ki Kim ),윤승환 ( Seung Hwan Youn ),박현선 ( Hyeon Seon Park ),김은영 ( Eun Young Kim ),박형천 ( Hyung Chun Park ) 대한뇌종양학회 2003 대한뇌종양학회지 Vol.2 No.2

Congenital glioblastomas have been rarely reported in the literatures and known to have a higher propensity to cause intratumoral hemorrhage compared to pediatric brain tumors. We report a case of definite congenital glioblastoma, which was not detected by endovaginal fetal sonography until 35+1 weeks gestation and presented with intratumoral hemorrhage after birth. Brain CT and MRI scan showed a intracranial mass with internal hemorrhage and small portion of contrast enhancement. If the rapid growing intracranial lesion with internal hemorrhage is detected by fetal sonography or MRI late in gestation, a congenital malignant tumor as well as vascular malformations should be considered.

말기 신부전 환자에서 부갑상선 기능항진증으로 외과적 부갑상선 절제술을 시행 받은 환자의 임상적 경과

한승혁(Seung Hyeok Han),이상철(Sang Cheol Lee),강이화(E . Hwa Kang),구영석(Young Suk Goo),박형천(Hyung Chun Park),노현정(Hyun Jeong Roh),노현진(Hyun Jin Noh),윤수영(Soo Young Yoon),윤도식(Do Sik Yun),최소래(So Rye Choi),강신욱(Shin W 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1

배 경 : 말기 신부전 환자의 내과적 치료에 교정되지 않는 중증 이차성 부갑상선 기능항진증시 외과적 부갑상선 절제술이 시행되어져 왔다. 부갑상선 절제술 시행 후 추적결과에 대한 보고가 드물어 본 연구를 시행하였다. 방 법 : 1990년부터 1999년까지 신촌세브란스병원에서 중증 이차성 부갑상선 기능항진증으로 외과적 부갑상선 절제술을 시행 받은 24 명을 대상으로 후향적으로 분석하였다. 결 과 : 술후 병리소견으로 미만성 17예, 결절성 6예, 선종이 1예였다. 임상증상으로 골통 또는 관절통은 19명(79.2%), 근육통은 17명(70.8%), 신체 불쾌감은 10명(41.7%), 소양증은 13명 (54.2%)였고, 술후 임상증상의 호전을 보였다. 술후 혈청 칼슘, 혈청 인, intact PTH는 각각 7.3±1.4 ㎎/dL, 4.0±1.3 ㎎/dL, 89.3±146.1 pg/mL로 술전과 비교하여 감소하였고(p<0.01), 혈청 alkaline phosphatase는 술후 738.8±935.1 IU/L로 술전 보다 증가하였다(p<0.01). 재발 5예 중 결절성 과증식형이 4예로 미만성 과증식형에 비해 높은 빈도를 보였고(p=0.006), 비재발군에 비해 수술 전후의 intact PT H의 감소차가 적었다(945.3±374.6 v s 1,385.8±481.8, p=0.036). 결 론 : 중증 이차성 부갑상선 기능항진증에서 외과적 부갑상선 절제술은 증상완화나 술후 intact PTH의 감소 등 좋은 결과를 기대할 수 있다. 병리학적 유형과 술후 intact PTH 감소 정도가 재발을 예측할 수 있는 인자로 생각된다. Backg round : Medical treatments such as restriction of phosphate, phosphate binder use, and active vitamine D therapy have been widely used for hyperparathyroidism in ESRD patients, and surgical parathyroidectomy should be considered in patients with uncontrolled hyperparathyroidism. Methods : A retrospective study w as performed in 24 ESRD patients with severe and uncontrolled hyperparathyroidism despite of medical treatment who undertook surgical parathyroidectomy in Severance hospital from 1990 to 1999. Results : Sixteen patients had total parathyroidectomy with immediate autotransplant, 7 patients had subtotal parathyroidectomy and only 1 patient had minimally invasive parathyroidectomy. An excellent short-term control of hyperparathyroidism was achieved in all patients after parathyroidectomy. Preoperative bone and joint pain improved in 16 of 19 patients. Muscle weakness and pain improved in 11 of 17 patiens, malaise improved in 8 of 10 patients and pruritus improved in 10 of 13 patients. In addition, clinical laboratory finding improved after parathyroidectomy. No clinical differences were seen between 16 patients who undertook total parathyroidectomy with immediate autotransplant and 7 patients who undertook subtotal parathyroidectomy. Recurrence of hyperparathyroidism ocurred in 5 of 24 patients with 4 nodular hyperplasia and 1 diffuse hyperplasia in pathologic finding . T he less degree of attenuated response of intact PTH levels immediately after operation w as observed in 5 recurrent cases. Conclusion : Good results were obtained after parathyroidectomy. We believe that histologic subtype and the attenuated response of intact PTH after surgical parathyroidectomy could be possible predictors of the recurrent hyperparathyroidism.

장기 지속성 외래 복막투석 환자에서 복막기능 변화에 영향을 미치는 인자

이상철(Sang Cheol Lee),한승혁(Seung Hyeok Han),윤수영(Soo Young Yoon),강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),한대석(Dae Suk Han),이호영(Ho Yung Lee),구영석(Young Seok Goo),강이화(E . Hwa Kang),박형천(Hyung Chun Park),노현정(Hyun 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.1

목 적 : 장기 지속성 외래 복막투석 환자의 복막기능에 대한 국내연구가 부족한 실정이다. 저자는 장기간 지속성 복막투석 환자에서 복막기능 변화 및 영향인자를 분석하고자 하였다. 방 법 : 복막 평형 검사를 시행한 5년 이상의 복막투석 환자 124명에서 복막 평형 검사와 임상적 특성을 근거로 복막기능 특성 차이를 단면연구를 통해 분석하였다. 또한 시작시 검사를 시행한 31명에서 5년 후 재검사와 비교하여, 복막기능의 변화와 영향인자에 대해 분석하였다. 결 과 : High transport군에서 D/ P Cr이 가장 높았고, 한외여과량은 가장 낮았으며, 1일당 2.5% 이상 고농도 포도당 투석액의 사용횟수가 가장 많았고, 혈청 알부민 수치가 가장 낮았다. 한외여과 부전은 17명으로 나머지 107명과 비교시 D/P Cr이 높았고(0.83±0.14, p<0.001), 1일당 2.5% 이상의 고농도 포도당 투석액의 사용횟수가 더 많았으며(1.64±0.60/일, p<0.001), 평균 복막투석 기간이 길었다(100.3±25.3개월, p=0.033). 124명의 평균 D/P Cr과 상관관계를 보이는 인자는 복막염 발생 빈도(p=0.006), 1일당 2.5% 이상의 고농도 포도당 투석액의 사용횟수 였으며(p<0.001) 혈청 알부민과는 역상관관계를 보였다(p< 0.001). 지속성 외래 복막투석 시행 후 1년 이내 복막 평형 검사를 시행한 31명의 환자를 5년 후 재검사를 시행하였을 때 D/P Cr은 5년 후에 증가하였고, 한외여과량은 감소하였으나 유의한 차이를 보이지 않았다. 총 복막염의 발생 횟수가 0회 또는 1회였던 군(n=17)과 2회 이상이었던 군(n =14)간의 5년간 D/P Cr의 변화량을 비교시 2회 이상이었던 군에서 변화량이 증가하였고(0.13±0.18, p=0.014), 이는 총 복막염의 발생횟수와 유의한 상관관계를 나타내었다(p=0.001). 또한 D/ P Cr의 변화는 1일당 평균 고농도 포도당 투석액 사용횟수와도 유의한 상관관계를 나타내었다(p=0.003). 결 론 : 복막기능 변화의 영향인자는 투석기간, 복막염 발생빈도, 고농도 포도당 투석액 사용 등이었다. 따라서 복막기능 보존을 위해 복막염 발생을 예방하고, 고농도 포도당 투석액 사용을 줄이는 것이 필요하다. Background : According to previous studies on peritoneal membrane function, solute transport significantly increased 3 years after the begining of peritoneal dialysis. However, there were only few reports regarding the change of peritoneal membrane function in long-term CAPD patients in Korea. Methods : Clinical factors affecting peritoneal membrane function were analyzed, in patients who maintained CAPD more than 5 years. 124 patients performed peritoneal equilibration test (PET) 5 years after CAPD were included. Cross sectional study was performed to know the differences of clinical characteristics among 4 types of peritoneal membrane transport characteristics based on PET. Also, clinical factors affecting peritoneal memebrane function were analyzed in 31 patients who had undertaken PET initially and 5 years after the beginning of CAPD. Results : D/P Cr was the highest (p<0.001) and ultrafiltration was the lowest (p=0.011) in high transport group. Also, the number of hypertonic glucose exchanges (more than 2.5%) per day was the highest (p=0.02), and serum albumin w as the lowest (p<0.001) in this group. 17 patients were included in ultrafiltraion failure group. D/P Cr and the number of hypertonic glucose exchanges w as significantly higher (p<0.001, p<0.001, respectively ) and the duration of peritoneal dialysis w as significantly longer (p=0.033) in ultrafiltration failure group compared with the others. D/P Cr of 124 patients was well correlated with the number of peritonitis (γ=0.246, p=0.006), and the number of hypertonic glucose exchanges (γ=0.33, p<0.001), but inversely correlated with serum albumin (γ=-0.452, p<0.001) with the statistical significance. In 31 patients who undertook PET within 1 year after the begining of CAPD, although not significant, D/P Cr increased and ultrafiltration decreased after 5 years. A significant increase in D/P Cr (p=0.014) w as seen in patients who experienced more than 2 episodes of peritonitis (n=14), compared with patients who experienced either peritonitis free or single episode of peritonitis (n=17). T he linear regression analysis showed that the number of peritonitis and the number of hypertonic glucose exchanges per day were significantly correlated with the increased D/P Cr after 5 years (p=0.001, p=0.003, respectively). Conclusion : Clinical factors affecting peritoneal membrane function were the number of peritonitis, the use of hypertonic glucose exchanges and the duration of peritoneal dialysis. To preserve peritoneal membrane function, it is recommended to avoid hypertonic glucose exchanges and to reduce the number of peritonitis.