증례 : 신장 ; 신경색을 동반한 외상성 신동맥 박리를 스텐트 삽입술로 치료한 1예

박성원 ( Sung Won Park ),나현희 ( Hyun Hee Na ),박상현 ( Sang Hyun Park ),이기재 ( Ghi Jai Lee ),조영권 ( Young Kwon Cho ),고행일 ( Haeng Il Koh ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5S

본 증례는 외상으로 인한 신경색을 동반한 신동맥 박리를 경피적 혈관 성형술과 스텐트 삽입술로 치료한 경우로 추가적인 항응고제 투여 없이도 신혈류가 완전히 개선되었고, 스텐트 삽입만으로 신경색이 호전된 증례이다. 또한 신동맥 박리 및 신경색이 발생하고 24시간 후에 신혈류를 개선하였음에도 신혈류 및 신경색이 회복되었던 것으로 보아 우연히 발견한 신동맥 박리의 경우 경피적 중재술을 적극적으로 고려해 볼 수 있을 것으로 생각된다. Renal artery dissection may be caused by iatrogenic injury, trauma, or underlying arterial disease such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. The treatment for renal artery dissection is chosen based on the patient`s hemodynamic status, renal function, and the feasibility of the treatment modality. However treatment and long-term management of renal artery dissection is controversial. A 43 year-old man visited the emergency department after being jammed in a cultivator. He complained of abdominal pain and vomiting. We performed abdominopelvic computed tomography and found a right renal artery dissection with infarction. At 24 hours after the accident, he was treated with balloon dilatation and endovascular stenting of the right renal artery. He was discharged without renovascular hypertension or renal insufficiency complications. (Korean J Med 77:S1237-S1240, 2009)

임상 : 우연히 발견된 송과체 낭종의 자기공명영상 소견

정종락 ( Jong Rak Jung ),장회영 ( Hoe Young Chang ),이기재 ( Ghi Jai Lee ),김명수 ( Myoung Soo Kim ) 대한뇌종양학회 2011 대한뇌종양학회지 Vol.10 No.1

Objective: We performed this study to determine the incidence and magnetic resonance imaging (MRI) characteristics of pineal cysts. Material and Methods: We analyzed 1,168 patients with MR imaging between January 1, 2009 and May 13, 2010. MR imaging signal, enhancement patterns, size of the pineal cyst and amount of deformity of the tectum were analyzed. Result: Overall, 48 patients (4.1%) with pineal cyst were found in the 1168 patients evaluated. The most dominant signal of T2-weighted image, T1-weighted image, and fluid-attenuated inversion-recovery images of the pineal cyst were isointense compared with cerebrospinal fluid (CSF) in 46 patients (46/48), isointense compared with CSF in 30 patients (30/48), and hyperintensity compared with parenchyma in twenty one patients (21/48). Cyst enhancement pattern were slight cyst wall enhancement in twelve patients, and strong cyst wall enhancement in twenty four patients. Tectal deformity was ob-served as follow ; no contact between the cyst and the tectum in three patients, the cyst touching the tectum in twenty six, the cyst mildly deforming the tectum but not narrowing the aqueduct in nine, and the cyst moderately deforming the tec-tum but not narrowing the aqueduct in three patients. The diameter of the antero-posterior direction was 8.39±2.59 mm. Conclusion: The frequency of pineal cyst evaluated with MR images was 4.1%. The MR signal and enhancement of pi-neal cyst were constant in most cases. But some cases showed different signal. This variability may make them indistin-guishable from other pineal region tumors.

종양내 출혈로 진단된 청신경 초종 -증례보고-

고영초 ( Young Cho Koh ),유헌 ( Heon Yoo ),권오기 ( O Ki Kwon ),김용만 ( Yong Man Kim ),주미 ( Mee Joo ),이기재 ( Ghi Jai Lee ) 대한뇌종양학회 2002 대한뇌종양학회지 Vol.1 No.1

The authors report unusual presentation of a vestibular schwannoma in a 53-year-old man, who presented with sudden onset of severe headache and, vomiting followed by left peripheral type facial palsy two weeks prior to admission. He had been well except for a longstanding left hearing difficulty, which had been considered as an aging process. In addition, he had mitral valve replacement surgery two years prior to admission , for which he had taken anticoagulant(Warfarin 2mg) everyday with regular monitoring of coagulability. Plain CT scan on admission demonstrated a 3×4×3cm sized high density mass at the left cerebellopontine angle with erosion and widening of the left internal auditory meatus. Brain MRI showed a heterogenous signaled mass with high signal on T1WI with little contrast enhancement and low signal on T2WI suggestive of multistaged hematomas within the peripherally enhancing tumor. Under the impression of intratumoral repeated bleeding in a patient with preexisting vestibular schwannoma, left suboccipital craniectomy was undergone to remove a large extraaxial tumor, mixed with large amount of hemorrhages. Postoperative course was uneventful except for persistent left facial palsy and hearing loss. Postoperative anticoagulation was started on the 5th postoperative day.

혈관 조영술과 경정맥 신우조영술에서 각종 조영제의 비교 연구

이기재,이문규,전우기,한창열 인제대학교 1989 仁濟醫學 Vol.10 No.2

혈관 조영술과 경정맥 신우조영술에서 조영제의 역할은 중요하다. 조영제의 임상적 유용성, 부작용 그리고 조영 효과 등의 비교 연구로 새로운 비이온성 조영제가 개발되어 사용되어 지고 있는데 본원 방사선과에서는 Iopamidol (IopamiroR)이라는 저삼투질 농도의 비이온성 조영제를 종래의 이온성 조영제와 비교 사용하여 임상적으로 우수하다는 결과를 얻었기에 이에 보고하는 바이다. A new non-ionic contrast medium, iopamidol (IopamiroR) was compared with conventional ionic contrast media, diatrizoate sodium meglumine (MD-76R) and iothalamate meglumine (ConrayR), for safety and efficacy in 79 patients undergoing angiography and IVP. Minor side effects were less frequently caused by non-ionic contrast medium, and change of physiologic parameters, such as blood pressure, heart rate and respiration rate, was insignificant in ionic and non-ionic contrast media. In image quality, there was no significant difference in angiography, but non-ionic contrast medium was superior to ionic contrast medium in IVP. Therefore, in spite of higher cost, we think that non-ionic contrast medium is safer and can be used preferentially, particularly in those patients at high risk.

흉부외상 환자에서 응급 전산화 단층촬영의 효용성에 관한 분석

우건화,김원율,김경환,김홍용,이기재 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.1

Background. Trauma is the third leading cause of death, irrespective of age, and the leading cause of death in persons under 40 years of age. Computed tomography(CT) is an effective technique in the initial emergent evaluation of the abdomen and head following blunt trauma. Most chest injuries are not seen on conventional chest radiography, or may be underestimated. But routine use of CT in the initial emergent evaluation of chest trauma is controversial. CT, however, has been shown to be useful in the diagnosis of unsuspected chest injuries and in directing therapeutic interventions. This review discusses the efficacy of emergent CT in patients with blunt trauma on the chest. Methods. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram(CXR) was carried out on 121 patients with blunt trauma on the chest. The interval between CXR and CT was less than 1 hour. Results. Among 121 patients, 42 patients had normal initial chest roentgenogram in whom 19 patients showed normal CT findings, Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (49.3% and 45.1% respectively), whereas 65.7%(44/67) of patients had thoracostomy only by CXR. Conclusion. Although sometimes abused in patients with chest trauma, CT of the thorax is an effective method of detecting thoracic injuries and provides accurate information regarding their pattern and extent in the initial emergent diagnosis.

급성 뇌경색증에서 Transcranial Doppler의진단적 가치에 관한 연구

윤세라,이기재,김호균 인제대학교 1999 仁濟醫學 Vol.20 No.1

급성 뇌경색증에서 Transcranial Doppler의 진단적 가치에 관한 연구

윤세라,이기재,김호균 인제대학교 1999 仁濟醫學 Vol.20 No.1S

Transcranial doppler(TCD)의 두개내 혈관협착, 특히 다발성 협착의 진단의 적용에 대해서 알아보았다. 현재 관용적으로 쓰이고 있는 TCD상의 혈류속도의 증가만을 기준으로 하였을 때와 혈류속도외에 혈류의 형태학적인 변화, 측부 순환의 양상, 혈류속도의 감소, 좌우 비대칭성 등의 다양한 진단 지표를 고려하였을 때의 결과를 뇌혈관촬영술과의 상관관계에 비추어 비교하여 보았다. 두개내의 다발성 혈관협착의 빈발성과 그에 따른 복잡한 혈류양상 때문에 혈류속도 외에 다양한 진단 지표를 동시에 고려하였을 때가 TCD의 민감도, 특이도, 및 정확도를 증가시켜 TCD의 진단적 가치를 높임을 알 수 있었다. Objectives: The purpose of this study is to evaluate the usefulness of morphologic changes and collateral flow patterns in addition to velocity criteria using transcranial doppler(TCD) in detection of intracranial vascular stenosis, especially in cases of multiple stenoses. Methods and Materials : Medical records, angiography, and TCD findings were reviewed in 86 patients with acute cerebral infarction who underwent both cerebral angiography and TCD examination. Angiography was performed after TCD within a week. Angiography and TCD were interpreted blindly by neurologist and neuroradiologist. TCD was interpreted, using the velocity criteria according to the previous normal data of Yonsei medical collage, and to the morphologic changes and collateral flow patterns, retrospectively. Results: Total 373 sites of patients, who had good windows of TCD at intracranial portion of carotid siphon(siphon), proximal portion of middle cerebral artery(M1), and basilar artery were evaluated. Total 67 sites(46 patients) of stenoses were found 28 sites of M1, 30 sites of siphon, and 9 sites of basilar artery, Fifty eight of 67 sites had more than one site of intracranial stenosis. Among them, 43 sites had multiple stenoses within a vascular territory proximally and distally. When we used mean velocity as a sole parameter of diagnostic criteria, the overall sensitivity, specificity, and accuracy of TCD in detection of the stenosis at M1, siphon. and basilar artery were 19.4%, 85.0%, and 79.4%, respectively. When abnormal flow waveforms, collateral flow patterns, and decreased MV were considered together, they were improved to 55.2%, 91.1%, and 78.8%, respectively. When these parameters were considered in patients with multiple stenoses, one of the most confusing factor of diagnosis, false negative ramie was decreased markedly. The sensitivity was increased to 53.5%, close to that wish single stenosis (58.3%), resulting in better correlation with angiography and TCD examination. Conclusion: Owing to the high frequency of multiple stenoses and iris complex flow pat terns in intracranial stenosis, TCD may not be effective screening test for intracranial vascular stenosis if increased mean velocity is used as a sole criteria. So it seems to be better in detection of intracranial vascular stenosis that variable parameters such as changes in flow waveforms, collateral flow patterns, decreased mean velocity, and asymmetry index are considered simultaneously.

지방종사의 유병율과 지기공명영상 소견

김선희,김정석,이기재,심재찬,방선우,유석봉,김호균 인제대학교 2000 仁濟醫學 Vol.21 No.2

Objectives: To evaluate the prevalence and MR appearance of incidental fatty filum terminate in a random population. Methods and Materials: The prevalence of fatty filum terminate on MRI, which was diagnosed by high signal intensity along filum terminate on T1-weigted image, was studied in 479 patients referred to MRI for evaluation of the lumbosacral spine for recent 22 months, and its MR appearance was evaluated. Sagittal and axial T1-weighted and turbo spin-echo(TSE) T2-weighted images were obtained, using 1.0T MR unit. Results: Of the 479 MRI examinations reviewed, 16 patients were found to have fatty filum terminate. There were 11 men and 5 women, ranged in age from 16 to 61(mean. 41.1) years. None had neurologic deficit. The length ranged iron 3 to 14.5(mean, 8.8)cm and the maximal diameter ranged 1.6 to 4.6(mean, 2.4)mm. Cranio-caudal extent was variable from L1-2 level to S2-3 level, but they were detected most frequently at L4-5 level(12/16) and also observed at sacrum level in 8 cases. The level of conus was L1-2 or L1 body level, except one case which was L3 body level. Conclusion: Fatty filum terminale, which was seen as linear high signal intensity on sagittal T1-weighted image. was detected to have variable length from L1-2 to S2-3 level along the course of the filum terminate. They were present in 3.3% of 479 lumbosacral spine MR examinations, however the incidence can be higher if considering the slice thickness of sagittal scan and the extent of axial scan.

Moyamoya병 1례

김병조,김성환,박용원,이기재 인제대학교 1993 仁濟醫學 Vol.14 No.4

저자들은 뇌혈관조영술로 확진된 Moyamoya병 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Moyamoya disease is a chronic, progressive vascular disorder, characterized by stenosis or occlusion of the supraclinoid portion of the internal carotid artery with extension Into the proximal portion of the anterior and middle cerebral arteries. There is an associated finding of collateral vascular networks(Moyamoya vessels, that is "something hazy, like a puff of smoke" appearance) in the region of the basal ganglia. We experienced a case of Moyamoya disease in a 11 year old girl who had frequent episodic transient weakness of the left lower extremity and headache, which was confirmed by four vessel angiogram.

두통 환자에서 뇌자기공명영상의 유용성

전인석,김철환,이언숙,서홍관,이기재 인제대학교 1999 仁濟醫學 Vol.20 No.1S

연구배경; 두통은 가장 일반적인 증상이지만 많은 경우에서 사람을 무능력 하게 한다. 무엇보다 두통이 심하거나 오래 계속될 경우 뇌종양에 대한 공포가 있다. 임상 의사들도 최근 의료 사고 및 의료 분쟁의 증가로 인해 방어 진료를 하고 있다. 이런 이유에서 최근 고가 장비인 뇌자기공명영상을 두통 환자에서 시행하는 일이 많아지고 있다. 이 연구는 두통을 호소하는 환자에게서 신경학적 징후가 없을때, 뇌자기공명영상이 유용성이 있는 지를 알아보기 위한 연구이다. 방법; 1993년 1월 1일부터 1997년 3월 31일까지 서울백병원과 상계백병원 신경과, 신경외과, 소아과, 가정의학과 외래에 두통을 주소로 내원하여, 뇌자기공명영상을 시행한 환자 중에서, 임상 병록지를 검토하여 외상. 국소적 신경 증상 및 징후를 나타내거나 의식 소실이 있었던 경우, 과거력상 뇌혈관 사고의 병력이 있었던 경우를 제외시킨 123명을 대상으로 성별, 연령, 병력, 동반 증상, 두통의 이환 기간, 지자기 공명영상 소견을 조사하였다. 결과; 연구 대상은 남자 40명(32.5%), 여자 83명(675%)으로 총 123명이었다 환자의 연령은 7세에서 70세였으며, 평균 연령은 41.8세였다. 40대가 36명(29.3%), 30대가 29명(23.6%)이었다. 환자들의 병력은 고혈압이 10예(8.1%)로 가장 많았고 특별한 질병이 기재되어 있지 않은 경우가 107예(87.1%)였다. 두통과 연관된 뇌자기공명영상 이상 소견 14예 중에 동반질환이 있었던 예는 모두 5예(4.0%)였으며 상관 관계에는 유의성이 있었다(P<0.05). 두통과 동반한 증상은 오심 25예(20.3%), 어지러움 11예(8.9%) 구토 9예(7.3%) 안구통 7예(5.7%)였다. 두통과 동반한 증상과 뇌자기공명영상 이상 소견과의 상관 관계에는 유의성이 없었다(P>0.05). 두통의 이환 기간은 12개월에서 60개월이 37예(30.0%)로 가장 많았고, 1개월에서 11개월이 28예(22.8%), 60개월 이상이 27예(22.0%), 1개월 미만이 22예(17.9%)의 순이었다. 두통의 평균 이환 기간은 4년 2개월이었다. 두통 이환 기간과 뇌자기공명영상 이상 소견과의 상관관계에는 유의성이 없었다(P>0.05). 뇌자기공명영상 소견은 총 123예 중 정상 소견이 96예(78.0%), 이상 소견이 27예(22.0%)였으며, 이상 소견 중에 두통과 관련이 있는 소견은 14예(11.4%)로, 열공경색증(lacunar infarction) 8예(6.5%), 뇌허혈(cerebral ischemia) 3예(2.4%), 뇌수막종(meningioma) 2예(1.6%), 거미막낭종(arachnoid cyst) 1예(0.8%), 투명중격낭(cyst of septum pellucidum) 1예(0.8%)이며, 두통과 관련이 없는 이상 소견은, 뇌위축(cerebral atrophy) 3예(2.4%), 송과체낭종(pineal cyst) 1예(0.8%), mega cisterna magna 1예 (0.8%)였다. 결론; 본 연구에서 두통과 임상적으로 의미있는 뇌자기공명영상 소견은 두통 환자 123명 중에 14예(11.4%)였다. 따라서 두통 환자에서 적극적인 병력 청취와 이학적 검사를 실시하되, 충분한 기간 적절한 치료에도 반응이 없는 두통 환자는 뇌자기공명영상 촬영 등의 검사를 고려해야겠다. Background: Headache is a common symptom. but for many it can be a debilitating problem. The patients with headache tend to worry excessively about the possibility of cerebral tumor as the cause when it is severe and longstanding. Clinicians have protective attitude towards the management of headache because medical law suits have increased recently. For this reason, expensive Brain Magnetic Resonance Imaging has been used more often in the evaluation of headache patients recently. So we studied the usefulness of Brain Magnetic Resonance Imaging in the management of patients with headache who were neurologically normal. Methods: From January 1, 1993 to March 31, 1997, 123 patients with headache who had visited the department of neurology, neurosurgery, pediatric, and family medicine in Seoul and Sanggye Paik Hospital and had undergone Brain Magnetic Resonance Imagings. We reviewed the charts and selected the patients who had no prior histories of trauma, focal neurologic symptoms and signs, loss of consciousness, and cerebrovascular accidents. We checked their age, sex, past medical history, duration of headache, and Brain Magnetic Resonance Imaging findings. Results: There were total of 123 patients with headache. Subjects were 40 males(32.5%) and 83 females(67.5%). Male-to-female ratio was 1:2.1. The age ranged from 7 to 80 years with an average of 41.8 years. Thirty six patients(29.3%) were in their forties, 29(23.6%) in their thirties. Ten patients(8.1%) had histories of hypertension. Five of 10 patients(4.1%) with pastmedical disease were related with abnormal Brain Magnetic Resonance Imagings(P<0.05). The symptoms accompanying headache in order of frequency were nausea 25(20.3%), dizziness 11(8.9%), vomiting 9(7.3%), and eye pain 7(5.7%), Associated symptoms with headache did not correlate with abnormal Brain Magnetic Resonance Imagings(P>0.05) The duration of headache was 12 to 60 months in 37 patients(30.0%) , 1 to 11 months in 28(22.8%), above 60 months in 27(22.0%), and below 1 month in 22(17.9%), with an average duration of 4 years and 2 months. The duration of headache did not correlate with abnormal Brain Magnetic Resonance Imagings(P>0.05). Brain Magnetic Resonance Imaging findings were normal in 96 patients(78.0%). abnormal in 27(22.0%) headache relaxed findings in 14(11.4%) ; lacunar infarction in 8(6.5%), cerebral ischemia in 3(2.4), meningioma in 2(1.6%), arachnoid cyst in 1 (0.8%), and cyst of septum pellucidum in 1 (0.8%). Conclusions: There were clinically meaningful findings in Brain Magnetic Resonance Imaging in 14(11.4%) among 123 patients with headache. Primary care physician should take history and perform physical examination intensively, but consider Brain Magnetic Resonance Imaging if headache does not resolve by proper management.