수두증을 동반한 송과체 부위 종양에 대한 내시경적 치료

김정훈,나영신,김준수,안재성,김창진,권병덕,Kim, Jeong Hoon,Ra, Young Shin,Kim, Joon Soo,Ahn, Jae Sung,Kim, Chang Jin,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Purpose : In general, pineal region tumors are managed by using microsurgical approach or stereoctactic biopsy. However, in selected cases endoscopic approach to pineal lesions might prove to be as effective as microsurgery and less invasive. We report an alternative surgical strategy for managing certain patients with pineal neoplasms that allows treatment of the symptomatic hydrocephalus as well as tumor biopsy under direct vision in the same sitting. Materials and Methods : Twenty-two patients with pineal region tumors with associated hydrocephalus were treated in one session by endoscopic third ventriculostomy and endoscopic tumor biopsy at our institution from October 1996 to January 2000. All patients were retrospectively evaluated. Results : There was no operative mortality. There was one cause of significant bleeding during biopsy, but was controlled endoscopically, and the patient recovered completely without neurologic deficit resulting from intra-operative bleeding. The symptoms related to increased intracranial pressure(ICP) have resolved in all patients, and the need for a shunt is completely eliminated. Histological diagnosis was achieved in 21 of the 22 patients by this procedure. A biopsy was not obtained in one patient. Although this pineal region tumor was seen endoscopically, this could not be biopsied because of technical difficulties in working around an enlarged massa intermedia. The lesions included fourteen germinomas, three mixed germ cell tumors, and one each of the followings: pineocytoma, pineoblastoma, pineocytoma/pineoblastoma(intermediate type), meningioma, and low grade glioma. Five of the 22 patients subsequently underwent formal microsurgical tumor removal. Additional chemotherapy or radiotherapy could then be initiated according to the histological diagnosis. Conclusion : We consider that endoscopy affords a minimally invasive way of reaching three objectives by one-step surgery in the management of pineal region tumors with associated hydrocephalus : 1) cerebrospinal fluid(CSF) sample for analysis of tumour markers and cytology, 2) treatment of hydrocephalus by third ventriculostomy, and 3) several biopsy specimens can be obtained identifying tumors which will require further open surgery or adjuvant radiation and/or chemotherapy. However, complications and morbidities should be emphasized so as to be avoided with further technical experience.

Recurrence and Extraneural Metastasis in 31 Meningeal Hemangiopericytomas

김정훈,김준수,김창진,황승균,정희원,권병덕,Kim, Jeong Hoon,Kim, Joon Soo,Kim, Chang Jin,Hwang, Sung Kyun,Jung, Hee Won,Kwun, Byung Duk The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.3

목 적 : 높은 재발율과 전이 가능성의 특징을 갖고 있는 수막 혈관외세포종은 perivascular pericytes에서 기원하는 드문 종양으로, 저자들이 경험한 수막 혈관외세포종에 있어서 종양의 재발 및 신경계외 전이에 대하여 알아 보고자 한다. 연구 대상 및 방법 : 1982년부터 1999년까지 수술을 시행하여 수막 혈관외세포종으로 진단받은 31명의 환자를 대상으로 후향적 연구를 시행하였다. 진단 후 재발까지의 기간, 재발에 영향을 미칠 수 있는 여러 가지 인자들, 그리고 신경계외 전이의 기간 및 부위 등을 분석하였다. 결 과 : 총 31명의 환자들 중 12명의 환자들에서 원발성 부위에 종양이 재발하였다(38.7%). 전체의 환자들에서 재발이 발생하지 않았던 평균 기간(recurrence-free period : RFP)은 104개월이었으며 처음 수술 후 5년, 그리고 10년의 재발이 발생하지 않았던 율(recurrence free period : RFP)은 각각 59.2%, 33.6% 이었다. 원발성 부위에 종양의 재발을 보였던 12명의 환자들 중 4명의 환자들에서 첫 수술 후 5년 이후에 재발을 관찰 할 수 있었다. 처음 수술시의 절제 정도가 재발에 가장 큰 영향을 미쳤다. 처음 수술시에 완전 절제한 군의 RFP는 111 개월이었으며, 추적 관찰 5년째 RFR는 완전 절제한 경우 72.7%, 불완전 절제한 경우 20.8%로 그 차이는 통계 적으로 유의하였다(p=0.0060). 통계적으로 유의성은 없었지만 완전 절제 후 부가적인 방사선 치료를 시행하였을 경우가 완전 절제만을 시행한 경우보다 RFR가 높아 추적 관찰 5년째의 RFR는 각각 100%, 그리고 70.3% 이었다(p=0.3359). 4명의 환자들(12.9%)에서 수막 혈관외세포종의 신경계외 전이가 발생하였으며, 이 경우 신경계 외 전이의 평균 기간은 107개월, 그리고 추적 관찰 5년, 10년째의 신경계외 전이율은 각각 4.4%, 24.9% 이었다. 결 론 : 수막 혈관외세포종은 수술적 제거 후 원발성 부위에 또는 원발성 부위에서 멀리 떨어진 부위에 재발의 가능성이 무척 높은 종양이다. 이러한 재발의 가능성을 줄이는 가장 중요한 인자는 수술적 제거 정도로 처음 수술시에 가능한 완전 절제를 시도하여야 한다. 그리고 처음 수술시에 완전 절제가 가능하였다고 하여도 완전 절제 후 부가적인 방사선 치료를 시행하는 것이 재발의 위험성을 낮출 수 있을 것으로 생각한다. 원발성 부위의 재발 또는 신경계외 전이는 오랜 시간이 지난 후에도 가능할 수 있으므로 장기간의 추적 관찰이 필요하다고 생각한다. Purpose : Meningeal hemangiopericytoma(M-HPC), characterized by a high local recurrency and metastatic potential, is a rare neoplasm arising from perivascular pericytes. A retrospective study was performed to identify the recurrence and extraneural metastasis in M-HPC. Materials and Methods : We reviewed the records of 31 M-HPC patients treated from 1982 through 1999 at our institution. The time to recurrence and the various parameters affecting recurrence were determined. Extreneural metastasis was also analyzed. Results : The rate of local recurrency was 38.7%(12/31). The overall average recurrence-free period(RFP) before the first recurrence was 104 months, with overall recurrence-free rates(RFRs) at 5 and 10 years after first surgery of 59.2% and 33.6%, respectively. Of the 12 patients who experienced local recurrence, 4 had recurrences 5 years later after the first surgery. Complete excision at the first operation significantly extended the average time before first recurrence from 43 to 111 months. The 5-year RFRs for the groups of complete excision and incomplete excision were 72.7% and 20.8%, respectively(p=0.0060). Although there was no statistical significance, complete excision followed by adjuvant radiotherapy of more than 50Gy extended the RFP. The 5-year RFRs for the groups of complete excision and complete excision with adjuvant radiotherapy were 70.3% and 100%, respectively(p=0.3359). Four patients(12.9%) presented one or more extraneural metastases that were developed at an average of 107 months after the first operation with the 5- and 10-year metastasis rates of 4.4% and 24.9%, respectively. Conclusions : M-HPC has a propensity to recur either locally or at distant sites after surgical resection. Complete excision is the most important factor to reduce recurrence. However, even with complete excision, adjuvant radiotherapy of more than 50Gy significantly reduces the risk of recurrence. Local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up.

아메드 녹내장삽입물 수술 후의 각막내피세포 변화

김정훈,김창식,Jeong Hoon Kim,Chang Sik Kim 대한안과학회 2006 대한안과학회지 Vol.47 No.12

Purpose: To evaluate the change in corneal endothelial cells after Ahmed glaucoma valve implantation. Methods: We prospectively evaluated the change in density and shape of the corneal endothelium of 35 eyes of 35 patients those underwent Ahmed glaucoma valve implantation for the treatment of refractory glaucoma. All surgeries were performed by one surgeon. The corneal specular microscopy was performed by non-contact specular microscope before surgery and 1 month, 6 months and 12 months after surgery. Evaluation was performed on the superior, superotemporal, superonasal and central area of the cornea in both eyes at each test. Results: The mean follow-up was 12.1 months (range, 6~24 months). There was a statistically significant decrease in corneal endothelial cell density in operated eye compared to the other eye. Mean percentage decrease in corneal endothelial cell count of operated eye was 5.5% at 1 month, 9.7% at 6 months, and 14.8% at 12 months after surgery. The superotemporal area, which was the closest site from the tube, showed the greatest decrease of endothelial cell density by 17.4%, while the central cornea showed the lowest decrease by 12.8% in 1 year after surgery. The morphological evaluation of the endothelial cells by coefficient of variation and hexagonality suggested the cell were getting stabilized in 1 year after surgery, although the change was not statistically significant. Conclusions: There was a statistically significant corneal endothelial cell loss in operated eye compared to the other eye after Ahmed glaucoma valve implant surgery. The corneal endothelial cell loss was increased in time up to 14.8% at 1 year after surgery.

서비스 단계별 확장 가능한 온라인 게임 서버 구조에 대한 연구

김정훈,Kim Jeong-Hoon 한국컴퓨터산업학회 2006 컴퓨터産業敎育學會論文誌 Vol.7 No.3

본 논문에서는 사용자 수 증가로 인한 확장 가능한 온라인 게임 서버 구조를 제시하고 있다. 현재 상용 서비스 중인 대부분의 온라인 게임 서버에서는 로긴서버, 캐시서버, 데이터베이스서버, 게임서버, NPC서버 등으로 구성된 하나의 서버 그룹을 운영하다가 사용자 수 증가에 따라 같은 구조의 또 다른 서버 그룹을 추가 설치하고 있다. 그러나 본 논문에서 제안하는 서버 구조는 서버를 추가 설치할 때 로긴서버, 캐시서버, 데이터베이스서버, 게임서버, NPC서버 등의 한 그룹을 추가시키지 않고 게임서버만을 추가한다. 이후 캐시서버나 데이터베이스서버에 부하가 걸릴 때에만 또 다른 서버 그룹을 추가시켜 서버 추가 비용을 최대한 줄일 수 있게 하였다. The purpose of this study is to propose the online game server architecture which can expand as the number of users increases. In most online game servers, there is a server group composed of a login server, a cache server, a database server, a game server, and an NPC server, and when the number of users increases, an additional server group with the same structure is installed. The server architecture proposed in this study does not install a server group composed of a login server, a cache server, a database server, a game server, an NPC server, etc., but installs a game server only. When there is a need for the cache server and database server, the required servers will be additionally installed, thus reducing costs.

두개강내 수막종과 동맥류를 동반한 뇌동정맥기형 - 증 례 보 고 -

김정훈,하영수,박종운,현동근,Kim, Jeong Hoon,Ha, Young Soo,Park, Chong Oon,Hyun, Dong Keun 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

The cerebral arteriovenous malformation(AVM) rarely coexists with primary intracranial tumor. The authors experienced a patient with intracerebral hematoma due to AVM rupture in whom intracranial meningioma and intracranial aneurysms coexisted. The meningioma was located at convexity of right frontal lobe, and arteriovenous malformation at temporo-occipital lobe of same hemisphere with feeding from right middle cerebral artery, and three intracranial aneurysms exist at the cavernous portion of right internal carotid artery, AVM feeding artery, and intranidal of the AVM. The authors report a rare case of coexisted intracranial AVM, meningioma and aneurysms with review of literatures.

유두상 갑상선암에서의 BRAF 변이와 임상병리학적 인자와의 관계

김정훈,최재영,Jeong-Hoon Kim,and Jae-young Choi 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.3

열보호재료의 열 및 물질전달 현상에 관한 수치해석적 연구

김정훈,권창오,서정일,배철호,송동주,Kim, Jung-Hoon,Kwon, Chang-Oh,Seo, Jeong-Il,Bai, Cheol-Ho,Song, Dong-Joo 대한기계학회 1999 大韓機械學會論文集B Vol.23 No.9

A numerical analysis is performed to predict the thermal response and ablation rate for charring or non-charring material which is designed to be used as thermal protection system (TPS). The numerical program composed of in-depth energy balance equation and the aerotherm chemical equilibrium (ACE) program. The ACE program calculates various thermochemical state from ablation products. The developed numerical program is verified by comparing the reported results from literature. The sensitivity tests for input parameters are performed. The thermal behavior of ablating material is mainly affected by density of ablating material, convective heat transfer coefficient and recovery enthalpy of flow field.

수요자중심의 컴퓨터 게임 교과과정에 대한 연구

김정훈,Kim Jeong-Hoon 한국컴퓨터산업학회 2005 컴퓨터産業敎育學會論文誌 Vol.6 No.3

게임 산업체에서 요구하는 기술 능력과 컴퓨터 관련 학과 졸업생들의 능력 차이로 기업들의 재교육비가 크게 증가하는 것은 바람직하지 않다. 이에 본 논문에서는 게임 업체에서 요구하는 인력의 기술 능력 수준과 컴퓨터 관련 학과 졸업자들의 기술 능력 수준을 비교, 분석하고 이를 바탕으로 게임 소프트웨어 전문 인력의 실무 능력 향상 및 활용도 제고를 위한 교과 과정을 제시하고자 한다. Since there is difference between the technical skill of the graduates and the requirement of the game company, company's professional training expenditure is increasing. This paper suggests a new curriculum to meet the requirement of company and produce the game software professionals.

『성제총록(聖濟總錄)』과 『동의보감(東醫寶鑑)』의 침향 배오 처방 비교 연구

김정훈,김현정,박민주,이장천,이부균,Kim, Jeong-Hoon,Kim, Hyun-Jung,Park, Min-Joo,Lee, Jang-Cheon,Lee, Boo-Kyun 대한한의학방제학회 2019 大韓韓醫學方劑學會誌 Vol.27 No.1

Objectives : In spite of the difficulty of getting Agarwood, the number of species of wild Agarwood is rapidly decreasing by insistent demands. Here, we investigate how various formula of Agarwood is used so that we can make use of them more helpful in clinics today. Methods : Determining the range of 'the Sovereign and Minister' component more than 12.96%" or 'equally used', this study distinguished whether Agarwood is used as 'the Sovereign and Minister' component among 409 Agarwood formulas in "Sheng ji zong lu(聖濟總錄)" and 103 Agarwood formulas in "Donguibogam (東醫寶鑑)". Additionally, we analyzed the component ratio of Agarwood, and also the usage in Deficiency-Excess pattern. Results : Among Agarwood formulas in "Sheng ji zong lu" and "Donguibogam", each percentage of Agarwood formulas which Agarwood comprises 'the Sovereign and Minister' component was 26%(106/406) and 13%(13/99). Analyzing these formulas of "Sheng ji zong lu", 53 formulas were used in Deficiency pattern and other 53 formulas were used in Excess pattern. Also in "Donguibogam", 6 formulas were used in each Deficiency pattern and Excess pattern, and only 1 formula in both of Deficiency and Excess pattern. Conclusions : Showing almost equal ratio of usage in Deficiency-Excess pattern, this study showed that those Agarwood formulas of "Sheng ji zong lu" and "Donguibogam" which Agarwood comprises 'the Sovereign and Minister' component can be used in both Deficiency-Excess pattern evenly.

고 CEA혈증으로 인해 재발성 직장암으로 오인된 갑상선 수질암 1예

김정훈,Jeong Hoon Kim,M.D. 대한갑상선-내분비외과학회 2005 The Koreran journal of Endocrine Surgery Vol.5 No.1

The medullary carcinoma of the thyroid gland is relatively rare tumor, accounting about 1.2∼10% of the all thyroid malignancies, which arises from the parafollicular C-cells in thyroid gland. Operation is the only means to cure the patients. Serial concentrations of serum CEA and calcitonin seem to play an important role in the diagnosis and clinical management and also in the therapeutic monitoring of patients with medullary thyroid cancer. In this case, patient with high serum CEA levels after the resection of rectal cancer underwent abdomen CT scan, colonofibroscopy, FDG-PET scan and chest X-ray, but this imaging methods couldn't detect recurrent evidence of rectal cancer. Neck ultrasonography was performed after 8 years from operation, and fine needle aspiration biopsy was performed for thyroid nodule. As diagnosed to suspicious medullary carcinoma, patient underwent total thyroidectomy and central compartment neck dissection. Patient diagnosed as medullary thyroid cancer without lymph node metastasis and capsular invasion pathologically. As well as this case, in patients with high serum CEA levels after definitive surgical resection of gastrointestinal cancer, if imaging study or FDG-PET scan detect no evidence of recurrence, evaluation of thyroid such as neck ultrasonography and serum calcitonin should be performed. (Korean J Endocrine Surg 2005;5:29-31)