• 동의신경정신과학회지
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• 제16권2호
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• pp.277-285
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• 2005

2005년 5월 자생한방병원 한방신경정신과에 입원한 환자에 대하여 긴장성 근육통 증후군의 관점에서의 접근을 통해 이완 요법치료를 실시하여 환자 동통 치료에 대하여 양호한 결과를 보였고 환자의 통증 회복 의지에 대한 심리 상태에도 변화가 있었다. 그 결과 다음과 같은 소견을 보였다. 1. 기질적인 원인이 있는 만성 경항부 통증 환자에서 환자의 심리적 상태를 고려한 이완요법을 병행하여 통증 지각 감소와 심리적 자신감 회복에 양호한 결과를 보였다. 2. 긴장성 근육통 증후군에서의 환자의 내재되어 있는 심리상태가 통증을 일으킨다고 보는 관점은 한의학적 관점에서는 기(氣)의 순환 장애에서 오는 기통증(氣痛症), 기울증(氣鬱症)으로 볼 수 있으며, 이완 요법은 환자 치료에 정서, 심리적인 측면을 고려한 점에서 이정변기요법(移精變氣療法)등과 같은 한방정신요법과 유사성을 찾아 볼 수 있다. 3. 이완 요법은 통증 치료에 있어서 심리적 이완, 안정을 도모하고, 통증에 대한 과도한 관심을 억제하여 통증 지각 완화에 도움이 된다.

• Tuberculosis and Respiratory Diseases
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• 제45권3호
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• pp.596-603
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• 1998

소세포 폐암에 동반된 LEMS는 부종양성 증후군의 일종으로 LEMS가 진단된 환자의 50% 이상에서 소세포 폐암이 동반되는데 특히 흡연력이 있는 고령에서 잠재성암을 진단하기 위한 적극적인 노력이 필요하다. 저자 등은 기괸지경 검사상 조직학적으로 진단되지 않았으나 폐암이 강력히 의심되어 적극적으로 수술적 치료를 시행하여 소세포 폐암을 진단하였고, 수술 후 LEMS의 임상양상이 호전되었으며 항암 화학요법후 추가로 호전된 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제58권1호
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• pp.50-53
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• 2015

Objective : The purpose of this study was to evaluate radiographic/clinical outcomes of adolescent idiopathic scoliosis (AIS) patients treated by a Korean neurosurgeon. Methods : Ten AIS patients were treated by a single neurosurgeon between January 2011 and September 2013 utilizing segmental instrumentation with pedicle screws. Basic demographic information, curve pattern by Lenke classification, number of levels treated, amount of correction achieved, radiographic/clinical outcomes [by Scolisis Resarch Society (SRS-22r) questionnaire] and complications were evaluated to determine the surgical results. Pulmonary function test was utilized to assess forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) before and after surgery. Results : The average percentage of correction of the major structural curve was 73.6% (ranged from 64% to 81.5%). Preoperative and final postoperative absolute FVC averaged 3.03 L and 3.76 L (0.73 L increase, p=0.046), and absolute FEV1 averaged 2.63 L and 3.49 L (0.86 L increase, p=0.021). Preoperative and final postoperative average self-image and function scores of SRS-22r were, $2.6{\pm}0.5$, $3.3{\pm}0.1$, $4.0{\pm}0.5$, and $4.6{\pm}0.0$, respectively. There was a significant improvement of the self-image and function scores of SRS-22r questionnaires before and after surgery (p<0.05). There was no case of neurological deficit, infection and revision for screw malposition. One patient underwent a fusion extension surgery for shoulder asymmetry. Conclusion : Radiographic/clinical outcomes of AIS patients treated by a Korean neurosurgeon were acceptable. Fundamental understanding of pediatric spinal deformity is essential for the practice of AIS surgery.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.637-642
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• 2016

Objective : Although many treatment modalities have been introduced for trigeminal neuralgia (TN), the long-term clinical results remain unsatisfactory. It has been particularly challenging to determine an appropriate treatment strategy for patients who have responded poorly to initial therapies. We analyzed the surgical outcomes in TN patients who failed prior treatments. Methods : We performed a retrospective analysis of 37 patients with recurrent or persistent TN symptoms who underwent surgery at our hospital between January 2010 and December 2014. Patients with follow-up data of at least one year were included. The prior treatment modalities of the 37 patients included microvascular decompression (MVD), gamma knife radiosurgery (GKRS), and percutaneous procedures such as radiofrequency rhizotomy (RFR), balloon compression, and glycerol rhizotomy (GR). The mean follow-up period was 69.9 months (range : 16-173). The mean interval between the prior treatment and second surgery was 26 months (range : 7-123). We evaluated the surgical outcomes using the Barrow Neurological Institute (BNI) pain intensity scale. Results : Among the 37 recurrent or persistent TN patients, 22 underwent MVD with partial sensory rhizotomy (PSR), 8 received MVD alone, and 7 had PSR alone. Monitoring of the surgical treatment outcomes via the BNI pain intensity scale revealed 8 (21.6%) patients with a score of I, 13 (35.1%) scoring II, 13 (35.1%) scoring III, and 3 (8.2%) scoring IV at the end of the follow-up period. Overall, 91.8% of patients had good surgical outcomes. With regard to postoperative complications, 1 patient had transient cerebrospinal fluid rhinorrhea (2.7%), another had a subdural hematoma (2.7%), and facial sensory changes were noted in 8 (21.1%) patients after surgery. Conclusion : Surgical interventions, such as MVD and PSR, are safe and very effective treatment modalities in TN patients who failed initial or prior treatments. We presume that the combination of MVD with PSR enabled us to obtain good short- and long-term surgical outcomes. Therefore, aggressive surgical treatment should be considered in patients with recurrent TN despite failure of various treatment modalities.

• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.363-375
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• 2018

Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal age-adjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.

• 재활치료과학
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• 제7권1호
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• pp.79-88
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• 2018

목적 : 본 연구에서는 뇌졸중 환자의 치료 효과를 증진시키기 위한 방법으로, 로봇 기반에 연속적이며, 실시간으로 환자의 의지에 따른 표면 근전도 신호에 비례한 제어가 가능한 최적 알고리즘을 구현 및 재활로봇과 PC소프트웨어에 적용기술을 개발하였다. 연구방법 : 뇌졸중 환자의 치료를 위한 재활로봇 제어 알고리즘 개발을 위해서 본 연구에서는 선형 재귀모델을 이용하였다. 또한, 이를 PC 소프트웨어에 적용하여 실제 근전도 신호에 비례하여 게임을 진행할 수 있도록 환경을 구축하였으며, 이를 활용하여 모의 훈련을 진행하였다. 결과 : 모의실험 결과 실제 움직인 위치와 선형 재귀모델로부터 추정된 위치의 결과가 상당히 유사하게 나타나는 것을 확인할 수 있었다. 또한 3명의 피험자를 대상으로 실험 한 결과, 3번의 각기 다른 시도에 따라 훈련이 진행되면서 그 결과가 좋아짐을 확인할 수 있었다. 결론 : 본 연구에서는 재활로봇에 적용 가능한 실시간으로 동작하는 근전도에 비례한 움직임을 유도해 낼 수 있는 선형 재귀 모델을 개발하였다. 또한, 이를 활용한 소프트웨어도 함께 구축하여 그 활용 가능성이 높음을 확인하였다. 향후 실제 재활로봇에 적용하여 자가-재활 및 원격재활 로봇에 기본 알고리즘으로 널리 활용될 수 있을 것이라 기대된다.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.58-65
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• 2000

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

• Journal of Chest Surgery
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• 제37권7호
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• pp.553-558
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• 2004

심장 박동상태에서 시행하는 관상동맥우회술(off-pump CABG)은 심폐체외순환하에서 시행하는 관상동맥우회술(on-pump CABG)에 비해 수술 후 유병률을 줄일 수 있는 방법으로 보고되고 있다. 저자들은 특히 수술 후 합병증의 발생 가능성이 높은 당뇨환자에 있어서 off-pump CABG와 on-pump CABG의 임상 결과를 비교하여 off-pump CABG가 당뇨환자의 유병률에 미치는 영향을 알아보고자 한다. 대상 및 방법: 2001년 1월부터 2003년 6월까지 연세대학교 심장혈관병원에서 관상동맥우회출만을 시행받은 682명(off-pump CABG군: 424명, on-pump CABG: 258명)의 환자들 중 당뇨가 있는 환자 244명을 대상으로 하였다. 이 중 off-pump CABG는 154명, on-pump CABG는 90명의 환자들에서 시행하였다. 이 환자들을 대상으로 수술 전 위험요소들과 수술 후 결과를 비교하였다. 결과: 연령, 남녀 비 및 수술 전 고혈압 등의 위험요소와, 수술 전 뇌경색이나 심근경색의 기왕력 등 수술위험 요소도 두 군간의 통계적인 차이를 보이지 않았다. 이식편수는 on-pump CABG에서 유의하게 많았으나, 수술 시간은 off-pump CABG에서 통계적으로 유의하게 짧았고, 수술 후 강심제 사용빈도는 off-pump CABG에서 유의하게 낮았다. 수술 사망은 차이가 없었으며, 수술 후 측정한 CK-MB, 중환자실 인원기간 및 호흡기 사용시간은 off-pump CABG에서 통계적으로 유의하게 낮았다. 그러나 출혈로 인한 재수술, 수술 후 심근경색증, 감염, 신부전증, 신경학적 합병증 및 수술 후 입원 기간 등은 두 군간에 통제적 유의성이 없었다. 결론: 당뇨환자에서 시행한 off-pump CABG는 on-pump CABG에 비해 심근의 손상이 적으면서 수술 후 회복이 빨랐다. 따라서 두 방법 모두 좋은 결과를 보여 주었으나, off-pump CABG가 당뇨환자에서 좀 더 효과적인 수술 방법이라고 생각한다. 그러나 전향적인 연구 등 더 많은 연구가 필요하리라 생각한다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제12권1호
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• pp.149-156
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• 2001

베타 용혈성 A군 연구균(group A beta-hemolytic streptococcus)에 의한 류마치스성 열 이후에 Sydenham 무도병이 발현되는 환자 군에서 강박 증상 또는 틱 증상이 나타난다는 보고가 있은 후, A군 연구균 감염과 강박 장애 또는 틱 장애 사이의 관계가 주목받게 되었다. A군 연구균 감염 후에 강박 증상 또는 틱 증상이 유발되는 환자들은 갑작스런 발병과 극적인 증상 악화를 보이고 사춘기 이전에 발병하며 무도병 모양의 운동 및 독특한 양상의 운동 과잉 등의 신경학적 이상을 보이고 또 그 경과가 악화 및 완화를 반복하는 양상을 보인다. 이런 임상적 특징을 보이는 소아 환자 군을 PANDAS(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)라고 부르게 되었다. 이후 현재까지 강박 장애와 틱 장애뿐 아니라 주의력 결핍/과잉운동 장애, 신경성 식욕부전증, 신체이형장애 환자들이 PANDAS 범주에 속한다는 보고들이 있어 왔다. 본 증례는 7세까지 정상적인 발달을 보이다가 A군 연구균 감염 수개월 후부터, 인지 기능, 사회성, 언어 및 의사소통에 장애를 보이고 틱 증상과 함께 얼굴과 손발에 이상 운동을 보이는 환자를 기술하였다. 이에 저자들은 본 증례가 소아기 붕괴성 장애의 양상을 보이는 PANDAS 증례라고 생각되어 이를 문헌 고찰과 함께 보고함으로써, PANDAS가 틱 장애, 강박 장애, 주의력 결핍/과잉운동 장애, 신경성 식욕부전증, 그리고 신체이형장애 등의 양상을 보일 뿐 아니라 소아기 붕괴성 장애의 양상을 보일 수 있다는 사실을 보고하고자 한다.

• 혜화의학회지
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• 제8권2호
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• pp.245-257
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• 2000

A clinical study was done 40 patients of chronic prostatitis who was treated in Dept. of Internal Medicine, Oriental Medicine Hospital, Taejon University, from 1 Mar. 1999 to 31 Oct. 1999. The results were as follows. 1. In distribution of age, 30's and 40's were 57.5% the most, 20's and 60's were 35.0%, 50's was 7.5%. 2. In distribution of past history, the urethritis(45.0%) was the most. 3. In distribution of ocupation, a white-collar worker was 35.0%, a business man was 22.5%, a public servant was 12.5%, etc. 4. Sitting the mean time of day were distributed 5~7 hours, above 7 hours, 3~5 hours, under 3 hours, etc. 5. The resting interval of a long distance drive were distributed 2 hours(35.0%), 3 hours(32.5%), etc. 6. The habit of enduring ejaculation during sexual intercourse was showed 45.0%. 7. The habit of enduring urination was showed 20.0%. 8. Influency of mental stress was showed 90.0%. 9. Ten cases(25.0%) were showed riding horse or riding bicycle. 10. Four cases(10.0%) were showed wearing tight trousers. 11. The habit of put a wallet his hip pocket was showed 57.5%. 12. The most common symptom was distributed the others symp-tom(66.8%) and the voiding symptom(63.3%) more than pain-neuro-logical symptom(37.5%) and symptom related with sexual function (26.6%). 13. In distribution of palpation, lower abdominal pain, lumbar pain, perineal or parascrotal pain were mostly showed right side. Moreover diagnosis of pulsation was weakly showed chi pulse of right. 14. Duration of disease were distributed above 1 year(82.5%), under 1 year(17.5%). Degree of prostatitis was severe showed adove 1 year. 15. The distribution of WBC count of the prostatic secretion, com-paring with before therapy and after therapy, were showed from 5 cases to 0 case in very many/HPF, from 23 cases to 13 cases in many/HPF, from 12 cases to 13 cases in 10~30/HPF, from 0 case to 13 cases in under 10/HPF. 16. Therapeutic improvement of symptom were distributed pain-neurological symptom(94.8%), the others symptom(90.8%), the void-ing symptom(89.6%) and symptom related with sexual function(67.5%). 17. Differentiation of symptoms and signs were distributed dificiency of spleen-lung vital energy, wetness-heat of lower warmer, dificiency of spleen-kidney yang, dificiency of kidney yin, wetness-phlegm, dificiency of vital energy and blood. The prescriptions were Bojungikgitang(44.6%), Yukmijihwangtang(20.7%), Palmijihwangtang(12.0%), etc.