• Tuberculosis and Respiratory Diseases
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• 제60권3호
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• pp.353-356
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• 2006

폐결핵 치료중 흉부엑스선상 악화 및 갑자기 발생한 하지 마비와 감각이상으로 자기공명영상 촬영후 급성 횡단척수염 진단 및 객담 검사상 다제내성 결핵균 검출로 2차 결핵약제와 스테로이드 병합치료를 시행하여 부분적으로 호전을 보였던 증례이다. 급성 횡단척수염은 매우 드문 질환이며 균주의 직접 침범이나 면역학적 기전으로 발생하나 후자가 더 가능성 있는 기전으로 생각되어지고 있다. 아직도 결핵 및 다제내성 결핵의 유병률이 높은 국내 상황에서 드물게 결핵이 원인으로 추정된 급성 횡단척수염의 증례를 보고하는 바이다.

• Journal of the Korean Wood Science and Technology
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• 제36권1호
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• pp.36-44
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• 2008

목조건축물로부터 해체된 고목재를 해당 건축물의 복원이나 새로운 건축물에 재사용하기 위해서는 열화 및 부후 부위를 제외한 건전재의 재질 및 강도성능에 대한 평가가 필요하다. 트러스 현재로 사용된 부재와 사찰에 사용된 부재에 대해 현미경으로 수종식별을 행하고 KS 기준에 따라 각종 물성 및 강도 시험을 행하여 문헌에 의한 결과와 비교 검토하였다. 잎갈나무(Korean larch)는 재질 및 강도 성능이 기존 문헌값보다 높게 나타났으며, 소나무(Korean red pine)와 가문비나무(Yezo spruce)의 경우 해체재의 강도성능이 대체적으로 낮게 나타났다. 육안에 의한 건전부위의 시험편 내의 조직적 열화는 현미경적으로도 관찰되지 않았다. 인장시험편의 중앙부 두께가 5 mm에서 3 mm로 변함에 따라 인장강도가 증가하여 시험편 치수에 대한 검토가 필요한 것으로 판단되었으며, 압축 및 휨 시험법은 현행 기준으로도 적합한 수준이었다. 고목재류에 대한 구체적인 기초 강도 성능평가를 위한 시험방법 및 철물접합부의 접합성능에 대한 차후 연구 검토가 필요한 것으로 평가되었다.

• 대한골관절종양학회지
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• 제12권1호
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• pp.57-62
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• 2006

척추의 거대 세포종은 진단이 어려운 경우가 많고, 고도의 악성도로 인해서 수술이 불가능한 경우가 많다. 척추의 거대 세포종은 높은 재발율과 함께 척수의 기계적 압박 가능성으로 인해 방사선 치료가 근간이었으나, 최근에는 근치적 절제술과 함께 기구를 이용한 전후방 고정술을 시행 하여 좋은 결과를 보고 하고있다. 본 정형외과학교실에서는 경부 동통을 유발하며 제3경추를 침범한 거대세포종에 대해서 근치적 절제술과 함께 후방 기기술을 통한 융합을 시행 하였으며, 추시 관찰상 우수한 치료 결과를 보였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제29권11호
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• pp.1484-1490
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• 2000

Objectives : In spinal metastasis and myeloma, percutaneous vertebroplasty could be an effective treatment method to provide spinal stabilization and to relief pain for early rehabilitation. The authors report twenty-five cases the clinical results of percutaneous vertebroplasty for twenty-five cases of spinal metastasis and myeloma. Materials and Methods : From September 1998 to December 1999, seventy percutaneous vertebroplasties(PVP) were performed for spinal metastases and myeloma in 25 patients, sixteen women and nine men ranging in age from 34 to 74. The primary malignancies were 6 multiple myelomas, and in metastatic tumore from various origin. All patients complained of severe pain and had osteolytic vertebral body destructions without spinal cord compression. To evaluate clinical improvement, suObjective verbal analogue pain score(VAS) and Karnofsky performance scale(KPS) were used. Thin sliced(2mm-thickness) sectional computed tomography(CT) was performed before and after PVP. Plain X-ray film was followed up every 1 month to assess the vertebral column stability. Results : In 25 patients, a total of seventy PVPS were performed successfully : 6 cervical, 33 thoracic and 31 lumbar vertebrae. Most patients had clear improvement of pain after PVP ; mean as score was 8.1 and 2.9 before and after PVP, respectively. Improvement was maintained in most patients. No further collapse of treated vertebrae was observed(mean follow-up, 7 months). Leakage of PMMA was notod in the spinal canal(13 levels), neural foramen (2 levels), adjacent disk(15 levels), paravertebral soft tissue(14 levels) and vein(8 levels). Pulmonary embolism was detected in three patients after the procedure, but was not associated with clinical symptoms. Conclusion : These results indicate that percutaneous vertebroplasty can be valuable treatment method in osteolytic spinal metastasis and myeloma, providing immediate pain relief and spinal stabilization and contributing to early rehabilitation.

• Journal of Korean Neurosurgical Society
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• 제43권6호
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• pp.294-299
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• 2008

Objective : To evaluate the clinical characteristics and surgical outcomes of the patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy. Methods : The authors reviewed the clinical and neurodiagnostic findings, surgical managements and outcomes in six consecutive patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy who had been treated with surgical decompression and fusion procedures between January 1999 and December 2005. The mean age of the 6 patients (four women and two men) at the time of surgery was 42.8 years (range, 31-55 years). The mean follow-up period was 56.5 months (range, 17-112 months). The neurological outcome was evaluated before and after operations (immediately, 6 months after and final follow-up) using grading systems of the walking ability, brachialgia and deltoid power. Results : At immediate postoperative period, after 6 months, and at final follow-up, all patients showed apparent clinical improvements in walking ability, upper extremity pain and deltoid muscle strength. Late neurological deterioration was not seen during follow-up periods. There were no serious complications related to surgery. Conclusion : Surgical decompression and stabilization in patients with cervical spondylotic myelopathy associated with athetoid cerebral palsy have been challenging procedure up to now. Our results indicate that early diagnosis and appropriate surgical procedure can effectively improve the clinical symptoms and neurological function in patients with cervical spondylotic myelopathy and athetoid cerebral palsy, even in those with severe involuntary movements.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.216-223
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• 2011

Objective : The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. Methods : We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. Results : The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). Conclusion : Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.

• Tuberculosis and Respiratory Diseases
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• 제75권4호
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• pp.165-169
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• 2013

An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs. It is thought to be a neoplastic or reactive inflammatory condition, controversially. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. The optimal treatment method is not well-known for patients ineligible for surgery. We report a 47-year-old patient with aggressive recurrent IMT of the lungs. The patient had been admitted for an evaluation of back-pain two years after a complete resection of pulmonary IMT. Radiation therapy was performed for multiple bone recurrences, and the symptoms were improved. However the patient presented again with aggravated back-pain six months later. High-dose steroid and non-steroidal anti-inflammatory drugs were administered, but the disease progressed aggressively, resulting in spinal cord compression and metastasis to intra-abdominal organs. This is a very rare case of aggressively recurrent pulmonary IMT with multi-organ metastasis.

• Journal of Korean Neurosurgical Society
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• 제29권12호
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• pp.1577-1583
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• 2000

Objectives : Among the various types of minimally invasive spine surgeries, thoracoscopic surgery is becoming more widely accepted and increasingly utilized. This report delineates our clinical experience using thoracoscopy to resect herniated thoracic discs in 16 patients who suffered from myelopathy or intolerable radiculopathy. Patients and Methods : Between Mar. 1997 and Sep. 1999, 16 consecutive patients underwent thoracoscopic discectomy for treatment of herniated thoracic discs. There were 12 men and 4 women(mean age 43.5 years ; range 18-61 years). Eleven patients presented with myelopathic signs and symptoms from spinal cord compression and 5 patients had incapacitating thoracic radicular pain without myelopathy. The surgical level was varied between T3 and T12. The pathology of specimen were 11 hard discs and 5 soft discs herniations. Thoracoscopic techniques were performed with long narrow spine instruments and high speed drill through 3 or 4 ports under one lung ventilated general anesthesia. During the operation three patients were converted to open thoracotomy due to intolerable one lung ventilation, excessive bleeding and inadequate operation field. The mean operation time was 264min.(range : 100-420min.), and postoperative mean admission period was 11 days. Results : Clinical and neurological outcomes were good in all patients(mean follow-up period 20 months). Among the eleven myelopathic patients, 8 improved neurologically, and 3 stabilized. Among the five radiculopathic patients, 4 recovered completely and no patient had worsened. Postoperative complications were pleural effusion in one case, intercostal neuralgia in one, delayed hemopneumothorax in one, prolonged air leakage in one and pneumonia in one case. Conclusions : Thoracoscopic discectomy needs a steep learning curve to be familiar to anatomical space and handling of endoscopic instruments. However, it is technically feasible and can be effectively performed with acceptable results.

• Journal of Hospice and Palliative Care
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• 제12권2호
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• pp.88-94
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• 2009

흉통은 외래 및 응급실에서 볼 수 있는 흔한 증상으로 그 원인 또한 다양하다. 또한 흉통의 원인에 따라 치료와 예후가 다르기 때문에 흉통의 원인을 정확히 진단하는 것은 무엇보다 중요하다. 흉통을 호소하는 환자들 중 대부분은 개인병원, 종합병원의 내과, 흉부외과 등을 거쳐 기본적인 검사를 실시하고 특별한 이상이 없다고 진단 받고 통증클리닉으로 보내지는 경우가 많지만, 최근에 다른 과를 거치지 않고 직접 통증클리닉을 찾는 환자가 많아짐을 고려할 때 정확한 진단이 필수적이다 하겠다. 본원에 흉통을 주소로 입원치료 중에 있던 환자에서 전이성 척추종양에 의해 급속도로 진행된 척추파괴 및 척수압박 증상을 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Radiation Oncology Journal
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• 제18권4호
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• pp.309-313
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• 2000

자궁 평활근육종의 경부림프절로의 전이는 지금까지 보고되지 않았으며 타 부위로의 전이 시에도 방사선치료는 드물게 이용되어왔다. 저자들은 자궁 평활근육종 환자에서 수술과 골반부 방사선치료를 시행 받고 10개월 후에 경부림프절 전이가 발생하여 인접한 후두주위공간, 척추골, 척추관을 함께 침습하였기에 방사선치료와 화학요법의 경험과 함께 보고하는 바이다. 전이된 종양은 수술이 불가능하여 방사선치료가 의뢰되었으며 총 6,000 Gy의 경부 방사선치료와 taxol과 carboplatin으로 화학요법을 시행하였다. 전이 암은 점차로 크기가 감소하여서 거의 만져지지 않을 정도로 되었다. 환자는 경부 방사선치료와 화학요법을 시행 받은 후 8개월간 척수압박증상을 발생하지 않았고, 연하곤란은 회복되어서 좋은 상태를 유지하였다. 광범위한 경부전이 암이 고선량 경부방사선치료와 화학요법에 좋은국소 반응을 보였기에 수술이 불가능한 전이성 평활근육종 환자에서 이 두 가지 치료법이 고려될 수도 있겠다.