• Journal of Korean Neurosurgical Society
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• 제42권2호
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• pp.77-82
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• 2007

Objective : The authors tried to reveal some unique features of lipomeningomyelocele (LMMC), including clinical presentation, factors precipitating onset of symptoms, pathologic entities of LMMC associated with tethered cord syndrome, and surgical outcome in LMMC patients. Methods : Seventy-five patients with LMMC were enrolled in this study. Neuro-imaging and intraoperative findings allowed classification of LMMC into three Types. The patients were divided into two groups by age : A (51 patients), from birth to 3 years, and B (24 patients), from 3 to 24 years. For prevention of retethering of the cord, a mega-dural sac rebuilding procedure was performed in 15 patients. Results : During a mean postoperative follow-up period of 4 years, the surgical outcome was satisfactory in terms of improved pain and motor weakness, but disappointing with reference to the resolution of bowel and bladder dysfunction. Among these 75 patients with LMMC, preoperative deficits were improved after surgery in 29 (39%), remained stable in 28 (37%), changed slightly in 13 (17%), and worsened in 5 (7%). Patients in group A achieved better outcomes than those in group B. Depending on the type of lesion, patients with types I and II LMMC have better outcomes than those with type III LMMC. Finally, retethering of the cord with neurological deterioration occurred in 4 (5.3%) of the 75 patients, but no retethering was found in the 15 patients who were recently treated with a mega-dural sac rebuilding procedure. Conclusion : Our data continue to support the opinion that early diagnosis and optimal surgery are still essential for the treatment of patients with LMMC, since there is a high likelihood of residual neurological functions that can be preserved. Based on our surgical experience of untethering and decompression of lipomas, a mega-dural sac repair is useful to prevent retethering of the cord.

• Journal of Chest Surgery
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• 제41권6호
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• pp.718-723
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• 2008

배경: 최근 20년간 수술적인 기법, 마취 기술, 심폐기 운용, 중환자실 관리의 발전으로 심장수술의 사망률과 합병증은 상당히 감소하였지만 심장수술이 중추신경계에 상당한 위험 요소가 되는 것은 널리 알려진 바이다. 이 연구는 두경부 MRA를 통해 심장 수술 대상자에서 불현성 뇌혈관계 질환의 유병률과 두경부 MRA 상에서 비정상적인 소견을 보인 환자의 치료 방침의 변화를 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2008년 6월까지 두경부 MRA 촬영에 동의한 107명의 심장수술 예정자(21세에서 83세까지의 연령분포를 보인 남자 71명과 여자 36명)를 대상으로 하였다. 이 환자들 중에서 신경학적인 고위험군의 비율과 그 환자들의 치료 방침의 변화를 관찰하였다. 결과: 신경학적으로 고위험군 환자의 비율은 15.7% (17예)였으며, 이중 11예는 허혈성 심질환, 6예는 판막 질환이였으며, 이 중 2예의 환자만이 이전에 신경학적인 병력이 있었다. 14명(13.1%)의 환자에서 치료 방침에 변화가 있었다. 결론: 심장수술 대상자에 있어 불현성 뇌혈관계 질환은 비교적 높은 것으로 생각되며, 이를 밝히는 데 있어 두경부 MRA가 의미 있는 것으로 생각된다.

• Radiation Oncology Journal
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• 제29권3호
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• pp.156-163
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• 2011

Purpose: To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. Materials and Methods: We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-five patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Results: Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing's disease). Amenorrhea was abated in 7 of 10 patients, galactorrhea in 8 of 8 patients, acromegaly in 7 of 11 patients, Cushing's disease in 4 of 4 patients. Long-term complication was observed in 4 patients; 3 patients with cerebrovascular accident, 1 patient developed dementia. Of these patients, 3 of 4 received more than 60 Gy of irradiation. Conclusion: EBRT is highly effective in preventing recurrence and reducing mass effect of non-secreting adenoma. Effort to improve tumor control of secreting adenoma is required. Careful long-term follow-up is required when relatively high dose is applied. Modern radiosurgery or proton RT may be options to decrease late complications.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제44권3호
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• pp.112-119
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• 2018

Objectives: Temporomandibular joint ankylosis (TMJA) is a joint pathology caused by bony and/or fibrous adhesion of the joint apparatus, resulting in partial or total loss of function. Materials and Methods: This is a retrospective study conducted between 2012 and 2016 in the northwest region of Nigeria. The data retrieved includes gender, age, etiology of ankylosis, duration of ankylosis, laterality of ankylosis, type of imaging technique, type of airway management, types of incision, surgical procedure, mouth opening, interpositional materials used, and complications. Results were presented as simple frequencies and descriptive statistics. Results: Thirty-six patients with TMJA were evaluated during the study period. There were 21 males (58.3%) and 15 females (41.7%), yielding a male:female ratio of 1.4:1. The patients' age ranged from 5 to 33 years with $mean{\pm}standard$ deviation ($13.8{\pm}6.6years$). Thirty-five cases (97.2%) were determined to be true/bony ankylosis, while only 1 case (2.8%) was false/fibrous ankylosis. Most of the TMJA cases (16 cases, 44.4%) were secondary to a fall. In our series, the most commonly utilized incision was the Bramley-Al-Kayat (15 cases, 41.7%). The mostly commonly performed procedures were condylectomies and upper ramus ostectomies (12 cases each, 33.3%), while the most commonly used interpositional material was temporalis fascia (14 cases, 38.9%). The complications that developed included 4 cases (11.1%) of severe hemorrhage, 1 case (2.8%) of facial nerve palsy, and 1 case (2.8%) of re-ankylosis. Conclusion: Plain radiographs, with their shortcomings, still have significant roles in investigating TMJA. Aggressive postoperative physiotherapy for a minimum of 6 months is paramount for successful treatment.

• Clinical and Experimental Pediatrics
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• 제53권1호
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• pp.106-110
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• 2010

해마경화증은 난치성 측두엽간질의 가장 흔한 원인들 중 하나이다. 일반적으로 해마경화증은 뇌 자기공명영상에서 높은 민감도와 특이도로 규명될 수 있다. 이 병변의 뇌 자기공명영상 소견은 해마에 국한된 조영증가와 이와 연관된 위축된 해마 소견이라 할 수 있다. 반면에 국소성 겉질 형성이상증은 회백질-백질 경계부의 불분명함, 백질 부분의 이상 조영증강 소견을 보인다. 저자들은 수술적 치료 이전에 뇌 자기공명 영상에서 좌측 측두엽의 겉질 형성이상증의 소견을 보였으나, 수술 후 병리검사에서 해마경화증 외에 정상소견을 보였던 1례를 경험하였기에 보고하고자 한다.

• Investigative Magnetic Resonance Imaging
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• 제12권2호
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• pp.161-169
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• 2008

목적 : 유방 절제 생검 후 유방암이 진단된 환자에서 잔류종양과 추가 병변을 진단하는데 있어 자기공명영상의 유용성을 알아보고자 하였다. 대상 및 방법 : 2005년 3월부터 2007년 8월까지 유방 절제 생검으로 유방암이 진단되고 수술 전 자기공명영상을 시행한 16명의 환자를 대상으로 하였다. 생검 후 생긴 공동 주위로 두껍고 불규칙한 조영증강 테두리를 보이거나 공동에 연하여 조영증강되는 종괴가 있는 경우를 잔류종양이 있다고 보았다. 또한 공동과 분리된 다초점성, 다발성, 혹은 반대측 유방 병변 등의 추가 병변을 확인하였다. 수술 후 조직학적 소견을 비교하여 자기공명영상의 정확성을 평가하였고 자기 공명영상소견에 따라 향후 치료에 변화가 있었는지를 알아보았다. 결과 : 공동주위 조영증강 소견으로 잔류종양을 평가하는 자기공명영상의 민감도와 특이도는 각각 85.7%(6/7)와 55.6%(5/9)이었다. 자기공명영상으로 6명의 환자에서 다초점성(multifocal), 다발성(multicentric), 혹은 반대측 유방에 추가 병변을 발견하였다. 자기공명 영상의 결과에 따라 7명의 환자에서 치료 범위가 변화되었다. 결론 : 절제 생검 후 자기공명영상에서 보인 소견 중 공동주위 조영증강 소견만으로 잔류종양 유무를 감별하기 어렵다. 그러나 유방 자기공명영상은 다초점성 및 다발성 혹은 반대측 병변을 포함한 추가병변을 발견하는 데 도움을 주어 수술적 치료에도 유용한 정보를 제공한다.

• 한국임상수의학회지
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• 제25권2호
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• pp.131-135
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• 2008

5연령의 치와와 견이 사지 부전마비를 평가하기 위해서 내원하였다. 내원 시에 보행이 불가능한 사지 부전마비와 목 부위 통증을 보였다. 방사선 상에서 환축추 아탈구와 C1 등쪽의 추궁과 C2의 가시돌기의 거리가 증가 된 소견을 보였다. 외과적 고정은 투시기 유도 하에서 복측 접근을 통하여 2개의 나사(screw)를 사용하여 실시하였으며, 외부 고정(neck brace)을 3주 동안 실시하였다. 수술 후 4주 후 임상증상이 개선되어 보행이 가능 하였으며, 방사선 상에서 고정을 유지하고 있었으며, 나사의 이주 소견은 없었다. 4개월 후에 임상증상이 완전히 회복되었다. 본 증례에서는 복측 나사 고정을 투시기 유도하에서 실시함으로, 나사의 적합한 각도로 위치 시킬 수 있었다.

• 대한두개안면성형외과학회지
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• 제13권2호
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• pp.111-118
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• 2012

Purpose: The nasal bone fracture is known as the most common facial fracture, with the postoperative results and the patient's satisfaction known to be lower than other facial fractures. The patient's satisfaction is firstly related to the accurate comprehension of the spatial relationship in the fractured nasal bone and secondly to the accurate reduction based on accurate comprehension. The aim of this study is to evaluate the objective usefulness of the three-dimensional (3D) imaging. Methods: The survey was conducted on 10 randomly selected cases of nasal bone fractures among the 46 cases with 3D computed tomography (CT) during the past one year. It was requested upon 4 plastic residents and 4 plastic surgeons to draw 3D aspect of fractured nasal bone directly on the printed photos of cadaver nasal bone, based on simple X-ray and two-dimensional (2D) CT. They were compared with the real fractured nasal bone aspects based on the 3D image and marked the difference in the 10-point scale of 0 to 10. Results: The average score of the 4 residents was 1.62 and that of the 4 surgeons was 4.47 out of 10 by simple X-ray. The average score of the 4 residents was 5.67 and that of the 4 surgeons was 7.25 out of 10 by 2D CT. Conclusion: It was surmised that the precise analysis and accurate comprehension of the spatial relationship of the fractured nasal bone using the 3D image, as based on the 2D CT images, can produce more favorable satisfaction levels in the patients.

• 대한두개안면성형외과학회지
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• 제21권5호
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• pp.288-293
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• 2020

Background: Pilomatrixoma is a benign tumor that originates from the hair follicle matrix. It usually presents as a hard, slow growing, solitary mass that can be easily misdiagnosed as other skin masses. The aim of this study was to clinically analyze a case series of pilomatrixoma in pediatric patients from Korea. Methods: A total of 165 pediatric patients from 2011 to 2018 with a histological diagnosis of pilomatrixoma were included. A retrospective review was performed using the electronic medical records, including patient demographics, number and location of the mass, clinical and imaging presentation, and postoperative outcomes. Results: There were 61 male and 104 female patients with 152 solitary and 13 multiple pilomatrixomas. Among solitary pilomatrixomas, the lesion commonly occurred in the head and neck (84.2%), followed by upper limbs (11.2%), lower limbs (3.3%), and trunk (1.3%). The pilomatrixoma lesion presented as the following types based on our clinical classification: mass (56.02%), pigmentation (25.31%), mixed (12.65%), ulceration (4.82%), and keloid-like (1.2%). Ultrasonography showed a high positive predictive value (95.56%). There were no specific complications observed except for two cases of recurrence. Conclusion: Pilomatrixoma has various clinical feature presentations and commonly occurs in the head and neck. Ultrasonography is a helpful diagnostic tool. Surgical removal of the lesion is the main treatment method with a low recurrence rate.

• Journal of Chest Surgery
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• 제30권1호
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• pp.55-60
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• 1997

본 인제대학교 의과대학 서을 백병원 흉부외과학교실에서는 1987년 9월 부터 1995년 12월까지 원발성 종격동 종양의 진단하에 수술을 시행한 40례를 대상으로 하여 임상적 고찰을 하였다. 관찰 대상은 남자 18례와 여자 22례로 연령은 Vll에서 68세까지 였으며 평균 )4.1세였다. 종양의 진단시 증상은 흉통(12.5%), 기침(12.5%), 호흡곤란(7.5%) 경부종괴(7.5%), 흉부불쾌감(5.0%) 등이었다. 진단은 모든 예에서 단순 흉부엑스선 사진과 흉부 전산화단층촬영을 실시하였고 5례 에서는 자기공명영상을 시행하였다. 경피적 침생검은 22례에서 시행하여 16례에서 조직학적 진단을 얻었다(민감도 72.7%). 종양의 위치별 분포는 전상부 종격동 24례(60.0%), 후부 종격동 14례(35.0%), 중부 종격동 2례(5.0%)였다. 종양의 종류는 흉선종 11례(27.5%), 신경성종양 10례(25.0%), 배아세포종 7례(17.5%), 낭종 8례(20.0%), 거대 림프 절비대(Castleman's disease) 2례(5.0%), 방추세포육종 1례(2.5%) 그리고 림프종 1례(2.5%), 였다. 악성 종양은 5례로 침습성 흉선종 3례, 방추세포육종 1례, 림프종 1례였다. 치료는 양성의 모든 예와 악성종양 3례에서 완전절제하였고, 2례는 수술이 불가능하였다. 수술후 사망은 없었고 합병증은 창상피열, 성대마비, 어깨강직이 각각 1례씩 있었다.