• 한국산학기술학회:학술대회논문집
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• 한국산학기술학회 2011년도 추계학술논문집 1부
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• pp.326-329
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• 2011

Mortality associated with maxillofacial infection is relatively low due to the development of antibiotics, and improved oral care. However, inappropriate treatment, delayed treatment, old age, underlying systemic disease, and drug-resistant micro-organisms can potentially result in life threatening situations such as cavernous sinus thrombosis, mediastinitis, and sepsis. Sepsis is the most dangerous state with high mortality, ranging from 20~60%. The treatment of sepsis involves properly monitoring vital functions, fluid resuscitation, surgical drainage, and empirical use of high doses of antibiotics until culture results are available. Ventilatory support maybe be required as well. We encountered a 64-year-old patient who died from sepsis that developed as the result of an odontogenic infection. The initial diagnosis was right temporal, infraorbital, buccal, pterygomandibular space abscess. Despite surgical and medical supportive care, the condition progressed to sepsis and after four days the patient died due to multiple organ failure.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.168-170
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• 2014

Dural arteriovenous fistula (AVF) is very rare, acquired lesion that may present with intracranial hemorrhage or neurological deficits. The etiology is not completely understood but dural AVF often has been associated with thrombosis of the involved dural sinuses. To our knowledge, this is the first well documented intracranial hemorrhage case caused by dural AVF following microvascular decompression for hemifacial spasm. A 49-year-old male patient had left microvascular decompression of anterior inferior cerebellar artery via retrosigmoid suboccipital craniotomy. The patient was in good condition without any residual spasm or surgery-related complications. However, after 10 months, he suffered sudden onset of amnesia and dysarthria. Computed tomography and magnetic resonance imaging revealed the presence of dural AVF around the left transverse-sigmoid sinus. The dural AVF was treated with Onyx$^{(R)}$ (ev3) embolization. At the one-year follow up visit, there were no evidence of recurrence and morbidity related to dural AVF and its treatment. This case confirms that the acquired etiology of dural AVF may be associated with retrosigmoid suboccipital craniotomy for hemifacial spasm, even though it is an extremely consequence of this procedure.

• Journal of Chest Surgery
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• 제28권4호
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• pp.355-359
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• 1995

A clinical analysis was performed on 48 cases with mitral stenosis who received open mitral commissurotomy from December 1983 to June 1991 at the Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital. Fifteen patients were men and 33 were women. the mean age was 35.6 years with the range of 16 to 61 years. The distribution of preoperative NYHA Functional Classes was as follows; class II, 25 patients; class III, 20 patients; class IV, 3 patients. Three patients had cerebral emboli preoperatively, all of whom were in atrial fibrillation. The preoperative electrocardiographic studies revealed that 32 patients had sinus rhythms and 16 had atrial fibrillations. Twenty-six patients had open mitral commissurotomy alone and 22 patients had additional cardiac procedures. Intraoperatively, there were 6 cases of left atrial thrombosis. There was no perioperative death but early postoperative complications were found in 3 cases. The patients were followed up from 2 to 99 months[mean 33.7 months . There was one case of late unexplained sudden death. There was a case of late postoperative cerebral infarction, 5 cases of mitral restenosis and 3 cases of congestive heart failure and/or arrhythmia. Mitral valve replacements were required in 3 patients.But, it is evident that open mitral commissurotomy has many advantages beyond mitral valve replacement concerning the results of the mitral valve replacement underwent during the same period at the Department of Thoracic & Cardiovascular Surgery, Chungnam National University Hospital.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제33권5호
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• pp.445-448
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• 2011

Mortality associated with maxillofacial infection is relatively low due to the development of antibiotics, and improved oral care. However, inappropriate treatment, delayed treatment, old age, underlying systemic disease, and drug-resistant microorganisms can potentially result in life threatening situations such as cavernous sinus thrombosis, mediastinitis, and sepsis. Sepsis is the most dangerous state with high mortality, ranging from 20~60%. The treatment of sepsis involves properly monitoring vital functions, fluid resuscitation, surgical drainage, and empirical use of high doses of antibiotics until culture results are available. Ventilatory support maybe be required as well. We encountered a 64-year-old patient who died from sepsis that developed as the result of an odontogenic infection. The initial diagnosis was right temporal, infraorbital, buccal, pterygomandibular space abscess. Despite surgical and medical supportive care, the condition progressed to sepsis and after four days the patient died due to multiple organ failure.

• Pediatric Infection and Vaccine
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• 제21권1호
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• pp.59-64
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• 2014

부비동염은 흔하고 일반적으로 소아에서는 양성질환인 경우가 많다. 경험적으로 사용하고 있는 항생제로 인해 소아의 부비동염의 두 개강 내 합병증은 드물지만, 발생할 경우 생명에 위협적일 수 있다. 두 개강 내 합병증은 정맥동 혈전, 안와 합병증, 뇌수막염, 뇌수막하 농양 등이 있다. 이러한 합병증은 소아에서 심각한 예후를 보일 수 있다. 따라서 뇌수막하 농양을 초기에 정확하게 진단하여 치료를 시작하는 것이 중요하다. 저자들은, 급성 부비동염 치료 중이던 15세 남아가 3일간의 발열, 두통을 동반한 편마비 증상으로 내원하여 뇌 전산화 단층촬영에서 뇌수막하 농양으로 진단되어 항생제 투여 및 신경학적 수술로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제41권4호
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• pp.230-235
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• 2007

Objective : We investigated the incidence of the vascular abnormalities associated with spontaneous intracerebral hemorrhage [ICH] using three-dimensional computed tomographic angiography [3D-CTA]. Methods : We prospectively assessed consecutive 76 patients with spontaneous intracerebral hemorrhage [ICH] who underwent 3D-CTA between June 2003 and May 2005. The patients with a recent history of trauma or mainly subarachnoid hemorrhage were excluded. We investigated relationship between vascular abnormality and ICH location. The findings of 3D-CTA were classified as one of three patterns with ICH; type A [without evidence of vascular abnormality], type B [with no vascular abnormality as the source of hemorrhage, but with incidental vascular abnormality], and type C [presence of a vascular abnormality as the source of hemorrhage]. Results : Sites of ICH were lobar 26, basal ganglia 23, thalamus 17, posterior fossa 6 and dominant intraventricular hemorrhage [IVH] 4. Among 76 patients, sixteen [21.1%] vascular abnormalities were noted excluding 13 cases of stenoocclusive disease. Sixteen cases included 6 cases of cerebral aneurysms [7.9%], 5 moyamoya diseases [6.6%], 4 arteriovenous malformations [5.3%] and 1 dural sinus thrombosis [1.3%]. Lobar ICH [30.8%] had a higher vascular abnormalities than other types, and younger age [<40] group had a higher incidence of vascular abnormalities than old age group. The patterns of 3D-CTA include sixty cases [79.0%] of type A, 6 cases [7.8%] of type Band 10 cases [13.2%] of type C. The vascular abnormalities were found in 8 [13.5%] of 59 hypertensive patients and 8 [47.0%] of 17 non-hypertensive patients [p=0.006]. Conclusion : 3D-CT angiography is considered a useful screening tool for ICH patients with suspected cerebrovascular abnormalities and should be considered in such clinical settings, especially in lobar type and in non-hypertensive younger patients.

• Clinical and Experimental Pediatrics
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• 제46권12호
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• pp.1253-1259
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• 2003

목 적 : 신생아 경련은 일반적으로 임상적 양상이 소아나 성인과는 크게 다르며 그 빈도도 드물지 않다. 그러나 국내에서는 이에 대한 연구 및 자료가 부족하여 저자들은 신생아 경련으로 입원한 환자를 대상으로 이들의 임상양상, 치료 및 예후에 관해 알아보고자 본 연구를 시행하였다. 방 법 : 2000년 1월부터 2003년 4월까지 경북대학교병원 소아과에서 신생아 경련으로 치료받았던 41명(남 24, 여 17, 재태연령 $38.4{\pm}3.6$주)을 대상으로 후향적 연구를 시행하였으며 이들의 병력상에 나타난 위험인자, 신경학적 진찰소견, 검사실 소견, 뇌 영상소견, 뇌파소견, 경련의 양상, 치료에 대한 반응 및 예후를 비교하였다. 결 과 : 경련시작 당시의 나이는 $6.1{\pm}4.6$일이었고 경련의 양상은 다발성 간대가 17례(42%), 비정형적 발작이 10례(24%)로 가장 많았다. 병력상 위험인자로서는 비정상적 분만력 및 신생아 가사가 11례(27%), 전해질 이상이 11례(27%), 경련의 가족력이 3례(7%), 뇌의 구조적 이상이 3례(7%), 기타 저혈압 2례(5%) 핵황달, 청색형 선천성 심장병으로 인한 저산소증, 선천성대사이상 등이 3례(7%)였으며 나머지 8례(20%)에서는 위험인자가 발견되지 않았다. 뇌영상 촬영상 21례(51%)에서 비정상적인 소견을 보였으며 이중 뇌출혈이 9례(22%)였으며 뇌백질연화증이 2례(5%), 뇌경색이 2례(5%)였고 그 외 선천성 수두증, cortical dysplasia, dural sinus thrombosis, 시상부위 음영증가 등의 소견을 보였다. 뇌파는 전체 41례 중 33례에서 시행되었고 17례(52%)에서 이상소견을 보였다. 치료는 저혈당이나 전해질이상이 동반된 경우 이를 교정해 주었으며 항경련제로는 phenobarbital을 1차 약제로 사용하였고 반응이 없는 경우 phenytoin을 추가하였다. 경련이 재발하거나 나쁜 예후를 보인 환아들은 많은 수에서 신생아 가사에 의한 뇌손상이나 뇌의 선천성 기형이 있었으며 뇌파상에 비정상적인 배경파나 뇌영상소견상 이상을 보이는 경우가 많았다. 결 론 : 신생아 경련의 많은 경우가 비정상적인 출산력과 미숙아, 기타 전해질이상과 관련된 문제가 많았고 전반적으로 약물에 대한 반응이 좋았으며 경련 발생 당시의 임상적 소견이나 검사소견 특히 뇌파나 뇌영상 촬영 소견상 큰 이상이 없었던 경우에는 예후가 좋았다. 따라서 신생아 경련의 위험요소를 잘 이해하고 분만 및 경련발생 시 적절한 대처를 해주는 것이 환아의 예후에 중요한 요인으로 작용하는 것 같다.