• 대한영상의학회지
• /
• 제81권4호
• /
• pp.965-971
• /
• 2020

동면종은 갈색지방세포로부터 기원한 드문 양성종양이다. 척추에서 발생한 골 내 동면종은 매우 드물고, 근래에 들어서 문헌에 보고되기 시작하여 현재까지 단 12예만이 보고되어 있다. 우리는 우연히 발견된 흉추의 골 내 동면종의 다양한 영상 검사 소견과 병리학적 소견을 보고하고자 한다. 또한 문헌 고찰을 통해 이전에 보고되었던 증례들과 임상 양상 및 영상 소견을 비교하여 분석하였다.

• Journal of Korean Neurosurgical Society
• /
• 제30권2호
• /
• pp.173-179
• /
• 2001

Purpose : To assess therapeutic effects of percutaneous polymethylmethacrylate(PMMA) vertebroplasty on the pain caused by osteoporotic thoracic and lumbar vertebral body compression fractures in a large scale of a prospective clinical design, and to determine clinical factors influencing its therapeutic effects. Methods : A prospective clinical study was carried out in 349 vertebral levels of 159 patients between April 1998 and July 1999. The compression fractures were confirmed with bone scan and spine CT, and bone marrow density was measured. Visual analogue scale(VAS) score was used for pre- and post-operative assessments of the pain. All 159 patients were assessed immediately after surgery, and 140 patients of them were followed-up for about 6 months in average. Results : Partial and complete pain relief was sustained immediately after operation in 73%, through follow-up period in 88% of the patients. Pain relief was not proportional to the amount of PMMA or the rate of increase in the height of the compressed vertebral body. It appears that 3 to 6cc of PMMA was proper enough to sustain pain relief. Better clinical improvement was achieved in the patients treated within 6 months after occurrence of vertebral body fracture. The most frequent surgical complication was epidural leakage of PMMA, and the most serious complication was extravertebral leakage into the paravertebral muscles, which appeared to exert the worst influence on the outcome. However, surgery was not required in these patients. Conclusion : Therapeutic effects of PMMA percutaneous vertebroplasty on osteoporotic vertebral body compression fractures were confirmed in a relatively large scale of prospective clinical study. It appears that good outcome can be achieved in patients treated within 6 months after fracture, treated each level with 3 to 6cc of PMMA in amount. without serious complications.

• 한국운동역학회지
• /
• 제31권4호
• /
• pp.308-313
• /
• 2021

Objective: The purpose of this study was to investigate the effect of different kettlebell mass (30%, 40%, and 50% of the body mass) on kinematics and kinetic variables of kettlebell swing. Method: Total of 16 healthy male who had at least 1 year of kettlebell training experience were participated in this study (age: 31.69 ± 3.46 yrd., height: 173.38 ± 4.84 cm, body mass: 74.53 ± 6.45 kg). In this study, a 13-segments whole-body model (upper trunk, lower trunk, pelvis, both side of forearm, upperarm, thigh, and shank) was used and 26 reflective markers were attached to the body to identify the segments during the movement. A 3-dimensional motion analysis with 8 infrared cameras and 4 channeled EMG was performed to find the effect of kettlebell mass on its swing. To verify the kettlebell mass effect, a one-way ANOVA with a repeated measure was used and the statistical significance level was set at 𝛼=.05. Results: Firstly, in all lower extremity joints and thoracic vertebrae, a statistically significant change in angle was shown according to an increase in kettlebell mass during kettlebell swing (p<.05). Secondly, in both the up-swing and down-swing phases, the knee joint and ankle joint ROM showed a statistically significant increase as the kettlebell mass increased (p<.05) but no statistically significant difference was found in the hip joint and thoracic spine (p>.05). Lastly, the hamstrings muscle activity was statistically significantly increased as the kettlebell mass increased during up-swing phases (p<.05). Also, as the kettlebell mass increased in P4 of the down swing phase, the gluteus maximus showed a statistically significantly increased muscle activation, whereas the rectus femoris showed a statistically significantly decreased muscle activation (p <.05). Conclusion: As a result of this study, hip extension decreased and knee extension increased at 40% and 50% of body mass, and the spine also failed to maintain neutrality and increased flexion. Also, when kettlebell swings are performed with 50% of body mass, synergistic muscle dominance appears over 30% and 40% of body mass, which is judged to have a risk of potential injury. Therefore, it is thought that for beginners who start kettlebell exercise, swing practice should be performed with 30% of body mass. In addition, even in the case of experienced seniors, as the weight increases, the potential injury risk may increase, so it is thought that caution should be exercised when performing swings with 40% and 50% of body mass. In conclusion, it is thought that increasing the weight after sufficiently training with 30% of the weight of all subjects performing kettlebell swing is a way to maximize the exercise effect as well as prevent injury.

• Nuclear Medicine and Molecular Imaging
• /
• 제40권3호
• /
• pp.148-154
• /
• 2006

목적 : 방사성동위원소 뇌조조영술은 자발성 두개강내 저뇌압증이 의심되는 환자에서 뇌척수액의 누출을 진단하는데 유용한 검사이지만, 뇌척수액의 누출 부위를 증명하지 못하는 경우가 있다. 본 연구의 목적은 방사성동위원소 뇌조조영술의 검사 방법을 변화함으로써 뇌척수액 누출 부위의 진단율을 향상시키고, 검사 소요시간을 단축할 수 있는지 알아 보고자 한다. 대상 및 방법 : 자발성 두개강내 저뇌압증으로 진단되어 방사성동위원소 뇌조조영술을 시행한 7명의 환자(평균 나이=$38{\pm}8$세, 남자 2명, 여자 5명), 8회 검사를 대상으로 하였다. 모든 환자들은 자주막하강에 $^{99m}Tc$-DTPA 185-222 MBq을 투여한 후 10분, 30분, 1시간, 2시간, 4시간 그리고 6시간에 방광을 포함하는 요추부부터 두부까지의 영상을 얻었다. 그리고 영상시간에 따라 뇌척수액의 누출과 방광의 방사능 조기 출현을 평가하였다. 결과: 방사성동위원소 뇌조조영술을 통해 8예 모두에서 뇌척수액의 누출 부위를 확인할 수 있었다. 뇌척수액의 누출 부위는 경흉추 경계부(cervico-thoracic junction)에서 3예, 경흉추 경계부와 C1-2에서 2예, 경흉추 경계부와 흉추부, 흉요추부 여러 곳 그리고 요추부가 각각 1예씩 이었다. 모든 예에서 1시간까지의 영상을 통해 모든 예에서 뇌척수액의 누출 부위를 발견할 수 있었으며, 모두 두 곳 이상에서 누출이 있었다. 이 중 경흉추 경계부를 포함하는 경우가 5예였다. 지연 영상에서 뇌척수액의 누출 부위가 추가로 발견된 경우는 단 1예 뿐 이었다. 조기 방광방사능 출현은 6예에서 관찰되었으며, 모두 뇌척수액 유출부위가 더 먼저 관찰되었다. 결론: 방사성동위원소 뇌조조영술은 자발성 두개강내 저뇌압증 환자에서 뇌척수액의 누출 부위를 확인하는데 매우 예민한 검사이며, 검사법을 변형함으로써 뇌척수액의 누출 부위를 발견하는 빈도를 향상시키고, 검사시간을 단축할 수 있을 것으로 기대된다.

• Journal of Korean Neurosurgical Society
• /
• 제29권2호
• /
• pp.240-248
• /
• 2000

Objective : Spontaneous intracranial hypotension is a rarely reported syndrome of spontaneous postural headache associated with low CSF pressure and has rarely been demonstrated radiographically or surgically. But recently, it is being recognized with increasing frequency. The purpose of this study was to characterize clinical and imaging features, etiologic factors, and outcome in the spontaneous intracranial hypotension. Patients and Methods : We reviewed our experience with documented cases of spontaneous intracranial hypotension in 5 consecutive patients with orthostatic headaches from April 1998 to April 1999. Results : The mean age was 41 years(from 35 to 49 years). All patients had postural headaches, which were completely alleviated by recumbency position. Nausea, neck pain, horizontal diplopia, photophobia, and blurred vision were noted in some of the patients. Brain MRI showed diffuse pachymeningeal gadolinium enhancement, subdural collections of fluid, and descent of the brain. The opening pressure from lumbar puncture was $4cmH_2O$ or less in three of five patients whereas the opening pressure was within normal range in two patients. All patients underwent radioisotope cisternography and computerized tomographic myelography. On radioisotope cisternography, CSF leakage was suspected at the level of cervical area(1 patient), upper thoracic area(2 patients), mid-thoracic area(1 patient). Computed tomography myelography revealed extraarachnoid accumulation of contrast media(compatible finding with CSF leakage) at the level of cervical or thoracic area. In all patients, the symptoms resolved in response to supportive measures or epidural blood patch(1 patient). Conclusion : Spontaneous spinal CSF leakage is increasingly recognized as a cause of spinal postural headache. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine and can be demonstrated by variable diagnostic method. The condition is usually self-limiting and its prognosis is typically good.

• 대한골관절종양학회지
• /
• 제1권1호
• /
• pp.38-44
• /
• 1995

1988년부터 1993년까지 최근 6년간 고신의료원에서 전이성 골종양으로 진단받고 치료받았던 환자중 조직학적으로 확진되었던 417명의 환자를 대상으로 후향적 조사를 통하여 연령별, 성별, 골전이 부위별 분포와 원발성 암에 따른 전이의 양상을 분석하여 다음과 같은 결과를 얻었다. 1. 골전이를 가장 잘 일으키는 원발성 암은 폐암(29.5%), 위암(15.3%), 유방암(11.3%), 자궁경부암(5.3%), 간암(4.8%)등의 순이었으며, 원발 부위 미상의 전이성 골종양은 7.7%였다. 2. 연령 분포는 40대 이후에서 발생한 경우가 85.3%로 대부분을 차지하였으며, 평균 연령은 54.8세였다. 남자의 경우 50대(39.4%), 60대(27.5%), 40대(14.3%)의 순이었으며, 여자의 경우는 50대(31.9%), 40대(21.7%), 60대(20.5%)의 순으로 발생하였다. 3. 골전이 부위별 분포는 척추(25.2%), 골반골(16.0%), 늑골(15.3%), 대퇴골(14.5%), 두개골(8.3%), 상완골(5.5%), 견갑골(5.1%)등의 순이었으며, 골전이의 분포 양상은 체간골이 75.8%로 가장 많았고, 그 다음으로 근위부의 장관골이 19.8%, 슬관절과 주관절 이하의 원위 골격계가 4.4%의 순으로 나타났다. 척추 중에서는 흉추(42.1%), 요추(39.1%), 경추(13.2%), 천추(5.6%)의 순으로 나타났다. 4. 골전이 부위별 분포는 원발성 암의 종류에 관계없이 다발성 전이(73.1%)가 단발성 전이(26.9%) 보다 많았다. 5. 원발성 종양에 따른 분포 양상은 폐암의 경우 연령 분포는 50대, 60대, 40대의 순이었고, 남녀비는 2.3 : 1이었으며, 골전이는 척추, 골반, 대퇴골의 순으로 발생하였다. 위암의 경우 연령 분포는 50대, 60대, 40대의 순이었고, 골전이 부위는 척추, 대퇴골, 골반의 순이었다. 유방암의 경우 연령 분포는 40대, 50대, 30대의 순이었고, 골전이 부위는 척추, 늑골, 골반의 순이었다. 6. 원발 부위 미상의 전이성 골종양의 경우는 60대가 가장 많았으며, 30대부터 70대까지 분포되어 있었다. 골전이 부위는 척추, 대퇴골, 골반골, 늑골, 견갑골의 순이었으며, 조직학적으로는 선암, 편평세포암이 많았다.

• Journal of Korean Neurosurgical Society
• /
• 제30권5호
• /
• pp.642-646
• /
• 2001

A 12-years-old female admitted to the hospital with the complaint of pain on the right upper chest area which persisted about 1 month prior to admission. $Caf{\acute{e}}$-au-lait spots of various size laying on a whole body and freckling on the axilla were found on physical examination. A huge mass was found on the plain chest X-ray and on chest MRI. The mass encroached thoracic spine, posterior rib, back muscles, and then into the neural canal and compressed thoracic spinal cord. On the 5th day of hospitalization, the patient complained tingling on the both legs and 2 days later, monoparesis on the right leg. Open thoracotomy and decompressive laminectomy was done to remove mass. Pathologic reports confirmed rhabdomyosarcoma, embryonal type.

• Journal of Korean Neurosurgical Society
• /
• 제52권3호
• /
• pp.204-209
• /
• 2012

Objective : The authors performed a retrospective study to assess the accuracy and clinical benefits of a navigation coupled with O-arm$^{(R)}$ system guided method in the thoracic and lumbar spines by comparing with a C-arm fluoroscopy-guided method. Methods : Under the navigation guidance, 106 pedicle screws inserted from T7 to S1 in 24 patients, and using the fluoroscopy guidance, 204 pedicle screws from T5 to S1 in 45 patients. The position of screws within the pedicle was classified into four groups, from grade 0 (no violation cortex) to 3 (more than 4 mm violation). The location of violated pedicle cortex was also assessed. Intra-operative parameters including time required for preparation of screwing procedure, times for screwing and the number of X-ray shot were assessed in each group. Results : Grade 0 was observed in 186 (91.2%) screws of the fluoroscopy-guided group, and 99 (93.4%) of the navigation-guided group. Mean time required for inserting a screw was 3.8 minutes in the fluoroscopy-guided group, and 4.5 minutes in the navigation-guided group. Mean time required for preparation of screw placement was 4 minutes in the fluoroscopy-guided group, and 19 minutes in the navigation-guided group. The fluoroscopy-guided group required mean 8.9 times of X-ray shot for each screw placement. Conclusion : The screw placement under the navigation-guidance coupled with O-arm$^{(R)}$ system appears to be more accurate and safer than that under the fluoroscopy guidance, although the preparation and screwing time for the navigation-guided surgery is longer than that for the fluoroscopy-guided surgery.

• The Journal of Korean Physical Therapy
• /
• 제26권5호
• /
• pp.358-364
• /
• 2014

Purpose: Flexed posture commonly increases with age in older women and is characterized by an excessive curvature in the thoracic spine (kyphosis), forward head posture, and decline in height. This study was conducted in order to determine the relationship between flexed posture, physical performance, and psychosocial factors in community dwelling elderly women in Korea. Methods: Fifty-two subjects with thoracic kyphosis of $40^{\circ}C$ or greater participated in this study. Flexed posture was measured using kyphosis angle (KA), forward head posture (FHP), and round shoulder (RS), and physical performance was evaluated using the short physical performance battery (SPPB), grip strength, and static and dynamic balance. Psychosocial factors were measured using depression and the quality of life (QOL). All data were analyzed using SPSS 18.0 software for windows. Results: KA showed significant correlation with SPPB score (r=-0.447) and dynamic balance (r=0.426) (p<0.05) depression (r=0.405) and QOL (r=-0.464) but not with grip strength and static balance in elderly individuals. FHP and RS showed significant correlation with SPPB score (r=0.002, r=-0341) and dynamic balance (r=-0.278, r=0.346) (p<0.05) but not with psychosocial factors. Conclusion: These findings suggest that flexed posture provides meaningful information about physical performance and psychosocial factors in elderly women. Our data suggest that the flexed posture may need to be addressed as part of the health management process for elderly women.

• The Korean Journal of Pain
• /
• 제31권2호
• /
• pp.125-131
• /
• 2018

Background: The thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs. Methods: A total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy. Results: The cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00-2.00) for Group A, 2.50 (2.00-3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00-3.00) for Group B, and 2.00 (2.00-3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image. Conclusions: Injection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.