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뇌실외 배액수술중인 시상부 출혈환자에서 조기 임상 경과의 의의
김라선,배학근,윤석만,도재원,이경석,윤일규 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.1
Objective:The purpose of this study is to investigate the significance of an early clinical course during the external ventricular drainage(EVD) in patients with thal amic hemorrhage. Methods : During the last 11 years(1990-2000), a hundred patients with thalamic hemorrhage who underwent EVD were studied. Thirty-four patients underwent temporary closing of EVD at the mean interval of 4.5 days after EVD. The clinical course was divided into 3 groups according to change of Glasgow Coma Scale(GCS) scores of 2 or more within 3 days after EVD compared with those just before EVD : deteriorated, unchanged, and improved. Results : The factors affecting mortality were unchanged(odds ratio [OR] 0.05, 95% confidence interval [CI]0.01-0.38, p=0.0028) and deteriorated clinical course(OR 0.06, 95% CI 0.01-0.38, p=0.0033), GCS scores at the time of admission(OR 1.3, 95% CI 1.02-1.66, p=0.0346), amount of hematoma(OR 0.91, 95% CI 0.83-1.00, p=0.0461) and hematoma enlargement(OR 0.06, 95% CI 0.01-0.65, p=0.0198). The factor affecting the early clinical deterioration was the hematoma enlargement(OR 0.11, 95% CI 0.03-0.38, p=0.0005). The shunt operation was predicted in patients who showed the clinical improvement after EVD followed by the clinical deterioration within 48 hours after temporary closing of EVD. Conclusion : It is suggested that an early clinical course during the maintenance of EVD is important to predict mortality and necessity of shunt operation. Key words:Thalamic hemorrhage;External ventricular drainage;Hematoma enlargement;Shunt.
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Crowned Dens Syndrome: A Case Report and Review of the Literature
이광수,김라선,박형기,장재칠 대한척추신경외과학회 2014 Neurospine Vol.11 No.1
The crowned dens syndrome (CDS), also known as periodontoid calcium pyrophosphate dehydrate crystal deposition disease, is typified clinically by severe cervical pain, neck stiffness and atlantoaxial synovial calcification which could be misdiagnosedas meningitis, epidural abscess, polymyalgia rheumatica, giant cell arthritis, rheumatoid arthritis, cervical spondylitis or metastatic spinal tumor. Crystalline deposition on cervical vertebrae is less well known disease entity and only a limited number of cases have been reported to date. Authors report a case of CDS and describe the clinical feature.
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이경석,김라선,김성호,심재준,도재원,배학근 순천향대학교 순천향의학연구소 2010 Journal of Soonchunhyang Medical Science Vol.16 No.2
Disability evaluation is the most important procedure in the welfare for the disabled. There was a major shift from the medical model of disability to the adoption of the interactive model and the impacts of environmental factors in all aspects of health and functioning. By the literature review, we compared the medical model and the social model of the disability for a better disability evaluation scheme. We explored the concept and structures of the International Classification of Functioning, Disability and Health (ICF). We tried to explain the concept and controversial issues of the disability evaluation. The ICF was designed to record and organize a wide range of information about health and health-related state. However, the ICF is a new classification method, not an assessment tool for the severity of the disability. For the disability evaluation, it would be better to use the Korean Academy of Medical Sciences (KAMS) guides for the disability evaluation, which was published by KAMS. To make a good welfare for the disabled, Korean medical doctors should learn the KAMS guides. It is necessary to study and participate in the development of the better evaluation scheme.
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Unexpected Severe Cerebral Edema after Cranioplasty : Case Report and Literature Review
이광수,박석규,김라선,조성진 대한신경외과학회 2015 Journal of Korean neurosurgical society Vol.58 No.1
This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.
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