비용절감을 위한 변압기의 경제적 운영

윤경혁 대한전기협회 1988 대한전기협회지 Vol.- No.140

비용절감을 위한 변압기의 경제적 운영

윤경혁 대한전기협회 1988 대한전기협회지 Vol.- No.141

頭蓋內 發生된 髓膜腫

尹京赫,金鎭宇,黃成奎,咸印碩,朴淵默,金乘來 慶北大學校 醫科大學 1988 慶北醫大誌 Vol.29 No.1

최근 6년 동안 경북대학병원에 입원하여 종양 절제술을 받은 남, 여 52명의 두개내에 발생된 수막종 환자에 대하여 임상적으로 분석검토하였다. 남, 여의 발생비는 1대 2.3이었으며, 40∼50세 연령층에서 가장 많았다. 천막 상부에서의 발생이 88.5%로서 대뇌 궁륭부, 접형골연부 및 시상동 인접부의 순으로 발생되었으며 천막 하부에서의 발생은 7.7%로서 주로 소뇌교각부이었다. 종양의 크기는 최장경이 3-5㎝가 가장 많았으며 조직 소견으로서는 Meningotheliomatous type이 가장 많았고 다음이 Fibroblastic type이었다. 방사선학적 소견으로서는 두개골에 변화를 일으킨 것이 48.1%, 뇌혈관 조영술상에서 종양상을 나타낸 것이 63.4%이었으며, 전산화 단층촬영상에서는 고밀도상이 82.2%, 저밀도상이 2.2% 그리고 석회침착이 15.4%였다. 또한 동반된 뇌부종은 대개 Grade Ⅰ과 Ⅱ로서 78.7%였다. 증상 출현시로부터 절제술시까지의 기간은 2년이내가 50.0%였다. 종양의 완전절제는 80.8%에서 가능하였으며 재발의 가능성이 없는 것은 75.0%였다. 사망율은 1.9%였으며 이환율은 19.2%였다. Clinical studies and analyses have been made on 52 male and female patients with intracranial meningioma, admitted to department of neurosurgery, Kyungpook National University Hospital during past 6 years. The ratio of male and female was 1 to 2.3, and 40-50 age bracket was most frequently affected. The meningioma occurred above tentorium was 88.5% of all, with cerebral convexity (32.7%) as the most common site followed by sphenoid ridge (15.4%), parasagittal (11.6), Parasellar region (7.7%) The one occurred below tentorium accounted for 7.7%, mainly at the cerebellopontine angle (5.8%). The most common size of the tumor was 3 to 5 ㎝ in diameter (30.8%). The most frequent type of tumor was meningotheliomatous, followed by fibroblastic type in the histological classification. Abnormal findings on the skull by the tumor covered 48.1% on plain films. The tumor blushing was 63.4% on cerebral angiograms. In the brain CT scanning without contrast enhancement, hyperdensity of the tumor covered 82.2%; hypodensity-2.2%; calcification-15.4%. The peritumoral edema was noted in 78.7%, mainly with grade Ⅰ and Ⅱ in the degree. The interval between the onset of symptoms and time of the operation was not more than 2 years in 50% of patients. Total removal of the tumor was possible in 80.8% of the whole cases, and the operative findings indicated a possible rate of recurrence as 25%. The rate of morbidity and mortality was 19.2% and 1.9% respectively.

결절성 경화증에 동반된 뇌상실피하 거세포 성상세포종 : 증례보고 Case Report

윤경혁,황성규,함인석,박연묵,김승래 慶北大學校 醫科大學 1988 慶北醫大誌 Vol.29 No.4

A case of subependymal giant-cell astrocytoma with tuberous sclerosis, 8-year old girl, was observed. Past history and physical examinations revealed epilepsy, mental retardation and facial adenoma sebaceum. Brain CT scan showed multiple calcified nodules in the periventricular region and strongly enhanced intraventricular mass which caused hydrocephalus by obstructing foramina of Monro and the third ventricle. By transcortical, transventricular approach, we removed the tumor totally. Even after removal of the tumor, hydrocephalus was not relieved and ventriculoperitoneal shunt was done. Microscopically, the tumor was composed of large fusiform or pyramidal cells which have a bulky homogeneous hyaline cytoplasm and form multiple perivascular pseudorosettes.

出血을 일으킨 腦動脈瘤 患者의 腦窒擴張

金鎭宇,尹京赫,黃成奎,咸印錫,朴淵默,金乘來 慶北大學校 醫科大學 1988 慶北醫大誌 Vol.29 No.1

최근 3년동안 경북대학병원에 입원된 지주막하 출혈을 일으켰던 100명의 직달술을 받은 뇌동맥류 환자를 대상으로하여 출혈에 의하여 발생된 뇌실확장에 관한 분석을 하였다. 뇌실의 확장은 54%에서 발생되었으며 Mild가 27%, Moderate가 19% 그리고 Severe가 8%였다. 그리고 뇌실확장은 출혈후 1주 이내인 조기 즉 급성으로 나타난 것이 32%로서 동맥류의 발생부위와는 거의 관계가 없었으며, 그리고 2주이후 만성적으로 나타난 것은 22%로써 중대뇌 동맥류에서 가장 낮은 발생빈도를 나타내었다. 뇌실확장의 발생빈도는 출혈에 의한 신경학적 장애소견이 심할수록, 출혈의 회수가 많을수록 높았다. 동맥류의 수술을 받은 환자에서 출혈에 의한 수두증(Hydrocephalus)의 발생은 9명(9.0%), 그리고 정상뇌압수두증(NPH)의 발생은 3명(3.0%)으로서 이들 12명(12.0%)은 뇌척수액의 이동술을 받았다. 그리고 뇌위축에 의한 뇌실확장과 정지상태의 수두증은 각각 22명(22.0%) 및 20명(20.0%)이였다. 뇌척수액의 이동술을 받은 12명 중에서는 11명(11.0%)이 지연성으로 발생된 뇌실확장으로 분석되었다. Analysis and studies have been made on ventricular dilatation in 100 aneurysmal patients with SAH, who received craniotomies for aneurysms by clipping method, at department of neurosurgery, Kyung-pook National University, Taegu Korea, during past 3 years. Ventricular dilatation after aneurysmal bleeding account for 54% of all cases, mild degree-27%, moderate-19% and severe-8%. The incidence of acute ventricular dilatation occurred within one week after bleeding was 32%, regardless of the site of aneurysm. However, chronic dilatation found after two weeks from bleeding covered 22%, less frequently occurring among the aneurysms of middle cerebral artery than anterior and posterior communicating arteries. The incidence of ventricular dilatation had significant relationship to the degree of neurological disorders and the number of bleeding. The patient with ventricular dilatation were classified in 4 groups: Hydrocephalus (9.0%), Normal pressure Hydrocephalus (3.0%), Cortical atrophy (22.0%) and arrested hydrocephalus (20.0%). Among 100 aneurysmal patients with SAH, only 12 had shunting procedures with good results. Eleven of them requiring shunting were analysed as the patients with chronic ventricular dilatation.

흡인 배농술에 의한 뇌농양의 치료

하용수,김진우,윤경혁,황성규,함인석,박연묵,김승래 慶北大學校 醫科大學 1987 慶北醫大誌 Vol.28 No.1

최근 8년동안 경북대학병원에 입원된 뇌농양 환자 35명에 대한 농양의 원인, 형태, 부위 및 크기, 그리고 흡인 배농술에 의한 치료의 결과를 분석 검토하였다. 성별로는 남자(74%)에서 현저히 많았으며, 성별로는 10∼20세층(48.6%)에서 가장 많았다. 원인별로는 만성 중이염(48.6%)에 의한 것이 가장 많았으며 원인 미상이 17.1%였다. 농양의 부위는 대부분이 천막상부(88.6%)에서 발생되었으며, 측두엽(42.9%)에서의 발생이 가장 많았고 다음이 전두엽 및 두정엽의 순위였다. 그리고 단방형의 농양은 82.9%였으며 다발성 농양은 5.7%였다. 농양의 크기는 최장경이 3㎝∼5㎝가 65.7%로써 가장 많았으며, 주위 부종의 심도는 Grade Ⅱ(54.3%)가 가장 많았다. 술전 신경학적 장애는 심도가 45.7%, 중등도가 34.3% 그리고 경도가 20%였다. 흡인 배농술에 의한 치료결과는 Good이 65.7%, Poor가 14.3%였으며 사망율은 8.6%였다. 생존자중 신경학적 장애소견이 없이 퇴원한 것은 모두 50%였다. Studies through the analyses were made on brain abscesses of 35 male and female patients admitted at Kyungpook NAtional University Hospita, for the past 8 years. The sex incidence was considerably high among males, 74%, and age incidence was highest between 10-20 year-old group, 48.6%. The most frequent cause was OMPC, 48.6%, and the unknown was 17.1%. The cases were exclusively located supratentorial hemisphere, with the following breakdown: temporal-42.9%, on the top, followed by frontal, parietal lobe. The unilocular abscess type occupied 82.9%, and multiple form was 5.7% of all the cases. The size of abscess was found mostly in the group of 3-6㎝ in longest diameter, 65.7%. The grade Ⅱ of the peritumoral edema was the most frequent finding on CT scanning, 54.3%. The breakdown of preoperative consciousness level was; severe-45.7%, moderate-34.3%, mild-20%. The result of the operation revealed; good-65.7%, poor-14.3%, and the mortality rate was 8.6%. 50% of all survival cases were discharged without any neurological deficit.

자발성 뇌실질내 혈종의 임상적 관찰

하용수,김진우,윤경혁,황성규,함인석,박연묵,김승래 慶北大學校 醫科大學 1987 慶北醫大誌 Vol.28 No.1

최근 3년 동안 경북대학병원에 입원된 비외상성 뇌실질내 혈종 환자 남, 녀 100명을 대상으로 하여 분석, 검토하였다. 혈종의 발생 빈도는 남자에서 다소 많았으며(1.4:1) 50∼60세 층에서 가장 높은 빈도를 나타내었다. 원인은 고혈압 및 동맥 경화로 추정된 것이 70%로써 가장 많았으며, 다음이 동·정맥 기형과 동맥류의 순이었고 원인 미상은 13%였다. 발생 부위는 피각부가 55%로써 가장 많았으며 다음이 피질하 및 시상부 순위였다. 그리고 30∼60㎖의 혈종이 38%로써 가장 많았다. 혈종의 형태는 국한된 것이 65%이었으며, 술전 신경학적 장애 정도는 G.Ⅲ 및 G.Ⅳ가 전체의 64%였다. 수술 치료후 Good 상태는 37%, poor 상태는 16%이었으며 사망율은 29%였다. 연령, 혈종의 부위 및 크기, 술전 신경학적 장애 그리고 혈종의 형태등은 치료 결과에 현저한 영향을 주는 요소 들이었다. Analyses and studies have been made on 100 male and female patients with non-traumatic spontaneous intracerebral hematoma at Kyunpook National Universiy Hospital, during the past 3 years. The sex incidence was found to be higher among males. The 50-60 age bracket was the most frequent among the patient's age groups. The predominant cause of non-traumatic intracerebral hematoma was thought to be from hypertension and arteriosclerosis, 70%, followed by arteriovenous malformation, cerebral aneurysm, and 13% of the cases accounted for undetermined causes. The most frequent location of the hematoma was putamen, 55%, and followd by subcortical, thalamus in that order. In amount of the hematoma, 30-50cc group ranked top, occupying 38% of all cases. The limited type of hematoma was 65%, which was slightly higher than that of the destructed type. The grade Ⅲ, and Ⅳ in the preoperative clinical grade took up 64% of the whole. The surgical results revealed; Good-37%, Poor-16%, and mortality rate was 29%. It was found that, the age, site of hematoma, and preoperative clinical grade strongly influence the results of the surgery.

임상 : 청신경초종에 대한 감마나이프 방사선수술의 합병증

이동현 ( Dong Hyun Lee ),박성현 ( Seong Hyun Park ),박재찬 ( Jae Chan Park ),황정현 ( Jeong Hyun Hwang ),윤경혁 ( Kyung Hyeok Yoon ),황성규 ( Sung Kyoo Hwang ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Objectives:The treatment of vestibular schwannoma(VS) is challenging due to a high morbidity rate after microsurgery. On the other hand, gamma knife radiosurgery(GKRS) is regarded as an alternative treatment method for VS due to its low morbidity rate. The authors retrospectively analyzed the complications of GKRS to evaluate the therapeutic usefulness of GKRS in VS. Methods:Complications were analyzed retrospectively in 33 cases of VS treated by GKRS at our hospital from March 2005 to May 2008 in terms of patient age, prescription dose, and tumor size, Results:Major complications, such as, signs of increased ICP or ataxia developed in 4 patients, and all had a tumor volume of more than 10 ml. Three of the four were treated by subtotal tumor resection. Hydrocephalus developed in four patients, and two underwent ventriculo-peritoneal shunt placement. Conclusion:Early complications of GKRS in cases with a large VS were significant. Our results support a treatment strategy of subtotal tumor removal followed by scheduled radiosurgery or fractionated radiosurgery for the manage-ment of large VS.