• 한국산학기술학회논문지
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• 제18권7호
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• pp.565-568
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• 2017

쇼그렌 증후군은 입안 건조와 호중성백혈구 감소증을 주로 보이는 자가면역질환이다. 일반적으로 쇼그렌 증후군은 중추신경계를 잘 침범하지 않는 것으로 알려져 있다. 하지만 드물게, 쇼그렌 증후군에서 미세혈관병성 변성이 생기고, 이로 인해 소혈관에 영향을 미치기도 한다. 34세의 여자 환자가 왼쪽 위사분맹 및 왼쪽 팔다리의 저린 증상이 있어 내원하였다. 뇌자기공명영상에서 오른쪽 후대뇌동맥 영역의 급성 뇌경색 소견이 확인되었다. 혈액학적 검사는 항핵항체 (FANA2+) 및 항DNA항체 (anti-SS-A (RO)) 양성이었다. 그리고 침샘 섬광조영술에서 타액 분비양이 현저히 저하되었다. 따라서 환자는 쇼그렌 증후군으로 진단할 수 있었다. 본 환자의 경우처럼 쇼그렌 증후군에서 대혈관을 침범하는 것은 매우 드문 일이다. 또한 쇼그렌 증후군 환자가 저혈소판증을 보였을 경우, 항혈소판 제재를 쓰는 것이 어려울 수 있다. 이 연구는 대혈관 침범 및 저혈소판증을 보인 쇼그렌 증후군 환자에서 항혈소판 제재 및 하이드록시클로로퀸을 통한 성공적인 치료와, 이와 관련된 임상 양상 및 병태생리를 보고한 사례연구이다.

• Journal of Korean Neurosurgical Society
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• 제57권1호
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• pp.1-5
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• 2015

Objective : Cerebral vessels, such as intracerebral perforating arterioles isolated from rat brain, have been widely used as an ex vivo model to study the cerebrovascular function associated with cerebrovascular disorders and the therapeutic effects of various pharmacological agents. These perforating arterioles, however, have demonstrated differences in the vascular architecture and reactivity compared with a larger leptomeningeal artery which has been commonly implicated in cerebrovascular disease. In this study, therefore, we developed the method for studying cerebrovascular function utilizing the olfactory artery isolated from the mouse brain. Methods : The olfactory artery (OA) was isolated from the C57/BL6 wild-type mouse brain. After removing connective tissues, one side of the isolated vessel segment (approximately $-500{\mu}m$ in length) was cannulated and the opposite end of the vessel was completely sealed while being viewed with an inverted microscope. After verifying the absence of pressure leakage, we examined the vascular reactivity to various vasoactive agents under the fixed intravascular pressure (60 mm Hg). Results : We found that the isolated mouse OAs were able to constrict in response to vasoconstrictors, including KCl, phenylephrine, endothelin-1, and prostaglandin $PGH_2$. Moreover, this isolated vessel demonstrated vasodilation in a dose-dependent manner when vasodilatory agents, acetylcholine and bradykinin, were applied. Conclusion : Our findings suggest that the isolated olfactory artery would provide as a useful ex vivo model to study the molecular and cellular mechanisms of vascular function underlying cerebrovascular disorders and the direct effects of such disease-modifying pathways on cerebrovascular function utilizing pharmacological agents and genetically modified mouse models.

• Parasites, Hosts and Diseases
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• 제55권3호
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• pp.267-285
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• 2017

Angiostrongylus cantonensis invades the central nervous system (CNS) of humans to induce eosinophilic meningitis and meningoencephalitis and leads to persistent headache, cognitive dysfunction, and ataxic gait. Infected mice (nonpermissive host), admittedly, suffer more serious pathological injuries than rats (permissive host). However, the pathological basis of these manifestations is incompletely elucidated. In this study, the behavioral test, histological and immunohistochemical techniques, and analysis of apoptotic gene expression, especially caspase-3, were conducted. The movement and motor coordination were investigated at week 2 post infection (PI) and week 3 PI in mice and rats, respectively. The cognitive impairs could be found in mice at week 2 PI but not in rats. The plaque-like lesion, perivascular cuffing of inflammatory cells, and dilated vessels within the cerebral cortex and hippocampus were more serious in mice than in rats at week 3 PI. Transcriptomic analysis showed activated extrinsic apoptotic pathway through increased expression of TNFR1 and caspase-8 in mice CNS. Immunohistochemical and double-labeling for NeuN and caspase-3 indicated the dramatically increased expression of caspase-3 in neuron of the cerebral cortex and hippocampus in mice but not in rats. Furthermore, western-blotting results showed high expression of cleaved caspase-3 proteins in mice but relatively low expression in rats. Thus, extrinsic apoptotic pathway participated in neuronal apoptosis might be the pathological basis of distinct behavioral dysfunctions in rodents with A. cantonensis infection. It provides the evidences of a primary molecular mechanism for the behavioral dysfunction and paves the ways to clinical diagnosis and therapy for A. cantonensis infection.

• 생약학회지
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• 제17권2호
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• pp.113-122
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• 1986

In order to investigate the pharmacological activities of the combined preparation of crude drugs, Chunghyulgangki-Tang was studied. Chunghyulgangki-Tang has been widely used to cerebral apoploxy, hypertension and arteriosclerosis, etc. In this study, water extract of Chunghyulgangki-Tang was conducted in attempt to investigate for analgesic, sedative, antipyretic, isolated ileum and heart, blood vessels and blood pressure action in mice, frogs, rats, guinea-pigs and rabbits. The following results were obtained; Analgesic action by the acetic acid stimulating method in mice was recognized. Sedative activities by the wheel cage method and rotor rod method in mice were shown. Prolonged action against the hypnotic duration induced by thiopental-Na was significantly noted in mice. The effect of antipyretic in endotoxin febrile rats was significantly recognized. Spontaneous motility of the isolated ilem of mice was suppressed and contractions of the isolated ileum of mice and guinea-pigs induced by acetylcholine chloride, barium chloride and histamine were remarkably inhibited. Acceleration of isolated heart motility was shown in frogs. Vaso-dilating and hypotensive actions were recognized in rabbits. According to the above results, effects based on the oriental medicinal references were approximate to the actural experimental results.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.489-492
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• 2009

Purpose: Autologous fat injection is ideal for patients who wish to add contour, projection and gross volumization of the aging, atrophic face and is claimed to be a safe procedure. However, there are several case reports in the literature where patients have suffered from acute visual loss and cerebral infarction after facial fat injection. This paper will explore a rare case of vessel related complication, an arteriovenous fistula that occurs after fat injection on forehead. Method: A 28 - year - old female who showed a non - tender, soft $1.0{\times}2.5cm$ sized mass on forehead for 3 weeks. A thrill could be detected on the totuous dilatated vessel - like structure around the mass. She had a fat injection on forehead for soft tissue augmentation 3 months prior to developing the mass. 3 - dimensional brain CT angiography showed arteriovenous fistula. Results: The fistula is totally excised with ligation of feeding vessels. Pathology report showed an atypical vessel which had intimal thickening, myxoid degeneration and thrombus formation. There were no evidences of recurrence at least for 2 months of follow - up. Conclusion: An occurrence of arteriovenous fistula after autologous fat injection is very rare. After perforation of artery and vein by coincidence, blood extravasates with the formation of a hematoma capsule and a pseudocapsule around it. The hematoma capsule would expand and clot would reabsorb resulting in a cavity leading to fistula formation. Other vessel related complications like acute visual loss or cerebral infarction are very severe. Therefore, surgeons should be cautious during facial fat injection to avoid vessel injuries.

• Journal of Medicine and Life Science
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• 제17권3호
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• pp.65-73
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• 2020

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disease of the cerebral small blood vessels caused by mutations in the NOTCH3 gene on chromosome 19. Although CADASIL was known as a rare disease, recent research has suggested that the NOTCH variants could be found frequently even in the general population. The main clinical features included recurrent stroke, migraine, psychiatric symptoms, and progressive cognitive decline. On brain magnetic resonance imaging, patients with CADASIL showed multifocal white matter hyperintensity lesions, lacunar infarcts, microbleeds, and brain atrophy. Among them, lacunar infarcts and brain atrophy are important in predicting the clinical outcomes of patients with CADASIL. In the Jeju National University Hospital, we have diagnosed 213 CADASIL patients from 2004 to 2020. Most NOTCH3 mutations were located in exon 11 (94.4%), and p.Arg544Cys was the most common mutation. The mean age at diagnosis was 61.0±12.8 years. The most common presenting symptoms were ischemic stroke (24.4%), followed by cognitive impairment(15.0%), headache (8.9%), and dizziness(8.0%). Although the exact prevalence of CADASIL in Jeju is still unknown, the disease prevalence could be as high as 1% of the population considering the prevalence reported in Taiwan. Therefore, it is necessary to discover efficient biomarkers and genetic tests that can accurately screen and diagnose patients suspected of having CADASIL in this region. Ultimately, it is urgent to explore the exact pathogenesis of the disease to identify leading substances of treatment potential, and for this, multi-disciplinary research through active support from the Jeju provincial government as well as the national government is essential.

• Journal of Chest Surgery
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• 제55권1호
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• pp.55-60
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• 2022

Background: Robot-assisted repair of atrial septal defect (ASD) can be performed under either beating-heart or non-beating-heart conditions. However, the risk of cerebral air embolism (i.e., stroke) is a concern in the beating-heart approach. This study aimed to compare the outcomes of beating- and non-beating-heart approaches in robot-assisted ASD repair. Methods: From 2010 to 2019, a total of 45 patients (mean age, 43.4±14.6 years; range, 19-79 years) underwent ASD repair using the da Vinci robotic surgical system. Twenty-seven of these cases were performed on a beating heart (beating-heart group, n=27) and the other cases were performed on an arrested or fibrillating heart (non-beating-heart group, n=18). Cardiopulmonary bypass (CPB) was achieved via cannulation of the femoral vessels and the right internal jugular vein in all patients. Results: Complete ASD closure was verified using intraoperative transesophageal echocardiography in all patients. Conversion to open surgery was not performed in any cases, and there were no major complications. All patients recovered from anesthesia without any immediate postoperative neurologic symptoms. In a subgroup analysis of isolated ASD patch repair (beating-heart group: n=22 vs. non-beating-heart group: n=5), the operation time and CPB time were shorter in the beating-heart group (234±38 vs. 253±29 minutes, p=0.133 and 113±28 vs. 143±29 minutes, p=0.034, respectively). Conclusion: Robot-assisted ASD repair can be safely performed with the beating-heart approach. No additional risk in terms of cerebral embolism was found in the beating-heart group.

• Korean Journal of Radiology
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• 제20권8호
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• pp.1285-1292
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• 2019

Objective: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. Materials and Methods: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. Results: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). Conclusion: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

• Journal of Korean Neurosurgical Society
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• 제58권6호
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• pp.547-549
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• 2015

Acute subdural hematoma (SDH) of arterial origin is rare, especially SDH associated with an arteriovenous malformation (AVM) is extremely rare. The authors report a case of acute spontaneous SDH due to rupture of a tiny cortical AVM. A 51-year-old male presented with sudden onset headache and mentality deterioration without a history of trauma. Brain CT revealed a large volume acute SDH compressing the right cerebral hemisphere with subfalcine and tentorial herniation. Emergency decompressive craniectomy was performed to remove the hematoma and during surgery a small (5 mm sized) conglomerated aciniform mass with two surrounding enlarged vessels was identified on the parietal cortex. After warm saline irrigation of the mass, active bleeding developed from a one of the vessel. The bleeding was stopped by coagulation and the vessels were removed. Histopathological examination confirmed the lesion as an AVM. We concluded that a small cortical AVM existed at this area, and that the cortical AVM had caused the acute SDH. Follow up conventional angiography confirmed the absence of remnant AVM or any other vascular abnormality. This report demonstrates rupture of a cortical AVM is worth considering when a patient presents with non-traumatic SDH without intracerebral hemorrhage or subarachnoid hemorrhage.

• Investigative Magnetic Resonance Imaging
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• 제1권1호
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• pp.94-102
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• 1997

목적: 자기공명혈관조영술(magnetic resonance angiography: MRA)을 이용하여 뇌동맥류를 비침습적 방법으로 진단하고자 하는 시도가 있었지만 크기가 3mm 이하인 경우 진단에 애로가 많았다. 뇌동맥류의 진단에 있어 최근 개발된 고해상도, 고속의 slice interpolation 자기 공명혈관조영술과 디지탈 감산 혈관조영술(digital subtraction angiography: DSA)의 결과를 전향적으로 비교하여 보편적인 선별 검사법으로 가능성을 확인하고자 하였다. 대상 및 방법: 총 19명의 환자에서 26개의 뇌동맥류를 대상으로 하였다. 모두 자기공명혈관조영술을 먼저 촬영하여 기원혈관, 동맥류경부의 확인, 인근 작은 혈관과의 연관관계등을 확인한 후 디지탈 감산 혈관조영술을 시행하여 비교하였다. 영상은 1.5T 초전도형기계(Vision, Siemens, erlangen, Germany)를 이용하여 slice interpolation 을 이용한 자기공명혈관조영술로 촬영하였다. 촬영은 TR / TE / FA = 30 / 6.4 / 25, matrix $512{\times}160$, 관찰면 $200{\times}150$, 촬영시간 7분 42초, 유효 두께 0.7mm, 총 두께가 102.2mm로 하여 대공(foramen magnum)에서 전뇌동맥(anterior cerebral artery)의 A3 부위까지 충분히 포함되도록 하였다. 영상분석은 최대강도투사(maximum intensity projection: MIP)를 사용하였으며 두개강내 동맥류가 있는 경우 다면재구성(multiplanar reconstruction: MPR) 기법을 사용하였다. 결과: 19명의 환자중 2명이 3개, 3명이 2개, 나머지 14명이 각각 1개씩의 두개강내 동맥류를 가져 모두 26개 였으며 파열된 동맥류가 14개였고 파열되지 않은 동맥류가 12 개이었다. 크기가 2mm 이하가 8개, 3-5mm가 9개, 6-9mm가 7개이며 10mm이상이 2개가 있었다. 처음 검사에서 자기공명혈관조영술과 디지탈 감산 혈관조영술에서 23개의 동맥류중 내경동맥에 1mm 크기의 동맥류 1개를 제외한 25개를 각각 발견할 수 있어 96%의 예민도를 보였으나 진음성과 위음성은 없어 특이도를 측정할 수 없었다. 크기와 모양을 확인하는데 자기공명혈과조영술과 다면재구성을 동시에 사용한 경우 디지탈 감산 혈관조영술과 같은 성적을 보인 반면 동맥류 경부와 기원혈관을 확인하는데도 자기공명혈관조영술의 다면재구성을 동시에 사용한 경우가 자기공명혈관조영술 또는 디지탈 감산 혈관조영술만 사용한 경우 보다 월등히 좋았다. 결론: Slice interpolation 기법을 이용한 고해상 자기공명혈관조영술은 두개강내 동맥류를 검사하는데 디지탈 감산 혈관조영술과 동일한 성적을 보여 앞으로 비침습적 일차 선별 검사법으로 가능할 것으로 생각된다.