• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.172-178
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• 2012

Objective : The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. Methods : We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. Results : For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022). Conclusion : IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.

• 약학회지
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• 제41권2호
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• pp.247-254
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• 1997

The proteinase-activated receptor (PAR-2) belongs to the family of seven transmembrane region receptors, like the thrombin receptor, it is activated by specific proteolytic clea vage of its extracellular amino terminus and a synthetic peptide (SLIGRL). The earthworm protein fraction (EPF) extracted from Lumbricus rubellus elicted dose- and endothelium-dependent relaxations in phenylephrine-contracted rat thoracic aorta, whereas heat inactivated EPF (0.5 ${\mu}g$ /ml) had no effect. In the presence of the nitric oxide synthase inhibitor NG-methyl-L-arginine (1.8 micro M), EPF (0.5 ${\mu}g$ /ml)-induced relaxations were partially inhibited. Furthermore, EPF (0.5 ${\mu}g$ /ml) dramatically caused relaxation of thrombin-desenstized rat thoracic aorta. These results indicate that EPF activates PAR-2 in vascular endothelial cell. Intravenous injection of EPF (20 mg/kg, bolus) into anesthetized rats produced a marked depressor response. EPF (0 ~ 80 ${\mu}g$ /ml, gradient) was very effective on increasing of perfusion volume in rabbit ear vessel preparations. These results imply the usefulness of EPF as a vascular smooth muscle relaxant and indicate that the activation of PAR-2 may be a mechanism of EPF on hemokinetic improvement.

• Archives of Reconstructive Microsurgery
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• 제17권2호
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• pp.120-125
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• 2008

Purpose: Heat therapy by heat lamp after microvascular surgery is being used for preventing blood vessels's contraction and blood-flow's disturbance. As usually, incandescent lamp has been used. But there have been several problems and need for improvement in the existing heat lamp treatment. So we would like to introduce improved heat lamp to keep an appropriate temperature and intensity of illumination. Methods: The existing heat lamps are the ones of general light stands covered with newspaper, having 60 watt light bulb of incandescence and lampshade made of aluminum. We have tried to improve shortcomings of the existing heat lamps by enlarging the size of aluminum lampshade and attaching a curtain that can block heat and light. We conducted a comparative study between the existing and improved heat lamps. Under the assumption that there are several affected parts, we have also measured the distance from heat lamp to patients' eye region and then intensity of illumination. Result: The target temperature of surface was realized in 11 minutes with the maximum temperature reaching at 36.6 degrees C in 28 minutes at the existing heat lamp while the target temperature reached in 7 minutes with the maximum temperature reaching at 39.0 degrees C in 17 minutes at the improved heat lamp. The existing and improved heat lamp showed 38 lx and 0.1 lx of intensity of lumination, respectively. Conclusion: Using improved heat lamps, we can keep an appropriate temperature and we think we can make contribution to patients' treatment by making them and their neighbors able to sleep with minimized disturbance thanks to low intensity of illumination secured by blocking light.

• Nuclear Medicine and Molecular Imaging
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• 제42권1호
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• pp.8-16
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• 2008

목적: 내경동맥 또는 중대뇌동맥의 죽상 동맥 경화증 환자에서의 두개외강-내강 우회로술(이하 우회로술) 후의 연속적인 혈류 역학적 변화를 $^{99m}Tc$-ECD 아세타졸아마이드 부하 뇌혈류 단일 광자 방출 전산화 단층 촬영(이하 아세타졸아마이드 부하 SPECT)으로 평가하여 중대뇌 동맥의 각 분지별 영역에 대한 우회로술의 혈류역학적 개선효과를 알아보고자 하였다. 대상 및 방법: 전향적 방법으로 최근 3개월 내에 혈관 폐색성 징후가 발생하여 우회로술을 시행받은 환자를 대상으로 수술 전과 수술 1 주 후, 3-6 개월 후에 아세타졸아마이드 부하 SPECT를 시행하였다. 영상 분석을 위해 SPM의 SPECT 표준 뇌에 공간 정규화한 후 Anatomical Automated Labeling으로 중대뇌동맥의 지배를 받는 양측 전두, 측두, 두정 영역에 관심 구역을 설정하여 각 관심 영역별로 뇌혈류 지표(PI; $C_{region}/C_{ipsilateral\;cerebellum}$) 및 뇌혈관 예비능 지표$((PI_{acetazolamide}-PI_{basal})/PI_{basal})$로 정하여 이들 지표의 수술 전후 변화를 평가하였다. 결과한 측에 성공적인 우회로술을 시행한 환자 17 명(남:여=12:5, 나이 $53{\pm}2$세)을 분석하였다. 전체적으로 뇌혈류는 수술 1 주 후 유의하게 증가하나 3-6 개월 후 감소하여 수술 이전의 수준으로 유지되었으며 ($1.01{\pm}0.09{\rightarrow}1.06{\pm}0.09}{\rightarrow}1.02{\pm}0.10,\;p=0.005$) 뇌 혈관 예비능은 수술 1 주 후 유의하게 증가한 이후 유의하지는 않으나, 3-6개월 이후까지 계속 호전되었다($-0.14{\pm}0.05{\rightarrow}-0.07{\pm}0.04{\rightarrow}0.05{\pm}0.05,\;p=0.004$). 각 뇌 영역별로 뇌혈류는 두정 영역에서 수술 직후 증가하였다가($1.12{\pm}0.09{\rightarrow}1.18{\pm}0.09,\;p=0.003$) 수술 3-6개월 이후 감소하여($1.12{\pm}0.09,\;p=0.003$) 수술 이전의 수준으로 유지되었다. 뇌혈관 예비능은 수술 측의 전두 영역($-0.15{\pm}0.07{\rightarrow}0.08{\pm}0.05$), 두정 영역($-0.16{\pm}0.07{\rightarrow}-0.07{\pm}0.05$)에서 모두 수술 직후 유의하게 증가하였고(p<0.01) 이후 유의하지는 않으나 3-6개월까지 계속 호전되었다. 결론: 성공적인 우회로술 후 뇌혈류는 전체적으로 유의한 변화가 없었으나 뇌혈관 예비능은 중대뇌동맥 영역 전체에 걸쳐 수술 후 단기간에 유의한 호전을 보였으며 장기간 유지되었다. 따라서 뇌혈관 예비능의 호전여부는 우회로술에 의해 증가된 뇌관류압을 평가할 수 있는 중요한 지표로 생각되며 향후 우회로술에 의한 뇌졸중 재발방지 효과를 알아보기 위해 뇌혈관 예비능의 변화와 예후와의 상관관계에 대한 연구가 필요하리라 생각된다.

• 생명과학회지
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• 제20권5호
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• pp.710-716
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• 2010

막걸리와 막걸리지게미를 시료로 하여 난소를 절제하여 갱년기 장애를 유도한 흰쥐에 투여함으로써 난소절제에 의한 estrogen 결핍에서 발생되는 지질조성의 변화와 혈류 및 혈소판 응집능에 미치는 막걸리와 막걸리 지게미의 영향을 검토해 보았다. 난소절제에 의한 estrogen 결핍에서 발생되는 혈청 중의 AST와 ALT의 효소 활성은 막걸리와 막걸리 지게미 농축물을 각각 투여하였을 때, 모두 Sham군과 비슷하게 감소하였으며, TG, TCHO 및 HDL농도의 변화를 알아본 결과, 난소를 절제한 OVX-control군이 난소를 절제하지 않은 Sham군과 비교해 TG와 TCHO의 함량이 증가하였고 막걸리와 막걸리 지게미 농축물을 투여한 군에서는 OVX-control군에 비해 감소하였다. 그러나 혈청 중 좋은 콜레스테롤인 HDL의 농도는 막걸리와 막걸리 지게미 농축물의 투여로 증가함을 알수 있었다. 그리고 막걸리 농축물과 막걸리 지게미 농축물의 효소활성과 지질개선 효과를 비교해 볼 때, 막걸리 농축물 투여군이 막걸리 지게미 농축물 투여군보다 조금 더 증가되는 경향을 보였다. 혈류 및 혈소판 응집에 미치는 영향에 대한 결과는 막걸리와 막걸리 지게미 농축물 투여로 인해 OVX-control군보다 혈류속도가 빨라짐을 확인할 수 있었고, 막걸리 농축물과 막걸리 지게미 농축물 중 막걸리 농축물 투여군이 막걸리 지개미 농축물 투여군 보다 빠른 혈류 개선 효과 즉 높은 혈액 유동성을 나타내었다. 그리고 난소절제로 증가되어진 혈소판 응집현상도 막걸리와 막걸리 지게미 농축물 투여로 인하여 감소되어 혈소판 응집 억제 효과를 확인할 수 있었다. 또한 in vitro 실험에서 막걸리와 막걸리 지게미 농축물의 투여로 인한 ACE 활성 저해 효과도 확인하였으며, 막걸리와 막걸리 지게미 농축물을 비교하여 볼 때 막걸리 지게미 농축물보다 막걸리 농축물에서 더욱 높은 ACE 활성저해 효과를 보였다. 이상으로 in vitro에서의 ACE 저해 효과와 더불어 동물실험에서 막걸리와 막걸리 지게미 농축물이 혈청 중의 효소활성과 지질조성의 변화를 나타내어 지질개선효과를 볼 수 있었으며, 혈류 속도 증가와 혈소판 응집 억제 효과도 함께 보여 혈행 개선 효과도 확인할 수 있었다. 그리고 전반적인 실험결과에서 막걸리 농축물이 막걸리 지게미 농축물보다 조금 더 효과 있는 결과를 보였는데 이는 막걸리 농축물속에 발효를 통한 부유물의 여러 유효성분들이 더 많을 것으로 추정되고, 여러 가지 생리활성에도 영향을 준 결과로 사료되어진다. 또한 본 연구에서 시료로 사용된 페기 되어지는 막걸리 지게미 농축물에서도 막걸리 농축물보다는 낮은 효과이지만 생리활성을 보인 것으로 보아 막걸리지게미를 이용한 고부가가치 활용방안도 기대되어진다.

• 혜화의학회지
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• 제18권2호
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• pp.37-45
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• 2009

In early 1970s, Electronic Manometers were researched and developed for modernization and objectification of pulse diagnosis. Method of finger pressing, also known as cuffs pressing, is essential for sensing a pulse wave. I think comprehension and deduction of problem from the existing Hi-soo type electronic manometer, will be important for making a better one. The Hi-soo type electronic manometer is constructed of cuff pressing type sensor, differential amplifier, transmitter and recorder. Pulse movement and pulse wave, gauging blood flow, is analyzed by pulse image of "Yixuerumen(醫學入門)". At standard of pulse wave, huanmai(緩脈) is distinguish from chishu(slow and fast, 遲數), fushen(float and sink, 浮沈), interference wave, modificated wave, and phase angel. The Hi-soo type electronic manometer had no explanation of formational mechanism, significantly different with pulse wave which is early known and reported. The strength of Hi-soo type electric manometer is use of cuff pressing type sensor. Above all, the importance of electric manometer is reading the pulse movement accurately then expressing it as pulse wave. From now on the improvement of precise sensor should make a progress.

• Journal of Chest Surgery
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• 제20권2호
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• pp.404-410
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• 1987

An 18-day-old male neonate with hypoplastic left heart syndrome underwent surgical intervention by modification of the Norwood procedure on September 23, 1986. Hypoplastic left heart syndrome is a serious congenital cardiac anomaly that has a fatal outlook if left untreated. Included in this anomaly are [1] aortic valve atresia, and hypoplasia of the ascending aorta and aortic arch, [1] mitral valve atresia or hypoplasia, and [3] diminutive or absent left ventricle. Patent ductus arteriosus is essential for any survival, and there is usually a patent foramen ovale. Coarctation of the aorta is frequently associated with the lesion.z With a limited period of cardiopulmonary bypass, deep hypothermia, and circulatory arrest, the ductus arteriosus was excised. The main pulmonary artery was divided immediately below its branches, and the distal stump of the divided pulmonary artery was closed with a pericardial patch. The aortic arch was incised, and a 1 5mm tubular Dacron prosthesis was inserted between the main pulmonary artery and the aortic arch. A 4mm shunt of polytetrafluoroethylene graft was established between the new ascending aorta and the right pulmonary artery to provide controlled pulmonary blood flow. Following rewarming, the heart started to beat regularly, but the patient could not be weaned from cardiopulmonary bypass. At autopsy, the patient was found to have hypoplasia of the aortic tract complex with mitral atresia and aortic atresia. A secundum atrial septal defect was noted. Right atrial and ventricular hypertrophy was present, and the left ventricle was entirely absent. Although unsuccessful in this case report, continuing experience with hypoplastic left heart syndrome will lead to an improvement in result.

• Archives of Reconstructive Microsurgery
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• 제23권1호
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• pp.13-17
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• 2014

Purpose: Soft tissue defect on foot and ankle is vulnerable and requires a thin flap for improvement of aesthetic and functional results. Lateral supramalleolar flap is a simple and fast procedure, which can preserve and supply reliable constant blood flow, and causes fewer donor site complications. The authors reviewed our cases and report the clinical results. Materials and Methods: Ten cases of soft tissue defects on the lower leg, around the ankle were treated with lateral supramalleolar flap. There were seven males and three females with a mean age of 54.8 years. The mean size of flaps was $5.9{\times}6.3$ cm and the mean follow-up period was 23 months. Flap survival and postoperative complications were evaluated. Results: Nine flaps survived completely without loss of flap. There was one case of partial wound dehiscence requiring debridement and repair, and another case of necrotic flap change requiring partial bone resection and closure. All patients were capable of weight bearing ambulation at the last follow up. Conclusion: The authors suggest that the lateral supramalleolar flap could be a useful option for treatment of soft tissue defect around the ankle joint.

• 동의생리병리학회지
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• 제17권2호
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• pp.467-475
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• 2003

This studt was investigated to prove the effect of GMYM on the brain damage. The results were as follows; 1. GMYM showed significantly inhibitory effect on LDH release by NMDA. AMPA and Kinate. 2. GMYM showed significantly inhibitory effect on LDH release by BSO and Fe2+. 3. GMYM decreased coma duration time in a infatal dose of KCN and showed 30% of survival rate in a fatal dose. 4. GMYM showed improvement of forelimb and hindlimb test after MCA occulusion in neurological exemination. 5. GMYM decreased ischemic area and edema incited by the MCA blood flow block. These results indicate that GMYM can be used in the brain damage sujected to brain ischemia. Further study will be needed about the functional mechanism and etc.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1563-1569
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• 1992

From Jan. 1981 to Dec. 1991, we had treated 25 patients with congenital coronary art-eriovenous fistulas [CAVF] in Seoul National University Hospital. A retrospective review was made to delineate the course and the management of CAVF and to clarify the role of surgical treatment. Fifteen patients were male and 10 were female with The mean age of 17.4 years[from 3 months to 58 years]. The most frequent symptom was dyspnea on exertion[56%]. Other symptoms were angina and palpitation. Sixty-eight percent of the patients were symptomatic. Fifty-three percent of patients less than 20 years old were symptomatic and 100% of patients over 20 years old were symptomatic. Three patients had multiple CAVFs. The fistula drained into the right ventricle in 13, pulmonary artery in 9, left ventricle in 4, right atrium in 2, and left atrium in 1. Thirteen patients had other associated cardiac lesions. The mean pulmonary-to-systemic blood flow[Qp /Qs] in the isolate CAVF group was 2.19. All patients were operated on to correct the fistulas and other associated cardiac lesions. All patients were followed from 1 month to 11 years without late death. Postoperative complication rate was 24% -significant arrhythmia [3], recurred CAVF[1], psychosis[1], pneumonia [1]. Symptomatic improvement was evident postoperatively. Below 20 years old, 94% of patients were asymptomatic, but above 20 years old, symptoms persisted in 25%. In summary, early elective repair of CAVF is indicated in all patients because of higher complication rate and frequent persistent symptoms in older patients.