• Journal of Chest Surgery
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• 제35권10호
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• pp.712-723
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• 2002

체외순환은 뇌 혈류의 변화를 유도하며 이러한 변화가 수술 후 직 간접적인 뇌 손상의 원인이 될 수도 있다. 최근 체외순환 중 뇌 혈류 변화는 동맥혈액의 이산화탄소 분압과 밀접한 관련이 있는 것으로 보고되고 있다. 본 연구는 체외순환을 이용한 심장수술시 뇌 대사에 대한 정상 탄산분압과 고 탄산분압의 임상적 영향을 비교 조사하기 위해 전향적으로 계획되었다. 대상 및 방법: 심장수술이 계획된 36명의 성인 환자들을 연구목적에 따라 무작위적으로 정상탄산분압군(Pa$CO_2$35~40 mmHg, n＝18) 혹은 고탄산분압군(Pa$CO_2$45~55 mmHg, n＝18)으로 나눈 뒤 중등도 저체온(비인두 온도 29~3$0^{\circ}C$)의 비박동성 체외순환을 실시하였다. 수술 중, 각 환자들의 중대뇌동맥 혈류속도(뇌혈류 속도), 뇌동정맥 산소함량 차, 뇌산소 추출률, 뇌산소 대사율, 뇌산소 운반율, 뇌산소운반/뇌산소대사 비율, 뇌정맥 산소 불포화도(내경 정맥구 혈액 산소 포화도$\leq$50%), 동맥혈액 및 내경정맥 혈액 가스분석 등을 평가하였고, 수술 후 신경학적 합병증(섬망증세) 발생 정도 역시 관찰하여 양 그룹간에 비교하였다. 결과 : 체외순환 동안 고탄산분압군이 정상탄산분압군에 비해 뇌혈류 속도(169.13 $\pm$ 8.32 vs 153.11 $\pm$8.98%), 뇌산소 운반율(1,911.17$\pm$250.14 vs 1,757.40$\pm$249.56), 뇌산소운반/뇌산소대사 비율(287.38$\pm$28.051 vs 246.77$\pm$25.84), 내경 정맥구 산소분압(41.66$\pm$9.19 vs 31.50$\pm$6.09 mmHg), 그리고 내경 정맥구 산소포화도(68.97$\pm$10.96 vs 58.12$\pm$12.11%) 등이 유의하게 더 높았으나 (p＝0.03), 뇌동정맥 산소함량차(3.9$\pm$0.3 vs 4.9$\pm$0.3 mL/dL), 뇌산소 추출률(0.3$\pm$0.03 vs 0.4$\pm$0.03), 뇌산소 대사율(5.8 $\pm$0.5 vs 6.8$\pm$0.6), 동맥혈 pH는 고탄산분압군이 더 낮았다(7.36$\pm$0.09 vs 7.46$\pm$0.07, p＝0.04). 체외순환 동안 뇌정맥혈 불포화를 보인 환자 수는 고탄산분압군이 정상탄산분압군 보다 유의하게 더 적었다(3명 vs 9명, p＝0.03). 수술 후 신경학적 합병증(섬망)의 지속시간 역시 고탄산분압군이 정상탄산분압군 보다 더팔았다(36시간 vs 60시간, p=0.009). 결론: 이상의 연구결과들은 심장수술 동안 고탄산분압 체외순환이 뇌대사 및 수술 후 신경학적 결과에 보다 유익한 효과를 제공해 줄 수 있음을 시사하고 있다.

• 대한핵의학회지
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• 제37권2호
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• pp.94-102
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• 2003

목적: 아세타졸아마이드를 이용한 뇌혈류 SPECT는 폐쇄성 뇌혈관질환이 있는 환자에서 혈역학적 부전을 평가 하는데 유용하다. 본 연구는 아세타졸아마이드 부하 $^{123}I-IMP$ SPECT를 실시하여 뇌국소부위의 혈역학적 부전의 정도를 정확히 평가할 수 있는지를 살펴보았다. 대상 및 방법: 뇌혈관 질환이 의심되는 18명의 (남: 16, 여: 2, 평균연령 61세) 환자를 대상으로 하였다. 뇌국소부위의 혈관확장 예비능을평가하기 위하여 아세타졸아마이드 투여후 $^{123}I-IMP$ SPECT를 실시하였다. PET은 SPECT 검사 전후로 2주 이내의 간격을 두고 실시하였으며, 뇌혈류, 산소추출분획, 뇌산소대사율 및 뇌혈액량을 구하였다. 모두 46개의 직사각형의 관심영역 (ROIs)을 4개의 다른 뇌단층면에서 직접그리고 병변 부위의 관심영역내에서의 $^{123}I-IMP$ 섭취와 반대측의 동일영역의 관심영역에서 $^{123}I-IMP$ 섭취비율인 AI 를 구하여 PET 에서 얻어진 자료들과 비교하였다. 결과: 18명의 환자의 414 개의 해부학적 영역에서의 뇌의 혈역학적인 평가는 각 환자의 산소수출분획과 뇌혈류/뇌혈액량에 따라 정상 (n=107), stage I (n=117) 또는 stage II (n=140) 로 나누었다. 혈관 확장 예비능을 나타내는 ${\triangle}AI$ (아세타졸아마이드투여시 AI 값-기저상태의 AI 값) 의 값은 정상, stage I 및 stage II 에서 각각 $-6.25{\pm}7.77%,\;-10.38{\pm}10.41%$ 및 $-13.30{\pm}10.51%$으로 세군간에 유의한 차이가 있었다 (p<0.05). 뇌혈관 협착이 있는 대뇌반구에서 ${\triangle}AI$와 뇌혈류량, 산소추출분획 및 뇌혈액량/뇌혈류량의 상관계수는 각각 0.20, -0.28 및 -0.28로 통계적으로 유의한 상관관계를 보였다(p<0.01). 결론: 정상인과 stage I 그리고 stage II 의 혈역학적부전 환자들간의 뇌혈관확장 예비능에 유의한 차이가 있었으며, 이러한 결과로 볼 때 아세타졸아마이드 부하에 대한 국소뇌혈류의 변화는 뇌관류압에 대한 보상적 혈관확장의 정도를 비교적 정확히 반영할 수 있다고 볼 수 있다.

• 대한핵의학회지
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• 제30권4호
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• pp.484-492
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• 1996

허혈성 뇌 병변에서 $^{99m}Tc$-glucarate의 섭취에 관한 연구를 하기 위하여 중뇌동맥 폐쇄 쥐 뇌허혈 모델을 재관류한 군과 하지 않은 군으로 나누어 만들었다. $^{99m}Tc$-glucarate와 [$^{18}F$]FDG를 연속적으로 투여하여 그 분포 양상을 이중 자가방사촬영법으로 관찰하였다. 조직의 괴사 여부를 알기 위하여 TTC 염색도 실시하여 동일한 뇌표본에 대하여 3가지의 영상을 동시에 얻을 수가 있었다. 얻은 영상으로 섭취 또는 비섭취정도를 보아 0점에서 3점까지 점수를 매겨 합하여 비교하였다. 수술한 쥐들 18마리 중 10마리가 신경학적 증상을 보이면서 살아남아 실험대상이 되었다. TTC 염색으로 확인한 경색크기는 재관류하지 않은 군이 컸다. [$^{18}F$]FDG 섭취양상은 TTC 염색과 거의 비슷하였다. 다만 일부에서 TTC 염색되는 곳에 [$^{18}F$]FDG 가 중간정도로 섭취되는 곳이 있었고 TTC 염색되지 않는 곳에 [$^{18}F$]FDG가 중간정도 섭취되는 곳이 있었다. TTC로 염색된 부위에는 $^{99m}Tc$-glucarate가 섭취되지 않았다. TTC로 염색되지 않는 곳에 일부분 $^{99m}Tc$-glucarate가 섭취되었다. TTC와 [$^{18}F$]FDG가 염색되거나 섭취되지 않는 곳에 $^{99m}Tc$-glucarate가 섭취되지 않는 곳이 있었다. 그러나 [$^{18}F$]FDG의 중간 정도의 섭취나 [$^{18}F$]FDG와 TTC사이에 부합하지 않는 곳 등과 $^{99m}Tc$-glucarate 섭취와 대응시키기 어려웠다 $^{99m}Tc$-glucarate가 재관류 군에서 더 넓고 많이 섭취되었다. 결론적으로 $^{99m}Tc$-glucarate는 비생존 허혈조직에만 섭취되는데 관류재개통에 따라 다양하게 섭취되었고 재관류모델에 더 많이 넓게 섭취되었다. 중뇌동맥폐색 및 재관류 모델로 $^{99m}Tc,\;^{18}F$ 및 TTC 동시영상을 얻어 생존능과 포도당대사의 부합 비부합 여부를 밝히고 그 의의를 조사한 후 $^{99m}Tc$-glucarate섭취와 상관을 조사하면 $^{99m}Tc$-glucarate섭취의 의의를 밝힐 수 있을 것으로 본다.

• Annals of Clinical Neurophysiology
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• 제14권1호
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• pp.20-24
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• 2012

Background: Migraine patients can be sensitive to external or internal stimuli, such as light, noise, or hormonal changes. Using transcranial Doppler ultrasonography (TCD) with breath-holding method, we evaluated the changes of cerebrovascular reactivity (CVR) to hypercapnia in women with migraine without aura between fasting and postprandial period. Methods: Twelve women with migraine without aura and the same number of age and sex-matched healthy controls with no significant history of headache participated in this study. Using TCD examinations, we studied mean flow velocity in middle cerebral artery with better temporal window. Each subject was examined consecutively before and after a standard meal, together with serum glucose level and blood pressure. CVR was evaluated with breath-holding index (BHI). Results: Postprandial-BHI (mean+SD) was significantly higher than fasting-BHI (mean+SD) in patients group but not in controls (in patient group; postprandial-BHI=1.38, fasting-BHI=1.08, in control group; postprandial-BHI=1.25, fasting-BHI=1.18, P=0.021 and 0.239, respectively). After meal, serum glucose level was significantly enhanced but blood pressure was not in both groups. Serum glucose level of patients showed a tendency of mild positive correlation with BHIs (${\gamma}$=0.448, P=0.032). Conclusions: Although exact mechanisms are unclear, cerebrovascular reactivity of some women with migraine without aura may be influenced by prandial state.

• Annals of Clinical Neurophysiology
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• 제1권1호
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• pp.31-35
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• 1999

Dignosis of migraine is only based on the medical history, and objective methods to aid the clinical diagnosisare absent. Although transcranial Doppler ultrasonography (TCD) abnormalities in headache-free migraineurs have been reported previously, diagnostic criteria for migraine is still lacking and this may limit the practical application of TCD for migraine. We prospectively studied several abnormal TCD indices in interictal migraineurs and their sensitivity and specificity to define the optimal diagnostic criteria. Young (20 yrs$age=29.0{\pm}6.1yrs$) were compared to 69 controls (M:F=25:44, Mean $age=31.2{\pm}5.5yrs$). Elevated MFV (> 2SD)was observed in 63% of migraineurs while n 12% of control (p<0.01). High AI (>25%) or high HI (>3.0) was present in 17% of migraineurs, while 3% and none in controls (p<0.01). Sensitivity of elevated MFV, high AI, and high HI was 63%, 17%, 17% and specificity was 88%, 97%, 100%, respectively. If all these indices were combined, sensitivity and specificity reached 69% and 86%. These preliminary results suggest pathophysiological implication of vasospasm in interictal migraineurs, and TCD may be practically applicable for migraine. Optimal diagnostic criteria and therapeutic options for patients with abnormal TCD findings remain to bo determined.

• 동의생리병리학회지
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• 제21권5호
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• pp.1250-1259
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• 2007

Bambusae Caulis in Liquamen(BCL) has been commonly prescribed for stroke patients in the traditional Oriental medicine. So this study is aims to investigate the anti-apoptotic and neuroprotective effects of Bambusae Caulis in Liquamen(BCL) manufactured by different production process on the focal ischemia induced by intraluminal filament insertion in rats. The focal ischemia was induced by intraluminal filament insertion into middle cerebral artery. The animals were divided into four groups (n=15 in each group). The ischemia induced and not treated group : Control group, the ischemia induced and oral medication of the three kinds of BCL : BCL-A group, BCL-B group, BCL-C group. BCL-A was produced by heating at a low temperature$(250^{\circ} C)$ in electric kiln and filtering. BCL-B was produced by heating at a high temperature$(900^{\circ} C{\sim}1,000^{\circ}C)$ in yellow earth kiln and refining and filtering. BCL-C was produced by heating at a low temperature$(400^{\circ} C)$ yellow earth kiln and no refining and filtering. The anti-apoptotic and neuroprotective effects of the oral medication of BCL were observed by Bax, BCL-2, cytochrome c, mGluR5, cresyl violet and ChAT-stain. Our study suggests that BCl-A(was produced by heating at a low temperature in electric kiln and filtering) and BCL-C(was produced by heating at a low temperature in yellow earth kiln and no refining and filtering) show anti-apoptotic and neuroprotective effects on the focal ischemia induced by intraluminal filament insertion in rats and BCL-C is more effective than BCL-A.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.425-429
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• 2001

Objective : Patients with poor grade aneurysm usually present with increased intracranial pressure(ICP), even those without an intracranial clot. Based on this fact, the present study investigated a significance of intracranial pressure monitoring in those patients. Patients and Methods : A total of 60 patients with Hunt and Hess Grade IV(50 patients) or V(10 patients) were treated for aneurysmal subarachnoid hemorrhage(SAH) during a 3-year-period, and intraparenchymal ICP was measured in the majority, immediately after arrival to the emergency room. Early surgery including intraoperative ventriculostomy was undertaken within 3 days after SAH. An ultraearly surgery was performed without preceding angiogram or ICP monitoring in patients with large sylvian hematomas, highly suggestive of middle cerebral artery aneurysm. Outcomes were assessed by the Glasgow Outcome Scale(GOS) at 6 months. Results : In overall, favorable outcome(GOS scores 1-2) was seen in 27(54.0%) of admission Grade IV and 1(10.0%) of admission Grade V patients. Of the 38 surgical patients with preoperative ICP monitorings, 25 patients (80.6%) exhibiting ICP values of less than 40mmHg showed favorable outcome, however, no patients with ICP values above 40mmHg recovered(Fisher's exact test, p=0.0001). Conclusion : It is concluded that a preoperative ICP above 40mmHg before ventriculostomy indicate significant vital brain destruction as intractable intracranial hypertension, and Grade IV patients at admission with an ICP below 40mmHg can be of benefit from early surgical intervention while Grade V patients still remains unfavorable.

• Journal of Korean Neurosurgical Society
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• 제30권1호
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• pp.73-77
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• 2001

Object : To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. Method : Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. Result : Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. Conclusion : Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.

• The Korean Journal of Physiology and Pharmacology
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• 제15권6호
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• pp.333-338
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• 2011

Black ginseng (BG) has been widely used as herbal treatment for improving physiological function. In order to investigate the neuroprotective action of this herbal medicine, we examined the influence of BG on the learning and memory of rats using the Morris water maze, and we studied the effects of BG on the central cholinergic system and neural nitric oxide synthesis in the hippocampus of rats with neuronal and cognitive impairment. After middle cerebral artery occlusion was applied for 2h, the rats were administered BG (100 or 400 $mgkg^{-1}$, p.o.) daily for 2 weeks, followed by training and performance of the Morris water maze test. The rats with ischemic insults showed impaired learning and memory on the tasks. Treatment with BG produced improvement in the escape latency to find the platform. Further, the BG groups showed a reduced loss of cholinergic immunoreactivity and nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d)-positive neurons in the hippocampus compared to that of the ISC group. These results demonstrated that BG has a protective effect against ischemia-induced neuronal and cognitive impairment. Our results suggest that BG might be useful for the treatment of vascular dementia.

• 대한한방내과학회지
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• 제41권2호
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• pp.204-212
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• 2020

This study aimed to investigate the effect of traditional Korean medical treatments on a stroke patient with gait disturbance, cognitive impairment, dysuria, and dysphagia. A 78-year-old female with chronic middle cerebral artery infarction had symptoms of gait disturbance, cognitive impairment, dysuria, and dysphagia. After being treated with Korean medicine therapies, including acupuncture and herbal medicine, the patient's symptoms were significantly improved. During all the treatments, Indices including manual muscle test, functional ambulation category, functional independence measuring, mini-mental state examination-K, global deterioration scale, pelvic symmetry, functional ambulation profile used to evaluate her symptoms indicated improvement in her symptoms, without any side effects. Traditional Korean medical treatments, such as acupuncture and herbal medicine, can be considered to be effective therapies for a stoke patient who has symptoms of gait disturbance, cognitive impairment, dysuria, and dysphagia.