• Archives of Plastic Surgery
• /
• 제51권2호
• /
• pp.208-211
• /
• 2024

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.

• Journal of Chest Surgery
• /
• 제42권5호
• /
• pp.576-587
• /
• 2009

배경: Nitric oxide (NO)-cGMP 신호전달체계의 상향 조절(up-regulation)이 급성심근경색 3일 후 흰쥐의 혈관반응성의 변화에 관여한다고 알려져 있으나 그 기전에 대해서는 명확히 규명되지 않았다. 대상 및 방법: 좌전하행관상동맥을 30분간 폐쇄한 후 급성심근경색을 유도한 군을 AMI군으로, 동일한 모의 수술(sham operation)을 하였으나 관상동맥을 폐쇄하지 않은 군을 SHAM군으로 하였다 AMI 혹은 SHAM수술 3일 후 흰쥐의 대동맥 고리절편(내피를 보존한 대동맥 절편을 E(+), 내피를 제거한 대동맥 절편을 E(-))에서 phenylephrine (PE), KCl, acetylcholine (Ach) 및 sodium nitroprusside (SNP)에 대한 농도-반응 관계를 측정하였다 AMI군의 E(+) 대동맥 절편에서 PE의 농도-반응 관계를 NO synthase (NOS) 억제제인 $N{\omega}$-nitro-L-arginine methyl ester (L-NAME)와 cyclooxygenase 억제제인 indomethacin으로 각각 전처치한 대동맥 절편과 비교하였다. 혈장 nitrite/nitrate 농도는 Griess reaction으로 측정하였고, 방사면역 분석법을 이용한 흉부 대동맥 절편의 cGMP정량과 real time PCR을 이용한 endothelial nitric oxide synthase (eNOS) mRNA 발현양상 측정을 하였다. 결과: AMI군에서의 심근경색의 평균 크기는 $21.3{\pm}0.62%$였다. AMI군에서 심박수와 수축기 및 이완기 혈압은 의미있는 변화가 없었다. E(+)와 E(-) 대동맥 절편에서 PE와 KCl에 대한 수축반응의 민감도는 AMI군 대동맥 절편에서 의미 있게 감소하였다(p<0.05). L-NAME은 이러한 수축반응을 완전하게 역전시켰으나 indomethacin은 효과가 없었다(p<0.05). 또한 AMI군에서 Ach에 대한 이완반응의 민감도가 의미 있게 감소하였다(p<0.05). AMI군에서 SHAM군에 비해 혈장 nitrite/nitrate 농도(p<0.05), 기저 cGMP 농도(p<0.05), 및 eNOS mRNA 발현양상(p=0.056)이 증가하였다. 결론: 이상의 결과들로 보아 eNOS의 발현 증가와 NO-cGMP 신호전달체계의 상향조절이 급성심근경색 3일 후 흰쥐 흉부대동맥에서의 수축 및 이완 반응성 감소의 원인으로 생각된다.

• Journal of Chest Surgery
• /
• 제32권5호
• /
• pp.413-421
• /
• 1999

배경: 폐장의 허혈-재관류 손상은 폐이식에서 발생하는 조기 이식장기 실패의 주요 원인의 하나로 알려져 있다. 최근 갑상선 호르몬의 활성형인 삼요드티로닌 (T3)이 심장을 비롯한 여러 장기의 허혈 손상을 줄여주는 효과가 있음을 시사하는 보고가 있다. 본 연구에서는 이러한 T3의 허혈-재관류 손상에 대한 효과가 폐장의 허혈 손상에도 효과가 있을 것으로 기대하고 덱스트란을 주성분으로 하는 세포외액성 폐보존액에 T3를 추가한 새로운 폐보존액을 제조하여 그 효과를 검증하고자 하였다. 대상 및 방법: 12마리의 황견을 6마리씩 두 군으로 나누어 제 1군에서는 새로 개발한 폐보존액을 사용하고, 제 2군에서는 유로콜린스 용액을 사용하여 폐를 적출 하였다. 적출한 폐장은 각각의 보존액에 담그어 섭씨 4도에서 20시간 보관한 후, 각 군에 6마리씩 총 12례의 좌측 폐이식을 시행하였다. 이식된 좌측폐만의 기능을 관찰하기 위해서 폐이식 후 재관류를 15분시킨 후에 우측 주폐동맥과 우측 주기관지를 결찰하고, 2시간 동안 혈역학적 변수와 가스분석을 시행하고, 측정이 종료된 후 바로 희생하여 폐조직 일부를 떼어내어 조직검사와 수분 함량 및 MDA양을 측정 비교하였다. 결과: 동맥혈 산소분압은 제 1군에서 재관류 후 60분, 90분 120분에 각각 147$\pm$25 mmHg, 148$\pm$22 mmHg, 159$\pm$21 mmHg, 제 2군에서는 각각 133$\pm$26 mmHg, 132$\pm$29 mmHg, 135$\pm$30 mmHg로 제 1군에서 조금 높은 경향을 보였으나 통계적으로 유의성은 없었다. 각 시간에서의 최대 흡기압은 제 1군에서 14.0$\pm$0.5 cmH2O, 14.2$\pm$0.6 cmH2O, 15.7$\pm$0.8 cmH2O, 제 2군에서는 17.8$\pm$2.0 cmH2O, 18.0$\pm$1.9 cmH2O, 19.3$\pm$2.7 cmH2O으로 제 1군에서 조금 낮은 경향을 보였으나 통계적 유의성은 없었다. 동맥혈 이산화탄소 분압은 제 1군에서 각 시간에 27.9$\pm$2.2 mmHg, 27.7$\pm$2.4 mmHg, 28.0$\pm$3.0 mmHg, 제 2군에서는 36.8$\pm$6.0 mmHg, 43.2$\pm$8.1 mmHg, 53.1$\pm$17.4 mmHg로 제 1군에서 유의하게 낮았다 (p<0.05). 폐혈관 저항 및 조직 MDA양은 두 군간에 유의한 차이가 없었다. 폐 조직 수분 함량은 제 1군에서 유의하게 낮았고, 조직학 검사상 폐조직 손상의 정도도 제 1군에서 적었다. 결론: 이상의 결과에서 T3를 포함한 새로 개발한 폐보존액이 유로콜린스 용액과 비교하여 폐보존능이 우수함을 확인할 수 있었고, 이는 T3가 폐이식시 폐장의 효과적 보존에 유용한 역할을 함을 시사하였다.

• Tuberculosis and Respiratory Diseases
• /
• 제54권1호
• /
• pp.91-103
• /
• 2003

연구배경 : 히스타민은 폐 내에 널리 분포하며 강력한 폐혈관수축 작용과 모세혈관 투과성 증가 작용이 있을 뿐만 아니라 폐포내피세포 표면에서 P-selectin의 발현을 증가시키고 IL-8 분비를 촉진시켜 호중구의 조직 내 이동 및 활성화에 관여한다고 보고되고 있어. 호중구의 역할이 중요한 내독소로 유도되는 급성폐손상의 발병기전에 내인성 히스타민이 관여할 것으로 추정되나 자세한 역할은 아직 잘 알려져 있지 않다. 이에 본 연구는 내독소로 유도되는 급성폐손상의 발병기전에서 내독소는 폐장내에서 히스타민의 생성을 증가시키며, 이렇게 생성된 내인성 히스타민은 H2 수용체를 통하여 호중구의 폐내 침윤에 관여할 것이라고 가정하고 이를 검증하려 하였다. 방법 : Sprague-Dawley 쥐를 이용하여 생리 식염수를 기도 내 투여한 대조군, 내독소를 기도 내 투여한 내독소군, H1 수용체 차단제(mepyramine) 및 H2 수용체 차단제(ranitidine)를 정주한 H1 처치군 및 H2 처치군, H3 수용체 차단제(thioperamide)를 복강내 투여한 H3 처치군 등 모두 다섯 군으로 나누어 내독소 투여 후 각각 1,2,6 시간에 시간대 별로 혈청 및 폐포세척액내에서 히스타민의 농도를 측정하였고, 각군에서 폐 염증 및 폐 손상 지표로써 폐포세척액 내 총세포 수, 호중구 수 및 폐포세척액 단백량를 측정하여 내독소 투여군과 비교하였다. 또한, 내독소 투여 후 6시간째에 폐 관류 후 얻은 폐 조직에서 폐 조직 내 호중구 침윤을 반영하는 myeloperoxidase 활성도를 비교하였다. 결과 : 내독소군에서 내독소 투여 2시간째 폐포세척액 히스타민 농도가 대조군에 비해 유의하게 높았으며, 폐포세척액 총 세포 수와 호중구 수는 내독소 투여 6시간째에 유의하게 높았다. 폐조직내 MPO 활성도 역시 대조군에 비해 유의하게 높았다. H2 처치군에서 폐포세척액 총 세포 수 및 호중구 수는 내독소 투여 후 6시간 째에 내독소군에 비해 유의하게 낮았으며, 폐 조직 내 MPO 활성도 역시 내독소군에 비해 유의하게 낮았다 폐포세척액 단백량은 각 군에서 내독소군에 비해 유의한 차이를 보이지 않았다. 결론 : 이상의 결과로 내독소로 유도되는 급성 폐손상에서 내독소 투여 2시간 후 폐포세척액 히스타민 농도가 증가하며 내인성 히스타민은 주로 H2 수용체를 매개하여 호중구의 폐내 침윤 기전에 관여할 것으로 추정되었다.

• 대한화상학회지
• /
• 제24권2호
• /
• pp.21-29
• /
• 2021

Purpose: Frostbite is a hazard to people exposed to cold environments. With the progression of modern industrial development and change of leisure behavior encountering cold environments, frequent accidental exposure to frostbite injury during work and human behavior is increasing, and the predisposing factors of frostbite were greatly changed than before. The purpose of this study was to make epidemiological analysis, and to review the treatment outcomes of frostbite. Methods: From March 2010 to February 2021, this study has included 27 patients with second- to third-degree frostbite injuries in Advanced Burn Reconstruction Center, Bundang Jesaeng Hosptial. A retrospective study was made about the distribution of age, gender, predisposing factors, prevalent area, type of managements, and the length of treatment period. Results: In our institution, acute management of frostbite patients has included rewarming, anticoagulation therapy (acetylsalicylic acid), and agents to improve vascular perfusion (lipo-prostaglandin E1 [Eglandin^®]). The 25 frostbite patients with second-degree frostbite (92.6%) were successfully managed by the conservative treatment alone with a mean of 20.3 days healing time. Two patients with third-degree frostbite (7.4%) also showed good outcomes after surgical reconstruction with a mean of 59 days healing time. In our clinical experiences of third-degree frostbite, definitive surgical reconstruction should be recommended to wait for more than 4~6 weeks for identification of clear demarcation of necrotic tissue caused by frostbite. In this study, 43 frostbite injuries site in 27 frostbite patients occurred. Among them, 15 patients (55.6%) had multiple-site frostbite injury. The most common predisposing cause of frostbite was refrigerant gas accidents (44.4%), followed by outdoor activity in cold environments (40.8%), misapplying ice pack for treatment purposes (7.4%), barefoot walking on the cold ground (3.7%), and loss of consciousness in cold grounds (3.7%). The most prevalent sites of frostbite injuries revealed as the hand (58.1%), followed by the foot (32.6%), face (7.0%), and abdomen (2.3%). And in the winter season from the November to March, the incidence rate of frostbite injuries was high at 74.1%. Conclusion: This study included 27 frostbite patients with 43 frostbite sites since last decade in a single institution at the community hospital. The frostbite patients with second-degree frostbite (92.6%) were successfully healed by the conservative treatment alone with a mean of 20.3 days healing time. The most common predisposing cause of frostbite was refrigerant gas accidents (44.4%), followed by outdoor activity in cold environments, etc. The most prevalent site of frostbite injuries was the hand (58.1%). And the most prevalent seasonal incidence of frostbite was from November to March (74.1%).

• 대한약침학회지
• /
• 제20권2호
• /
• pp.127-131
• /
• 2017

Objectives: Polymorphonuclear neutrophils (PMNs) constitute the first line of defense against invading microbial pathogens. Early events in inflammation involve the recruitment of neutrophils to the site of injury or damage where changes in intracellular calcium can cause the activation of pro-inflammatory mediators from neutrophils including superoxide generation, degranulation and release of myeloperoxidase (MPO), productions of interleukin (IL)-8 and tumor necrosis factor ${\alpha}$ ($TNF-{\alpha}$), and adhesion to the vascular endothelium. To address the anti-inflammatory role of flavonoids, in the present study, we investigated the effects of the flavonoids quercetin and vitexin on the stimulus-induced nitric oxide (NO), $TNF-{\alpha}$, and MPO productions in human neutrophils. Methods: Human peripheral blood neutrophils were isolated, and their viabilities were determined by using the Trypan Blue exclusion test. The polymorphonuclear leukocyte (PMNL) preparations contained more than 98% neutrophils as determined by morphological examination with Giemsa staining. The viabilities of cultured neutrophils with various concentrations of quercetin and vitexin ($1-100{\mu}M$) were studied using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays. Neutrophils were cultured in complete Roswell Park Memorial Institute (RPMI) medium, pre-incubated with or without quercetin and vitexin ($25{\mu}M$) for 45 min, and stimulated with phorbol 12-myristate 13-acetate (PMA) ($10^{-7}M$). NO production was carried out through nitrite determination by using the Griess method. Also, the $TNF-{\alpha}$ and the MPO productions were measured using enzyme-linked immunosorbent assay (ELISA) kits and MPO assay kits. Results: Neutrophil viability was not affected up to a concentration of $100{\mu}M$ of quercetin or vitexin. Both quercetin and vitexin significantly inhibited $TNF-{\alpha}$, NO, and MPO productions in human neutrophils (P < 0.001). Conclusion:The present study showed that both quercetin and vitexin had significant anti-inflammatory effects. Thus, treatment with either quercetin or vitexin may be considered as a therapeutic strategy for treating patients with neutrophil-mediated inflammatory diseases.

• Advances in pediatric surgery
• /
• 제10권1호
• /
• pp.1-8
• /
• 2004

A re-pull-through operation for Hirschsprung's disease is performed when the primary operation has failed because of the remnant or acquired aganglionosis, anastomotic stricture and/or fistula. The purpose of this study is to review our experience of the re-pull-through procedure for Hirschsprung's disease. From May 1978 to July 2003, 26 patients who underwent re-pull-through operations at the Department of Pediatric Surgery, Seoul National University Children's Hospital, were studied retrospectively by means of chart review as well as telephone interview. The mean age at primary operation and re-operation were llmonths (2 months - 10 years) and 43 months (1 year - 23 years 3 months), respectively. Initial operation for Hirschsprung's disease was Duhamel's procedure in 17, Swenson's in 6 and Soave's 3. Causes of failure of primary operation were remains of secondary aganglionic segment (n=23), vascular arcade injury (n= 1), rectoperineal fistula (n=2, due to mesenteric torsion and poor blood supply), Mean interval between the primary operation and the re-operation was 34 months (6 months-22 years). Reoperation methods were Soave's in 12, Duhamel's in 8, APSP (abdomino-posterosagittal pull-through procedure) in 5, and Swenson's in 1 case. In 2 cases of repeated rectoperineal fistula or rectourethral fistula, re-APSP were performed 3 times, respectively. A total of 29 re-pull-through operations were performed. Postoperative complications were wound infection (n=1), adhesive ileus (n=1), rectoperineal fistula (n=3), rectourethral fistula (n=2), and death due to pulmonary embolism (n=1). Mean follow up period of reoperation was 78 months (1 month-23years). In current state, 2 patients have an ileostomy because of repeated rectoperineal fistula and rectourethral fistula. Of the remaining 23 patients, 21(91 %) are totally continent with or without minimal soiling. Reoperation for Hirschsprung's disease was effective and safe for the patients complicated to the initial pull-through operation.

• Archives of Plastic Surgery
• /
• 제37권2호
• /
• pp.129-136
• /
• 2010

Purpose: Anatomically, the foot is provided with insufficient blood supply and is relatively vulnerable to venous congestion compared to other parts of the body. Soft tissue defects are more difficult to manage and palliative treatments can cause hyperkeratosis or ulcer formation, which subsequently requires repeated surgeries. For weight bearing area such as the heel, not only is it important to provide wound coverage but also to restore the protective senses. In these cases, application of flaps for hind foot reconstruction is widely recognized as an effective treatment. In this study, we report the cases of soft tissue reconstruction for which various types of flaps were used to produce good results in both functional and cosmetic aspects. Methods: Data from 37 cases of hind foot operation utilizing flaps performed between from June 2000 to June 2008 were analyzed. Results: Burn related factors were the most common cause of defects, accounting for 19 cases. In addition, chronic ulceration was responsible for 8 cases and so forth. Types of flaps used for the operations, listed in descending order are radial forearm free flap (18), medial plantar island flap (6), rotation flap (5), sural island flap (3), anterolateral thigh free flap (2), lattisimus dorsi muscular flap (2), and contra lateral medial plantar free flap (1). 37 cases were successful, but 8 cases required skin graft due to partial necrosis in small areas. Conclusion : Hind foot reconstruction surgeries that utilize flaps are advantageous in protecting the internal structure, restoring functions, and achieving proper contour aesthetically. Generally, medial plantar skin is preferred because of the anatomical characteristics of the foot (e.g. fibrous septa, soft tissue for cushion). However alternative methods must be applied for defects larger than medial plantar skin and cases in which injuries exist in the flap donor / recipient site (scars in the vicinity of the wound, combined vascular injury). We used various types of flaps including radial forearm neurosensory free flap in order to reconstruct hind foot defects, and report good results in both functional and cosmetic aspects.

• 한국산학기술학회논문지
• /
• 제19권2호
• /
• pp.456-461
• /
• 2018

목동맥 스텐트 삽입술은 목동맥 내막절제술에 적합하지 않은 환자에게 시행할 수 있는 목동맥 협착증의 대체 치료법으로 알려져 있다. 목동맥 내막절제술, 혈관성형술 또는 스텐트 삽입술 후에 드문 부작용으로 뇌내출혈이 발생할 수 있고, 이러한 출혈이 발생하는 원인은 대부분의 경우 재관류 손상과 관련이 있는 것으로 추정하고 있다. 이전의 연구에서는 내막절제술과 비교하여 목동맥 스텐트 삽입술 후 뇌내출혈의 빈도가 더 높다고 보고한 바 있다. 본 연구에서는 뇌경색으로 내원한 80세 남자환자를 대상으로 증례보고를 통해 동일 분야 연구에 활용하고자 자료 분석을 하였다. 80세 남자가 갑자기 발생한 오른 팔의 근력저하를 주소로 방문하였다. 왼쪽 속목동맥의 90% 협착이 발견되어 목동맥 스텐트 삽입술을 시행하였고, 시술 후 실시한 뇌 CT에서 시상을 포함하는 후대뇌동맥 영역의 뇌출혈이 뇌실내출혈까지 진행되어 있음을 관찰하였다. 이러한 출혈은 스텐트 삽입술이 시행된 동맥에서 공급될 가능성이 낮은 혈관 영역에서 발생했기 때문에, 이 경우에 내막절제술 시행 후 과다혈류에 의한 출혈과 다른 양상을 확인하였다.

• The Korean Journal of Physiology and Pharmacology
• /
• 제21권5호
• /
• pp.475-485
• /
• 2017

The present study aimed to explore the neuroprotective effect and possible mechanisms of rhGLP-1 (7-36) against transient ischemia/reperfusion injuries induced by middle cerebral artery occlusion (MCAO) in type 2 diabetic rats. First, diabetic rats were established by a combination of a high-fat diet and low-dose streptozotocin (STZ) (30 mg/kg, intraperitoneally). Second, they were subjected to MCAO for 2 h, then treated with rhGLP-1 (7-36) (10, 20, $40{\mu}g/kg$ i.p.) at the same time of reperfusion. In the following 3 days, they were injected with rhGLP-1 (7-36) at the same dose and route for three times each day. After 72 h, hypoglycemic effects were assessed by blood glucose changes, and neuroprotective effects were evaluated by neurological deficits, infarct volume and histomorphology. Mechanisms were investigated by detecting the distribution and expression of the nuclear factor erythroid-derived factor 2 related factor 2 (Nrf2) in ischemic brain tissue, the levels of phospho-PI3 kinase (PI3K)/PI3K ratio and heme-oxygenase-1 (HO-l), as well as the activities of superoxide dismutase (SOD) and the contents of malondialdehyde (MDA). Our results showed that rhGLP-1 (7-36) significantly reduced blood glucose and infarction volume, alleviated neurological deficits, enhanced the density of surviving neurons and vascular proliferation. The nuclear positive cells ratio and expression of Nrf2, the levels of P-PI3K/PI3K ratio and HO-l increased, the activities of SOD increased and the contents of MDA decreased. The current results indicated the protective effect of rhGLP-1 (7-36) in diabetic rats following MCAO/R that may be concerned with reducing blood glucose, up-regulating expression of Nrf2/HO-1 and increasing the activities of SOD.