터슨 증후군 : 위험 인자 및 예후

김종호 경북대학교 의과대학원 2010 국내석사

터슨 증후군은 두개강내 출혈로 인한 두개내압의 상승으로 발생한 유리체 출혈 및 망막 출혈을 말하는 것으로 대체로 시력예후가 좋은 편이다. 그러나 망막 전막 등의 합병증이 발생하게 되면 최종 시력저하를 보일 수 있다. 터슨 증후군의 발병률에 관한 보고가 있으나 모든 뇌출혈 환자에서 안저검사가 불가능함에 따라 발병률의 차이를 보이고 있다. 그래서 본 저자는 터슨 증후군과 신경학적 이상의 관련성을 알아보고자 하였다. 1999년 2월부터 2008년 11월 까지 경북대학교 병원에서 터슨 증후군으로 진단받고 유리체절제술을 시행한 환자를 대상으로 의무기록을 후향적으로 분석하여 환자의 나이, 성별, 두개강내 출혈의 종류, 술 전 나안 및 교정시력, 고혈압 유무, 두개강내 출혈이 발생한 시기부터 수술까지의 기간, 술 후 나안 및 교정시력, GCS 점수, Fisher 등급, Hunt와 Hess 등급, WFNS 등급을 분석하였다. 술 후 1주, 2주, 4주, 8주, 이후 1달간격으로 안과적 검사를 시행하였다. 터슨 증후군을 보이는 환자에서는 그렇지 않은 환자에 비해서 신경학적 검사 즉, 낮은 GCS 점수를 보이고, Fisher 등급, Hunt Hess 등급, WFNS 등급에서 높은 경향을 보인다. 신경학적 검사에서 터슨 증후군의 발병 위험이 큰 환자에서 안저검사를 시행하여 터슨 증후군의 합병 유무를 확인하여 적절한 안과적 처치를 시행하여 영구적인 시력장애를 남기지 않도록 해야 할 것이다. Terson's syndrome is the occurrence of a vitreous hemorrhage or retinal hemorrhage in association with subarachnoid hemorrhage by increased intracranial pressure. The prognosis of Terson's syndrome is usually good. But, if the complication like epiretinal membrane develop, the final BCVA decrease. The purpose of this study is to investigate the correlation of Terson's syndrome with neurologic abnormality. The medical records of 15 patients, 19 eyes which underwent vitrectomy because of Terson's syndrome from Feb, 1999 to Nov. 2008, was analyzed retrospectively. The age, sex, type of intracrainal hemorrhage, preoperative UCVA and BCVA, postperative UCVA and BCVA, the presence of hypertension, the duration until operation, GCS socre, Fisher grade, Hunt and Hess grade, WFNS grade. Follow-up ophthalmological examinations were performed at postoperative weeks 1,2,4,8, and monthly. The result was that the patients with Terson's syndrome had low GCS scores, high Fisher grade, Hunt and Hess grade, WFNS grade as compared with the patients without Terson's syndrome. Who have high Fisher grade, Hunt and Hess grade, WFNS grade and low GCS scores must be done ophthalomogic examination and we must prevent permanent low visual acuity from complication of Terson's syndrome.

반흔의 형성과정 중 섬유아세포와 근섬유아세포에 대한 표피각질세포의 영향

이용직 경북대학교 의과대학원 2010 국내박사

Purpose: During wound healing, myofibroblasts play a central role in matrix formation and wound contraction. At the end of healing, there is evidence that myofibroblasts disappear via apoptosis. Hypertrophic scarring is a pathologic condition that myofibroblasts persist in the tissue. It has been hypothesized that abnormalities in epidermal-dermal crosstalk explain this pathology. These experiments were performed in order to find out how myofibroblasts worked in monolayer co-culture with keratinocytes. Materials & Methods: For initial assessment, human myofibroblasts from hypertrophic scar tissue (Hmyo) and TGF-β induced myofibroblasts from normal dermal fibroblasts (Imyo) were characterized by microarray. And then human keratinocytes co-culture was applied into several different experimental groups. Each group was analyzed by immunohistochemistry, RT-PCR, and Real-time PCR. Results: On microarray, numerous extracellular matrix- and smooth muscle cell associated gene were up-regulated in Imyo and Hmyo respectively, suggesting Hmyo are fully differentiated. Decreased collagen type 1 (COL1A1) gene expression was shown in keratinocytes co-cultured Imyo. Smooth muscle acin(SMA) gene expression in Imyo also decreased by keratinocytes co-culture. SMA gene expression decreased in keratinocytes co-cultured Hmyo. Conclusion: These observations strongly suggest that keratinocytes play a role in the development of pathological fibrosis in hypertrophic scar by influencing the behavior of dermal fibroblasts or myofibroblasts. It is expected that this analysis would provide the basis of hypertrophic scar pathophysiology and new therapeutic approaches.

저산소 환경에서 선천성 정맥기형 환자의 민무늬근세포의 HIF-1 α 발현 분석

이동걸 경북대학교 의과대학원 2010 국내박사

Purpose: Venous malformation(VM), which is a vascular malformation, causes discomfort, pain, and disfigured appearance. The molecular bases of VMs are poorly understood. VM lesions are going to be hypoxic easily. Since hypoxia is known to induce angiogenesis via HIF-1 α (hypoxia-inducible factor-1 α), we examined the implication of hypoxia in VM vascular smooth muscle cells(VSMC) biologic behavior. In this time, we investigated expression patterns of HIF-1 α for further understanding the molecular mechanism of this disease entity. Methods: Vascular smooth muscle cells from normal veins and VMs were cultured under hypoxic conditions (2% O2, 5% CO2) and the effects of hypoxia on the HIF-1 α expression were measured by RT-PCR, Real-time PCR, Immunohistochemical stains and so on. Results: In overall expressions of HIF-1 α, high expression were shown in 6, 12 hours hypoxia and decreased in 24 hours hypoxia. Expressions in VM VSMC were two times higher than normal VSMC. Immunohistochemically, Location of HIF-1 alpha was in mainly nucleus. The intensity in VM VSMC was stronger in 6, 12 hours hypoxia. Therefore, the expression pattern is indicative of higher susceptibility to hypoxia of smooth muscle cells in VMs. Conclusions: It is demonstrated that high expression of HIF-1 α to hypoxia in VM VSMC is one of important factors for downstream angiogenesis of VM. Furthermore, it is suggested that this study would provide the basis of VM's pathophysiology and new therapeutic approaches.

유형별 창상의 치유에 영향을 주지 않는 적절한 은 함량

문정환 경북대학교 의과대학원 2010 국내박사

Purpose : Silver has been known to have antimicrobial, anti-inflammatory, antioxidant properties. Free silver cations have a potent antimicrobial effect which destroys microorganisms by disrupting the function of bacterial cell membranes and denaturing the bacterial DNA and RNA. On the other way, silver has a distinct negative effect on cell level. This study suggests a comprehensive approach to support optimal nanosilver contents of hydrocolloid dressing in wound healing process. Materials & Methods : We divided the Sprague-Dawley rats into two categories by types of wound model : fresh surgical wound and 3rd degree burn wound. Four round (diameter 2cm) wounds were made bilaterally on the dorsal aspect of all rats’ trunk and were divided into four groups of hydrocolloid dressing materials. Group A : nanosilver 0 wt%, Group B : nanosilver 1.5 wt%, Group C : nanosilver 2.5 wt%, Group D : nanosilver 3.5 wt%. We compared each group with gross findings by tracing the remained wound, histological and biomolecular test on each time period. Results : In fresh surgical wound, Group A, B and C showed statistically higher percentage of wound healing. Histologically, Group B and C showed less inflammatory cell infiltration, Group A, B showed faster and more prominent angiogenesis. In burn wound, Group B and C showed statistically better wound healing process and wound contraction than the other groups. Histologically, Group B and C showed better finding than other groups. In biomolecular analysis, using by Western blot test including fibronectin, TGF-β, Laminin α3 and β-actin, Group B showed higher expression than other groups. Conclusion : This study demonstrates that the level below nanosilver 2.5wt% have optimal effective results. Group 3.5wt% shows statistically lower wound healing process than other groups suggesting overcontaing nanosilver take adverse effect on cells in decreasing cell viability and cell proliferation.

低溫法時에 放射性 Rose bengal의 血中消失率에 關하여

김광식 경북대학교 의과대학원 1965 국내석사

The disappearance rate of the radioactive(I-131 labelled) rose bengal dye from the blood was studied in 7 hypothermic dogs. Hypothermia was achieved by means of body surface cooling wiht ice water and rewarming with hot water(45-48℃). The range of oesophageal temperatures was from 24 to 26℃. Five μc. of rose bengal dye was injected for 4 normothermic and 7 hypothermic dogs. Blood samples were obtained at the intervals of 2, 8 and 16 minutes after the injection of the dye, and analysed by well type scintillation counter. derum protein, thymol turbidity and takata reaction were studied simultaneously. Results were as follows. 1. The disapnearance of radioactive rose bengal dye from the blood was retarded at the hypothermic condition compared with control group. Mean value of the radioactivity levels at 8:2 minutes and 16:2 minutes were 79.2% and 67.5% respectively, while that of normothermic group at the same intervals were 42.9 and 18.5%. 2. There were no significant differences of serum protein levels, thymol turbidity and takata test between normothermic and hypothermic dogs.

감염성 폐질환과 연관된 가성폐동맥류의 혈관 내 치료에서 CT 폐동맥 조영술 및 선택적 폐동맥 조영술의 역할 : The Role of Pulmonary CTA and Selective Pulmonary Angiography in Endovascular Management of Pulmonary Artery Pseudoaneurysms Associated with Infectious

신태범 경북대학교 의과대학원 2007 국내박사

Purpose: To determine the value of performing selective angiography based on the findings of pulmonary computed tomographic (CT) angiography for the detection of a pulmonary artery pseudoaneurysm (PAP) associated with infectious lung diseases and to evaluate the usefulness of endovascular management of these PAPs. Materials and Methods: Over a 6-year period, 11 PAPs were diagnosed in 10 patients (seven men and three women; age, 23-84 years). All patients presented with massive hemoptysis. The underlying diseases were cavitary pulmonary tuberculosis (n=7), lung abscess (n=2), and a fungus ball (n=1). The detection rates of PAP by bronchial/thoracic angiography, main pulmonary angiography, and selective pulmonary angiography were analysed. When a pseudoaneurysm was detected, feeding artery occlusion was performed with coils or n-butyl cyanoacrylate. Results: The findings of main pulmonary angiography were contrast agent filling of the pseudoaneurysm (n=4) and hypoperfusion of the diseased pulmonary segment without contrast agent filling of the pseudoaneurysm (n=6). The selective angiography based on pulmonary CT angiography demonstrated five cases of pseudoaneurysm that were not found on the main pulmonary angiography. Embolization of the pseudoaneurysm was successfully performed in nine of the 10 patients. One patient experienced a rupture of the subsegmental branch of the inferior pulmonary artery during the procedure. Conclusion: Because main pulmonary angiography alone may fail to demonstrate a pseudoaneurysm, a selective angiography based on the anatomic information obtained from pulmonary CT angiography is essential for detection of a pseudoaneurysm. In addition, endovascular management of a PAP appears to be a safe and effective treatment.

전층 창상에서 하이알룬산 제재의 치유효과

송재민 경북대학교 의과대학원 2009 국내석사

Hyaluronic acid(Connettivina) is a major carbohydrate component of the extracellular matrix and can be found in skin, joints, eyes and most other organs and tissues. First described in 1934, it has since been used across a wide variety of medical fields as diverse as neurosurgery, cutaneous wound healing and cosmetic surgery. It creates a hydrophilic environment; controls water retention, ionic and molecular diffusion; forms 3-dimensional structures; and plays an important role in the process of tissue repair. We used Connettivina to evaluate the effects of these dressing materials on wound healing and compared them with other dressing materials through the animal experiment. 40 Sprague-Dawley(SD) rats with full thickness wounds were treated with Connettivina pad, Connettivina gel, Bactigras and Gauze. Four round(diameter 2cm) full thickness skin defect were made on the dorsal aspect of the SD rat’s trunk. We divided the wound into four groups of dressing material: Group A with Connettivina (Gauze pad type) and Connettivina 0.2% Gel (Gel type, 30g), Group B with Connettivina (Gauze pad type) only, Group C with Bactigras , Group D with Gauze as a negative control group. We compared each group with gross findings by means of percentage of wound contraction, percentage of wound epithelization and percentage of total wound healed area by tracing the remained wound area on the 0, 4th, 6th, 8th, 10th, 14th, 17th and 21th day after wound formation. Wound biopsy were performed on the 4th, 6th, 8th, 10th, 14th, 17th and 21th day after wound formation. Connettivina (Gauze pad type) and Connettivina 0.2% Gel (Gel type, 30g) group(Group A) and Bactigras (Group C) shows statistically higher percentage of wound contraction and higher percentage of wound healed than the other groups. In histologically, Connettivina (Gauze pad type) and Connettivina 0.2% Gel (Gel type, 30g) group(Group A) and Connettivina (Group B) show less inflammatory cell infiltration, faster and more prominent angiogenesis than the others in early inflammatory period. On the 21st day after wound formation, more matured, thickened reepithelization and regularly aligned collagen formation were seen on Connettivina (Gauze pad type) and Connettivina 0.2% Gel (Gel type, 30g) group(Group A). This study suggest Hyaluronic acid(Connettivina) induces stable reepithelization and collagen synthesis in the wound healing process, and is expected as one of effective dressing material for treatment of wound healing 저자들은 인체 세포외 기질의 주성분이며, 창상 치유과정에서 중요한 역할을 담당하는 하이알룬산(Hyaluronic acid)를 주성분으로 하는 새로운 드레싱 재료인 Connettivina�� 를 이용하여 백서의 전층 창상을 대상으로 하여 기존에 사용되고 있는 드레싱 재료인 Bactigras�� 및 고식적인 거즈의 창상치유 효과를 육안적, 조직학적으로 비교하였다. 창상 치유 초기 삼출물의 흡수는 거즈를 사용하여 드레싱 한 군을 제외한 군에서 빠르게 감소하는 소견을 볼 수 있었고, 창상 수축율 및 창상 치유율은 다른 군에 비해 Connettivina�� (Gauze pad type) and Connettivina�� 0.2% Gel (Gel type, 30g)을 함께 사용한 군과 Bactigras�潁� 사용한 군에서 통계적으로 유의한 높은 결과를 나타내었다. 조직학적으로는 Connettivina�� (Gauze pad type)와 Connettivina�� 0.2% Gel (Gel type, 30g)을 함께 사용한 군과 Connettivina�� (Gauze pad type)를 사용한 군에서 다른 군들에 비해 염증세포가 조기에 감소한 것을 관찰할 수 있었고, 시간이 경과함에 따라 신생혈관 및 교원질형성도 다른 군에 비해 활발한 것으로 나타나 기존의 드레싱 재료인 Bactigras�� 를 사용한 군에 비해 손색없는 결과를 나타내었고, 재상피화는 Connettivina�� (Gauze pad type) and Connettivina�� 0.2% Gel (Gel type, 30g)을 함께 사용한 군에서 Bactigras�潁� 사용한 군보다 활발한 것으로 나타났으며, Connettivina�� (Gauze pad type)를 사용한 군과는 큰 차이가 없었다. 결론적으로 패드 타입 및 겔 타입의 Connettivina�潁� 이용한 드레싱은 삼출물의 흡수성이 우수하고, 창상 치유 초기 염증단계를 가속화 시켜 다음단계로의 이행을 유도하여 결과적으로 보다 빠른 치유율을 보임으로써 창상치유 기간을 단축 시키는 것으로 나타났다. 앞에서 논의한 바와 같이 Connettivina�瑛� 창상 치유에 있어 적합한 물성을 가지고 있으며 이전 드레싱 제재를 대체 및 보완할 수 있는 치료제로 생각된다.

MGMT -535G>T polymorphism is associated with prognosis for patients with metastatic colorectal cancer treated with oxaliplatin-based chemotherapy : Oxaliplatin 포함한 항암요법으로 치료 받은 전이성대장암환자에서 MGMT -535G>T 유전자 다형성의 임상적 의의

Park Jee hyun 경북대학교 의과대학원 2009 국내박사

The present study analyzed the polymorphisms of DNA repair genes and their impact on the response to chemotherapy and survival of patients with colorectal cancer. A total of 94 patients with recurrent or metastatic colorectal cancer treated with oxaliplatin-based combination chemotherapy were enrolled in the present study. The single nucleotide polymorphisms of 16 DNA repair genes were determined using a PCR-RFLP assay. In a logistic regression analysis adjusted to age, sex, primary site, disease status, and regimen, the POLR2C (rs4937) and MSH2 (rs3732183) polymorphisms were significantly associated with the response to the oxaliplatin-based chemotherapy among the 60 patients assessable for response. Plus, a multivariate survival analysis showed that the MGMT (rs1625649) -535G>T polymorphism was significantly associated with progression-free survival (PFS), where the TT genotype was found to correlate with a worse PFS than the combined GG+GT genotype (HR = 3.221; 95% CI = 1.458-7.116; P = 0.004). For the clinical parameters, curative resection was also a significant prognostic factor in a Cox model for PFS and overall survival (OS) (HR=0.234 and 0.263; P < 0.001 and 0.018, respectively). In conclusion, the MGMT (rs1625649) -535G>T polymorphism was found to be correlated with PFS in patients with advanced colorectal cancer treated with oxaliplatin-based chemotherapy.