척추관 협착증 환자 진료 프로세스 개발

이환모,김호중,김긍년,안풍기,천자혜,신현주,김양수,신혜선,김인숙,정혜경,김영아,채형기,박인영,Lee, Hwan Mo,Kim, Ho Jung,Kim, Keung Nyun,Ahn, Poong Gi,Chun, Jahae,Shin, Hyun-Ju,Kim, Yang Soo,Shin, Hye Sun,Kim, In Sook,Chung, Hye Kyung,Kim, You 한국의료질향상학회 2009 한국의료질향상학회지 Vol.15 No.2

연구배경: 수술적 치료가 필요한 척추관 협착증 환자들은 주로 60세 이상의 고령환자로 장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술 후 환자들의 재원일수의 증가는 병원의 병상가동률을 감소시키고, 전공의에게는 불필요한 업무를 증가시킨다. 연구목적: 비용 효과면에서 최적화된 진료 지침의 개발은 불필요한 의료비의 감소 및 Hospital Induced Complication을 줄여 환자 만족도를 증진시킬 수 있으며, 각 환자에 대한 전공의 업무를 줄일 수 있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문요양기관 연구방법: 정형외과 및 신경외과의 척추관 협착증 환자의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program(EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과: CP 적용 전, 후 비교를 통해 재원일수는 3.8일이 감소하였으며, 이에 따라 병상 가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교 검토 중이다. 또한, CP 개발 및 CP Master Program의 사용을 통한 전공의 업무 감소에 대해 검토하고 있다.

다발성 요추간반 탈출증에서 추간반조영술의 진단적 의의

이상원,김긍년,진동규,김영수,조용은,진병호,Lee, Sang-Won,Kim, Keung-Nyun,Chin, Dong-Kyu,Kim, Young-Soo,Cho, Yong-Eun,Jin, Byung Ho 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5

Objective : The introduction of MRI makes it easy to detect multiple lumbar disc herniation. However, MRI is not a physiologic test for detecting the symptomatic level. For the surgical plan, it is very important to determine the symtomatic level among the multiple lumbar disc herniation. In this regard, we studied diagnostic significance of discography on multiple lumbar disc herniation in determining the symptomatic level. Method and Material : We retrospectvely analyzed the discographic and clinical findings of 121 patients with multiple lumbar disc herniation for investigating the diagnostic availability of discography. All were surgically treated from January 1995 through May 1998. Result : Discography provocated the same pain as usual symptom in 99 out of 121 patients(81.8%). Compared with surgical findings, the diagnostic accuracy of the discography in multiple lumbar disc herniation was 75.6%, sensitivity was 64.6%, and specificity 87.2%. There was no correlation between the pain provocation of discography and the extent of annular degeneration on CT/discogram. The pain provocation showed good correlation with the extent of annular disruption on CT/discogram. The rate of same result(correlation rate) between the discography and D.I.T.I was 81.4% in multiple lumbar disc herniation patients with unilateral leg pain. Conclusion : These results indicate that in multiple lumbar disc herniation, the discography is considered useful diagnostic tool to determine the symptomatic level and to decide the surgical plan.

요통증에 대한 잘토프로펜의 유효성 및 안정성 평가를 위한 제 III 상 임상시험

조용은,김한성,김긍년,진동규,진병호,김영수,임승철,오성훈,안정용,Cho, Yong-Eun,Kim, Han-Sung,Kim, Keung-Nyun,Chin, Dong-Kyu,Chin, Byung-Ho,Kim, Young-Soo,Rhim, Seung-Chul,Oh, Seung-Hoon,Ahn, Jung-Yong 대한임상약리학회 1999 臨床藥理學會誌 Vol.7 No.1

OBJECTIVE : Nonsteroidal antiinflammatory drugs(NSAIDs) are widely used in the treatment of a number of arthritic conditions or lumbago, but gastrointestinal lesions have often limited their clinical utilization. Zaltoprofen is a new propionic acid derivative provided with marked antiiflammatory, antiarthritic, analgesic and antipyretic activities in previous Japanese clinical trials. A comparative, randomized, double blind clinical trial was designed to assess the efficacy, tolerability and safety of zaltaprofen(ZP) compared to ketoprofen(KP) in the treatment of lumbago. MATERIALS AND METHODS : A total of 191 adult patients (66 males and 125 females) suffering from lumbago participated in this double-blind, multicenter trial of 25-weeks duration. Using the randomization table, 96 patients(ZP group) were treated with 3 tablets daily of Zaltoprofen 80mg and placebo for 2 weeks; the other 95 patients(KP group) took 3 tablets daily of Ketoprofen 50mg and placebo for 2 weeks. The therapeutic efficacy was assessed using parameters, measured in baseline conditions and after 7, 14 days of treatment : 1) Subjective pain scale measured using visual analogue scale 2) Objective range of motion (Flexion, extension, abduction and rotation). The safety was assessed by : 1) Appearance during the study of subjective and objective side effects 2) Laboratory tests performed before study commencement and at the end of the therapy. The parametric and non-parametric data were analysed statistically using t-test, paired t-test, repeated measures of ANOVA and Chi-square test. RESULTS : Therapy with ZP or KP produced a marked improvement in subjective pain scale and objective range of motion in both groups of patients (p<0.0001 and p<0.05). But No statistically significant differences were observed between the two groups. 20 of 96 patients (20.83%) treated with ZP and 37 of 95 patients (38.95% ) treated with KP had side effects. 20 patients treated with ZP and 34 patients treated with KP had the gastrointestinal complaints. But the side effect was short-lasting and was disappeared a few days after discontinuation of therapy. The laboratory tests in both groups showed no statistically significant variations. CONCLUSION : Zaltoprofen provides an excellent therapeutic weapon for the treatment of lumbago. It possesses a marked analgesic activity and induces a satisfactory improvement of the range of motion and is generally equivalent to that achieved with ketoprofen. On the other hand, the frequency of side effects in zaltoprofen group is lower than that of ketoprofen group.

골수유래 간엽줄기세포의 조건배지가 Ntera-2 인간신경세포의 신경돌기 성장에 미치는 영향

오진수 ( Jin Soo Oh ),( Meng Lu Liu ),( Hong Lian Jin ),안성수 ( Sung Su An ),김긍년 ( Keung Nyun Kim ),윤도흠 ( Do Heum Yoon ),하윤 ( Yoon Ha ) 한국조직공학·재생의학회 2009 조직공학과 재생의학 Vol.6 No.4

Bone marrow derived mesenchymal stem cell(BMSC) based cell therapy can promote functional recovery and regeneration in central nervous system(CNS) disease models. These beneficial effects have been primarily attributed to the differentiation potential into varieties of cell lineages and the therapeutic paracrine factors secreted by BMSC after transplantation. Many secreted factors from BMSC have been identified recently in the conditioned media. However, the effects of these factors on the neuronal regeneration need further verification with relevant neuronal models. Ntera-2 neurons have been used for the therapy of several different CNS diseases in animal models. Recently some clinical trials have confirmed the safety and potential efficacy of Ntera-2 neurons for stroke therapy. In this study, the Ntera-2 neuron model was used to directly verify the effect of BMSC conditioned media(BMSCCM) on neurite outgrowth in vitro. Our study confirmed that the BMSC-CM could increase both the neurite length and branch number of Ntera-2 neurons, compared to the control group with non-conditioning media. Since the BMSC can secret many therapeutic factors into the conditioned media, our data support the theory that BMSC promote neurite outgrowth through secreting paracrine factors.

뇌실질내 발생한 표피양 낭종 1예 : Case Report

김긍년,최중언,윤수한,김태승 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.5

Intraparenchymal epidermoid cyst is extremely rare. The authors treated a case of intraparenchymal, temporal lobe epidermoid cyst in 21-year old male who had presented with a generalized seizure attack and headache without any neurological deficits The diagnosis was based on the characteristics of CT Scan and MR imaging. The cyst was totally removed via transtemporal approach. Postoperative course was uneventful . The authors report this rare case with a review of the literature.

뇌동맥류와 고혈압의 관계에 대한 임상적 연구

김긍년,주진양,이규창 대한신경외과학회 1993 Journal of Korean neurosurgical society Vol.22 No.9

To investigate relationship between intracranial aneurysm and systemic hypertension, 199 consecutive cases of intracranial aneurysm which were treated surgically were analized in regard to the incidence of hypertension and to the effect of hypertension on their outcome. The incidence of hypertension in cases with aneurysm was higher than in general population. Multiple aneurysm patients had significantly higher incidence of hypertension than single aneurysm paients did. The amount of subarachnoid clot on postictal CT scan and neurological status on admission were not statistically different between hypertensive and normotensive group. Frequency of rebleeding was significantly higher in hypertensive group than in normotensive group. The incidence of cerebral vasospasm or hydrocephalus was statistically not significant between hypertensive group and normotensive group. The clinical outcome was similar between two groups.

스포츠 두부 손상

윤영설,진동규,김긍년,장진우,김영수 대한스포츠의학회 1999 대한스포츠의학회지 Vol.17 No.1

Head injury is the most frequent direct cause of death in sports. Furthermore, injury to the head takes an singular importance when we realise the brain is neither capable of regeneration nor, unlike many other body parts and organs, of transplantaion. Every effort must be made to protect the athlete's head as injury can lead to dementia, epilepsy, paralysis and death. There are three distinct types of stress that can be generated by an acceleration force to the head : compressive, tensile and shearing forces. The differential diagnosis with a head injury includes cerebral concussion, intracranial hemorrhage, postconcussion syndrome, second impact syndrome, malignant brain edema. 90 to 95% of all head injuries are cerebral concussions and more than 90% all cerebral concussions fall into mild categories. With a head injury the ABCs of first aid must be followed and then a neurological examination will be followed. In the case of the intracranial hematoma. definite surgical evacuation is indicated and in cases of the closed head injuries and most severe degree of concussion. observation is appropriate, with careful neurological monitoring. Over the last 20 years there has been a dramatic decrease in the most serious head injuries due to multiple factors. There are five areas that can affect a reduction in head injuries. The first two involve rules and coaching technique changes. The other three areas involve improvements in conditioning (especially of the neck), equipment, and finally medical supervision. The reduction in incidence and severity of athletic head injury gas been the results of changes and improvements instituted following constant study and research. And also, for the reduction in incidence of athletic head injury every effort or team physician, athletic trainer, physical trainer and team coaches should be necessary.

SPAMM-MRI를 이용한 척수공동증의 예후 평가

김영수,김긍년,진병호,정태섭,윤도흠,조용은,진동규,김한성 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.1

척추관 협찬증 환자 진료 프로세스 개발

이환모,김호중,김긍년,안풍기,천자혜,김양수,신혜선,김인숙,정혜경,김영아,채형기,박인영 한국의료QA학회 2009 한국의료질향상학회지 Vol.15 No.2

연구배경: 수술적 치료가 필요한 척추관협착증 환자들은 주로 60세 이상의 고령환자로장기간의 입원 시 기회 감염의 증대와 불필요한 의료비의 증대를 가져오게 되며, 수술후환χ}들의 재원일수의 증가는병원의 병상가 동률을감소시키고, 전공의에게는불필요한 업무를 증가시킨다. 연구목적: 비용·효과면에서 최적화된 진료지침의 개발은 불필요한 의료비의 감소및 Hospital Induced Complication을 줄여 환자만족도를증진시킬 수 있으며, 각 환자에 대한전공의 업무를 줄일 수있다. 의료기관: 서울특별시에 소재한 2,075병상의 종합전문 요양기관 연구방법: 정형외과및 신경외과의 척추관협착증환자 의 처방을 비교하여 최적의 표준진료지침을 개발하고 최종적으로 CP Master Program (EMR 프로그램)에 입력하여 환자에게 적용하였다. 연구결과': CP 적용전, 후비교를통해 재원일수는 3.8일 이 감소하였으며, 이에 따라 병상가동률 및 진료수익이 증가했으리라고 예상되며 현재 비교검토중이다. 또한,CP 개발및 CP Master Program의 사용을 통한 전공의 업무감소에 대해 검토하고 있다.

급성 척수손상 환자의 치료 : 최근의 세포치료 연구 결과를 중심으로

윤도흠,하윤,윤승환,김은영,현동근,박종운,박소라,구성욱,김긍년,조용은,박형천 대한척추신경외과학회 2004 Neurospine Vol.1 No.1

A therapy to treat injuries to the central nervous system is, to date, a major clinical challenge. The devastating functional consequences they cause in patients have encouraged many scientists to search, in animal models, for a repair strategy that could, in the future, be applied to humans. To highlight the current understanding of traumatic spinal cord injury, we provide information regarding state-of-the-art care for the acute spinal cord injured model, and explore future treatments aimed at neural preservation and reconstruction. This article also reviews recent phase I clinical trials in neural and nonneural cell transplantation, stressing that the transition from basic science to clinical applications.