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        후두와 뇌병변의 최소침습수술에서 Fibrin Glue의 사용

        손은익,김일만,김동원,임만빈 계명대학교 의과학연구소 2000 계명의대학술지 Vol.19 No.1

        The posterior fossa surgery(PFS) via lateral suboccipital craniectomy(SOCE) and partial mastoidectomy always has the potential cerebrospinal fluid(CSF) leakage and painful deformity in the suboccipital and retroauricular area. This study describes the efficacy of our mathods for dural closure and cranioplasty to prevent CSF leakage and suboccipital depression respectively after posterior fossa exploration using retrosigmoid suboccipital approaches. This techniques were performed in the consecutive 10 patients who underwent PFS in a park-bench position for different types of lesions. The SOCE and driling of the mastoid process were done minimally. Following intradural works, dura was closed in a watertight manner usually using a graft, thereafter reinforced with GelfoamR and biological human allogenic fibrin glue (GreenplastR). After augmentation of dural suture, opened mastoid air cells were bone-waxed and covered with fat graft by anchoring sutures. For the reconstructive cranioplasty, autologous bone chips and dust obtained at craniectomy were wrapped with SurgicelR. Then it was replaced to the site of suboccipital bone defect and GreenplastR was applied on and around the bone plate. The age of patients ranged from 33 to 61 years. Five cases of hemifacial spasm have been undertaken decompression of the facial nerve and four cases of cerebellopontine angle masses(meningioma, epidermoid, arachnoid cyst, and cerebellar metastasis) were treated by retrosigmoid approach. Computed tomography and plain cranial films taken a few month later showed successful and good appearance of the suboccipital and retromastoid area. All patients made a excellent recovery without any postoperative complications. Preliminary results of up to 10 months show no CSF leakage nor a persistent headache. There was no adverse reactions related to fibrin glue. We think that the present technique is a valuable method to minimize or avoid postoperative CSF leakage and to restore an autologous bone plate in a cranial defect by piecemal craniectomy.

      • SCIESCOPUSKCI등재

        무증상 역류성 식도염의 자연 경과 -건강 검진자를 대상으로 한 후향적 연구-

        손주익 ( Ju Ik Son ),김재준 ( Jae J. Kim ),박문경 ( Moon Kyung Park ),한성혁 ( Seong Hyeock Han ),김지은 ( Jee Eun Kim ),이재욱 ( Jae Wook Lee ),심상군 ( Sang Goon Shim ),이준행 ( Jun Haeng Lee ),손희정 ( Hee Jung Son ),김영호 ( Y 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.2

        목적: 건강 검진이 늘어나면서 무증상이면서 내시경 검사상 역류성 식도염 소견을 보이는 환자들도 증가하고 있다. 그러나 아직까지 증상을 동반하지 않은 식도염의 자연 경과나 치료방침에 대해서는 체계적인 연구가 없는 실정이다. 이에 저자 등은 건강 검진자를 대상으로 시행한 상부소화관내시경 검사상 우연히 발견된 무증상 역류성 식도염 환자들의 의무 기록을 후향적으로 검토하여 자연 경과 및 경과에 영향을 미치는 인자들을 알아보고자 하였다. 대상 및 방법: 1994 Background/Aims: The natural history of endoscopically proven reflux esophagitis without any gastrointestinal symptom is not clear. The aim of the present study was to evaluate the natural course of asymptomatic reflux esophagitis without any specific tre

      • KCI등재후보
      • KCI등재후보

        인간 뇌 신경교종에 있어서 c-myc 암유전자 발현의 in situ hybridization 검색

        손은익,임만민,이정교,권건영,김인홍,서민호,김동원 啓明大學校 醫科大學 1992 계명의대학술지 Vol.11 No.3

        In order to elucidate the relationship between c-myc oncogene expression and tumor grade in human brain glioma, we studied two low grade gliomas, three high grade gliomas, and one normal brain tissue with in situ hybridization and biotin-labeled c-myc probe. All the specimens were formalin fixed and paraffin-embedded. Many cytoplasmic c-myc RNA grains were observed in low grade glioma, and numerous cytoplasmic c-myc RNA grains were observed in high grade glioma, but only a few were seen in normal brain tissue. In conclusion, these findings show that there is direct relationship between the degree of c-myc oncogene expression and grading of glioma.

      • SCOPUSKCI등재

        Structure-Reactivity Correlations in Nucleophilic Displacement Reactions of Y-Substituted-Phenyl X-Substituted-Cinnamates with Z-Substituted-Phenoxides

        Son, Yu-Jin,Kim, Eun-Hee,Kang, Ji-Sun,Um, Ik-Hwan Korean Chemical Society 2013 Bulletin of the Korean Chemical Society Vol.34 No.8

        Second-order rate constants ($k_N$) have been measured spectrophotometrically for the nucleophilic displacement reactions of 4-nitrophenyl X-substituted-cinnamates (4a-4e) and Y-substituted-phenyl cinnamates (5a-5e) with Z-substituted-phenoxide anions in 80 mol % $H_2O$/20 mol % DMSO at $25.0{\pm}0.1^{\circ}C$. The Hammett plot for the reactions of 4a-4e with 4-chlorophenoxide (4-$ClPhO^-$) consists of two intersecting straight lines, which might be taken as a change in the rate-determining step (RDS). However, it has been concluded that the nonlinear Hammett plot is not due to a change in the RDS but is caused by stabilization of the ground state of substrates possessing an electron-withdrawing group in the cinnamoyl moiety through resonance interactions, since the Yukawa-Tsuno plot exhibits an excellent linear correlation with ${\rho}X=0.89$ and r = 0.58. The Br${\o}$nsted-type plot for the reactions of 4-nitrophenyl cinnamate (4c) with Z-substituted-phenoxides is linear with ${\beta}_{nuc}=0.76$. The Br${\o}$nsted-type plot for the reactions of Y-substituted-phenyl cinnamates (5a-5d) with 4-chlorophenoxides (4-$ClPhO^-$) is also linear with ${\beta}_{lg}=-0.72$. The Hammett plot correlated with ${\sigma}^-$ constants for the reactions of 5a-5d results in a much better linear correlation than that correlated with ${\sigma}^o$ constants, indicating that a partial negative charge develops on the O atom of the leaving aryloxide. Thus, the reactions have been concluded to proceed through a concerted mechanism.

      • KCI등재후보

        고혈압성 뇌실질내혈종의 뇌정위적제거술에 대한 결과분석 : Analysis of Factors Affecting Outcome

        손은익,임만빈,이정교,김인흥,김동원 啓明大學校 醫科大學 1990 계명의대학술지 Vol.9 No.2

        The ultimate purpose of treatment in hypertensive intracerebral hematoma(HICH) is effective evacuation of the hematoma with minimal damage to normal brain tissue and prevention of increasing intracranial pressure and progression of an ICH into neighbouring tissue. According to this viewpoint, stereotactic surgery in patients of HICH is recent trend for its safety and precision. An analysis of 50 consecutive patients from Jun. 1988 to Mar. 1989 undergoing stereotactic surgery with urkinase irrigation in HICH was performed. We excluded the HICH below 15cc of volume, poor clinical grade as coma with herniation sign, intraventricular hemorrhages only, infratentorial hematoma and atypical spontaneous intracerebral hematomas as angiographically verified aneurysms, AVM and Moyamoya diseases. Procedures were accomplished utilizing the CT-guided BRW stereotactic frame, then urokinase irrigation was done every 6 hours through a stereotactically inserted catheter until a sufficient volume was drained, and then the patient was checked by a follow-up CT scan. The results were analysed as follows: The incidence was highest in 6th decade with male predominence(62%). Mean dose of urokinase was 6000 IU ×18.73(4.6 days). The statistical analysis of the factors affecting outcome showed that initial neurological grading was highly significant (P<0.001); volume of hematoma was significant also (p<0.05). Associated intraventricular hemorrhage especially ventricular tamponade in HICH was highly poor prognostic factor. Overall good result was 54% and mortality rate was 12% All computations were performed by means of the commonly used SPSS statistical package.

      • SCOPUSSCIEKCI등재

        중증 미만성 뇌손상의 예후에 관한 분석

        손은익,임만빈,김인흥 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.7-12

        Computed tomography(CT) has enabled early recognition and treatment of focal injuries in patients with head trauma. However, CT has been less beneficial in identifying diffuse brain injury(DBI). The authors have analyzed retrospectively, a series of 132 patients with DBI observed for 2 years from Aug. 1986 to Jul. 1988 to evaluate the significance of the factors affectiong ourcome. Eighty-three patients were selected as being compatible with moderate and severe diffuse axonal injury(DAI) classified by Gennarelli, defined by coma without a CT lesion that is an obvious cause and coma greater than 24 hr with or without decerebration. The results are summarized as follows: 1) The 38(45.7%) out of 83 patients were found below age of 20, but there was no statistical significance between age distribution and outcome. 2) In case of initial Glasgow coma scale(GCS) of 7 or 8, 32(86.5%) out of 37 patients revealed good outcome, but 18(90%) of 20 patients with a score of 3 or 4 revealed poor outcome(p<0.001). 3) With regard to brain swelling in CT, there was significant statistical difference to outcome(p<0.05). 4) Small hemorrhages on corpus callosum, basal ganglia, basal cistern, peritentorial, lateral ventricle that is characteristic CT findings for DAI were showed 58(70%) out of cases. It might be concluded that initial GCS, brain swelling and small hemorrhages in CT were significant factors affecting outcome in DAI.

      • KCI등재후보

        Beriplast P(Fibrin glue)를 점적한 근육절편과 Histoacryl blue(N-butyl 2-cyanoacrylate)를 백서 대뇌표면과 대퇴동맥에 접착시 조직학적 변화 : 뇌동맥류 수술에의 이용성 The possibility of using in intracranial aneurysm surgery

        손은익,임만빈,이상숙,김찬환,김상열,김인홍,김동원 啓明大學校 醫科大學 1989 계명의대학술지 Vol.8 No.1

        The authors performed experimental work with the application of the histoacryl blue(N-butyl 2-cyanoacrylate and the beriplast P?? (Fibrin glue) soaked muscle to the cerebral cortex and the femoral artery in 26 rats for evaluating usefulness in the reinforcement of the cerebral aneurysm. 4 sham-operated animals with applying physiologic saline served as controls. The animals were sacrificed at intervals as 1 week, 2 weeks, 4weeks and 3 months with intraperitonal injection of the sodium pentobarbital 60mg and examed the gross and the light microscopic findings. The gross findings of the cyanoacrylate adhesive applied group showed marked fibrosis and adhered tightly to the femoral artery and the cerebral cortex without true interconnection between the cyanoacrylate and the artery or the brain tissue. There was also showed evidence of degradation of the cyanoacrylate at 3 months. On the another hand, the fibrin glue soaked muscle applied group showed moderate fibrosis compared to the cyanoacrylate group without evidence of the inflammatory reaction. The evidence of the fibrin glue and the muscle piece remained until 2 week and disappeared completely thereafter. The true interconnection between fibrin soaked muscle piece to the artery was existed definitely, but doubtable to the brain cortex. On the microscopic findings of the femoral artery, the cyanoacrylate applied group showed marked foreign body reaction and necrosis of the arterial wall, especially at 2 week, which subsided the foreign body reaction in some degree and repaired the necrotized arterial wall with marked thickening of the endothelium at 3 months. In the fibrin glue soaked muscle applied group, the microscopic findings showed mild increased inflammatory cells, especially eosinophile, and the adhered muscle piece to the arterial adventitia tightly with the intact arterial wall at 2 weeks. The evidence of the fibrin glue disappeared and the muscle cells showed necrosis since 2 weeks. At 4 weeks, only small amount of the muscle cells remained with capillary proliferation at applying site and absence of the muscle cells with increased fibrosis with intact arterial wall at 3 months. On the brain specimen, the cyanoacrylate adhesive applied group showed marked thickening of the meningeal membrane with the increased inflamatory cells, especially at 2 weeks. The fibrin glue soaked muscle piece applied group showed only mild meningeal thickening with near absence of the inflammatory cells. The results of this experiment showed doutable tissue acceptance of the cyanoacylate(N-butyl 2-cyanoacry-late) in using for coating or wrapping of the aneurysm and the fibrin glue soaked muscle showed tissue acceptance, but the fate of the fibrin glue and the muscle piece disappeared 2 or 4 weeks later with fibrosis only. So the fibrin glue have to be used with another non-toxic, permanent material for the reinforcement of the cerebral aneurysm.

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