NADH-Methemoglobin Reductace 결핍에 의한 선천성 Methemoglobin 혈증 1예

장봉열,김영재,김건영,최정매,한기옥,김문중,신성혜,이춘희 예수병원 1992 예수병원학술지 Vol.13 No.-

마우스 악하선의 배설관결찰에 따른 상피성장인자의 변화에 관한 면역조직화학적 연구

장봉열,홍정표,조한국 慶熙大學校 大學院 1993 高凰論集 Vol.12 No.-

The purpose of this study was evaluate immunohistochemical observation to epidermal growth factor of the effect of duct ligation of mouse submandibular gland. Fifty two mice were aging 3 months old, devided into experimental group(36 mice) and control group (16 mice). Under general anesthesia, 36 animals were ligated in left side duct of submandibular gland. Experimental animals were sacrificed consecutively on 1st, 6th, 12th hours and 1st, 2nd, 3rd, 5th, 7th, 14th day after duct ligation. These specimens fixed with formalin and sectioned in paraffin. Subsequently were stained with H-E and immunohistochemistry to observe epidermal growth factor. The results were as follows ; 1. After duct ligation, the acinar cells were atrophied and disappeared and granular convoluted tubule cells in which cytoplasm atrophied and granules reduced, degenerated duct-like structure. 2. With the time lapse, epidermal growth factor in cytoplasm of granular convoluted tubule cells reduced with change of features of granular convoluted tubule. 3. From 7th day after duct ligation, there are suggested that duct-like structure were originated from granular convoluted tubule and these were regressive changes by secretory disturbance.

백서 악하선의 배설관결찰에 따른 선조직의 변화에 관한 실험적 연구

장봉열,조한국 慶熙大學校 齒科大學 1989 慶熙齒大論文集 Vol.11 No.-

The purpose of this study was to evaluate histological, histochemical and electron microscopic observation of the effects of duct-ligation of rat salivary gland; Fourty eight Sprague-Dawley white rats weighting about 50gm were divided into experimental group (32 rats) and control group (16 rats). Under general anesthesia with thiopental sodium, 32 animals were ligated in the left side duct. Experimental animals sacrificed consecutively on the 1st, 6th hours and 1st, 2nd, 4th, 7th and 14th day after duct ligation. The specimens were fixed with formalin and glutaraldehyde solution, sectioned in paraffin and epon and observed through histologial, histochemical and electron microscopic study. The results were as follows; 1. Submandibular glands showed severe degeneration in the deep portion rather than superficial due to duct ligation. 2. After duct ligation, Acini were.atrophied and diappeared by degrees, interacinar tissue shows ligation due to inflammatory cell infiltration and the degeneration of connective tissue. 3. From the 4th day after duct ligation, The superficial portion of salivary gland was replaced into proliferating ductal cells which were matured and dilated gradually. 4. PAS and mucicarmine reactions were decreased and disappeared gradually with the atrophy and disappear of acini, but showed strongly positive reaction on secretory materials in duct like structure. 5. Ultrastructualiy acinar cells showed the loss of nuclear membrane, nuclear pyknosis and irregular arrangement of rough-surfaced endoplasmic reticulum were separated each other due to the loss of intercellular juntional complex. After 7th days, it showed immature ductal cells in the superficial portion of salivary gland which had a number of mitochondria and free ribosome.

백서 악하선의 배설관결찰에 따른 선조직의 변화에 관한 실험적 연구

장봉열,조한국 대한구강악안면병리학회 1989 대한구강악안면병리학회지 Vol.12 No.1

An Effect of Endocrinological Changes related to the Stress on the Submandibular Gland in Rats

장봉열,김성훈,전양현,홍정표,Chang, Bong-Youl,Kim, Sung-Hoon,Chun, Yang-Hyun,Hong, Jung-Pyo The Korean Academy of Orofacial Pain and Oral Medi 2000 Journal of Oral Medicine and Pain Vol.25 No.3

현대에는 날로 복잡해지는 생활양식의 변화에 따라 다양한 스트레스에 노출되고 그로 인한 면역계, 신경계 또는 각종 장기의 기능이상이 점차로 증가되고 있다. 최근 치과에 내원하는 환자들 중 구강건조증을 호소하는 환자들의 다수는 스트레스에 노출되어 있고, 임상적으로도 방사선 타액선 기능 검사에서 타액선, 특히 악하선의 기능이 현저하게 저하되어 있는 소견을 관찰할 수 있 다. 더욱이 이는 타액선 조영술에서 이미 보고된 바 있는 면역성 질환인 $Sj\ddot{o}gren$ 증후군과는 다른 양상으로 관찰되고 있어, 이에 본인은 백서에 스트레스와 관련이 깊은 내분비적 환경 변화를 유도함으로써 이와같은 변화가 악하선 조직의 병리적 변화와 어떠한 연관성을 갖는 지를 관찰하고자 본 실험을 시행하였다. 생후 7주된 Sprague-Dawley계 웅성 백서(165-209g/bw) 40마리를 2 개의 실험군(부신 제거군 : ADX 군, 부신 제거 후 dexamethasone 투여군 : DEX 군)으로 나누어 실험하였다. ADX 군은 외과적으로 부신을 제거한 후 다른 조건을 부여하지 않았고, DEX 군은 외과적으로 부신을 제거한 후 매일 dexamethasone($1.5*10^{-46}mg/g$ I.V./day)을 투여하였으며, 이들을 각각 실험 후 즉시, 1일, 3일, 5일, 7일에 희생시켰다. 그 후에는 즉시 악하선을 적출하여 면역조직화학법으로 Clusterin의 발현 정도 및 부위를 관찰하였다. 그 결과는 다음과 같았다. 1. 광학현미경 하에서, 양 군 모두 유의할만한 조직학적 변화는 관찰되지 않았다. 2. ADX 군에서는 실험기간 전반에 걸쳐 도관세포와 선포세포에서 clusterin이 발현되었다. 3. DEX 군에서는 소수의 선세포에서 국소적으로 clusterin이 관찰되었으나, 전반적으로 도관세포, 선포세포에서 공히 clusterin이 관찰되지 않았다. 부신을 제거한 군에서는 실험기간 전반에 걸쳐 clusterin이 발현되었는데, 이는 clusterin이 스트레스의 생리적 반응의 결과로서 세포보호작용을 한다는 사실에 기초하여 볼 때, 부신을 제거하였을 때도 스트레스를 받았을 때와 같은 영향이 백서의 악하선에 가해졌을 것으로 생각된다. 반면, 부신제거후 glucocorticoid agonist인 dexamethasone을 투여하였을 때, clusterin이 감소 내지 관찰되지 않았던 것은 부신제거에 의해 악하선에 가해졌던 영향을 dexamethasone이 길항하여 나타난 결과로 볼 수 있어, 스트레스에 의해 부신으로부터 분비되는 glucocorticoid가 타액선을 보호하는데 중요한 작용을 하는 것을 시사한다.

척추를 침범한Gorham-Stout Disease의 치료

장삼열,김형민,장봉순,이춘기 대한척추외과학회 2021 대한척추외과학회지 Vol.28 No.2

Study Design: Narrative review. Objectives: To present up-to-date evidence on the treatment of Gorham-Stout disease (GSD) involving the spinal column. Summary of Literature Review: Gorham-Stout disease (GSD) is a rare disease that is characterized by progressive bone resorption associated with vascular or lymphatic angiomatosis. Although various treatment options have been described and investigated, there is no consensus on the appropriate treatment for GSD. Materials and Methods: Review of the associated literature and latest research. Results: The available treatment options for spinal GSD are systemic agents (including interferon-alpha, bisphosphonate, denosumab, and sirolimus), radiotherapy, surgical treatment, and percutaneous vertebroplasty. Conclusions: Treatment for spinal GSD should be case-specific and involve multiple modalities, including systemic medications, radiotherapy, and surgical treatment. 연구 계획: 종설목적: 척추를 침범한 Gorham-Stout 병의 치료에 대한 최신 지견 소개선행 연구문헌의 요약: Gorham-Stout 병은 림프 혈관의 증식으로 인해 진행하는 뼈 흡수를 특징으로 하는 매우 드문 질환이다. 여러 가지 치료 방법들이 시도되었으나, 아직까지 어떠한 치료가 가장 효과적인가에 대해서는 아직 연구가 충분하지 않다. 대상 및 방법: 문헌 고찰 및 최신 연구의 소개결과: Gorham-Stout 병의 치료에 사용될 수 있는 치료법에는 인터페론, 비스포스포네이트, 데노주맙, 시롤리무스 등의 약물 치료, 방사선 치료, 수술적 치료와 척추성형술 등이 있다. 결론: Gorham-Stout 병은 질환의 상태(병변의 위치, 범위, 질병의 진행 여부 등)에 따라 치료가 달라지며, 여러 가지 방법들을 함께 활용하여 치료하여야 한다.

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

장삼열,Mok Sujung,Park Sung Cheol,Kim Hyoungmin,장봉순 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.4

Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

김형민,장봉순,장삼열 대한척추신경외과학회 2022 Neurospine Vol.19 No.1

Lumbar degenerative disease is a common problem in an aging society. Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical (MIS) technique that utilizes a retroperitoneal antepsoas corridor to treat lumbar degenerative disease. OLIF has theoretical advantages over other lumbar fusion techniques, such as a lower risk of lumbar plexus injury than direct lateral interbody fusion (DLIF). Previous studies have reported favorable clinical and radiological outcomes of OLIF in various lumbar degenerative diseases. The use of OLIF is increasing, and evidence on OLIF is growing in the literature. The indications for OLIF are also expanding with the help of recent technical developments, including stereotactic navigation systems and robotics. In this review, we present current evidence on OLIF for the treatment of lumbar degenerative disease, focusing on the expansion of surgical indications and recent advancements in the OLIF procedure.

원발성 악성 척추 종양에서 수술적 절제 방법과 절제연의 임상적 의의: 다기관 후향적 연구

김형민,장삼열,박세준,장봉순,이종서,이춘기 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.4

Study Design: A retrospective multi-center study. Objectives: To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma. Summary of Literature Review: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy. Materials and Methods: We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test. Results: Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004). Conclusions: Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma. Key words: Primary spinal sarcoma, En bloc resection, Survival, Recurrence, Metastasis 연구 계획: 후향적 다기관 연구목적: 본 연구진은 원발성 악성 척추 종양 환자에서 절제 방법 및 수술 절제연이 생존 기간, 국소 재발 및 원격 전이 등 임상적 결과에 미치는 영향을 분석하고자 하였다. 선행 연구문헌의 요약: 원발성 악성 척추 종양에서 수술적 치료와 음성 절제연은 생존 기간의 연장 등 보다 좋은 임상 결과와 연관이 되어 있다고 알려져있다. 하지만 절제 방법 및 수술 절제연을 종합적으로 분석한 연구는 이제까지 많지 않았다. 대상 및 방법: 1997년부터 2016년까지 두 개의 기관에서 원발성 척추 종양으로 수술을 시행 받은 환자를 후향적으로 분석하였으며, 절제 방법(일괄 및분할)과 수술 절제연(양성 및 음성)이 생존 기간, 국소 재발 및 원격 전이 등에 미치는 영향을 생존 분석(Kaplan-Meier curve analysis and log rank test)으로 평가하였다. 결과: 총 33명(남자 21명, 여자 12명)의 환자가 연구에 포함되었으며, 평균 나이는 45.1세, 추시 기간의 중간값은 36개월이었다. 13(39.4%)예의 연골육종, 12(36.4%)예의 골육종이 가장 많은 조직학적 진단을 차지하였다. 전체 환자를 절제 방법 및 절제연을 기준으로 네 그룹으로 나누었을 때, 그 분포는다음과 같았다. 1) 완전 일괄 절제 (total en bloc resection) 및 음성 절제연: n=12(36.4%), 2) 완전 일괄 절제 및 양성 절제연: n=5(15.2%), 3) 완전 분할 절제 (total piecemeal resection): n=12(36.4%), and 4) 불완전 절제(subtotal resection): n=4(12.1%). 생존 분석을 시행하였을 때, 완전 일괄 절제 및 음성 절제연을 시행 받은 환자들에서 유의하게 긴 생존 기간(p=0.030), 적은 원격 전이 (p=0.025) 및 국소 재발 (p=0.004)의 발생이 관찰되었다. 결론: 원발성 악성 척추 종양에서 보다 좋은 종양학적 결과(oncological outcome)를 얻기 위해서는 완전 일괄 절제술을 통해 음성 절제연을 얻고자 하는노력이 필요하겠다. 약칭 제목: 원발성 척추암의 수술적 치료

Difficulty Looking Down in Patients with Muscular Dystrophy after Scoliosis Correction: A Preliminary Report

홍성화,장봉순,장삼열,강동호,김형민 대한척추외과학회 2023 대한척추외과학회지 Vol.30 No.2

Study Design: Retrospective comparative radiological study. Objectives: This paper aimed to shed light on the difficulty experienced by patients with muscular dystrophy in looking down at the ground after surgery for spinal deformity correction. Summary of Literature Review: Neuromuscular scoliosis (NMS), which tends to result in thoracolumbar kyphosis and pelvic imbalance, often occurs in patients with muscular dystrophy. Preceding studies have focused mainly on normalizing NMS curvature, without considering neck motion. Materials and Methods: This retrospective case series included eight patients who underwent posterior spinal deformity correction surgery for NMS between July 2021 to April 2022. Whole-spine lateral radiography was taken before and after surgery to measure cervical lordosis, thoracic kyphosis, lumbar lordosis, chin-brow vertical angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and C7-S1 SVA. Additional information regarding patients’ ability to flex their neck sufficiently was also included. Logistic regression was performed to assess neck flexion difficulty with radiographic sagittal parameters. Results: All patients were able to look down sufficiently preoperatively. However, 75% (n=6) of the patients, who had larger preoperative C7-S1 SVA (p=0.028), displayed significant postoperative difficulty in neck flexion. Conclusions: Correction of NMS requires special consideration regarding sagittal balance and head position. Preoperative positive sagittal balance is related to postoperative difficulty in neck flexion.