자발성 두개내 저압증(Spontaneous Intracranial Hypotension)의 임상적 분석

조규종,김원,최옥경,임경수 대한응급의학회 1999 대한응급의학회지 Vol.10 No.4

Backgrouds : Headache is one of the common symptoms complained by patients at the emergency department. Postural headache is the characteristic symptom that is aggravated at upright position and relieved at recumbent position. This postural headache is associated with low cerebrospinal fluid (CSF) pressure. Spontaneous intracranial hypotension(SIH) is an unusual syndrome of postural headache and low CSF pressure without a precipitating event. The diagnosis of SIH is confirmed by 60mmH2O or less CSF opening pressure on lumbar puncture. However, the cases of SIH with normal CSF opening pressure have been reported. so it is needed to complement the diagnostic criteria of SIH. Methods : A retrospective descriptive study with reviewing medical records of 10 patients who had been admitted at Asan Medical Center from Apr. 1995 to Jul. 1999 was done. Analyses were done of 22 variables of age, sex, clinical symptoms, spinal analysis findings, radiologic findings and therapeutic modality. Fisher's exact test and Mann-Whitney test were applied for statistical analysis (p-value < 0.05). Results ; 1. The male to female ratio was 3:7, and the mean age was 37.30±5.96 years. 2. Postural headache was characteristic symptom & complained by all patients. 3. The mean CSF pressure was 22.8±30.8 mmH2O. 4. Brain MRI demonstrated the pachymeningeal enhancement in all patients. 5. Radioisotope cisternography demonstrated slow ascent of tracer to the cerebral convexity in 88.9% patients, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer in 66.7% patients, respectively. 6. 90.0% of all patients were recovered with autologous epidural blood patches, and 10.0% were recovered with conservative management. Conclusion : The SIH is an unusual syndrome. but we can diagnose the SIH in the patient, complains of a postural headache, if any following two or more criteria are present. 1. 60mmH2O or less CSF opening pressure on lumbar puncture. 2. Brain MRI finding : the pachymeningeal enhancement. 3. Cisternography findings : slow ascent of tracer to the cerebral convexity, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer.

생체내 심근허혈-재관류 모델에서 멜라토닌의 재관류 부정맥에 대한 심근보호작용에 관한 연구

조규종,김원,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Background: Recently, a few studies demonstrated that melatonin reduced the severity of myocardial reperfusion injuries, such as reperfusion arrhythmias. However, it is uncertain whether the melatonin reduces reperfusion arrhythmias in thus anesthetized animals because results were obtained using isolated hearts. Thus, to see whether melatonin reduces reperfusion arrhythmias in anesthetized animals, we examined the effect of melatonin on the incidence of reperfusion arrhythmias in an anesthetized-cat model of regional ischemia. Method: Adult mongrel male cats(n=30, 2.9∼4.2 kg) were anesthetized under positive-pressure artificial ventilation with room air. The animals of the control group(n=15) were subjected to 20-minute left anterior descending coronary artery(LAD) occlusion followed by abrupt reperfusion. The animals in experimental group(n=15) were divided into two. Group I(n=6) was pretreated with melatonin, 1 mg/kg, before occluding the LAD. Group II(n=9) was pretreated with melatonin, 10 mg/kg. The animals in experimental group were subjected to ischemia/reperfusion insult following drug treatment: melatonin was applied intra-peritoneally for 3 minutes just before LAD coronary artery ligation. The Fisher's exact test was used to compare the data from different animal groups. p<0.05 was considered significant. Results: The incidence of ventricular fibrillation(VF) during the reperfusion phase in group II(pretreated with melatonin, 10 mg) was significantly smaller than that in the control group(p-value = 0.0029). However, no statistically significant difference of VF incidence was found between group I(pretreated with melatonin, 1 mg) and the control group. Conclusion: Employing an anesthetized-cat model of regional cardiac ischemia, we investigated the dose-dependant effects of melatonin on reperfusion-induced arrhythmia. The cats pretreated with 10 mg/kg of melatonin before ischemia had a significantly reduced incidence of lethal reperfusion-induced arrhythmia, but there was no difference between the cats pretreated with 1 mg/kg of melatonin before ischemia and the control group.

癌의 溫熱藥物 治療法에 對한 考察

趙珍浩,孫彰奎,趙鍾寬 대전대학교 한의학연구소 2001 혜화의학회지 Vol.9 No.2

A literature study on cancer therapy of warm-hot oriental medicine was done, and the results were as follows. 1.In oriental medicine, oncogens are six exopathogens, seven modes of emotion, overwork, pathogenic factors, and especially related with pathologic cold situation. 2.There are many capillaries in tuomr, and because temperature of inner space of tumor is higher than normal organization. Tumor cell has a character which is weak for high temperature. 3.Warm-hot herb drugs have effects of dissipating mass, warming kidney to reinforce yang and dispering, so it has a function of suppressing tumor as well as improving immunity in cancer therapy. 4.In traditional medical books, main prescriptions of cancer therapy are xinzhiyinyang-gongjiwan(新製陰陽功積丸), qianjinxiaoshiwan (千金硝石丸), feiqiwan(肥氣丸), xibenwan(息賁丸), fuliangwan(腹梁丸), beiqiwan(??氣丸), bentunwan(賁豚丸), zengsunwujiwan(增損五積丸), and these are composed of warm-hot herb drugs. 5.In current, the study of warm-hot drugs is progressed in immunological capacity, anti-tumor activity, stimulating bone marrow and regulating hormone secretion. It will be expected that adavanced study of these must be accomplished in cancer patients.

癌의 發生과 免疫에 대한 考察

조정효,손창규,조종관 대전대학교 한방병원 2001 惠和醫學 Vol.10 No.1

Most cancers are thought to originate from a single cell that has undergone a somatic mutation, but the progeny of this cell must undergo further changes, probably requiring several additional mutations, before they become cancerous. This phenomenon of tumor progression, which usually takes many years, reflects the operation of evolution by mutations and natural selection among somatic cells. The rate of the process is accelerated both by mutagenic agents (tumor initiators) and by certain nonmutagenic agents (tumor promoters). Thus many factors contribute to the development of a given cancer, and since some of these factors are avoidable features of the environment, a large proportion of cancers are in principle preventable.

癌에서 新生血管 形成과 血瘀의 相關性에 關한 考察

趙珍浩,孫彰奎,趙鍾寬 대전대학교 한의학연구소 2001 혜화의학회지 Vol.9 No.2

A study on relation of angiogenesis and blood stagnation in cancer was done, and the results were as follows. 1.Angiogenesis is a sequence of vascular proliferation and accomplished by regulation of anti-angiogenesis factor and indicating factor. These factors are secreted in the course of blood coagulation, inflammation, and regeneration. 2.Angiogenesis in cancer is a important action in growth of tumor and metastasis because it supply oxygen and nutrition. 3.The complicated processes, for example, platelet coagulation, action of coagulator factor & dissolution factor and interaction of variety factors are related to blood stasis and promoting blood circulation to remove blood stasis in oriental medicine. 4.Promoting blood circulation to remove blood stasis is expected to suppress angiogenesis, and we expect advanced study will be accomplished in future.

상부 조기 위암 환자의 복강경하 상부 위절제술 3례 경험

조규석,김형철,박경규,이문수,송옥평,임철완,신웅진,주종우,유기원 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Background : The reported incidence of early gastric cancer located in the upper portion of the stomach has been increasing with the recent advances in its diagnosis and screening. Recently, we have successfully performed laparoscopic assisted proximal gastrectomy and gastric tube reconstruction without pyloroplasty on three patients with early gastric carcinoma localized to the upper third of the stomach. We describe our modification of this procedure in this report. Method : After creating an surgical pneumoperitoneum, the stomach was mobilized using laparoscopic coagulating shears. Upper half of the greater curvature and three-quarters of the lesser curvature were then dissected along with regoinal D2 lymphadenectomy. This was followed by a 5 cm, longitudinal mini-laparotomy in the upper abdomen, and the construction of the exteriorized stomach with a gastric tube measuring 20 cm long and 4 cm wide. Reconstruction with an esophagogastrostomy was performed using a circular stapler. Result : No post-operative morbidity or mortality was observed in this small series of patients. The average operative time was 250 minutes (range 220-300 minutes), and the average blood loss was 150 ml (range 90-180 ml). The mean number of lymph nodes harvested during these laparoscopic proximal gastrectomies was 24 nodes (range 22-25 lymph nodes). The average postoperative hospital stays was 7.5 days (range 7-8 days). Conclusion : Our technique of laparoscopic assisted proximal gastrectomy and gastric tube reconstruction without phloroplasty offers a minimally invasive technique with the potential of impoving the post-operative quality of life patients with an early-stage proximal gastric cancer.

다발성 대장암 간전이 환자의 간절제를 위한 새로운 시도

주종우,김형철,임철완,신응진,조규석,유기원,송옥평,홍대식,박성진,조준희,이혜경,김희경,권계원,고은석 순천향의학연구소;Soonchunhyang Medical Research Institute 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Multiple bilobar liver matastases (MBLM) are the main cause of low resectability in the colon cancer liver metastases. The authors experienced one case of initially non-resectable colon cancer liver metastases. He was curatively and safely treated with a two-stage hepatectomy using the new method of future remnant liver volume growing. A 54-year-old man was referred to our department with the sigmoid colon cancer combined with MBLM, which were checked in two small metastatic lesions in the left lobe and five large sized lesions in the right lobe in the computed tomogram (CT). A laparoscopic assisted anterior resection was primarily performed. We performed the 1^(st) stage hepatectomy 3 weeks after the colon resection. Intra-operative Ultrasonogram (US) found 9 small superficial metastatic lesions in the left lobe. All that lesions were completely removed by non-anatomical wedge resection. An occlusion ballon catheter was placed in the right portal vein through a small branch of the inferior mesenteric vein at that time. The future remnant liver volume was sufficiently increased 3 weeks after the 1^(st) hepatectomy. A right hepatectomy was safely performed 22 days after the 1^(st) hepatectomy. The patient received a regional chemotherapy (interleukin2 based immuno-chemotherapy through hepatic artery) for 4 months, then received 9 cycles of systemic chemotherapy (biweekly Oxaliplation, leucovorin, plus 5-fluorouracil) without any recurrence evidence.

도플러지수를 이용한 급성 심근경색증의 진단에 있어 노인 환자의 특징

김원,조규종,오세현,이영수,이은주,홍진숙,김영득,현석천,임경수 대한노인병학회 2000 Annals of geriatric medicine and research Vol.4 No.4

범하수체 기능저하증을 동반한 일차성 중추성 림프종의 1예

김원영,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

A primary central nervous system lymphoma(PCNSL) is defined as a lymphoma limited to the cranial-spinal axis without systemic involvement. PCNSLs were formerly very rare, only 0.5∼ 1.2% of all intracranial neoplasms, and were usually associated with acquired immuno-deficiency syndrome(AIDS) and other immune-compromised states. Recently, there has been a clear rise in the incidence of this disease among normal individuals. We describe a 77-year-old female with hyponatremia who presented with a confused mental state. Computed tomography(CT) of the brain demonstrated a suprasellar mass with enhancement. We evaluated the basic hormonal studies and the magnetic resonance imaging(MRI). A ventricular biopsy was done, and the result was a diffuse, large, B-cell-type malignant lymphoma. She presented panhypopituitarism and partial central diabetes insipidus. She received chemotheraphy and was discharged in an improved condition. We report a case of panhypopituitarism due to PCNSL and give a review of the literature.

특발성 자발성 신장 파열 1예

윤재철,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

Primary aldosteronism is a syndrome characterized by hypertension, hypokalemia, suppressed plasma renin activity, and elevated serum aldosterone levels. Conn first described it 1955 in association with adrenal cortical adenoma(Conn's syndrome). Today, it can be divided into at least six distinctive sub-groups. The diagnosis of primary aldosteronism is usually suspected when the patient presents with poorly controlled hypertension with hypokalemia. The main issues in the evaluation of primary aldosteronism are to differentiate an adenoma from hyperplasia and to localize the adenoma. Basic hormonal studies and computed tomographic(CT) scanning can be used effectively for that differentiation. An adenoma is one of a few potentially curable forms of hypertension, and it is best treated by removing the adrenal tumor. We experienced a case of a typical adrenal adenoma. The patient was a 37-year-old male who had experienced in both his legs over a period of several days a weakness due to hypokalemia. He was diagnosed using basic hormonal studies and adrenal CT scanning. After, he received laparoscopic adrenalectomy and was discharged with improved condition.