60세 이상에서 불안정 요추로 인한 척추경나사못 고정술 후 추적관리

지용철,이시우,최은석,손병길 대한신경외과학회 1999 Journal of Korean neurosurgical society Vol.28 No.8

小兒의 頭腔內 發生한 巨大髓膜腫

池溶哲,朴淵默,曺守鎬,金乘來 慶北大學校 醫科大學 1979 慶北醫大誌 Vol.20 No.2

저자들은 지난 4년동안 경북대학병원 신경외과에 입원한 소아에서 수막종의 발생부위와 거대종양으로 인하여 완전절체가 불가능 하였던 매우드문 섬유아세포성 거대수막종(Fibroblastic giant meningioma) 2예를 수술, 치험하였기에 보고한다. Two rare cases of large, solid fibroblastic meningiomas in children are presented. The first case was a 6 year-old boy whose tumor was originated from tuberculum sellae extending to subfrontal and suprasellar region and it showed partial cystic degeneration. Another case was a 14 year-old boy whose tumor originated from falx cerebri and tentorium cerebelli. Neurological symptoms and signs have been reviewed. In both cases, these huge tumors could not be removed completely due to its anatomical location. However, we were able to resect almost completely by piecemeal technique. Postoperatively, neurological symptomes and signs were not worsened, compared to preoperative states.

흰쥐의 지연성 국소 뇌경색기 세포고사와 p53의 지역적 발현양상과 성별에 따른 차이

지용철,박승원,김영백,황성남,최덕영,민병국,권정택,김미경,석종식 중앙대학교 의과대학 의과학연구소 1999 中央醫大誌 Vol.24 No.1

Apoptosis is known to be responsible for numerous physiologic and pathologic events in the live body. Recently, it is also known to play an important role in the mechanism of delayed cerebral infarction. In this study, we wanted to know that the P53 gene and apoptosis related with delayed focal cerebral infarction and gender difference. So we made a delayed focal cerebral infarction in rat brain and measured cerebral infarction volume and counted the number of apoptotic and P53 positive cells in the infarct core and the peri-infarct zone in both sexes. Eighteen Sprague-Dawley rats(9 males and 9 females) underwent right middle cerebral artery ligation with 10-0 nylon followed by temporary clamping of bilateral common carotid arteries for 30 minutes and then released for reperfusion. After seventy- two hours of operation, the whole brain were stained with 2,3,5-triphenyltetrazolium chloride to measure infarction volume. We also performed immunohistochemical staining for apoptosis and P53 and measured the number of positive cells (cell/HPF) and the thickness positive areas. The infarction volume of the males (11.3±2.2㎣) was significantly larger than that of the female(7.2±1.2㎣). The munber of apoptotic and P53 positive cells were not different between sexes but the apoptotic and the P53 positive areas in males rats were significantly larger than those in female rats(p<0.05). The authors concluded that the planimetric expression of apoptosis and P53 protein at delayed focal cerebral infarction related to gender difference and that it seemed to be one of important causes of gender difference.

편측 후방경유법을 이용한 제5요추체 신경초종의 제거 및 척추체 재건술

지용철,김영백,박승원,황성남,최덕영,석종식 중앙대학교 의과대학 의과학연구소 1999 中央醫大誌 Vol.24 No.1

We are reporting here one case of large schwannoma which replaced entire cancellous portion of the fifth lumbar vertbral body. The patient was a 60-year old woman who presented with longstanding low back pain which was gradually accompanted by radiating pain on her left leg. Unilateral pediculectomy and partial corpectomy was done to remove the tumor. After the bone graft pedicle screw fixation was done from the third lumbar vertebra to the first sacral bone for reinforcement. At discharge she had no neurologic deficit and solid fusion of the area was confirmed radiologically one year later.

요추간판 미세 현미경 수술 후 재입원 환자의 분석

지용철,손병길,최은석,이시우,신종현,차영훈,Chi, Yong-Chul,Son, Byung-Gil,Choi, Eun-Seok,Lee, Si-Ou,Shin, Jong-Hyun,Cha, Young-Hoon 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Objectives : After lumbar microdiscectomy there are relatively higher incidence of readmission because of various postoperative discomfort. Analyzing these readmitted patients in our private hospital where the patients can be readmitted more easily, we expect to find out which factors are associated with improvement of the surgical outcome. Patients and Methoes : After discharge all significant patient's clinical data were registered to our computerized data bank system and periodic follow-up were performed. The authors analysed 651(97.7%) cases followed up over 2 years(average 3 years) out of 666 patients who underwent a initial lumbar microdiscectomy from May, 1994 to April, 1997. Among them, 63 patients(9.7%) were readmitted. Results : Among the patients readmitted, 29 patients(4.5%) were reoperated because of recurred disc herniation, 17 patients were myofascial pain syndrome, 4 patients were discitis, 3 patients were adhesion and one patient was epidural abscess. Treatment results of these readmitted patients showed that success rate of all readmitted patients was 68.3%, reoperation was 58.6% and myofascial pain syndrome was 82.4%. Conclusion : Treatment results of the patients readmitted because of a continuous lumbago or leg pain after microdiscectomy were acceptable through the careful analysis of the causes of the recurrent symptom. Therefore, the incidence of the chronic failed back syndrome can be reduced by efforting a more active management through readmission.

開頭術時 自家輸血法의 適用 : Perioperative Blood Collections and Acute Hemodilution

池溶哲,金相喆,金乘來 慶北大學校 醫科大學 1979 慶北醫大誌 Vol.20 No.2

뇌지주막하 출혈을 일으킨 뇌동맥류 환자 29명중 16명과, 뇌종양환자 5명에서 개두술시 마취상태에서 수술직전에 채혈한 동맥혈액으로써 수술중에 자가수혈법을 적용하고, 13명의 뇌동맥류 환자를 대조군으로 하여 결과를 비교 관찰하였다. 대조군 13명의 동맥류환자에서 hemoglobin과 hematocrit의 평균치는 개두술전이 각각 12.5gm%, 40%이었고, 수술후가 각각 12.2gm%, 39%로써 수술동안 공혈자에 의한 저장혈액을사용한 평균 수혈량은 1104ml였다. 자가수혈균 16명의 동맥류 환자에서 hemoglobin과 hematocrit의 평균치는 자가수혈을 위한 동맥혈액의 채혈전이 각각 12.6gm%, 38%이었고, 평균 채혈량 850ml를 채혈한 후 각각 9.6gm%, 28%로써 저하되었다. 수술동안 자가수혈법의 적용과 공혈자에 의한 저장혈의 평균 수혈량이 438ml의 보충으로써 수술직후 hemoglobin과 hematocrit의 평균치는 11.9gm%, 37%로써 채혈전 hemoglobin치와 hematocrit치에 도달하였으며 대조군에서 사용한 저장혈액의 수혈량과를 비교할 때 약 60%가 절약되었다. 5명의 뇌종양 환자중 2명의 뇌하수체 종양환자에서는 개두술시에 저장혈액을 전혀 사용하지 않고도 수술을 할 수 있었다. Autotransfusion has been known to have many benefits in patients who might have anticipated or unanticipated hemorrhage during elective or emergency surgical procedures. Thirty-four patients were enrolled in this study; 29 patients with intracranial aneurysms with subarachnoid hemorrhage and 5 patients with intracranial tumors. Sixteen aneurysmal patients were randomly selected for autotransfusion group, whose hematocrit value ranged between 21 to 39% after aspiration of mean arterial blood volume of 850ml. for autotransfusion, and 13 patients were given only homologous banked blood during surgical operation as control group. During surgical operation for direct clipping on aneurysmal neck and partial or complete resection of tumors in autotransfusion group. autotransfusion was applied by the method of perioperative blood collection and acute hemodilution of 30% hematocrit value. In 13 control aneurysmal patients who needed homologous banked blood during surgical operation to maintain normal blood pressure and intravascular blood volume, average mean volume of banked blood required was 1104ml. In 16 aneurysmal autotransfusion group. it was only 438ml of banked blood, and furthermore in 4 patients among them, homologous banked blood was not needed at all. In 2 patients with pituitary adenoma among 5 patents of intracranial tumors, no homologous blood transfusion was necessary.

두위변동에 따른 생체징후, 뇌관류압 및 뇌압의 변화에 관하여

지용철,배장호,한동로,도은식,김오룡,최병연,조수호 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.5

Intracranial pressure was monitored in 23 patients, either who exhibited an increase in pressure or who were considered at risk for the development of intracranial hypertention. The intracranial pressure was measured while the patient was in the position from supine to 50 degree of head elevation. The intracranial pressure was decreased during head elevation, but 8 cases(34.8%) were not changed. The maximal cerebral perfusion pressure was seen at 50 degree of head elevation(52.2%), next 30 degree(21.7%) and 40 degree(17.4%) in orders. The changes of vital sign were not significant during head elevation. To control the intracranial pressure, the patient who where managed in the position of 30° and 50° head elevation showed most effective cerebral perfusion pressure without any significant changes of the vital sing and central venous pressure.

기관내삽관이 뇌압변동에 미치는 영향

김흥대,지용철 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

전신마취시 후두경의 사용과 기관내삽관이 혈압 및 뇌압을 상승시킬 수 있음은 잘 알려져 있으며 이는 이미 뇌압이 상승되어 있는 환자에게는 매우 위험할 수 있다. 따라서 저자들은 현재 통상 시행되고 있는 전신마취 유도방법인 thiopental, S.C.C., intubation 과정이 어느 정도의 뇌압상승을 유발시키는지를 알아보기 위하여, 뇌압측정장치가 되어있는 개두술 환자 13명에게 위와 같은 마취유도시 뇌압 및 동맥압의 변화를 측정하여 보았던바 뇌압은 7.1±7.23㎜Hg, 동맥압은 43.5±25.46㎜Hg, 뇌관류압은 33.3±27.53㎜Hg 상승되었다. 이러한 결과로 미루어 보아, 이미 뇌압이 상승되어 있는 환자의 마취유도 시에는 필히 마취유도에 따른 뇌압상승을 예방할 수 있는 처치를 강구해야만 할 것으로 사료된다. It is well known that intracranial pressure (ICP) and mean arterial pressure (MAP) are increased by laryngoscopy and endotracheal intubation during induction of general anesthesia, and it may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to konw the range of ICP increase during induction of the conventional general anesthesia with intubation following thiopental and succinylcholine injections. Intracranial pressure and MAP were measured in 13patients who underwent craniotomy. All the patients were monitored cerebral epidural ICP and intra-arterial pressure pre-operatively. The results were as follow: 1. Intracranial pressure was increased of 7.1 ±7.23㎜Hg. 2. Arterial pressure was increased of 43.5 ±25.46㎜Hg. 3. Cerebral perfusion pressure was increased of 33.3 ± 27.53㎜Hg. It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patients with increased ICP.

신바람 나는 십대-우리의 주인됨을 위해서

지용철 우리신학연구소 1996 갈라진 시대의 기쁜소식 Vol.- No.266

Clonidine이 고양이 척수후각세포의 Activity에 미치는 효과

지용철,김진혁,고상돈,신홍기,김기순,Chi, Yong-Chul,Kim, Jin-Hyuk,Koh, Sang-Don,Shin, Hong-Kee,Kim, Kee-Soon 대한생리학회 1988 대한생리학회지 Vol.22 No.1

Effect of clonidine on the dorsal horn cell responses to mechanical stimulations were studies in 3 spinalized cats and 10 cats with intact spinal cord. The type of dorsal horn cells was determined according to their response patterns to four graded mechanical stimulations (brush, pressure, pinch and squeeze) applied to the respective receptive fields. In the present study the results obtained only from the wide dynamic range (WDR) cells were included. The responses of the WDR cells to noxious mechanical stimuli were selectively suppressed following intravenous administration of clonidine into the experimental animals. The clonidine-induced changes in responses of the WDR cells to mechanical stimulation were not affected by naloxone or propranolol whereas effect of clonidine on WDR cell responses was almost completely abolished after intravenous administration of yohimbine. Also in the spinalized cats results parallel to those observed in cats with intact spinal cord were obtained. The results of present study strongly implies that analgesic action of clonidine can be mediated through excitation of ${\alpha}_{2}-adrenoceptor$ even at the spinal cord level without supraspinal mechanism.