실험적 급성 뇌혈상태에 대한 Calcium 갈항제와 Steroid의 효과

신규만,김성학 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.2

The purpose of this study to determine the therapeutic effect of nimodipine(N.P.) and methylprednisone(M.P.) on the changes of cytochrome oxidase activity(COA) and lipid peroxidation(L.P.) in the acute phase of focal cerebral cerebral sichemia. Acute focal cerebral ischemia was induced by transorbital occlusion of proximal part of the left middle cerebral artery(MCA) with Heifetz clip under the operating microscope. The experimental animals were devided into 6 groups. The occlusion group was that the acute focal ischemia was induced by 4-hour of occlusion of the MCA only. The circulation group was that of 2-hour recirculation after acute focal ischemia. The steroid treatment group was that of M.P(15㎎/㎏) initial intravenous injection at 30 minutes after occlusion and then repeated injection at intervals of one half hours. The N.P. treatment group was that of continuous intravenous N.P.(1μ㎏/min) infusion, initiated 30 minutes after induction of the ischemia. The combined treatment group was that was treated with intravenous infusions of M.P. as the same procedures with the M.P. and N.P. treatment groups. The sham control group was the animals with removal of the orbital contents with no occlusion of MCA. The results obtained were as follows : In the steroid treatment group COA was significantly increased to 189.76% and L.P. significantly reduced to 53.14% and the N.P. treatment groups COA was significantly increased to 170.88% and L.P. significantly reduced to 56.20% of the values of the occlusion group, respectively. In the combined treatment group COA was very significantly 220.35% and L.P. reduced highly significantly decreased to 48.85% of the values of the occlusion group. It can be concluded the above results indicate the therapy of N.P. combination with M.P. has the therapeutic effect in the management of acute focal ischemia of this cat model.

뇌하수체 선종의 외과적치료에 대한 연구

신규만 梨花女子大學校 醫科大學 醫科學硏究所 1990 EMJ (Ewha medical journal) Vol.13 No.4

The author has reviewed the results of microsurgical management in 56 patients with pituitary adenoma, In a series of 56 pituitary adenomas, 10(18%) were nonsecreting and 46(82%) produced hypersecretion syndrome : prolaction(34), human growth hormone(6), mixed prolactin and growth hormone(1), adrenocortcotropic hormone(5). The number of microadenomas were 6 cases. In the aspects of operative procedures the trans-sphenoidal procedure approach were given in 38(69%) cases and the transcranial approach in 18(31%) cases. In anatomic(radiographic and operative) classification, non-surprasella extension(5), occupies surprasellar cistern(27%), recesses of third ventricle obliterated(11), third ventricle grossly displaced(7) and parasellar extension(5) were observed. The overall morbidity and mortality were 3.6% and 10.7% respecterely.

척수내농양 : 1예 보고 Case report

신규만,계종수,최호익,이기찬,주정화 대한신경외과학회 1975 Journal of Korean neurosurgical society Vol.4 No.1

Intramedullary spinal cord abscess is rare condition, and that, the diagnosis of an abscess is rarely established before operative interference is indicated. A case of spinal cord abscess is reported upon 42 year-old male who was admitted to this hospital because of severe pain in the posterior lower neck and weakness in all 4 extremities. The patient have no history of infection or operation in recent past. On admission the subject was in state of quadriparesis, and the superficial sensory impairement was up to the level of T₁3 spinal dermatome. In an early course of the illness the motor weakness had started to appear in the left arm and the impairement of pain and temperature sensations in the right leg, indicating a picture of Brown-Sequard's syndrome. Radiographic examinations disclosed a localized enlargement of lower cervical canal with a widening of interpedicular distance and showed a defect and obstruction of dye column at C6 spinal level, which were suggestive of picture of intramedullary tumor. Operation the exposed spinal laminae and dura showed nothing abnormal, but the dura mater was under the great perssure. Opening the dura the spinal cord was swollen, tense and nonpulsatile with dusky red discoloration on a surface of the cord. Pus contents were obtained by needle aspiration and through a myelotomy opening the contents were evacuated completely. Culture of the pus contents produced no organisms. Pathology reported a nonspecific suppurative inflammation on the biopsy. The surgical treatment was combined with the administration of antibiotics, in full the-apeutic doses and steroid postoperatively. Two weeks after the surgery he showed significant recovery from the neurological dysfunctions in his legs.

실험적 급성 허혈성 뇌부종에서 포도당과 유산염함량의 변화와 이에 대한 Methylprednisolone 효과

신규만 梨花女子大學校 醫科大學 醫科學硏究所 1986 EMJ (Ewha medical journal) Vol.9 No.2

It is the purpose of this investigation to study the effect of methylprednisolone(M.P.) on the alterations of glucose and lactate in the acute focal ischemic cerebral edema of the cats. The acute occlusion of left middle cerebral artery(MCA) of forty cats for 1, 3 and 5 hours respectively were accomplished by applying the Heifetz clip through the transorbital approach under the operating microscope. Twelve cats were not recirculated as a untreated group, twelve cats were recirculated for 2 hours as a recirculation group and twelve cats were recirculated for 2 hours and given M.P.(15㎎/㎏) at 30 minutes after occlusion initially, and then every one and a half hour as a treatment group. In 1-hour untreated group glucose was reduced to 67.3% and lactate increased to 156.6%, of the sham control, in the recirculation group glucose was increased to 552.7% and lactate decreased to 79.8%, in the treatment group glucose was increased to 3334.5% and lactate decreased to 74.6% of the sham control. In 3-hour untreated group, glucose decrease to 45.5% and lactate increased to 161.3% of the sham control, in the recirculation group glucose rose to 520.0%, lactate to 135.3% of the sham control. in the treated group glucose rose to 1187.3%, lactate to 101.2% of the sham control. In 5-hour untreated group, glucose decreased to 25.5% and lactate increased to 187.9% of the sham control. In the recirculation group glucose drecreased to 12.7% and lactate increased to 196.0%, in the treated group glucose rose to 103.6%, lactate to 157.2% of the sham control. Our experimental studies of the therapeutic beneficial effects of M.P. were observed in cats of 1-or 3-hour occlusion of MCA with 2-hour recirculation. Therefore, it was suggested that MP will prolong the period of potential reversibility of cerebral ischemia following reperfusion within 3 hours of ischemia.

두뇌외상의 산염기및 가스대사장애에 관한 연구

신규만 고려대학교 의과대학 1974 고려대학교 의과대학 잡지 Vol.11 No.1

뇌동정맥 기형의 등급과 외과적 치료 성적

신규만 梨花女子大學校 醫科大學 醫科學硏究所 1997 EMJ (Ewha medical journal) Vol.20 No.2

Objectives : Arterovenous malformations(AVVMs) represent the most commonly encountered symptomatic vascular malformations in the field of vascular neurosurgery. Surgically accessible AVMs that present with hemorrhage should be removed to reduce the risk of subsequent hemorrhage. The advance of surgery is based on the size, location and pattern of venous drainage and these anatomic features influence the treatment risk. The author studied the above features for predictor of the surgical resection of AVMs. Methods : Nineteen patients(8 male and 11 female patients) with intracranial AVMs were treated at the Ewha Womans Medical Center between March 1989 and Dec. 1996. The mean age, and sexual ratio, of the pts as will as symptoms, location, feeding arteries, pattern of venous drainage and size of the nidus were studied. AVMs were graded according to the Spetzler and martin grade system. Overall outcome and postoperative results in eighteen patients were evaluated according to Glasgow Outcome SCale(GOS). Results : The average age at the time of treatment was 30.8 years old(range 4-55 years old). The hemorrhage was the most common symptom, occurring in 15(80%) patients, and 2(10%) patients presented with headache, 195%) patient with seizure, 1(5%) patient with neurological deficit. The feeding arteries were as the followings ; middle cerebral artery 8(42%), anterior cerebral artery 2(10%), posterior cerebral artery 1(5%), The pattern of draining veins were described into superficial and deep ; superficial 9(47%), deep 10(53%), The size of the nidus were as the followings ; small(<3cm) 9(47.5%), medium(3-6cm) 9(47.5%), large(>6cm) 1(5%), The Spetzler-Martin's grade and the outcome according to the grade were as follows ; gradeⅠ;3(17%) resulted GOS-5 3 patients, grade Ⅱ ;5(26%) did GOS-5 6 patients, grade Ⅲ; 5(26%) did GOS-5 4 patients and GOS-4 1 patient, grade Ⅳ;4(21%) did GOS-5 3 patients and GOS-4 1 patient, grade Ⅴ;1(5%0 did GOS-1 1 patient. Overall, there were no death in surgical treatment, patients, the morbidity value was 2(10%0 patients, the remainder were completely cured. Conclusion : The Spetzler-Martin grade Ⅰ-Ⅳ AVMs were associated with low rates of surgical morbidity and mortality, Therefore, surgery is the best treatment in the these grades.

실험적 급성 국소 뇌허혈에 대한 Mannitol, Steroid, Phenytoin 및 Barbiturates의 병합치료 효과

신규만,박동빈,김성학 梨花女子大學校 醫科大學 醫科學硏究所 1988 EMJ (Ewha medical journal) Vol.11 No.2

The authors have studied the therapeutic effect of the combinations of mannitol, methylprednisolone(MP), phenytoin and barbiturates on the acute focal cerebral ischemia (AFCI) in cats. The experimental animals were divided into three groups. Group I was the cats with the removal of the orbital contents without occlusion of MCA. Group Ⅱ was that of 2-hour recirculation after AFCI following the occlusion of MCA for 3 hours. Group C was subdivided into four subgroups as Group Ⅲ-a, Group Ⅲ-b, Group Ⅲ-c and Group Ⅲ-d. Group Ⅲ-a was that of treatment of combinations of mannitol and MP, Group Ⅲ-b that of combinations of mannitol and phenytoin. Group Ⅲ-c that of combinations of mannitol and barbiturates, and Group Ⅲ-d that of combinations of mannitol, MP (60mg/kg) phenytoin and barbiturate. As the biochemical studies cytochrome oxidase activities (COA) and the concentrations of lipid peroxidation(LP) were determined, and as the pathohistologic studies the degree of the infarcted areas, hemispheric swellings and the comparative microscopic findings of the infarcted areas were studied. In Group Ⅲ-a and Group Ⅲ-b no therapeutic effect on the AFCI was presented. In Group Ⅲ-c the partial effect of brain protection were demonstrated only in LP and the degree of hemispheric swelling, but Group Ⅲ-d provided nearly complete protection from ischemic damage. These experimental data suggested that the medical measures of the combinations of mannitol, MP, phenytoin and barbiturates can make the AFCI fully reversible and would applicable in the clinical field.

뇌동맥류 파열 후 뇌지주막하 출혈로 인한 신경학적으로 불량한 환자에 대한 급성기 수술의 성적

신규만,김명현,송준혁,김성학 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.2

Objective: Despite of recent advances in pharmacological treatment and improvement surgical and anesthetic techniques, subarachnoid hemorrhage(SHA) from ruptured intracranial aneurysms with poor clinical grades still carries unacceptably high morbidity and mortality rates. Recently surgery for aneurysmal SAH with poor clinical grade has increased interest. Method : The authors experienced 57 patients with poor clinical grade (Hunt and Hess grade Ⅳ-Ⅴ) after ancurysmal SAH. Among them 25 patients were treated with immediate CSF drainage via ventriculostomy, blood pressure control, early angiography(except 3 patients) and surgery within 12 hour of admission. The outcomes of patients were categorized using a four-tiered scale : 1) independent and working 2) impaired but independent 3) severly impaired and dependent 4) dead Results : The average age was 48(13-75) and the male to female ratio was 7:18 in surgical group. The average time to admission and surgery was 12 hours or less among the 25 patients. Among them 9 cases were dead, 2 cases were severly impaired and dependent, 3 cases were impaired but dependent, and 11 cases were independent and working. In this patient all cases, exception one could be ligated with a clip. Conclusion : The above results suggest that the acute aggressive surgery based on appropriate selection in poor aneurysmal SAH patients can reduce of the mortality.

실험적 국소 뇌허혈에 대한 재관류의 효과

신규만 梨花女子大學校 醫科大學 醫科學硏究所 1985 EMJ (Ewha medical journal) Vol.8 No.4

Focal cerebral ischemia initiates a series of event from the regional development of ischemic edema, loss of neural function and culminating in eventual infarction. The purpose of this study is to determine the effect of recirculation in acute focal cerebral ischemia. Sixty adult mongrel cats of either sex underwent production of focal ischemia by transorbital occlusion of the left middle cerebral artery with a Heifetz clip. The duration of ischemia was 1, 3 and 5 hours. In 5 animals in each group, the ischemic brain was reperfused for 1, 4 and 7 hours by removing the clip from the artery. It was observed that provided the restoration of cerebral blood flow in cats can be accomplished within 1 hour in cats or at least within 3 hours of the insult, the reversal of the neurological deficits and prevention of irreversible cerebral infarction can be expected. Therefore the prevention of cerebral infarction must first be directed toward improving blood flow during the insult as rapidly as possible to-minimize the time that cerebral blood flow is below threshold for the formation edema.

포진후 통증환자에 대한 신경차단술의 효능 : 예비적 보고

신규만,조도상,조용재,김명현,김상진,김성학 이화여자대학교 의과대학 2005 EMJ (Ewha medical journal) Vol.28 No.1

Objectives : Of all the chronic pain syndromes postherpetic neuralgia ranks the most refractory to treatment. The eight postherpetic neuralgia patients have been treated with nerve blocks or neurolysis and obtained good result. We evaluate the therapeutic effect of nerve blocks for postherpetic neuralgia and reviewed the pathology, clinical consideration, treatments and prevention. Materials and Methods : Eight patients with established postherpetic neuralgia enrolled in pain clinic of Mokdong Hospital of Ewha Womans University from March,2004 to December. Average age at 58 and about 63% of patients were over 68 years. Affected area of forehead was two patients. They have been treated with stellate ganglion block (SCB), two times supraorbital and supratrochlear nerves blocks and neurolysis with absolute alcohol. Face affected patient has was one and has been treated with 5 times SGB, 2 times supraorbital and supratrochlear nerves blocks, infraorbital and mental nerves blocks, and then 2times maxillary and mandibular nerves blocks. Chest affected two patients were treated with intercostal nerve blocks. Thoracic wall affected one patient received 2 times thoracic epidural blocks and thoracic nerve block. Scapalur and thoracic wall affected patient has been treated with SGB and 2 times thoracic epidural block. The chest and thoracic wall affected patient received 10 times intercostal blocks,2 times thoracic epidural blocks,3 times thoracic root block and neurolysis of intercostal nerves with absolute alcohol. The injected agents were 1% mepibacaine or 0.25% mercain heavy and methylprednisolone succinated, and at weekly intervals the agents were injected. Results : All patient having been treated with nerve blocks were free of pain at 3-9 months. Conclusion : Although no controlled trial has been done of nerve blocks to treat postherpetic neuralgia, this technique is safe in experienced hands and, if effected, may be repeated. It suggested that local anesthetics and steroid are the effective components in nerve blocks. Data on the relief of acute pain with nerve blocks, however cannot be extrapolated to predict the prevention of postherpetic neuralgia. The best way to prevent herpes zoster becasuse of post herpetic neuralgia is so difficult to treat.