企業生産性 測定方法

金承來(Seung-Lae Kim) 강원대학교 사회과학연구원 1984 사회과학연구 Vol.20 No.-

Sequential ¹H MR Spectroscopy(MRS) Studies of Kaolin-Induced Hydrocephalic Cat Brain

김명진,황성규,황정현,장용민,김용선,김승래,Kim, Myung Jin,Hwang, Sung Kyoo,Hwang, Jeong Hyun,Chang, Yongmin,Kim, Yong Sun,Kim, Seung Lae The Korean Neurosurgical Society 2000 Journal of Korean neurosurgical society Vol.29 No.11

목 적 : 실험적으로 유발된 고양이 수두증 모델을 통하여 양자 자기공명 분광상의 수두증에서의 임상적 적응과 경시적 뇌 대사산물의 변화를 규명하는데 목적이 있다. 대상 및 방법 : 30마리의 고양이에서 뇌대조내에 kaolin을 주입후 수두증을 유발한후 양자 자기공명 분광상을 이용하여 kaolin 주입전, 주입후 1, 3, 7, 14, 21, 28일째에 주요 대사산물인 N-acetyl aspartate(NAA), creatine(Cr), choline (Cho), lactate(Lac)의 분광상을 분석하였다. 결 과 : 30마리의 고양이에서 모두 수두증이 유발되었고, 급성기에 NAA/Cr비가 감소하는 소견보였으며, 1마리에서 lactate peak이 관찰되었다. 만성기(>14 days)까지 생존한 4마리의 고양이에서 NAA/Cr비의 증가가 관찰되었으며 이는 임상적 증상의 회복과 상응하는 결과를 나타내었다. 결 론 : Kaolin 유발 수두증모델에서 양자 자기공명 분광상은 급성기의 진단적 정보의 제공과 수두증에서의 뇌대사 및 생화학적 결과를 반영해 준다. 그리고, 급성기에서 lactate peak없이 NAA/Cr비의 감소와 만성기의 NAA/Cr비의 회복은 수두증으로인한 뇌실질의 손상이 신경세포 자체보다는 축색손상을 의미한다. 급성기말까지 초기 NAA/Cr비 감소가 회복없이 lactate peak이 동반되는 경우는 불량한 예후인자가 된다. 만성기의 NAA/Cr비의 정상화는 NAA/ Cr비의 감소를 보이는 뇌피질위축의 경우와의 감별진단에 실마리를 제공한다. Objectives : The aim of this study is to evaluate the sequential metabolic changes in experimental hydrocephalus and the clinical applicability to the diagnosis and prognosis of hydrocephalus using proton MR spectroscopy. Methods : Hydrocephalus was experimentally induced in 30 cats(2-3kg body weight) by injecting 1ml of sterile kaolin suspension(250mg/ml) into the cisterna magna. Proton MRS was performed with a 1.5 T MRI/MRS unit (Vision Plus, Siemens) at pre-treatment and at 1, 3, 7, 14, 21, and 28 days after the kaolin injection. PRESS(TR/TE=1500/270msec) technique was employed. The major metabolites which include N-acetyl aspartate (NAA), creatine(Cr), choline(Cho), and lactate(Lac) were quantitatively analyzed and the relative concentrations ratios were evaluated. Multislice $T_2$-weighted images were also obtained using fast spin echo sequence(TR/TE= 2500/96msec) to monitor the morphologic changes along with progression of hydrocephalus. Results : Hydrocephalus was successfully induced in all 30 cats. Twenty five cats died within 3 days and one at the end of the second week. In all animals, the NAA/Cr ratios initially decreased during the acute stage. In 4 surviving cats, the NAA/Cr ratios initially decreased during the acute stage(<14 days) and then gradually increased to the prekaolin level as follows : pre-kaolin($1.49{\pm}0.04$), day 1($1.11{\pm}0.07$), day 7($1.17{\pm}0.04$), day 14($1.40{\pm}0.03$), day 21 ($1.46{\pm}0.06$), day 28($1.43{\pm}0.03$). These levels were relatively well correlated with the symptomatologic improvement. Lactate peak, which reflects the evidence of ischemia, did not appear throughout the entire period except in one case which expired at the end of the second week. Conclusions : The NAA/Cr ratio of the sequential proton MRS in kaolin-induced hydrocephalic cats reflects a metabolic aspect of the hydrocephalus at each stage. A decreased NAA level at the early stage is from both neuronal and axonal damage which may provide diagnostic information in the acute stage of hydrocephalus. In addition, the initial fall of NAA/Cr ratio and recovery in the late stage, when no lactate peak emerges, may suggest that the main insult of the parenchyma is not to the neuron itself but to the axon, which may be related to a good prognosis. However, emergence of the lactate peak and unrecoverable NAA/Cr at the end of the acute phase may be a poor prognostic factor. In the chronic stage, recovery of NAA/Cr ratio may provide a diagnostic clue for the differentiation between hydrocephalus and cortical atrophy.

제 1, 2 경추간 판하철사고정술 없는 후방 경관절 나사못 고정술 및 골유합술

신용환,황정현,성주경,황성규,함인석,박연묵,김승래,Shin, Yong Hwan,Hwang, Jeong Hyun,Sung, Joo Kyung,Hwang, Sung Kyu,Hamm, In Suk,Park, Yeun Mook,Kim, Seung Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objective : The goal of this study was to evaluate the clinical outcome of the posterior C1-2 transarticular screw fixation without C1-2 sublaminar wiring in atlantoaxial instability. Methods : Between Apr. 1995 and Feb. 2000, we used this technique in treat randomly selected 17 patients (11 men, 6 women) who had atlantoaxial instability. The causes of instability were : type II-A odontoid process fracture(10 cases) ; type II-P odontoid process fracture(1 case) ; Os odontoideum(2 cases) ; transverse ligament laxity due to rheumatoid disease(1 case) ; and, transverse ligament injury without bone fracture(3 cases). All cases were operated with posterior C1-2 transarticular screw fixation with 3.5mm cortical screw and interlaminar iliac graft without sublaminar wire fixation. The mean follow-up period was 28 months(5 to 58 months) and the mean age at the time of operation was 41 years(15 to 68 years). All Patients were allowed to ambulate with Philadelphia neck collar on the first post-operation day. Results : Bony fusion was successfully achieved in all cases demonstrated at 3-month follow-up studies. There was no operative mortality or morbidity. Conclusion : The authors conclude that the posterior transarticular screw fixation without C1-2 sublaminar wiring provide adequate stability with high bony union rate in atlantoaxial instability of various causes.

뇌동맥류 수술 환자에서 급성 수두증 병발후 단락술이 요하는 만성 수두증 합병의 임상적 및 형태학적 비교

신용환,황정현,함인석,성주경,황성규,박연묵,김승래,Shin, Yong Hwan,Hwang, Jeong Hyun,Hamm, In Suk,Sung, Joo Kyung,Hwang, Sung Kyoo,Park, Yeun Mook,Kim, Seung Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objectives : The incidence of acute hydrocephalus(AHC) after aneurysmal subarachnoid hemorrhage reported as 13-31%. The AHC resolves spontaneously in some cases(simple AHC), but about 30% of the AHC progresses to shunt-dependent hydrocephalus(SDHC). The aim of this study was to understand clinical predisposing factors causing SDHC with performing differential clinical analyses between 2 subgroups, the simple AHC and the progresed SDHC. Methods : The 250 surgically treated patients with aneurysmal SAH over last two years were evaluated. Forty four patients(17.6%) of them showed the AHC. Of theses 37 cases were retrospectively analyzed, excluding 7 patients who died within 2 weeks after hemorrhage attack. Of the 37 AHC cases, 21 patient(56.8%) were complicated with the simple AHC, and 16 cases(43.2%) were progressed SDHC. Results : The older age(p<0.05), poor clinical grade(p=0.03), larger amount of SAH in perimesencephalic cistern on CT scan(p=0.005) were significantly related to the SDHC. No significant difference was noted in aneurysm location, multiplicity, rebleeding, hypertension and Fisher grade between 2 subgroups. Conclusion : Of the total 37 AHC, the simple AHC was 56.8% and the progressed SDHC 43.2%. The older age, poor clinical grade, large amount of SAH in perimesencephalic cistern were significant predisposing factors causing the SDHC. The large amount of SAH in perimesencephalic cistern is the single most important predisposing factor developing the progressed SDHC.

대뇌 신경교종증 : 임상특징 및 예후에 관한 연구

조대철,황정현,성주경,황성규,함인석,박연묵,변승열,김승래,Jo, Dae-Chuol,Hwang, Jeong-Hyun,Sung, Joo-Kyung,Hwang, Sung-Kyu,Hamm, In-Suk,Park, Yeun-Mook,Byun, Seung-Yul,Kim, Seung-Lae 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Objectives : Gliomatosis cerebri is an uncommon primary brain tumor characterized by diffuse neoplastic proliferation of glial cells, with the preservation of the underlying cytoarchitecture. The aim of this study is to evaluate clinical features, outcome of surgical treatment and adjuvant therapy of gliomatosis cerebri. Methods : Between Jan. 1990 and Dec. 2000, 12 patients were diagnosed with gliomatosis cerebri based on characteristic radiological and histological findings. The patients' age ranged from 18 to 77(mean 44) years and the male to female ratio was 7 : 5. Nine patients underwent decompressive surgery and three, biopsy only. Postoperative radiation therapy was given in all cases except three. In addition to radiation therapy, four patients received chemotherapy. The mean duration of follow-up period was 18.8 months. Results : The most common presenting symptom were seizure and motor weakness. The mean duration of symptom was 5.9 months. There was 5 bilateral lesions and tumor involved corpus callosum in 5, basal ganglia-thalamus in 4, and brain stem in 2. There was no operative mortality but four patients died during the follow-up. The mean survival period for 11 patients was 20.5 months from the time of diagnosis. In univariate analysis, the lesion involving corpus callosum, basal ganglia-thalamus and brain stem correlated significantly with the short length of survival(p<0.05). Also, postoperative radiation as a adjuvant therapy prolonged the patient's survival(p<0.05). Conclusions : In the management of gliomatosis cerebri patients, early detection by MR imaging, active management of increased intracranial pressure, decompressive surgical removal and postoperative adjuvant therapy such as radiation is thought to be a good treatment modality.

자발성 척수내혈종 - 증례보고 -

황정현,성주경,황성규,함인석,박연묵,김승래,Hwang, Jeong Hyun,Sung, Joo Kyung,Hwang, Sung Kyoo,Hamm, In Suk,Park, Yeun Mook,Kim, Seung Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Hematomyelia is an extremely rare condition that cause severe neurological symptoms. We reported 4 cases of spontaneous hematomyelia, two cases of cavernous angioma and two cases of hematoma. In all patients, the clinical course was progressive ; motor and sensory abnormalities below the lesion and voiding difficulties were the common presenting symptom complex. The preoperative diagnosis was made by magnetic resonance imaging and the all patients underwent surgical exploration. Complete removal of hematoma was done in 3 patients and complete evacuation after aspiration of hematoma were performed in one patients. Neurological function did not worsen postoperatively in any patients. The early diagnosis with magnetic resonance imaging and immediate surgical treatment of the hematoma and the associated vascular malformation are considered to be the best way to halt the progression of the disease.

제 II 형 치상돌기 골절에서 전방경유 나사못 고정술

김명진,황정현,성주경,황성규,함인석,박연묵,김승래,Kim, Myung-Jin,Hwang, Jeong-Hyun,Sung, Joo-Kyung,Hwang, Sung-Kyu,Hamm, In-Suk,Park, Yeun-Mook,Kim, Seung-Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.11

Objective : The aim of this study is to evaluate clinical outcome of anterior screw fixation for type II odontoid fractures for the prliematim of atlanatoaxial mobility. Methods : Between 1995 and 1999, we treated 15 cases of type II odontoid fractures by anterior screw fixation among 44 cases of odontoid fractures. Thece included 14 males and 1 female aged from 23 to 63 years, with a mean age of 39.7 years. The causes of trauma were traffic accident in 13 cases, slip down in 1 and fall down in 1. The fracture type was type II-P in 7 cases, type II-A in 3, type II-N in 2 and type II-A and P in 3. The fracture line was oblique downward and backward in 6 cases, oblique downward and forward in 3 and horizontally in 6. The range of follow up was 4 to 47 months(mean 26.5 months). Results : Adequate reduction and fixation were obtained in 12 cases. Three cases in which fracture type and line were type II-A and oblique downward forward were failed, so posterior transarticular screw fixation was performed. All except 3 failed cases had adequate cervical movement and stability. There were no operative mortality nor morbidity. Conclusion : Anterior screw fixation provides the best anatomical and functional results for type II odontoid fracture with intact transverse ligament when fracture line is horizontal or oblique downward and backward. But it is limited when fracture line is oblique downward and forward.

The Contributory Factors of CSF Shunt Failure

김영돈,황성규,황정현,성주경,함인석,박연묵,김승래,Kim, Young Don,Hwang, Sung Kyoo,Hwang, Jeong Hyun,Sung, Joo Kyung,Hamm, In Suk,Park, Yeun Mook,Kim, Seung Lae The Korean Neurosurgical Society 2001 Journal of Korean neurosurgical society Vol.30 No.1

목 적 : 뇌실 복강간 단락술 부전의 기여인자를 조사 및 분석하여 뇌실 복강간 단락술의 합병증 및 재수술의 가능성을 줄이는 데에 목적이 있다. 대상 및 방법 : 1995년 1월부터 1998년 12월까지 본원에서 뇌실 복강간 단락술을 시행 받은 237명의 수두증 환자를 후향적 방법으로 고찰하여 뇌실 복강간 단락 부전의 기여인자 및 단락기 생존율을 통계학적으로 분석하였다. 결 과 : 수두증의 원인은 종양, 출혈, 감염, 선천성 기형, 정상 뇌압 수두증, 외상 등이었다. 68명의 환자에서 109회의 재수술이 이루어졌다. 재수술의 이유는 폐색, 근위부 카세타의 위치이상, 감염 등이었다. 단락기 생존율은 1년, 2년, 3년에 각각 77.1%, 75.4%, 74.1%이었다. 10세 이하의 환자에서 재수술의 빈도가 통계학적으로 의의 있게 높았다. 그리고 수두증의 원인에 따라서 통계학적으로 의의 있게 재수술의 빈도 차이가 있었다. 결 론 : 대부분의 뇌실 복강간 단락 부전은 술후 1년내에 발생하였다. 환자의 나이 및 수두증의 원인이 뇌실 복 강간 단락 부전의 주요 기여인자였다. To investigate contributory factors of CSF shunt failure, 237 patients, who underwent shunt placement from January 1995 to December 1998 at our hospital, were reviewed retrospectively. The causes of the hydrocephalus were tumor, hemorrhage, infection, congenital anomaly, normal pressure hydrocephalus, trauma and others. One hundred nine revisions of CSF shunting were done during follow up periods. The causes of shunt revisions were mechanical obstruction, malposition, infection and others. The contributory factors of CSF shunt failure and shunt survival rate were analyzed using SPSS. The shunt survival rate at 1, 2 and 3 years after procedure was 77.1%, 75.4%, 74.1% respectively. In the young age group below 10 years old, postinfectous hydrocephalus was the most common high risk factor for shunt revision. In conclusion, the most shunt failures developed in the first year after surgery and the age and causes of the hydrocephalus were major determinant factors of shunt revision.

백서의 가역성 뇌허혈 모형에서 저체온의 효과와 적용시기

최병연,정병우,송광철,박진한,김성호,배장호,김오룡,조수호,김승래,Choi, Byung-Yon,Jung, Byung-Woo,Song, Kwang-Chul,Park, Jin-Han,Kim, Seong-Ho,Bae, Jang-Ho,Kim, Oh-Lyong,Cho, Soo-Ho,Kim, Seung-Lae 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.2

Objective : We studied to clarify the effective time zone of mild hypothermic neural protection during ischemia and/or reperfusion after middle cerebral artery occlusion. Methods : In a reversible cerebral infarct model which maintained reperfusion of blood flow after middle cerebral artery occlusion for two hours, the size of cerebral infarction, cerebral edema and the extent of neurological deficit were observed and analyzed for comparison between the control and the experimental groups under hypothermia($33.5^{\circ}C$). The temporalis muscle temperature was reduced to $33.5^{\circ}C$ by surface cooling for two hours during middle cerebral artery occlusion for study group I. The following groups applied hypothermia for two-hour periods after reperfusion : group II(0-2 hours), group III(2-4 hours), and group IV(4-6 hours). They were rewarmed to $36.5^{\circ}C$ until sacrified at 2, 4, 6, 12, and 24 hours after reperfusion. Control group was maintained at normothermia without hypothermia. Results : In the experimental groups with hypothermia, the average value of the size of cerebral infarction($mean{\pm}SD$) was $1.97{\pm}1.65%$, which was a remarkable reduction over that of the control, $4.93{\pm}3.79%$. In the control, a progressive increase was shown in the size of infarction from point of reperfusion to 6 hours after reperfusion without further changes in size afterward. Intra-ischemic hypothermia(group I) prevented ischemic injury but did not prevent reperfusion injury. Group II examplified the most neural protective effect in comparison to the control group and group IV(p<0.05). The cortex was more vulnerable to reperfusion injury than the subcortex. Mild hypothermia showed more neural protective effects on the cortex than subcortex. Conclusion : The most appropriate time zone for application of mild hypothermia was defined to be within four hours following reperfusion.

韓國産 家兎에서 얻어진 補體의 人間組織適合性 抗原試驗에의 適用

孫壽相,鄭泰浩,金乘來 啓明大學校 醫科大學 1985 계명의대학술지 Vol.4 No.1

본 연구는 한국산 백색가토에서 얻어진 보체를 조직 직합성 항원(HLA)시험에 사용하기 위해 시도되었다. 30필의 가토 혈청을 정상인 임파구와 작용시킨 미특이성 세포독성검사에서 15필에만 음성을 나타내었고 음성을 표시한 가토 혈청의 적혈구 항체를 사용한 보체역가 CH50은 평균 0.29이였다. 이들 혈청들을 HLA시험에 적용한 결과 15개 표본중 13개에서 1:1과 1:2 희석에서 A, B, C, loci시험판에 사용이 가능하였으며 시험혈청 8번은 특히 DR loci용 시험판에 사용할 가치가 있었다. 한편 이들 성적은 미국 Fel-Freezer 회사나 일본 에이겐사의 상업용 보체혈청을 사용하였을 때와 유의한 차이는 보이지 않았다. 따라서 평균 체중 2.5㎏ 정도의 한국산 가토에서 채혈하여 적혈구 항체의 CH50의 평균이 0.2~0.3을 표시하고, 인간 임파구에 대한 비 특이성 세포독성을 표시하지 않는 혈청은 적당한 ABC loci를 갖는 시험판과 DR loci시험판을 사용하여 일차적으로 HLA시험을 거쳐 적당한 혈청들을 모으면 능히 HLA시험용보체 혈청이 될 것으로 판명되었다. This study was carried out to determine the usability of Korean albino rabbit serum as a complement in the test of HLA. Thirty albino male rabbits, weighing 2.5kg were purchased from the market. They were kept in an outdoor rabbit kennel and were fed ordinary diet for 30 days. Each was fasted overnight prior to bleeding of 20ml from ear vein. The blood samples were clotted separately to avoid hemolysis. The serum was centrifuged at 4℃ for removal of residual RBC and stored at -70℃. No special treatment was given during and handling. Fifteen rabbits of negative antihuman factors tested by microcytotoxicity test were selected for this experiment. Average CH50 of the 15 rabbits was 0.29. Among these 15 rabbits serum, 13 sample showed positive at the dilution of 1:1 and 1:2 through the microcytotoxicity test of Terasaki with ABC tray. Two rabbit serum showed availability as a complement for DR tray. In accordance with this result, it was suggested that Korean albino rabbit serum could be used as a complement for HLA test.