지속적 정량 주입법에 의한 뇌척수액 유출저항 측정의 실험적 고찰

박윤관,오우석,정용구,정흥섭,서중근,이훈갑,주정화,이기찬 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.4

The author has performed the experimental study to define the validity of the constant infusion technique used in determining the outflow resisitance(Ro) of cerebrospinal fluid(CSF). The reduced formula of the constant infusion technique in clinical setting assume that the initial resing Ro and the post-infusion equilibrium Ro are equal, which means that the Ro value in constant regardless of CSF pressure or infusion rate. Although this assumption allows such measurement to be simply and readily applicable in clinical situation, these two Ro values are practically different. So the effect of such assumption on calculated Ro data has been investigated. Using 2 different methods Ro was measured simultaneously on each of 20 adult cats ; one method was clinically using reduced formula(RoFc) andthe other, derived from the data of CSF fromation rate which was calculated by modified Masserman's method(RoFm). Constant infusion was performed with varying state of infusion(0.01 to 0.2m/min). Mean values of resting CSF pressure and superior sagittal sinus pressure were 8.8±2.9㎜Hg and 5.7±1.2㎜Hg respectively. Mean calculated rate of CSF formation of integrative modifiying Massereman method was 0.0183±0.003㎖/min. The maximum Ro was achieved between the rate of infusion of 0.02 and 0.03㎖/min and achieved between the range of CSF pressure of 14 and 18㎜Hg. Either in level of low CSF pressure or in rate of low infusion, RoFc showed remarkably higher values than RoFm. But this difference did not distinguished in the higher range of CSF pressure of infusion rate. The minmum and maxmum value of RoFc differed the more and RoFm, the less. These findings suggest that in order to obtain more accurate Ro data with constant infusion technique, it must be corrected in low range of CSF pressure or the rate of infusion should be increased several times as that of CSF formation at the risk of possibility of induction of a pressure wave.

Myelotomy 후 척수체 성감각유발전위의 변화에 대한 실험적 연구

박윤관,정흥섭,임창수,서중근,이훈갑,이기찬,주정화 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

Direct spinal epidural surface recordings of spinal evoked potentials have been made in 16 adult cats with acute spinal cord injuries produced experimentally in which myelotomy was performed in 8 cats 1 hour after the injury. The remaining 8 animals served as control. The spinal cord injury with 20gm-20㎝ was inflicted over the entire dorsal surface of the spinal cord at L2-3 interspace by Alien's weight-drop method which was improved by placing a curved steel plate anterior to the spinal cord to provide a smooth, hard surface for the receipt of posterior cord impact. Under the operating microscope, a median posterior longitudinal myelotomy approximately 10 ㎜ to 15 ㎜ in length was made at the injury site 1 hour after the injury. Animals were evaluated electrophysiologically either from preinjury state to post -injury 4 hours(control group) or from preinjury state to post myelotomy 3 hours (myelotomy group). The component waves of the spinal somatosensory evoked potentials(SSEP) of control group disappeared sequentially after the injury in the following order : N4, N3, N2, N1. In myelotomy group, N4 and N3 wave also disappeared, but N1 and N2 wave remained. The latencies of the component waves increased & its amplitudes decreased sequentially after the injury. In myelotomy group, as com-with the control group, post-traumatic latency rate increase as wall as amplitude were both reduced.

Systemic Heparin과 Intrathecal Urokinse가 뇌혈관 연축에 미치는 효과에 대한 실험적 연구

박윤관,정용구,이훈갑,이기찬,주정화 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.6

The author has investigated the protective effects of systemic Heparin and intrathecal Urokinase in the multi-hemorrhage canine model of severe chronic cerebral vasospasm. Each of 20 adult mongrel dogs was assigned to one of three experimental groups. All animals received a total of 12㎖ of fresh unheparinized autologous blood via three cisternal injections. Selective vertebral angiograms were obtained before and 8 days after the initial subarachnoid blood injection. Seven animals were treated by systemic Heparin for 7 days, the other seven were treated by intracisternal Urokinase for 3 days, and the remaining were not treated. Comparisons were based on the percentage of reduction in basilar artery diameter(% RBAD). The ultrastructural changes were studied by transmission electron microscopy(TEM). There was a mean reduction(± standard deviation) of 65±7% in control dogs, 53±5% in dogs with systemic Heparin(difference significant t-test, p<0.01), 37±6% in dogs with intrathecal Urokinase(difference signignificant, t-test, p<0.01). The preventive effects of intrathecal Urokinase was superior to systemic Heparin. There was a stroung trend toward reduction of medial necrosis in the basilar artery in dogs with intrathecal Urokinase(P<0.01), and with systemic heparin(0.05<p<0.1) compared to control animals. Intimal proliferation was unusual in all three groups, but reduction of intimal proliferation was significant in dogs with treatment. All this morphological changes correlated with degree of angiographic vasospasm. Since chronic severe angiographic vasospasm was present with relatively mild proliferation of the arterial wall, the author believe that vasospasm in this stage is due to long-lasting smooth muscle contraction and not to arterial wall thickening. In preventing vasospasm, it appears that early lysis of subarachnoid blood clot by intrathecal Urokinase has some benefits. And also these observations supports the hypothesis that persistence of clotted blood around the intracranial arteries is the cause of the vasospasm.

백서 허혈성 국소 뇌경색에서의 소뇌 실정핵 자극 효과

박윤관,김대환,정흥섭,이기찬,주정화,이훈갑 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.3

Elecrical stimulation of the cerebellar fastigial nucleus(FN) increases cerebral blood flow(CBF) and reduces brain damage after focal cerebral ischemia. The authors studied whether the neuroprotection elicited from electrical stimulation of the cerebellar FN is attibutable to the elevation in regional CBF(rCBF) or reduction in release of excitatory amino acid. Sprague-Dawley rats were anesthetized with a mixture of halothane(3% for the induction and 1% for maintenance) and oxygen, and artificially ventilated through a tracheal cannula. Arterial pressure, blood gases and body temperature were monitored. The middle cerebral artery(MCA) was occluded distal to the lenticulostriate branches. The FN was then stimulated for 1 hour(100uA : 50Hz : 1sec on/1sec off). The changes in rCBF were measured by hydrogen clearance method for 2 hours, over the regions corresponding to the ischemic core and penumbra. Postischemic release of glutamate and aspartate were measured by microdialysis for 2 hours at the same site of measurement of rCBF. Infarct volume was determined 8 hours later in 2, 3, 5-triphenyl tetrazolium chloride(TTC)-stained sections. FN stimulation(n=12) increased mean arterial pressure by 28±16mmHg. In nonstimulated control rats(n=12), mean AP was not changed significantly during the experimental procedures. Compared with nonstimulated animal, stimulation of FN for 1 hour following MCA occlusion significantly increased rCBF in ischemic core and penumbra by 53.6% and 67.6% respectively. And the volume of infarction decreased by 42% at 8 hours after MCA occlusion. The concentration of glutamate and aspartate in ischemic core after MCA occlusion increased both in the control group(to 12.2±3.3 folds and 10.4±4.1 folds, respectively) and in the stimulation group(10.5±2.8 and 11.2±4.1 folds, respectively). The concentration of glutamate and aspartate in penumbra did change significantly neither in the control group(to 2.5±1.3 folds and 1.8±0.6 folds, respectively) nor in the stimulation group(1.9±0.5 folds and 2.1±0.4 folds, respectively). There was no significant difference between the two groups. These data indicate that neuroprotection elicited from electrical stimulation of the erebellar FN is attributable to the elevation in rCBF but no to the reduction in release of excitatory amino acid.

Masserman 방법에 의한 뇌척수액 생성률 측정의 새로운 변형

박윤관,정용구,정흥섭,서중근,이훈갑,주정화,이기찬 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.8

Two modifications of the Masserman method for the measurement of cerebrospinal fluid (CSF) formation have been designed and compared with the Pappenheimer technique, the Masserman method and its old form of modification in animal experiment. Among the theoretical limitations of the Masserman method, resorption of CSF during the period of measurement was taken into account with two modifications of its integration in this study. The first one was calculated by reduced formula for a simple integration and the second one was produced by Simpson's formula of integration. Twenty adult cats were used for the experiment. Mean CSF production rate calculated by the Pappenheimer method, the Masserman method, the modified Masserman method and newly designed two modifications were 0.0207±0.0018㎖/min, 0.0128±0.0031㎖/min, 0.0166±0.0027㎖/min, 0.0183±0.003㎖/min and 0.0197±0.0033㎖/min respectively. When compared with the Pappenheimer method, data obtained from the Masserman method were significantly underestimated(p<0.01). All modifications have well correlated with the Pappenheimer method, and newly modified Masserman methods showed better cerrespondence.

초기혈관조영술상 음성의 소견을 보인 지주막하출혈에 대한 임상연구 : Whether or not to Repeat the Angiography

박윤관,정흥섭,이기찬,이훈갑 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.3

In recent years there has been a tendency to abandon repeat cerebral angiography in patients with subarachnoid hemorrhage(SAH) if the inital angiogram is normal because prognosis is said to be excellent. Our experiences does not support such a conclusion. In 291 cases with subarachnoid hemorrhages(SAH), four vessel cerebral angiograpjhy was performed to investigate a source of the hemorrhage. The first four vessel study on admission revealed 234 cases(80.4%) of ruptured cerebral aneurysms. Fifty-five of 291 patients with primary subarachnoid hemorrhage(SAH) did not show vascular lesion in initial pan-angiography studies. In order to define the benefit of control angiography these patients were reviewed. Among 41 patients who underwent repeat angiography, a second angiography showed an aneurysm in 24(58.5%). Twelve of the twenty-four cases had aneurysms in the anterior communicating artery. But the age, sex, initial clinical grade and CT grade of patients with aneurysm in repeat angiography were indistinguishable from thoses of patients without aneurysm. Even in the patients who showed angiographic vasospasm in intial angiography, probability of revealing an aneurysm was not different from those without spasm. We conclude that repeat angiography is necessary in the cases of SAH with normal initial angiogram regardless of the CT findings and the presence of vasospasm.

만성 뇌경막하 혈종 외막의 병리조직소견과 외막 투과성에 대한 연구

박윤관,이기찬,이훈갑 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.4

Permeability of membrane of chronic SDH is a unique characteristic. And various types of attenuation of chronic subdural hematoma(SDH) appearing on computerized tomography(CT) scans are related to the changes occurring as the result of recurrent bleeding. The authors have investigated the membrane permeability of SDH according to the histological changes of the outer membrane of chronic SDH. A consecutive seires of 19 adult patients with chronic subdural hematoma has been studied in respect to the post-operative subdural drainage after burr-hole craniostomy and closed system drainage. The subdural drain was kept for 5 days. The amount and the pattern of daily drainage were correlated with histological findings of the outer membrane. The outer membrane of chronic SDH was very rich in blood vessels and contains giant capillaries. One electron microscopic finding of giant capillaries was the frequent formation of gap junctions between adjacent endothelial cells. Numerous red or white blood cells was spilling into the interstitial space of the outer membrane. In positive cases to both membrane hemorrhage and surface clot, total amount of drainage was significantly different from the cases without these findings(p=0.0263). In cases without membrane hemorrhage, the presence of migrating inflammatory cell was well correlated with total drainage amount(p=0.028). From these findings it is suggested that endothelial gap junction of macrocapillaies might play an important role in permeability of the outer membrane. But the recent episode of bleeding could act as a barrier and decrease the permeability actually. After resolution of fibrin clot infiltrated inflammatory cells which contribute to fibrinolysis would decrease and then the permeability would increase.

정상체중 신생아의 뇌경막하 혈종

박윤관,서중근,이훈갑,주정화 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.2

A normal-weight full-term newborn infant with a posterior fossa subdural hematoma is described. This potentially trea table condition has been previously diagnosed in only 13 reported cases. The clinical characteristics in this case were the lack of specific symptoms and signs indicating the nature and location of the leision and the presence of signs of intracranial hypertension. Computed tomography allowed for earlier confirmation of the diagnosis and early surgical treatment resulted in excellent recovery.

지주막하출혈 환자의 Atrial Natriuretic Factor와 심전도 이상 소견에 대한 연구

박윤관,정흥섭,이기찬,이훈갑 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.11

Atrial natriuretic factor(ANF) is a diuretic natriuretic peptide hormone produced by both the heart and brain. It has been postulated to play a role in the hemodynamic and sodium (EKG) abnormalities is known to occur frequently after cerebrovascular accident, specidly subarachnoid hemorrhage. A prospective study was undertaken to evaluate the relation between the changes of ANF and EKG findings and clinical findings. Thirtyfive nonselected patients with SAH were followed with serial measurements of plasma ANF, plasma antidiuretic hormone (ADH), serum sodium, serum osmolarity, and electrocardiography(EKG) at 2nd 5th, and 7th day after hemorrhage. Mean plasma ANF valeus at 2nd 5th, and 7th day of hemorrhage were 202.3& 109.6ppJm1, 134.6+ 83.5ppJml, and 1233+ 69.9pghl, respectively. Mean plasma ADH values were within normal limits(32-4.4pg/d). At a later stage, 9 patients showed hyponatremia and hypoosmolarity, among whom 8 patients had elevated ANF and 1 patient elevated ADH. The delayed and persistent rise of plasma ANF was correlated with the development of hyponatremia. One or more EKG abnormalities were found in 13 patients. Mean ANF values of patients with normal EKG(131.8_t48.7pg/ml) were significantly different from those with abnormal EKG(272.22 107.5ppJml). The changes of plasma ANF appeared unrelated to age, sex, clinical grade, CT grade, and bleeding site. The results of this study indicate that elevated plasma ANF is closely related with electrophysiological changes of myocardium and that the transitory myocardial ischemia might be the source of plasma ANF after SAH.

Systemic Heparin과 intrathecal Urokinase가 뇌혈관 연축에 미치는 효과에 대한 실험적 연구

박윤관,정용구,정홍섭,이훈갑,이기찬,주정화 고려대학교 의과대학 1989 고려대 의대 잡지 Vol.26 No.1

The author has investigated the protective effects of systemic Heparin and intrathecal Urokinase in the multi-hemorrhage canine model of severe chronic cerebral vasospasm. Each of 20 adult mongrel dogs was assigned to one of three experimental groups. All animals received a total of 15ml of fresh unheparinized autologous blood via three cistemal injections. Selective vertebral angiograms were obtained before and 8 days after the initial subarachnoid blood injection. Seven animals were treated by systemic Heparin for 7 days, the other seven were treated by intracisternal Urokinase for 3 days, and the remaining were not treated. Comparisons were based on the percentage of reduction in basilar artery diameter(% RBAD). The ultras-tructural changes were studied by transmission electron microscopy(TEM). There was a mean reduction(± standard deviation) of 65±7% in control dogs, 53±5% in dogs with systemic Heparin(difference significant, t-test, p<0.01), 37±6% in dogs with in-trathecal Urokinase(difference signignificant, t-test, p<0.01). The preventive effects of in-trathecal Urokinase was superior to systemic Heparin. There was a strong trend toward reduction of medial necrosis in the basilar artery in dogs with intrathecal Urokinase(P<0.01), and with systemic Heparin(0.05< P<0.1) compared to control animals. Intimal proliferation was unusual in all three groups, but reduction of intimal proliferation was significant in dogs with treatment. All this morphological changes correlated with degree of angiographic vasospasm. Since chronic severe angiographic vasospasm was present with relatively mild proliferation of the arterial wall, the author believe that vasospasm in this stage is due to long-lasting smooth muscle contraction and not to arterial wall thickening. In preventing vasospasm, it appears that early lysis of subarachnold blood clot by intrathecal Uroklnase has some benefits. And also these observations support the hypothesis that persistence of clotted blood around the intracranial arteries is the cause of the vasospasm.