허리엉치신경얼기의 말단가지를 이루는 척수신경구성

우정수(Jung-Su Woo),허미선(Mi-Sun Hur),김호정(Ho-Jeong Kim),이규석(Kyu-Seok Lee) 대한체질인류학회 2011 해부·생물인류학 (Anat Biol Anthropol) Vol.24 No.2

이 연구는 허리엉치신경얼기에서 분지하는 각 말단신경의 척수신경 구성과 참여량을 밝히는 데 목적이있다. 한국성인 시신의 25쪽(남: 17, 여자: 8, 왼쪽: 13, 오른쪽: 12, 평균나이: 73.6세)에서 허리엉치신경얼기와 그 말단신경을 떼어내 Guanidine-HCl (0.2 M)에 약 2주 동안 담가 신경주위결합조직을 부드럽게 한 후 수술현미경(OPMI-Pico, Carl Zeiss) 아래에서 신경다발을 분리하였다. 허리엉치신경얼기에서 분지되는 말단신경의 주요 구성성분으로 엉덩아랫배신경은 88.2%에서 L1로만 구성되었고 엉덩샅굴신경은 100% 모두 L1로, 음부넙다리신경은 62.5%에서 L1과 L2로, 가쪽넙다리피부신경 56.0%에서 L2와 L3으로, 넙다리신경은 88.0%에서 L2, L3 그리고 L4로 구성되었다. 또 폐쇄신경은 100%에서 L2, L3 그리고 L4로 구성되었고, 궁둥신경의 온종아리부분은 84.0%에서 L4, L5, S1 그리고 S2로, 정강부분은 96.0%에서 L4, L5, S1 그리고 S2로, 위볼기신경은 56.0%에서 L4, L5 그리고 S1로 구성되었다. 아래볼기신경은 54.2%에서 L5와 S1 그리고 S2로, 뒤넙다리피부신경은 40.0%에서 S1과 S2로, 관통피부신경은 56.0%에서 S2와 S3으로, 음부신경은 52.9%에서 S3으로만 구성되었다. 한편, 참여하는 척수신경의 굵기를 살핀 결과, 엉덩아랫배신경의 경우 L1 (0.72 ㎜)이 가장 많이 참여하였고 엉덩샅굴신경도 L1 (0.63 ㎜)에서, 음부넙다리신경은 L2 (0.72 ㎜)에서, 가쪽넙다리피부신경도 L2 (0.80 ㎜)에서, 넙다리신경은 L3 (2.68 ㎜)에서, 폐쇄신경도 L3 (1.27 ㎜)에서, 궁둥신경의 온종아리부분은 S1 (2.12 ㎜)에서, 궁둥신경의 정강부분도 S1 (2.22 ㎜)에서, 위볼기신경은 L5 (1.09 ㎜)에서, 아래볼기신경은 S1 (1.27 ㎜)에서, 뒤넙다리피부신경은 S2 (1.04 ㎜)에서, 관통피부신경은 S3 (1.09 ㎜)에서, 음부신경은 S4 (1.46 ㎜)에서 가장 많은 신경섬유가 참여하였다. 이 연구의 결과는 척수신경뿌리 병변시 임상적 증상을 예측하는 데 도움이 될 것으로 생각된다. The purpose of this study was to classify the spinal nerve compositions of the terminal branches of the lumbosacral plexus, providing data of their participating quantities. Twenty-five sides of the lumbosacral plexus extracted from Korean adult cadavers were used in this study. The iliohypogastric nerve was mostly arisen from L1 (88.2%, thickness L1 0.7 ㎜). The ilioinguinal nerve was arisen from only L1 (100%, thickness L1 0.6 ㎜). The genitofemoral nerve was commonly arisen from L1 and L2 (62.5%, thickness L1 0.6 ㎜, L2 0.7 ㎜). The lateral femoral cutaneous nerve was classified into 4 types, and the most common type was that L2 and L3 composed this nerve (56.0%, thickness L2 0.8 ㎜, L3 0.4 ㎜). The femoral nerve was classified into 2 types, and it was usually composed of L2, L3 and L4 (88.0%, thickness L2 1.4 ㎜, L3 2.7 ㎜, L4 2.3 ㎜). The obturator nerve was arisen from L2, L3 and L4 in all cases (100%, thickness L2 0.5 ㎜, L3 1.3 ㎜, L4 1.1 ㎜). The common fibular component of sciatic nerve was mostly arisen from L4, L5, S1 and S2 (84.0%, thickness L4 0.9 ㎜, L5 2.0 ㎜, S1 2.1 ㎜, S2 1.2 ㎜). The tibial component of sciatic nerve was mainly arisen from L4, L5, S1 and S2 (96.0%, thickness L4 0.9 ㎜, L5 1.9 mm, S1 2.2 ㎜, S2 1.9 ㎜). The superior gluteal nerve was commonly derived from L4, L5 and S1 (56.0%, thickness L4 0.7 ㎜, L5 1.1 ㎜, S1 0.9 ㎜). The inferior gluteal nerve was comprised of L5, S1 and S2 in several cases (54.2%, thickness L5 0.9 ㎜, S1 1.3 ㎜, S2 0.8 ㎜). The posterior femoral cutaneous nerve was composed of S1 and S2 in higher freqeuncy (40.0%, thickness S1 0.9 ㎜, S2 1.0 ㎜, S3 0.8 ㎜). The perforating cutaneous nerve was arisen from S2 and S3 in higher frequency (56.0%, thickness S1 0.7 ㎜, S2 0.9 ㎜, S3 1.1 ㎜). The pudendal nerve was derived from S3 in many cases (52.9%, thickness S3 1.5 ㎜). These anatomical results may be helpful to predict the spinal nerve root lesions of the lumbosacral plexus.

Anatomic Confirmation of the Motor Fibers in the Cervical Nerves Innervating to the Trapezius Muscle

Jung-Su Woo(우정수),Mi-Sun Hur(허미선),Bum-Seung Kang(강범승),Seon-Young Park(박선영),Kyu-Seok Lee(이규석) 대한체질인류학회 2012 대한체질인류학회지 Vol.25 No.1

등세모근에 분포하는 운동신경성분을 확인하기 위하여 목신경에서 등세모근으로 가는 신경성분을 조 사하였다. 한국성인 시신 팔신경얼기 13쪽(남 7, 여: 6)을 사용하였다 13쪽 중 셋째 목신경에서는 4쪽에서 넷째 목신경 에서는 3쪽에서 해부 도중 손상되었다. 셋째 목신경에서 운동성분은 9쪽 중 7쪽에서 관찰하였고(77.8%),2예에서는 관찰하지 못하였다(22.3%) 넷째 목신경에서 10쪽 중 9쪽에서 운동성분을 확인하였고(90.0%), 1쪽에서는 확인하지 못하였다(10.0%). 셋째 목신 경에 존재하는 운동성분의 양은 중간정도가 가장 많았고(57.1%;7쪽 중 4쪽), 넷째 목신경의 양은 셋째 목신경 에 비해 비교적 많았다(44.4%; 9쪽 중 4쪽) 셋째 목신경과 넷째 목신경에 포함된 운동성분의 양은 각각 114± 112와 219± 167개 였다. 이 연구의 결과 퉁세모근에 분포하는 목신경에 존재하는 운동성분은 넷째 목신경에 있어 출현빈도와 양에서 더 많았다. This study aimed to confirm the presence of motor fibers in the cervical nerves distributing to the trapezius muscle. Thirteen cases were examined. Motor fibers were present in C3 in 7 of 9 cases(77.8%) and were absent in 2 of 9 cases(22.3%); the other 4 cases were damaged during dissection. C4 exhibited motor fibers in 9 of 10 cases(90.0%), whereas motor fibers were absent in 1 of 10 cases(10.0%); and 3 cases were damaged. The motor fibers in C3 were of medium size(57.1%; 4/7 cases), whereas those in C4 were large(44.4%; 4/9 cases). The average number of motor fibers in C3 and C4 were 114±112 and 219±167, respectively. These results show that C4 is more important in terms of the frequency and size of the cervical motor fibers distributing to the trapezius muscle.

OK-432를 이용한 재발성 하마종 치험 1례

우정수(Jeong Su Woo),이흥만(Heung Man Lee),권순영(Soon Young Kwon),정광윤(Kwang Yoon Jung) 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.1

Plunging ranula is occured in about 10% of all ranula cases although surgery is the first choice therapy. However, frequent recurrences of the disease due to insufficient surgery have been reported, and various therapies have been designed in addition to surgery. We here report a case on whom we conducted intralesional injection of OK-432 for recurrent plunging ranula. A 36-year-old man was admitted who had a 2-months history of swelling of right submandibular area. He had been operated for right plunging ranula twice, 7 years ago. Under fluoroscopic guidance, contents of the ranula were aspirated and OK-432 solution was injected twice with 3-week interval. Examination after 6 weeks showed that the cystic ranula seen before therapy had disappeared completely and no recurrence was encountered after 18months. Therefore the intralesional injection of OK-432 is effective method for treatment of the plunging ranula.

부인두강 종물로 발현된 갑상선 유두상암종

우정수(Jeong Su Woo),김용환(Yong Whoan Kim),정광윤(Kwang Yoon Jung),최건(Geon Choi),최종욱(Jong Ouck Choi) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.1

An unusual case of nodal metastases from thyroid neoplasm known as parapharyngeal space mass is likely to be overlooked. And identification of the primary lesion by excisional biopsy calls for a secondary operation. Therefore, it is important to be aware of the possible lymphatic spread of the thyroid neoplasm to the parapharyngeal space. In this case, completion thyroidectomy should be considered. Here, we present a case of thyroid papillary carcinoma masquerading as a parapharyngeal space tumor. The mass was removed by transcervical approach and pathologically diagnosed as a metastatic thyroid papillary carcinoma. Successful results were obtained after additional completion thyroidectomy.

후두암 세포주에서 $TGF-{\beta}1$에 의한 MMP2와 MMP9의 발현 양상

권남영,김형진,우정수,권순영,정광윤,Kwon Nam-Young,Kim Hyung-Jin,Woo Jeong-Su,Kwon Soon-Young,Jung Kwang-Yoon 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.2

Backgrounds and Objectives: Metastasis is a complex multistep process that requires sequential interactions between the invasive cell and the extra-cellular matrix. Transforming growth factor-${\beta}1$ ($TGF-{\beta}1$) is a multifunctional regulator of cellular differentiation, motility and growth. Loss of sensitivity to the growth inhibitory effects by $TGF-{\beta}1$ plays important roles in neoplastic progression. The aim of this study was to investigate the role of $TGF-{\beta}1$ in the neoplastic invasion and metastasis through matrix metalloproteinase (MMP) of laryngeal cancer cell lines. Material and Methods: Two laryngeal cancer cell lines, SNU-899 and SNU-1076 were treated with recombinant $TGF-{\beta}1$, and the expression of MMP-2 and MMP-9 was immunohistochemically evaluated and gelatinase activity was studied by gelatin zymogram. Results: The cell growth inhibition was evident on 4th days after 1ng/ml and 10ng/ml $TGF-{\beta}1$ treatment. The expressions of MMP-2 and MMP-9, and their gelatinase activities were increased in dose-dependent manner. Conclusion: $TGF-{\beta}1$ treatment in laryngeal cancer cell lines induces the expression of MMP-2 and MMP-9, thus playing a role in the digestion of extracellular matrix gelatin.

기관절제술후 기관 단단문합술 치험 결과

신동진,조우진,백승국,우정수,권순영,정광윤,Shin Dong-Jin,Cho Woo-Jin,Baek Sungkuk,Woo Jeong Su,Kwon Soon-Young,Jung Kwang-Yoon 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.1

Tracheostomy and endotracheal intubation are often performed in patients with acute and chronic respiratory failure. Recently, the incidence of iatrogenic tracheal stenosis has increased. Tracheal resection and end-to-end anastomosis would be one of the most physiologic treatment options for severe tracheal stenosis. Also, this treatment can be applied to the management of trachea invaded by thyroid cancer and tracheal neoplasm. The authors aimed to analyze the outcomes of end-to-end anastomosis of trachea following segmental resection in tracheal stenosis and tracheal invasion of cancer that we have recently experienced. Materials and methods Authors retrospectively studied 19 cases treated by tracheal resection with end-to-end anastomosis between Feburuary 1996 and January 2003. 12 patients had tracheal stenosis, 6 patients had tracheal invasion by thryroid cancer and 1 patient had tracheal cancer. We analyzed the direct causes of tracheal stenosis, preoperative vocal cord function, operation technique, early and delayed postoperative complications, and the outcome of end-to-end anastomois. Result Decannulation without significant aspiration was achieved in 16 cases($89.5\%$). A 27 year-old man could not be decannulated because of restenosis. A 62 year-old woman could not be decannulated because of bilateral vocal cord palsy. Conclusion End-to-end anastomosis is a safe and effective surgical method for tracheal stenosis. Case selection for end-to-end anastomosis and preservation of recurrent laryngeal nerve during operation is very important.

어깨밑신경의 해부학적 연구

김재현(Jae-Hyoun Kim),우정수(Jung-Su Woo),허미선(Mi-Sun Hur),이규석(Kyu-Seok Lee) 대한체질인류학회 2014 해부·생물인류학 (Anat Biol Anthropol) Vol.27 No.4

한국성인 시신 팔신경얼기 20쪽에서 위와 아래어깨밑신경의 분지양상과 분지되는 가지의 개수를 확인하고, 근육에 분포하는 각 가지들의 척수신경의 구성을 확인하는 데 이 연구의 목적을 두었다. 위어깨밑신경이 3개의 가지로 일어나는 유형을 16쪽(80.0%)에서 관찰하였고, 4개의 가지로 일어나는 유형을 4쪽(20.0%)에서 관찰하였다. 아래어깨밑신경은 2개의 가지로 나뉘어져 어깨밑근과 큰원근에 각각 하나씩 분포하였다. 위어깨밑신경의 가지들은 척수신경 구성에 따라 7가지 유형으로 분류하였다. 첫째, 둘째, 셋째 가지는 다섯째와 여섯째 목신경으로 구성된 유형이 가장 많았고, 넷째 가지는 모두 여섯째 목신경으로만 구성되었다. 아래어깨밑신경은 척수신경 구성에 따라 각각 세 유형으로 분류하였으며, 어깨밑근에는 다섯째 목신경만 분포하는 유형이 11쪽(55.0%)으로 가장 많았고, 큰원근에는 여섯째와 일곱째 목신경이 분포하는 유형이 13쪽(65.0%)으로 가장 많이 관찰되었다. This study aimed to determine the number of branches of the upper and lower subscapular nerves and to classify the spinal nerve compositions of each branch. Twenty sides of the brachial plexus extracted from Korean adult cadavers were used in this study. The upper subscapular nerve was composed of three branches in 16 sides (80.0%), composed of four branches in 4 sides (20.0%). The lower subscapular nerve arose from posterior cord with one branch, innervating the subscapularis and the teres major muscles. In case of the upper subscapular nerve, the first branch was comprised of C5 in 40.0%, C5 and C6 in 60.0%, the second branch was composed of C5 in 15.0%, C5 and C6 in 85.0%, the third branch was arisen from C5 and C6 in 75.0%, C6 in 25.0% and the forth branch appeared in four sided was derived from C6. The nerve branch innervating the subscapularis muscle was composed of C6 in 55.0%, C5 and C6 in 40.0%, C6 and C7 in 5.0%. The nerve branch innervating the teres major muscle was composed of C6 and C7 in 65.0%, C5, C6 and C7 in 25.0%, and C6 in 10.0%. The injury was often due to an accidental damage or lesion of the subscapular nerve, these anatomical results may be helpful to predict the involving area of the lesion.

Frequency and Quantity of the C7 Contribution to the Ulnar Nerve

Mi-Sun Hur(허미선),Jung-Su Woo(우정수),Ho-Jeong Kim(김호정),Kyu-Seok Lee(이규석) 대한체질인류학회 2013 해부·생물인류학 (Anat Biol Anthropol) Vol.26 No.3

말초신경을 연구하는 많은 해부학자와 임상가들은 팔신경얼기 끝신경의 척수신경 뿌리구성에 대해 관심을 가지고 있다. 이러한 관점에서, 자신경의 척수신경 뿌리구성은 명확하지 않다. 여러 해부학 교과서에는 자신경이 C8, T1의 앞가지로 구성되어 있고, 종종 C7도 포함되는 것으로 기술되어 있다. 그러나 자신경에 참여하는 C7의 빈도와 참여량에 대한 문헌은 있지 않다. 이 연구의 목적은 자신경에 참여하는 C7의 빈도와 참여량을 관찰하는 데 있다. 한국성인시신의 팔신경얼기 100쪽을 사용하였다. 자신경을 포함하는 팔신경얼기를 겨드랑에서 떼어낸 후, Guanidine-HCl (0.2 M)에 2주 동안 담구어 신경다발을 둘러싸는 결합조직을 부드럽게 하였다. C7은 모든 경우에서 자신경에 분포하였다(100%). 자신경에 분포하는 C7의 말이집축삭의 수는 1,452±429 (mean±S.D.)였다. C7의 말이집축삭의 수가 C8의 말이집축삭의 수보다 적었고, T1의 말이집축삭의 수와 비슷하였지만, C7은 자신경에 자주 참여하는 것이 참여하는 것이 아니라, 항상 참여하는 성분으로 여겨질 수 있다. 이 연구의 결과는 다양한 사고로 인한 자신경 손상시 정확한 진단과 치료에 대한 자료를 제공할 것이다. Many anatomists and clinicians who investigate the peripheral nerve concern about the composition of the spinal roots of each terminal nerve of the brachial plexus. From this viewpoint, the spinal root composition of the ulnar nerve is still unclear. Several anatomy textbooks describe that the ulnar nerve is composed of the ventral rami of the C8, T1 and often C7. There is no literature regarding the frequency and contribution quantity of C7 to the ulnar nerve. The purpose of present study was to determine frequency and contribution quantity of the C7 to the ulnar nerve. Fifty cadavers of brachial plexus were obtained from cadavers of Korean adults. The brachial plexus containing the ulnar nerve were extracted from the axilla and the extracted samples were immersed in Guanidine-HCl (0.2 M) for 2 weeks to soften the connective tissue around the nerve bundles. C7 was contributed to the ulnar nerve in all sides (100%). The numbers of the myelinated axons of C7 participating to the ulnar nerve was 1,452±429 (mean±S.D.). Thus the C7 can be considered as always participating component of the ulnar nerve, not often participation, although numbers of the myelinated axons of C7 was lesser than those of the C8, but similar to those of the T1. The results of the study provide a reference for accurate diagnosis and treatment regarding ulnar nerve injury due to various accidents.

후두미세수술 전후 성대 용종의 크기 및 위치가 음성의 질의 변화에 미치는 영향

한원규,김민수,오경호,우정수,정광윤,권순영,Han, Won Gue,Kim, Min-Su,Oh, Kyung Ho,Woo, Jeung Soo,Jung, Kwang Yoon,Kwon, Soon Young 대한후두음성언어의학회 2016 대한후두음성언어의학회지 Vol.27 No.2

Background and Objectives : Vocal polyps are caused by inflammation induced by stress or irritation. Many patients with vocal polyps complain voice discomfort. For vocal polyps, surgery such as laryngeal microsurgery has been the mainstay of management. We analyzed the clinical features of vocal polyps, and how the size and location of vocal polyps affect the outcomes of surgery. Methods : We retrospectively reviewed 42 patients from March 2014 to December 2015, who were diagnosed as unilateral single vocal polyp. When we operated on a vocal polyp with laryngeal microscopy, we measured their size and location. The quality of voice was evaluated by GRABS scale, jitter, shimmer, NHR (noise to harmonic ratio), MPT (maximum phonation time), and VHI (voice handicap index) before operation and 4 weeks after operation. Results : When we divided the patients into large-sized vocal polyp group (the longest length >3 mm) and small-sized vocal polyp group (the longest length ${\leq}3mm$), all parameter differences tend to be greater at large sized vocal polyp. However, these differences were not statistically significant (p>0.05). When we divided into two groups depending on the volume of vocal polyp, no distinct tendency was found. When we compared the location (anterior, mid and posterior) of vocal polyp with the improvement of voice quality, more change was found at mid portion vocal polyp, except the difference of VHI. However, these differences were also not statistically significant (p>0.05). Conclusion : All parameter differences tend to be greater at large vocal polyp and polyp of the mid location.

후두암 세포주에서 TGF-β1에 의한 MMP2와 MMP9의 발현 양상

정광윤(Kwang Yoon Jung),권순영(Soon Young Kwon),우정수(Jeong Su Woo),김형진(Hyung Jin Kim),권남영(Nam Young Kwon) 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.2

Backgrounds and Objectives: Metastasis is a complex multistep process that requires sequential interactions between the invasive cell and the extra-cellular matrix. Transforming growth factor-β1 (TGF-β1) is a multifunctional regulator of cellular differentiation, motility and growth. Loss of sensitivity to the growth inhibitory effects by TGF-β1 plays important roles in neoplastic progression. The aim of this study was to investigate the role of TGF-β1 in the neoplastic invasion and metastasis through matrix metalloproteinase (MMP) of laryngeal cancer cell lines. Material and Methods: Two laryngeal cancer cell lines, SNU-899 and SNU-1076 were treated with recombinant TGF-β1 , and the expression of MMP-2 and MMP-9 was immunohistochemically evaluated and gelatinase activity was studied by gelatin zymogram. Results: The cell growth inhibition was evident on 4th days after 1ng/ml and 10ng/ml TGF-β1 treatment. The expressions of MMP-2 and MMP-9, and their gelatinase activities were increased in dose-dependent manner. Conclusion: TGF-β1 treatment in laryngeal cancer cell lines induces the expression of MMP-2 and MMP-9, thus playing a role in the digestion of extracellular matrix gelatin.