의식불명 환자에서 경관급식에 의한 혼합형 식사와 상업용 조합식이의 효과 비교

정상섭(Chung Sang-Sup),이규성(Lee Kyu-Sung),김희선(Kim Hee-Son),김정남(Kim Jung-Nam),이종호(Lee Jong-Ho),임현숙(Lim Hyun-Suk) 韓國營養學會 1995 Journal of Nutrition and Health Vol.28 No.4

Stereotactic Radiosurgery를 위한 소형 조사면의 선량측정

추성실(Sung Sil Chu),서창옥(Chang Ok Suh),노준규(John J.K Loh),정상섭(Sang Sup Chung) 대한방사선종양학회 1989 Radiation Oncology Journal Vol.7 No.1

The treatment planning and dosimetry of small fields for stereotactic radiosurgery with 10 MV x-ray isocentrically mounted linear accelerator is presented. Special consideration in this study was given to the variation of absorbed dose with field size, the central axis percent depth doses and the combined moving beam dose distribution. The collimator scatter correction factors of small fields (1x1~3x3cm²) were measured with ion chamber at a target chamber distance of 300cm where the projected fields were larger than the polystyrene buildup caps and it was calibrated with the tissue equivalent solid state detectors of small size (TLD, PLD, ESR and semiconductors). The central axis percent depth doses for 1x1 and 3x3cm² fields could be derived with the same acuracy by interpolating between measured values for larger fields and calculated zero area data, and it was also calibrated with semiconductor detectors. The agreement between experimental and calculated data was found to be under ±2% within the fields. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor regions was performed with dose planning computer system (Therac 2300) and was verified with film dosimetry. The more the number of strips and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. The circular cone, we designed, improves the alignment, minimizes the penumbra of the beam and formats ball shape of treatment area without stellate patterns. These dosimetric techniques can provide adequate physics background for stereotactic radiosurgery with small radiation fields and 10MV x-ray beam.

대이개신경 이식을 이용한 추체골 우회 안면신경 재건술

박현선,조경기,정상섭,Park, Hyeon-Seon,Cho, Kyung-Gi,Chung, Sang-Sup 대한미세수술학회 1993 Archives of reconstructive microsurgery Vol.2 No.1

Although various methods had been reported for reanimination of facial nerve palsy, interposition nerve graft remains superior to other methods if there is a wide gap to be bridged. Dott described a excllent facial nerve reconstruction by sural nerve graft bypassing petrous bone. But his method needs two surgical fields and is performed in two stages. Authors desribe a traumatic facial nerve palsy treated by one stage facial nerve reconstruction that is performed in one surgical field by using a great auricular nerve interposition graft and bypass the petous bone.

아데노 바이러스 Cytosine Deaminase/Thymidine Kinase 융합 유전자의 항 종양효과

김영우,최재영,장진우,박용구,정상섭,Kim, Young Woo,Choi, Jae Young,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : We investigated the feasibility of a double suicide gene/prodrug therapy, involving direct introduction of the herpes simplex virus Type 1 thymidine kinase(TK) gene and the Escherichia coli cytosine deaminase(CD) gene, via a recombinant adenoviral vector and ganciclovir(GCV) and/or 5-fluorocytosine(5-FC) treatment, in C6 glioma cells. Methods : Efficient gene transfer and transduction of C6 glioma cells via a recombinant adenovirus were evaluated by infecting cells with adenovirus bearing the ${\beta}$-galactosidase gene and then staining cells with 5-bromo-4-chloro-3-indolyl-13-D-galactoside. CD/TK expression in cells infected with adenovirus bearing the CD/TK gene(ad-CD/TK) was examined by immunoblotting analysis. For in vitro cytotoxicity experiments, the cells were infected with ad-CD/TK or ad-${\Delta}E1$(as a control). After addition of a variety of concentrations of GCV and 5-FU, either separately or in combination, cell viability was determined by staining the cells with crystal violet solution 6 days after infection. Result : C6 glioma cells were efficiently transduced with recombinant adenoviral vector at multiplicities of infection of 200 or more. In vitro cytotoxicity of GCV and/or 5-FC, either alone or in combination, was exclusively observed in the cells transduced with ad-CD/TK. Obvious cytotoxicity(>50% inhibition) was observed in the presence of 5-FC at concentrations greater than 30ug/ml or GCV at concentrations greater than 0.3ug/ml at a multiplicity of infection of 100. Additionally, cytotoxicity in the presence of both GCV and 5-FC was greater than that after sinlge-prodrug treatments, indicating additive effects of the prodrug treatments. Conclusion : The administration of a double-suicide gene/prodrug therapy might have great potential in the treatment of brain tumors.

Stereotactic Radiosurgery for Intracranial Tumors

서창옥 (Chang Ok Suh),정상섭 (Sang Sup Chung),추성실 (Sung Sil Chu),김영수 (Young Soo Kim),윤도흠 (Do Heum Yoon),김선호 (Sun Ho Kim),노준규 (John Juhn Kyu Loh),김귀언 (Gwi Eon Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.1

연세대학교 의과대학 세브란스병원에서는 1988년 8월 10MV 선형 가속기를 이용한 방사선 뇌수술(radiosurgery, stereotactic external beam irradiation)을 시작한 이래 1991년 12월까지 총 24예의 두개강내 종양에 대하여 방사선 뇌수술을 시행하였다. 대상 환자들의 조직학적 유형은 뇌수막종이 5예, 두개인두종이 3예, 악성임파종이 1예, 전이성 뇌종양이 2예 있었다. 대상환자들은 몇가지 다른 질병상태에서 방사선 뇌수술을 받았는데, 10예는 뇌정위적 생검이나 신경방사선학적 영상만으로 진단을 한 후 일차적인 치료로 방사선 뇌수술을 시행했으며, 9예에서는 수술 후 잔류 종양에 대하여 방사선 뇌수술을 시행하였다. 또 3예에서는 방사선 치료후 재발한 종양에 대해 구제요법으로 시행하였고, 2예에서는 외부 방사선 조사와 함께 추가 방사선조사로써 시행되었다. 6개월 이상 추적 조사된 환자 16명 중에서 7명 (뇌수막종 2예, 신경교종 4예, 악성임파종 1예)이 CT Scan 또는 MRI상 종양의 완전 소멸을 보였고 나머지 9예는 모두 종양 크기의 감소를 보였다. 방사선 수술시 급성 부작용은 없었고 4예에서 만성 합병증이 나타났는데 3예에서 신경학적 증상의 발현과 함께 CT Scan상 뇌부종이 나타났었고 1예의 두개인두종에서는 방사선에 의한 시신경 손상으로 생각되는 시력 소실이 있었다. 저자들의 경험 예들은 조직학적 유형이 다양하고 증례수가 많지 않고 추적 조사 기간이 짧기 때문에 결론을 얻기 어렵지만 정위적 방법으로 종양에 다량의 방사선을 일시에 조사함으로써 완전 관해까지의 우수한 종양 제어효과를 얻을 수 있었다. 그러나 여러 가지 종류의 뇌종양의 치료에 있어서 방사선 뇌수술이 생존율 향상이나 삶의 질의 향상에 기여할 수 있는지를 알기 위해서는 더 많은 증례를 통하여 경험을 축적하여야 할 것이다. Between August 1988 and December 1991, 24 patients with intracranial tumors were treated with stereotactic radiosurgery (RS) using a 10 MV linear accelerator at Severance Hospital. Yonsei University College of Medicine. There were 5 meningiomas. 3 craniopharyngiomas. 9 glial tumors, 2 solitary metastases, 2 acoustic neurinomas, 2 pineal tumors. and 1 non-Hodgkin's lymphoma. Ten patients were treated as primary treatment after diagnosis with stereotactic biopsy or neuroimaglng study, Nine patients underwent RS for post-op. residual tumors and three patients as a salvage treatment for recurrence after external Irradiation, Two patients received RS as a boost followed by fractionated conventional radiotherapy. Among sixteen patients who were followed more than 6 months with neuroimage. seven patients (2 meningiomas, 4 benign glial tumors. one non-Hodgkin's lymphoma) showed complete response on neuroimage after RS and nine patients showed decreased tumor size. There was no acute treatment related side reaction. Late complications include three patients with symptomatic peritumoral brain edema and one craniopharyngioma with optic chiasmal injury. Through this early experience, we conclude that stereotactically directed single high doses of irradiation to the small intracranial tumors is effective for tumor control. However, in order to define the role of radiosurgery in the management of intracranial tumors. we should get the long-term results available to demonstrate the benefits versus potential complications of this therapeutic modality.

난치성 암성 통증 제어를 위한 뇌정위적 대상회 절개술

정진영,장종희,장진우,박용구,정상섭,Jung, Jin Young,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

두개인두종에 대한 감마나이프 방사선수술

장종희,장진우,박용구,정상섭,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.5

Objective : The purpose of this study are to evaluate the effectiveness of Gamma Knife radiosurgery(GKS) as a treatment of craniopharyngioma and to investigate the proper dose planning technique in GKS for craniopharyngioma. Method : Between May 1992 and March 1999, seven Gamma Knife radiosurgical procedures were done for residual tumor mass of 6 patients with craniopharyngioma after microsurgical resection. Conventional radiation therapy was not performed. In this study, their clinical, radiological and radiosurgical data were analyzed and the radiation dosage to the optic pathway, hypothalamus, pituitary stalk, and cavernous sinus were calculated and correlation with clinical outcome was evaluated. The mean follow-up period was 33.5 months(12.3-55.2 months). Result : The mean tumor volume was 4.4cc(0.4-18.0cc) and the maximum radiation dose ranged from 14 to 32 Gy(mean 20.9Gy). The radiation was given with isodose curve, 50-90% and the marginal dose varied within 8-22.4Gy(mean 12.7Gy). The mean number of isocenter was 4.3(1-12). The tumor was well controlled in all cases. In 5 of 7 cases, the size of tumor decreased to 10-50% of pre-GKS volume and remaining two showed no volume change. The mean dose to optic pathway was 5.7Gy(5.1-11.2Gy) and there were no complications. Conclusion : GKS seems to be effective for control of craniopharyngioma as an adjuvant treatment after microsurgical resection and even suboptimal dose for tumor margin is considered to be enough for tumor control. It is safe with careful dose planning to protect surrounding important structures, especially optic pathway. We believe conventional radiation therapy should be avoided because it has limitation for dose planning of additional treatments such as radiosurgery or intracystic instillation of radioisotope in case of recurrence.

터어키안 주변종양에 대한 감마나이프 방사선 수술

장종희,장진우,박용구,정상섭,Chang, Jong Hee,Chang, Jin Woo,Park, Yong Gou,Chung, Sang Sup 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

Objective : Around the sellar area, there are many important structures. But, the optimal radiation dosage for minimal toxicity to surrounding neural tissue has not been firmly established. The purpose of this study is to evaluate the radiosurgical outcome of juxtasellar tumors and to investigate the relationship between radiation dosage and toxicity to neural tissue. Method : Between May 1992 and June 2000, we treated 65 juxtasellar tumors by using the Leksell Gamma Knife. Among them, 52 patients who could be followed more than 1 year were included in this study. The radiosurgical dosage to the optic pathway, cavernous sinus, Meckel's cave, hypothalamus, pituitary gland and stalk, and brain stem was analyzed and correlated with clinical outcome. The mean follow-up period was 33.5 months(range 12.2- 99.0 months). Result : The clinical response rate was 69.2%. The volume response rate was 61.0% and the radiologic control rate was 92.7%. There were 4 complications(7.7%) of 2 trigeminal neuropathy, 1 abducens nerve palsy, and 1 trigeminal and transient abducens nerve palsy. The optic apparatus appeared to tolerate doses greater than 10Gy. The risk of cranial nerve complications in cavernous sinus seemed to be related to doses of more than 16Gy. In 3 of 4 patients who received more than 16Gy to cavernous sinus, the abducens or trigeminal neuropathy occurred. Also, one patient who received more than 15Gy to the Meckel's cave, trigeminal neuropathy developed. The hypothalamus, pituitary gland and stalk, and brain stem were relatively tolerable to radiation. Conclusion : Gamma Knife radiosurgery seems to be an effective method to control the growth of juxtasellar tumors. To avoid injury to surrounding important neural tissue, careful dose planning and further study for radiation toxicity to neural tissue were needed.

뇌동정맥기형에 대한 감마나이프 방사선수술시 치료성적에 영향을 주는 인자들

장종희,박용구,최재영,장진우,정상섭,Chang, Jong Hee,Park, Yong Gou,Choi, Jae Young,Chang, Jin Woo,Chung, Sang Sup 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.12

Objective : The goal of this study was to evaluate the effect of Gamma Knife radiosurgery(GKS) on cerebral arteriovenous malformation(AVM) and the factors associated with complete occlusion. Patients and Methods : A total of 369 radiosurgical procedures for 336 patients with cerebral AVMs were performed between December 1988 and June 2001. Three hundreds and twenty-four cases of 293 patients who were treated with GKS procedures from May 1992 to December 2000 were analyzed. Various clinical and radiologic parameters were evaluated. Results : The total obliteration rate for the cases with satisfactory radiological follow-up(more than 2 years) after GKS was 79.3%. In multivariate analysis, maximal diameter, angiographic form of AVM nidus, and number of draining veins significantly influenced the result of radiosurgery. In addition, marginal radiation dose, Spetzler-Martin grade, and flow pattern of AVM nidi also partly influenced the radiosurgical outcome. Conclusion : GKS on cerebral AVM is considered as an effective treatment modality. The risk of hemorrhage seems to decrease within the latency interval between GKS and complete occlusion of nidus. Along with the size, topography, or radiosurgical parameters of AVMs, it is necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

상지 구획 증후군 이후 발생한 치명적인 뇌출혈

한인보 ( In Bo Han ),정영선 ( Young Sun Chung ),신동은 ( Dong Eun Shin ),허륭 ( Ryoong Huh ),정상섭 ( Sang Sup Chung ),안정용 ( Jung Yong Ahn ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.2

Compartment syndrome has a wide spectrum from muscle pain to a life- threatening condition, such as acute renal failure and disseminated intravascular coagulation (DIC). Intracerebral hemorrhage (ICH) due to compartment syndrome has not been reported. We report a patient who presented with ICH leading to death. A 25-year-old female with no significant past history developed extensive compartment syndrome followed by rhabdomyolysis, acute renal failure, DIC, and ICH. Although the patient underwent a fasciotomy and hemodialysis and received aggressive resuscitation with massive transfusions of blood and intravenous fluids, she died. This case stresses the importance of early diagnosis and prompt treatment of compartment syndrome to prevent devastating complications. (J Korean Soc Traumatol 2006;19:178-182)