뇌종양의 악성도 판정을 위한 분열기 세포측정에 관한 연구

한용표,변진수,허철,홍순기,김헌주,조미연,정순희,김호근 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.11

Tissue markers of cellular proliferation have been utilized as prognostic indicators in tumors of the central nervous system. Nucleolar organizer regions represent transcriptionally active sites of ribosomal deoxyribonucleic acid and can be identified by a simple argyrophilic technique. The authors describe a standardized approach to the assessment of these argyrophilic nucleolar organizer regions(AgNORs) in 25 astrocytomas(including 6 glioblastomas), 6 oligodendrogliomas and 1 xanthochromic astrocytoma, which were also estimated in association with 2-year survival post-operatively. Appropriate sections were silver stained and AgNORs were counted in 1000 cells. In cases of astrocytoma, the mean AgNORs/cell count of group survived more than 2 years after operation was significantly different from that survived less than 2 years : 1.93±1.13 vs. ≥ 4.79±3.90. And the mean AgNORs/cell count was 1.53±0.32 in low grade astrocytoma. 2.03±0.59 in grade Ⅲ astrocytoma, and ≥6.64±3.77 in grade Ⅳ astrocytoma. Among the patients with the same grade astrocytoma, the mean AgNORs/cell count was lower in the cases of long survival rather than short survival. The assessment of AgNORs can be easily performed by any surgical pathology laboratory without specialized equipment. It may be used as a valuable and independent prognosticator of biological behavior in cases of astrocytoma.

뇌교출혈의 치료

한용표,윤범수,허철,홍순기,이병우,장재훈,김헌주 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.4

Most of untreated pontine hematomas are known to be fatal. Even though the patient may survive, the sequelae of pontine hematoma is serious. Fourteen cases of pontine hematoma who were treated either surgically or conservatively were analysed. Among nine cases treated surgically, three showed good recovery, three died postoperatively, and moderate to severe disability remained in three cases. On the other hand, conservative treatment resulted in one good recovery, one moderate disability, and four deaths. We hope to emphasize the efficacy of surgical treatment on pontine hematoma.

소뇌경색의 조기진단 및 치료

한용표,이병우,장재훈,윤범수,정상섭,이규창 대한신경외과학회 1984 Journal of Korean neurosurgical society Vol.13 No.3

Cerebellar infarction may be rapidly fatal when the patient is not diagnosed and treated promptly. Since 1980, we have encountered five patients of cerebellar infarction and here we analysed the cases and reviewed the literature. All patients were treated by means of the posterior fossa decompression with mortality rate of 20%. By the mode of onset and progression of symptoms and signs, the patient of cerebellar infarction could be divided into two groups ; The patients who took the benign course showed the initial symptoms of headache, nausea, vomiting, dizziness and lack of balance, and were usually recovered spontaneously with the conservative treatment. On the contrary, the patients who took the progressive course showed rapidly progressive deterioration of the initial symptoms and signs and mental state. They could be recovered by the early posterior fossa decompression. The emphasis should be given to the early diagnosis and treatment for the purpose of recover in the patient of cerebellar infarction.

Management of Coma with Intracranial Lesions

한용표 연세대학교 의과대학 1984 연세의대논문집 Vol.17 No.1

굴근반사의 중추반사궁에 관한 실험적 연구

韓勇彪 대한신경외과학회 1980 Journal of Korean neurosurgical society Vol.9 No.2

The flexion reflex is generally known as a withdrawal reflex in response to a painful stimulus. Since Sherrington's first detail report in 1910, it has been established that the flexion-reflex" is a central reflex evoked by a painful stimulus applied to the skin or afferent nerves. Recent studies indicate that the reflex is not a single component but has two components, the early and the late. Although many aspects of the reflex is known, it is still obscure as to the pathways for the lwo components of the reflex. The central reflex arc of the each component has not been localized systematically. Furthermore, there are considerable discrepancies in literatures regarding to the type of afferent nerve fiber responsible for the flexion reflex. The present study was, therefore, conducted to find out the pathways for the flexion reflex including the location of the central reflex arc and the afferent nerve fiber types in an experimental animal. Sixteen healthy adult cats (2∼3.5㎏) were preanesthetized with ketamine hydrochloride (20 ㎎/㎏, im.) and decerebrated anemically by ligating the basilar artery and the bilateral common carotid arteries. Animals were paralized with gallamine triethiodide and kept under artificial respiration. The flexion reflex was elicited by stimulating the sural nerve and recorded as a form of compound action potential from the nerve supplying to the semitendinous muscle. The central, reflex arc of the flexion reflex was localized by comparing the reflex components of decerebrate cats with those of decerebrated and spinalized cats. The type of efferent nerve fiber responsible for each component of the flexion reflex was identified by recording afferent volleys from the sural nerve at 40~50mm proximal to the stimulating site. The results are summarized as follows: 1) The flexion reflex is composed of two components, the early and the late. The early and the late components have a latency of 7.8 and 173.8 msec, and a duration of 7.3 and 906.3 msec, respectively. 2) The central reflex arc of the early component and most of the late component is in the spinal cord while some of the late component is mediated by either rostral part of the spinal cord or the brain stem, most likely medulla oblongata. 3) The afferent nerve fibers responsible for the early component are Aβ and Aδ fibers and that of the late component is C fibers, In general, temporal summation from C fibers is necessary to elicit the late component. These results indicate that the two componts of the flexion reflex have different pathways. This may imply that the two components have different functional role.

성인의 aqueductal stenosis

한용표,김흥치,김상철,정상섭,이헌재 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.1

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis is confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The frist case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.

시상간교의 형태학적 연구

한용표,정인혁,신태선 최신의학사 1980 最新醫學 Vol.23 No.1

Von Recklinghausen 씨 병과 병발한 다형성 교아종

한용표,김헌주,김상철,정상섭,이헌재 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

Von Recklinghausen's disease, first described by Firsty and Smith in 1849, which is characterized by the abnormal cutaneous pigmentation and skin tumors. Their concomittant occurrence with pheochromocytoma, ganglioneuroma, neuroblastoma, medulloblastoma etc., have been reported in many cases. But so little experience has been recorded pertaining to malignant astrocytoma associated with von Recklinghausen's disease that the following case report is thought worthy of presentation in order that further aspects of this unusual problem may be the general attention.

뇌실내 출혈의 치료에 있어 뇌실도관법에 대한 고찰

한용표 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

Among all of the cerebrovascular problems that which has the highest mortality and worst prognosis is the problem of intraventricular hemorrhage. The mortality is highest immediately following the hemorrhage. Because direct surgical intervention is thought to be very dangerous in patients with intraventricular hemorrhage most of these patients have been treated conservatively. This study gives the results of evacuation of the intraventricular blood plus the placement of external drainage catheters which decrease the intraventricular pressure and provide an outlet for the blood should the patient have further hemorrhage. Such a procedure is associated with clinical improvement which better prepares such patients for subsequent surgical treatment. Eighteen patients who had intraventricular hemorrhage between June 1973 and April 1974 are analyzed as to the results of this operative treatment. Also the literature concerning this new method is reviewed. The operative procedure was as follows: Under local anesthesia using 1% procaine unilateral or bilateral burr holes were made in the frontal area. Ventriculostomy was made through these holes. The ventricle was irrigated with physiologic sa??e removing the hematoma or the bloody ventricular fluid. The irrigation was continued until the fluid became relatively clear. Following the initial irrigation, the cannular was removed and a Nelaton catheter placed into the ventricle. The catheter was fixed to the scalp and connected to a drainage bottle under aseptic conditions. The ventricular drainage was maintained at 200㎜H₂O for 7-10 days. Prior to surgery 2 million units of procaine penicillin was injected into the ventricle. Pest??peratively, 5㎎ of Gentamycin was injected through the catheter twice a day. Surgical drainage of the ventricle was done 3 hours to 7 days after the onset of clinical signs of hemorrhage. The external ventricular drainage was maintained for an average of 7.0 days. Results: 10 patients(56%) improved and could be discharged. 4 died of recurrent intraventricular hemorrhage, of gastrointestinal bleeding, or of myocardial infarction during hospitalization. However, all of these 4 patients showed some clinical improvement following the operative procedure. Only "4'patients expired after surgery- This mortality. of 44% is considerably less than the usually found mortality of 80-100% for intraventricular hemorrhage and 60-70% in subarachnoid hemorrhage. On the basis of this study a mere active treatment of patients with intraventricular hemorrhage. including operative drainage of the ventricles is proposed.

다발성 손상환자에서 병발된 지연성 뇌경막외 혈종의 처치

홍순기,김헌주,한용표 대한응급의학회 1990 대한응급의학회지 Vol.1 No.1

It is well known that a large number of patients die, not because of primary brain damage, but also entirely because of secondary brain insults that occur following polytrauma. Of special concern is identification and anticipation of those preventable and correctable factors that cause further damage to the already injured brain. For the past one year, we have encountered polytraumatized patient with delayed extradural hematoma, resulting in variable outcome. These following comments below should be emphasized as a guidlines of prevention against delayed onset of intracranial mass lesion on polytrauma patients. 1. Delayed onset of intracranial mass lesion should be much more frequent in victims of fall than in patients with vehicular injuries. 2. The treatment regimen such as fluid replacement for hemorrhagic shock, osmotherapy and hyperventilation might induce delayed intracranial hematoma to a sizeable lesion to render patient's life dangerous. 3. Brain CT scan study, especially in case of polytrauma patients, should be repeated as many as possible, preoperatively and immediately after postoperative period.