뇌손상 후 운동신경기능 회복 기전 : 기능적 뇌 자기공명영상의 유용성 The Usefulness of fMRI Study

장성호,한봉수,장용민,변우목,김성호,조윤우 한국뇌학회 2001 한국뇌학회지 Vol.1 No.1

목적: 본 연구는 뇌손상환자에서 기능적 뇌 자기공명영상(functional magnetic resonance imaging, fMRI)을 이용한 대뇌운동피질 뇌지도화를 시행하여, 운동신경기능 회복 기전에 대한 기능적 뇌 자기공명영상의 유용성에 대하여 연구하였다. 방법: 신경학적 증상과 병력이 없는 성인 8명과 뇌손상환자 5인을 대상으로 하였다. 뇌손상환자 중 2명은 뇌종양환자이었으며 1명은 뇌출혈, 1명은 뇌경색, 1명은 뇌낭미충증환자이었다. 기능적 자기공명영상은 1.5T MR scanner로 Blood Oxygen Level-Dependent(BOLD) 기법을 적용하였다. 운동과제는 손가락을 1-2Hz의 주기로 쥐었다 펴기를 반복하도록 하였다. 결과: fMRI를 촬영한 결과 정상인 8인, 즉 총 16개의 손중 15개의 손과 환자 5인의 이환되지 않은 손운동시 반대측 일차 운동피질 꼭지(knob)를 중심으로 일차 감각운동피질(SM1)이 활성화되었다. 정상인 중 1인의 한 손에서 반대측 SM1과 동측 일차 운동피질(primary motor cortex, M1) 및 보조운동영역이 동시에 활성화되었다. 뇌손상환자의 이환측 손운동시 환자 1에서는 일차감각피질(primary sensory cortex, S1), 환자 2와 환자 3에서는 양측 SM1, 환자 4와 환자 5에서는 반대측 SM1이 활성화되었다. 환자 1에서는 손상된 M1의 운동신경기능이 S1으로 이전된 것으로 추정되며, 환자 4와 5에서는 손의 운동신경기능이 피질척수로에 의하여 유지되고 있는 것으로 추정되었다. 그러나 환자 2와 환자 3에서 발견된 동측 운동피질 활성화는 본래 정상적으로 존재하던 운동신경 경로인지 뇌손상 후에 발생한 운동신경기능 회복 경로인지 구분할 수는 없었다. 결론: fMRI을 통한 대뇌 운동피질 지도화는 뇌손상 후 병변 주위로의 재조직되는 회복 기전과 피질척수로에 의해 운동신경기능이 유지되고 있음을 입증하는데에 유용할 것으로 생각된다. Objective: This study investigated the usefulness of functional magnetic resonance imaging (fMRI) in the research of motor recovery mechanisms in brain injured patients. Method: Eight control subjects and five brain injured patients were investigated. Out of five patients, two were with brain tumor, one cerebral hemorrhage, one cerebral infarction, and one neurocysticercosis. fMRI was performed using the blood oxygen level-dependent (BOLD) technique at 1.5 TMR scanner with a standard head coil. The motor activation task consisted of finger flexion-extension exercises in 1-2 Hz cycles. Results: fMRI showed activation of the contralateral primary sensori-motor cortex(SM1) by the hand movements of all control subjects and by the unaffected hand movements of all brain-injured patients. Activation of the supplementary motor area(SMA) by one hand movement was also seen in one control subject. Hand movements of the affected hand of the brain injured patients resulted in activation of the contralateral primary sensory cortex(S1) in patient 1, both SM1 in patients 2 and 3, and the contralateral SM1 in patients 4 and 5. Conclusions: It is concluded that fMRI is useful for the research of perilesional reorganization and sparing of the corticospinal tract during the motor recovery mechanisms after brain injury.

Endovascular Treatment of Ruptured Dissecting Basilar Artery Aneurysm : One Case Report

Byun, Woo Mok,Park, Bok Hwan 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

뇌지주막하출혈로 발현된 환자의 파열된 기저동맥박리 동맥류의 합당한 치료는 stent 설치와 코일색전술을 이용한 혈관 내 치료법이다. 저자들은 stent 설치와 코일색전술로 치료된 파열된 기저동맥박리 동맥류 52세 여자 환자의 증례를 보고한다. Optimal treatment for ruptured dissecting basilar artery aneurysms in patients presenting with SAH is endovascular method using stent placement and coil embolization. We report a case (52-year-old woman) of ruptured dissecting aneurysm of the basilar artery which was treated with stent placement and coil embolization.

In Vivo and In Vitro Studies of the Steady State Free Precession-Diffusion-Weighted MR Imagings on Low b-value : Validation and Application to Bone Marrow Pathology

Byun, Woo Mok 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

목적 이 연구는 낮은 b값의 SSFP-확산강조영상에 의한 물분자의 확산 성질 측정이 가능한지를 알기 위한 모형연구를 하고 이 기법이 골수질환에 적용이 가능한 가를 아는 것이 목적이다. 재료 및 방법 모형 연구 : 순수한 물로 구성된 모형에서 확산강조 영상을 시행하였다. 섭씨 3도, 23도 그리고 63도의 순수한 물로 구성된 모형에서 SSFP 확산강조영상과 echo planner imaging(EPI) 확산강조영상 (b값: 1000 s/mm²)을 모두 시행하여 각각에서 신호 대 잡음 비(SNR; signal to noise ratio)와 확산계수를 얻었다. 임상 연구 : 10명의 천골 부족 골절, 10명의 골다공증에 의한 급성 요추 압박골절, 그리고 전이암에 의한 요추 압박골절 8명에서 각각 SSFP 확산강조영상을 시행하였다. SSFP 확산 강조영상 외 확산계수를 측정하기 위해 single shot stimulated echo-acquisition mode sequence를 이용한 확산강조영상을 시행하였다. 결과 모형연구에서 EPI 확산 강조영상뿐만 아니라 SSFP 확산강조영상에서 물의 온도가 증가됨에 따라 신호강도의 감소를 보였다. EPI-확산계수 영상에서 확산계수 값은 3도의 물은 0.13×10^(-3) mm²/s, 23도는 0.22×10^(-3) mm²/s 그리고 63도에서 0.37×10^(-3) mm²를 나타냈다. 이러한 결과는 SSFP 기법은 비록 낮은 b 값을 가지지만 확산 강조 영상으로 확신된다. SSFP 확산강조영상에서 모든 천골 부족 골절과 골다공증 척추 압박골절은 높은 확산계수를 의미하는 저신호강도를 전이암에 의한 압박골절은 낮은 확산 값을 나타내는 고신호 강도를 보였다. 결론 SSFP 확산강조영상에서 다른 확산계수를 가진 골수질환이 영상화 되었으며 모든 양설골절은 주위 정상 골수에 비해 저신호강도, 악성종양에 의한 골절은 고신호강도로 관찰되었다. Purpose : The purpose of this study was a phantom study to measure the diffusion properties of water molecules by steady-state free precession diffusion-weighted imaging (SSFP- DWI) with a low b-value and to determine if this sequence might be useful for application to the evaluation of bone marrow pathology. Materials and methods : 1. The phantom study: A phantom study using two diffusion weighted sequences for the evaluation of the diffusion coefficient was performed. Three water-containing cylinders at different temperatures were designed: phantom A was 3℃, B was 23℃ and C was 63℃. Both SSFP and echo planar imaging (EPI) sequences (b-value: 1000 s/mm²) were performed for comparison of the diffusion properties. The Signal to noise ratios (SNR) and apparent diffusion coefficient (AUC) values of the three phantoms using each diffusion-weighted sequence were assessed. 2. The Clinical study: SSFP-DWI was performed in 28 patients [sacral insufficiency fractures (10), osteoporotic lumbar compression fractures (10), malignant compression fractures (8)]. To measure the ADC maps, a diffusion-weighted single shot stimulated echo-acquisition mode sequence (650s/ mm²) was obtained using the same 1.5-T MR imager. Results : For the phantom study, the signal intensity on the SSFP as well as the classic EPI-based DWI was decreased as the temperature increased in phantom A to C. The ADC values of the phantoms on EPI-DWI were 0.13×10^(-3) mm²/s in phantom A, 0.22×10^(-3) mm²/s in B and 0.37×10^(-3) mm²/s.in C. The SSFP can be regarded as a DWI sequence in view of the series of signal decreases. Conclusion : Bone marrow pathologies with different diffusion coefficients were evaluated by SSFP-DWI. All benign fracturews were hypointense compared to the adjacent normal bone marrow where as the malignant fractures were hyperintense compared to the adjacent normal bone marrow.

방사선학적으로 확진된 신증후군과 동반된 신정맥 혈전증 1예

변우목,장재천,정경화 영남대학교 의과대학 1987 Yeungnam University Journal of Medicine Vol.4 No.2

저자들은 신증후군의 증상으로 본 영남대학교 의과대학 부속병원에 내원한 환자에서 임상증상과 임상검사 소견 및 초음파, 신주사, 신동맥조영술 등의 소견으로 신정맥 혈전증을 의심하였고 신정맥조영술을 시행아여 신증후군과 동반된 신정맥 혈전증임이 확진된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Renal vein thrombosis is usually a complication of multiple underlying renal disease rather than primary process. High incidence of renal vein thrombosis in patients with nephrotic syndrome, which suggest the nephrotic syndrome play a paramount role in the genesis of renal vein thrombosis or thromboembolic phenomena. But these are likely to relationship of "egg and chicken", and then we can not determine what is primary of these. Recently authors experienced a case that was questioned renal vein thrombosis with nephroticsyndrome clinically, labratory and preliminary radiologically, and this case is confirmed by selective left renal venography. Here we report a case of renal vein thrombosis with nephrotic syndrome which successfully managed with oral anticoagulants and reviewed literatures.

Ceftizoxime의 장내세균에 대한 시험관내 및 생체내 향균효과

변우목,장재천,박복환,김희선,김성광 영남대학교 의과대학 1989 Yeungnam University Journal of Medicine Vol.6 No.1

반합성 β-lactam 항생제로서 세균에 β-lactamase에 대해 높은 안정성을 나타내는 ceftizoxime의 임상 분리 장내 세균 18주에 대한 시험관내 및 생체내 항균효과와 내성균의 출현여부를 조사하고 ampicillin,tetracycline, gentamicin 및 cefadroxyl와의 항균력을 시험관내 실험으로 비교하였으며 또한 마우스 장내 정상균총에 미치는 영향을 관찰하여 다음과 같은 결론을 얻었다. 1.Ceftizoxime은 그람음성 장내 세균에 대하여 시험관내에서 높은 항균력을 나타내었으며 이러한 항균력은 ampicillin,tetracycline,gentamicin보다 높았으며 β-lactamase 산생 내성균주의 치료제로 알려진 cefadroxyl보다도 높았다. 2.시험관내 다제 내성균주는 ampicillin, cefadroxyl, gentamicin 및 tetracycline에 대한 내성주는 E.coli1주, ampicillin, cefadroxyl 및 tetracycline에 대한 내성주는 E coli2주, ampicillin, gentamicin 및 tetracycline에 대한 내성주는 shigella dysenteriae이였으며, ampicillin 및 tetracycline에 대한 내성주는 Enterobacter cloacae였고 ampicillin 및 tetracycline에 대한 내성주는 E.coli5주이었다. 3.Ceftizoxime에 대한 내성균주의 출현율은 매우 낮았다. 4.서로 다른 내성을 보인 9균주 E.coli6 strains, shigella, dysenteriae, Enterobacter cloacae, and Samonella typi중 plasmid분리는 6균주에서 관찰되었으며이는 E.coli5주와 shigella dysenteriae1주 있었다.그러나 항생제에 대한 저항의 marker로서는 결정할 수 없으므로 이를 위해서는 curing experiment를 사용하여야 한다. 5. Ceftizoxime은 마우스 장내 정장균층에는 현저한 영향을 미치지 않았다 이상의 결과에서 Ceftizoxime은 그림음성 장내 세균에 대하여 높은 항균력을 나타내며 장내세균 감염치료에 선택적 항생제로 이용돨수 있을 것으로 사료돤다. Ceftizoxime sodium is a new synthetic β-lactam antibiotic combining potent antibacterial activity with high stability to a wide range of bacterical β-lactamase. This experiment was achieved to evaluate the antibacterial activities of ceftizoxime sodium against Gram negative enteric bacteria isolated from in outpatient visiting Yeungnam university hospital and to study the emergence of drug induced bacterial varients which resist to ceftizoxime in vitro. The antibacterial activity of the ceftizoxime was compared with that of antibacteric and its effect on population of normal instestinal flora in mice was observed. The results are summarized as follows: 1.Highly effective antibacterial activity of ceftizoxime against Gram negative enteric bacilli was demonstrated and this antibacterial activity was superior to that of ampicillin. 2.Several test strains shows multiple antibiotic resistence. Among 15 strains of Escherichia coli.1 strain was resistent to ampiccillin,cefadroxyl,gentamicin, tetracycline,and 2 strains were resistent to ampiccillin, cefadroxyl,tetracycline, five strains of Escherichia coli and Enterobacter cloacae was resistent to ampiccillin,tetracycline and shigella dysenteria was resistent to ampicillin,gentamicin tetracycline. 3.The frequency of in vitro emergence of resistent varients among ceftizoxime sensitive bacteria in the presence of increasing concentrations of the compound was found to be low. 4.Plasmid was isolated in 6 of 9 strains 6 strains of Escherichia coli Shigella dysenteriae. Enterobacter cloaceae and salmonella typhi That showed different antibiotic resistance.They were 5 strains of Escherichia coli and 1 strain of Shigella dysenteriae. However, plsmid could not be considered as a hallmark for antibiotic resistance by this. Further studies with curing experiment are to be accomplished for this purpose. 5.Changes in the bacterial count of normal intestinal flora following 25mq/kg/day adminstration of ceftizoxime over 5 consecutive days were not singnificant In conclusion ceftizoxime appered to be a drug of choice in the treatment of Gram negative enteric bacilli infection.

각종 조혈모세포 근원별 CD34+ 양성세포율 및 혈구 집락배양의 비교

목지오,변재호,김숙자,전진우,원종호,백승호,서원석,홍대식,박희숙 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

목적: 각종 조혈모세포의 근원인 말초혈액(PB), 고용량 항암요법과 조혈성장인자 투여후 얻은 말초혈액(MPB), 골수(BM) 및 제대혈 (UB)의 단핵구를 이용하여 CD₃₄+ 세포양성율 및 각종 조혈전구 세포의 집락 형성능을 비교 관찰하고자 한다. 방법: flow cytometry와 anti-CD₃₄+ 단세포항체를 이용하여 각종 조혈모세포 근원의 CD₃₄+ 양성세포함유 정도를 측정하였고, 분리된 단핵구를 집락배양하여 CFU-GM, BFU-E, CFU-GEMM 및 HPP-CFC의 집락형성능을 관찰하였다. 결과: 1) 각 조혈모세포의 근원별 CD₃₄+ 양성세포의 분리 전후의 비교 CD₃₄+ 양성세포의 양성률은 고용량 항암요법과 조혈성장인자 투여후 얻은 말초혈액에서 3.46±0.72%로 가장 높았으며 골수와 제대혈에서 각각 1.78±0.86%과 1.53±0.43%으로 비슷하였으며 말초혈액에서 0.14%로 가장 낮았다. CD₃₄+ 세포를 분리하였을 때, 분리후 CD₃₄+ 양성세포는 제대혈액에서 96.99±1.95%로 가장 높았으며 고용량 항암요법과 조혈성장인자 투여후 얻은 말초혈액에서 72.54±14.06%, 골수에서 60.6±1.9%, 그리고 말초혈액에서 54%로 나타났다. 2)각 조혈모세포의 근원별 조혈전구세포의 집락형성 CFU-GM, BFU-E, CFU-GEMM 그리고 HPP-CFC를 사용한 집락배양결과 CD₃₄+ 양성세포 분리군에서 비분리군에 비해 집락수가 많았으며, CFU-GM의 경우 그 비는 말초혈액, 골수, 그리고 제대혈액에서 각각 112배, 10배, 5배, 26배 또한 CFU-GEMM은 각각 136배, 8배, 12배가 높았다. 결론: 각종 조혈모세포의 근원별 CD₃₄+ 양성세포의 양성세포율 및 조혈전구세포 집락배양비교시 CD₃₄+ 양성세포와 조혈전구세포가 말초혈액이나 골수보다 MPB나 제대혈에서 훨씬 많은 것을 관찰하였다. Background: Classically bone marrow is the major source of hemopoietic stem cells of the allo/autologous hemopoietic stem cell tansplantation. Recently, hemopoietic stem cells circulate in peripheral blood, "mobilized" with cytokines and/or cytotoxic chemotherapy and umbilical cord blood stem cells, are widly used for high dose chemotherapy with hemopoietic stem cells support. The aim of this study is to investigate the possibility of clinical applications of selected CD34+ cells with source of hemopoietic stem cells such as, peripheral blood(PB), mobilized PB(MPB), bone marrow(BM), and umbilical cord blood(UB) Methods: We evaluated the comparison of the clonogenicithy and percentage of CD₃₄+ cells according to each source of hemopoietic stem cells in before and after separation of CD₃₄+ cells through in vitro colony assay and flow cytometry with anti-CD₃₄+ monoclonal antibody. Results: 1) CD34+ cells were detected in PB, MPB, BM, and UB at incidences of 0.14%, 3.46 ±0.72%, 1.78±0.86%, and 1.53±0.43% of total mononuclear cells. And the most CD34+ cells were detected in UB after seperation of CD₃₄+ cells. 2) The colony counts revealed more in CD₃₄+ isolating group. Clonogenicity of CD₃₄+ cells in PB, MPB, BM, and UB was 112-fold, 10-fold, 5-fold, and 26-fold in colony forming unit-granulocyte and macrophage(CFU-GM), and 136-fold, 8-fold, 3-fold, and 12-fold in colony of forming unit-granulocyte, erythrocyte, monocyte, megakaryocyte(CFU-GEMM). The colony counts of UB and MPB were large numbers more than PB and BM. Conclusion: Clonogenicity and percentage of CD₃₄+ cells are superior MPB and UB than in PB and BM.

소아복부 종괴의 방사선학적 고찰

변우목,권혁포,황미수,장재천,김선용,박복환 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.1

최근 5년간의 소아의 복부종과 23예를 발생빈도, 부위 및 방사선학적 소견을 중심으로 비교분석하여 다음과 같은 결론을 얻었다. 1. 전체 23예중 신경아세포종이 6예로 가장 많았고, 그 다음이 Wilms'종양 5예, 담도낭종, 난소종양, 수전증 등의 순위였다. 2. 발생연령별로 분석해 본 결과 6세 이하가 78%(14예)를 차지했고 특히 후복강 종양은 6세 이하에 집중되어 있었다. 3. 부위별로는 후복강 종양이 60%(14예)로 가장 많았다. 4. 방사선학적 소견을 분석하여 본 결과 1) 단순 복부촬영상 신경아세포종의 50%에서 특징적인 석회화 음영을 볼 수 있었고 후복강 종양의 대부분에서 비특이적인 석회화 음영을 볼 수 있었다. 2) 초음파 소견상 저에코, 고에코 또는 혼합에코 등의 종괴 내부성장을 알 수 있었으나 종괴의 정확한 해부학적 위치를 파악할 수 없는 경우가 많았다. 3) 경정맥 신우 조영촬영상 신우신배의 비정상적인 소견과 신장의 전위소견으로부터 신장내 종양과 신장외 다른 부위의 종양을 구분할 수 있었다. 4) 전산화 단층촬영상 종괴 내부의 성상뿐만 아니라 종괴의 해부학적인 위치, 주위 구조와의 관계, 임파절이나 다른 부위로의 전이유무를 알 수 있었다. The abdominal tumors in children are different from those of adult. These tumors are the third most common one, preceded by leukemia and brain tumors, in children under 15 years. X-ray examination is the most important method among diagnostic approaches. The role of diagnostic imaging is to identify the precise anatomic location and extent of pathologic process with the minimal number of imaging procedures. 23 cases of abdominal tumors were reviewed in respect of age incidence, site of origin, radiologic findings. The results are briefly summarized as follows: 1. Neuroblastoma was the most common(6cases) and wilm's tumor(5 cases), choledocal cyst(4 cases), ovarian mass(3 cases), hydronephrosis(2 cases), were descending order in frequency. 2. The most common site was retroperitoneum(60%) Kidney was the single most common site of origin. 3. Radiologic findings. The most common findings of plain radiography was ill defined soft tissue mass and this method was helpful in the presence of calcification especially in neuroblastoma. Ultrasonographic pattern was anechoic(cystic), echoic or mixed pattern, but this method provide less precise anatomical details, nevertheless ultrasonography was paticullary useful imaging modality for the pediatric abdominal tumors. IVP findings were renal displacement, caliceopelvic system distortion or nonvisualization of kidney, these information was helpful in determining the location of tumors. CT scan showed homogenous or inhomogenous, cystic or solid, mass with their anatomic location. 4. Ultrasonography was the most widely used specific diagnostic method, but had limited value in detecting the anatomic location of tumors. CT scan was superior to ultrasound for determining the extent of tumors.

경동맥 죽상경화반의 고해상도 자기공명영상

변우목,조재호 영남대학교 의과대학 2004 Yeungnam University Journal of Medicine Vol.21 No.2

A thromboembolic stroke is believed to be precipitated by a rupture of vulnerable atheromatous plaques. Until recently the assessment of a further risk of stroke in high-risk patients in whom atherosclerosis has presented with a transient ischaemic attack (TIA), has been confined to a quantitative assessment of the luminal patency of the internal carotid artery. These traditional stratification parameters are no longer believed to be the most accurate predictors of a thrombo-ernbolism. This is because the process of vessel wall remodeling can maintain a luminal patency, and consequently, quite large friable plaques may remain unidentified. Accordingly, there is a need for an improved risk assessment. The fibrous cap of a vulnerable plaque is thinner, and an intraplaque hemorrhage and inflammation can occur during the development of atherosclerotic plaque. Several imaging methods for identifying vulnerable plaques have been developed. Recently, high resolution magnetic resonance (MR) imaging has emerged as an accurate non-invasive tool that can characterize the carotid plaque components in vivo. A High resolution carotid magnetic resonance is capable of distinguishing an intact, thick fibrous cap from a thin and ruptured cap in carotid plaque. In addition, a plaque MR can identify the active inflammation and detect a hemorrhage. High resolution carotid MR imaging is a valuable noninvasive method for quantifying the plaque components and identifying vulnerable plaque.

Usefulness of Three Dimensional Proset MR Images for Diagnosis of Symptomatic L5-S1 Foraminal and Extraforaminal Stenosis

Kim, Sang Woo,Kim, Chang Hwan,Kim, Min Su,Jung, Young Jin,Byun, Woo Mok The Korean Neurosurgical Society 2013 Journal of Korean neurosurgical society Vol.54 No.1

Objective : To suggest a new useful diagnostic technique, principles of the selective excitation technique-magnetic resonance images (Proset-MRI), and to know the precise radiologic findings that can prove symptomatic foraminal and extraforaminal stenosis at L5-S1. Methods : Nineteen patients with symptomatic L5-S1 stenosis were checked by Proset-MRI. Four patients were performed decompressive surgery and 15 patients were performed selective nerve root block (SNRB) at L5. The pain scale of patients was checked by Visual Analogue Scale (VAS) scores at the pre- and post-treatment state. Results : Proset-MRI findings of patients with symptomatic stenosis are root swelling (RS) and indentation. The comparisons with VAS scores had a meaningful statistical result at each RS (p<0.01) and indentation (p<0.01). However, the findings of RS combined with indentation lacked statistical significance (p=0.0249). In addition, according to a comparison with the treatment modalities, reducing of VAS scores had statistical meaningful significance in decompressive surgery cases (p<0.01), and also in SNRB cases (p<0.01) after a 3-month follow-up period. Conclusion : The three dimensional Proset-MRI is very useful and sensitive technique to diagnose the symptomatic foraminal and extraforaminal stenosis at L5-S1.

Subcutaneous Emphysema and Inflammation of the Neck after Tracheal Puncture by an Intubating Stylet

Jung, Gul,Byun, Woo Mok,Lim, Hyung Jun,Kim, Jong Gyun,Kwak, Dong Min,Lee, Deok Hee,Kim, Sae Yeon,Song, Sun Ok,Seo, Il Sook,Jee, Dae Lim,Kim, Heung Dae,Park, Dae Pal 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2

한 41세 남자 환자가 충수돌기염 절제술을 받기 위하여 전신마취를 받았다. 삽관을 위해 후두경으로 보자, 난해한 기도삽관이 예상되어 유도자를 사용하였다. 기도삽관 중 돌출된 유도자가 기도를 손상시켰으며, 이에 의해 목에서부터 상부종격동까지의 피하기종과 목의 염증성 종창이 생겼다. 환자는 호흡곤란과 관련된 증상을 보이지 않아 호흡기의 손상을 의심하기 어려웠고, 주 증상이었던 염증성 종창에 초점을 두게 되어 진단에 차질을 빚었으나, 환자는 대증치료로 회복하였다. 유도자를 사용하여 기관내 삽관을 하는 경우 유도자의 위치를 재점검하여 유도자에 의한 기도 손상을 유발하지 않도록 유념해야 할 것이다. Laryngo-tracheal perforation caused by the use of a stylet during tracheal intubation is a rare complication. We present a case of subcutaneous emphysema and connective tissue inflammation after tracheal intubation. The patient was a 41-year-o1d male undergoing general anesthesia for an appendectomy. The intubation was difficult during laryngoscopy (Cormack- Lehane Grade III). An assistant provided an endotracheal tube with a stylet inside while the laryngoscope was in place. During intubation, a short, dull sound was heard with a sudden loss of resistance after the distal tip of the endotracheal tube passed the rima glottis. A sonogram and computerized tomography revealed subcutaneous emphysema from the neck to the upper mediastinum and fluid collection between the trachea and the thyroid. This lesion apueared to have been caused by the protruded, loose stylet. Anesthesiologists should be aware of the damage a loose stylet protruding beyond the tip of the endotracheal tube can cause.