급성 경막하 혈종에서 응급 두개골 천공의 위치

문수현,김근회,권택현,박윤관,정흥섭,서중근,Moon, Soo-Hyeon,Kim, Geun-Hoe,Kwon, Taek-Hyun,Park, Youn-Kwan,Chung, Hung-Seob,Suh, Jung-Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.5

The motality rate of acute subdural hematoma(ASDH) associated with closed head injury is high in spite of recent advances in neurosurgery. Many variables in regard to outcome of ASDH have been assessed. But among them, intracranial pressure(ICP) control and the time interval between injury and operative evacuation are the only things that can be affected by doctor. We introduced a simple method to the management of ASDH for reducing the time interval between injury and operation. When the immediate decompressive operation of ASDH was impossible by any causes, we made a burr hole at the center of hematoma, usually on 2-3cm above temporal squama and 1-2cm behind coronal suture under local anesthesia before main operation. Partial hematoma evacuation was achieved through the burr hole and it was effective in preventing further worsening of patients neurological status before main operation. Prompt hematoma evacuation through the burr hole seemed to be effective in delaying secondary ischemic brain damage and made easy to closing the dura opening and replacement of the bone flap at the end of main decompressive operation. This easy method may reduce the time interval between injury and operation. We represent surgical technique with two cases of ASDH managed with this simple method.

척수원추에 발생한 혈관모세포종 - 증례보고 -

문수현,김세훈,권택현,박윤관,정흥섭,서중근,Moon, Soo-Hyeon,Kim, Se-Hoon,Kwon, Taek-Hyon,Park, Youn-Kwan,Chung, Heung-Seob,Suh, Jung Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6

Intramedullary spinal hemagioblastomas usually develope in cervical or thoracic region of spinal cord, but rarely in conus medullaris. We report a case of hemangioblastoma developed in conus medullaris. The 19-year-old male patient presented with slowly progressing low back pain and paresthesia of both legs. MRI and spinal angiography revealed a well-vascularized mass lesion in the conus medullaris with syrinx formation. Total excision of hemangioblastoma was achieved via posterior approach. Postoperatively, patient's walking difficulty was worsened transiently, but it was improved at discharge.

해마 조직 절편 배양을 이용한 무산소 손상에 대한 MK-801, CNQX, Cycloheximide 및 BAPTA-AM의 효과

문수현,권택현,박윤관,정흥섭,서중근,Moon, Soo-Hyeon,Kwon, Taek-Hyon,Park, Youn-Kwan,Chung, Heung-Seob,Suh, Jung Keun 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Objective : Glutamate induced excitotoxicity is one of the leading causes of cell death under pathologic condition. However, there is controversy whether excitotoxicity may also participate in the neuronal death under low intensity insult such as simple hypoxia or hypoglycemia. To investigate the role of NMDA receptor in low intensity insult, we chose anoxia as the method of injury and used organotypically cultured hippocampal slice as the material of experiment. Materials & Methods : The hippocampal slices cultured for 2-3 weeks were exposed to 60 minutes of complete oxygen deprivation(anoxia). Neuronal death was assessed with Sytox stain. Corrected optical density of fluorescence in gray scale, used as cellular death indicator, was obtained from pictures taken at 24 and 48 hours following the insult. The well-known in vivo phenomenon of regional difference in susceptibility of hippocampal sub-fields to ischemic insult was reproduced in HOSC(hippocampal organotypic slice culture) by complete oxygen deprivation injury. Results : $CA_1$ was the most vulnerable to complete oxygen deprivation in hippocampus while $CA_3$ was resistant. Oxygen deprivation for 10 and 20 minutes with glucose(6.5g/l) present was insufficient to induce neuronal death in the cultured hippocampal slice. However, after 30 minutes exposure under anoxic condition, neuronal death was able to be detected in the center of $CA_1$ area. The intensity and area of fluorescence indicating cell death correlated with the duration of oxygen deprivation. NMDA receptor and non-NMDA receptor blocking with MK-801(30 & $60{\mu}M$) and CNQX($100{\mu}M$) did not provide cellular protection to HOSC against damage induced by oxygen deprivation, but increased intracellular calcium buffering capacity with BAPTA-AM($10{\mu}M$) was effective in preventing neuronal death (p=0.01, Student's t-test). Cycloheximide($1{\mu}g/ml$, $10{\mu}g/ml$) provided no protection to HOSC against insult of complete oxygen deprivation for 60 minutes and combined therapy of MK-801(30 & $60{\mu}M$) and cycloheximide(1 & $10{\mu}g/ml$) was also ineffective in preventing neuronal death. Conclusion : The results of this study show that the another mechanism not associated with glutamate receptor(NMDA & non NMDA) may play major role in cell death mechanisms induced by complete oxygen deprivation and increased intracellular calcium during anoxia may participate in the neuronal death mechanism of oxygen deprivation. Further investigation of the calcium entry channel activated during oxygen deprivation is necessary to understand the neuronal death of anoxia.

배양조건에 의한 일과성 저산소상태 후 신경세포회복의 차이

문수현,오재인,박윤관,정흥섭,이훈갑,이기찬,Moon, Soo-Hyeon,Oh, Jae-Inn,Park, Youn-Kwan,Chung, Heung-Sub,Lee, Hoon-Kap,Lee, Ki-Chan 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.9

Objective : The transverse hippocampal slice is one of the most commonly studied in vitro models of mammalian brain physiology. However, despite its broad usage, there has been no standardization of slice preparation techniques or recording condition. It is well known that variations in recording conditions can result in profound different effects to neuronal responses. Evoked field potentials, recorded extracellularly, were used to investigate the effects of variations in hippocampal slice preparation protocol on hypoxia responses of CA1 neurones. Material & Methods : Before hypoxic injury, hippocampal slices were incubated for 4 hours. During incubation period, the slices were placed in a incubation chamber($21^{\circ}C$) for recovery from preparation injury and then transferred to recording chamber($34^{\circ}C$) for more recovery and baseline electric recording with current stimulation(0.1Hz). Various time periods in incubation chamber and recording chamber were applied to each experimental group(group 1=60min : 180min, group 2=90min : 150min, group 3=180min : 60min, time in incubation chamber : time in recording chamber) before 10 min hypoxia produced by replacing 95% $O_2$+5% $CO_2$ mixed gas to 95% $N_2$+5% $CO_2$ gas. Calcium, Magnesium ions and several drugs effecting on glutamate receptor also were studied. Recoveries from hypoxic injury of hippocampal slices were estimated by percent recovery of population spike(PS). Statistic analysis of study were performed using paired t-test. Results : The percent recovery of PS after 10min hypoxia was considerably enhanced by increasing the period of current stimulation during incubation period before hypoxic injury. Temperature effect on the result of this experiment was also studied(group 4) but the result from this showed no statistic significance. Low magnesium ion concentration of artificial CSF(Mg-free aCSF) during incubation period enhanced the recovery of PS but low calcium (calcium-free) and high magnesium ion concentration(2mM) reduced it after hypoxic injury. L-glutamate($100{\mu}M$) and AP-5($50{\mu}M$) had no effect on the recovery of PS but CNQX($10{\mu}M$) in artificial CSF during incubation period markedly enhanced the recovery of PS. Co-treatment of AP-5($50{\mu}M$), CNQX($10{\mu}M$) and high magnesium concentration(2mM) enhanced recovery of PS in immediate following period of hypoxic injury but the effect of cotreatment after then decayed rapidly and lost statistic significance. Conclusions : Judging from above results, the condition of baseline recording is important in observing the recovery of population spike after hypoxia, and the time and the condition should be controled more strictly to obtain reliable results.

폐경 여성에서 타목시펜 사용 후 발견된 거대 자궁내막용종

문수현 ( Soo Hyeon Moon ),이성의 ( Seong Eui Lee ),정인국 ( In Kook Jung ),정주은 ( Ju Eun Jeong ),박원영 ( Won Young Park ),이우희 ( Woo Hee Yi ),서동수 ( Dong Soo Suh ),윤만수 ( Man Soo Yoon ),김기형 ( Ki Hyung Kim ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.12

Tamoxifen is a synthetic non-steroid anti-estrogen that has been used effectively for several years in the adjuvant treatment of breast cancer. But, the drug has been associated with development of endometrial poylp, hyperplasia and adenocarcinoma possibly mediated through its agonistic estrogen properties during the menopausal period in which estrogens are at a low level. Endometrial polyp has been described as the most common endometrial pathology in association with postmenopausal tamoxifen treatment. We present the case of woman with a giant endometrial polyp of uncommon dimension who was receiving adjuvant tamoxifen for 5 years after breast cancer surgery.

Simvastatin이 자궁내막증 환자의 자궁내막 기질세포 증식과 세포자멸사에 미치는 영향

문수현 ( Soo Hyeon Moon ),이성의 ( Seong Eui Lee ),김휘곤 ( Hwi Gon Kim ),최욱환 ( Ook Hwan Choi ),이규섭 ( Kyu Sup Lee ),나용진 ( Yong Jin Na ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.2

목적: 본 연구는 자궁내막증을 가진 여성의 자궁내막 기질세포 배양에 simvastatin을 첨가하여 세포증식 억제와 세포자멸사유도에 미치는 영향을 알아보기 위하여 시행되었다. 연구 방법: 4명의 자궁내막증 환자로부터 채취한 자궁내막조직에서 분리한 자궁내막 기질세포를 simvastatin을 첨가하지 않은 대조군과 2 μM과 10 μM의 simvastatin을 각각 첨가한 처리군으로 나누어 48시간 배양한 후 세포의 형태를 관찰하고, 세포자멸사로 나타나는 sub-G1기를 측정하였다. 세포자멸사에 관여하는 유전자로 알려진 Bcl-2와 Bax의 발현 정도와 caspase-3 효소 활성도를 조사하였다 결과: 대조군에 비해 simvastatin 농도가 높아짐에 따라 기질세포의 증식이 억제되었고, simvastatin 처리군에서 sub-G1기가 현저히 증가되어 simvastatin이 세포자멸사를 유도함을 알 수 있었다 (P<0.05). Bcl-2의 발현은 simvastatin을 처리한 군에서 대조군에 비해 감소하는 것으로 나타났으나 Bax의 발현에는 큰 변화가 없었다. Caspase-3의 효소 활성 조사에서 10 μM simvastatin을 첨가한 군이 대조군에 비해 활성도가 유의하게 증가하였다 (P<0.05). 결론: Simvastatin은 자궁내막 기질세포의 증식과 세포자멸사 억제유전자인 Bcl-2의 발현을 억제하고 caspase-3의 효소 활성을 증가시키는 것으로 나타나 자궁내막증의 치료제로 이용될 수 있을 것으로 사료된다. Objective: To evaluate the effects of simvastatin on the proliferation and apoptosis of human endometrial cells from women with endometriosis. Methods: Endometrial tissues were obtained from four women with endometriosis. The endometrial stromal cells isolated from tissue were cultured with 0, 2 and 10 μM simvastatin treatments for 48 hours. The proliferation of endometrial stromal cells was inhibited with 2 and 10 μM simvastatin treatments compared to control. The effect of simvastatin on the sub-G1 phase of cell cycle was determined by flow cytometry. The expression of apoptosis related molecule (Bcl-2, Bax and caspase-3) was examined in control and simvastatin treatments using western blot. Results: The sub-G1 phase was higher in 10 μM simvastatin than in control and 2 μM simvastatin (P<0.05). This result showed that simvastatin could induce apoptosis of stromal cells. The expression of Bcl-2 was increased in simvastatin treatments slightly (P<0.05) and the expression of Bax was not different between control and experimental groups. The activation of caspase-3 was significantly higher in 10 μM simvastatin treated group than control and 2 μM simvastatin treated groups (P<0.05). Conclusion: Simvastatin induces apoptosis of endometrial stromal cells and inhibits their proliferation. It was considered that simvastatin could potentially be a therapeutic agent for the treatment of endometriosis.

임상 ; 산후출혈처치에 있어 recombinant activated factor 7의 임상적 유용성

문수현 ( Soo Hyeon Moon ),김승철 ( Seung Chul Kim ),주종길 ( Jong Kil Joo ),서동수 ( Dong Soo Suh ),이동형 ( Dong Hyung Lee ) 대한주산의학회 2013 Perinatology Vol.24 No.1

목적: 본 연구는 고식적 처치로는 치료가 어려운 산후출혈환자에서 recombinant activated factor Ⅶ (rFVIIa) 사용의 임상적 효용성을 알아보기 위하여 시행되었다. 방법: 2010년부터 2012년까지 부산대학교병원을 방문한 32명의 산후출혈 환자 중 고식적 방법으로 처치하여도 지속적인 출혈 소견을 보이는 10명에게 rFVIIa를 투여하였다. 모든 환자의 진료 기록과 rFVIIa 투여 결과를 후향적으로 분석하여 “완전 반응군(complete responder)”, “부분 반응군(partial responder)”, “불량 반응군(poor responder)”으로 구분하였고, 수혈요구량과 혈액응고인자의 변화를 분석하였다. 결과: rFVIIa 투여 후 출혈이 멈춘 “완전 반응군(complete responder)”은 4명, 출혈이 줄어든 “부분 반응군(partial responder)”은 6명이었으며, “불량 반응군(poor responder)”은 없었다. rFVIIa 투여 후 수혈 요구량은 줄었으나 농축적혈구 외에는 통계적으로 유의한 차이를 보이지는 않았다(P<0.01). 혈액응고와 관련된 인자 중 Fibrinogen 과 INR은 통계적으로 유의하게 줄었으나, 그 외 인자들에서는 뚜렷한 차이를 보이지 않았다(P<0.01). 결론: 심한 산후출혈 환자에서 rFVIIa의 사용은 출혈량을 줄이는데 유용하게 쓰일 수 있을 것으로 보이며, 모성 사망을 줄이는데 기여할 수 있을 것으로 사료된다. Purpose: This study was aimed to investigate the clinical efficacy of recombinant activated factor VII (rFVIIa) for patients with intractable postpartum hemorrhage. Methods: This was a retrospective study of ten patients who were treated with rFVIIa from July 2010 to February 2012 in one tertiary center. To evaluate each case, we used a standardized case record form. The primary outcome measures were response of rFVIIa, reduction of blood product requirement, changes of coagulation parameter. The response of rFVIIa was categorized to three groups: “complete responder”, “partial responder”, “poor responder”. Results: After the administration of rFVIIa, effect for bleeding was completely responded in 4 patients, partially responded in 6 patients, and poorly responded in none. A certain amount of reduction in blood product requirements was noted following rFVIIa administration, although no significant differences were observed statistically between before and after rFVIIa administration except RBC (P<0.01). Fibrinogen and INR were significantly reduced in all case types, but other coagulation parameters were not (P<0.01). Conclusion: The present results suggest that rFVIIa is a beneficial therapeutic option that could reduce blood loss and contribute to reduction of maternal morbidities and mortalities in patients with massive postpartum hemorrhage.

분만 후 후복막강 혈종으로 오인된 신동맥류 파열

김승철 ( Seung Chul Kim ),문수현 ( Soo Hyeon Moon ),주종길 ( Jong Kil Joo ),이동형 ( Dong Hyung Lee ) 대한주산의학회 2010 Perinatology Vol.21 No.3

Aneurysms in the renal artery are relatively rare and predominately asymptomatic. Histological data estimate that renal artery aneurysms (RAAs) are found in 0.1% of the general population. The most catastrophic complication of RAA is rupture, which occurs in less than 3% of patients. Nearly 30 cases of rupture of RAA (RRAA) during pregnancy have been reported in the international literature, but no RRAA diagnosed after labor has been reported. We report on the first case of acute RRAA after labor, which was initially misdiagnosed as postpartum retroperitoneal hematoma, and provide a brief review of the literature.

임신 제 2삼분기에 지속되는 오심과 구토로 내시경 검사 후 진단된 진행성 위암

신수일 ( Su Il Shin ),이성의 ( Seong Eui Lee ),문수현 ( Soo Hyeon Moon ),정혜인 ( Hye In Chong ),김정태 ( Jeong Tae Kim ),장성규 ( Sung Kyoo Jang ),이동형 ( Dong Hyung Lee ),최욱환 ( Ook Hwan Choi ) 대한주산의학회 2007 Perinatology Vol.18 No.4

Gastric cancer is rarely associated with pregnancy and its incidence is reported to be 0.1%. The dilemma in the treatment of this rare occasion is that it is usually diagnosed at an advanced stage. The most common reason for delayed diagnosis is that early symptoms of gastric cancer, such as nausea, vomiting and epigastric discomfort, are nonspecific and usually misinterpreted as those related to pregnancy. Clinicians` reluctance to request diagnostic studies is another reason for delayed diagnosis. So these make the prognosis much worse. We must consider the rare possibility of gastric cancer in case of persistent nausea and vomiting. We report a case of advanced gastric cancer diagnosed by gastroscopic examination performed in the second trimester because of persistent nausea and vomiting.

흉추부 경막외에 발생한 골수의 형질세포종 : 증례 보고 Case Report

문수현,박정율,박윤관,정흥섭,서중근,이훈갑 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.10

Spinal cord compression associated with plasma cell neoplasm is observed always in the patients suffering from the multiple myeloma or solitary plasmacytoma that occur in the marrow of the spine. Authers report a rare case of extramedullary plasmacytoma forming a mass in the epidural space of the thoracic spine. In 70 year old woman with paraplegia, MRI of the thoracic spine indicated a presence of epidural mass at the 2nd to 8th thoracic vertebrae. There was no abnormal bony changes in the spine on plain X-ray and MFU. Total removal of the epidural mass was performed by posterior approach. Histopathologic examination including immunohistochemical stain showed the plasma cell neoplasm producing IgM and kappa light chain. Cancer workup after operation including bone marrow study and whole body simple radiologic studies supported the diagnosis of extramedullary plasmacytoma.