http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
실험적 중추성 폐부종에 대한 Alpha-Adrenergic Blockade의 효과
강준기,장상근,김문찬,하영수,송진언 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.1
An experimental neurogenic pulmonary edema model in cats is described in which we have attempted to produce a neurogenically mediated hemodynamic storm. This experimental study was done to better define the hemodynamic responses to the elevated intracranial pressure and the effect and role of the alpha-adrenergic blockade in the neurogenic pulmonary edema. 50 adult cats weighing 2.5 to 4.0 kg, were used in this study. The components of the pathophysiological hemodynamic responses, systemic changes, lung weight, and histopathological changes of lung in experimental models were studied in groups of animals when intracranial pressure[ICP) was raised for 2 hours by intraventricular infusion with normal saline to 200mmH₂O and 300mmH₂O. We have also observed the effect of the alpha-adrenergic blockade(pentolamin) in the neurogenic pulmonary edema which was produced by elevated intracranial pressure. The animals were divided into 5 groups: The normal control group was comprised of 10 normal cats. Control and pentolamin treated animal groups which had an elevated ICP of up to 200mmH₂O consisted of 10 cats each. Control and pentolamin treated animal groups which had an elevated ICP of up to 300mmH₂O consisted of 10 cats each but in addition they had a neurogenically mediated pulmonary edema. 1) In the animal groups of elevated ICP to 200mmH₂O and 300mmH₂O, there were hemodynamic systemic changes which were neurogenically mediated and resulted in an immediate elevation in blood pressure from 30mmHg to 6OmmHg. There was also bradycardia, a slight elevation of central venous pressure, and reduction of PaO₂ during the controlling of the elevated ICP. The hemodynamic responses of the animals that had an elevated ICP of up to 300 mmH₂O were significantly more changed than the 200mmH₂O ICP group. The hemodynamic responses of the pentolamin treated animals with elevated ICP of up to 200 and 300mmH₂O less changed and nearly approached the normal limit. 2) This animal model allows quantitative measurement of the neurogenically mediated pulmonary edema of the lungs by weighing. The lung weights of the animals with an elevated ICP of up to 200 and 300mmH₂O were significantly greater then the normal control value (P<0.05) and the lung weights of the animals with an elevated ICP of 300mmH₂O were significantly greater than those with an ICP of 200mmH₂O (P<0. 01). The lung weights of the pentolamin treated animal groups with the elevated ICP were significantly less than the control group but showed little increase in the lung weight when compared to the norma1 value. 3) By controlling the elevated ICP above 200mmH₂O in the experimental animals we have confirmed gross and micropic appearances of hemorrhagic pulmonary edema. Partial destruction and. congestion appeared along with hemorrhage in the alveolar and alveolar wall in the groups with an ICP of 300mmH₂O. Histopathological changes of the pentelamin treated animals with the elevated ICP were significantly less severe than in the control groups and also had a tendency of returning to to a normal state. 4) This experimental model may facilitate clarification of the pathophysiolagical pathogenesis of neurogenic pulmonary edema. The authors defined the concept of neurogenic palmonaty edema as resulting from an increase in pulmonray capillary permeability mediated by massive symphathetic discharges to those vessels. Blockade of the sympathetic innervation to the systemic and pulmonary vascular beds lowers the vascular pressures and brings the pulmonary capillary pressures back to normal.
사대골(斜臺骨) 하부에 발생된 뇌수막종 경구(經口)를 통한 수술 1예 보고
장상근,허춘웅,강준기,송진언 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.1
Midline lesion at the base of skull have been considered in the past to be inoperable, partially resectable, and even when resectable, unpleasant difficult. According for the above has been the poor visulization of minimal surgical exposure, copious bleeding and lack of adequate fluoroscopic depth monitoring. These built-in difficulties may prove to be a fertile ground for microsurgery. Presently the use of the surgical dissecting microscope, portable image intensifiers and specifically designed microinstruments has enabled to permit approach of clival area for removal of the clival tumor. Authors had experience of transoral approach for removal of lower third of clival meningioma, and reviewed surgical approachs to midline lesion at the base of the skull.
두부손상 및 혼수상태하의 급성뇌압상승에 대한 Thiopental 및 Mannitol의 효과
강준기,장상근,강세기,김문찬,허춘웅,송진언 대한신경외과학회 1981 Journal of Korean neurosurgical society Vol.10 No.1
Laboratory and clinical evidence indicates a potentially important role for barbiturates i n the management of brain injury and intracranial hypertension. The present report describes our experience with the thiopental and mannitol therapy in 30 consecutive patients who were over 20 mmHg of intracranial pressure (ICP) in severe head injuries and the other comatous conditions. The anthors have analyzed the effects of thiopental on outcome in comatous 30 patients by continuous monitoring of ICP. High dose barbiturate therapy induced with an intravenous bolus of thiopental, 40mg/kg and the infusion of barbiturates intermittently continued until control of the ICP (below 20mmHg) was obtained. In those patients responding to thiopental, the daily mannitol requirement was reduced from 3.5 to 0.5gm/kg/day. Our overall results are presented; 1) In patients with intracranial mass lesions only very high ICP (〉40mmHg) on barbiturate management was significantly associated with a poor neurological deficit and outcome from injury, while the patients with any increased in ICP above 20 to 29mmHg was associated with a moderate neurological disability and better outcome with thiopental and mannitol treatment. 2) In patients with surgical mass lesion ICP between 20 to 29mmHg was significantly associated good neurological picture and outcome, but the patients in ICP above 40mmHg, had a 75% motality. 3) Decreases in ICP over 20mmHg were seen in 75% of the patient who had managed with thiopental and mannitol. 4) Thiopental responders have returned to a good recrovery and minimal deficit, but thiopental nonresponsiveness was associated with a competely unfavorable outcome: 5 deaths, 1 vegetative survior.