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지주막하출혈에 의한 지연성 허혈신경장애의 진단에 있어서 경두개도플러 검사의 신뢰도
김종문,강성돈,Kim, Jong Moon,Kang, Sung Don 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7
Objective : The reliability of transcranial doppler sonography(TCD) for predicting delayed ischemic neurologic deficit( DIND) was investigated in patients with aneurysmal subarachnoid hemorrhage(SAH). Methods : The velocity of blood flow through the middle cerebral artery was measured by TCD in 70 patients treated surgically within 72 hours due to ruptured cerebral aneurysm. A correlation between measured maximal mean blood flow velocities and clinical factors including age, hypertension, Hunt-Hess grade, Fisher grade, DIND, and outcome was made. Results : An age-dependent reduction of the measured maximal mean velocities was found(r=-0.4043, p<0.001). Flow velocities in hypertensive patients were significantly lower than in the normotensive individuals(two-tailed T test, p<0.05). There was no significant difference between the flow velocities and evaluated other clinical factors. When the flow velocities of 14 patients who developed DIND were compared with those of patients without deficits, no significant difference was seen. A significant increase in flow velocities in the days before the onset of DIND was found only in 4 of 14 cases. High flow velocities did not necessarily mean impending neurological deficits : 6 of 70 patients tolerated flow velocities over 160cm/s. Conclusion : We suggest that TCD readings have limited utility for predicting DIND following SAH, especially in older or hypertensive patients. More direct measurements of blood flow are necessary to adequately predict which patients are at high risk of DIND.
Polystyrene Latex Bead에 의한 뇌혈관연축 모델에서 K<sup>+</sup> 통로활성제의 전신투여
장성조,강성돈,윤기중,Jang, Sung Jo,Kang, Sung Don,Yun, Ki Jung 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.6
Objectives : It has been reported that the presence of a pharmacologically inactive foreign substance, polystyrene latex bead, in subarachnoid space activates a non-specific immunological response and elicits arterial narrowing. Recently the activation of potassium($K^+$) channels may be of benefit in relieving cerebral vasospasm. The present study examined the effects of systemic administration of a ATP-sensitive $K^+$ channel activator, cromakalim, on the polystyrene latex bead-induced cerebral vasospasm. Methods : The spasm models similar to that caused by subarachnoid blood injection were created by injection of bead into rabbit cisterna magna. Intravenous injections of cromakalim were administered twice daily(bid) 30 minutes after induction of vasospasm. Animals were killed by perfusion-fixation 2 days after vasospasm. Basilar arteries were removed and sectioned, and the luminal cross-sectional areas were measured. Results : Injection of bead elicited an arterial constriction, reducing arterial diameter to 33.3% of resting tone. Cromakalim inhibited bead-induced constriction at a dose of 0.3mg/kg(Mann-Whitney test, p<0.01). Conclusion : These results support the concept that the cellular events triggered by inactivation of ATP-sensitive $K^+$ channels are responsible for the pathogenesis of vasospasm. The findings also indicate that cromakalim represents a potential therapeutic agents for the treatment of cerebral vasospasm.
김종문,강성돈,Kim, Jong Moon,Kang, Sung Don 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6
Objective : Antifibrinolytic treatment after aneurysmal subarachnoid hemorrhage has been shown to have no significant effect on outcome since a reduction in the rate of rebleeding was offset by an increase in the incidence of hydrocephalus and ischemic events. As the results of early aneurysm surgery and a change of strategy in the intensive medical treatment, outcome in patients with cerebral ischemia has been improved. On the other hand, rebleeding still remains as a major cause of death. A short course of tranexamic acid(TA) was tried to study its efficacy and safety in reducing the incidence of rebleeding before aneurysm surgery. Methods : A total of 507 patients with ruptured cerebral aneurysm operated within 3 days after the attack from 1990 to 1999 were included in this study. Group A consisted of 302 consecutive patients treated from 1990 through 1995 served as control. Two hundred-five patients in group B were treated with TA from 1996 through 1999. Both groups were evaluated for comparability of demographic and clinical variables including age, Hunt-Hess grade, Fisher grade, aneurysm location, hypertension, day of surgery, and initial hydrocephalus. The relationships of TA with rebleeding, ischemia, and chronic hydrocephalus were also studied. Results : There was no significant difference in patient demographics and clinical characteristics between group A and group B. Sixteen patients(5.3%) suffered a recurrent hemorrhage in group A and three(1.5%) in group B(p<0.05). Chronic hydrocephalus requiring a shunt was found in a significantly greater proportion in group B than in group A(p<0.05). The incidence of cerebral ischemia was not elevated in group B compared with group A. Conclusion : Considering the fact that the reduction of fatal rebleeding outweighed the increased incidence of hydrocephalus, the authors believe that a short course of TA is beneficial in diminishing the risk of rebleeding prior to early surgical intervention.
뇌실복강간 단락술의 합병증으로 생긴 뇌척수액 복수 - 증 례 보 고 -
이병회,강성돈,김종문,Lee, Byoung Hoi,Kang, Sung Don,Kim, Jong Moon 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.11
Ventriculoperitoneal(VP) shunting has been associated with a variety of complications. CSF ascites secondary to VP shunting is very rare. We report a case of 68-year-old man with VP shunt in whom subclinical peritoneal infection presented with ascites. The patient was treated successfully with antibiotics and removal of the shunt. CSF ascites complicating VP shunt is reviewed and the pathogenesis of this condition is discussed.
중증 뇌동맥류 환자의 조기 수술에 있어서 뇌압 측정의 중요성
김상수,김종문,강성돈,Kim, Sang Su,Kim, Jong Moon,Kang, Sung Don 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.4
Objective : Patients with poor grade aneurysm usually present with increased intracranial pressure(ICP), even those without an intracranial clot. Based on this fact, the present study investigated a significance of intracranial pressure monitoring in those patients. Patients and Methods : A total of 60 patients with Hunt and Hess Grade IV(50 patients) or V(10 patients) were treated for aneurysmal subarachnoid hemorrhage(SAH) during a 3-year-period, and intraparenchymal ICP was measured in the majority, immediately after arrival to the emergency room. Early surgery including intraoperative ventriculostomy was undertaken within 3 days after SAH. An ultraearly surgery was performed without preceding angiogram or ICP monitoring in patients with large sylvian hematomas, highly suggestive of middle cerebral artery aneurysm. Outcomes were assessed by the Glasgow Outcome Scale(GOS) at 6 months. Results : In overall, favorable outcome(GOS scores 1-2) was seen in 27(54.0%) of admission Grade IV and 1(10.0%) of admission Grade V patients. Of the 38 surgical patients with preoperative ICP monitorings, 25 patients (80.6%) exhibiting ICP values of less than 40mmHg showed favorable outcome, however, no patients with ICP values above 40mmHg recovered(Fisher's exact test, p=0.0001). Conclusion : It is concluded that a preoperative ICP above 40mmHg before ventriculostomy indicate significant vital brain destruction as intractable intracranial hypertension, and Grade IV patients at admission with an ICP below 40mmHg can be of benefit from early surgical intervention while Grade V patients still remains unfavorable.
퍼지기반 해양 미생물 이용 수소 제조 공정의 고장유형 및 영향분석
박성호,안준건,김수현,유영돈,장대준,강성균,PARK, SUNG HO,AHN, JUNKEON,KIM, SU HYUN,YOO, YOUNG DON,CHANG, DAEJUN,KANG, SUNGKYUN 한국수소및신에너지학회 2018 한국수소 및 신에너지학회논문집 Vol.29 No.4
In this study, the failure mode and effect analysis (FMEA) of hydrogen production process by using the Thermococcus onnurineus NA1 was conducted and advanced methodology to compensate the weakness of previous FMEA methodology was applied. To bring out more quantitative and precise FMEA result for bio-hydrogen production process, fuzzy logic and potential loss cost estimated from ASPEN Capital Cost Estimator (ACCE) was introduced. Consequently, risk for releasing the flammable gases via internal leakage of steam tube which to control the operating temperature of main reactor was caution status in FMEA result without applying the fuzzification and ACCE. Moreover, probability of the steam tube plugging caused by solid property like medium was still caution status. As to apply the fuzzy logic and potential loss cost estimated from ACCE, a couple of caution status was unexpectedly upgraded to high dangerous status since the potential loss cost of steam tube for main reactor and decrease in product gases are higher than expected.