모야모야병에 대한 최근의 외과적 치료

김달수,유도성,허필우,김재건,조경석,강준기,Kim, Dal Soo,Yoo, Do Sung,Huh, Pil Woo,Kim, Jae Keon,Cho, Kyoung Suok,Kang, Joon Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

MMD의 외과적 치료에서 소아에서는 직접 및 간접적인 혈관문합술을 병합하거나 아니면 간접적인 혈관문합술들을 병합하여 시행하는 경향이 있고, 성인에서는 혈관의 직경이나 MMD의 진행속도로 보아 STA-MCA 문합술과 같은 직접적인 수술이 많이 활용되고 있으나, 소아나 성인에서나 모두 공통적으로 보다 넓은 뇌표면에 여러 가지 수술방법을 병합하는 것이 좀더 광범위한 범위에 뇌혈류 공급을 증가 시키는데 도움이 된다고 보는 경향이다. 수술의 적응증은 혈관조영상에서의 나타난 질병의 정도보다는 acetazolamide를 이용한 PET 나 SPECT 검사로서 뇌혈류 예비량에 기준을 두고 있는 현상이 혈류 역학적으로도 합리적인 것으로 보인다. 수술후 합병증을 줄이려면 수술중에 정상탄산, 정상체온, 정상혈압을 유지 시킴과 동시에, 수술직후 통증관리도 철저히 하는 것이 매우 중요하다. The authors reviewed the recent trend of surgical treatment for pediatric as well as adult onset moyamoya disease(MMD). Combined direct and indirect arterial anastomosis or multiple indirect arterial bypasss has been increasing for pediatric MMD and direct arterial bypass is recommended for adult MMD, especially in patients with hemorrhagic MMD. Besides perioperative complications related to the management of MMD and 1999 annual report by the Research Committee on Spontaneous Occlusion of the Circle of Willis(Moyamoya Disease) of the Ministry of Health and Welfare, Japan will be summarizd.

허혈성뇌졸중의 수술치료시 동반되는 합병증과 관리

김달수,유도성,허필우,조경석,강준기,Kim, Dal Soo,Yoo, Do Sung,Huh, Pil Woo,Cho, Kyoung Suok,Kang, Joon Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.8

Recently various operative procedures including microsurgery or endovascular surgery have been increasing for the management of ischemic cerebrovascular diseases. Carotid endarterectomy(CEA), extracranial-intracranial(EC-IC) arterial bypass, embolectomy, decompressive craniectomy, arterial transposition, intravascular thrombolysis, and percutaneous transarterial angioplasty and stenting (PTAS) are available surgical modalities for ischemic stroke. This article focuses the complications and perioperative management of patients treated with CEA and carotid PTAS among various surgical managements for ischemic stroke.

하나님의 나라와 자율적 섭리

김달수(Dal Soo Kim) 한국기독교학회 2000 한국기독교신학논총 Vol.19 No.-

This is a study on the parable of the seeds growing automatically (Mk. 4 : 26-29). In this parable the Kingdom of God is compared to the farming. The story is centering around the seed and moves back and forth between the farmer and the earth. It begins with a farmer sowing the seeds on the earth. The farmer seems to symbolize the disciples directly because St. Paul also calls him a sower(1 Cor 3 : 6). But now it sounds like meaning the church(theology) which is rooted in the disciples. The seed seems to symbolize the gospel as the seed of the Kingdom of God. The subject of the story suddenly turns over. It leaves the farmer and goes to the earth and seed. The seed sowed by farmer now sprouts, grows and produces a crop automatically with the earth. The seed`s growing looks like growing of the Kingdom of God. The `automatically (αυτοματη) seems like a symbolical word to accentuate the Kingdom of God growing automatically in the nature at the outside of the church. The earth looks like the world of natural science. The story makes a big change again. The farmer comes back for the harvest. This time, however, it is not the reversal but the synthesis. Harvest seems to symbolize an evaluation. From the natural science the seed which the church has sowed brings a crop with it. Theology brings an ethical rule to evaluate whether the crop of natural science is suit to build the Kingdom of God. We could say that it is an automatic providence of God planed for the theology and the science to build the Kingdom together by their own automatic gifts from God.

안테나 배열을 이용한 간섭신호 제거에 관한 연구

김달수(Dal Soo, Kim),신윤기(Yoon Ki, Shin),박의열(El Yul, Park) 대한전자공학회 1990 대한전자공학회 학술대회 Vol.1990 No.11

Experimental Fluid Percussion Brain Injury Induces Temporally and Regionally Specific Expressions of Heat Shock Protein Genes

김영화(Younghwa Kim),김달수(Dal Soo Kim),박선화(Sun-Hwa Park),김태식(Tae Sik Kim),선웅(Woong Sun),김현(Hyun Kim),김창미(Changmee Kim) 대한해부학회 2004 Anatomy & Cell Biology Vol.37 No.1

HSP유전자군은 다양한 스트레스 자극에 의해 발현이 유도되는 것으로 알려져 있음에도 불구하고 외상성 뇌 손상 후 hsp 유전자들의 발현양상에 대한 명확한 보고가 없다. 이 연구에서는 외상성 뇌손상 모델로써 유압출 뇌손상 동물모델을 사용하였으며, 외상성 뇌손상 스트레스에 의해 유도되는 hsp 유전자들의 발현양상은 in situ hybridization 방법을 사용하여 비교 분석하였다. 그 결과 hsp70 superfamily member인 hsp110, hsp70과 작은 hsp member인 hsp25의 발현 양상은 많은 차이를 보였다. Hsp110과 hsp70은 뇌손상 후 1시간 내에 발현하기 시작하여 손상 후 3시간에 최고의 발현을 보였으며, hsp25는 손상 후 6시간에 발현하기 시작하여 손상 후 6일까지 지속되었다. Hsp110과 hsp70은 손상부위에서 높은 발현을 보인 반면, hsp25는 손상 부위 뿐만 아니라 손상부위와 멀리 떨어진 같은 쪽 대뇌피질 전 영역에 걸쳐 발현하였다. 이러한 결과는 다양한 hsp유전자들을 조합하여 순차적으로 조작함으로써 급성 혹은 지연된 외상성 뇌 손상 후 세포사 및 신경학적 기능이상을 완화시킬 수 있을 가능성을 시사한다. Although the induction of various members of hsp (heat shock protein) gene family has been linked to the resistance to apoptosis by a range of diverse stress stimuli, detail information has not been available yet as to the temporal and spatial expression patterns of various hsp genes after traumatic brain injury. In the present study, using a lateral fluid percussion (FP) injury as a model of traumatic brain injury, expression profiles of stress induced hsp genes were comparatively evaluated in the adult rat brain by in situ hybridization (ISH). We found that the temporal and regional expression patterns between the hsp70 superfamily members, hsp110 and hsp70, and the small hsp member, hsp25 are distinct. While the hsp110 and hsp70 expression was observed as early as 1 hr after injury and maximally induced at 3 hr after injury, the hsp25 expression appeared 6 hr after injury and the expression sustained until 6 days after the injury. Moreover, the expression of hsp110 and hsp70 was localized primarily in the impact site, that of the small hsp25 was observed throughout the ipsilateral cortical area in the distant regions remote from the impact site as well as in the impact site following injury. These results suggest that the sequential and combinatorial manipulation of various hsp genes can be exploited in reducing acute and delayed post-traumatic apoptosis and associated neurological dysfunction.

LCD 소자 최적화의 실험적 고찰

강대관,김달수,김현철,송낙운,Kang, Dae-Gwan,Kim, Dal-Soo,Kim, Hyun-Chul,Song, Nag-Un 대한전자공학회 1990 전자공학회논문지 Vol. No.

본 논문에서는 LDD 소자의 최적화의 물리적 의미를 수치 씨뮬레이션을 통해 다루었으며 관련 실험을 통하여 최적화된 LDD 구조를 해석해 보았다. 첫째, 수치해석에 의하면 최적화 조건시에 드레인 n-영역에서의 전계는 고르며 낮은 분포를 보이고 있고, 전류는 이 영역에서 넓게 퍼져 흘렀다. 아울러 이때 최적점은 모든 공정 및 전기조건을 고려하여 총체적으로 최적화하여 얻어져야함이 발견되었다. 둘째, 실험에 의하면 최적 조건의 경우 기판전류와 드레인 전류비에 의해 n-영역의 최대전계는 극소화되었다. 이때 소자의 수명은 최대가 되었으며 n-영역의 저항은 channel 저항에서 $n^+$ 접합 저항으로 유연하게 변환이 되었다. In this paper, the physical meanings of LDD optimization are treated by numerical simulation and related experiments are attempted to analyzed the optimized LDD structure. Firstly, according to the numerical analysis, the electric field under the n-region near drain is low and uniformly distributed and the current flow is widely distributed in this region under the optimized conditions. It is also found that this optimized point should be achieved by globally optimizing all the process and electrical conditions. Secondly, the maximum electric field, which is obtained from the substrate current to the drain current ratio, is minimized under the optimized condition according to the experiment. Further, the device lifetime is maximized and the n-resistance is changed smoothly from the channel resistance to the $n^+$junction resistance.

급성 중증 뇌종창 환자의 양측성 감압개두술 후 뇌압 및 뇌혈류 측정

유도성,김달수,허필우,조경석,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suck,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

저체온요법 치료 환자에서의 두개강내와 액와부의 온도차이

유도성,김달수,허필우,조경석,김재건,박춘근,강준기,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyung-Suck,Kim, Jae-Gun,Park, Chun-Kun,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objective : The brain temperature is about $0.4-1^{\circ}C$ higher than that of the other peripheral body area. But most of these results have been obtained in normothermic condition. The objective of this study is to evaluate the temperature difference between the brain and axilla, in patients under hypothermia. Methods : Sixty-three patients(37 women and 26 men) who underwent craniotomy with implantation of the thermal diffusion flowmetry sensor were included in this study. The temperature of the cerebral cortex and axilla was measured every 2 hours, simultaneously. The patient group was divided according to axillary temperature hyperthermia( over $38^{\circ}C$), normothermia($36-38^{\circ}C$) and hypothermia(under $36^{\circ}C$). Total 1671 paired sample data were collected and analyzed. Results : The temperature difference between the cerebral cortex and the axilla was $0.45{\pm}1.04^{\circ}C$ in hyperthermic patients, $0.97{\pm}1.1^{\circ}C$ in normothermic patients and $1.04{\pm}0.81^{\circ}C$ in hypothermic patients. The temperature difference has statistical significance in each group(unpaired t-test, p<0.05). Conclusion : From our study the temperature difference between the brain and the axilla in hypothermic condition increased more than that of normothermic state. And in hyperthermic condition, the temperature difference decreased.

이중 도관을 이용한 뇌농양의 지속적 세척술 - 수술 수기 -

박재효,유도성,김달수,허필우,조경석,강준기,Park, Jae-Hyo,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suok,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10

We present a modified method for the treatment of brain abscess. The double lumen extraventricular drainage (EVD) catheter which was developed for the intracerebral hematoma management, was applied for the treatment of brain abscess drainage. We placed the double lumen EVD catheter into the abscess cavity by free-hand technique and irrigated the abscess cavity continuously with antibiotics solution for 7 days. Simultaneous intravenous antibiotics was administered for 4 weeks. The continuous irrigation with double lumen catheter was found to be safe and effective treatment modality in the brain abscess.

신경외과 환자 치료 중 발생한 Dialysis Disequilibrium Syndrome - 증례보고 -

우희경,유도성,김달수,허필우,조경석,강준기,Woo, Hee-Kyung,Yoo, Do-Sung,Kim, Dal-Soo,Huh, Pil-Woo,Cho, Kyoung-Suok,Kang, Joon-Ki 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.3

Neurological symptoms may develope when the blood urea nitrogen is lowered too rapidly by hemodialysis. It is known that these symptoms, known as dialysis disequilibrium are associated with cerebral edema. However, the pathogenesis of brain swelling and neurological deterioration after rapid hemodialysis is controversial. The reverse urea hypothesis suggests that hemodialysis removes urea more slowly from the brain than from the plasma, creating an osmotic gradient that results in cerebral edema. The idiogenic osmole hypothesis proposes that an osmotic gradient between brain and plasma develops during rapid dialysis because of newly formed brain osmoles. Authors report a such case and discuss the possible mechanism and preventive methods.