4.7T에서 생체내 자기공명분석법을 이용한 신생아 뇌에서의 인 자기 공명분석 소견

서대철,문치웅,이대근,김기수,이윤,임태환,박철민,최혜영,박형섭,황온유,유시준,Suh, Dae-Chul,Moon, Chi-Woong,Lee, Tae-Keun,Kim, Ki-Soo,Yi, Yun,Lim, Tae-Hwan,Park, Cheol-Min,Choi, Hye-Young,Park, Hyoung-Sup,Hwang, On-You,Yoo, Shi-Joon 대한영상의학회 1993 대한영상의학회지 Vol.29 No.1

In vivo 31P NMR spectra were obtained in eight infant brain at 4.7T. Each phosphorus metabolite and its ratio were analyzed to evaluate the brain damage and maturity, and compared with the reported data obtained at the lower field strength, Measurement of T1 relaxation time at 4.7T was done in an infant and a cat brain invivo. PCr/Pi and PCr/$\beta$-ATP ratio were used as a marker of brain damage. PME/PDE revealed higher values than those of the reported data obtained at the lower field strength and the defference was partly attributed to the long T1 relaxation time of PME rather than the brain immaturity. Although the resolution of the spectrum was improved at 4.7T, a long repetition time is recommended to minimize T1 difference of phosphorus metabolites of brain at 4.7T.

Effects of Locus Coeruleus/Subcoeruleus Stimulation on the Tail Flick Reflex and Efflux of Noradrenaline into the Spinal Cord Superfusates

박경표,김종성,서대철,박형섭,Park, Kyung-Pyo,Kim, Jong-Sung,Suh, Dae-Chul,Park, Hyoung-Sup The Korean Society of Pharmacology 1994 대한약리학잡지 Vol.30 No.1

배외측 뇌교의 전기자극은 척수 수준에서 동통의 역치를 증가시키고, 또한 말초로 부터 오는 유해성 자극에 의해 야기되는 척수후각세포의 흥분성을 억제하여 진통효과를 나타낸다. 이러한 진통효과는 noradrdnergic 원심신경을 매개로 한다고 하였지만, 이직까지 이를 직접적으로 뒷받침하는 신경화학적인 증거는 보고되지 않았다. 따라서 본 실험은 뇌교에 위치한 청반핵(Locus coeruleus)의 전기자극시, 척수 수준에서 일어나는 동통조절효과를 쥐꼬리 회피 반사(Tail Flick Reflex)를 이용해 관찰하고, 이러한 동통조절효과는 어떤 신경전달물질을 매개로해서 일어나며, 또한 생체내에서 직접 유리 되는지 살펴보기 위해 Push Pull technique을 이용해 척수액내 noradrenaline의 농도 변화를 HPLC로 측정하였다. 청반핵자극시의 동통조절기전을 알아보기위해 yohimbine, naloxone 그리고 vehicle의 3group 으로 나누어 각 길항제의 효과를 실험하였다. 청반핵 자극시 TF latency의 증가(>6.Ssec)를 보이는 역치 자극강도가 yohimbine $30{\mu}g$을 척수내로 투여한 후에는 $135\;{\mu}A$로서 안정시의 $55\;{\mu}A$에 비해 147% 증가되어 유의한 변화를 보여주었다(P<0.01, n=5). $Naloxone\;20{/mu}g$을 투여한 실험군 에서도 초기 역치자극강도 $54\;{\mu}A$에서 $120\;{\mu}A$로서 123% 증가되어 역시 유의한 변화를 보여주었다(P<0.01, n=5). 그러나 vehicle group에서는 투여 전, 후 역치자극강도의 변화가 없었다. 청반핵 자극이 없는 안정상태에서의 TF latency 값은 모두 3.1 sec였고 yohimbine과 naloxone투여후에는 각각 2.5 sec,2.6sec로 감소되어, 긴장성 억제가 차단되는 것으로 나타났다(각각 P<0.05,P<0.1,n=5).청반핵의 전기자극$(100\;{\mu}A)$은 척수액내 noradrenaline의 농도를 증가시켰으나(평균 4.18mg/ml에서 7.74 ng/ml로, p<0.05, n=10),dopamine의 농도는 증가되지 않았다. 이상의 결과는 청반핵 자극에 의한 척수내 동통조절효과는 opioid 계외에 부분적으로 noradrdnaline을 매개로 해서 이루어지며, 이에 관여하는 수용체는 ${\alpha}_2$ 임을 보여주었다. Inhibition of the nociceptive Tail Flick Reflex (TFR) was observed with electrical stimulation of the locus coeruleus/subcoeruleus (LC/SC) in the male Sprague - Dawley rats under light anesthesia, and the involved neurotransmitter (s) were characterized. Electrical stimulation of LC/SC induced the analgesia with the stimulation threshold (intensity of the current, given for 100 usec and in 100 Hz frequency, which caused the TF latency longer than 6.5 sec) around 55 uA. Intrathecal administrations of ${\alpha}_2$ antagonist, yohimbine (30 ug) or opioid antagonist, naloxone (20 ug) increased the stimulation threshold by 147% and 123% respectively (from 55 uA to 135 uA,9 and from 54 uA to 123 uA;P0.01, n=5, each). The basal TF latency without stimulation (3.1 sec) was reduced by the antagonists (to 2.5 sec by yohimbine, p<0.05, n=5; to 2.6 sec by naloxone, p<0.1, n=5), vehicle only did not show any effect. Noradrenaline(NA) in the spinal cord superfusates measured with HPLC was increased by the LC/SC stimulation, from 4.18 ng/ml before to 7.74 ng/ml after stimulation (P<0.05, n=10). The result suggest that analgesia induced by LC/SC stimulation is mediated, at least in part, by the noradrenergic system in which ${\alpha}_2$ receptor is involved, as well as the opioid system.

청반핵 자극으로 인한 노르아드레날린의 유리가 동통의 조절에 미치는 영향

박경표(Kyung-Pyo Park),김종성(Jong Sung Kim),서대철(Dae Chul Suh),박형섭(Hyoung-Sup Park) 대한약리학회 1994 대한약리학잡지 Vol.30 No.1

배외측 뇌교의 전기자극은 척수 수준에서 동통의 역치를 증가시키고, 또한 말초로 부터 오는 유해성 자극에 의해 야기되는 척수후각세포의 흥분성을 억제하여 진통효과를 나타낸다. 이러한 진통효과는 noradrdnergic 원심신경을 매개로 한다고 하였지만, 이직까지 이를 직접적으로 뒷받침하는 신경화학적인 증거는 보고되지 않았다. 따라서 본 실험은 뇌교에 위치한 청반핵(Locus coeruleus)의 전기자극시, 척수 수준에서 일어나는 동통조절효과를 쥐꼬리 회피 반사(Tail Flick Reflex)를 이용해 관찰하고, 이러한 동통조절효과는 어떤 신경전달물질을 매개로해서 일어나며, 또한 생체내에서 직접 유리 되는지 살펴보기 위해 Push Pull technique을 이용해 척수액내 noradrenaline의 농도 변화를 HPLC로 측정하였다. 청반핵자극시의 동통조절기전을 알아보기위해 yohimbine, naloxone 그리고 vehicle의 3group 으로 나누어 각 길항제의 효과를 실험하였다. 청반핵 자극시 TF latency의 증가(>6.Ssec)를 보이는 역치 자극강도가 yohimbine 30μg을 척수내로 투여한 후에는 135μA로서 안정시의 55μA에 비해 147% 증가되어 유의한 변화를 보여주었다(P<0.01, n=5). Naloxone 20{/mu}g을 투여한 실험군 에서도 초기 역치자극강도 54μA에서 120μA로서 123% 증가되어 역시 유의한 변화를 보여주었다(P<0.01, n=5). 그러나 vehicle group에서는 투여 전, 후 역치자극강도의 변화가 없었다. 청반핵 자극이 없는 안정상태에서의 TF latency 값은 모두 3.1 sec였고 yohimbine과 naloxone투여후에는 각각 2.5 sec,2.6sec로 감소되어, 긴장성 억제가 차단되는 것으로 나타났다(각각 P<0.05,P<0.1,n=5).청반핵의 전기자극(100μA)은 척수액내 noradrenaline의 농도를 증가시켰으나(평균 4.18mg/ml에서 7.74 ng/ml로, p<0.05, n=10),dopamine의 농도는 증가되지 않았다. 이상의 결과는 청반핵 자극에 의한 척수내 동통조절효과는 opioid 계외에 부분적으로 noradrdnaline을 매개로 해서 이루어지며, 이에 관여하는 수용체는 α₂ 임을 보여주었다. Inhibition of the nociceptive Tail Flick Reflex (TFR) was observed with electrical stimulation of the locus coeruleus/subcoeruleus (LC/SC) in the male Sprague - Dawley rats under light anesthesia, and the involved neurotransmitter (s) were characterized. Electrical stimulation of LC/SC induced the analgesia with the stimulation threshold (intensity of the current, given for 100 usec and in 100 Hz frequency, which caused the TF latency longer than 6.5 sec) around 55 uA. Intrathecal administrations of α₂ antagonist, yohimbine (30 ug) or opioid antagonist, naloxone (20 ug) increased the stimulation threshold by 147% and 123% respectively (from 55 uA to 135 uA,9 and from 54 uA to 123 uA;P0.01, n=5, each). The basal TF latency without stimulation (3.1 sec) was reduced by the antagonists (to 2.5 sec by yohimbine, p<0.05, n=5; to 2.6 sec by naloxone, p<0.1, n=5), vehicle only did not show any effect. Noradrenaline(NA) in the spinal cord superfusates measured with HPLC was increased by the LC/SC stimulation, from 4.18 ng/ml before to 7.74 ng/ml after stimulation (P<0.05, n=10). The result suggest that analgesia induced by LC/SC stimulation is mediated, at least in part, by the noradrenergic system in which α₂ receptor is involved, as well as the opioid system.

MDS-Spiral Coil을 이용한 뇌 동맥류의 경혈관적 치료

정은철,최혜영,서대철,한문희 梨花女子大學校 醫科大學 醫科學硏究所 1995 EMJ (Ewha medical journal) Vol.18 No.4

수술적 치료가 적용되지 않았거나 수술적 접근이 어려웠던 2례의 동맥류환자에서 MDS coil을 이용하여 경헐관적 색전을 시행하였다. 후하소동맥의 동맥류의 경우는 4×80mm coil 한개를 색전한 후 후하소뇌동맥의 혈류가 일시적으로 감소하였으나 추적검사상 이상소견없이 완전한 색전을 보였다. 후교통동맥류의 예에서는 5×80mm coil세개를 성공적으로 삽입하고 3×8mm coil을 추가로 삽입하였을 때 coil의 일부가 동맥류의 경부에서 내경동맥으로 빠져 나왔다. Curved microsnare catheter를 이용하여 일부를 제거하고 일부는 동맥류와 내경동맥에 걸쳐있었다. 색전직후의 동맥조영검사상 동맥류는 성공적으로 색전되었으며 동맥조영검사상 내경동백을 폐색하지 않으므로 시술을 중지하였다. 뇌의 동맥류환자에서 수술이 불가능하거나 수술적 접근이 어려운 경우, 수술후 동맥류가 재발한 경우 또는 파열되지 않은 동맥류 등에서 MDS coil을 이용한 경혈관적색전술은 시술을 대치할 수 있는 유용한 치료법이다. 0bjectives : To report e experience of performing embolization procedure of aneurysms with mechanical detachable coils(MDC). Methods : Two patients underwent embolization of eneurysms with mechanical detachable coils. One patient who had an aneurysm in the left posterior inferior cereberllar artery(PICA) underwent the embolization procedure with one spiral coil(4mm×80mm) and another patient who had an aneurysm in the left posterior(P-comm.) communicating artery aneurysm underwent the embolization procedure with four spiral coils(three 5mm×8mm and one 3mm×80mm). Results : Immediately after coil placement in the PICA the flow of contrast in the PICA reduced significantly. It may resulted from compression of the origin of PICA by the coil-packed aneurysm. The posttreatment course was not uneventful In case of P-comm. aneursym, the last coil(3mm×80mm) which embolized in the aneurysm, escaped from the aneurysm into the left internal carotid artery. Thej retrieval of the coil in the internal carotid artery with 3F microretrieval cathter was sucesfully performed. Conclusion : This preliminary experience suggests that the embolization procedure with mechanical detachable coils is a usful modality of treatment of cerebral aneurysm in case ofinoperable cases.

방사선학적으로 진단된 우발적인 경막하 마취례

이상민,김혜령,조명원,박은경,서대철,한부경 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.6

Malposition of catheter in the subdural space is a possible complication during attempted epidural anesthesia. We report here an inadvertent subdural block confirmed by the radiographic contrast material. Epidural anesthesia was planned for a full-term gravida and epidural catheter was inserted about 3 cm cranially at the level of L1-2. After injection of 19.5 ml local anesthetic, blood pressure was 70/50 mmHg. Fluid was rapidly infused and intravenous ephedrine 10 mg was given. After then, vital signs were well maintained and twin babies were delivered without events. Twentyfive minutes later, she complained chest tightness and became tachypneic. Ketamine 50 mg was given and endotracheal intubation was performed with ease. She obeyed command, but could not open her eyes for some duration. Self respiration returned after 110 minutes and minute ventilation was 6 liter/minute at that time. 160 minutes later, extubation was done and radiological examination was performed using contrast materiaL The cathter tip was positioned in anterior subdural space at T12 level.

심장 점액종의 신경학적 합병증 1례

남병극,김종성,정선주,이재홍,서대철,이명종 대한신경과학회 1996 대한신경과학회지 Vol.14 No.1

중심정맥 카테터 제거후 발생한 기이성 공기 색전증 1 예

김주영,송재관,고윤석,임채만,김원동,서대철,엄완식 대한내과학회 1995 대한내과학회지 Vol.48 No.3

Paradoxical air embolism (PAE) can be a devastating complication which may occur in patients at risk for venous air embolism. With improved diagnostic techniques, such as echocardiography, PAE is being identified more frequently as a possible etiology in ischemic strok. A 80-year-old woman was admitted to intensive care unit with severe dyspnea and purulent sputum. Immediate after admission dyspnea was worsen, then mechanical ventilator support begun and triple-lumen central venous catheter was placed in right subclavian vein for proper nutritional supply and easy to blood sampling. Echocardiography showed no abnormal finding. On the 36th hospital day, she could spontaneous respiration with 30% oxygen by T-Piece. After 3 days she was transferred to general ward. At the next day, central venous catheter was removed, but dressing was not placed over the wound and pressure was not exerted on the area while catheter tip was processd for bacterial culture. She became tachypneic, anxious, and comatous. The blood pressure was 160/100 mmHg; heart rate, 150/ min; respiration rate, 36/min; temperature, 36.℃. Electrocardiography revealed sinus tachycardia and righ axis deviation. Partial oxygen tension of arterial blood was 42 mmHg while breathing with 3 L/min oxygen flowing through a T-piece. Chest roentgenogram was unchanged from previous film. Computed tomography of the brain showed multiple small round air density in the frontal and occipital lobe, suggestive of cerebral embolism due to paradoxical air embolism. We thought that she had a catheter in place long enough for a fibrinous tract to form that could remain open after the removal of the catheter and lack of a dressing impermeable to air would allow air to be entrained through a tract during inspiration, then this air delivered to cerebral circulation via pulmonary arteriovenous fistula.

활동성 궤양성 대장염 환자에서 발생한 뇌정맥 혈전증 1예

김종성,홍원선,남승우,민영일,정훈용,양석균,유창식,주연호,서대철 대한소화기학회 1998 대한소화기학회지 Vol.32 No.3

The cerebral thromboembolic disease is a rare extraintestinal manifestation of the ulcerative colitis. but it is one of the major causes of death in patients with ulcerative colitis. The outcome in cerebral venous thrombosis is poor, leading to death or major neurological sequelae in about 60% of patients. A 27-year old female with a 6-year history of ulcerative colitis episodically developed seizure for one month. Brain MRI showed cerebral infarction with old hemorrhage in the left frontotemporal hemisphere. Cerebral angiography showed no evidence of vasculitis or atheromatous cbange. Cardiac echocardiogram and radionuclide venography of the lower extremities revealed no evidence of thrombi. Tests for coagulation abnormality were also normal. She was managed with antiplatelet agent and antiepileptics. In addition, total proctocolectomy was performed for the patient.

활동성 궤양성 대장염 환자에서 발생한 뇌정맥 혈전증 1예

남승우,양석균,정훈용,주연호,홍원선,민영일,김종성,유창식,서대철 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.32 No.3