소아뇌졸중의 보험의학적 고찰

안계훈,Ahn, Gye-Hoon 한국생명보험의학회 2010 保險醫學會誌 Vol.29 No.2

Moyamoya disease (MMD) is a progressive occlusive disease of the cerebral vasculature with particular involvement of the circle of Willis and the arteries that feed it. MMD is one of cerebrovacular accident,which is treated with sugical maeuver in pediatic neurosurgery. Moyamoya (ie, Japanese for "puff of smoke") characterizes the appearance on angiography of abnormal vascular collateral networks that develop adjacent to the stenotic vessels. The steno-occlusive areas are usually bilateral, but unilateral involvement does not exclude the diagnosis. The exact etiology of moyamoya disease is unknown. Some genetic predisposition is apparent because it is familial 10% of the time. The disease may be hereditary and multifactorial. It may occur by itself in a previously healthy individual. However, many disease states have been reported in association with moyamoya disease, including the following: 1) Immunological - Graves disease/thyrotoxicosis 2) Infections - Leptospirosis and tuberculosis 3) Hematologic disorders - Aplastic anemia, Fanconi anemia, sickle cell anemia, and lupus 4) Congenital syndromes - Apert syndrome, Down syndrome, Marfan syndrome, tuberous sclerosis, Turner syndrome, von Recklinghausen disease, and Hirschsprung disease 5) Vascular diseases - Atherosclerotic disease, coarctation of the aorta and fibromuscular dysplasia, 6)cranial trauma, radiation injury, parasellar tumors, and hypertension etc. These associations may not necessarily be causative but do warrant consideration due to impact on treatment.(Mainly neurosurgical operation.) The incidence of moyamoya disease is highest in Japan. The prevalence of MMD is 1 person per 100,000 population. The prevalence and incidence of moyamoya disease in Japan has been reported to be 3.16 cases and 0.35 case per 100,000 people, respectively. With regard to sex, the female-to-male ratio is 1.4:1. A bimodal peak of incidence is noted, with symptoms occurring either in the first decade(5-10yr) or in the third and fourth decades (30-40yr)of life. Mortality rates of moyamoya disease are approximately 10% in adults and 4.3% in children. Death is usually from hemorrhage. In aspect of life insurance, MR is 1700%, EDR is 16 per 1000 persons. Children and adults with moyamoya disease (MMD) may have different clinical presentations. The symptoms and clinical course vary widely from asymptomatic to transient events to severe neurologic deficits. Adults experience hemorrhage more commonly; cerebral ischemic events are more common in children. Children may have hemiparesis, monoparesis, sensory impairment, involuntary movements, headaches, dizziness, or seizures. Mental retardation or persistent neurologic deficits may be present. Adults may have symptoms and signs similar to those in children, but intraventricular, subarachnoid, or intracerebral hemorrhage of sudden onset is more common in adults. Recently increasing diagnosis of MMD with MRI, followed by surgical operation is noted. MMD needs to be considered as the "CI" state now in life insurance fields.

개 앞띠겉질에서 parvalbumin과 calbindin D-28k 양성반응세포의 출생후 발달에 관한 연구

윤상필(Sang-Pil Yoon),안계훈(Gye-Hoon Ahn),문정석(Jeong-Seok Moon),김종중(Jong-Joong Kim),유호진(Ho-Jin You),김진호(Jin-Ho Kim),장인엽(In-Youb Chang) 대한해부학회 2002 Anatomy & Cell Biology Vol.35 No.2

출생시부터 출생후 180일까지 개의 앞띠겉질에서 칼슘결합단백인 parvalbumin과 calbindin D-28k 양성반응세포의 출현 시기, 분포양상, 발생양상을 확립하기 위하여 면역조직화학적 방법을 이용한 실험 결과 다음과 같은 결론을 얻었다. Parvalbumin 면역반응은 출생후 7일에 VI층 뭇극세포에서 처음 관찰되었다. GABA계 사이신경세포에서 parvalbumin 면역 반응은 안쪽에서 바깥쪽으로 퍼져나가는 현상을 보였고, 출생후 180일에 성숙형과 유사한 분포상을 보였다. 면역반응은 주로 발생중인 비피라밋세포에서 나타났으나 parvalbumin에 양성반응을 보이는 V층의 피라밋세포가 출생후 14일부터 90 일까지 일시적으로 관찰되었다. Calbindin D-28k 면역반응은 parvalbumin 면역반응과는 차이가 있었다. Calbindin D-28k 면역반응은 출생시 V층 피라밋세포에서 처음 나타났고, 이 양상은 출생후 90일까지 지속되었다. Calbindin D-28k에 양성반응을 보이는 사이신경세포는 출생시 속과립층 아래 영역과 백색질에 분포하였고, 출생후 14일가 되어서는 속과립층의 위∙아래 영역 모두에서 증가하였으며, 성숙형과 유사한 분포상은 출생후 180일에 확립되었다. 이상의 결과로 미루어 미성숙한 상태의 사이신경세포 뿐만 아니라 미성숙 피라밋세포에서 칼슘결합단백이 일시적으로 발현되는 것은 칼슘의 증가에 의한 손상으로부터 신경세포를 보호하는 칼슘결합단백의 기능과 연관이 있는 것으로 사료된다. We have examined the ontogeny of parvalbumin and calbindin D-28k immunoreactivities in the canine anterior cingulate cortex from the day of birth (P0) through P180. At P7, parvalbumin immunoreactivity appears firstly in layer VI multipolar cells. The parvalbumin immunoreactivity in GABAergic interneurons appears to follow an ‘inside-out’gradient of radial mergence and reaches an adult-like pattern by the end of the 6th postnatal month. Immunoreactivity is limited mainly to developing nonpyramidal cells, whereas pyramid-like parvalbumin immunoreactive cells are transiently observed in layer V from the P14 to the P90. The developmental pattern of calbindin D-28k immunoreactivity differs from that of parvalbumin immunoreactivity. Calbindin D-28k immunoreactivity develops firstly in layer V pyramidal cells from P0, which continues through the third postnatal month. Calbindin D-28k immunoreactive interneurons are located in the infragranular layers and white matter at P0 and increase in both the supragranular and infragranular layers by P14. This is followed by an adult-like pattern at the P180. These data suggested that parvalbumin and calbindin D-28k may play a role in protecting immature neurons from intracelluar calcium influx during postnatal development.

면역세포화학적 방법을 이용한 고양이 중간뇌에서 Calbindin D-28k 와 Parvalbumin을 함유한 GABA의 분포상에 관한 연구

김종중(Jong-Joong Kim),정상봉(Sang-Bong Jeong),김남훈(Nam-Hoon Kim),안계훈(Gye-Hoon Ahn),정윤영(Yoon-Young Chung),문정석(Jeong-Seok Moon),장인엽(In -Youb Chang),김홍순(Hong-Soon Kim) 대한체질인류학회 2000 대한체질인류학회지 Vol.13 No.2

간추림 고양이 중간뇌에서 calbindin D-28k (CB) 와 parvalbumin (PV), 그리고 gamma-aminobutyric acid (GABA) 의 분포상과 세포의 형태 및 크기를 관찰하고, 동일세포 E 안에서 이들의 공존을 확인하기 위하여 본 실험을 시행 하였다. CB, PA 및 GABA 에 대한 특이성을 지난 단세포군항체를 이용한 면역세포화학적 염색을 하여 관찰한 결과 다음과 같은 결론을 얻었다. 1 적색핵, 흑색질, 눈돌림신경핵, 청색핵에서 CB-IR, PV-JRGABA-IR 세포를 가장 많이 관찰할 수 있었다. 2 적색핵에서는 PV-IR 세포가, 흑색질에서는 CB-IR 세포가 더 많이 출현하였다. 3. PV-IR 과 GABA-IR 이 통일세포에 공존하는 것을 관찰할 수 있었다. 4. CB-IR, PV-IR, GABA- IR 세포의 세포체의 형태는 방추형, 타원형, 원형이었고 그 크기는 15-20 μm 이었으며 세포의 모양을 흩극, 이극, 뭇극신경원이었다.

흰쥐 뇌에서 Tyrosine Hydroxylase분비세포의 출현시기 및 분포에 관한 면역조직화학적 연구

정윤영,선희매,김영택,김남훈,안계훈,장인엽,김종중,문정석,강양수 조선대학교 부설 의학연구소 1999 The Medical Journal of Chosun University Vol.24 No.1

The immunohistochemical (ABC method) studies on the ontogeny and localization of the catecholamine-synthesizing enzyme tyrosine hydroxylase (TH) were examined in rat brain from the 12th fetal day until the 9th postnatal day. The results obtained were as follows : 1. Tyrosine hydroxylase was first detected immunohistochemically at embryonic day 13(E13). At this stage, the TH-containing neurons were still migrating and cytologically immature. 2. The changes occuring from the early to the late prenatal stages of development appeared to be the result of an increase in the number and size of the TH-containing cells and in the length of nerve fibers. 3. The distribution of the TH-containing neurons at embryonic day 19(E19) more closely resembled catecholaminergic neurons in the adult rat brain : 1) a rhombencephalic group became the A1-7 ; 2) a ventral mesencephalic group became A8-10 ; 3) a ventral prosencephalic group and a few neurons ventral to the striatum became A11-14 ; and 4) the cells of the olfactory bulb corresponded to the A15. 4. The cytodifferentiation of the TH-immunoreactive neurons was accompanied by continued migration to form the collective catecholaminergic groups during ontogenesis. In addition, the morphology of the TH-immunoreactive neurons in the late prenatal stage resembled in the adult rat brain.