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하윤,윤도흠,윤승환,박소라,조용은,박형천 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.5
Objective : The transplantation of bone marrow cells into the injured spinal cord improves neurologic functions in experimental animals. However, it is unclear whether bone marrow cells can similarly improve the neurologic functions of complete spinal cord injury patients. To study their therapeutic effects in human spinal cord injury (SCI), we transplante autologous bone marrow cells into the SCI sites and administer granulocyte macrophagecolony stimulating factor (GM-CSF) in three complete SCI patients. Methods : Bone marrow cell transplantation with GM-CSF administration was performed on two patients (patients1 and 2), wherein concentrated bone marrow cell pastes were injected into the injury area using a sterile 21 gauge fine needle. The total volume of bone marrow cells injected was 1.8ml (cell concentration 1.1X106/ul). Patient 3 was administered GM-CSF only. The follow up periods were 5 months (patient 1), 4 months (patient 2) and 6 months (patient 3). Results : Sensory improvements were followed immediately after the operations. Sensory recovery in the sacral segment was noticed at 3 weeks (patient 1), 13 days (patient 2) and at 2 months (patient 3) postoperatively. Significant motor improvements were noticed at 3 months in patients 1 and 2, and at 4 months in patient 3. All three patients showed neurologic improvements at the last follow up 5,4 and 6months respectively (Frankel grade C, AIS grade C). Conclusion : Treatment of SCI patients with autologous bone marrow cell transplantation and GM-CSF administration shows some beneficial effects during the early postoperative periods. However, long-term and more comprehensive clinical studies are required.
하윤,윤도흠,연동수,김현옥,이진주,조용은,최중언,Ha, Yoon,Yoon, Do Heum,Yeon, Dong Su,Kim, Hyun Ok,Lee, Jin Ju,Cho, Yong Eun,Choi, Joong Uhn 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.8
Objectives : Cord blood stem cells have been widely used as donor cells for bone marrow transplantation recently. These cells can give rise to a variety of hematopoietic lineages to repopulate the blood. Recent observations reveal that some bone marrow cells and bone marrow stromal cells(MSCs) can grow to become either neurons or glial cells. It is, however, unclear whether or not there exists stems cells which can differentiate into neurons in the blood during the early stages of postnatal life. Methods : Human cord blood stem cells were prepared from human placenta after full term delivery. To induce neuronal differentiation of stem cells, ${\beta}$-mercaptoethanol was treated. To confirm the neuro-glial characteristics of differentiated stem cells, immunocytochemical stain for NeuN, neurofilament, glial fibrillary acidic protein(GFAP), microtubule associated protein2(MAP2) was performed. RT-PCR was performed for detecting nestin mRNA and MAP2 mRNA. Results : We showed in this experiment that neuro-glial markers(NeuN, neurofilament, MAP2, GFAP) were expressed and axon-like cytoplasmic processes are elaborated in the cultured human cord blood stem cells prepared from new born placenta after full term delivery. Nestin mRNA was also detected in fresh cord blood monocytes. Conclusions : These results suggest that human cord blood derived stem cells may be potential sources of neurons in early postnatal life.
하윤,김찬형,장종희,박용구,정상섭,장진우 대한정신약물학회 2003 대한정신약물학회지 Vol.14 No.2
Despite a long and controversial history, psychosurgery has persisted as a modern treatment option for some severe, medically intractable psychiatric disorders. The empirical basis of psychosurgery is weak because of the lack of well-designed investigations. Several carefully conducted studies in which independent evaluation has been made, however, show convincingly that highly selective stereotactic operations on the brain can benefit some carefully selected, chronically ill psychiatric patients with a low rate of unwanted side effects. The goal of this article is to review the current state of psychosurgery. In this review, the definition of psychosurgery, patient selection criteria, and anatomical and physiological rationales for anterior cingulotomy, subcaudate tractotomy, anterior capsulotomy, limbic leuktomy, vagus nerve stimulation and deep brain stimulation are discussed.
척수손상백서에서 인간 제대혈 세포이식에 의한 신경기능의 회복
하윤,윤승환,박형천,김긍년,윤도흠,조용은 대한신경외과학회 2004 Journal of Korean neurosurgical society Vol.35 No.3
Objective : Recent advances in stem cell biology make it possible to induce the regeneration of injured axons and to replace lost cells in the injured spinal cord. It has been found that stem cells in human cord blood differentiate into mature neurons and glial cells both in vitro and in vivo. These findings suggest that human umbilical cord blood cells(HUCBs) can be used as therapeutic donor cells in cases of spinal cord injury. Methods : To attempt the repair an injured cord following spinal cord injury(SCI), we transplanted HUCBs into contused spinal cords. This was found to promote a long-term improvement in neurologic function relative to a lesion-control group. HUCBs were cultured in vitro for 7 days. Bromodeoxyuridine(BrdU) was added to the media to allow the BrdU to integrate into dividing cells. Cultured HUCBs(2X106 cells) were then injected into the injury epicenter 7 days after SCI. The Basso-Beattie-Bresnahan(BBB) locomotor rating system was used to score functional improvement in HUCBs transplanted rats. Immunohistochemical staining for neurofilament, macrotubule associated protein 2(MAP-2), glial fibrillary acidic protein(GFAP), and nestin was performed. Results : Immunohistochemical analysis 5 weeks after SCI showed that gliogenesis of the transplanted donor HUCBs had occurred within the adult rat spinal cord. These donor-derived astrocyte-like cells extended their processesinto the host tissues and integrated well. HUCBs derived neurons(neurofilament, MAP-2) and nestin expressing cells were also detected. Behavior analysis using BBB rating scores showed that functional improvement was greater in transplanted rats than in non-treated rats. Conclusion : HUCBs are one of the potential sources for transplantation material for the treatment of SCI.
Radiological Changes in Adjacent and Index Levels after Cervical Disc Arthroplasty
하윤,신준재,김광렬,손동욱,신동아,이성,김긍년,윤도흠 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.1
Purpose: The purpose of this retrospective study was to evaluate radiological and clinical outcomes in patients undergoing cervical disc arthroplasty (CDA) for cervical degenerative disc disease. The results may assist in surgical decision-making and enable more effective and safer implementation of cervical arthroplasty. Materials and Methods: A total of 125 patients who were treated with CDA between 2006 and 2019 were assessed. Radiological measurements and clinical outcomes included the visual analogue scale (VAS), the Neck Disability Index (NDI), and the Japanese Orthopaedic Association (JOA) myelopathy score assessment preoperatively and at ≥2 years of follow-up. Results: The mean follow-up period was 38 months (range, 25–114 months). Radiographic data demonstrated mobility at both the index and adjacent levels, with no signs of hypermobility at an adjacent level. There was a non-significant loss of cervical global motion and range of motion (ROM) of the functional spinal unit at the operated level, as well as the upper and lower adjacent disc levels, compared to preoperative status. The cervical global and segmental angle significantly increased. Postoperative neck VAS, NDI, and JOA scores showed meaningful improvements after one- and two-level CDA. We experienced a 29.60% incidence of heterotrophic ossification and a 3.20% reoperation rate due to cervical instability, implant subsidence, or osteolysis. Conclusion: CDA is an effective surgical technique for optimizing clinical outcomes and radiological results. In particular, the preservation of cervical ROM with an artificial prosthesis at adjacent and index levels and improvement in cervical global alignment could reduce revision rates due to adjacent segment degeneration.