이마앞겉질을 제거한 흰쥐 중격옆핵내 이마겉질-중격옆핵로 신경연접의 미세구조

송형곤(Hyoung-Gon Song),안의태(E-Tay Ahn),고정식(Jeong-Sik Ko),박경호(Kyung-Ho Park) 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.5

성격형성, 순간기억, 인지력, 감정깊이 조절기능들과 관련이 있는 이마앞겉질에서 보상, 욕구, 중독, 기대감 등과 관련이 있는 중격옆핵으로 들어오는 신경연결을 확인하고 연접형태의 미세구조를 밝히고자 이 연구를 시행하였다. 체중 250~300 g 정도의 흰쥐를 실험동물로 하였으며, 이들을 정상군, 대조군, 실험군으로 구분하여 실험하였다. 실험군 동물은 sodium pentobarbital로 마취하여 뇌정위고정대에 고정시킨 후 한쪽 이마뼈에 구멍을 만들고 이마앞겉질을 흡인하여 제거하였으며, 2일 후 희생시켜서 1% paraformaldehyde와 1% glutaraldehyde 고정액으로 관류고정시켰다. 뇌에서 중격옆핵을 punching하여 관류고정액에서 다시 고정한 후, 2% osmium tetroxide액에서 이차고정을 시행하였다. Araldite에 포매하였고 미세절편은 4% uranyl acetate와 2.7% lead citrate로 이중 염색하였으며, JEOL 100CX-II 전자현미경으로 관찰하였다. 관찰결과, 대조군 중격옆핵의 미세구조는 정상군과 차이를 보이지 않았다. 실험군의 중격옆핵에서는 신경그물의 구조에 상당한 변화를 보였는데, 가장 뚜렷한 변화를 보인 것은 퇴행된 축삭종말들로서 축삭가지돌기연접(axodendritic synapse)과 축삭가시연접(axospinous synapse)을 이룬 것들 가운데 일부였다. 퇴행중인 축삭종말들 외에도 아교세포의 세포질돌기들이 확장하여 퇴행구조들을 분리시키면서 용해시켰고, 퇴행종말과 연접했던 가지돌기나 가지돌기가시 안에는 많은 티끌 같은 물질들이 흩어져 있었다. 특히 퇴행종말과 연접했던 가지돌기가시들이 가지돌기 속으로 퇴축되면서 가지돌기들이 팽대현상을 보였다. 이와 같은 변화는 이마앞겉질에서 중격옆핵으로 들어온 축삭종말들이 퇴행하면서 일어나는 병리적 진행과정으로 신경학적 실험에서 흔히 관찰되는 것이었다. 따라서 대뇌 이마앞겉질에서 중격옆핵으로 정보를 보내는 신경섬유의 종말은 가시돌기세포 (spiny cell)의 가지돌기 (dendrite)와 가지돌기가시(dendritic spine)에 연접하는 것이 밝혀졌다. Prefrontal cortex is called psycological cortex, since it deals with making up of individual personality, regulation of personal depth of feeling, working memory, planning, maintaining attention, etc. Whereas, nucleus accumbens (septi) is called the center of reward and motivation or the center of pleasure, since it deals with feeding, drinking, sex, exploration, appetitive learning, drug addiction, etc. Present study was aimed at the proving the prefronto-accumbens input ultrastructurally. Sprague Dawley rats anesthetized with sodium pentobarbital and were removed their prefrontal cortex with suction instrument. Two days following the operation, heads of rats were fixed by perfusion of with 1% glutaraldehyde-1% paraformaldehyde solution via left ventricle. Peristaltic pump was used during perfusion. Two hours later, brains were removed and refixed for 24 hours in the refrigerator, and small tissues of the nucleus accumbens were punched out with punching needle. Tissue blocks were fixed in 2% osmic acid for 2 hours and were embedded in araldite mixture. Ultrathin sections stained with uranyl acetate-lead citrate solution were observed with JEOL 100 CX II electron microscope. In the nucleus accumbens, some axodendritic terminals and axospinous terminals were found degenerated, and volume of activated glial cytoplasm was increased. The degenerated terminals were seen isolated from intact structures by activated glial processes and removed by glial cytoplasm. The result confirms that axon terminals coming from prefrontal cortex input to the spiny neurons of nucleus accumbens septi, on their dendrites and/or dendritic spines.

'퇴원설명문'에 의한 72시간내 부적절한 응급센터 재방문의 감소

박하영,심민섭,송형곤,송근정,Park, Ha Young,Sim, Min Seob,Song, Hyoung Gon,Song, Keun Jeong 한국의료질향상학회 2006 한국의료질향상학회지 Vol.12 No.1

Background : Patients who were discharged from the emergency department(ED) may revisit. These patients are divided into two groups; one is expected scheduled condition, the other is unexpected condition. These patients of inappropriate revisits to the ED would be unsatisfied, difficult to make rapport and take legal action as a result of additional medical charges. The purpose of this study was to reduce inappropriate revisits to the ED with a new method which was developed by analyzing inappropriate revisits in 2002. Methods : This study was conducted in a tertiary hospital consisting of 1,278 beds. The most common cause of inappropriate revisits was the medical team's lack of explanation about a disease. Thus we decided that the effective method was to offer full explanations to patients to understand the clinical pathway of a disease. We made four types of stickers to explain most common 4 diseases in 2003. An emergency physician completed 'discharge explanation report' and explained it to patients in 2004. Results : In 2002 inappropriate revisited patients were 164, patients with four diseases were 79. During the same period of 2003, inappropriate revisited patients were 56 (-65.9%), four disease patients were 6 (-92.4%) and in 2004 inappropriate revisited patients were 52, four disease patients were 19. Causes of revisits were lack of explanation about a disease in 35 patients (44.3%) in 2003, and 5 patients (83.3%) in 2003, and 16 patients (84.2%). Conclusions : Application of 'explanation stickers' at discharge reduced inappropriate revisits from 34.5% in 2002 to 15.9% in 2003. Application of 'Discharge explanation report' by emergency physician reduced inappropriate revisits from 15.9% in 2003 to 13.5% in 2004. Reduction of inappropriate revisits elevated the quality of medical treatment, and decreased patients' dissatisfaction in ED.

일개 응급센터에서 급속가압수액주입기의 사용경험

홍종근 ( Chong Kun Hong ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1

Purpose: Hypovolemia is not uncommon among trauma patients in the emergency department (ED). Successful resuscitation of a hypovolemic patient often requires rapid intravenous administration of massive amounts of fluid. A rapid fluid infuser is used in the ED for this purpose, there have been no studies of their clinical uses and effectiveness. We studied clinical experience with a rapid fluid infuser at an urban university hospital in Seoul, Korea. Methods: We reviewed the medical records of 38 patients admitted to the ED with a history of application of a rapid fluid infuser from January 2004 to July 2005. Adult trauma patients older than 15 years of age were included in this study. Clinical data on the patients and the volume of fluid used to achieve a stable blood pressure were extracted from their medical records. Results: The total number of adult trauma patients with a history of application of a rapid fluid infuser from January 2004 to July 2005 in the ED was 16. The mean systolic blood pressure for deciding to apply the rapid fluid infuser was 74.9±12.7 mmHg. The mean time and volume used to achieve a stable blood pressure were 40.4 min and 2947.3±1339.2 ml, respectively. In all patients, the amount of fluid infused before using the rapid fluid infuser was between 500 ml and 10,000 ml, compared to 1,000 ml and 6,200 ml with the rapid fluid infuser. The mean amount of fluid per min. via the rapid fluid infuser was 85.5 ml. Vital signs were stabilized in 11 patients, 6 of the 11 were discharged alive. Conclusion: The mean amount of fluid delivered per min. via the rapid fluid infuser was much less than expected; thus, there should be clinical guidelines on volume resuscitation with a rapid fluid infuser in the ED. In the future, prospective, multicenter, clinical-data collection is needed for a more sophisticated study. (K Korean Soc Traumatol 2006;19:41-46)

슬부 외상환자에서 Ottawa Knee Rule의 유용성에 관한 연구

한상국 ( Sang Kuk Han ),송형곤 ( Hyoung Gon Song ),송근정 ( Kuen Jeong Song ),정연권 ( Yeon Kwon Jeong ),심민섭 ( Min Seob Sim ),최필조 ( Pil Cho Choi ) 대한외상학회 2003 大韓外傷學會誌 Vol.16 No.2

Background: We performed this study to validate the Ottawa Knee Rule for determining the need for radiography in patients with acute knee injuries. Methods: A prospective study was performed from August 2001 to July 2002. The patient population was composed of a convenience sample of 242 eligible adults out of 453 adult patients with acute knee injuries. The attending emergency physician assessed each patient for standardized clinical variables and determined the need for radiography according to the decision rule. After the findings of clinical evaluation had been recorded, radiography was performed in each patient, irrespective of the determination of the rule. The rule was assessed for its ability to correctly identify fracture of the knee. Results: The decision rule had a sensitivity of 1.0 and a specificity of 0.46. The potential reduction in use of radiography was estimated to be 40%. The probability of a fracture, existing when the decision rule was negative, is estimated to be 0%. Conclusion: A prospective validation has shown the Ottawa Knee Rule to be 100% sensitive for identifying fractures of the knee and to have the potential to allow physicians to reduce the use of radiography in patients with acute knee injuries.

Acriflavin-Guanosine 복합제(AG60)투여가 Ehrilich 암세포를 이식한 흰생쥐 위창자 내분비세포에 미치는 영향

박경호(Kyung-Ho Park),송형곤(Hyoung-Gon Song),고정식(Jeong-Sik Ko),안의태(E-Tay Ahn),김진국(Jin-Gook Kim) 대한해부학회 2002 Anatomy & Cell Biology Vol.35 No.1

최근 국내에서 개발된 항암제 acriflavine과 guanosine 복합제(AG60)는 암세포의 증식을 뚜렷하게 억제시키면서도 위창 자 상피의 세포분열에는 영향을 미치지 않는 것으로 알려져 있다. 이 실험에서는 AG60이 위창자의 운동에 관여하는 위창 자 내분비세포에 미치는 영향을 알아보았다. 실험동물은 25~30 g의 흰생쥐 (ICR mouse)를 사용하였다. 정상대조군은 암세포를 이식하지 않은 동물을 사용하였으며, 실험군은 각 동물의 샅고랑부위의 피부밑에 Ehrlich carcinoma cell (107 cell)을 이식한 후, 다음날부터 격일 간격으로 실험군별로 각각 AG60 (5 mg/kg 또는 30 mg/kg) 또는 5-fluorouracil (5-FU, 60 mg/kg)을 7회 주사하였고, 실험대조군에는 암세포를 이식한 후 약물은 투여하지 않고 생리식염수를 격일 간격으로 주사하였다. 모든 실험동물의 위 몸통부위, 샘창자 시작부 위, 막창자꼬리, 곧창자를 절취하여 10% formalin에 고정한 다음 통상적인 방법으로 파라핀에 포매하였다. 각 절편은 면역세포염색방법을 이용하여 somatostatin, secretin, neurotensin, motilin 분비세포를 염색하였다. 한편 각 조직에서 점막부위를 택하여 단위면적 0.25mm2에 분포하는 면역반응세포의 수를 계수하였으며, 세포의 분포상태와 형태를 관찰하여 아래와 같은 결과를 얻었다. 1) 정상대조군 동물의 위에서는 somatostatin 면역반응세포는 18.5±0.71개로서 많이 관찰되었지만, neurotensin, secretin, motilin 면역반응세포는 관찰되지 않았다. 샘창자에서는 somatostatin 면역반응세포는 7.0±0.10개 정도이었으나, neurotensin, secretin, motilin의 면역반응세포는 매우 드물게 관찰되었다. 2) 정상대조군 동물의 막창자꼬리와 곧창자에서는 somatostatin, neurotensin, secretin, motilin의 면역반응세포가 관찰되지않았다. 3) 위점막에서의 somatostatin 면역반응세포는 정상군의 18.5±0.71개에 비하여 실험대조군 10.0±4.20개, AG60 5 mg/kg 투여군 11.5±0.71개, AG60 30 mg/kg 투여군에 13.5±2.10개, 5-fluorouracil 투여군 11.5±0.71개로서 거의 변화가 없었다. 4) 샘창자점막에서의 somatostatin 면역반응세포는 정상군의 7.0±0.10개에 비하여 실험대조군 0.5±0.71개, AG60 5 mg/kg투여군 3.0±1.41개, AG60 30 mg/kg 투여군 0.5±0.71개, 5-fluorouracil 투여군 2.5±0.71개로서 전체적으로 감소하였다. 5) 샘창자 점막에서의 secretin 면역반응세포는 실험대조군, AG60 5 mg/kg 주사군, AG60 30 mg/kg 주사군과 5-fluolrouracil주사군 모두에서 정상대조군에서와 마찬가지로 매우 드물게 관찰되었다. 6) 샘창자 점막에서의 neurotensin과 motilin 면역반응세포는 정상대조군에서만 드물게 관찰되었고, 실험대조군, AG60 5 mg/kg 주사군, AG60 30 mg/kg 주사군, 5-fluorouracil 주사군에서는 관찰되지 않았다. AG60 또는 5-FU와 같은 항암제 투여가 흰생쥐의 somatostatin 세포, secretin 세포, neurotensin 세포, motilin 세포 등의 창자내분비세포에 미치는 영향은 크지 않다고 생각된다. 그러나 5-FU는 장내분비세포에는 큰 영향을 주지 않지만 위창자상피세포의 세포분열지수에 영향을 크게 주기 때문에 위창자의 기능에 장애를 준다고 생각된다. To study the tumor-suppression effect of a newly developed anti-tumor agent AG60 [ acriflavine (1) : guanosine (1)composition, Taerim Pharm. Co., Seoul, Korea], each Ehrlich carcinoma (107 cells)-inoculated mouse received the subcutaneous injection of 0.2 ml of saline, 5mg/kg of AG60, and 30 mg/kg of AG60, every other day for two weeks. Animals were sacrificed, and stomach, duodenum, appendix vermiformis and rectal tissues were resected and fixed in 10% neutral formalin. Tissue blocks were washed, dehydrated, embedded and cut in 6 μm-thick sections. For immunocytochemistry, the streptavidine-biotin-peroxidse method was used with a InnoGenex (San Ramon, Calif., USA) staining kit. The tissues were incubated with rabbit antisera against somatostatin (Biogenesis, Poole, England, UK) diluted 1 : 300, secretin (Biogenesis, Poole, England, UK) diluted 1 : 2,400, neurotensin (Biogenesis, Poole, England, UK) diluted 1 : 2,600, or motilin (Biogenesis, Poole, England, UK) diluted 1 : 1,000 for 24 hour at 4?C, followed by incubation in biotinylated antirabbit IgG and horseradish peroxidase-streptavidin conjugate for 1 hour at room temperature. The antigen-antibody reaction sites were visualized by incubating the sections with diaminobezidine tetrahydrochloride (DAB) for 5~15 minutes at room temperature. After mounting in canada balsam, they were examined in a Leica DM RB microscope. The number of the immunoreactive cells in the area of gastrointestinal mucosae (mean number of immunoreactive cells per 0.25mm2) were observed and calculated. The results are as follows : 1. In the fundic gland of normal mouse, somatostatin immunoreactive cells were detected (18.5±0.71), but neurotensin, secretin, or motilin immunoreactive cells were not found. In the duodenal mucosa of normal mouse, somatostatin immunoreactive cells were detected (7.0±0.10), but neurotensin, secretin or motilin immunoreactive cells were rarely found. 2. Immunoreactivity of somatostatin, secretin, neurotensin or motilin cells was not found in appendix vermiformis and rectum of normal mouse. 3. On immunocytochemical study, somatostatin immunoreactive cells in the fundic glands of normal, experimental control, AG60 (5mg/kg)-treated, AG60 (30 mg/kg)-treated and 5-fluorouracil (60 mg/kg)-treated groups were 18.5± 0.71, 10.0±4.20, 11.5±0.71, 13.5±2.10, 11.5±0.71, respectively. 4. On immunocytochemical study, somatostatin immunoreactive cells in the duodenal mucosae of normal, experimental control, AG60 (5 mg/kg)-treated, AG60 (30 mg/kg)-treated and 5-fluorouracil (60 mg/kg)-treated groups were 7.0±0.10, 0.5±0.71, 3.0±1.41, 0.5±0.71, 2.50±0.71, respectively. 5. On immunocytochemical study, secretin immunoreactive cells in the duodenal mucosae of normal, experimental control, AG60 (5 mg/kg)-treated, AG60 (30 mg/kg)-treated and 5-fluorouracil (60 mg/kg)-treated groups were rarely found. 6. On immunocytochemical study, neurotensin and motilin immunoreactive cells in the duodenal mucosae of normal groups were detected, but immunoreactivies were not detected in experimental control, AG60 (5 mg/kg)-treated, AG60 (30 mg/kg)-treated or 5-fluorouracil (60 mg/kg)-treated groups.

응급실로 내원한 외상성 화농성 근염 환자의 분석

나지웅 ( Ji Ung Na ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1

Purpose: Pyomyositis is a rare disease in temperature climate region. The diagnosis of pyomyositis is often delayed, and pyomyositis is often misdiagnosed in the emergency department. Methods: The medical records of 11 patients who were diagnosed as having traumatic pyomyositis in the emergency department at Samsung Medical Center in Seoul, Korea, between 2000 and 2006 were reviewed. Their clinical features, such as history, symptoms, clinical findings, duration from onset of symptoms to diagnosis, medical history, laboratory data, results of imaging studies and clinical course were collected. Results: The psoas muscles were most commonly involved. Computer tomography and magnetic resonance imaging aided in accurate diagnosis of the infection and of the extent of involvement. Incision, drainage, and antibiotics therapy eradicated the infectioin in all patients Conclusion: Pyomyositis should be a part of the differential diagnosis for patients with traumatic muscle pain. Radiologic evaluation, such as computer tomography and magnetic resonance imaging, must be considered in the diagnosis of traumatic pyomyositis. (K Korean Soc Traumatol 2006;19:81-88)

다발성 외상환자의 동반흉부손상 진단시 복부/골반 CT 촬영의 유용성

박상오 ( Sang O Park ),송형곤 ( Hyoung Gon Song ),심민섭 ( Min Seob Sim ),정연권 ( Yeon Kwon Jeong ),최필조 ( Pil Cho Choi ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: The objective of this study is to investigate the effect of the Abdomen/Pelvis CT scan for diagnosis of additional thorax injuries in multiple trauma patients. Methods: This study was conducted with 143 multiple trauma patients who visited on the emergency department of Samsung Medical Center, from May. 1997 to Apr. 2004. We reviewed and analysed medical record, the result of their Chest AP view, abdomen/pelvis and Chest CT scan, retrospectively. Results: For 143 abdomen/pelvis injury patients, 84 patients (58.7%) were identified as having additional thorax injuries by Chest CT scans. Detection rate of rib fractures and pulmonary contusions were no difference between Chest AP view and Abdomen/Pelvis CT scan. But Abdomen/Pelvis CT scan had more effective detection rate than Chest AP view in pneumothoraces (15.9% Vs 93.6%) and hemothorace(69.2% Vs 92.3%). Conclusions: Abdomen/Pelvis CT scan provided more important information than Chest AP view for the diagnosis of the thoracic traumas that often missed on initial evaluation in multiple trauma patients. Among the thoracic injuries, pneumothoraces and hemothoraces can be highly detected in Abdomen/Pelvis CT scan.

도심 지역에 위치한 일개병원의 고 연령 교통사고 환자에 대한 임상적 연구

이영환 ( Young Hwan Lee ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1

Purpose: For prevention and suitable administration, the effect of age on the severity of injuries in traffic accidents should be considered when evaluating a patient, but there have not been enough epidemiological studies that evaluate the age factor in traffic accidents. For that reason, we investigated old-aged patients who were involved in traffic accidents (65 years old or more) and who were admitted to the emergency department of a college hospital in an urban city of Korea. Methods: We collected data from traffic-accident patients who came to the emergency room of a university hospital in Seoul from Jan.1, 2004 to Dec.31, 2005. We compared their abilities to ambulate and the RTSs (Revised trauma scores) by using a LSD (least significant difference), linear regression. Results: A total of 1460 patients were included. The mean RTS of all traffic-accident patients was 7.77±0.280. The scores for drivers and passengers, motor-cycle drivers and passengers, bicycle drivers and passengers, and pedestrians were 7.79±0.21, 7.78±0.22, 7.54±0.25, 7.77±0.20, and 7.80±0.21 respectively (p=0.000). There was no statistically significant difference between the RTS of patients over 65 years and that of other patients. In a regression analysis, the number of patients over 45 ages who were able to ambulate was lower than that of younger people, independently of other influencing factors (B=-0.330, R-square = 0.243, p=0.000). Conclusion: We expected that RTS of old age group more than 65 years old will significantly lower than that of others, but there was no statistically significant difference. (K Korean Soc Traumatol 2006;19:74-80)

경기도 지역의 일개 대형 놀이공원에서 발생한 환자를 통한 대형 놀이공원에서의 외상성 손상의 양상

이재혁 ( Jae Hyuk Lee ),심민섭 ( Min Seob Sim ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.1

Purpose: There are no reports on amusement-park-related injuries in Korea. Thus, the objective of this study was to describe traumatic injury patterns that occurring in an amusement park. Methods: The medical records of an infirmary were retrospectively reviewed. From January 1, 2008, to December 31 2008, patients who were transferred to the nearest emergency departments of hospitals for the purpose of further test and treatment were enrolled. Demographics, injury types and involved parts of the body were analyzed. Results: A total of 3,608 patients visited an infirmary for traumatic injury and about two-thirds had soft tissue injuries. Of those, 191 patients (5.3%) were transferred to the emergency department of a hospital. Of the patients who were transferred to a hospital, laceration and contusion were the responsible injuries for about half. Laceration was the most common injury in pediatric patients, and a sprain or a strain was the most common in adult patients. The most commonly injured parts of the body were the extremities in adult patients. However, in pediatric patients, injuries of the head, face and neck were similar to injuries of the extremities. Conclusion: Soft tissue injury was the most common amusement-park-related injury. Laceration was the most common reason to transfer a patient to a hospital. There were differences in injury type and injured part of the body between adult and pediatric patients. (J Korean Soc Traumatol 2009;22:103-107)

외상 환자와 비외상 환자에서 삼투압차와 에탄올 농도의 상관관계 및 추정 에탄올 농도의 정확도

장형우 ( Hyung Woo Chang ),심민섭 ( Min Seob Sim ),한상국 ( Sang Kuk Han ),송형곤 ( Hyoung Gon Song ) 대한외상학회 2009 大韓外傷學會誌 Vol.22 No.2

Purpose: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. Methods: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin`s concordance correlation coefficient. Results: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson`s correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin`s concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. Conclusion: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients. (J Korean Soc Traumatol 2009;22:148-153)