추골동맥 및 분지부 동맥류의 치료결과

안재성,김준수,김정훈,권양,권병덕,Ahn, Jae Sung,Kim, Joon Soo,Kim, Jeong Hoon,Kwon, Yang,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.1

Objective : Aneurysms of vertebral artery and its branches make up approximately 3% of all intracranial aneurysms. As the aneurysm have an intimate relationship with lower cranial nerves and medulla, surgical management of the aneurysms are one of the challenging neurosurgical problems. The authors analyzed the management outcomes for aneurysms arising from vertebral artery and its branches. Methods : At the authors' institution between May 1989 and Jan. 2000, 42 patients were treated with transcranial and endovascular surgery for aneurysms of vertebral artery and its branches. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Forty two patients were comprised of 28 female and 14 male patients aged from 26-80 year old(mean : 51.8). Of the 42 patients, 37 patients(88%) had subarachnoid hemorrhage. Of the 37 patients with subarachnoid hemorrahge, 35 patients(95%) were in good neurological status(Hunt Hess grade I-III), 2 patients(5%) in poor grade(H-H grade IV-V) before operation. Location of the aneurysm were 16 in vertebral artery, 12 in vertebro-PICA junction, and 14 in the peripheral PICA. Twenty nine patients were treated with transcranial surgery and 13 patients with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I and II ; 24, GOS III ; 2, GOS IV ; 1 and GOS V(death) ; 2. The causes of mortality related to transcranial surgery were rebleeding after failure in clipping in one and suspected brainstem infarct in one. Morbidity was attributed to vasospasm(3), lower CN palsy(7, including temporary dysfunction) and pseudomeningocele(1). The management outcome of the endovascular surgery was : Glasgow outcome scale(GOS) I-II ; 9, GOS III ; 1, GOS IV ; 1, and GOS V(death) ; 2. The causes of mortality related to endovascular surgery were sepsis from pneumonia(1) and vasospasm(1). There were one cerebellar infarct and one lateral medullary syndrome. Conclusion : Excellent and good surgical results can be expected in 80% of the patients with aneurysms of vertebral arery and its branches. The outcomes of endovascular surgery in treating vertebral artery aneurysm were satisfactory and endovascular surgery may offer a therapeutic alternative especially in vertebral dissecting aneurysm.

기저동맥 분지부 동맥류의 치료결과

안재성,김정훈,권양,권병덕,Ahn, Jae Sung,Kim, Jung Hoon,Kwon, Yang,Kwun, Byung Duk 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.7

Objective : The authors analyzed the results of management outcomes for basilar bifurcation aneurysms treated with transcranial surgery and endovascular surgery. Methods : At the authors' institution between May 1989 and December 1998, 47 aneurysms with 45 patients were treated with transcranial surgery including surgical clipping/wrapping and endovascular surgery for basilar bifurcation aneurysms. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : Of the 45 patients, 87 percent of the aneurysms were ruptured and 13% unruptured. Forty six percent of the patients had multiple aneurysms including basilar bifurcation aneurysm. Of the 39 patients with subarachnoid hemorrahge, 77% were in good neurological status(Hunt Hess grade I-III), 23% were in poor grade(H-H grade IV-V). Thirty two patients were treated with transcranial surgery and 15 patients were treated with endovascular surgery. Two patients who had treated with wrapping surgery later bled during follow-up period and treated with endovascular surgery. The management outcome of the transcranial surgery was : Glasgow outcome scale(GOS) I 66%, GOS II 12.5%, GOS III 6.3%, GOS IV 6.3% and GOS V(death) 9.4%. The major causes of morbidity related to transcranial surgery were perforator occlusion, vasospasm and retraction injury. The management outcome of the endovascular surgery was : GOS I 66.7%, GOS II 6.7%, and GOS V 26.7%. The major causes of mortality related to endovascular surgery were related to intraoperative aneurysmal bleeding. Conclusion : This report documents that more than 75% of patients undergoing treatment either transcranial or endovascular surgery can expect good clinical outcomes. Treatment modality in management of basilar bifurcation aneurysm must be carefully selected based on various considering factors.

비파열 뇌동맥류의 수술적 치료

안재성,권양,권병덕,Ahn, Jae Sung,Kwon, Yang,Kwun, Byung Duk 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.3

Objective : The purpose of this report is to assess the morbidity and mortality associated with clipping of intracranial unruptured aneurysms. Methods : At the authors' institution between May 1989 and December 1998, a total of 128 unruptured aneurysms in 110 patients were treated with surgical clippings. The medical records and neuroimaging studies of the patients were reviewed retrospectively. Results : The main locations of the aneurysms were : middle cerebral artery 31%, internal carotid-posterior communicating artery 28%, anterior communicating artery 16%, paraclinoid 6.5%, internal carotid-anterior choroidal artery 7%, posterior circulation 7%. Forty three percent of the aneurysms were symptomatic and 57% asymptomatic. The overall outcome of the surgery was : Glasgow outcome scale(GOS) I 86%, GOS II 6%, GOS III 4.3%, GOS IV 0% and GOS V(death) 3.5%. The operative risk is higher for large to giant aneurysms, and for aneurysms in posterior circulations. Patients with non-giant aneurysm in anterior circulation showed no mortality, but morbidity of 8.2%, and in posterior circulation : 25% of mortality and 75% of morbidity. Patients with giant anterior circulation aneurysm have 22% of mortality and 22% of morbidity. For patients with giant posterior circulation aneurysm, mortality and morbidity were 25% and 25%, respectively. The postoperative deaths were related to occlusion of the major parent artery in 3 cases(75%). The postoperative morbidity was related to occlusion of artery(9/13), intraoperative rupture(3/13), and cranial nerve injury(1/13). Conclusion : This report documents 3.5% mortality and 13% of morbidity in the clipping surgery for unruptured intracranial aneurysms, and the relatively low risk of surgical clipping in non-giant and those located in anterior circulation. The natural history, especially risk of bleeding, of the unruptured intracranial aneurysms is still controversial. However, with respect to surgical results, unruptured non-giant aneurysm located in anterior circulation should be operated in patients with low risk.

Ki-67, Proliferating Cell Nuclear Antigen, Flow Cytometry를 이용한 수막종의 증식력 분석

안재성,김정훈,권병덕,Ahn, Jae Sung,Kim, Jeong Hoon,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.7

Objective : In this study, we investigated the relationship between the histologic grading of meningiomas and proliferative potentials determined by the Ki-67, proliferating cell nuclear antigen(PCNA) and flow cytometry (FCM) with the aim of determining whether these potentials can be used as a parameter to the proliferative activity, in particular of atypical and malignant meningiomas. Methods : This study consisted of 47 meningiomas(6 malignant, 14 atypical, and random sampled 27 benign meningiomas). By immunohistochemical staining of Ki-67 and PCNA on formalin-fixed, paraffin-embedded sections, the anti-human rabbit polyclonal antibody against Ki-67 antigen and anti-PCNA monoclonal antibody(PC10) scores were counted. FCM was also performed on paraffin-embedded tissue using a selective staining technique for DNA. DNA ploidy, S-phase fraction, and proliferative index(PI)) were determined. Results : The results are summarized as follows ; 1) Proliferation rates as assessed by Ki-67 and PCNA closely correlated with the degree of anaplastic histologic features. 2) Proliferative potentials determined by FCM(S-phase fraction and PI) were not able to distinguish between benign and atypical/malignant meningiomas. 3) DNA ploidy was not a useful indicator of histologic grade in these tumors. 4) Proliferative potentials such as Ki-67 staining index(SI) and PCNA SI did not correlate with the ploidy pattern. 5) There was a linear correlation between Ki-67 SI and PCNA SI, but we could not find a correlation between Ki-67 SI and S-phase fraction or PI. Our results also did not show a statistically signficant correlation between PCNA SI and S-phse fraction or PI. Conclusions : We conclude that evaluation of the proliferative potentials with Ki-67 and PCNA is important as an additional factor for the prediction of malignancy in meningiomas. A dual study of Ki-67 and PCNA SIs on the same tissue might improve the accuracy with which the proliferative potential of a tumor can be predicted. We demonstrated that FCM in meningiomas is not valuable in predicting the behavior of these neoplasms, but we did observe a trend toward more malignancy with higher percent S-phase fraction and higher PI. Analysis of the S-phase fraction and PI might therefore be a useful tool to discriminate among histologic grades of meningiomas.

비파열 뇌동맥류의 치료-자연경과 및 수술적 치료결과

안재성,권병덕,Ahn, Jae Sung,Kwun, Byung Duk 대한신경외과학회 2001 Journal of Korean neurosurgical society Vol.30 No.6

Objectives : The best results of treating intracranial aneurysms can be achieved with treating aneurysm before they rupture. Some recent reports about the risk of the bleeding of the unruptured intracranial aneurysm(UIA) being too low(0.05% per year) compared with 1~2% of the previously reported bleeding probability, casts the question about the need for treatment of the UIAs. The purpose of this report is to review the recent reports about the risk of rupture of the UIAs and to assess the morbidity and mortality associated with surgical treatment for UIAs.

여름에 발생한 혈구탐식림프조직구증을 동반한 중증쯔쯔가무시병 1예

안재성 ( Jae-sung Ahn ),노진희 ( Jin-hee Noh ),김형래 ( Hyung-rae Kim ),정지원 ( Jiwon Jung ),조재철 ( Jae-cheol Jo ),임지훈 ( Ji-hun Lim ),전재범 ( Jae-bum Jun ) 대한내과학회 2017 대한내과학회지 Vol.92 No.3

쯔쯔가무시병은 가을철에 호발하는 열성 질환이다. 저자들은 여름에 중증패혈증 양상을 보인 HLH 환자에서 쯔쯔가무시병을 진단하였으며, doxycycline으로 치료 후 호전을 보인 예를 경험하여 이를 보고하는 바이다. In Korea, scrub typhus usually occurs in October and November. Hemophagocytic lymphohistiocytosis (HLH) is a distinct clinical entity characterized by a high fever, pancytopenia, hepatosplenomegaly, histiocyte proliferation, and hemophagocytosis. We encountered a summertime case of severe scrub typhus presenting as HLH. A 49-year-old female complained of abdominal pain and fever 3 days in duration. On hospital day 3 she was transferred to the intensive care unit because of clinical deterioration accompanied by severe sepsis. As an eschar was evident on the right shoulder, we commenced doxycycline. Her condition improved dramatically and she was discharged on day 14. Although the indirect immunofluorescence antibody test (IFA) for Orientia tsutsugamushi was negative on admission, a repeat IFA test was positive; the antibody titer was 1:5,120 on hospital day 10. Scrub typhus should be considered during differential diagnosis in a patient with severe sepsis in any season except the fall. (Korean J Med 2017;92:321-325)

립모션을 활용한 휴대용 수화통역기

안재성(Jae-Sung Ahn),김유리(Yu-Ri Kim),김혜지(Hae-Ji Kim),조재혁(Jae-Heok Jo),노광현(Kwang-Hyun Ro) 대한전자공학회 2016 대한전자공학회 학술대회 Vol.2016 No.11

This paper proposes a potable sign language translator with a smart device and a leap motion for hearing-impaired person. A leap motion sensor which supports hands and finger motions as computer input is used for extracting the raw data of sign language. For the recognition of finger language and sign language, DWT and $1 algorithm are being applied. 31 finger languages and 47 sign languages have been tested. The average recognition ratio was 85.64% and the average recognition time was 0.542sec. For the commercialization, the portable sign language translator integrated with a 8“ tablet and a leap motion was implemented.

경량 UHPC의 보수용 모르타르 및 시멘트 패널로서의 활용 가능성에 대한 실험적 검토

안재성(Jae Sung Ahn),김형기(Hyeong-Ki Kim) 한국건설순환자원학회 2023 한국건설순환자원학회 논문집 Vol.11 No.3

후측방 유합술 시 탈무기질화 골기질을 적용한 경우의 유효성과 안정성

안재성(Jae-Sung Ahn),이호진(Ho-Jin Lee),박유진재진(Eugene Park),노창균(Chang-Kyun Noh),이기영(Ki Young Lee) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.3

목적: 요추 후측방 유합술 시 탈무기질화 골기질의 효과를 분석하고자 한다. 대상 및 방법: 2009년부터 2012년까지 탈무기질화 골기질을 사용한 30예(I군)와 자가 후방 장골을 사용한 30예(II군)를 조사하였다. 수술 후 2년 동안 주기적 단순 방사선 사진을 촬영하여 Lenke’s scale에 따라 분류 후 굴곡-신연 측면 방사선 사진을 통해 골유합 여부를 확인하였다. 또한 수술 후 2년째 척추경 나사못 주위 방사선 투과대 여부를 조사하였으며, 환자의 임상 증상 평가를 위해 visual analogue scale과 Oswestry disability index (ODI) 점수를 각각 조사하여 분석하였다. 결과: I군 중 19예는 유합, 11예는 불유합되었으며, II군 중 22예는 유합, 8예는 불유합되어 두 군에서 통계적으로 유의한 차이는 보이지 않았다(p=0.57). 유합이 일어난 주수에 있어서도 두 군 간의 통계적 차이는 없었다(p=0.097). 수술 후 2년째에 평가한 척추경 나사못 주위 방사선 투과대 여부, 요통과 ODI 점수에 있어서도 각각 양 군 간의 통계적인 유의성은 없었다. 결론: 요추 후측방 유합술 시 탈무기질화 골기질의 사용은 자가골과 유사한 골유합률을 보이며, 자가골 이식에 따른 합병증을 피할 수 있어 효과적인 골대체재로 생각된다. Purpose: The purpose of this study is to analyze the effects of demineralized bone matrix on posterolateral lumbar fusion. Materials and Methods: From 2009 to 2012, 30 patients who had undergone posterolateral fusions using demineralized bone matrix (group I) and 30 who had received autogenous posterior iliac bone grafts (group II) were investigated. Bone union was determined by evaluating serial simple lumbar radiographs taken during the 24 months after surgery. Bone status was classified according to Lenke’s scale and the bone fusion was finally determined by flexion/extension lateral radiographs. We also examined halo signs around the pedicular screws evident on the radiographs, scored back pain using a visual analogue scale (VAS), and Oswestry disability index (ODI) score 2 years after surgery to evaluate clinical status of patients. Results: In group I, 19 patients showed union and 11 patients did not; the values for group II were 22 and 8. These proportions did not differ significantly (p=0.57). Time to union was somewhat shorter in group II (25.3±7.9 weeks), but did not differ significantly from that of group I (p=0.097). No statistical significance in the periscrew Halo count, VAS for back pain, and ODI score was observed between the two groups. Conclusion: The union rate after using demineralized bone matrix for lumbar posterolateral fusion is similar to that attained when autogenous bone grafts are employed, and lacks the morbidity associated with such grafts. Thus, demineralized bone matrix is an effective bone graft substitute when posterolateral fusion surgery of the lumbar spine is required.

경추 척수증에서 후궁 확장 형성술의 수술 중, 수술 후 합병증에 따른 임상적 결과 비교

안재성(Jae-Sung Ahn),이준규(June-Kyu Lee),이기수(Gi-Soo Lee),신병건(Byung-Kon Shin) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.5

목적: 경추 척수증 환자에서 후궁 성형술 후 발생한 합병증이 임상적 결과를 변화시키는지 비교 분석하고자 한다. 대상 및 방법: 경추 척수증으로 2006년 3월부터 2011년 3월까지 충남대학교병원에서 후궁 확장 성형술 시행받은 환자 중 최소 2년 이상 추시한 총 152예를 대상으로 했고, 평균 추시 기간은 39.7개월이었다. 후궁 확장 성형술 중 경첩 골절이 발생해 금속판 고정술을 한 경우 또는 술 후 자연적 후궁 간 유합이 발생한 경우를 A군, 그렇지 않은 경우를 B군으로 나누었고 visual analogue scale score (VAS) 및 Neck Disability Index (NDI)로 측정하였다. 결과: A군 중 술 중 경첩 골절에 따른 금속 고정술은 11예, 술 후 자연적 후궁 간 유합 발생은 20예였다. 술 전 평균 VAS score는 A군 7.52점, B군 7.26점, 술 후 A군 2.87점, B군 3.03점이었다. NDI는 A군 술 전 평균 74.32%, 술 후 평균 43.84%였으며, B군 술 전 평균 75.74%, 술 후 평균 45.36%였다. 두 군 모두 술 후 추시에서 VAS score 및 NDI에는 유의한 차이 없었다. 결론: 후궁 확장 성형술 중 발생한 경첩 골절에 따른 금속판 고정 또는 술 후 자연적 후궁 간 유합 합병증이 발생된 예에서 임상적 결과는 유의한 차이가 없었다. Purpose: The purpose of this study is to compare and analyze the clinical results according to the complications occurring after laminoplasty for cervical myelopathy patients. Materials and Methods: Among patients diagnosed as cervical myelopathy, 152 cases in which patients underwent cervical laminoplasty from March 2006 to March 2011 from Chungnam National University Hospital and had follow-up for at least two years were selected for the study, and the mean follow-up period was 39.7 months. The cases were divided into two groups; cases that underwent plate fixation for hinge fracture during cervical laminoplasty or showed postoperative spontaneous interlamina fusion were included in group A and cases that did not show such complications were included in group B. Clinical results were measured using visual analogue scale (VAS) score and Neck Disability Index (NDI) preoperatively, postoperatively, and on the final follow-up. Results: Among 152 cases, 31 cases were included in group A and 121 cases in group B. Group A consisted of 11 cases of fixation due to intraoperative hinge fracture and 20 cases of postoperative spontaneous interlamina fusion. Mean preoperative VAS score was 7.52 in group A and 7.26 in group B, and mean postoperative VAS score was 2.87 in group A and 3.03 in group B. Mean NDI improved from 74.32% preoperatively to 43.84% postoperatively in group A and 75.74% preoperatively to 45.36% postoperatively in group B. In both groups, on postoperative follow-up, no significant difference of VAS score and NDI was found and both showed improvement compared to before surgery. Conclusion: The clinical results of cases that underwent plate fixation for hinge fracture that occurred during cervical laminoplasty and postoperative spontaneous interlamina fusion showed no significant difference compared to cases that did not show any complications.