경후두과 접근법 및 경후두과와 접근법을 이용한 추골동맥 및 후하소뇌동맥 동맥류의 수술적 치료

양나래,서의교 대한뇌혈관외과학회 2011 Journal of Cerebrovascular and Endovascular Neuros Vol.13 No.3

Objective : Since posterior circulation vascular lesions are adjacent to important structures such as the brain stem and lower cranial nerves, the acquisition of anatomical information and the careful selection of approaches are essential for the surgical treatment of these lesions. We examined the characteristics and the indications of the far lateral suboccipital approach which exposes lesions without retraction of the brain stem for the treatment of either a vertebral artery (VA) or posterior inferior cerebellar artery (PICA)aneurysm. We present the best diagnostic tool to determine the approaches. Methods : We have reviewed 11 patients who received surgical treatments between 2005 and 2011 for VA or PICA aneurysms. All of the patients had 3-dimensional computed tomography (3DCT) angiography performed to investigate the relation of the location between the aneurysm and hypoglossal canal. Results : Eight of the 11 patients were treated with the transcondylar fossa approach (TCFA) as their lesions were located proximal to the hypoglossal canal, while three were treated with the transcondylar approach (TCA) as their lesions were located distal to the hypoglossal canal. Of the three patients treated with the TCA, one had temporary palsy of the 11th cranial nerve and the others recovered without any neurological defects. 3DCT angiography showed the relation of the location between the aneurysm and hypoglossal canal. Conclusion : The TCFA and TCA are good approaches to expose lesions without retraction of the brain stem. To determine the approaches for the surgery of VA or PICA aneurysms, using 3DCT before surgery is advantageous in understanding the positional relations between the hypoglossal canal and the lesions. During the actual surgery, the posterior condylar canal through which the posterior condylar emissary vein passes can be used as an anatomical landmark for TCFA. With this approach,craniocervical instability can be avoided.

신경외과의사의 미래의 역할 : Hybrid Neurosurgeon을 넘어 Convergence Neurosurgeon으로

양나래 이화여자대학교 의과학연구소 2020 EMJ (Ewha medical journal) Vol.43 No.2

With advances in medicine and technology, treatment modalities for diseases have evolved. Consequently, physicians’ roles have also changed. Because of advances in endovascular treatment, neurosurgeons specializing in cerebrovascular surgery are increasingly using endovascular techniques. Accordingly, the number of so-called “hybrid neurosurgeons” who perform both traditional craniotomy cerebrovascular surgeries and endovascular treatments is on the rise. This phenomenon is also occurring in department of neurology, traditionally a non-surgical specialty, and the number of neurologists using endovascular treatments is also increasing. Nowadays endovascular treatments become more common across medical specialties such as neurointerveional radiology, neurosurgery, and neurology. In this time, what should be the role of neurosurgeons? Standardized hybrid surgeons should contribute to society by treating hemorrhagic stroke and ischemic stroke, maintaining a proper number of hybrid-neurosurgeons to ensure demand for such treatments is met. Further, more neurosurgeons should be trained to perform sophisticated traditional surgeries, as these surgeries cannot be performed by anyone else. Finally, neurosurgery patients often require a combination of surgical and medical treatment. In these situations, primary and secondary prevention are also crucial. And, many neurosurgery patients also have psychoneurotic symptoms. Within neurosurgery backgrounds, we, neurosurgeons, need to be intensivists for critical care medicine, hospitalization experts, epidemiologists, neuropsychiatry experts, and basic researchers. Because we have to be in charge of neurosurgical patients with various problems in our healthcare environment. Therefore, advancing beyond hybrid neurosurgeons and beginning an era of convergence neurosurgeons should be our role in the future.

Acute Cholecystitis as a Cause of Fever in Aneurysmal Subarachnoid Hemorrhage

양나래,홍경숙,서의교 대한중환자의학회 2017 Acute and Critical Care Vol.32 No.2

Background: Fever is a very common complication that has been related to poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). The incidence of acalculous cholecystitis is reportedly 0.5%–5% in critically ill patients, and cerebrovascular disease is a risk factor for acute cholecystitis (AC). However, abdominal evaluations are not typically performed for febrile patients who have recently undergone aSAH surgeries. In this study, we discuss our experiences with febrile aSAH patients who were eventually diagnosed with AC. Methods: We retrospectively reviewed 192 consecutive patients who underwent aSAH from January 2009 to December 2012. We evaluated their characteristics, vital signs, laboratory findings, radiologic images, and pathological data from hospitalization. We defined fever as a body temperature of >38.3°C, according to the Society of Critical Care Medicine guidelines. We categorized the causes of fever and compared them between patients with and without AC. Results: Of the 192 enrolled patients, two had a history of cholecystectomy, and eight (4.2%) were eventually diagnosed with AC. Among them, six patients had undergone laparoscopic cholecystectomy. In their pathological findings, two patients showed findings consistent with coexistent chronic cholecystitis, and two showed necrotic changes to the gall bladder. Patients with AC tended to have higher white blood cell counts, aspartame aminotransferase levels, and C-reactive protein levels than patients with fevers from other causes. Predictors of AC in the aSAH group were diabetes mellitus (odds ratio [OR], 8.758; P = 0.033) and the initial consecutive fasting time (OR, 1.325; P = 0.024). Conclusions: AC may cause fever in patients with aSAH. When patients with aSAH have a fever, diabetes mellitus and a long fasting time, AC should be suspected. A high degree of suspicion and a thorough abdominal examination of febrile aSAH patients allow for prompt diagnosis and treatment of this condition. Additionally, physicians should attempt to decrease the fasting time in aSAH patients.

한방치료로 호전된 창만 치험 2례

양나래,김미경,최동준,한창호,Yang, Na-rae,Kim, Mi-kyung,Choi, Dong-jun,Han, Chang-ho 대한중풍순환신경학회 2009 대한중풍.순환신경학회지 Vol.10 No.1

The purpose of this study is to report the effectiveness of oriental medical treatment including Hubaksenggangbanhagamchoinsam-tang(厚朴生薑半夏甘草人蔘湯) and moxibustion (and acupuncture) on abdominal distension. Two patients complainted of abdominal distension, vomiting, dyschezia and so on. According to the pattern identification (辯證論治), the distension of both patients were diagnosed as deficiency distension(虛脹). So we decided to treat the patients by means of tonification the deficiency(補虛) including Hubaksengganggamchoinsam-tang and moxibustion. And the symptoms improved after treatment. So we report these cases.

파두 투여 후 호전된 뇌경색 환자의 장마비 치험 1례

양나래,권영주,조우근,최동준,한창호,Yang, Na-rae,Kwon, Young-joo,Jo, Woo-keun,Choi, Dong-jun,Han, Chang-ho 대한중풍순환신경학회 2010 대한중풍.순환신경학회지 Vol.11 No.1

Paralytic ileus is one of the common complications in stroke patients. In western medical treatment, surgery or conservative care is used for treating ileus. In this case, patient diagnosed as paralytic ileus had problems of constipation, or abdominal distension. Therefore the patient were treated with Crotonis Fructus(巴豆), and the patient showed improvement in X-ray findings and these symptoms. So we report this case.

항고혈압제제를 복용 중인 성인 고혈압 환자의 한열 특성에 관한 연구

양나래,한창호,Yang, Na-Rae,Han, Chang-Ho 대한한방내과학회 2013 大韓韓方內科學會誌 Vol.34 No.3

Objectives : The aim of this study was to investigate the correlation between Cold-Heat pattern tendency and demographic traits, physical character, and vital signs in hypertensive patients taking anti-hypertensive agents. Methods : 28 hypertensive patients 30 to 69 years old were recruited. We assessed their general characteristics, physical characteristics (height, weight, waist circumference, etc.), vital signs without respiratory rate (blood pressure, pulse rate, temperature) and administered a Cold-Heat pattern questionnaire. After that, we analyzed statistical data on separate groups according to Cold-Heat characteristics or other criteria. Results : 1. Heat group patients had statistically higher scores in waist, body mass index (BMI), waist circumference and pulse rate. 2. Over weighted group patients had statistically lower scores in cold Pattern Identification. 3. Higher BMI group (above 23/25) patients had statistically significantly higher Heat scores and lower Cold scores, higher waist circumference group patients had lower Cold scores. Conclusions : From the above result in hypertensive patients taking hypertensive agents, Heat group had a obesity tendency and the inverse is also valid. Later, progressed study based on more samples and varied data will contribute to diagnosis the Cold-heat Pattern identification in hypertensive patients.

전이성 뇌종양의 뇌정위 방사선 수술, 조금 더 생각해봐야 할 것은?

양나래 이화여자대학교 의과학연구소 2022 EMJ (Ewha medical journal) Vol.45 No.1

제주도 패총 출토 어패류와 어로구 小考

양나래,강창화 제주학회 2016 제주학회 학술발표논문집 Vol.2016 No.1

제주도 패총 출토 어패류와 어로구 소고(小考)

양나래,강창화 제주학회 2016 제주학회 학술발표논문집 Vol.2016 No.2

체내에서 침이 발견된 사례 보고

양나래,김미경,최동준,한창호,Yang, Na-Rae,Kim, Mi-Kyung,Choi, Dong-Jun,Han, Chang-Ho 대한한방내과학회 2011 大韓韓方內科學會誌 Vol.32 No.1

Objectives : To report the cases of forgotten needles found in the patients' bodies since Dong-guk University Ilsan Hospital opened, and arouse considerable attention to prevent recurrence. Methods : Oriental medical doctors in the hospital has applied acupuncture on patients' bodies in case of need, and the other staffs removed the needles after treatment. Results : All the patients in the cases had cerebrovascular disease with paralysis, aphasia, cognitive disorder and disturbance of consciousness as well as dysphagia requiring gastrotomy tube and dysfunction of respiration requiring tracheal cannula. The pathways the acupuncture needles were passing through are presumed to be transtracheal via the hole of tracheal cannula in two cases, and transgastrointestinal via mouth or the opening of gastrotomy tube. The needle was excreted with stool without any harm to the patient in the latter case, while the impact of the needles on the respiratory system or thorax of the patients in the former two cases is ambiguous. The hospital has taken some measures to prevent recurrence. Conclusions : There are not a few at high-risk of occurrence of forgotten needles that might induce medical problems among patients in oriental medical clinics or hospitals. Authors expect this report arouses all the people involved in the whole procedure of acupuncture treatment, including oriental medical doctors, nurses, nurse-assistants and caregivers considerable attentions to the possible occurrence and risk of forgotten needles.