외과적 협자에 의한 일시적 혈관차단이 내피세포에 미치는 영향

도성신,신호 中央醫學社 1987 中央醫學 Vol.52 No.1

The effects of temporary clipping on the arterial endothelium in rats were examined with electron microscopy. Twenty four rats were anesthetized and right common carotid arteries were exposed. Temporary clips were used to occlude the carotid arteries for 5, 30, and 60 minutes in 6 animals each. The clips were then removed and blood flow resumed for periods of 0 and 30 minutes, respectively. The TEM examination of the endothelium subjected to ischemia by acute occlusion revealed numerous intracytoplasmic vacuoles and alteration of organelles. Interendothelial junctions were frequently disrupted, and focal areas of endothelial cell desquamation with cleavage between endothelial cells and the underlying internal elastic lamina were also seen. All of these alterations were detected in arterial segments that had been compressed for as little as 30 minutes. Similar alterations were observed in segments that had been compressed for 30 minutes followed by removal of the clip and resumption of blood flow for 30 minutes. However, the adherence of platelets and fibrin to altered endothelial cells and to exposed subendothelial tissue was markedly increased following resumption of blood flow for 30 minutes.

골 견인술에 의한 경추골절 탈구환자의 치료에 대한 임상적 연구

도성신,안욱,신호 中央醫學社 1983 中央醫學 Vol.45 No.3

For the patient with fracture dislocation of the cervical spine, skeletal traction method is simple, safe and effective way to decompress and protect the spinal cord reestablishing the normal alignment of the spine. Skeletal traction is indicated as the initial treatment for the reduction of cervical fracture dislocations, and when properly applied, this method eliminate the necessity of laminectomy, spinal fusion, and the use of plaster supports in almost all cases of injury to this part of the spine. The results were satisfactory in most of our patients and the incidence of com-plication was negligiable or minor. The technique for correct application is briefly described.

두개내압 상승과 중추 α-adrenoceptor와의 관계

도성신,김형근,조광룡 대한신경외과학회 1983 Journal of Korean neurosurgical society Vol.12 No.1

Urethane 마취가토에서 경뇌막외강내에 삽입한 ballon을 통한 가압 및 두개내압 기록 방법에 의하여 내압상승에 따른 혈압상승에 관여하는 α-adrenoceptor의 성질을 구명코자 하였다. 1) 두개내압의 상승에 따라 현저한 혈압상승이 나타났다. 2) B-HT는 혈압하강 및 심박감소를 일으켰고, 내압상승에 따른 혈압상승을 현저하게 억제하였다. 3) Piperoxan은 내압상승에 따른 혈압상승을 강화시켰다. 4) Piperoxan은 B-HT의 혈압하강 및 심박감소 작용에 길항하였고, 내압상승에 따른 혈압상승작용에 대한 B-HT의 억제작용에도 길항하였다. 5) Prazosin은 내압상승에 따른 혈압상승작용에 거의 영향을 미치지 못하였다. 6) Prazosin은 B-HT의 혈압하강, 심박감소작용 및 내압상승에 따른 혈압상승에 대한 억제작용 모두에 전혀 영향을 미치지 못하였다. 이상의 실험성적으로 내압상승에 따른 혈압상승에는 중추 α-adrenoceptor가 중요한 역할을 하며 그 성질은 α₂- 형일 것으로 추론하였다. The author attempted to clarify the nature of α- adrenoceptors in relation to the pressor response to the increased intracranial pressure (ICP) in urethane anesthetized rabbits, using the epidural balloon method. 1) The blood pressure increased in parallel with the raised ICP which was made by gradual inflation of the balloon. 2) B-HT 920, an α₂- agonist, which elicited depressor and bradycardiac responses in normal rabbits inhibited markedly the pressor response to the raised ICP. 3) Piperoxan, an α₂- antagonist, potentiated the pressor response to the raised ICP. 4) Piperoxan antagonized the depressor and bradycardiac responses by B-HT 920 as well as the inhibitory effect of B-HT 920 on the pressor response to the raised ICP. 5) The pressor response to the raised ICP were not affected at all by prazosin, an α₁- antagonist. 6) Neither the depressor and bradycardiac responses by B-HT 920 itself nor the inhibitory effect of B-HT 920 on the pressor response to the raised ICP were significantly affected by prazosin. It is inferred from these observations that the central α-adrenoceptors play an important role in producing the pressor response to the raised ICP and that the receptors involved here seems to be of α₂- type.

실험적 뇌지주막하 출혈에 의한 뇌혈관 연축에 대한 Vasodilators의 영향

조하영,도성신,신호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5

This paper notes the effect of vasodilators on the cerebral vasospasm induced by experimental subarachnoid hemorrhage. Artificial subarachnoid hemorrhage produced by dual injection of non-heparinized autologous blood into the cisterna magna in rabbits with 72 hours interval gave rise to considerable narrowing or spasm of the basilar artery and its branches demonstrated by cerebral angiography. SAH was induced in 12 rabbits by injecting 1.3㎖/㎏ of autologous fresh arterial blood into the cisterna magna, followed by suspending the rabbits in a head-down position at 30 degree for 1 hour in order to accumulate blood around the basilar artery. The animals were divided into 4 groups ; a group receiving nifedipine, a group receiving aminophylline, a group receiving papaverine, a group receiving trifluoperazine HCl. Angiographically vertebrobasilar arterial spasm was demonstrated 3 days the 2nd autologous blood injection into the cisterna magna. Radiographically visible spasm was resistent to the vasodilating drugs. Rabbits were sacrificed by the overdose injection of sodium phenobarbital at the end of experiment.

두개내압 상승을 반복할 때의 가토혈압상승과 중추 α-adrenoceptor와의 관계

장석정,도성신,박승규,신호,김봉환 대한신경외과학회 1985 Journal of Korean neurosurgical society Vol.14 No.2

Urethane 마취 가토에서 경뇌막외강네 balloon 방법을 통하여 가압(가압 balloon내 식염수 주입속도 0.058/min)에 의한 cushing반응(이를 일차가압 실험이라 함)을 관찰한 다음 즉시 가압 balloon내 주입되었던 식염수를 일시에 제거한 후 30~60분을 기다려 다시 가압실험(이를 이차가압 실험이라 함)을 실시하면 더욱 급격한 cushing반응이 나타났다. 이 이차가압실험에 있어서의 cushing반응에 대한 몇가지 자율신경계 약물의 효과를 조사하였다. 1) 일차가압 실험 시작시의 내압은 26±0.9 ㎜Hg, 혈압은 105±3.1 ㎜Hg 심박은 245±5.7 beats/min이였다. 일차가압실험에서는 가압초기에 내압의 상승에 따라 혈압은 현저한 상승을 보이고 심박은 감소하였다. 최고혈압 상승시에 내압은 165±9.2 ㎜Hg, 원혈압에 대한 혈압 상승율은 49±4.7%, 원심박에 대한 심박 감소율은 16±2.9%, 식염수 주입량은 1.20±0.2 ㎖였다. 2) 이차가압실험 시작시의 내압은 33±1.4 ㎜Hg, 혈압은 84±2.8 ㎜Hg, 심박은 213±6.3 beats/min였다. 이차가압실험에서는 일차가압실험의 가압초기에 나타났던 경미한 혈압 하강을 볼 수 없었고, 급격한 혈압 상승을 일으켰다. 최고혈압상승시의 내압은 137±11.5 ㎜Hg, 혈압 상승율은 71±6.6%, 심박 감소는 거의 없었고 식염수 주입량은 0.52±0.1 ㎖였다. 3) 정맥내 chlorisondamine은 이차 가압에 의한 cushing반응을 억제하였다. 4) 측뇌강내 corynanthine 투여는 일차가압에 의한 coshing반응에는 거의 영향을 주지 못하였으나 이차가압에 의한 cushing반응은 억제하였다. 5) 측뇌실내 clonidine, yohimbine 및 prazosim은 이차가압에 의한 cushing반응에 거의 영향을 미치지 못하였다. 이상의 성적으로 가토에서 일차가압에 의한 cushing 반응후에는 중추 α₂-adrenoceptor의 기능저하가 일어나며, 이차가압에 의한 cushing반응에는 중추 α₁-adrenoceptor가 중요한 역활을 하고 있는 것으로 추론 하였다. It is well documented that elevation of intracranial pressure is accompanied by arterial blood pressure (cushing response) in laboratory animals as well as in human. When the elevation of intracranial pressure (ICP) was repeated in a rabbit at an interval of 30-60 min, the blood pressure increased more promtly than in the First elevation of ICP, suggesting that mechanism involved in the pressure might be different. Therefore, this study was undertaken to clarify the pharmacological characteristics of the response to the first and repeated (second) elevation of ICP in urethane anesthetized rabbits. Increasing ICP, induced by infusion of saline into a ballooned in the epidural space, produced arise of the arterial blood pressure. When the blood pressure reached a peak, the ballon was suddenly deflated to reduce the ICP and blood pressure declined (the first ICP evevation experiment). After 30-60 min the same procedure was repeated (the second ICP-elevation experiment) Results are summarized as follows; 1) In the first ICP elevation experiment, the arise of ICP was relatively slow at the beginning of the infusion but became sharp as the infusion proceeded. Coinciding with the gradual increase of ICP, there was a slight decrease in BP When ICP increased sharply BP also increased abruptly and heart rate decreased. 2) In the second ICP elevation experiment, the slight decrease in BP which appeard at the begining of the first ICP elevation experiment rat observed, so that only an abrupt arise of BP was seen. 3) Intravenous chlorisondamine inhibited the pressure responses in the second ICP elevation experiment. 4) Intraventricular corynanthine had little effect on the pressure response to the first ICP elevaton but inhibited the pressure response to the second ICP elevation. 5) Intraventricular clonidine, yohimbine and prazosin little effect on the pressure response to the second ICP elevation. From this results that functional integrity of central α₂-adrenoceptor which took part in the pressure response to the first ICP elevation might have deranged in the second ICP elevation and that central α₁-adrenoceptors play a dominant role in the pressure response to the second ICP elevation.

후방 경유 요추제 유합술

김윤모,도성신,박승규,신호 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.3

The authors present 4 cases of spondylolisthesis, 1 case of spondylolysis and 2 cases of Tbc spondylitis of lower lumbar spine treated by posterior lumbar interbody fusion, with follow-up periods of 3 months to 2 years. All cases had severe low back pain. Other common manifestations were radiating pain to leg. All cases were treated with laminectomy, which included a mesial facetectomy followed by posterior lumbar interbody fusion. The spondylolisthesis was reduced to zero degress in three cases by the use of vertebral spreader. The fusion rate of intervertebral space in radiological finding was 100 %. One case become pain free, 4 cases had mild degree of pain, I case had moderate degree of pain and I case was not improved. The authors conclude that posterior lumbar interbody fusion is applicable as a surgical treatment of patient with spondylolisthesis and Tbc spondylitis.

다낭성 질환을 동반한 다발성 뇌동맥류 : 1예 보고 A Case Report

조하영,도성신,김영숙,신호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.5

We have experienced a rare case of multiple intracranial aneurysms associated with polycystic kidney and polycystic liver, which were incidental findings after minor leakage. A 57-year-old female was admitted with the chief complaint of severe headache under the impression of subarachnoid hemorrhage due to rupture of the intracranial aneurysm(which were appeared as the right middle cerebral artery and A-com aneurysm). The brain CT scan showed subarachnoid hemorrhage in the right sylvian fissure and the right temporal lobe. On physical examination, 2FB hard irregular palbable mass was noted on the right costal margin. On neurological examination, her neck was mildly stiff and other signs were within normal limit. We checked abdominal sonography, abdominal CT scan and carotid angiography preoperatively, and reviewed the literature about polycystic disease associated with intracranial aneurysm and discussed about it.

불안정성 흉·요추부 골절 및 골절-탈구의 Harrington씨 봉에 의한 내고정술의 임상적 고찰

장석정,박승규,도성신,신호 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.1

From January, 1984 to January, 1985 twelve patients with unstable fracture and fracture-dislocation of the thoraco · lumbar spine with neurologic deficits were treated with Harrington Instrumentation. Fixation by Harrington Instrumentation appeared to provide stabilization, reduction and return of neural function. Author performed Harrington Instrumentation with experience of 12 cases of unstable thoraco · lumbar spine fracture and fracture-dislocation with neurologic deficits. Results were as follows: 1) Spinal fracture and fracture-dislocation were most common in thoraco · lumbar Junction. 2) Harrington Instrumentation was very effective for keeping the spine stability in unstable fracture. 3) Six cases (50%) had a complete neurologic deficit and six cases (50%) had a incomplete neurologic deficit, two cases of the six patients with complete neurologic deficits recovered slightly but two cases with incomplete neurological deficit gained complete recovery. 4) During the postoperative period, early ambulation was possible and average admission period were 71 days. 5) Correction of spinal deformity A. Average value of kyphotic angle (12.5˚) B. Average value of Iw (Index of wedging) (1.32) C. Displacement was completely corrected in eight patients (100%)

뇌량 주위 동맥에 발생한 외상성 뇌동맥류 : 수술 치험 2예 보고 Report of Two Cases

김윤모,박승규,도성신,신호 대한신경외과학회 1987 Journal of Korean neurosurgical society Vol.16 No.3

Two cases of the traumatic aneurysms of the pericallosal artery that occurred after closed head injury are reported. The mental deterioration, urinary incontinence and crural-predominent hemiparesis are attributable to the delayed intracranial hemorrhage after rupture of the traumatic aneurysm of the pericallosal artery. As soon as the diagnosis has been confirmed by the cerebral angiography, surgical treatment is recommended to reduce the high mortality and morbidity and the procedure as in the congenital aneurysm.

V.S.P(Variable Screw Placement) Plate를 이용한 Unstable Thoraco-Lumbar Spine에 대한 치험

이성태,장석정,김충현,안태형,도성신,신호 대한신경외과학회 1989 Journal of Korean neurosurgical society Vol.18 No.4

Fourteen consecutive patients underwent application of V.S.P.(Variable Screw Placement) spinal plate between January 1989 and July 1989. Operative indications were spondylolisthesis, spinal stenosis, segmental instability, herniated disc with instability, pseudoarthrosis, unstable fracture, and failed surgery syndrome. Our patients consist of 8 cases of spondylolisthesis, 4 cases of fracture-dislocation, one case of spondylolysis with instability, one case of herniated disc(L1-2 interspace). Overall results showed 36% excellent, 50% good, 7%, fair, 7% poor. Two deep wound infections were observed. Screw alignment and the angular relationship of each screw to the spinal plate is considered as important technical factors in minimizing screw failure.