뇌졸중이 병발한 POEMS 증후군

강규식 대한뇌졸중학회 2001 Journal of stroke Vol.3 No.2

Background : POEMS syndrome is a rare variant of plasma cell dyscrasia with multisystemic manifestation. Strokes associated with POEMS syndrome are rare. Case Report : We describe three cases of POEMS syndrome associated with stroke and suggest a possible pathogenic mechanism. MRI revealed unilateral or bilateral posterior borderzone infarcts(BZI); between the middle cerebral artery and posterior cerebral artery. In all the patients, Theres was elevated fibrinogen level. Recently, fibrinogen was reported to be highly correlated with interleukin-6(IL-6) in plasma. The latter is closely associated with diverse manifestations of POEMS syndrome. Conclusion : We suggest that elevated fibrinogen level may play a role in the pathogenesis of stroke. Korean Journal of Stroke 2001;3(2): 180~184

정규수술 스케쥴 관리를 통항 정규수술 취소율 감소 및 취소사유 의무기록화

강규식,조숙정,장현자,김연자,박정화,최미경,김춘자,이영란,김현정,이인선,김소정,최소진,편숙희,유연자,김홍식 한국의료QA학회 2009 가을학술대회 Vol.2009 No.3

Nuss방법으로 오목가슴 수술을 받는 환아에서 desflurane 마취 후 각성 흥분에 대한 늑간신경차단과 fentanyl의 효과

강규식,서용한,안기량,김천숙,유시현,정지헌,정지원 순천향의학연구소 2008 Journal of Soonchunhyang Medical Science Vol.14 No.2

Background : The rapid recovery from desflurane anesthesia is likley to be accompanied by postoperative emergence agitation, which is considered due to the early appearance of pain. We aimed to evaluate the effect of IV fentanyl or intercostal nerve block for the prevention of emergence agitation. Methods : Fifty-four pediatric patients undergoing pectus excavatum repair by the Nuss procedure were randomly assigned to receive intavenously dose of 0.9% normal saline 0.1ml/kg (group 1, n=18), fentanyl 1.5 ㎍/kg (group 2, n=18) or intercostal nerve block (group 3 : 0.5% ropivacaine 1.5 ml × 3 level, both, n = 18) before skin closure. Emergence agitation was evaluated at arrival to postanesthetic care unit (PACU) 10, 20 and 30 min respectively. PACU time and incidence of severe emergence agitation, respiratory depression and vomiting were evaluated by a blinded observer at the PACU. Results : Agitation score in group 2 and group 3 were significantly lower than that of group 1 at arrival to PACU 10, 20 and 30 min (P < 0.05). Agitation score in group 3 was significantly lower than that of group 2 at arrival to PACU (P < 0.05). Incidence of severe emergence agitation in group 2 and group 3 were significantly lower than that of group 1. Incidence of respiratory depression and vomiting in group 1 and group 3 were significantly lower than that of group 2. Conclusions : For prevention of emergence agitation after desflurane anesthesia in pediatric patients undergoing pectus excavatum repair, we recommend using IV fentanyl or intercostal nerve block.

만성 근골격계 환자에서 Prolotherapy시 고농도 포도당용액에 첨가한 Sarapin^(®)의 효과

강규식,이호철,안기량 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Background: Musculoskeletal injury is a major cause of chronic pain due to a weakness of the tendons and ligaments. Currently, prolotherapy is used for treating chronic pain by strengthening the tendons and ligaments. This study was designed to evaluate the effects of prolotherapy using Sarapin^(®) in patients with chronic musculoskeletal diseases. Methods: Forty, chronic musculoskeletal disease patients were randomly divided into two groups. Group 1 (N=20) had been treated with a 15% dextrose solution, 0.2% lidocaine. Group 2 (N=20) had been treated with a 15% dextrose solution, 0.2% lidocaine and 25% Sarapin^(®). The VAS (visual analogue scales) were measured before the injection and two months after the injection. Incidence of side effect and complication were checked too. Results: Both groups showed that a post-prolotherapy VAS was significantly reduced compared to the pre-prolotherapy VAS in 80%, 85% but there was no significant difference. Side effect and complication were not significant difference between both groups such as dizziness during injection, new pain development, and a hematoma except pain after the injection. Conclusions: These results show that prolotherapy using Sarapin^(®) is another good method for treating chronic musculoskeletal diseases.

한국인 환자의 아토르바스타틴에 의한 근육통 발병률에 대한 단일 병원 전향연구: 스타틴근육통 임상지수의 적용

강규식,김병건 대한신경과학회 2022 대한신경과학회지 Vol.40 No.1

Background: Statin-induced myalgia is a common cause of discontinuation and a barrier that interferes with long-term treatment. The incidence of myalgia reported by previous atorvastatin trials in Korea ranged from 0.8% to 3.4%. This study assessed the incidence of myalgia after atorvastatin was administered to Korean patients with dyslipidemia. In addition, the Statin Myalgia Clinical Index (SMCI) was used to assess the likelihood that a patient’s myalgia was caused by atorvastatin. Methods: Dyslipidemic patients were eligible to participate if they were statin-naïve or treated with statins other than atorvastatin. Muscle complaints were assessed at the baseline, the 10-weeks visit and the final follow-up visit (16 weeks or later). The SMCI score was calculated if a patient developed myalgia, which was rated as probable, possible or unlikely related to the statin. Results: A total of 89 patients were analyzed. The atorvastatin doses ranged from 10 to 80 mg. Six (7%) patients reported new and unexplained muscle pain. Information on the timing of myalgia relative to stopping was unavailable in two patients. After excluding these two patients, three (3.4%) out of 87 patients were classified by the SMCI as having possible or probable atorvastatin-associated myalgia. Conclusions: In this study, the incidence of myalgia was higher than the incidences reported by the previous trials in Korea. However, the incidence of statin-associated myalgia assessed using SMCI was comparable to those of the trials. The SMCI may help diagnosis of statin-associated myalgia in clinical practice and optimize treatment for patients with myalgia.

중대뇌동맥폐색으로 인하여 발생한 상하지의 떨림

강규식 대한뇌졸중학회 2002 Journal of stroke Vol.4 No.2

Limb shaking is an uncommon manifestation of transient ischemic attack, and there have been reports of limb shaking attacks due to internal carotid artery stenosis or occlusion. However, an occlusion of the middle cerebral artery has been rarely reported as a cause of limb shaking. We report a 51-year-old man with occlusion of the middle cerebral artery who developed attacks of limb shaking. The involuntary movements disappeared after superficial temporal artery-middle cerebral artery bypass surgery. We conclude that middle cerebral artery occlusion may present as limb shaking transient ischemic attacks. Korean Journal of Stroke 2002;4(2):142~146

두개내압저하의 신경계 증상

강규식,김병건 대한신경과학회 2019 대한신경과학회지 Vol.37 No.2

Intracranial hypotension usually arises in the context of known or suspected leak of cerebrospinal fluid (CSF). This leakage leads to a fall in intracranial CSF pressure and CSF volume. The most common clinical manifestation of intracranial hypotension is orthostatic headache. Post-dural puncture headache and CSF fistula headache are classified along with headache attributed to spontaneous intracranial hypotension as headache attributed to low CSF pressure by the International Classification of Headache Disorders. Headache attributed to low CSF pressure is usually but not always orthostatic. The orthostatic features at its onset can become less prominent over time. Other manifestations of intracranial hypotension are nausea, spine pain, neck stiffness, photophobia, hearing abnormalities, tinnitus, dizziness, gait unsteadiness, cognitive and mental status changes, movement disorders and upper extremity radicular symptoms. There are two presumed pathophysiologic mechanisms behind the development of various manifestations of intracranial hypotension. Firstly, CSF loss leads to downward shift of the brain causing traction on the anchoring and supporting structures of the brain. Secondly, CSF loss results in compensatory meningeal venodilation. Headaches presenting acutely after an intervention or trauma that is known to cause CSF leakage are easy to diagnose. However, a high degree of suspicion is required to make the diagnosis of spontaneous intracranial hypotension and understanding various neurological symptoms of intracranial hypotension may help clinicians.

Nuss 방법에 의한 오목가슴 수술 시 금속막대 삽입 후 발생한 긴장성 기흉 -증례보고-

강규식,김난설,안기량,김천숙,유시현,정진헌 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4

Nuss procedure was recently introduced, because of its excellent effect from the cosmetic point of view and improvement of the pulmonary function, but the complications such as heart injury, bar displacement, hemothorax, pneumothorax and tension pneumothorax sometimes occur. We experienced a 12 year-old female, who showed profound hypotension with a bradycardia and severe reduction in oxygen saturation followed by the tension pneumothorax after the operation by the Nuss method. The patient was treated with the immediate thoracostomy and recovered without any other problem. In anesthetic management of the pectus excavatum repair by the Nuss method, we should always pay attention to the possible occurrence of tension pneumothorax.

동시에 발생한 급성 뇌경색과 뇌출혈

강규식 대한뇌졸중학회 2006 Journal of stroke Vol.8 No.1

We report a patient with acute right corona radiata infarction and left caudate hemorrhage, which developed simultaneously. The patient was a 55-year-old man with a history of hypertension and diabetes. He was admitted to the hospital due to dysarthria and weakness in his left limbs. Besides of acute lesions, there were old lacunar infarcts and muliple microbleeds on brain imaging. The small vessel diseases caused by chronic hypertension might have predisposed him to both cerebral infarction and cerebral hemorrhage simultaneously.

백서 뇌출혈 모델에서 내인성 신경줄기세포의 증식

강규식,정상욱,주건,정근화,김만호,노재규 대한신경과학회 2005 대한신경과학회지 Vol.23 No.4

Background: Focal and global ischemia was shown to be potent in inducing neurogenesis in the subventricular zone (SVZ). However, it is unknown whether these new neurons can replace those lost following damage, such as intracerebral hemorrhage (ICH). We tested the hypothesis that ICH leads to an increase of cell proliferation in the SVZ and that the new neurons migrate into the damaged area of the hemorrhagic striatum. Methods: Experimental ICH was induced by an intrastriatal administration of collagenase in adult rats. Proliferating cells were labeled with intraperitoneal injections of 5-bromo-2'-deoxyuridine-5'-monophosphate (BrdU) over 3-day periods before sacrificing the animals, 0, 6, 9, 12 or 15 days after ICH. BrdU+ cells in the dorsolateral SVZ and the striatum were counted in three coronal sections per animal. Results: BrdU+ cells were found in the bilateral SVZs, the third ventricle, and ipsilateral cortex near the needle insertion site. The number of BrdU+ cells in the damaged striatum and the ipsilateral SVZ reached maximum counts 9 days after ICH. The BrdU+ cells were double-labeled with a neuronal marker, neuronal nuclear antigen (NeuN), and a glial marker, the glial fibrillary acidic protein (GFAP), in the hemorrhagic hemisphere. The percentage of BrdU+ cells that expressed NeuN and GFAP was ≈13% and ≈72%, respectively. Conclusions: These results suggest new evidence that endogenous neural stem cells are activated in the dorsolateral SVZ after ICH, and that the newly formed cells play a role for ICH-induced neurogenesis in what may be an adaptive process that contributes to recovery after a hemorrhagic stroke.