• Journal of Chest Surgery
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• 제52권6호
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• pp.392-399
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• 2019

Background: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA). Methods: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group. Results: There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period. Conclusion: RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.

• Journal of Oral Medicine and Pain
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• 제33권2호
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• pp.111-120
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• 2008

다양한 전신질환으로 입원한 환자들의 전신질환별 구강질환의 주소와 치료내용을 조사하여 기본적인 구강질환의 실태를 파악하고자 본 연구를 시행하였는데, 전신질환으로 입원하여 구강질환의 진단과 치료를 위하여 내원한 환자를 대상으로 연구한 결과 다음과 같은 결론을 얻었다. 1. 주된 전신질환인 내분비, 영양 및 대사 질환의 경우 구강질환은 치은염 및 치주질환 44.9%, 타액선의 질환 22.4%, 치아우식증 12.2%, 치수 및 치근단주위의 질환 4.1%, 매몰치와 매복치, 치아경조직의 기타질환 각각 2% 순서로 나타났다. 2. 주된 구강질환인 치은 및 치주질환의 경우 전신질환은 인슐린-비의존성 당뇨 39.2%, 뇌경색 29.4%, 신경근 및 신경총장애 5.6%, 뇌내출혈 3.9%, 위의 악성 신생물, 갑상선기능항진증, 정신분열증, 알콜성 간질환, 신증후군 각각 2% 순서로 나타났다. 이상의 결과로 전신질환이 있는 환자의 구강질환과 구강질환이 있는 환자의 전신질환에 대해서는 일정부분 파악이 되었으나 향후 전신질환으로 입원한 환자의 구강질환과 전신질환과의 상관관계에 대한 연구가 이루어져야 한다고 사료된다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제17권4호
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• pp.447-455
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• 1995

Cavernous sinus thrombosis is one of the major complications of abscesses of the maxillofacial region. The initial symptoms of CST are usually pain in the eye and tenderness to pressure. this is associated with high fluctuating fever, chills, rapid pulse, and sweating. Venous obstruction subsequently causes edema of the eyelids, lacrimation, proptosis, chemosis and retinal hemorrhages. Blindness is sometimes an accompaniment of cavernous sinus thrombosis when the infection also involves the orbit. There is also cranial nerve involvement (oculomotor, troclear, abducence) and ophthalmoplegia, diminished or absent corneal reflex, ptosis, and dilation of the pupil occur. The terminal stages bring signs of advanced toxemia and meningitis. Infections of the face can cause a septic thrombosis of the cavernous sinus. Furunculosis and infected hair follicles in the nose are frequent causes. Extractions of maxillary anterior teeth in the presence of acute infection and especially curettage of the sockets under such circumstances can cause this condition. The infection is usually staphylococcal. The inflection may spread directly through the pterygoid plexus of veins and the pterygomaxillary space and then ascend into the sinus or it may spread directly from the pterygopalatine space to the orbit. This is possible because of the absence of valves in the angular, facial, and ophthalmic veins. The treatment is empirical antibiotic therapy followed by specific anbibiotic therapy based on blood or pus culture. The inflection usually involves one side, however, it may easily spread to the opposite side through the circulus sinus. Unless it is treated early, the prognosis is poor even in this doses. Occasionally the antibiotics will not adequately resolve the septic thrombus, and death ensues. the use of anticoagulants to prevent venous thrombosis has been recommended, but the efficacy of such therapy has not been substantiated. Surgical access through eye enucleation has been suggested. We report a case which demonstrates cavernous sinus thrombosis by the infection after the functional neck dissection and the intraoral reconstruction with auriculomastoid fascio-cutaneous island flap.

• 한국산림과학회지
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• 제106권2호
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• pp.169-185
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• 2017

산림식생은 분류방법에 따라 식생유형의 결과가 다를 수 있다. 본 연구의 목적은 세 종류의 식생분류 방법론을 적용하여 결과를 비교하기 위해 충남 오서산 산림식생을 대상으로 2016년 9월부터 10월까지 총 80개소의 식생조사를 수행하였다. 얻어진 자료를 토대로 상관우점종에 의한 군락유형분류, 종조성에 따른 군락유형분류, 종간연관 분석을 실시하였다. 상관우점종에 의한 군락유형분류를 실시한 결과, 소나무군락, 신갈나무군락, 느티나무군락, 상수리나무군락, 층층나무군락, 졸참나무군락, 일본잎갈나무군락, 리기다소나무군락, 밤나무군락, 백합나무군락의 총 10개의 군락유형으로 구분되었다. 종조성에 따른 유형분류를 실시한 결과, 총 4개의 식생단위와 8개의 종군 유형으로 분류되었다. 종조성 체계의 최상위 수준에서 비목나무군락군으로 대표되어졌으며, 비목나무군락군은 진달래군락(진달래전형군, 쪽동백나무군), 느티나무군락(일본잎갈나무군, 큰개별꽃군)으로 분류되어, 1개 군락군 2개 군락 2개 군의 분류체계를 나타냈다. 종간연관 분석 결과는 크게 두 개의 그룹으로 나누어졌으며, 종조성에 의한 군락유형과 종간연관에 의한 유형은 지형적인 영향이 크게 작용하는 것으로 판단되었다. 조사지의 산림식생은 상관우점종에 의해 10개의 군락유형, 종조성에 의해 8개의 종군단위와 4개의 식생단위, 종간연관에 의해 2개의 유형으로 분류되어, 상관우점종, 종조성(종군유형${\rightarrow}$식생단위), 종간연관 순으로 식생단위가 단순화되는 것을 알 수 있었다. 결론적으로 산림식생은 분류방법론에 따라 다양한 식생유형이 분류되었고 또한 많은 환경요인들의 영향이 작용하고 있는 것으로 판단되었다.

• 대한한의학방제학회지
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• 제12권1호
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• pp.209-223
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• 2004

Objective: This study was conducted to investigate the effects of Coptidis Rhizoma on the plasma IL-6 and $TNF-{\alpha}$ level in mice by intracerebroventricular(I.C.V.) injection of Lipopolysaccharide (LPS). Method: 6 mice were assigned to each of the Normal group, the Control group, and the individual Experimental groups. In the Normal group only saline was administered intragastrically, and in the Control group LPS was injected intracerebroventricularly 1 hr after intragastric administration of saline. In the Experimental groups Coptidis Rhizoma(0.5g/kg, 1.0g/kg, 3.0g/kg) was administered intragastrically to mice 1 hr prior to LPS (100ng/mouse) I.C.V. Injection. To measure the plasma IL-6 and $TNF-{\alpha}$ level of mice, their blood samples were collected from retro-orbital venous plexus, immediately centrifuged at $4^{\circ}C$, and plasma was removed and stored frozen at $-83^{\circ}C$ for later determination of plasma IL-6 and $TNF-{\alpha}$. Result: 1. LPS I.C.V. Injection increased plasma IL-6 level significantly in a dose-dependent manner compared with Normal group. (P<0.01) The plasma IL-6 concentration reached a significant maximal level about 1 hr after LPS(100ng/mouse) I.C.V. Injection.(P<0.001) 2. Both the 0.5g/kg(Sample A) and 1.0g/kg(Sample B) groups to which Coptidis Rhizoma was administered intragastrically 1 hr prior to LPS(100ng/mouse) I.C.V. Injection showed insignificant lower plama IL-6 level in 1 hr than Control group(P>0.05), and 3.0g/kg group(Sample C) conversely showed higher plama IL-6 level than Control group. 3. LPS I.C.V. Injection increased plasma $TNF-{\alpha}$ level significantly in a dose-dependent manner compared with Normal group.(P<0.05) The plasma $TNF-{\alpha}$ concentration reached a significant maximal level about 1 hr after LPS(100ng/mouse) I.C.V. Injection.(P<0.001) 4. All Sample groups(0.5g/kg, 1.0g/kg, and 3.0g/kg) to which Coptidis Rhizoma was administered intragastrically with each constituent-dose 1 hr prior to LPS(100ng/mouse) I.C.V. Injection showed significant lower $TNF-{\alpha}$ plama level in 1 hr than Control group.(P<0.001) These data revealed that Coptidis Rhizoma might have anti inflammatory effect by reducing the plasma $TNF-{\alpha}$ level in a dose dependent manner in mice LPS I.C.V. Injection.

• 대한한의학방제학회지
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• 제12권1호
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• pp.195-208
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• 2004

Objective: This study was conducted to investigate the effects of Aconiti Tuber on the plasma IL-6 and $TNF-{\alpha}$ level in mice stimulated by intracerebroventricular(I.C.V.) Injection of Lipopolysaccharide(LPS). Method: 6 mice were assigned to each of the normal group, the control group, and the experimental group. In the normal group only saline was administered intragastrically, and in the control group LPS was injected intracerebro-ventricularly 1 hr after intragastric administration of saline. In the experimental groups (Aconiti Tuber 0.5g/kg, Aconiti Tuber 1.0g/kg, Aconiti Tuber 3.0g/kg) each sample was administered intragastrically to mice 1 hr prior to the stimulation by LPS I.C.V. Injection. To measure the plasma IL-6 and $TNF-{\alpha}$ level of mice, their blood samples were collected from retro-orbital plexus, immediately centrifuged at $4^{\circ}C$, and plasma was removed and stored frozen at $-83^{\circ}C$ for later determination of plasma IL-6 and $TNF-{\alpha}$. Result : 1. LPS I.C.V. Injection increased plasma IL-6 level significantly in a dose-dependent manner compared with normal group(P<0.01). The plasma IL-6 concentration reached a significant maximal level about 1 hr after LPS I.C.V. Injection(P<0.001). LPS I.C.V. Injection increased plasma $TNF-{\alpha}$ level significantly in a dose-dependent manner(P<0.05). The plasma $TNF-{\alpha}$ concentration reached a significant maximal level about 1 hr after LPS I.C.V. Injection(P<0.001). 2. Sample A group to which Aconiti Tuber(0.5g/kg) was administered intragastrically 1 hr prior to the stimulation by LPS I.C.V. Injection showed insignificant lower plasma IL-6 level in 1 hr than control group(P<0.0635), and sample B group (Aconiti Tuber 1.0g/kg) showed significant lower plasma IL-6 level in 1 hr than control group(P〈0.05), and sample C group (Aconiti Tuber 3.0g/kg) showed significant lower IL-6 plasma level in 1 hr than control group(P<0.01). 3. sample A group to which Aconiti Tuber(0.5g/kg) was administered intragastrically 1 hr prior to the stimulation by LPS I.C.V. Injection showed insignificant lower plasma $TNF-{\alpha}$ level in 1 hr than control group(P>0.05), and Both sample B(1.0g/kg) and sample C(3.0g/kg) groups showed significant lower $TNF-{\alpha}$ plasma level in 1 hr than control group(P<0.01). These data revealed that Aconiti Tuber might have the anti inflammatory effect by reducing the plasma IL-6 and $TNF-{\alpha}$ level in a dose dependent manner in mice LPS I.C.V. Injection.

• The Korean Journal of Pain
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• 제7권2호
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• pp.162-169
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• 1994

Blockade of cervicothoracic sympathetic ganglion (stellate ganglion controls pain on face, head, neck, shoulder, upper limbs, and upper chest, including their viscera and sympathetically maintained pain. This procedure also increases blood flow to the above areas and relieves hyperreactivity of sympathetic nervous system. Clinically, repeated stellate ganglion blocks with local anesthetic agent may become difficult with complications such as accidental intravascular or subdural injection, recurrent laryngeal nerve or bracheal plexus paralysis, pneumothorax and edema on injection site. Therefore, at times long-term cervicothoracic ganglion block with neurolytics is necessitated but its applications are prohibited by the critical structures surrounding ganglion. There are also few reports of neurolytic stellate ganglion block. This study was performed to observe the complications, gross changes of surrounding structures, and microscopic findings of ganglion cells after neurolytic block and to certify the possibility of clinical use of neruolytic stellate ganglion block. The unilateral superior cervical sympathetic ganglion of rabbit was blocked with absolute ethyl alcohol 0.4 ml at the level of cricoid cartilage. Normal ganglion was used as a control and 5 animals were sacrificed at each intervals of 7, 15 and 50 days after block. The results were as follows; 1) All experimental animals showed no specific changes of behavior, motor function. No necrotic tissues were present in the block area during the observation period. There were some gross scar tissues along the fascia of muscles surrounding the needle injection site, but gross atrophy of muscles or injured major vessels were not found. 2) Microscopically, structures of normal ganglion of rabbit were very similar to those of humans. Seven days after absolute ethyl achohol injection there were marked edema of ganglion cells and nuclei with irregular nuclear membrane. Some of the ganglion cells lost their nuclei and showed degenerative changes. Fifteen days after block, cell edema were decreased and loss of the Nissl's body was prominant. The ganglion cell structures looked close to normal but the cytoplasm and nucleus were generally contracted 50 days after block. These results suggest absolute ethyl alcohol injection on cervical sympathetic ganglion with above method mainly blocks pre- and post-synaptic fibers and the long-term neurolytic blockade of this ganglion may be possible in rabbits.

• Toxicological Research
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• 제23권3호
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• pp.279-287
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• 2007

Copper (Cu) is an essential trace element indispensable for brain development and function; either excess or deficiency in Cu can cause brain malfunction. While it is known that Cu and Fe homeostasis are strictly regulated in the brain, the question as to how systemic Fe status may influence brain Cu distribution was poorly understood. This study was designed to test the hypothesis that dietary Fe condition affects Cu transport into the brain, leading to an altered brain distribution of Cu. Rats were divided into 3 groups; an Fe-deficient (Fe-D) group which received an Fe-D diet ($3{\sim}5 mg$ Fe/kg), a control group that was fed with normal diet (35mg Fe/kg), and an Fe-overload group whose diet contained an Fe-O diet (20g carbonyl Fe/kg). Following a 4-week treatment, the concentration of Cu/Fe in serum, CSF (cerebrospinal fluid) and brain were determined by AAS, and the uptake rates of Cu into choroids plexus (CP), CSF, brain capillary and parenchyma were determined by an in situ brain perfusion, followed by capillary depletion. In Fe-D and Fe-O, serum Fe level decreased by 91% (p<0.01) and increased by 131% (p<0.01), respectively, in comparison to controls. Fe concentrations in all brain regions tested (frontal cortex, striatum, hippocampus, mid brain, and cerebellum) were lower than those of controls in Fe-D rats (p<0.05), but not changed in Fe-O rats. In Fe-D animals, serum and CSF Cu were not affected, while brain Cu levels in all tested regions (frontal cortex, striatum, hippocampus, mid brain, and cerebellum) were significantly increased (p<0.05). Likewise, the unidirectional transport rate constants $(K_{in})$ of Cu in CP, CSF, brain capillary and parenchyma were significantly increased (p<0.05) in the Fe-D rats. In contrast, with Fe-O, serum, CSF and brain Cu concentrations were significantly decreased as compared to controls (p<0.05). Cu transport was no significant change of Cu transport of serum in Fe-O rats. The mRNA levels of five Cu-related transporters were not affected by Fe status except DMT1 in the CP, which was increased in Fe-D and decreased in Fe-O. Our data suggest that Cu transport into brain and ensuing brain Cu levels are regulated by systemic Fe status. Fe deficiency appears to augment Cu transport by brain barriers, leading to an accumulation of Cu in brain parenchyma.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.28-35
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• 2008

Purpose: The pedicle of transverse rectus abdominis myocutaneous(TRAM) flap and deep inferior epigastric arterial perforator flap is deep inferior epigastic artery (DIEA) and accurate anatomic knowledge about perforator of DIEA is very important for the elevation of these flap. The authors investigated a detailed vascular network of perforator of DIEA in Koreans. Methods: 24 fresh cadavers were studied. Among them, 15 were examined based on the plain X-ray examination for the distribution and location of perforator of DIEA. And 9 fresh cadavers were examined based on the 3-dimensional computed tomography(CT) study for the distance between ending point of perforator of DIEA and mother artery, the distance between most medial mother artery and midline, the distance between most lateral mother artery and midline, and the running type of perforators of DIEA. Results: Based on the plain X-ray examination, suitable(external diameter$${\geq_-}0.5mm$$) perforators of DIEA are located between the level of umbilicus and 8 cm below it. Based on the 3D-CT study, average distance between the ending point of perforator of DIEA and the mother artery is 30.26 mm on the left, 28.62 mm on the right, respectively. The average distance between most medial mother artery and midline is 17.13 mm on the left, 15.76 mm on the right, respectively. The average distance between most lateral mother artery and midline is 56.31 mm on the left, 50.90 mm on the right, respectively. The main running course of suitable perforators of DIEA is type a, which is a direct musculocutaneous perforator vessel from main vascular axis passing outward to join the subdermal plexus, directly. Conclusion: 3-dimensional computed tomography study as well as plain X-ray examination provided more accurate and detail informations about perforators of DIEA in Koreans. These informations will help us understand the detailed vascular anatomy and operation with ease and safe in the lower abdomen of Koreans.

• Radiation Oncology Journal
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• 제16권2호
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• pp.125-138
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• 1998

목적 : 흰쥐의 전뇌에 방사선조사 후 cis-diamminedichloroplatinum(II)(cisplatin)을 복강내 주입하여 cisplatin이 방사선에 의한 후기 뇌손상(3개월, 6개월)에 미치는 효과를 알기 위하여 이 연구를 시행하였다. 방법 및 재료 : 흰쥐를 방사전조사군, cisplatin군, 방사선조사와 cisplatin 병용군으로 분류하였다. 방사선조사군은 선형가속기를 사용하여 20 Gy, 22.5 Gy의 x-ray를 각각 횐쥐의 전뇌에 단일조사하였다. Cisplatin군은 2, 4, 8mg/kg을 각각 복강내에 1회 주입하였다. 병용군은 방사선조사(20 Gy, 22.5 Gy) 후 즉시 cisplatin(2mg/kg)를 복강내에 1회 주입하였다. 각 군에 따라 치료 후 3개월과 6개월에 동물을 희생시키고 뇌의 조직병리학적 검사를 시행하였다. 결과 : Cisplatin군은 맥락총에 상피성 공포형성과 혈관주위의 부종 및 혈관의 확장이 3개월에 보였으며, 채상과 대뇌반구에 다원성 괴사가 3개월과 6개월에 나타났다. 방사선조사군과 병용군에서 뇌의 후기 방사선손상의 특징인 국소적 응고성 괴사와 혈관의 변화가 현저하게 나타났으며 현저한 혈관주위와 연수막에 성상세포의 증식은anti-GFAP 항체검사로 확인되었다. 방사선조사에 의한 혈관변화와 성상세포의 증식이 cisplatin에 의해서 증가되지는 않았다. 결론 : Cisplatin과 방사선조사에 의한 후기 뇌손상의 변화로 국소적 괴사가 양군에서 동시에 나타남으로서 뇌손상의 정도를 추정하는데 괴사가 지표인자로 이용될 수 있다고 본다. Cisplatin이 방사선에 의한 혈관의 변화와 성상세포의 증식에는 영향을 미치지 않았으므로, 뇌에서 cisplatin과 방사선의 상호작용을 파악하기 위해서는 향후 더 많은 실험이 필요하다.