• The Korean Journal of Pain
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• 제14권2호
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• pp.276-279
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• 2001

Epidural steroid injection is one method of releiving chronic back pain. However, problems with the loss of resistance to air technique include the possible subarachnoid or subdural injection of air resulting in headache, venous air embolism, and the introduction of air bubbles into the epidural space. Pneumocephalus is a rare complication of epidural block for epidural steroid injection. We report a case of a 58-year-old woman who developed a severe headache and posterior nuchal pain with incomplete oculomotor palsy due to pneumocephalus occuring after an epidural steroid injection.

• The Korean Journal of Pain
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• 제8권1호
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• pp.159-163
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• 1995

Accidental high epidural block is a rare but serious complication. It can result from many factors, which include the volume and concentration of drug, posture, puncture site, age, pregnancy or intra-abdominal mass, and patients' height and weight. We had a case of accidental high epidural block recently. This is a case report which was confirmed by an epiduragram. A healthy 50-year-old woman with a huge uterine myoma was scheduled for a total abdominal hysterectomy under continous epidural analgesia. Epidural catheterization was carried out smoothly. However, an unexpected hypotension was noticed after an epidural injection of 2% lidocaine 25 ml. Thereafter, the patient was intubated and her respiration was controlled during the operation. Using the 5mg of ephedrine, her blood pressure and pulse were well maintained. The scheduled operation was carried out for one hour uneventfully, but after the operation, she felt paresthesia on her hands in the recovery room. To differentiate between the high epidural and the subdural blocks. We injected 5 ml of a water soluble Niopam 300 through the catheter postoperatively. It was observed on the epiduragram that the catheter was placed in the epidural space. It was suggested that the high epidural block was induced from the widespread diffusion through the narrowed epidural space due to the engorgement of the epidural venous plexus by the patient's huge uterine myoma.

• Parasites, Hosts and Diseases
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• 제28권1호
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• pp.1-10
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• 1990

고양이 두개강 내에 주입된 스파르가눔의 형태와 운명을 파악하고 숙주의 항체형성 양상을 관찰하고자 102마리 의 스파르가눔을 22마리의 고양이의 뇌실질 내에 주입하고 2주, 1개월, 3개월, 6개월 후에 도살하여 충체의 희 수율 및 분포를 육안으로 확인하였고 스파르가눔 감염전, 감염후 1주, 2주, 1개월, 3개월, 6개월의 뇌척수액을 얻어 효소면역 법 (ELISA)을 이용하여 시G 항체가를 측정하여 다음의 결과를 얻었다. 1. 부검을 시행한 고양이 22마리 중 17마리에서 충체가 회수되었고, 뇌에 주입한 충체 총 102마리 중 43마리(42%)를 회수하였다. 충체의 두개강 내 분포는 경막하 또는 지주막하 공간에서 19마리(44%)가 검출되어 가장 많았고, 다음으로 뇌실질 내 16마리(37%), 측뇌실 내 2마리(5%)의 순이었다. 두개골의 판간층(diploic space)에 위치한 것이 1마리(2%)이었으며 두개골 외에서도 5마리(12%)가 관찰되었다. 이들 충체는 한 마리를 제외하고 모두 생존하고 있었으며 상당히 성장하여 있었다. 뇌에서 충체의 분포는 특별한 편중이 없이 전 부위에서 고르게 관찰되었고 척수에서는 검출되지 않았다. 2. ELISA를 이용하여 측정한 뇌척수액 내 IgG 항체가는 감염후 1개월부터 양성기준치 이상으로 증가하기 시작하여 감염후 3개월에는 현저하게 증가되었다. 고양이를 이용한 실험적 두개강 내 스파르가눔증은 주입한 충체의 약 400A 정도가 두개강 내에서 회수되므로 몇가지의 제약에도 불구하고 이 질병의 연구에 유용한 모델로 판단된다.

• Journal of International Society for Simulation Surgery
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• 제1권1호
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• pp.13-15
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• 2014

Nowadays, with advanced 3D printing techniques, the custom-made implant can be manufactured for the patient. Especially in skull reconstruction, it is difficult to design the implant due to complicated geometry. In large defect, an autograft is inappropriate to cover the defect due to donor morbidity. We present the process of manufacturing the 3D custom-made implant for skull reconstruction. There was one patient with skull defect repaired using custom-made 3D titanium implant in the plastic and reconstructive surgery department. The patient had defect of the left parieto-temporal area after craniectomy due to traumatic subdural hematoma. Custom-made 3D titanium implants were manufactured by Medyssey Co., Ltd. using 3D CT data, Mimics software and an EBM (Electron Beam Melting) machine. The engineer and surgeon reviewed several different designs and simulated a mock surgery on 3D skull model. During the operation, the custom-made implant was fit to the defect properly without dead space. The operative site healed without any specific complications. In skull reconstruction, autograft has been the treatment of choice. However, it is not always available and depends on the size of defect and donor morbidity. As 3D printing technique has been advanced, it is useful to manufacture custom-made implant for skull reconstruction.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.267-272
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• 2006

Objective : There have been recent reports that mesenchymal stromal cells that are harvested from adipose tissue are able to differentiate into neurons. In the present study, we administered adipose tissue derived stem cells in rats with cerebral infarction in order to determine whether those stem cells could enhance the recovery of motor function. Methods : Cerebral infarction was induced by intraluminal occlusion of middle cerebral artery in rats. The adipose tissue-derived mesenchymal stem cells were harvested from inguinal fat pad and proliferated for 2 weeks in DMEM media. Approximately $1{\times}10^6$ cells were injected intravenously or into subdural space of the peri-lesional area. The rotor rod test was performed at preoperative state[before MCA occlusion], and 1, 2, 3, 4, 6, 8 and 10 weeks after the cell therapy. Results : The motor functions that were assessed by rotor rod test at 1 week of the cell therapy were nearly zero among the experimental groups. However, there was apparent motor function recovery after 2 weeks and 4 weeks of cell injection in intravenously treated rats and peri-lesionaly treated rats, respectively, while there was no significant improvement till 8 weeks in vehicle treated rats. Conclusion : These results demonstrate that the adipose derived stem cell treatment improves motor function recovery in rats with cerebral infarction.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제27권5호
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• pp.431-437
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• 2005

Fibrin glue is composed of fibrinogen and thrombin and used in various regions for multiple use. Basic principle is that thrombin converts fibrinogen to fibrin in the presence of $Ca^{2+}$. The structure of fibrin is loose at the beginning, but after about 5 minutes a tight structure is formed under the influence of factor VIII which changes fibrin monomer into fibrin polymer. Fibrin glue is used for tissue adhesive, suture, local hemostasis, wound healing, closure of subdural space. Fibrin adhesive has been used in oral and maxillofacial surgery for hemostasis after tooth extraction in patients with coagulation disorders, skin graft fixation, reattachment of periodontal flaps, in combination with autogenous bone chips to fill the bony cavities following cyst removal, and for securing the hydroxyapatite granules for maxillary alveolar ridge augmentation. This study was designed for researching influence of fibrin glue during healing phase after making artificial bone defect.

• 대한두개안면성형외과학회지
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• 제16권1호
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• pp.11-16
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• 2015

Background: Source material used to fill calvarial defects includes autologous bones and synthetic alternatives. While autologous bone is preferable to synthetic material, autologous reconstruction is not always feasible due to defect size, unacceptable donor-site morbidity, and other issues. Today, advanced three-dimensional (3D) printing techniques allow for fabrication of titanium implants customized to the exact need of individual patients with calvarial defects. In this report, we present three cases of calvarial reconstructions using 3D-printed porous titanium implants. Methods: From 2013 through 2014, three calvarial defects were repaired using custom-made 3D porous titanium implants. The defects were due either to traumatic subdural hematoma or to meningioma and were located in parieto-occipital, fronto-temporo-parietal, and parieto-temporal areas. The implants were prepared using individual 3D computed tomography (CT) data, Mimics software, and an electron beam melting machine. For each patient, several designs of the implant were evaluated against 3D-printed skull models. All three cases had a custom-made 3D porous titanium implant laid on the defect and rigid fixation was done with 8 mm screws. Results: The custom-made 3D implants fit each patient's skull defect precisely without any dead space. The operative site healed without any specific complications. Postoperative CTs revealed the implants to be in correct position. Conclusion: An autologous graft is not a feasible option in the reconstruction of large calvarial defects. Ideally, synthetic materials for calvarial reconstruction should be easily applicable, durable, and strong. In these aspects, a 3D titanium implant can be an optimal source material in calvarial reconstruction.

• 한국어병학회지
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• 제7권2호
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• pp.151-160
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• 1994

스쿠지카섬모충(Scuticociliatid) 감염에 따르는 어체조직의 조직학적 손상유형과 심부조직으로의 이행 경로를 규명하기 위하여 중감염된 빈사상태의 넙치 (Paralichthys olivaceus) 치어 18 마리를 대상으로 전 장기 및 조직에 대한 병리조직학적 검사를 실시하였다. 피부 및 하부의 골격근조직은 다수의 스쿠지카충의 침입에 기인하여 심한 변성 또는 괴사소견과 함께 대식구의 침윤이 현저하였다. 비교적 초기병변에서는 치밀결합조직인 진피나 골격근섬유의 변성보다 이들을 지지하는 소성결합조직성분이 더욱 심한 변성소견을 보였다. 이들 병변부내 또는 병변부와 격리된 소성결합조직내의 혈관 또는 임파공간내에 수개의 충체가 확인되었다. 신경다발과 신경절내 또는 주위 소성결합조직내에 다수의 충체침입이 확인되었으나 실질의 조직학적 이상은 비교적 경미하였다. 뇌 및 척수의 경막하강에 다수의 충체밀집과 함께 신경실질을 포함한 인접조직은 경도 내지 심한 괴사소견을 보였으며 충체의 침입부위는 피질역에 주로 한정되어 있었다. 각종 아가미관련조직에서 섬모충의 기생이 확인되었으며 특히 소성결합조직은 다수의 충체침입으로 심한 변성소견을 수반하였으며, 특히 새궁 및 일차새변의 혈관내에서 충체가 인정되었다. 본 병리학적 검사결과에서 넙치치어에서의 스쿠지카섬모충은 어체내 침입 후 실질조직보다 소성 결합조직을 우선적으로 파괴하는 동시에 결합조직내의 혈관 또는 임파관으로 쉽게 이행하여 단시간내에 심부조직으로 확산되는 것으로 사료되었다.

• 한국임상수의학회지
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• 제23권2호
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• pp.96-101
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• 2006

두개 창상에 의해 신경증상을 나타내는 4 마리의 환자가 내원하여 일반 방사선 검사 및 컴퓨터단층촬영술(CT)과 자기공명영상(MRI)을 실시하였다. 일반 방사선 사진에서는 내원한 4 마리의 개에서 모두 특이소견을 관찰할 수 없었다. 3마리 개에서 실시한 CT 결과, 3마리 중 2마리의 환자에서 전두엽 부위에 고밀도로 나타나는 병변을 확인할 수 있었으나 소뇌 부위의 병변은 관찰되지 않았다. 이어서 실시한 MRI 검사 결과, 일부의 환자에서는 T1-강조영상에서 저신호로 나타나고 T2-강조영상에서 고신호로 나타나거나 T1-강조영상과 T2-강조영상에서 각각 등신호, 고신호로 나타나는 병변을 확인할 수 있었다. 병변 부위는 좌측과 우측 대뇌 부위, 소뇌전정 부위, 경막하 부위로 다양했다. 이들 환자는 내과적 치료를 실시한 후, 임상적으로 호전되었음을 확인하고 일부 환자는 MRI를 통해 추적검사를 하였다.