• The Journal of Internal Korean Medicine
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• v.40 no.4
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• pp.730-741
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• 2019

Objective: The aim of this study was to report the effectiveness of traditional Korean medicine treatment with rehabilitation exercise on a chronic intracerebral hemorrhage patient with a severe gait disturbance. Method: The patient was treated with Korean herbal medicine (Gami-sibjeondaebo-tang) along with acupuncture, moxibustion, and rehabilitation exercise. The treatment effect was evaluated through the Manual Muscle Test (MMT) and the Korean version of the Modified Barthel Index (K-MBI). The gait of the patient was evaluated by Functional Ambulatory Category (FAC) and the Timed Up and Go (TUG) test. The spatiotemporal parameters were evaluated by a walkway system (GAITRite(R) system) and gait symmetry was evaluated by Symmetry Criterion (SC). Results: After 111 days of traditional Korean medicine treatment, the spatiotemporal parameters and symmetry of the patient's gait improved. Conclusion: This study suggested that traditional Korean medicine treatment with rehabilitation exercise could be effective for gait disturbance in patients with chronic intracerebral hemorrhage.

• Pediatric Infection and Vaccine
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• v.29 no.3
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• pp.147-154
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• 2022

The clinical severity of coronavirus disease 2019 (COVID-19) in children is usually mild. Most of the affected patients completely recovered from COVID-19 before being released from approximately 7-day quarantine. However, children with comorbidities are at risk of more severe disease and adverse outcomes. We report three cases of COVID-19-affected adolescents with underlying chronic respiratory difficulty due to neurologic diseases who showed sudden clinical aggravations at the time of discharge, even after full clinical improvement. Patient 1 is a 17-year-old boy with Ullrich congenital muscular dystrophy who had cardiopulmonary arrest 9 days after the initial COVID-19 symptoms. Patient 2 is a 17-year-old girl with intracerebral hemorrhage with infarction in bed-ridden status who had cardiopulmonary arrest 11 days after the initial symptoms. Patient 3 is a 12-year-old boy with intraventricular hemorrhage with hydrocephalus in bed-ridden status who showed multiorgan failure 10 days after the initial symptoms. Remdesivir, dexamethasone, and empirical antibiotics were administered with mechanical ventilation and intensive unit care. Among the three patients, two (patients 1 and 3) were alive, and one (patient 2) expired. Clinicians caring for adolescents with chronic neurologic and/or pulmonary disease should keep in mind that these patients could have sudden deterioration after recovery from the acute phase of COVID-19 around or after the time of discharge.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.167-177
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• 2023

Background: Pressure injuries are localized areas of damage to the skin and/or underlying tissue, usually over a bony prominence due to pressure. Cerebrovascular disease increases the risk of pressure injuries due to the immobility caused by physical paralysis. The general approach to managing a patient with pressure injuries should include pain relief, the treatment of the infection, optimizing nutritional intake, proper positioning, and contamination prevention. Nonetheless, the duration of treatment for pressure injuries varies from person to person. Case report: An 80-year-old female intracerebral hemorrhage patient developed a pressure injury. To improve the injury faster, a Radix Astragali pharmacoacupuncture solution was applied to the pressure sore. The pressure injury's width, length, and depth was assessed using a ruler, and the exudate amount and tissue types were assessed. The treatment was performed for 35 days. The rate at which the size of the pressure sore lessened increased since the Radix Astragali pharmacoacupuncture solution was applied to the pressure sore. In addition, the tissue type of the pressure injury improved, and the exudates decreased. There was no significant difference in the Pressure Ulcer Scale for Healing Tool 3.0, since the Radix Astragali pharmacoacupuncture solution was applied to the pressure injury. Conclusion: This clinical case study suggests that the Radix Astragali pharmacoacupuncture solution might be effective in speeding up the healing of pressure injuries.

• The Journal of the Society of Stroke on Korean Medicine
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• v.6 no.1
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• pp.17-23
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• 2005

1. Purpose : The purpose of this study was done to compare the sex, past history, hematologic relationship between the Cerebral infarction patients and the Cerebral hemorrhage patients. 2. Methods : We selected the two study groups. The one is 20 Cerebral infarction patients and the other 20 Cerebral hemorrhage patients with confirmed by Brain CT or MRI. We made an investigation into past history. We examined and made a comparative study of CBC, LFT, Na, K, Cl in the both group. 3. Result & Conclusion : In the Cerebral hemorrhage group, there were many patients with Hypertension and Diabetes mellitus than the Cerebral infarction group. In the Cerebral infarction group, there were many patients with abnormal RBC count with no significant. Also, ESR is higher than the other group. Between the Cerebral infarction and the other group, we discovered significant cases with abnormal triglyceride, ALP in the Cerebral infarction group(p<0.05). Abnormal triglyceride is known one of important risk factor of Cerebral infarction, but this study was significant in the Cerebral hemorrhage group. Also, ALP was significant in the Cerebral hemorrhage group. Therefore more extensive research is needed.

• Journal of the Korean Society of Radiology
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• v.83 no.3
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• pp.538-558
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• 2022

The perivascular space (PVS) of the brain, also known as Virchow-Robin space, consists of cerebrospinal fluid and connective tissues bordered by astrocyte endfeet. The PVS, in a word, is the route over the arterioles, capillaries, and venules where the substances can move. Although the PVS was identified and described first in the literature approximately over 150 years ago, its importance has been highlighted recently after the function of the waste clearing system of the interstitial fluid and wastes was revealed. The PVS is known to be a microscopic structure detected using T2-weighted brain MRI as dot-like hyperintensity lesions when enlarged. Although until recently regarded as normal with no clinical consequence and ignored in many circumstances, several studies have argued the association of an enlarged PVS with neurodegenerative or other diseases. Many questions and unknown facts about this structure still exist; we can only assume that the normal PVS functions are crucial in keeping the brain healthy. In this review, we covered the history, anatomy, pathophysiology, and MRI findings of the PVS; finally, we briefly touched upon the recent trials to better visualize the PVS by providing a glimpse of the brain fluid dynamics and clinical importance of the PVS.

• Journal of fish pathology
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• v.10 no.1
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• pp.1-14
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• 1997

Major object of this study was to investigate the causative organism of th e diseased cultured fingerling of sea bass, L japonicus. The experimental results are summarized as follows ; Staphylococcus epidermidis, isolated from the liver, kidney, spleen and brain, was considered to be the causative organism. External symptoms of this disease were congestion and hemorrhages in eyes. Anatomical symptoms were hemorrhage of brain, congestion of liver, and slight swelling of kidney and spleen. Growth of the isolates was good on BHIA, HIA and Staphylococcus No. 110. The growth occurred at a range(optimum) of $10\sim45^{\circ}C(35\sim40^{\circ}C)$, 0~9% (1~3%) of NaCl concentration and pH 4~10(8). DNase and coagulase production of all isolated strains were nagative, but was positive in hemolysis. Urease was positive reaction, and novobiocin resistance was nagative. Acid was produced anaerobically from glucose and maltose. Acid was produced aerobically from glucose, galactose, sucrose, maltose and dextrine. But gas was not produced from any carbohydrates. When the isolated strain was injected intramuscularly on fingerling of sea bass, L japonicus, it had virulence at $1.7{\times}10^{10}$ viable cells/$m\ell$ for all fish examined but no virulence at $1.7{\times}10^4$ viable cells/$m\ell$. Bacitracin, Erythromycin and Nofloxacin were observed as bacteriostatic agents to the strain, but Colistin, Gentamicin and Nalidixic acid were not. There were remarkable congestion of the brain, regressive necrosis of the liver, and showed necrosis of the epithelial cells of renal tubules in kidney tissues.

• Clinical and Experimental Pediatrics
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• v.48 no.1
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• pp.68-74
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• 2005

Purpose : There is growing use of continuous renal replacement therapy(CRRT) for pediatric patients, but reports about the use and outcome of CRRT in children is rare in Korea. We report our experiences of CRRT in critically ill pediatric patients. Methods : We reviewed the medical records of 23 pediatric patients who underwent CRRT at Asan Medical Center between May 2001 and May 2004. We evaluated underlying diseases, clinical features, treatment courses, CRRT modalities and outcomes. Results : Ages ranged from three days to 16 years with a median of five years. Patients weighed 2.4 to 63.9 kg(median 23.0 kg; 10 patients ${\leq}20kg$). The underlying diseases were malignancy(nine cases), multiple organ dysfunction syndrome(five cases), hyperammonemia(four cases), acute renal failure associated with liver failure(three cases), dilated cardiomyopathy(one case) and congenital nephrotic syndrome(one case). Pediatric Risk of Mortality(PRISM) III score was $17.6{\pm}7.6$ and the mean number of failing organs was $3.0{\pm}1.7$. Duration of CRRT was one to 27 days(median : nine days). Eleven patients(47.8%) survived. Chronic renal failure developed in two cases, intracranial hemorrhage in one case, and chylothorax in one case among the survivors. PRISM III score and the number of vasopressor before the start of CRRT was significantly lower in the survivors($12.7{\pm}4.2$ and $0.9{\pm}1.1$) compared with nonsurvivors($22.1{\pm}7.8$ and $2.4{\pm}1.4$)(P<0.05). Conclusion : CRRT driven in venovenous mode is an effective and safe method of renal support for critically-ill infants and children to control fluid balance and metabolic derangement. Survival is affected by PRISM III score and the number of vasopressors at the initiation of CRRT.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.979-985
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• 1997

Between October 1991 and May 1995, 256 "New Duromedics Valve"(Edward TEKNA Bileaflet Valve) were implanted in 208 adult patients(171 mitral, 82 aortic and 3 tricuspid) with age ranging from 18 years to 70 years(mean 48.2$\pm$ 11.6 years). Postoperative complication rates were 12.2%, but there was none valve related one. Overall early mortality rate were 1.4%(1.6% for MVR, 2.1% for DVR, and none for AVR or TVR) respectively. Follow-up was 99% completed ranging in duration from 2 months to 46 months. There were 6 valve-related late complications(2.9%) with 2 patients with upper gastrointestinal bleeding, 2 with cerebral thxomtioembolism, 1 with valve thrombosis and 1 with valve endocarditis. Freedom from these valve-related major complications were 89.9% at 40 months. There were 5 late deaths(2.4%). one of these late deaths was considered valve-related. Overall actuarial survival rates at 40 months were 95.5%, 96.8% for mitral, 97.1% for aortic, 100% for tricuspid, and 92.0% for double valve replacement respectively. Preoperative New York Heart Association functional class were 2.9, and 1.3 in post-operative state. We have been trying to keep the international normalized ratio(INR) with range of 2.5 to 3.0. The INR of 4 patients of 5 with anticoagulant ralated complications was beyond the range. To reduce the rate of anticoagulant related complications, we felt very strongly that the INR should be kept between 2.5 and 3.0. In our cases, there was no structural failure or significant hemolysis in the absence of periprosthetic leak. This experience encourages us to continue using the "New Duromedics Valve".omedics Valve".uot;.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1224-1229
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• 2003

Purpose : Bacterial meningitis is a serious disease, especially in the neonatal period, and it carries a significant degree of mortality and morbidity. Group B streptococcus(GBS) is a common cause of neonatal bacterial meningitis. The purpose of this study was to evaluate the clinical manifestations, treatment results and complications of GBS meningitis. Methods : We analyzed 29 cases retrospectively who had been admitted to the pediatric ward or NICU in Asan Medical Center from May 1990 to January 2002. They had proven GBS in culture or latex agglutination test in CSF. Results : The male to female ratio was 1 : 1.9. There were two cases of early onset type and 27 cases of late onset type. All cases had normal birth weight with full term at delivery. The perinatal predisposing factors were premature rupture of membrane(two cases), and maternal colonization(two cases). The most common presenting symptoms were fever and irritability. Associated diseases were GBS sepsis(21 cases). There was relatively high sensitivity to penicillin derivatives. There were abnormal brain CT or MRI findings in 16 cases(64%), such as infarction, encephalomalatic change, effusion, hydrocephalus, hemorrhage and abscess. The intensive care unit admission rate and the incidence of DIC were higher in the group with complications. Two cases were discharged against advice. Conclusion : We recommend early detection and active treatment in Group B streptococcal meningitis to improve the prognosis.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1253-1259
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• 2003

Backgroud : Seizures in the neonate are relatively common and their clinical features are different from those in children and adults. The study aimed to provide the clinical profiles of neonatal seizure in our hospital. Methods : A total of 41 newborns with seizures were enrolled in this study over a period of three years. They were evaluated with special reference to risk factors, neurologic examinations, laboratory data, neuroimaging studies, EEG findings, seizure types, response to treatment, and prognosis, etc. Results : The average age at onset of seizures was $6.1{\pm}4.6days$ and the majority of patients(42%) had multifocal clonic seizure and 24% had subtle seizure. Factors that are known to increase risk of neonatal seizures include abnormal delivery history, birth asphyxia, and electrolyte imbalance, etc. However, they remain obscure in about 20% of cases. More than 50 percent showed abnormal lesions on neuroimaging studies such as brain hemorrhage, periventricular leukomalacia, brain infarction, cortical dysplasia, hydrocephalus, etc. and 17 out of 32 patients showed abnormal electroencephalographic patterns. Phenobarbital was tried as a first line antiepileptic drug and phenytoin was added if it failed to control seizures. The treatments were terminated in the majority of patients during the hospital stay. The overall prognosis was relatively good except for those with abnormal EEG background or congenital central nervous system malformations. Conclusion : Neonatal seizures may permanently disrupt brain development. Better understanding of their clinical profiles and appropriate management may lead to a reduction in neurological disability in later childhood.