• Title/Summary/Keyword: 신경계외 전이

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Recurrence and Extraneural Metastasis in 31 Meningeal Hemangiopericytomas (31예 수막 혈관외피세포종에 있어서의 재발 및 신경계외 전이)

  • Kim, Jeong Hoon;Kim, Joon Soo;Kim, Chang Jin;Hwang, Sung Kyun;Jung, Hee Won;Kwun, Byung Duk
    • Journal of Korean Neurosurgical Society
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    • v.30 no.3
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    • pp.349-357
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    • 2001
  • Purpose : Meningeal hemangiopericytoma(M-HPC), characterized by a high local recurrency and metastatic potential, is a rare neoplasm arising from perivascular pericytes. A retrospective study was performed to identify the recurrence and extraneural metastasis in M-HPC. Materials and Methods : We reviewed the records of 31 M-HPC patients treated from 1982 through 1999 at our institution. The time to recurrence and the various parameters affecting recurrence were determined. Extreneural metastasis was also analyzed. Results : The rate of local recurrency was 38.7%(12/31). The overall average recurrence-free period(RFP) before the first recurrence was 104 months, with overall recurrence-free rates(RFRs) at 5 and 10 years after first surgery of 59.2% and 33.6%, respectively. Of the 12 patients who experienced local recurrence, 4 had recurrences 5 years later after the first surgery. Complete excision at the first operation significantly extended the average time before first recurrence from 43 to 111 months. The 5-year RFRs for the groups of complete excision and incomplete excision were 72.7% and 20.8%, respectively(p=0.0060). Although there was no statistical significance, complete excision followed by adjuvant radiotherapy of more than 50Gy extended the RFP. The 5-year RFRs for the groups of complete excision and complete excision with adjuvant radiotherapy were 70.3% and 100%, respectively(p=0.3359). Four patients(12.9%) presented one or more extraneural metastases that were developed at an average of 107 months after the first operation with the 5- and 10-year metastasis rates of 4.4% and 24.9%, respectively. Conclusions : M-HPC has a propensity to recur either locally or at distant sites after surgical resection. Complete excision is the most important factor to reduce recurrence. However, even with complete excision, adjuvant radiotherapy of more than 50Gy significantly reduces the risk of recurrence. Local and distant recurrences may occur after a prolonged disease-free interval, emphasizing the need for long-term follow-up.

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Neural Reorganization in Retinal Outer Plexiform Layer Induced by Eccentric Viewing Training (중심외주시 훈련 후 망막 외망상층에서의 신경 재조직화)

  • Seo, Jae-Myoung
    • Journal of Korean Ophthalmic Optics Society
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    • v.19 no.2
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    • pp.247-252
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    • 2014
  • Purpose: This study was to investigate the properties and the location of neural reorganization following eccentric viewing training. Methods: 14 subjects with normal vision took part in eccentric viewing training. The measurements of the light sensitivity and multifocal electroretinogram were performed before and after the training. Results: The measurements of the light sensitivity and multifocal electroretinogram for pre-eccentric viewing training and post-eccentric viewing training showed the significant difference (p<0.047 and p<0.028, respectively). Conclusions: The retinal outer plexiform layer is unable to regenerate. However, the neural reorganization in the retinal outer plexiform layer is able to take place following eccentric viewing training.

Central Nervous System Complications of Coronary Artery Bypass Grafting - Comparison Between Off-Pump CABG and Conventional CABG (관상동맥 우회술 후의 중추신경계 합병증 - 심폐바이패스를 사용하지 않은 관상동맥 우회술과 기존의 관상동맥 우회술의 비교)

  • Chang, Ji-Min;Lee, Jeong-Sang;Kim, Ki-Bong;Ahn, Hyuk;Yoon, Byung-Woo;Kim, Yong-Jin
    • Journal of Chest Surgery
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    • v.33 no.12
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    • pp.941-947
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    • 2000
  • Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

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The Influence of the Sympathetic Nervous System on the Development and Progression of Cancer (교감신경계가 암의 발전과 진행에 미치는 영향)

  • Park, Shin-Hyung;Chi, Gyoo-Yong;Choi, Yung Hyun
    • Journal of Life Science
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    • v.28 no.1
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    • pp.116-129
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    • 2018
  • Living creatures possess long-conserved mechanisms to maintain homeostasis in response to various stresses. However, chronic and continuous exposure to stress can result in the excessive production of stress hormones, including catecholamines, which have harmful effects on health. Studies on the relationship between the sympathetic nervous system (SNS) and cancer have been conducted based on the traditional hypothesis that stress can promote cancer progression. Many preclinical and epidemiological studies have suggested that the regulation of ${\beta}$-adrenergic signaling, which mediates SNS activity, can suppress the progression of solid tumors. SNS activation has highly pleiotropic effects on tumor biology, as it stimulates oncogenes, survival pathways, the epithelial - mesenchymal transition, and invasion. Moreover, it inhibits DNA repair and programmed cell death and regulates the tumor microenvironment, including immune cells, endothelial cells, the extracellular matrix, mesenchymal cells, and adipocytes. Although targeted therapies on the molecular basis of tumor proliferation are currently receiving increased attention, they have clinical limitations, such as the compensatory activation of other signaling pathways, emergence of drug resistance, and various side effects, which raise the need for pleiotropic cancer regulation. This review summarizes the effects of the SNS on the development and progression of cancer and discusses the clinical perspectives of ${\beta}$-blockade as a novel therapeutic strategy for this disease.

Improvement of Attention and Short-term Memory of Mild Dementia Using iPad Applications: A Single Case Study (아이패드를 이용한 경도 치매 노인의 주의집중력과 단기 기억력 증진 : 단일대상연구)

  • Hwangbo, Seung Woo;Kim, Moon-Young;Kim, Jongbae;Park, Hae Yean
    • Therapeutic Science for Rehabilitation
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    • v.7 no.3
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    • pp.47-58
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    • 2018
  • Objective : This study was conducted to investigate the effects of iPad applications on improvement of attention and short-term memory in mild dementia. Methods : A single-case experimental study using A-B-A design was conducted. A total of 20 sessions, including 5 each for baseline phase A and A' and 10 for the intervention phase, were provided to the subject. Interventions were only provided during the intervention phase and were iOS-based iPad applications named "Memorado-Moving Balls" and "Circles." "Fit Brains-Matching Pairs" and "Fit-Brains-Spot the Difference" were used for each session to evaluate attention and short-term memory. MMSE-K, K-TMT-e A and B, and DST assessment tools were used pre- and post-intervention to assess attention and memory. Result : Fit Brains scores indicated improvement in both attention and memory during the intervention phase. K-TMT-e A showed 3 increased correct points and 3 reduced error points, and B showed 7 increased correct points and 2 reduced error points in post-tests, but the DST and MMSE-K showed no meaningful change. Conclusion : This single-case study identified improvements in attention and short-term memory in a person with mild dementia using iPad applications. Further studies regarding different applications and larger samples with long-term designs are necessary.

Improvement of Attention and Memory of Stroke Patient Using Smart Phone Applications : Single Case Study (스마트폰 어플리케이션을 이용한 뇌졸중 환자의 집중력과 기억력 증진: 단일 사례연구)

  • Lee, In-Seon
    • Therapeutic Science for Rehabilitation
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    • v.3 no.1
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    • pp.57-65
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    • 2014
  • Objective : In this study, to investigate the effect of Attention and Memory using a smart phone application intervention for stroke patients. Methods : single-subject experimental research was conducted using an ABA design. During the study, subject was applied to a total of 20 sessions with five times baseline, ten times intervention line, five times re-baseline. baseline and re-baseline did not have a separate intervention. During the intervetion line was trained by the application 'Master of memory(Numbers, Shapes, Fruits mode)' and 'Matching cute animals'. All sessions were evaluated an Attention and Memory using by 'Master of memory(Random mode)' and 'Memory free(Picture memory)' application. The resulting data was presented in graphs and descriptive statistics. Results : Implemented in all session, Attention and Memory assessment results showed the improvement of Attention and Memory in intervention line. Assessments conducted before and after the intervention, showed the improvement of Attention and Memory after the evaluation of interventions respectively. Conclusion : The results of this study are expected to be clinically useful. Follow-up studies on smart phone application intervention are needed for more targeted sampling study and conducted over a long period of time.

피부 병변은 닭 마렉병 진단에 결정적 단서를 제공한다

  • 조경오;박남용
    • Korean Journal of Veterinary Pathology
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    • v.6 no.2
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    • pp.101-104
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    • 2002
  • 닭의 전신장기에 림프종 발생이 특정인 마렉병(Marek's disease; MD)은 림프구성 백혈병(Lymphoid leukosis; LL)과 병리학적 소견이 매우 유사하여 감별이 요구된다. 마렉병 바이러스(Marek's disease virus; MDV)는 질병초기에서 후기에 이르기까지 모낭상피세포에 세포용해성 감염을 지속적으로 일으킨다. 세포용해성 감염이 있는 모낭상피세포는 변성내지 괴사되어 있고 핵내봉입체가 관찰된다. 또한 세포용해성 감염이 있는 모낭상피세포 바로 밑의 진피와 깃털 수질(feather pulp)내의 혈관주위에 림프구 침윤이 관찰된다. 이러한 피부병변은 MD의 특징적인 병변들로서 LL과 감별할 수 있는 결정적인 단서이다. 본 고에서는 MD에 관한 전반적인 것과 특히 MD 진단을 위한 피부병변의 유용성에 대해서 자세히 논하고자 한다. 양계산업에 문제를 야기하고 있는 림프구 증식성 종양은 크게 마렉병(Marek’s disease; MD)과 백혈병(Lymphoid leukosis; LL)이 있다. 이들 질환의 원인체들이 분리되기 전까지는 이들 질병들은 발병부위에 따라 질병명을 붙였다. 즉, 내부장기냐 근육에 발생한 것은 visceral lymphomatosis, 피부에 발생한 것은 skin leukosis, 말초신경의 병변은 poly­n neuritis, neuritis, neurolymphomatosis gallinarum, range paralyis로 불리었다. 또한 눈에 발생한 것은 blindness, gray eye, iritis, uveitis, ocular lymphomatosis라고 불리었다. 1961년에 Biggs는 이러한 림프구 증식성 질병을 마렉병과 백혈병 으로 분류하자는 제안을 하였고, 드디어 1960년대 중반에 림프구 증식성 병변 중의 일부에서 herpesvirus가 분리되어서 Biggs가 제안한 병명인 마렉병을 본격적으로 사용하게 되었다. MD는 마렉병 바이러스(Marek’s disease virus; MDV)가 원 인제로서 닭에 전염성이 강한 염증성에서 종양성의 병변을 내부장기, 피부, 근육, 안구, 중추신경계, 말초신경계 등에 일 으킨다. MDV는 림프종을 유발하기 때문에 처음에는 사람에서 림프종을 유발하는 Epstein-Bar 바이러스와 관련이 있을 것으로 생각되어 gamma-herpesvirus로 분류되었지만, MDV의 게놈 구조와 세포배양에서 빠르게 성장한다는 점 때문에 지금은 alpha-herpesvirus로 재분류 되었다. MDV는 바이러스 중화시험과 한천 겔 침강법에 의해서 3개의 혈청형으로 분류 된다. 혈청형 1은 종양원성 바이러스와 종양원성 바이러스의 계대배양에 의한 약독주가 있다. 혈청형 2는 자연적으로 발 생하는 비종양원성 닭의 MDV이고, 혈정형 3은 바종양원성 칠면조 herpesvirus (HVT)이다. 림프종을 유발하는 MDV 감염은 4개의 과정, 즉 초기 세포용해성 감염, 잠복감염, 후기 세포용해성 감염, 마지막으로 종양화로 나눌 수 있다. 감염의 경로를 보면, 흡입된 MDV는 폐의 대식세포에 감염한 후 전선 장기로 MDV를 전파 시킨다. 특히, 흉선, F냥, 비장 등의 림프구에 초기 세포용해성 감염을 일으키는데, B 림프구가 주로 감염된다. 세포용해성 감염음 방어하기 위해 몰려든 T 림프구가 활성화가 되면, T 세포도 감염되게 된다. 잠복감염은 여러 가지 사이토카인 등 을 포함한 면역반응에 의해서 일어나며, 이 때 잠복감염된 세포는 특히 혈중의 T 세포라고 한다. 혈중 MDV 감염세포 는 피부 모낭상피세포, 선장 등 상피세포 유래의 조직에 MDV를 전파 시켜서 이들 조직에서 후기 세포용해성 감염이 일어나게 한다. 후기 세포용해성 감염을 유발하는 것은 이러한 MDV가 감염된 혈중 림프구라는 증거는 혈중의 세포 외에는 감염성 바이러스가 없기 때문이다. 후기 세포용해성 감염이 있는 후 육안적 혹은 현미경적으로 검출이 가능한 림프종이 여러 장기에서 관찰된다. MDV가 감염되면 병변 발생부위에 따라서 다양한 임상증상이 발생한다. 즉 내부장기에 병변이 있을 경우는 침울, 체중감소, 산란율 저하 등이 발생하며, 신경계는 발생부위별 신경증상이 일어난다. 이러한 장기나 조직에서는 육안적으로 백색에서 회백색의 종양성 병변이 관찰된다. 말초신경에 병변이 발생한 경우에는 특히 좌골신경 및 신경총에서 호발하는데, 이들 조직은 편측성 혹은 양측성으로 종창되어 있다. 안구는 간혹 육안적으로 식별이 가능한 홍채 퇴색 및 증식 병변이 관찰된다. 피부형 MD는 특히 육용계에서 문제가 되고 있으며, 산란계의 내장형 MD가 발생한 경우에도 피부를 자세히 설펴보면 피부형 MD를 간혹 관찰할 수 있다. 피부형 MD는 모낭주위에 원형의 결절형태로 발생하는데, 이들 병변이 커지면 바로 옆의 병변과 융합 되어 큰 결절을 형성하기도 한다. (중략)

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Risk factor of influenza virus infection to febrile convulsions and recurrent febrile convulsions in children (인플루엔자 바이러스 감염에서 소아 열성 경련과 열성 경련의 재발에 관한 위험인자)

  • Moon, Jae Won;Kang, Jang Hee;Kim, Hyun Ji;Byun, Soon Ok
    • Clinical and Experimental Pediatrics
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    • v.52 no.7
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    • pp.785-790
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    • 2009
  • Purpose : Febrile convulsions are a common pediatric neurological disease, and it is important to prevent such a disease by controlling the risk factors that may recur. A recent report states that influenza virus infections have a high probability of a relationship with febrile convulsions; therefore, it is necessary to identify the clinical properties of febrile convulsions in relation to domestic influenza virus infections. Methods : Between November 2005 and February 2008, children hospitalized because of febrile convulsions and subsequently confirmed to have influenza infections were enrolled as subjects (patient group, n=11). The control subjects were those admitted with influenza virus infections but no febrile convulsions (control group 1, n=46) and those who developed febrile convulsions without influenza virus infection (control group 2, n=53). Results : The patient group showed a higher maximum body temperature ($39.3{\pm}0.5^{\circ}C$), more histories of past febrile convulsions (72.7%), and a shorter total duration of fever ($2.9{\pm}1.2$ days) than control group 1. When multivariate analysis was performed, the probability of febrile convulsions was found to be as high as 225.9 times in patients who had influenza virus infections with a past history of febrile convulsions (OR=225.9, 95% CI: 1.7-4780.0, P<0.05). When patients with febrile convulsions were compared based on the symptoms of influenza virus infections, the patient group showed a shorter duration of fever ($0.9{\pm}0.7$ days) before convulsion than control group 2; these convulsions were mostly a recurrence of febrile convulsions. When multivariate analysis was performed, the cases with a past history of febrile convulsions showed 5.5 times (OR=5.5, 95% CI: 1.2-25.1, P=0.03) the probability of convulsions when infected with the influenza virus, and this probability decreased by 0.3 times over one-day increments of the febrile period until febrile convulsions (95% CI: 0.1-0.9, P=0.02). Maximum body temperature, total duration of fever, family history of febrile convulsions, and complex febrile convulsions did not show a statistical significance. Conclusion : In cases of pediatric influenza virus infection, the past history of febrile convulsions could be identified within the risk factor of recurrent febrile convulsions. Therefore, influenza vaccination of children having a past history of febrile convulsions will be helpful to avoid the recurrence of these convulsions.

The Effects of CPM (Continuous Passive Motion) on Hand Function and Muscular Strength for Patients with Stroke (CPM (Continuous Passive Motion) 사용이 뇌졸중 환자의 손 기능과 근력향상에 미치는 영향)

  • Jeong, In-Seon
    • Therapeutic Science for Rehabilitation
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    • v.3 no.2
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    • pp.71-81
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    • 2014
  • Objective: The purpose of this study is to ob serve effects of CPM(Continuous Passive Motion) on hand functional and upper-extremity muscular strength rehabilitation for stroke patients. Method: Objects of this study, three patients have the symptoms of hemiplegia due to stroke. These are acute patients, within a 18 months after treatment and correspond in Brunnstrom stage 4~6. This study used single subject (A-B) design for three patients with a stroke and the effect of CPM was measured using Jebsen-Taylor hand function test, Purdue Pegboard test, hand muscular strength test. They received CPM for 3 weeks, 2 per day, 30 minutes for each, total 30 times. Results: Two patients' results of fingertip grip test in hand strength measurements did not change. Results of Jebsen-Taylor hand function test, Purdue Pegboard test and other hand muscular strength test were improved. To validate statistical results nonparametric statistical method, Wilcoxon signed ranks test was performed. P-Values are greater than 0.05 so difference between be fore and after treatment is not statistically significant result. Conclusion: Despite of limitation of short program period and fewer participants, CPM which has been conducted for stroke patients showed the effect on improvement of hand function and muscle strength. This study shows that CPM which is mainly used to treate lower-extremity rehabilitation can be use to improve performance of hand function and strength for patients with stroke.

Lumbar Angiomatous Meningioma in a Dog (개에서 발생한 요추 혈관종성수막종 증례)

  • Sohn, Jung-Min;Kim, Bo-Eun;Jung, Sun-Young;Ji, Seo-Yeoun;Yoon, Dae-Young;Kweon, Oh-Kyeong;Kim, Dae-Yong;Choi, Min-Cheol;Yoon, Junghee
    • Journal of Veterinary Clinics
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    • v.31 no.2
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    • pp.152-155
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    • 2014
  • An 11-year-old castrated Schnauzer presented with paraplegia for the last two weeks, initially developed pelvic limb ataxia 6 months ago and left pelvic limb paresis 3 months ago. On neurological examination, paraplegia and postural reaction deficits were noted in the pelvic limbs with no deep pain sensation, and the dog showed exaggerated spinal reflexes and involuntary urination. Magnetic resonance (MR) images of thoracolumbar spinal cord were obtained with a 0.3 Tesla magnet. A mass with a broad base to the dorsal and left dural margins was identified at the level of L2, causing marked spinal cord compression. The mass showed isointensity to the spinal cord on T1-weighted (T1W) precontrast images, hyperintensity on T2-weighted images, marked homogeneous contrast enhancement with well-defined margins and the "dural tail" sign on T1W postcontrast images. An intradural-extramedullay tumor was considered, most likely, meningioma was highly suggestive. Left-sided hemilaminectomy and dorsal laminectomy were performed. An intradural mass partially adherent to dura mater was compressing the spinal cord, and the mass was completely removed with the attached dura mater. A histopathologic diagnosis of angiomatous subtype meningioma was made.