• Title/Summary/Keyword: 신경학적 악화

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Surgical Experience of Paraclinoidal Aneurysms (상상돌기 주위 동맥류의 수술적 치험)

  • Kang, Hyung Gon;Jo, Chul Min;Huh, Jae Teack
    • Journal of Korean Neurosurgical Society
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    • v.30 no.sup2
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    • pp.203-210
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    • 2001
  • Objective : Paraclinoidal aneurysms termed that aneurysms arising from proximal internal carotid artery(ICA) between the site of emergence of the carotid artery from roof of the cavernous sinus and origin of the posterior communicating artery(PCoA). These aneurysms pose conceptual and technical surgical problems with regard to acquisition of proximal control and safe intracranial exposure. The efficiency of surgical technique according to the location of paraclinoidal aneurysm was studied for minimal exposure. Materials and Methods : Over the past four years, the authors treated surgically 171 cases of cerebral aneurysm, among them ten patients were paraclinoidal aneurysms with two patients unruptured aneurysms. Mean age was 47 years old, and all patients were female. Three patients were proximal posterior carotid artery wall aneurysms(one large, one giant), four patients carotid-ophthalmic artery aneurysms and three patients superior hypophyseal artery aneurysms. Results : There could be done clip in all cases, there were no deaths and no complication. And no patient developed sustained neurological deficits including visual function except hydrocephalus in one case. Four patients complained of visual disturbance but two patients had recovery after postoperation and two patient were not longer to bad. Conclusion : Our recent experience suggests that preoperative scrutiny of diagnostic angiography allows classification of all paraclinoidal aneurysms regardless of size and surgical technique which this classification has focused on operative approaches unique to each aneurysm projection was helpful to improve the operative outcome with good visual function and to shorten the operative time.

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Biportal Endoscopic Spinal Surgery for Lumbar Intervertebral Disc Herniation (두 개의 입구를 통한 내시경 척추 수술: 요추부 추간판 탈출증에의 적용)

  • Lee, Ho-Jin;Choi, Dae-Jung;Park, Eugene J.
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.3
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    • pp.211-218
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    • 2019
  • Herniation of the intervertebral disc is a medical disease manifesting as a bulging out of the nucleus pulposus or annulus fibrosis beyond the normal position. Most lumbar disc herniation cases have a favorable natural course. On the other hand, surgical intervention is reserved for patients with severe neurological symptoms or signs, progressive neurological symptoms, cauda equina syndrome, and those who are non-responsive to conservative treatment. Numerous surgical methods have been introduced, ranging from conventional open, microscope assisted, tubular retractor assisted, and endoscopic surgery. Among them, microscopic discectomy is currently the standard method. Biportal endoscopic spinal surgery (BESS) has several merits over other surgical techniques, including separate and free handling of endoscopy and surgical instruments, wide view of the surgical field with small skin incisions, absence of the procedure of removing fog from the endoscope, and lower infection rate by continuous saline irrigation. In addition, existing arthroscopic instruments for the extremities and conventional spinal instruments can be used for this technique and surgery for recurred disc herniation is applicable because delicate surgical procedures are performed under a brightness of 2,700 to 6,700 lux and a magnification of 28 to 35 times. Therefore, due to such advantages, BESS is a novel technique for the surgical treatment of lumbar disc herniation.

Outcome of LINAC Radiosurgery for a Cavernous Angioma (해면상혈관종에 대한 선형가속기를 이용한 고선량 정위 방사선수술의 임상경험)

  • Hong Semie;Chie Eui Kyu;Park Suk Won;Kim Il Han;Ha Sung Hwan;Park Charn Il
    • Radiation Oncology Journal
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    • v.21 no.2
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    • pp.107-111
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    • 2003
  • Purpose: To establish the role of stereoactic radiosurgery using a linear accelerator for the treatment of patients with cavernous angloma. Materials and Methods: Between February 1995 and May 1997, 11 patients with cavernous angioma were treated with stereotactic radiosurgery using a linear accelerator. Diagnoses were based on the magnetic resonance imaging in 8 patients, and the histological in 3. The vascular lesions were located on the brainstem (5 cases), cerebellum (2 cases) thalamus (1 case) and cerebrum (3 cases). The clinical presentation at onset included previous intracerebral hemorrhages (9 cases) and seizures (2 cases). All patients were treated with a a linac-based radiosurgery. The median dose of radiation delivered was 16 Gy ranging from 14 to 24 Gy, which was typically proscribed to the 80$\%$ isodose surface (range 50 $\~$ 80$\%$), corresponding to the periphery of the lesion with a single isocenter. Ten patients were followed-up. Results: The median follow-up was 49 months ranging from 8 to 73 months, during which time two patients developed an intracerebral hemorrhage, 1 at 8 months, with the other at 64 months post radiosurgery. One patient developed neurological deficit after radiosurgery, and two developed an edema on the T2 weighted images of the MRI surrounding the radiosurgical target. Conclusion: The use of stereotactic radiosurgery in the treatment of a cavernous angioma may be effective in the prevention of rebleedlng, and can be safely delivered. However, a longer follow-up period will be required.

Relationship between iron deficiency anemia and febrile convulsion in infants (영아에서 철결핍 빈혈과 열성경련과의 상관관계)

  • Jun, Youn Soo;Bang, Ho Il;Yu, Seung Taek;Shin, Sae Ron;Choi, Du Young
    • Clinical and Experimental Pediatrics
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    • v.53 no.3
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    • pp.392-396
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    • 2010
  • Purpose : The association between iron deficiency anemia and febrile convulsion in infants has been examined in several studies with conflicting results. Therefore, the authors aimed to evaluate the precise relationship involved. Methods : In this case-control study, the authors assessed 100 children with a diagnosis of febrile convulsion, aged between 9 months and 2 years, during January 2007 to July 2009. The control group consisted of 100 febrile children without convulsion; controls were closely matched to the cases by age, gender, and underlying disease. Results : The mean ages of the febrile convulsion and control group were $16.3{\pm}7.4$ and $15.8{\pm}6.1$ months, respectively, and the two groups had no differences in clinical features. Iron deficiency anemia (Hb <10.5 gm/dL) was more frequent in the febrile convulsion group than in the control group, although there was no statistical significance. Unexpectably, the RDW (red blood cell distribution width) was significantly lower and the MCNC (mean corpuscular hemoglobin concentration) was significantly higher among seizure cases than among the controls (P <0.05). There is no statistical difference between simple and complex febrile groups in the clinical and laboratory profiles. On multiple logistic regression analysis, iron deficiency anemia was more frequent, but the RDW was lower, among the cases with febrile convulsion, compared with the controls. Conclusions : Our study suggests that the iron deficiency anemia is associated with febrile convulsion, and screening for iron deficiency anemia should be considered in children with febrile convulsions.

Development of functional lighting fixture and Experiment of to the Biological effects (기능성 반사판 조명기구 개발 및 효능 실험)

  • Kim, Chang-Hwan;Kim, Hyeon-Soo;Chee, Chol-Kon
    • Proceedings of the Korean Institute of IIIuminating and Electrical Installation Engineers Conference
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    • 2004.11a
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    • pp.203-208
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    • 2004
  • We are living now under the bad air pollition contained the many plus(+)ion produed by the exhaust gases from automobil and Industrial plant. To be refreshe those air pollution. We developed the funtional lighting fixture which emit the lighting, negative(-)ion and Infraredray. The negative(-)ion and Infraredray refresh the air pollition and will arise nature healing power lot the human body and activate the body cell, and makes the good blood circulation and then we had the experiment to the Biological effect by the funtional lighting fixture.

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A Case Report of Pontine Infarction as an Initial Manifestation of Systemic Lupus Erythematosus: Diagnostic Clues from MRI and Digital Subtraction Angiography (전신성 홍반성 루푸스의 초기 증상으로 나타난 교뇌경색의 증례 보고: 자기공명영상 및 디지털감산 혈관조영술에서의 진단 단서)

  • Mi Sun Chung;Jun Soo Byun;Younghee Yim
    • Journal of the Korean Society of Radiology
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    • v.82 no.5
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    • pp.1281-1286
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    • 2021
  • Brainstem infarction due to vertebrobasilar insufficiency is a rare initial presentation of systemic lupus erythematosus (SLE) patients and small-vessel dissection as the direct cause of infarction has not been reported. We report the case of a 20-year-old female with acute infarction on the right side of the pons due to a small artery (pontine perforator) dissection, identified on digital subtraction angiography and high-resolution vessel wall MRI (vwMRI). She was diagnosed with SLE based on the presence of neurologic disorders and relevant laboratory findings. The pontine perforator-dissecting aneurysm had occluded and the right distal vertebral artery had resolved on subsequent vwMRI. She had a modified Rankin Scale (mRS) score of 1 at discharge with mild symptom improvement, and exhibited no further aggravation of symptoms at 3 or 12 months, maintaining an mRS score of 1.

Water Quality Analysis of Hongcheon River Basin Under Climate Change (기후변화에 따른 홍천강 유역의 수질 변화 분석)

  • Kim, Duckhwan;Hong, Seung Jin;Kim, Jungwook;Han, Daegun;Hong, Ilpyo;Kim, Hung Soo
    • Journal of Wetlands Research
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    • v.17 no.4
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    • pp.348-358
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    • 2015
  • Impacts of climate change are being observed in the globe as well as the Korean peninsula. In the past 100 years, the average temperature of the earth rose about 0.75 degree in celsius, while that of Korean peninsula rose about 1.5 degree in celsius. The fifth Assessment Report of IPCC(Intergovermental Panel on Climate Change) predicts that the water pollution will be aggravated by change of hydrologic extremes such as floods and droughts and increase of water temperature (KMA and MOLIT, 2009). In this study, future runoff was calculated by applying climate change scenario to analyze the future water quality for each targe period (Obs : 2001 ~ 2010, Target I : 2011 ~ 2040, Target II : 2041 ~ 2070, Target III : 2071 ~ 2100) in Hongcheon river basin, Korea. In addition, The future water quality was analyzed by using multiple linear regression analysis and artificial neural networks after flow-duration curve analysis. As the results of future water quality prediction in Hongcheon river basin, we have known that BOD, COD and SS will be increased at the end of 21 century. Therefore, we need consider long-term water and water quality management planning and monitoring for the improvement of water quality in the future. For the prediction of more reliable future water quality, we may need consider various social factors with climate components.

NEED FOR DEVELOPMENT OF HOME HEALTH NURSING PROGRAM IN KOREA (가정 간호 사업에 관한 연구)

  • Ruth M. Virginia;Moon Jung Soon
    • Journal of Korean Public Health Nursing
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    • v.5 no.1
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    • pp.53-69
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    • 1991
  • 가정간호사업 도입에 대한 대상자의 필요성에 대한 인식을 알아보고자, 1988년 7월 1일부터 동년 8월말까지 서울시내 5개 대학병원에서 퇴원하는 환자 390명과 환자 보호자 380명, 주민 780명, 총 1550명을 대상으로 조사한 결과 다음과 같은 결론을 얻었다. 1. $81\%$의 대상자가 가정간호 사업 도입이 필요하다고 한 반면 $7.5\%$는 필요 없다고 하였으며, $11.5\%$는 잘 모르겠다고 하였다. 필요성 인식 율은 주민이 $83\%$, 환자보호자가 $79\%$, 환자가 $78\%$로서 세 집단 간에 유의한 차이 가 있었다. (P<.01). 인구학적 변수별로 보았을 때, 교육수준과 가정수입에 따라 인식 율에는 유의한 차이가 있어서 (P<.001, P<.01), 교육수준이 높을수록, 수입이 많을수록 높았다. 2. 필요성 인식 율은 가정간호사업 이용의사에 따라서도 유의한 차이가 있어서 (P<.001), 이용의사가 많은 군이 인식 율도 높았다. 3. 환자들의 필요성 인식 율은 퇴원시기에 대한 의견과 병원비 지출액에 따라 유의한 차이가 있어서 (P<.05, P<.02), 퇴원시기가 적절하다는 군이 부적절, 하다는 군보다, 또한 병원비 지출액이 적을수록 인식 율이 높았다. 진단명에 따라서는 피부 및 피하조직 진환$(100\%)$, 임신 및 출산에 관련된 합병증$(90\%)$, 신경 및 감각기계 질환$(85\%)$, 부상 및 중독$(83\%)$, 신생물$(79\%)$, 등에서 필요성 인식 율이 높았다. 4. 가정간호사업 이용에 대한 대상자의 의견을 $47.8\%$가 이용할 의사가 있었고, $49.9\%$는 상황에 따라 결정하겠다고 하였으며, $3.2\%$는 이용하지 않겠다고 응답하였다. 인구학적 변수별로 보았을 때, 연령별로는 노년층, 성별로는 남성이, 교육수준은 낮은 군이, 의료보험을 가진 군이 이용할 의사가 많았으며, 통계적으로 유의한 차이가 있었다. (P<.01, p<.001, p<01, p<.01). 5. 환자들의 가정간호사업 이용 의사는 퇴원시의 상태에 따라서 유의한 차이가 있어서 (P<.02), 상태 가 입원 시와 변화가 없거나 악화된 군이 이용할 의사가 많았다. 진단별로는 내분비계 질환$(63\%)$, 신생물$(57\%)$, 혈액 및 조혈기능 장애$(55\%)$, 부상 및 중독$(55\%)$, 등이 이용할 의사가 많았다. 6. 대상자들이 가정간호사업의 장점으로 생각하는 것은 환자의 심리적 안정$(66\%)$, 시간 절약$(57\%)$, 가족의 편이$(57\%)$, 환자 간호에 대해 배운다$(53\%)$, 질병 과정을 배운다$(51\%)$ 등이었다. 7. 대상자들이 가정간호사업의 단점으로 생각하는 것은 응급시에 대처하기가 어렵다$(49\%)$, 환자가 불안해 할 것이다$(41\%)$ 가정환경이 환장에게 부적합하다$(43\%)$ 등이었다. 8. 가정간호사업에서 수용할 수 있는 간호 업무로$50\%$ 이상의 대상자가 지정한 것은 활력징후측정, 경구 및 비경구 투약, 운동과 휴식지도, 개인 위생관리, 보건교육, 정신 심리 간호 등이었다. 9. 가정간호사업에 대한 지불방법은 $32.9\%$가 제공된 업무에 따라 지불해야 한다는 의견으로 가장 많았다.

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Leukoencephalopathy after CNS Prophylactic Therapy in Pediatric Hematologic Malignancy (소아 혈액종양 환자에서 중추신경계 예방적 치료 후 발생한 백질뇌병증)

  • Lee, Jun Hwa;Lee, Sun Min;Choi, Eun Jin;Lee, Kun Soo
    • Clinical and Experimental Pediatrics
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    • v.46 no.6
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    • pp.566-571
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    • 2003
  • Purpose : Leukoencephalopathy(LE) is one of the most serious complications in children with hematologic malignancies during the course of treatment. Early recognition is important to reduce the impact and sequelae from LE. We therefore investigated the clinical features of LE following central nervous system(CNS) prophylaxis in children with hematologic malignancies and evaluated the significance of regular check-ups of brain MRI. Methods : We retrospectively reviewed children with hematologic malignancies who had CNS prophylaxis including intrathecal(IT) methotrexate(MTX) and/or cranial irradiation at the Department of Pediatrics, Kyungpook National University Hospital from Oct. 1995 to May 2002. Fifteen cases of acute leukemia and one case of lymphoma who experienced LE following CNS prophylaxis were included in the study. Clinical data were analyzed from the medical records and brain MRIs were reviewed by neuroradiologists. Results : The ages ranged from 1 to 13 years(median age=5.2 years), and the male to female ratio was 3 : 1. The time interval from the beginning of chemotherapy to the time of diagnosis of LE ranged from 2 to 17 months. They all had IT MTX two to 15 times and ten underwent cranial irradiation(1,800 rads). At the time of diagnosis, ten of them had neuropsychiatric symptoms including seizures, personality changes, headache, etc. After the change of treatment modality, four cases showed significant improvement on follow-up MRIs, six cases had no significant changes and two had worsening of LE. Four patients died of infection and bone marrow relapse. Conclusion : CNS prophylaxis with IT therapy and cranial irradiation may cause leukoencephalopathy during the course of treatment. As a result, regular brain MRI check-up is recommended for the early detection and reducing the incidence of LE, along with changes in the treatment modality.

Changes of Polyamine Metabolism and Delayed Neuronal Degeneration of Hippocampus after Transient Cerebral Ischemia in Mongolian Gerbils (뇌허혈 손상에 있어서 Polyamine 대사의 변동이 해마신경세포의 지연성괴사에 미치는 효과에 관한 연구)

  • Shin, Kyung-Ho;Shin, Hwa-Jung;Lee, Young-Jae;Kim, Hyung-Gun;Choi, Sang-Hyun;Chun, Yeon-Sook;Chun, Boe-Gwun
    • The Korean Journal of Pharmacology
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    • v.32 no.3
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    • pp.323-334
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    • 1996
  • Male Mongolian gerbils $(60{\sim}80g)$ were given DL-difluoromethylornithine (DFMO; 250mg/kg, ip) and methylglyoxal bis(guanylhydrazone) (MGBG; 50 mg/k, ip), respectively, 1 h prior to transient (7 min) occlusion of bilateral common carotid arteries (OBC7) and a daily dose of one of them for 6 days after recirculation, and the polyamine contents, activities of ornithine and S-adenosylmethionine decarboxylases (ODC and SAM-DC), and light microscopic findings of the hippocampus were evaluated. The hippocampal putrescine (PT) levels of the control gerbils treated with saline (STGr), markedly increased after OBC7, showing a peak level at 24 h after recirculation. The peak PT level was reduced in DFMO treated gerbils (DTCr) and in MGBG treated gerbils (MTGr). And 7 days after recirculation, the PT level of DTGr was decreased to about 75% of the PT level in the sham operated group (nonTGr) and to about 55% of the STGr level, respectively. The hippocampal spermidine (SD) level of STGr tended to decline, showing the lowest value at 8 h after recirculation. But the spermidine (SD) level of DTGr was somewhat higher at 8 h after OBC7 than those of STGr and MTGr The hippocampal spermine (SM) levels of all the experimental groups were little changed for 7 days after OBC. OBC7 markedly increased the hippocampal ODC activity. reaching a maximum (about 3 times higher than preischemic level) at 8 h and rapidly recovered to the control value by 24 h in STGr gerbils, and the OBC7-induced increase of ODC activity was significantly attenuated by DFMO or MGBG treatment. Whereas OBC7 induced a rapid decrease of the hippocampal SAMDC activity follwed by gradual recovery to the preischemic level, and the decrease of the SAMDC activity was slightly attenuated by DFMO or MGBG treatment. 7 Days after OBC7 the histological finding of the hippocampal complex stained with cresyl violet showed an extensive delayed neuronal damage in the CA1 region and to a lesser extent, in the dentate gyrus, sparing the CA3 region. And the neuronal death was aggevated by DFMO but significantly attenuated by MGBG. The immunochemical reactivity of hippocampus to anti-GFAP antibody was significantly increased in the CA1 region and to a lesser extent, in the dentate gyrus 7 days after OBC7, but was little changed in the CA3. And the increase of the anti-GFAP immunoreactivity was moderately enhanced by DFMO and significantly suppressed by MGBG. These results suggest that the polyamine metabolism may play a modulatory role in the ischemic brain damage.

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