• Journal of Korean Neurosurgical Society
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• 제47권3호
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• pp.203-209
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• 2010

Objective : The purpose of study was to evaluate the feasibility of brain magnetic resonance (MR) images of the rat obtained using a 1.5T MR machine in several blood-brain barrier (BBB) experiments. Methods : Male Sprague-Dawley rats were used. MR images were obtained using a clinical 1.5T MR machine. A microcatheter was introduced via the femoral artery to the carotid artery. Normal saline (group 1, n = 4), clotted autologous blood (group 2, n = 4), triolein emulsion (group 3, n = 4), and oleic acid emulsion (group 4, n = 4) were infused into the carotid artery through a microcatheter. Conventional and diffusion-weighted images, the apparent coefficient map, perfusion-weighted images, and contrast-enhanced MR images were obtained. Brain tissue was obtained and triphenyltetrazolium chloride (TTC) staining was performed in group 2. Fluorescein isothiocyanate (FITC)-labeled dextran images and endothelial barrier antigen (EBA) studies were performed in group 4. Results : The MR images in group 1 were of good quality. The MR images in group 2 revealed typical findings of acute cerebral infarction. Perfusion defects were noted on the perfusion-weighted images. The MR images in group 3 showed vasogenic edema and contrast enhancement, representing vascular damage. The rats in group 4 had vasogenic edema on the MR images and leakage of dextran on the FITC-labeled dextran image, representing increased vascular permeability. The immune reaction was decreased on the EBA study. Conclusion : Clinical 1.5T MR images using a rat depicted many informative results in the present study. These results can be used in further researches of the BBB using combined clinical MR machines and immunohistochemical examinations.

• Journal of Periodontal and Implant Science
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• 제48권2호
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• pp.92-102
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• 2018

Purpose: This study investigated the validity of the Charlson comorbidity index (CCI) as a predictor of periodontal disease (PD) over a 12-year period. Methods: Nationwide representative samples of 149,785 adults aged ${\geq}60$ years with PD (International Classification of Disease, 10th revision [ICD-10], K052-K056) were derived from the National Health Insurance Service-Elderly Cohort during 2002-2013. The degree of comorbidity was measured using the CCI (grade 0-6), including 17 diseases weighted on the basis of their association with mortality, and data were analyzed using multivariate Cox proportional-hazards regression in order to investigate the associations of comorbid diseases (CDs) with PD. Results: The multivariate Cox regression analysis with adjustment for sociodemographic factors (sex, age, household income, insurance status, residence area, and health status) and CDs (acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebral vascular accident, dementia, pulmonary disease, connective tissue disorders, peptic ulcer, liver disease, diabetes, diabetes complications, paraplegia, renal disease, cancer, metastatic cancer, severe liver disease, and human immunodeficiency virus [HIV]) showed that the CCI in elderly comorbid participants was significantly and positively correlated with the presence of PD (grade 1: hazard ratio [HR], 1.11; P<0.001; grade ${\geq}2$: HR, 1.12, P<0.001). Conclusions: We demonstrated that a higher CCI was a significant predictor of greater risk for PD in the South Korean elderly population.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.155-164
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• 2017

Objective : To evaluate the efficacy of balloon guiding catheter (BGC) during thrombectomy in anterior circulation ischemic stroke. Methods : Sixty-two patients with acute anterior circulation ischemic stroke were treated with thrombectomy using a Solitaire stent from 2011 to 2016. Patients were divided into the BGC group (n=24, 39%) and the non-BGC group (n=38, 61%). The number of retrievals, procedure time, thrombolysis in cerebral infarction (TICI) grade, presence of distal emboli, and clinical outcomes at 3 months were evaluated. Results : Successful recanalization was more frequent in BGC than in non-BGC (83% vs. 66%, p=0.13). Distal emboli occurred less in BGC than in non-BGC (23.1% vs. 57.1%, p=0.02). Good clinical outcome was more frequent in BGC than in non-BGC (50% vs. 16%, p=0.03). The multivariate analysis showed that use of BGC was the only independent predictor of good clinical outcome (odds ratio, 5.19 : 95% confidence interval, 1.07-25.11). More patients in BGC were successfully recanalized in internal carotid artery (ICA) occlusion with small retrieval numbers (<3) than those in non-BGC (70% vs. 24%, p=0.005). In successfully recanalized ICA occlusion, distal emboli did not occur in BGC, whereas nine patients had distal emboli in non-BGC (0% vs. 75%, p=0.001) and good clinical outcome was superior in BGC than in non-BGC (55.6% vs. 8.3%, p=0.01). Conclusion : A BGC significantly reduces the number of retrievals and the occurrence of distal emboli, thereby resulting in better clinical outcomes in patients with anterior circulation ischemic stroke, particularly with ICA occlusion.

• Journal of Acupuncture Research
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• 제29권3호
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• pp.139-148
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• 2012

Objectives : The purpose of this case is to report the improvement of two patients diagnosed with eight and a half syndrome after combination therapy of oriental and western medicine. Methods : We treated the patients with combination therapy of oriental and western medicine such as acupuncture, moxibustion, herbal medication, antithrombotic agents and steroid therapy. Changes of peripheral facial paralysis were evaluated using House-Brackmann facial grading system and the degree of dizziness, tenderness and pain of upper abdomen were assessed using numerous rating scale. Changes in motor grade of upper and lower extremities were evaluated using medical research council scale. Results : We have recently experienced two cases of eight and a half syndrome - a syndrome characterized by the coexistence of one and a half syndrome, a rare ophthalmoparetic syndrome characterized by a conjugate horizontal gaze palsy in one direction and an internuclear ophthalmoplegia in the other, and cranial nerve VII palsy. The one and a half syndrome was caused by acute cerebral infarction. Two patients in this report were improved through combination therapy of oriental and western medicine. Conclusions : We report the clinical course and treatment methods of eight and a half syndrome.

• Journal of Korean Neurosurgical Society
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• 제64권1호
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• pp.60-68
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• 2021

Objective : Until recently, the transfemoral approach (TFA) was used as the primary method of arterial approach in acute ischemic stroke (AIS). However, TFA resulted in longer reperfusion times and worse outcomes in the mechanical thrombectomy (MT) of patients with complex aortic arches and significant carotid tortuosity. We found that the transradial approach (TRA) is a more favorable alternative approach for MT in such cases. Methods : We performed a retrospective review of our institutional database to identify 202 patients who underwent MT for AIS between February 2015 and December 2019. Patient characteristics, cause of TFA failure, procedure time, intra-procedural complications, and outcomes were recorded. Results : Eleven (5.4%) of 202 patients, who underwent MT for AIS, crossed over to TRA for recanalization, and eight (72%) of 11 achieved successful recanalization (≥modified Treatment in Cerebral Infarction 2b). The mean age (mean±standard deviation [median]) was 82.3±6.6 (76) years, and five of the 11 patients were male. The last seen normal to puncture time was 467.9±264.72 (264) minutes; baseline National Institutes of Health Stroke Scale score was 28.9±14.5 (16). Six (55%) of the 11 patients had right vertebrobasilar occlusions, and the remaining five (45%) had anterior circulation occlusive disease. The time from groin puncture to final recanalization time (overall procedural time) was 78.0±20.1 (62) minutes. The mean crossover time from TFA to TRA was 45.2±10.5 (41) minutes. The mean time from radial puncture to final recanalization was 33.8±10.5 (28) minutes. Distal thrombus migration events in previously unaffected territories occurred in 3/8 patients (37%). At 90 days, three patients (28%) had a favorable clinical outcome. Conclusion : Although rare, failure of TFA has been known to occur during MT for AIS. Our results demonstrate that TRA may be an alternative option for AIS intervention for select patients with subsequent timely revascularization. However, the incidence of distal thrombus migration was high, and the first puncture to reperfusion time was prolonged because of the time taken for the crossover to TRA after failure of TFA. This study provides some evidence that the TRA may be a viable alternative option to the TFA for MT of AIS.

• 동의생리병리학회지
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• 제30권4호
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• pp.289-299
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• 2016

This study is aimed to report two cases of chronic kidney disease treated with Korean traditional medicine. We treated the patients with traditional herbal medicine and other treatments including acupuncture. We measured serum creatinine, estimated glomerular filtration rate(eGFR), blood urea nitrogen(BUN), albumin, red blood cell count(RBC), hemoglobin for several times during admission. Case 1 patient was diagnosed with right medulla infarction, bladder stone, chronic kidney disease. The symptoms were quadriplegia, right side dysesthesia, drowsiness and edema. Case 2 patient was diagnosed with acute cerebral infarction, hypertension, chronic kidney disease. The symptoms were right side weakness, delusion, anorexia, low back pain. Case 1 patient was hospitalized for 80 days, and case 2 patient was for 31 days. Korean traditional medicine decreased serum creatinine and BUN level, improved eGFR, increased RBC and hemoglobin. The symptoms of chronic kidney disease such as edema, general body weakness and anorexia were also improved. These cases suggest that Korean traditional medicine can be effective and safe for patients with chronic kidney disease.

• Journal of Chest Surgery
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• 제31권12호
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• pp.1159-1164
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• 1998

배경: 수술수기와 심근보호법의 발달로 인하여 최근 관상동맥우회로 이식술의 수술성적이 향상되고 있지만 술후 사망과 이환에 직면하고 있는 일부 환자들은 점점 증가하고 있어 수술후 이환과 사망에 대한 관심이 높아지고 있다. 대상 및 방법: 저자들은 관상동맥우회로 이식술을 받은 총 137명을 대상으로 술전 위험요인과 술후 이환 및 사망(이하 이환)과의 관계를 후향적으로 조사하였다. 수술전 위험요인으로는 나이, 성별, 술전심근경색, 응급수술, 좌심실박출계수, 비만 그리고 3혈관 질환 등 7개의 변수를 선택하였으며 수술후 이환은 부정맥, 상처감염, 뇌손상, 술후입원기간의 장기화, 폐렴, 급성신부전증, 인공호흡기의 장기간 사용 그리고 수술사망 등으로 하고 이중 하나만 발생하여도 이환이 있다고 간주하였다. 결과: 전체 환자의 평균 나이는 56.7세였고, 27세부터 74세까지의 분포를 보였다. 전체 환자의 수술사망률은 6.6%였고 이중 계획수술은 3.9%(5/128), 응급 또는 긴급수술은 44.4%(4/9)의 사망률을 보였다. 65세 이상의 환자에서 이환율은 65세 미만의 환자보다 통계적으로 유의하게 높았다. 성별에 의한 이환율의 차이는 없었으나 수술 사망률은 여자(5/41, 12.19%)에게서 남자(4/96, 4.17%)보다 더 높게 나타났다. 응급수술의 이환율은 100%로 계획수술의 환자에서보다 유의하게 높게 나타났다. 술전 좌심실 박출계수가 50% 미만인 환자에서 50% 이상인 환자보다 사망률이 유의하게 높게 나타났다. 결론: 결론적으로 관상동맥우회로 이식술 후 이환의 위험요인은 65세 이상의 고령과 응급 또는 긴급수술이었고 수술사망의 위험요인은 50% 미만의 술전 좌심실 박출계수와 응급 또는 긴급수술이었다.

• Journal of Chest Surgery
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• 제44권3호
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• pp.215-219
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• 2011

Background: Selective antegrade perfusion via axillary artery cannulation along with circulatory arrest under deep hypothermia has became a recent trend for performing surgery on the ascending aorta and aortic arch and when direct aortic cannulation is not feasible. The authors of this study tried using moderate hypothermia with right brachial and femoral artery perfusion to complement the pitfalls of single axillary artery cannulation and deep hypothermia. Materials and Methods: A retrospective analysis was performed on 36 patients who received ascending aorta or aortic arch replacement between July 2005 and May 2010. The adverse outcomes included operative mortality, permanent neurologic dysfunction and temporary neurologic dysfunction. Results: Of these 36 patients, 32 (88%) were treated as emergencies. The mean age of the patients was 61.9 years (ranging from 29 to 79 years) and there were 19 males and 17 females. The principal diagnoses for the operation were acute type A aortic dissection (31, 86%) and aneurysmal disease without aortic dissection (5, 14%). The performed operations were ascending aorta replacement (9, 25%), ascending aorta and hemiarch replacement (13, 36%), ascending aorta and total arch replacement (13, 36%) and total arch replacement only (1, 3%). The mean cardiopulmonary bypass time was $209.4{\pm}85.1$ minutes, and the circulatory arrest with selective antegrade perfusion time was $36.1{\pm}24.2$ minutes. The lowest core temperature was $24{\pm}2.1^{\circ}C$. There were five deaths within 30 post-op days (mortality: 13.8%). Two patients (5.5%) had minor neurologic dysfunction and six patients, including three patients who had preoperative cerebral infarction or unconsciousness, had major neurologic dysfunction (16.6%). Conclusion: When direct aortic cannulation is not feasible for ascending aorta and aortic arch replacement, the right brachial and femoral artery can be used as arterial perfusion routes with the patient under moderate hypothermia. This technique resulted in acceptable outcomes.

• Korean Journal of Radiology
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• 제22권11호
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• pp.1875-1885
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• 2021

Objective: Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. Materials and Methods: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. Results: A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. Conclusion: Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.

• 대한방사선기술학회지:방사선기술과학
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• 제32권3호
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• pp.313-323
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• 2009

확산강조영상 (diffusion weighted image, DWI)은 급성 뇌경색, 뇌종양, 뇌백질 질환, 뇌 막질의 확산 정도 등 여러 뇌질환의 진단을 획기적으로 향상시켰으며 그 활용도가 증가하고 있다. 본 연구는 $10{\sim}60$대 환자들의 뇌를 대상으로 두 기법간의 신호강도, 현성확산계수의 평균치를 측정하였다. 그 결과, 확산강조영상에서의 신호강도 평균값은 편도체부 (amygdala)가 가장 높고, 뇌척수액(cerebrospinal fluid)에서 가장 낮았다. 현성확산계수의 평균값은 뇌척수액이 높고, 교뇌 (pons)가 낮게 측정되었다. 확산강조 신호강도와 현성확산계수의 평균값은 $T_2^*$-DW-EPI 기법이 FLAIR-DW-EPI 기법보다 높고, b-value의 변화에 따른 평균값은 두 기법의 b-value에 모두 반비례하였다. 또한 뇌경색환자의 뇌의 시간 경과에 따른 분석결과, 초급성뇌경색 환자의 일반적인 MR 영상에서는 병변부분이 명확하지 않았으나 확산강조영상에서는 고신호강도로 나타났다. 출혈성 뇌경색, 급성 뇌경색 등 여러질환별로 분석한 결과 그 두 기법의 특성에 따라 신호강도의 값이 차이가 클수록 현성확산계수는 낮게 나타났다. 결론적으로 뇌 질환이 자주 발생되는 부위와 뇌 질환의 확산강조 신호강도 및 현성확산계수 값은 b-value의 변환과 영상기법에 따라 각각 다르게 나타났다. 이러한 정량적인 결과를 바탕으로 보다 안정적인 기법과 적절한 b-value 값을 이용하여 검사를 한다면 여러 뇌의 질환 및 병변 등을 발견, 판독하는 것뿐만 아니라 정상부위나 질환에 따른 기법별 신호의 인지를 통한 정확한 질병 진단과 치료에 중요한 의미가 있다고 사료된다.