• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.355-359
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• 2006

Objective : The purpose of our study is to examine the clinical significance of vertebrobasilar artery[VBA] fenestration and duplication. In addition, we review its incidence and pathogenesis. Methods : Cerebral angiography was performed in 803 patients and magnetic resonance angiography[MRA] in 880; the patients had or were suspected to have cerebrovascular disease. We retrospectively reviewed angiography and MRA. Results : Fifteen patients [eight men, seven women, 3 to 77 years of age, median age = 58 years] had a VBA fenestration and duplication. Seven [7/803 = 0.87%] of the patients undergoing cerebral angiography revealed fenestrations and one duplication of VBA. Ten patients [10/880 = 114%] among 880 patients that underwent MRA demonstrated fenestration of basilar artery[BA]. Two of 66 patients that underwent both conventional cerebral angiography and cranial MRA showed a fenestration of BA. Twelve fenestrations were located in the proximal portion of the BA and one was in the mid portion of the BA. One vertebral artery[VA] fenestration was located in the intracranial portion of the right VA, and one VA duplication was at the level of $C_{1-2}$ in the left VA. Conclusion : In addition to medial defects, flow phenomena at the proximal end of fenestrations, where hemodynamic stress and increased turbulence are present, may contribute to aneurysm formation. And arterial fenestration is a predisposing factor in vascular injury and cerebral ischemia.

• The Journal of Internal Korean Medicine
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• v.23 no.2
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• pp.253-259
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• 2002

Medial medullary infarction is caused by occlusion of vertebral artery or lower basilar artery. In this report, one case had impaired pain and thermal sense over half the body, and complained of dizziness, nausea and vomiting. The other symptoms were slippery pulse(脈滑), pale tongue with whitish coating(舌淡苔白), white face(面白), obesity(體肥) and unchanged skin color(肌色如故). We diagnosed this patient as the Gastrointestinal Phlegm(食痰) and prescribed Jengjengamiyijin-tang (Zhengchuanjiaweierchen-tang). The symptoms of impaired pain and thermal sense, dizziness, nausea, and vomiting were improved. So, we suggest that Jengjengamiyijin-tang (Zhengchuanjiaweierchen-tang) could be effective to the patient with the symptom of the Gastrointestinal Phlegm(食痰)

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.187-192
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• 2012

Objective : Stent-assisted coiling on intracranial aneurysm has been considered as an effective technique and has made the complex aneurysms amenable to coiling. To achieve reconstruction of intracranial vessels with preservation of parent artery the use of stents has the greatest potential for assisted coiling. We report the results of our experiences in ruptured wide-necked intracranial aneurysms using Y-stent coiling. Methods : From October 2003 to October 2011, 12 patients (3 men, 9 women; mean age, 62.6) harboring 12 complex ruptured aneurysms (3 middle cerebral artery, 9 basilar tip) were treated by Y-stent coiling by using self-expandable intracranial stents. Procedural complications, clinical outcome, and initial and midterm angiographic results were evaluated. The definition of broad-necked aneurysm is neck diameter over than 4 mm or an aneurysm with a neck diameter smaller than 4 mm in which the dome/neck ratio was less than 2. Results : In all patients, the aneurysm was successfully occluded with no apparent procedure-related complication. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. Follow-up studies showed stable and complete occlusion of the aneurysm in all patients with no neurologic deficits. Conclusion : The present study did show that the Y-stent coiling seemed to facilitate endovascular treatment of ruptured wide-necked intracranial aneurysms. More clinical data with longer follow-up are needed to establish the role of Y-stent coiling in ruptured aneurysms.

• Journal of Korean Neurosurgical Society
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• v.57 no.2
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• pp.119-122
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• 2015

Objective : To investigate the efficacy of endoscopic third ventriculostomy (ETV) for infantile hydrocephalus. Methods : Retrospectively reviewed the 17 infantile hydrocephalus cases who were treated with ETV between July 2009 and June 2013. The study includes 17 patients (4 Han and 13 Hui) between the ages of 51 and 337 days. Five cases with encephalitis history and 2 cases with cerebral hemorrhage, with the remaining 10 cases congenital hydrocephalus. ETVs were performed for all patients with 1 case failing because the severe ventricle inflammatory adhesion, excessive exudation, and vague basilar artery. Results : Among the 16 successful cases 7 cases improved remarkably : heads and ventricles reduced and cerebral cortexes thickening morphologically. The ventricles of the remaining cases were unchanged. Conclusion : The ethnic minority account for the majority of the patients in this study. ETV is effective for infantile obstructive hydrocephalus.

• The Journal of Korean Medicine
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• v.21 no.1
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• pp.109-113
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• 2000

A hiccup is an involuntary, spasmodic contraction of the diaphragm accompanied by a sudden closure of the glottis, which is reported commonly in patients with brain stem disease such as ischemic stroke, dolichoectatic basilar artery, tumor, encephalitis, and multiple sclerosis. 1) Intractable hiccup is an uncommon, chronic and incapacitating disturbance defined as a hiccup bout lasting more than 48hours or recurring despite various treatments and affecting male subjects more than female. 2) Constipation and hiccup are common symptoms in stroke patients and purgation therapy has been often used. We discovered two patients who had a hiccup symptom after purgation therapy(diarrhea) and so reported course and result of treatment.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.210-219
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• 2004

Extracellular $K^{+}$ concentration ([ $K^{+}$]$_{0}$ ) can be increased within several mM by the efflux of intracellular $K^{+}$. To investigate the effect of an increase in [ $K^{+}$]$_{0}$ on vascular contractility, we attempted to examine whether extracellular $K^{+}$ might modulate vascular contractility, endothelium-dependent relaxation (EDR) and intracellular $Ca^2$$^{+}$ concentration ([C $a^2$$^{+}$]$_{i}$ ) in endothelial cells (EC). We observed isometric contractions in rabbit carotid, superior mesenteric, basilar arteries and movse aorta. [C $a^2$$^{+}$]$_{i}$ was recorded by microfluorimeter using Fura-2/AM in EC. No change in contractility was recorded by the increase in [ $K^{+}$]$_{0}$ from 6 to 12 mM in conduit artery such as rabbit carotid artery. whereas resistant vessels, such as basilar and branches of superior mesenteric arteries (SMA), were relaxed by the increase. In basilar artery, the relaxation by the increase in [ $K^{+}$]$_{0}$ to from 1 to 3 mM was bigger than that by the increase from 6 to 12 mM. In contrast, in branches of SMA, the relaxation by the increase in [ $K^{+}$]$_{0}$ to from 6 to 12 mM is bigger than that by the increase from 1 to 3 mM. $Ba^2$$^{+}$ (30 $\mu$M) did not inhibit the relaxation by the increase in [ $K^{+}$]$_{0}$ from 1 to 3 mM but did inhibit the relaxation by the increase from 6 to 12 mM. In the mouse aorta without the endothelium or treated with $N^{G}$_nitro-L-arginine (30 $\mu$M), nitric oxide synthesis blocker, the increase in [ $K^{+}$]$_{0}$ from 6 to 12 mM did not change the magnitude of contraction induced either norepinephrine or prostaglandin $F_2$$_{\alpha}$. The increase in [ $K^{+}$]$_{0}$ up to 12 mM did not induce contraction of mouse aorta but the increase more than 12 mM induced contraction. In the mouse aorta, EDR was completely inhibited on increasing [ $K^{+}$]$_{0}$ from 6 to 12 mM. In cultured mouse aorta EC, [C $a^2$$^{+}$]$_{i}$ , was increased by acetylcholine or ATP application and the increased [C $a^2$$^{+}$]$_{i}$ , was reduced by the increase in [ $K^{+}$]$_{0}$ reversibly and concentration-dependently. In human umbilical vein EC, similar effect of extracellular $K^{+}$ was observed. Ouabain, a N $a^{+}$ - $K^{+}$ pump blocker, and N $i^2$$^{+}$, a N $a^{+}$ - $Ca^2$$^{+}$ exchanger blocker, reversed the inhibitory effect of extracellular $K^{+}$. In resistant arteries, the increase in [ $K^{+}$]$_{0}$ relaxes vascular smooth muscle and the underlying mechanisms differ according to the kinds of the arteries; $Ba^2$$^{+}$-insensitive mechanism in basilar artery and $Ba^2$$^{+}$ -sensitive one in branches of SMA. It also inhibits [C $a^2$$^{+}$]$_{i}$ , increase in EC and thereby EDR. The initial mechanism of the inhibition may be due to the activation of N $a^{+}$ - $K^{+}$pump. activation of N $a^{+}$ - $K^{+}$pump.p.p.p.

• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.75-80
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• 2012

Objective : To optimize the recanalization of acute cerebral stroke that were not effectively resolved by conventional intraarterial thrombolysis (IAT), we designed a double device technique to allow for rapid and effective reopening. In this article, we describe the feasibility and efficacy of this technique. Methods : From January 2008 to September 2009, twenty patients with acute cerebral arterial occlusion (middle cerebral artery : n=12; internal carotid artery terminus : n=5; basilar artery : n=3) were treated by the double device technique. This technique was applied when conventional thrombolytic methods using drug, microwires, microcatheters and balloons did not result in recanalization. In the double device technique, two devices are simultaneously placed at the lesion (for example, one microcatheter and one balloon or two microcatheters). Chemicomechanical or mechanicomechanical thrombolysis was performed simultaneously using various combinations of two devices. Recanalization rates, procedural time, complications, and clinical outcomes were analyzed. Results : The initial median National Institute of Health Stroke Scale (NIHSS) was 16 (range 5-26). The double device technique was applied after conventional IAT methods failed. Recanalization was achieved in 18 patients (90%). Among them, 55% (11 cases) were complete (thrombolysis in cerebral infarction 2B, 3). The median thrombolytic procedural time including the conventional technique was $135{\pm}83.7$ minutes (range 75-427). Major symptomatic hemorrhages (neurological deterioration ${\geq}4$ points in NIHSS) developed in two patients (10%). Good long term outcomes (modified Rankin Scale ${\leq}2$ at 90 days) occurred in 25% (n=5) of the cases. Mortality within 90 days developed in two cases (10%). Conclusion : The double device technique is a feasible and effective technical option for large vessel occlusion refractory to conventional thrombolysis.

• Journal of Korean Neurosurgical Society
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• v.47 no.1
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• pp.36-41
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• 2010

Objective: The aim of this study was to investigate the morphological characteristics of the thalamoperforating arteries that arise from the P1 segment of the posterior cerebral artery. Methods: Thalamoperforating arteries located in the interpeduncular fossa were dissected in 26 formalin-fixed human cadaver brains. We investigated the origin site of thalamoperforating arteries from the P1 segment, number and diameter. and variations in their origin. Results: Thalamoperforating arteries arose from the superior, posterior or posterosuperior surfaces of the P1 segment at the mean 1.93 mm (range, 0.41-4.71 mm) distance from the basilar apex and entered the brain through the posterior perforated substance. The average number was 3.6 (range 1-8) and mean diameter was 0.70 mm (range 0.24-1.18 mm). Thalamoperforating arteries could be classified into five different types according to their origin at the P1 segment: Type I (bilateral multiple), 38.5%; Type II (unilateral single, unilateral multiple), 26.9%; Type III (bilateral single), 19.2%; Type IV (unilateral single), 11.5%; Type V (unilateral multiple), 3.8%. In 15.4% of all specimens. thalamoperforating arteries arose from the only one side of P1 segment and were not noted in the other side. In such cases, the branches arising from the one side of P1 segment supplied the opposite side. Conclusion: Variations in the origin of the thalamoperforating arteries should be keep in mind to perform the surgical clipping, endovascular treatment or operation involving the interpeduncular fossa. In particular, unilateral single branch seems to be very risky and significant for surgical technique or endovascular treatment.

• Korean Journal of Veterinary Service
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• v.47 no.1
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• pp.55-59
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• 2024

A 4-year-old, spayed female German Shepherd dog (GSD) weighing 22.4 kg was referred to Chungnam National University Veterinary Medicine Teaching Hospital with the chief complaint of a cardiac murmur. A continuous murmur was detected at the left basilar region upon auscultation. In the thoracic radiographs, slight bulging of the aorta, the main pulmonary artery, and the left atrium were observed. Echocardiography revealed continuous turbulent flow directed from the main pulmonary artery towards the pulmonary valve and consistently within the main pulmonary artery. Based on all the results, a diagnosis of type II A patent ductus arteriosus (PDA) was made, and plans were established to treat it with transcatheter occlusion. Transcatheter occlusion was performed using a vascular plug and successfully deployed at the PDA. The patient did not exhibit any complications. GSDs are relatively less common compared to small-breed dogs in South Korea. Considering that GSDs are predisposed to PDA, it is crucial to periodically assess the presence of PDA through auscultation and echocardiography, even in the absence of clinical signs. Transcatheter occlusion using a vascular plug can be an option for treatment and can yield favorable outcomes.

• The Korean Journal of Pharmacology
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• v.32 no.1
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• pp.39-49
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• 1996

In the present study, we observed change in intracellular $Ca^{2+}$$([Ca^{2+}]_i)$ as measured with the fluorescent $Ca^{2+}-indicator$ fura-2 in association with force development of the rat basilar arteries during activation by$K^+$ depolarizing solution and U46619, a thromboxane analogue, in the absence and the presence of calcitonin-gent related peptide (CGRP). CGRP (30 and 100 nM) caused a concentration-dependent inhibition of U46619-induced contraction with decrease in $[Ca^{2+}]_i$, whereas it did not exert any effect on the $K^+$ (90 mM)-induced contraction and increase in $[Ca^{2+}]_i$, Further, $[Ca^{2+}]_i-force$ relationships were determined by plotting the ratio of $F_{340}/F_{380}$ $([Ca^{2+}]_i)$ as a function of the force induced by U46619, and the results were compared with those obtained in the presence of CGRP. The curves obtained in the presence of CGRP (30 and 100 nM) were significantly moved to downward without right shift of the curves suggesting that CGRP inhibited the U46619-induced contraction only by mediation of reduction in $[Ca^{2+}]_i$ with out any change in the sensitivity of contractile apparatus to $Ca^{2+}$. The CGRP-induced attenuation of $[Ca^{2+}]_i$ and force development was significantly inhibited under pretreatment with CGRP $(8{\sim}37)$ fragment (100 nM), a CGRP1 receptor antagonist. Both the reduced contraction and reduction in $[Ca^{2+}]_i$ caused by CGRP were fully reversed by pretreatment with charybdotoxin (100 nM) and iberiotoxin (100 nM), large conductance $Ca^{2+}-activated$ $K^+$ channel blockers, but not by apamin (300 nM), a small conductance $Ca^{2+}-activated$ $K^+$ channel blocker, and glibenclamide ( 1 ${\mu}M$), an ATP-sensitive $K^+$ channel blocker. In conclusion, it is suggested that the CGRP1 receptor, upon activation by CGRP, are coupled to opening of $Ca^{2+}-activated$ $K^+$ channel and cause to decrease in $[Ca^{2+}]_i$, thereby leading to vasodilation of the rat basilar artery. However, it is not defined that the mechanism underlying vasodilation whether the $K^+$ channel blockers, charybdotoxin and iberiotoxin directly block the CGRP receptors and that CGRP-evoked relaxation is dependent on the cyclic AMP or $K^+$ channel opening or both actions.