• Journal of Trauma and Injury
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• 제28권4호
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• pp.232-240
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• 2015

Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was $105.64{\pm}24.60mm\;Hg$, and the mean heart rate was $103.64{\pm}20.02per$ minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was $21.82{\pm}16.37hours$. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.

• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.150-154
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• 2015

Cerebral venous sinus thrombosis (CVST) following a closed head injury in pediatric patients is a rare condition, and an early spontaneous recanalization of this condition is extremely rare. A 10-year-old boy was admitted with a mild, intermittent headache and nausea five days after a bicycle accident. The brain computed tomography showed an epidural hematoma at the right occipital area with pneumocephalus due to a fracture of the occipital skull bone. The brain magnetic resonance imaging and the magnetic resonance venography demonstrated a flow signal loss from the right sigmoid sinus to the right jugular vein. The diagnosis was sigmoid sinus thrombosis, so close observations were selected as a treatment for the patient because of his gradually improving symptoms; however, he complained of vomiting 14 days the after conservative treatment. The patient was readmitted for a further examination of his symptoms. The laboratory and the gastroenterological examinations were normal. Due to concern regarding the worsening of the sigmoid sinus thrombosis, the brain magnetic resonance venography was rechecked and it revealed the recanalization of the venous flow in the sigmoid sinus and in the jugular vein.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.370-376
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• 2011

Objective : Posttraumatic cerebral infarction (PTCI), an infarction in well-defined arterial distributions after head trauma, is a known complication in patients with severe head trauma. The primary aims of this study were to evaluate the clinical and radiographic characteristics of PTCI, and to assess the effect on outcome of decompressive hemicraniectomy (DHC) in patients with PTCI. Methods : We present a retrospective analysis of 20 patients with PTCI who were treated between January 2003 and August 2005. Twelve patients among them showed malignant PTCI, which is defined as PTCI including the territory of Middle Cerebral Artery (MCA). Medical records and radiologic imaging studies of patients were reviewed. Results : Infarction of posterior cerebral artery distribution was the most common site of PTCI. Fourteen patients underwent DHC an average of 16 hours after trauma. The overall mortality rate was 75%. Glasgow outcome scale (GOS) of survivors showed that one patient was remained in a persistent vegetative state, two patients were severely disabled and only two patients were moderately disabled at the time of discharge. Despite aggressive treatments, all patients with malignant PTCI had died. Malignant PTCI was the indicator of poor clinical outcome. Furthermore, Glasgow coma scale (GCS) at the admission was the most valuable prognostic factor. Significant correlation was observed between a GCS less than 5 on admission and high mortality (p<0.05). Conclusion : In patients who developed non-malignant PTCI and GCS higher than 5 after head injury, early DHC and duroplasty should be considered, before occurrence of irreversible ischemic brain damage. High mortality rate was observed in patients with malignant PTCI or PTCI with a GCS of 3-5 at the admission. A large prospective randomized controlled study will be required to justify for aggressive treatments including DHC and medical treatment in these patients.

• Childhood Kidney Diseases
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• 제28권1호
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• pp.44-50
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• 2024

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease that affects multiple organs. More than half of the patients with SLE have kidney involvement, and up to 10% of patients with lupus nephritis develop end-stage renal disease (ESRD). Central nervous system (CNS) involvement in SLE occurs in 21% to 95% of patients. Severe neurological manifestations such as seizures, cerebrovascular disease, meningitis, and cerebrovascular accidents can develop in childhood-onset SLE, but cerebral infections, such as brain abscess and hemorrhage, are seldom reported in lupus nephritis, even in adults. Here, we report a rare case of childhood-onset SLE with ESRD, cerebral abscess, and hemorrhage. A 9-year-old girl diagnosed with lupus nephritis was administered high-dose steroids and immunosuppressant therapy to treat acute kidney injury (AKI) and massive proteinuria. The AKI deteriorated, and after 3 months, she developed ESRD. She received hemodialysis three times a week along with daily peritoneal dialysis to control edema. She developed seizures, and imaging showed a brain abscess. This was complicated by spontaneous cerebral hemorrhage, and she became unstable. She died shortly after the hemorrhage was discovered. In conclusion, CNS complications should always be considered in clinical practice because they increase mortality, especially in those with risk factors for infection.

• The Journal of Korean Physical Therapy
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• 제11권2호
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• pp.61-73
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• 1999

This study was performed to investigate the degree of demand and general features of services required of home visiting physical therapy for chronic ill patients. The study subjects were ambulatory and admitted patients treated with physical therapy at six general and one oriental hospitals, one welfare center, four health centers located in Taejon from March 2, 1999 to March 16. Authors developed structured questionnaire, and distributed it to each physical therapist of study organizations. Total number of distributed questionnaire was 500, and 405 questionnaire were collected and analysed finally. 1. $82.4\%$ of patients and $90.0\%$ of caregivers are showed that home visiting physical therapy was needed(p<0.05) 2. The rate of necessity for home visiting physical therapy by kinds of disease was $949\%$ in cerebral palsy, $95.0\%$ in upper spinal cord injury, $83.3\%$ in lower spinal cord injury, $84.5\%$ in cerebral vascular accident, $89.6\%$ in traumatic brain injury, $83.5\%$ in other diseases. 3. In the general features of required service for home visiting physical therapy, $33.7\%$ of patients and $34.4\%$ of caregivers want special isolated physical therapy center, $33.1\%$ of patients and $43.3\%$ of caregivers want 3 times per week in frequency, $46.7\%$ of patients and $45.0\%$ of caregivers want 30-60minutes in treatment duration, and $48.0\%$ of patients and $46.7\%$ of caregivers want more intensive care than general hospitals. 4. In the working place of home visiting physical therapy, $36.1\%$ of patients and $36.2\%$ of caregivers wants physical therapist worked in general hospital. Also, $53.3\%$ of patients and $52.2\%$ of caregivers answered no interested in physical therapist's gender. The most preferential age of home visiting physical therapist is thirties in $43.2\%$ of patients and $63.4\%$ in caregivers

• 한국전문물리치료학회지
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• 제12권3호
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• pp.67-73
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• 2005

Prospective memory (PM) is related to remember to carry out a previously intented behaviour. The purpose of this study was to develop a paradigm for measuring PM function to diagnosis in mild cognitive impairment 1 or brain injury in patients 2. among brain injured patients Thirty-eight normal healthy subjects participated in current study. The paradigm was composed of four conditions: a baseline and three intention conditions (expectation, execution 1 and 2). In the expectation condition, subjects were asked to make a new response to intented stimuli during ongoing task, but the intented stimuli never occurred. In the execution 1 (one type of expected stimulus) and 2 (two types of expected stimuli), the intended stimuli did occur in 20% of trials. The reaction time and error rate were calculated in each condition. Repeated measures using ANOVA of subject's mean reaction times (RTs) and mean error rates (ERs) showed main effects of conditions during ongoing task. The comparison of PM tasks in executive condition 1 and 2 also showed significance in RTs and ERs. This paradigm reflects sufficiently the performance of prospective memory function during ongoing task in normal individuals. Thus, we suggest that the paradigm will be helpful to study neural network of PM function using brain imaging techniques and diagnosis of PM dysfunction.

• 인간행동과 음악연구
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• 제18권2호
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• pp.67-85
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• 2021

본 연구에서는 중국 내 성인 뇌손상 환자를 대상으로 음악을 활용한 중재 연구들을 고찰하여 전반적인 특징과 음악중재 및 음악 특성에 대해 분석하였다. 연구 내 자료 선정기준에 따라 총 83편의 연구를 수집하여 분석한 결과는 다음과 같다. 2012년 이후 음악을 활용한 중재연구가 증가하였고, 이 중 무작위 대조군 연구설계가 가장 많았으며 뇌졸중 환자를 대상으로 진행한 연구가 가장 높은 비중을 차지하였다. 중재영역별로 분류한 결과 신체영역과 정서영역은 유사한 비중을 차지하였고, 음악치료사가 시행한 연구는 14편(24.5%)으로, 타 분야의 연구자에 의해 시행된 43편(75.4%)보다 적은 것으로 확인되었다. 중재 제공자의 전문 분야에 따라 중재의 특성에도 차이가 있었다. 타 분야 연구자가 중재한 연구들은 정서영역을 목표로 하여 기존의 녹음 음악을 사용한 감상 활동을 주로 진행 한 반면, 음악치료 전공자가 중재한 연구들은 신체영역의 목표를 위해 치료사가 재구성한 음악을 라이브로 제공한 경우가 많았다. 중재 내용의 기술 수준 및 기법의 적절성 평가 결과를 살펴보면 향후 중국 내 음악치료 연구에서 음악의 치료적 고유성과 중재자 전문성에 기반한 중재연구가 진행되어야 할 뿐 아니라, 연구 내 중재 기법을 구성하는 치료적 근거가 명확하게 기술되어야 함을 시사한다.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.730-737
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• 2017

Objective : Postoperative hydrocephalus is a common complication following craniectomy in patients with traumatic brain injury, and affects patients' long-term outcomes. This study aimed to verify the risk factors associated with the development of hydrocephalus after craniectomy in patients with acute traumatic subdural hemorrhage (tSDH). Methods : Patients with acute traumatic SDH who had received a craniectomy between December 2005 and January 2016 were retrospectively assessed by reviewing the coexistence of other types of hemorrahges, measurable variables on computed tomography (CT) scans, and the development of hydrocephalus during the follow-up period. Results : Data from a total of 63 patients who underwent unilateral craniectomy were analyzed. Postoperative hydrocephalus was identified in 34 patients (54%) via brain CT scans. Preoperative intraventricular hemorrhage (IVH) was associated with the development of hydrocephalus. Furthermore, the thickness of SDH (p=0.006) and the extent of midline shift before craniectomy (p=0.001) were significantly larger in patients with postoperative hydrocephalus. Indeed, multivariate analyses showed that the thickness of SDH (p=0.019), the extent of midline shift (p<0.001) and the coexistence of IVH (p=0.012) were significant risk factors for the development of postoperative hydrocephalus. However, the distance from the midline to the craniectomy margin was not an associated risk factor for postoperative hydrocephalus. Conclusion : In patients with acute traumatic SDH with coexisting IVH, a large amount of SDH, and a larger midline shift, close follow-up is necessary for the early prediction of postoperative hydrocephalus. Furthermore, craniectomy margin need not be limited in acute traumatic SDH patients for the reason of postoperative hydrocephalus.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.247-253
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• 2012

Purpose: Hemorrhage is a main cause of death in trauma patients. The goal of this study is to describe the characteristics of trauma patients with massive bleeding and to evaluate the prognostic factors concerning their survival. Methods: This study was performed retrospectively and included trauma patients with massive bleeding who had been treated from March 2007 to August 2012. The inclusion criterion was patients who received more than 10 U of packed red blood cells within the first 24 hours after visiting the emergency department. Based on their medical records, we collected data in terms of demographic findings, mechanisms of injury, initial clinical and laboratory findings, methods for hemostasis (emergency surgery and/or angioembolization), transfusion, injury severity score (ISS), revised trauma score (RTS) and trauma and injury severity score (TRISS). We used the Mann-Whitney U test and Fisher's exact test to compare the variables between the patients that survived and those that did not. We performed a logistic regression analysis with the significant variables from the univariate test. Results: Thirty-two(32) patients were enrolled. The main mechanisms of injury were falls and motor vehicle accidents. The mean transfusion amount of packed red blood cells (PRBC) was 17.4 U. The mean elapsed time for the first hemostasis (surgery or embolization) was 3.5 hours. The initial technical success rates were 83.3%(15/18) in angioembolization and 66.7%(8/12) in surgery. The overall mortality rate was 34.4%(11/32). The causes of death were bleeding, brain swelling and multiple organ failure. The ISS(25.5 vs 46.3, p=0.000), TRISS(73.6 vs 45.1, p=0.034) and base excess(<-12 mmol/L, p=0.020) were significantly different between the patients who survived and those who did not. Conclusion: The ISS was a prognostic factor for trauma patients with massive bleeding.

• 대한핵의학회지
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• 제34권6호
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• pp.445-455
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• 2000

목적: TBI 환자의 SPECT상 혈류장애를 보이는 부위의 분포를 조사하였으며 대뇌피질과 동반된 시상의 혈류변화를 관찰하여 환자의 인지 및 행동 장애 정도를 예측 할 수 있는지 알아보고자 하였다. 대상 및 방법: TBI 후 $0.5{\sim}55$개월까지(평균 10.3개월) 뇌손상 평가를 위해 MRI영상과 Tc-99m ECD SPECT를 시행한 103명의 환자를 대상으로 하였고 남자 81명과 여자 22명이었으며, 평균연령은 $34.7{\pm}15.4$세였다. 대상환자들은 MRI영상에서 정상, 국소손상 또는 미만성 손상여부에 따라 3군으로 나누었다. 신경심리학적 검사는 정신과 의사에 의한 행동 및 성격변화의 관찰과 임상심리사에 의한 인지기능검사에 의해 총 11개의 항목이 평가되었다. SPECT에서 혈류감소를 보이는 대뇌피질의 분포를 비교하였으며 대뇌피질과 시상의 혈류감소를 같이 보인 경우와 시상의 혈류가 정상인 경우로 나누어 인지 및 행동 장애정도와 관계가 있는지 Mann-whitney의 U검정을 이용하여 유의성을 알아보았다 결과: 혈류감소를 보인 병변의 분포는 전두엽(1군 42.3%, 2군 34.5%, 3군 33.3%), 측두엽($24{\sim}26%$), 시상($21{\sim}22.4%$), 두정엽과 후두엽(10%이하)순이었다. 또한 대뇌피질과 시상의 혈류감소가 같이 있었던 경우와 시상이 정상 혈류를 보였던 경우 신경정신과적 증상을 보인 항목 수와 비교한 결과 1군에서는 전자와 후자의 경우 각각 $4.7{\pm}1.5$개와 $3.2{\pm}1.4$개였으며, 2군에서 $5.0{\pm}1.1$개와 $4.8{\pm}1.2$개, 3군에서는 $6.8{\pm}1.8$개와 $6.3{\pm}1.1$개로 MRI에서 손상의 정도가 많을수록 신경정신과적 후유증은 많았으나 SPECT에서 시상의 혈류감소 유무에 따른 증상의 심각성과 관계는 1군에서만 유의하였다(p=0.002). 결론: TBI 후 기질적 정신장애를 갖는 환자의 뇌혈류 SPECT에서 혈류감소를 보이는 병변은 주로 전두엽, 측두엽, 시상순으로 많았고 특히 전두엽은 MRI에서 정상을 보인 군에서 더욱 많은 비율을 차지하였다. MRI에서 정상일 때 SPECT에서 대뇌피질과 시상의 혈류감소가 같이 동반된 경우 시상이 정상혈류를 보인 경우보다 인지 및 행동장애의 심각성과 유의한 관계를 보였다.