• Journal of Korean Neurosurgical Society
• /
• v.30 no.6
• /
• pp.705-710
• /
• 2001

Objective : Postoperative seizure is a well documented complication of aneurysm surgery. The purpose of the present study was to analyze risk factors for postoperative seizure. Methods : Between January 1990 and December 1996, we performed craniotomy for ruptured cerebral aneurysms in 321 patients. Among them 206 patients who could be followed up for more than 1 year(range, 1 to 4.6 years) were enrolled to present study. All patients were treated with anticonvulsants for 3 to 18 months postoperatively. We analyze the incidence of postoperative seizure in different sex and age groups, and risk factors associated with postoperative seizures following aneurysm rupture. For statistical processing chi-square test and Fisher's exact test were used. Results : In the follow-up period of 1 to 4.6 years(mean, 1.8 years) postoperative seizure appeared in 18 out of 206 patients(8.7%). Mean latency between the operation and the first seizure was 6 months(range, 3 weeks to 18 months). The age of the patients has significant influence on the risk of seizure, it occurred more often in younger patients(p =0.0014). Aneurysm location in the MCA was associated with a significantly a higher risk of seizure(p = 0.042). Eight patients(19%) out of 42 patients who suffered delayed ischemic neurologic deficit(DID) developed seizure. Delayed ischemic neurologic deficit was associated with significantly a higher risk of seizure(p =0.019). Infarct and hypertension were associated with significantly a higher risk of seizure(p <0.05). pre- or postoperative intracranial hematoma(intracerebral or epidural hematoma) was associated with significantly a higher risk of seizure(p <0.0001). H-H grade, Fisher grade, Glasgow Outcome Scale of patients and timing of operation after subarachnoid hemorrhage had no significant relation with the risk of seizure. Conclusion : Factors associated with the development of postoperative seizure were middle cerebral artery aneurysm, delayed ischemic neurologic deficit, infarct on late postoperative CT scan, hypertension, pre or postoperative intracranial hematoma(intracerebral or epidural hematoma). Identification of the risk factors may be help to focus the antiepileptic drug threapy in cases prone to develop seizures. Prospective evaluation is indicated.

• Childhood Kidney Diseases
• /
• v.2 no.1
• /
• pp.77-81
• /
• 1998

The author exprienced a case of glycogen storage disease type Ia(GSD-I) in an 18-year-old male patient who was admitted to our hospital due to proteinuria and hypertension. he was suspected to have GSD when 12 years old because of his family history of short stature and hepatomegaly. On admission, physical examination revealed short stature, heparomegaly, and The diagnosis of GSD-I was confirmed by compatible liver biopsy finding and enzyme assay which erealeddeficiency of glcose-6-phosphatase if hepatocyte. Sympromatic treatment was done using antihypertensive drugs and allopurinol with diet control. The authors report a case of glycogen storage disease type Ia completely confirmed by typical clinical manifestation, pathologic findings of the liver and the kidney, and the result of enzyme assay which revealed deficiency of glucose-6-phosphatase in hepatocytes with brief review fo related literatures.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.4
• /
• pp.766-775
• /
• 1997

Background : Primary malignant tumors of the trachea are extremely rare entities and account for a mere 0.1 per cent of all malignancies of the respiratory tract. Because of vague localizing signs, symptoms and a usually negative routine chest film, the patients with tracheal tumors are often treated for asthma or chronic obstructive pulmonary disease for considerable period of time before correct diagnosis. Method : We have made a review of the 17 cases of primary tracheal tumors in recent 15 years. We reviewed the clinical features including history of smoking and respiratory symptoms, the official readings of initial routine chest film, the cytologic examination of sputum, the time of delay in diagnosis, and the response according to the therapeutic modalities. Results : Eight out of 9 patients with squamous cell carcinoma(SCC) were above 50 years old, five out of 6 patients with adenoid cystic carcinoma(ACC) were below 50 years old. The most common location of primary tracheal tumors was the upper one-third of trachea in 8 cases(47%). The most frequent symptoms were dyspnea in 13/17 cases(76%) and then stridor or wheezing, cough. and sputum in order. The routine chest roentgenographic examinations were not helpful to diagnose tracheal carcinoma and the cytologic examinations of sputums were helpful to diagnose tracheal carcinoma in only one case with adenocarcinoma. The mean times of delay in diagnosis of patients with sec and ACC were 5 months and 24.9 months respectively. We had bronchial asthma in 8 cases(47%) and tracheal tumors in 4 cases(23%) as initial clinical impression. Conclusion : We would like to perform more comprehensive diagnostic tools(high KVP technique, the fibroptic bronchoscopic examination, chest CT scan etc.) in patients who had the suggestive points for the tracheal tumorse(1. unexplained hemoptysis or hoarsness, 2. inspiratory wheezing or stridor, 3. wax and waning of dyspnea according to changes of position, 4. progressive asthmatics unresponsive to antiasthmatic therapy) and radical resection of tumor or external radiation therapy with curative aim as possible.

• Childhood Kidney Diseases
• /
• v.3 no.2
• /
• pp.196-202
• /
• 1999

Purpose : When the mature kidney fails to reach its norml location in the renal fossa, the condition is known as ectopic kidney. Presenting symtoms can be various and it generally depend on the associated anomaly. Beside urologic anomalies such as hydronephrosis and vesicoureteral reflux, various anomalous vascular net work, skeletal anomaly or genital anomaly can be observed in this condition. Methods : Sixteen children with ectopic kidney was studied retrospectively to analyse initial presentation, accompanied anomaly and prognosis. Results : 56% of the children were accompanied with other urologic anomalies such as true incontinence and vesicoureteral reflux that required surgical treatment. 31% of children were either diagnosed incidentally during evaluation of other non-urologic disease or during follow-up evaluation of abnormal antenatal renal sonogram. Conclusion : Ectopic kidney can be often misdiagnosed as tumorous condition or as a surgical condition depend on the abnormal location of the kidney. Careful evaluation using abdominal sonogram, DMSA, VCUG and abdominal CT scan should be performed in order to search for associated anomalous condition and for proper management.

• The Journal of Internal Korean Medicine
• /
• v.14 no.2
• /
• pp.50-70
• /
• 1993

Clinical observation was done on 92 cases of Occlusive CVD, Cerebral hemorrhage (Subarachnoid hemorrhage) which were confirmed by Brain CT scan and observed for over 4 weeks, among the 121 cases which were more than 65 years of age. they admitted to the Dept. of Internal Medicine, Oriental Medical Hospital in Dong Guk Univ. from July 1992 to June 1993. The result were as follows; 1. In this study, Occlusive CVD was 74 cases, Cerebral hemorrhage (Subarachnoid hemorrhage was 2 cases) was 18 cases. 2. The ratio of male to female was 1.09:1. The age distribution showed the large number in the 65-69 year group(52.2%), 7th decade was 44.5% over 8th decade was 3.3% in ratio. 3. The site of Occlusive CVD was most common at MCA. the site of Cb-hemorrhage was most common at Basal ganglia. 4. The most common preceding disease was hypertension(47.8%) and the next were diabetes mellitus(14.1%), heart desease(14.1%). 5. Recurrence rate was 33.7% and 2nd attack was 20.7%, 3rd attack was 8.7%, 4th attack was 4.3% 6. Predisposing factors in Occlusive CVD were initiated usually during resting and sleeping, and that in Cb-hemorrhage were represented chiefly exercising(66.6%). 7. The smoker was 52.2%, the drinker was 32.6% in whole group. the drinker was 61.1% by the Cb-hemorrhage. 8. The ratio of the season distribution was as follow, fall 35.8%, winter 29.3%, spring 19.6%, summer 15.3%, that of the month distribution was november 15.2%. 9. Duration from on set in Occlusive CVD, 60.8% was within 5 days, that in Cb-hemorrhage, 77.8% was within 5 days. 10. Level of consciousness on attack was clear 42.2%, lethargy and mental change(dull, stupid etc.) 41.3%. The common symptoms were motor disturbance(90.2%), verbal disturbance(65.2%), headache(43.5%). 11. The physical theraphy of Occlusive CVD has been performed 75.7% in whole group and the average beginning time was 6.4 days, and that of Cb-hemorrhage has been performed 61.1% in whole group and the average beginning time was 13 days. 12. Duration of hospitalization was noted 11-20 days was 31.5%, over 21 days was 46.8%, and the average admission was 22.7 day(Occlusive CVD), 32days (Cb-hemorrhage). 13. The main complication were observed in the studies; urinary tract infection and pneumonia were noted in 6.5%, bed sore in 5.4%. 14. The ratio of systolic blood pressures in admission and discharge decreased from 58.7% to 28.3% in over 160 mmHg, that of diastolic blood pressures in admission and discharge decreased from 72.8% to 51.1% in over 90 mmHg. In 31(33.7%) of the 92 cases it showed the glucose levels of more than normal. 15. The patients have done family history of hypertension and C.V.A were 32.6% of all 16. Occlusive CVD In 83.8% and Cb-hernorrhage in 72.2% were improved 17. The herb medications were various Sunghyanggeonggisan, Sopungtang, CHunmagudeungeum were used most frequently and Gamidaebotang, Boyangwhanotang, Gagamyunjotang, Mangeumtang etc. were used as discharge.

• Radiation Oncology Journal
• /
• v.14 no.2
• /
• pp.149-158
• /
• 1996

Purpose : To get an accute steepness of dose gradients at outside the target volume in intracranial lesion and a less limitation of beam selection avoiding the high dose at normal brain tissue, this Photon Knife Radiosurgery System was developed in order to provide the three-dimensional dose distribution through the reconstruction of CT scan and the combined stereotactic trans-multiarc beam mode based on linear accelerator photon beam. Materials and methods : This stereotactic radiosurgery, Photon Knife based on linear accelerator photon beam was provided the non-coplanar multiarc and trans-multiarc irradiations. The stereotactic trans-multiarc beam mode can be obtained from the patient position in decubitus. This study has provided the 3-dimensional isodose curve and anatomical structures with the surface rendering technique. The dose distribution from the combined two trans-multiarcs (2M 2TM) was compared to that of four non-coplanar multiarcs (4M) with same collimator size of 25 mm in a diameter and total gantry movements. Results : In this study, it shows that the dose distributions of stereotactic beam mode are significantly depended on the selected couch and gantry angle in same collimator size. Practical dose distribution of combined stereotactic trans-multiarc beam has shown a more small rim thickness than that of the non-coplanar multiarc beam mode in axial, sagittal and coronal plane in our study. 3-Dimensional dose line displayed with surface rendering of irregular target shape is helpful to determine the target dose and to predict the prognosis in follow-up radiosurgery. Conclusions : 3-Dimensional dose line displayed with surface rendering of irregular target shape is essential in stereotactic radiosurgery. This combined stereotactic trans-multiarc beam has shown a less limitation of the selection couch and gantry beam angles for the target surrounding critical organs. It has shown that the dose distribution of combined trans-multiarc beam greatly depended on the couch and gantry angles. In our experiments, the absorbed dose has been decreased to $27%$ / mm in maximum at the interval of $50\%$ to $80\%$ of isodose line.

• Journal of Chest Surgery
• /
• v.32 no.6
• /
• pp.536-542
• /
• 1999

Background: The purpose of this study is to improve the quality of the diagnostic procedures in the preoperative evaluation so as to reduce the unnecessary thoracotomy and to ensure resectability in non-small cell lung cancer. Material and Method: Of 616 patients who underwent thoracotomy for primary lung cancer from January 1990 to December 1996, 59 patients(9.6%) turned out to have inoperable lesions after the thoracotomy. We reprospectively reviewed the bronchoscopic findings, methods of tissue diagnosis, CT scans, pulmonary function test and lung perfusion scan, reasons for nonresectability, and adjuvant therapy, and then followed up on the survival rate after exploratory thoracotomy. Result: The cell types were squamous cell carcinoma in 38, adenocarcinoma in 15, large cell carcinoma in 3 and others in 3. Primary loci were RUL in 20, RML in 6, RLL in 8, LUL in 13, LLL in 4 and others in 8. The reasons for non-resectability were various; direct tumor invaison to mediastinal structures(n=41), seeding on pleural cavity(n=8), poor pulmonary function(n=2), invasions to extranodal mediastinal lymph node(n=2), technical non- resectability due to extensive chest wall invasion (n=3), small cell carcinoma (n=1), malignant lymphoma(n=1), and multiple rib metastases(n=1). In the follow-up of 58 patients, 1-year survival rate was 55.2% and 2-year survival rate was 17.2% and the mean survival time was 14 months. When compared according to cell types or postoperative adjuvant therapeutic modalities, no significant difference in the survival rates were found. The squamous cell carcinoma was frequently accompanied by local extension to contiguous structures and was the main cause of non-resectability. In adenocarcinoma, pleural seeding with malignant effusion was frequently encountered, and was the major reason for non-resectability. Conclusion: These data revealed that if appropriate preoperative diagnostic tools had been available, many unnecessary thoracotomies could have been avoided. Both the use of thoracoscopy in selected cases of adenocarcinoma and the more aggressive surgical approach to the locally advanced tumor could reduce the incidence of unnecessary thoracotomies for non-small cell lung cancers.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.31 no.3
• /
• pp.474-480
• /
• 2004

The purpose of this in vitro study was to compare the remineralizing effects of three glass ionomer cements (high filled glass ionomer cement, compomer, resin modified glass ionomer cement) with resin composite (control group) on incipient interproximal caries, and to assess long-term change of remineralization effect, in each material, evaluated by microtomography. Proximal restoration was simulated with tooth specimen and Glass Ionomer Cements. And each of these groups was placed into a closed container with artificial saliva at $37^{\circ}C$ and pH 7.0 for a time period of thirty days with constant circulation. At the end of thirty and sixty days, tomographic images were taken from these specimens with micro CT scanner. Materials used in this study were as follows. Group 1: Fuji IX GP (GC Corp., Tokyo, Japan) Group 2: Vitremer (3M ESPE, St. Paul, Minn., USA) Group 3: F2000 (3M ESPE, St. Paul, Minn., USA) Group 4: Z250 (3M ESPE, St. Paul, Minn., USA) Using density-measuring program, the micro-density of carious lesions on the specimens were measured. The mean density changes of each group were compared to the other groups to evaluate the effect of remineralization. The results were as follows: 1. The lesion density of all groups increased. 2. The mean density increase of Group 1, 2, 3 were higher than that of Group 4 every month(p<0.05). 3. There were significant differences of density increase among glass ionomer group(Group 1, 2, 3).

• Journal of Hospice and Palliative Care
• /
• v.8 no.2
• /
• pp.152-155
• /
• 2005

Purpose: The lower extremity edema (LEE) is a common distressful symptom in advanced cancer patients and is hard to manage. We analyze the characteristics of LEE in patients with advanced cancer to provide the basic information of causes and adequate management. Methods: Physical examination, assessment of the location and severity of edema, blood chemistry (albumin, creatinine), Doppler Sono for patients with suspecting deep vein thrombosis (DVT), and abdomen CT scan for patient with suspecting lymph edema were performed. Severity of edema was classified according to NCI lymph edema scaling and improvement was defined as lowering at least 1 grade of edema after management. Results: Among 154 patient who had been admitted to Hospice Ward from Mar 2003 to Jan 2004, 33 had LEE, and 6 had both upper extremity edema and LEE except generalized edema. Their underlying cancers were stomach (7), lung (6), biliary tract (5), liver (5), colorectal (5), pancreas (2), and others (9). There were 12 patient with grade I, 20 patients with grade II, and 7 patients with grade III edema. The causes were hypoalbuminemia (11), lymph edema (10), DVT (7), obstruction of inferior vena cava (IVC) or portal vein (6), and dependent edema (5). The common managements were including leg elevation and diuretics. Elastic stocking was applied for patients with DVT and leg massage and pneumatic compression was used for lymph edema. The 2/3 patients were improved after management. Conclusion: The incidence of LEE in terminal cancer pts was high (25.3%) and their causes were variable including lymph edema, DVT, hypoalbuminemia and dependent edema. Active noninvasive management according to causes could result in good palliation.

• Radiation Oncology Journal
• /
• v.4 no.1
• /
• pp.35-43
• /
• 1986

Study patients with head and neck carcinoma were studied retrospectively to assess the impact of treatment on survival and local control rate by stage in the Dept of Radiation Therapy, Korea University Hae Wha Hospital between March 1981 and March 1986. Prior to definite radiotherapy, patients were evaluated by physical examination and radiologic studies including chest, laryngogram and CT scan and then these patients were grouped according to the American Joint Committee (AJC) staging system. They were treated with RT alone or postoperative irradiation to the dose of 7,200 cGy/8 weeks and 6,000 cGy/7 weeks respectively. The results were obtained and as follows; 1. Overall male to female sex ratio was 3.6:1. The peak age of patients with head and neck cancer was 6th decade. 2. In all patients treated by RT, the ratio of squamous cell 1 carcinoma to non-squamous cell carcinoma was 3.5:1 (60/77 patients). 3. The incidence according to the anatomic site of primary tumor was 22 cases in the larynx, 12 cases in PNS, 7 cases in nasopharynx, 6 cases in oropharynx, and 3 cases in hypopharynx. 4. According to AJC staging system,4 cases were Stage 1,7 in Stage II, 19 in Stage III and 27 in Stage IV. 5. The overall incidence of cervical lymph node metastases was $43\%$ and subdigatric and submaxillary triangle lymph nodes were the most frequent site of metastases. 6. Local control was achieved in $48\%$ of patients treated by radio-therapy. 7. The lung was the most common site for distant metastases, comprising 4 cases among 7 cases in which distant metastases occured. 8. The overall estimated 5-year survival rate was $43\%$ in the head and neck cancer treated with radiotherapy by life-table analysis.