• Journal of Chest Surgery
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• 제29권12호
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• pp.1347-1353
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• 1996

부산대학교병원 흉부외과에서 1982련 3월부터 1992년 2월까지 승모판막치환술을 받은 환자들을 대상으로하여 승모판막치환술 후 장기성적에 대한 분석을 시행하였다. 환자 중 남자는 159명이었고 여자는 215명이 었으며 평균연령은 31.8세였다. 병원사망율은 24례(6.4%)였고 가장 흔한 원인은 저심 박출증후군으로 12례였다. 치환된 판막은 기계 판막이 314개, 조직판막이 60개였고 재치환술을 시행한 경우는 31례로 모두 기계판막을 사용하였다. 거의 전환자에게 coumadin을 투여하여 항응고요법을 시행하였고 국제정상화비(INR)가 1.5~3.0이 되도록 하였다. 생존례의 추적관찰은 93%에서 가능하였고 2270환자-년이었다. 만기 사망례는 12례였는데 그 중 3례가 뇌출혈, 3례가 뇌혈관전색으로 사망하였다. 병원 사망율을 포함한 만기 생존율은 술후 10년에 82.3%였다. 만기합병증의 발생율은 전색증이 1.3%환자-년, 항응고요법과 관련된 출혈성함병증이 1.3%환자-년이었다. 술후 예후에 좋은 영향을 미칠 것으로 생각되는 요인으로는 뉴욕심장협 회의 심기능평가를 포함한 술전 환자상태, 첫 수술인 경우, 판막부속기 보전의 수술법 및 너무 크지 않은 기계판막\ulcorner 사용하지 않는 것으로 나타났다.

• Journal of Korean Neurosurgical Society
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• 제39권3호
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• pp.210-214
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• 2006

Objective : We investigate risk factors of cerebral microbleeds[MBs] and their relation to concomitant magnetic resonance[MR] findings in intracerebral hemorrhages[ICHs] patients. Methods : We studied 100 consecutive patients with primary ICH over a 1-year period. These patients underwent brain MR images using 3.0-T scanners within the first week of the hemorrhage. MBs and old hematomas were located and counted by using $T2^*-weighted$ gradient-echo MR imaging. We also counted lacunes and graded white matter and periventricular hyperintensity on T1- and T2-weighted spin-echo sequences. The association between MBs and vascular risk factors and MR abnormalities were analyzed. Results : MBs were seen in 77 of ICH patients, and their number ranged from 1 to 65 lesions [mean 11, median 6]. The locations of MBs were subcortex-cortex [40.6%], basal ganglia [26.7%], thalamus [14.1 %], brain stem [12.5%], and cerebellum [9.1 %]. Analysis of clinical data revealed that age, hypertension, history of stroke, and duration of hypertension were frequently associated with MBs. The incidence of lacunes, old hematomas, and advanced leukoaraiosis was significantly higher in the MBs group, compared with the patients without MBs. Conclusion : MBs are frequently observed in ICH patients with advancing age, chronic hypertension, and previous hemorrhagic stroke, and are also closely related with morphological signs of occlusive type microangiopathy, such as lacunar infarct and severe leukoaraiosis.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.360-368
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• 2009

Objective : The objectives of this study were to analyze the recanalization rates and outcomes of multimodal therapy that consisted of sequential intravenous (IV)/intra-arterial (IA) thrombolysis, mechanical thrombolysis including mechanical clot disruption using microcatheters and microwires, balloon angioplasty, and stenting for acute ischemic stroke, and to evaluate the prognostic factors related to the outcome. Methods : Fifty patients who were admitted to the hospital within 8 hours from ischemic symptom onset were retrospectively analyzed. Initial IV thrombolysis and subsequent cerebral angiography were performed in all patients. If successful recanalization was not achieved by IV thrombolysis, additional IA thrombolysis with mechanical thrombolysis, including balloon angioplasty and stenting, were performed. The outcomes were assessed by the National Institute of Health Stroke Scale (NIHSS) change and modified Rankin scale (mRS) and prognostic factors were analyzed. Results : Successful recanalization was achieved in 42 (84%) of 50 patients, which consisted of 8 patients after IV thrombolysis, 19 patients after IA thrombolysis with mechanical clot disruption, and 15 patients after balloon angioplasty or stenting. Symptomatic hemorrhage occurred in 4 (8%) patients. Good outcomes were achieved in 76% and 70% of patients upon discharge, and 93% and 84% of patients after 3 months according to the NIHSS change and mRS. The initial clinical status, recanalization achievement, and presence of symptomatic hemorrhage were statistically related to the outcomes. Conclusion : Multimodal therapy may be an effective and safe treatment modality for acute ischemic stroke. Balloon angioplasty and stenting is effective for acute thrombolysis, and produce higher recanalization rates with better outcomes.

• Tuberculosis and Respiratory Diseases
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• 제57권5호
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• pp.480-483
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• 2004

경피적 세침생검은 폐 및 종격동 질환이 있을 때 조직을 얻기 위하여 널리 시행되며 비교적 안전한 시술이다. 하지만 때로 치명적인 합병증이 생길 수도 있는데 저자들이 보고한 뇌공기 색전증도 그 중의 하나이다. 뇌 공기 색전증은 여러 가지 진단적 혹은 치료적 시술과 관련되어 발생할 수 있는 드물지만 치명적인 합병증으로 경피적 흉부 세침생검 시에도 발생할 수 있어, 시술 도중이나 후 갑작스런 신경학적 혹은 심혈관 이상 증상이 나타날 때는 공기 색전증의 가능성을 염두에 두어야 할 것이며 가능한 빠른 시간 내에 고압 산소 요법을 시작하는 것이 중요하다. 저자들은 경피적 흉부 세침생검 후에 발생한 뇌 공기 색전증 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• The Korean Journal of Physiology and Pharmacology
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• 제3권4호
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• pp.415-425
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• 1999

$[K^+]_o$ can be increased under a variety of conditions including subarachnoid hemorrhage. The increase of $[K^+]_o$ in the range of $5{\sim}15$ mM may affect tensions of blood vessels and cause relaxation of agonist-induced precontracted vascular smooth muscle $(K^+-induced$ relaxation). In this study, effect of the increase in extracellular $K^+$ concentration on the agonist-induced contractions of various arteries including resistant arteries of rabbit was examined, using home-made Mulvany-type myograph. Extracellular $K^+$ was increased in three different ways; from initial 1 to 3 mM, from initial 3 to 6 mM, or from initial 6 to 12 mM. In superior mesenteric arteries, the relaxation induced by extracellular $K^+$ elevation from initial 6 to 12 mM was the most prominent among the relaxations induced by the elevations in three different ways. In cerebral arteries, the most prominent relaxation was produced by the elevation of extracellular $K^+$ from initial 1 to 3 mM and a slight relaxation was provoked by the elevation from initial 6 to 12 mM. In superior mesenteric arteries, $K^+-induced$ relaxation by the elevation from initial 6 to 12 mM was blocked by $Ba^{2+}\;(30\;{\mu}M)$ and the relaxation by the elevation from 1 to 3 mM or from 3 to 6 mM was not blocked by $Ba^{2+}.$ In cerebral arteries, however, $K^+-induced$ relaxation by the elevation from initial 3 to 6 mM was blocked by $Ba^{2+},$ whereas the relaxation by the elevation from 1 to 3 mM was not blocked by $Ba^{2+}.$ Ouabain inhibited all of the relaxations induced by the extracellular $K^+$ elevations in three different ways. In cerebral arteries, when extracellular $K^+$ was increased to 14 mM with 2 or 3 mM increments, almost complete relaxation was induced at 1 or 3 mM of initial $K^+$ concentration and slight relaxation occurred at 6 mM. TEA did not inhibit $Ba^{2+}-sensitive$ relaxation at all and NMMA or endothelial removal did not inhibit $K^+-induced$ relaxation. Most conduit arteries such as aorta, carotid artery, and renal artery were not relaxed by the elevation of extracellular $K^+.$ Among conduit arteries, trunk of superior mesenteric artery and basilar artery were relaxed by the elevations of $[K^+]_o.$ These data suggest that $K^+-induced$ relaxation has two independent components, $Ba^{2+}-sensitive$ and $Ba^{2+}-insensitive$ one and there are different mechanisms for $K^+-induced$ relaxation in various arteries.

• 한국전문물리치료학회지
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• 제16권4호
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• pp.23-30
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• 2009

Core stability exercises for patients with hemiplegia have become increasingly important and a variety of exercises have been developed over the years to give the hemiplegic patients more stable postural control. This study examined the therapeutic effects of the core stability exercises on the ability of static and dynamic postural control. Fifteen hemiplegic patients (7 males, 8 females, age ranging from 46 to 76 years) hospitalized in a Daejoen rehabilitation hospital were enrolled in this study. Nine and 6 patients had a cerebral infarction and cerebral hemorrhage, respectively. The subjects participated in a core stability exercise program consisting of a total of 12 sessions 3 times each week over a 4-week period with each exercise lasting approximately 15 minutes. The ability of static and dynamic postural control by Berg Balance Scale (BBS) and Timed Up and Go (TUG), respectively, were measured before and after the core stability exercise. A Wilcoxon signed ranks test was used to compare the effects of the ability of static and dynamic postural control before and after core stability exercise in patients with hemiplegia. The ${\alpha}$=.05 level of significance was used for the statistical tests. Core stability exercises were effective in improving the ability of static postural control; BBS (p<.05). Core stability exercises were also effective in improving the ability of dynamic postural control; TUG (p<.05). Overall, core stability exercise is believed to be an important therapeutic method in rehabilitation programs for hemiplegic patients.

• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.117-121
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• 2016

Objective : Hemorrhagic moyamoya disease (hMMD) is associated with a poor clinical course. Furthermore, poorer clinical outcomes occur in cases of recurrent bleeding. However, the effect of hemodynamic insufficiency on rebleeding risk has not been investigated yet. This study evaluated the prognostic implications of the perfusion status during the clinical course of adult hMMD. Methods : This retrospective study enrolled 52 adult hMMD patients between April 1995 and October 2010 from a single institute. Demographic data, clinical and radiologic characteristics, including hemodynamic status using single photon emission computed tomography (SPECT), and follow up data were obtained via a retrospective review of medical charts and imaging. Statistical analyses were performed to explore potential prognostic factors. Results : Hemodynamic abnormality was identified in 44 (84.6%) patients. Subsequent revascularization surgery was performed in 22 (42.3%) patients. During a 58-month (median, range 3-160) follow-up assessment period, 17 showed subsequent stroke (hemorrhagic n=12, ischemic n=5, Actuarial stroke rate $5.8{\pm}1.4%/year$). Recurrent hemorrhage was associated with decreased basal perfusion (HR 19.872; 95% CI=1.196-294.117) and omission of revascularization (10.218; 95%; CI=1.532-68.136). Conclusion : Decreased basal perfusion seems to be associated with recurrent bleeding. Revascularization might prevent recurrent stroke in hMMD by rectifying the perfusion abnormality. A larger-sized, controlled study is required to address this issue.

• 대한한방내과학회지
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• 제21권3호
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• pp.369-376
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• 2000

Purpose : Cerebrovascular disease is the most frequent cause of death in Korea and it remains severe disabilities disturbing normal life, According to the previous studies, mortality of the stroke in the first one week is up to the 20% and 95% of stroke patients in the acute stage are accompanied by more than one complications. These complications affect not only the acute stage mortality but also the late stage rehabilitations. In Korea the oriental medicine is preformed in the treatment of stroke. Therefore it is important to recognize thoroughly the complications in the acute stage of stroke and to prevent them. But studies about complications of acute stage stroke is rarely presented in the fields of oriental medicine. So this study is prepared for investigating the characteristics and frequency of complications in the acute stage of stroke. And we are to assess the importance of theses acute complications by systemic reviewing the previous studies. Methods : Fifty one patients are included who had been admitted to ICU(intensive care unit) of Chenju Hospital of Wonkwang Oriental Medicine. Twenty nine patients are diagnosed as ischemic stroke and twenty one patients are diagnosed hemorrhagic stroke. Medical and neurological complications were investigated retrospectively based on medical notes excluding primary symptoms of stroke Le. motor weakness, sensory disturbance and speech disorder. And risk factors of stroke such as D.M. or hypertension are excluded. Results : Medical complications are more frequent than neurological ones. Most frequent medical complication is dysuria(61%) and constipation(45%), fever(30%) and aspiration pneumonia(22%) are followed in order of frequency. In Neurological complication dysphagia(56%), the exacerbation of infarction due to increased intracranial pressure(24%), irritability or insomnia(21%) is most frequently complicated in order of frequency. Conclusions : These complications are mostly caused by bed rest state in acute stage stroke. It is supposed that more aggressive management can prevent theses ones. And it is possible to improve the medical and neurological conditions by sticking theses study results.

• Journal of Korean Neurosurgical Society
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• 제49권6호
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• pp.329-333
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• 2011

Objective : As medical advances have increased life expectancy, it has become imperative to develop specific treatment strategies for intracranial aneurysms in the elderly. We therefore analyzed the clinical characteristics and outcomes of the treatment of unruptured intracranial aneurysms in patients older than 70 years. Methods : We retrospectively reviewed the medical records and results of neuroimaging modalities on 54 aneurysms of 48 consecutive patients with un ruptured intracranial aneurysms. ($mean{\pm}SD$ age, $72.11{\pm}1.96$ years; range, 70-78 years) who underwent surgical clipping over 10 years (May 1999 to June 2010). Results : Of the 54 aneurysms, 22 were located in the internal carotid artery, 19 in the middle cerebral artery, 12 in the anterior cerebral artery, and 1 in the superior cerebellar artery. Six patients had multiple aneurysms. Aneurysm size ranged from 3 mm to 17 mm ($mean{\pm}SD$, $6.82{\pm}3.07$ mm). Fifty of the 54 aneurysms (92.6%) were completely clipped. Three-month outcomes were excellent in 50 (92.6%) aneurysms and good and poor in 2 each (3.7%), with 1 death (2.0%). Procedure-related complications occurred in 7 aneurysms (13.0%), with 2 (3.7%) resulting in permanent neurological deficits, including death. No postoperative subarachnoid hemorrhage occurred during follow-up. The cumulative rates of stroke- or death-free survival at 5 and 10 years were 100% and 78%, respectively. Conclusion : Surgical clipping of unruptured intracranial aneurysms in elderly group could get it as a favorable outcome in well selected cases.

• 대한한의학회지
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• 제16권1호통권29호
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• pp.96-117
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• 1995

1. The Pung(風) is the necessary power for growth and maintenance of life. 2. The characteristics of the Pung(風) is the Yang evil, the features for opening and excretion, mobility and rapid change. That is the major cause of all diseases, and its mobility is the main character. 3. Jung Pung(中風) is the same concept of apoplexy in Western medicine. 4. Jung Pung(中風) is classified on the basis of pathology, anatomy, and histology in Western Medicine, but In Oriental Medicine that is classified on the basis of symptom and severity of disease. 5. In Western Medicine, Jung Pung(中風) was regarded as the local cause of disease, but in Oriental Medicine regarded as the physiological changes caused by the weakness of the whole body. 6. In the emergency care, the method of GaeKeum is compared to Levin tubing, the method of to the use of urokinase for the promotion of cerebrovascular circulatio, and the method of To(吐法) to suction for the elimination of Dam(痰), the method of Hun(熏法) to the use of solution for the improvement of circulation. 7. With the comparison of the cause and diagnosis, the hemorrhagic disease and infarction were regarded as the major agents in Western Medicine and the symptom appeared in the patient was the standard of diagnosis and therapy in Oriental Medicine. 8. In the Western therapy of cerebral hemorrhage, the method of coagulation and hemostasis was used for the elimination of hematoma and cerebral edema, but in Oriental Medicine, the method of YanghaelGiHael(凉血止血) was used for descending the PungHwa(風火) and hemostasis. 9. In the period of recovering injury, the physical therapy was underlined for the recovering of partial function in Western Medicine, the method of accupuncture and drug therapy was adapted for the normal function of the whole body.