• Journal of Acupuncture Research
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• v.17 no.4
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• pp.172-179
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• 2000

Objectives : Assuming that the characteristic of meridian system has been similar to this of electric potentials in human body and that measurements of electric potential at well(井穴) and sea(合穴) points in branches of the twelve meridians will be representative of measurements of the twelve meridians, to measure the electric potentials in three patient groups with arrhythmia(AP group), with arrhythmia and cerebral infarction(CI group), and with arrhythmia and hemorrhage(CH group), and then to find out the characteristic of meridian system among 3 groups. Methods : Thirty arrhythmic patients diagnosed by EKG, CT, and deficiency of the heart blood(心血虛症) were divided into 3 groups(AP, CI, CH group). Their electric potential of well and sea points in the meridians were measured 3 times by physiograph. Results : Measurements were analyzed by statistical factor analysis, we obtained that the left side electric potential of well and sea points in branches of the twelves meridians in AP group was divided into two factors, which were the hand meridian without the lung meridian, the foot meridian and the lung meridian, but the right side electric potential was divided into the hand and the foot meridian. In CH group both the left and the right side electric potential was divided into three factors. In CI group the left side electric potential was divided into three factors, but the right side electric potential was divided into two factors. Conclusions : In conclusion, their electrical potentials were different each other among 3 groups. Thus electrical potentials of well and sea points might be the representative meridian to show their characteristics.

• Journal of Korean Neurosurgical Society
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• v.30 no.6
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• pp.711-716
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• 2001

Objectives : Three-dimensional computed tomographic angiography(3D-CTA) is recently developed diagnostic imaging modality. We have studied this noninvasive method for possible role in replacing conventional angiography( CA) in the detection of aneurysms of the circle of Willis in patients with subarachnoid hemorrahge(SAH). Methods : We studied retrospectively, the 100 patients with SAH or unruptured aneurysms admitted to our hospital from October 1997 to December 1998. Among there, 85 patients underwent CTA, 82 patients underwent CA and 67 patients underwent both of CTA and CA. 3D-CTA was obtained using maximum intensity projection(MIP) and shaded-surface display(SSD) reconstruction. Results : Total 107 aneurysms were detected in 92 patients, and 64 aneurysms were detected in 67 patients underwent both CTA and CA. In five cases of those 67 cases, aneurysms were detected by CA but not by 3D-CTA. The detection rate of aneurysms(91.8%) and the detection rate of parent artery in cases of anterior communicating artery aneurysms(86.9%) with total 3D-CTA were relatively compatible with that of CA. But 3D-CTA was not enough in detection of posterior communicating artery aneurysms, internal carotid artery aneurysms as well as small sized aneurysm(<3mm). Conclusion : We consider CTA is valuable in as a screening test for cerebral aneurysm and follow-up test. And it is also valuable in early surgery for patients with aneurysmal rebleeding because of simple, quick, non-invasive method.

• Journal of Korean Neurosurgical Society
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• v.47 no.5
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• pp.325-331
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• 2010

Objective : We retrospectively evaluated the survival outcome of patients with brain metastasis from hepatocellular carcinoma (HCC). Methods : Between 1991 and 2007, a total of 20 patients were diagnosed as having brain metastasis from HCC. The mean age of the patients was 55 ${\pm}$ 13 years, and 17 (85.0%) were men. Seventeen (85.0%) patients had already extracranial metastases. The median time from diagnosis of HCC to brain metastasis was 18.5 months. Fourteen (70.0%) patients had stroke-like presentation due to intracerebral hemorrhage (ICH). Ten (50.0%) patients had single or solitary brain metastasis. Among a total of 34 brain lesions, 31 (91.2%) lesions had the hemorrhagic components. Results : The median survival time was 8 weeks (95% CI, 5.08-10.92), and the actuarial survival rates were 85.0%, 45.0%, 22.5%, and 8.4% at 4, 12, 24, and 54 weeks. Age < 60 years, treatment of the primary and/or extracranial lesions, and recurrent ICH were the possible prognostic factors (p = 0.044, p < 0.001, and p = 0.111, respectively). The median progression-free survival (PFS) time was 3 months (95% CI, 0.95-5.05). Conclusion : The overall survival of the patients with brain metastasis from HCC was very poor with median survival time being only 8 weeks. However, the younger patients less than 60 years and/or no extracranial metastases seem to be a positive prognostic factor.

• The Journal of Internal Korean Medicine
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• v.23 no.2
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• pp.286-291
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• 2002

Urinary tract infection(UTI) is one of the common complications in stroke patients. As it has negative effect on the recovery of stroke, it should be cured out immediately. But antibiotics might cause some adverse reactions such as diarrhea, eruption, anorexia, nausea and vomiting. so there have been several reports about treating urinary tract infection with Traditional Korean Medication. We treated a 54-year-old male patient with cerebral hemorrhage, who had had neurogenic bladder after stroke and had been urinated by intermittent catheterization. About 10 days later, he could void by himself without catheter, but showing the symptoms of UTI; Voiding pain, hematuria and yellowish pus. The pus culture grew Staphylococcus spp., which was resistant to most of antibiotics except vancomycin and teicoplanin. Based on accompanying symptoms of intermittent dizziness, headache, insomnia, nocturnal sweating, weak pulse, red tongue and urinary problem, we differentiated him as the deficiency of Yin of the Kidney[腎陰虛] and treated with Gagamyookmijihwang-tang (Jia-Jian-Liu-Wei-De- Huang-Tang), which improved his urinary symptoms and other general conditions without any side effect. In next follow-up culture, there was no pathogen. We conclude that Traditional Korean Medicine based on differentiation is useful in the treatment of urinary tract infection.

• Journal of Chest Surgery
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• v.26 no.9
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• pp.677-685
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• 1993

Experience with bileaflet mechanical valve replacement at the Inha Hospital in 192 patients, operated on from June 1986 until April 1993. Two hundred fourty-one prostheses [51 Duromedics, 79 St.Jude Medical, and 111 CafboMedics]were implanted during the total 195 operations. Mitral valve replacment[MVR]was done in 113 cases, aortic valve replacement[AVR]in 34, tricuspid valve replacement[TVR]in 2, and double valve replacement[DVR]in 46 cases.Of the total patients, 63.0% were women and 37.0% were men. The mean age of the patients was 40.8 years, ranged from 14 to 67years. Overall early mortality was 9.2\ulcorner%[18 out of 195]; 9.7%[11 out of 113]for MVR, 14,7% [5 out of 34]for AVR, and 4.3%[2 out of 46]for DVR. All of the operative survors were followed over a period of one to 83 months with a mean of 37 months, for total 543 patient-years. So far, eleven patients[6.7% of the long-term survivors]were lost to follov-up after a mean postoperative follow-up of 22.8 months. There were nine late deaths; three deaths due to prostetic valve endocarditis, two due to persistent heart failure, one due to cerebral hemorrhage, one due to aortic dissection after Bentall oreration, and two sudden deaths. Actuarial survival rate at 6.9 years was 94.8%, There were seventeen valve-related complications; three prosthetic valve thromboses, three thrombembolisms, three instances of prosthetic valve endocarditis, two paravalvular leakages, and six hemorrhagic complications related to anticoagulation. The actuarial rate of freedom from all valve-related complications at 6.9years was 91.3%. There were significant decreases in the heart size postoperatively that can be demonstrated by comparison of cardio-thoracic ratios on simple chest X-ray and left ventricle dimensions on echocardiography. We conclude that this midterm follow-up shows good results in terms of hemodynamics and durability although further long-term evaluations are mandatory.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1023-1030
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• 1999

This is a retrospective study of 42 pregnancies from 33 women with prosthetic heart valves who were on anticoagulation regimen prior to or during their pregnancy. Material and Method: Of the 17 women with bioprosthesis, 15 had 21 pregnancies following cessation of the anticoagulation therapy which resulted in the delivery of 20 healthy babies and 1 abortion. Remaining 2 had 3 pregnancies maintained with heparin, resulting in 2 healthy babies and 1 spontaneous abortion. Result: Among 16 women with mechanical heart valves, there were 7 pregnancies during which warfarin was used and this was associated with 4 fetal wastages(2 therapeutic abortion, 1 spontaneous abortion and 1 stillbirth with cerebral hemorrhage). However, in pregnancies where heparin was used, there was no fetal wastage. A patient who did not take anticoagulant for the first trimester and took warfarin for the remaining period and a patient who did not take anticoagulant during pregnancy delivered normal babies. There was an other fetal wastage in a patient on anti-platelet therapy for the first trimester and warfarin therapy for the remaining periods. There was 1 minor petechial complication in a heparin administered group. Conclusion: The study indicates that woman with bioprosthetic heart valves can go through pregnancy without undue risks or complications. On the other hand, the use of warfarin during pregnancy in women with mechanical heart valves, was shown to be associated with unacceptable high risk for the fetus. However, in the same group of women, judicious use of heparin during pregnancy was accompanied by a much reduced risk. The safety and adequate therapeutic range of heparin usage under such circumstances are subject to further studies.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.48-54
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• 1987

This report provides follow-up data on 557 patients [73 aortic, 357 mitral, and 127 multiple valve replacements] undergone lonescu-Shiley pericardial Xenograft valve replacement at Seoul National University Hospital between January, 1979 and December, 1985. There were 35 early death [6.3%] and 522 operative survivors were observed, and the cumulative follow-up is 1,140 patient-years [mean: 2.18 years per patient] The thromboembolic complications occurred in 34 cases [3.0% per patient-year] and the rate was 2.1% per patient-year for mitral and 0.3% per patient-year for aortic valve replacement in the presence of anticoagulation therapy. Among the 34 embolic episodes, 9 patients were dead [0.8% per patient-year] and the cause of death were 5 cerebral thromboembolism, 2 pulmonary embolism, and 2 intracerebral hemorrhage due to inappropriate anticoagulation after thromboembolic episode. Actuarial probability [+ SEM] of remaining free of thromboembolism for AVR is 88.1 x 11.1% at 5 years, for MVR 79.1 a 13.4% at 7 years and for multiple valve replacement 77.2 e 5.21% at 7 years. The incidence rate of thromboembolic complications after AVR is not less than that of MVR [0.3 Among the potential thromboembolic risk factors, atrial fibrillation is possible risk factor to increase the thromboembolic complication [0.05 < P < 0.1], but the importance of other factors, such as atrial clot, large left atrial size, mitral position, NYHA functional class, and age is less definite. A careful follow-up and the proper control of anticoagulation without omission, poor control, and arbitrary withdrawal is important for the successful management of the thromboembolic complications and the anticoagulation-related morbidity and mortality.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.33-36
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• 2010

Purpose: Brown's syndrome is characterized by the limited elevation in adduction from mechanical causes around the superior oblique tendon trochlea complex. In this particular case, post-traumatic facial deformity accompanied by Brown's syndrome was observed. We would like to report the satisfying cosmetic results obtained by reconstructing orbital roof and superior orbital rim and repositioning of zygoma. Methods: A 12-year-old patient was observed with facial deformity with strabismus in her right eye and orbital dystopia after the car accident and was eventually diagnosed with traumatic Brown's syndrome. Reconstructive surgeries could not be performed at the time of trauma due to the cerebral hemorrhage. At the second year after the trauma, a depressed fracture of the right orbital roof and superior orbital rim were reconstructed via the intracranial approach, and orbital dystopia was corrected via the zygoma triple ostectomy. In addition, a strabismus surgery was performed one year after her plastic surgery. Results: Facial deformity with orbital dystopia and strabismus was confirmed to be fully reconstructed after the surgery. Moreover, when the patient came in for a follow-up thirteen years after the operation, a developmental imbalance of the facial bones, diplopia, or any other surgical complications were not to be found. Conclusion: After the trauma, the patient with Brown's Syndrome accompanied by post-traumatic facial deformity, who went under the corrective surgeries after the meticulous examination and assessment pre-surgically, was able to acquire cosmetic satisfaction via those operations.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.425-429
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• 2001

Objective : Patients with poor grade aneurysm usually present with increased intracranial pressure(ICP), even those without an intracranial clot. Based on this fact, the present study investigated a significance of intracranial pressure monitoring in those patients. Patients and Methods : A total of 60 patients with Hunt and Hess Grade IV(50 patients) or V(10 patients) were treated for aneurysmal subarachnoid hemorrhage(SAH) during a 3-year-period, and intraparenchymal ICP was measured in the majority, immediately after arrival to the emergency room. Early surgery including intraoperative ventriculostomy was undertaken within 3 days after SAH. An ultraearly surgery was performed without preceding angiogram or ICP monitoring in patients with large sylvian hematomas, highly suggestive of middle cerebral artery aneurysm. Outcomes were assessed by the Glasgow Outcome Scale(GOS) at 6 months. Results : In overall, favorable outcome(GOS scores 1-2) was seen in 27(54.0%) of admission Grade IV and 1(10.0%) of admission Grade V patients. Of the 38 surgical patients with preoperative ICP monitorings, 25 patients (80.6%) exhibiting ICP values of less than 40mmHg showed favorable outcome, however, no patients with ICP values above 40mmHg recovered(Fisher's exact test, p=0.0001). Conclusion : It is concluded that a preoperative ICP above 40mmHg before ventriculostomy indicate significant vital brain destruction as intractable intracranial hypertension, and Grade IV patients at admission with an ICP below 40mmHg can be of benefit from early surgical intervention while Grade V patients still remains unfavorable.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.321-327
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• 2015

Objective : To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. Methods : We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. Results : A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR ${\geq}0.2$ and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p<0.001 and p=0.004), but on multivariate analysis, only CEAR ${\geq}0.2$ showed a statistically significant association (p=0.019). In the group with CEAR ${\geq}0.2$, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR <0.2. Clinical functional outcomes, based on the modified Rankin scale, were also significantly worse in patients with CEAR ${\geq}0.2$ (p=0.003) Conclusion : The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.