• 한국환경보건학회:학술대회논문집
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• 한국환경보건학회 2005년도 Proceedings of KSEH.Minamata Forum
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• pp.87-94
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• 2005

Results from previous studies revealed that metal level in the body is related to certain types of diseases. For example. serum copper level with chronic heart failure, iron and transferrin in the blood serum with acute cerebral vascular diseases, Zn in the CNS, lead with neurotoxicity, hypertension, genetic damage, arsenic with cancer skin lesion, Al with neurobehavioral function (cognitive impairment and memory disorder), and etc. The rate of stroke has increased in recent years and several metals were found to be responsible for causing stroke. This study compared several blood metal concentrations between stroke and non-stroke patients. Patients with stroke (116 samples) and non-stroke (111 samples including lowback pain and others) participated in this study. Total of 227 blood samples were collected and participants completed questionnaires regarding age, gender, occupation, residence, alcohol, smoking, and etc. To be qualified into the stroke group, patients have never experienced stroke previously. Subjects only included ischemic stroke and intracerebral hemorrhage patients diagnosed by brain CT and brain MRI. Patients with high risk of metal exposure such as herbal intake and job related exposure were excluded. 10ml of blood samples were analyzed by ICP-MS method at the Center of Nature and Science at Sangji University. Metal geometric mean (SD) concentrations in blood of study subjects showed higher values, 2.64-36.12%, than WHO reference values in Mn, Ni, Hg, Se, and As. Metal concentration in blood of stroke patients non-adjusted for potential confounders was higher except for Hg and also higher except for Ni in adjusted for potential confounders. Co was significantly higher in stroke patients (p=0.002) than non-stroke patients adjusted for potential confounders. Regression coefficient values of stroke patients was 0.17-8.25 in each metals. Odd ratio of stroke patients had 0.96 (Ni)-2.68 (Co) compared to non-stroke cases. This result means that Co increase of 1 raises the risk ratio of stroke by 2.86 times. Based on the results, metal concentration in blood seems to affect incidence of stroke.

• Investigative Magnetic Resonance Imaging
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• 제21권2호
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• pp.65-70
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• 2017

Purpose: To optimize the saturation time and maximizing the pH-weighted difference between the normal and ischemic brain regions, on 3-tesla amide proton transfer (APT) imaging using an in vivo rat model. Materials and Methods: Three male Wistar rats underwent middle cerebral artery occlusion, and were examined in a 3-tesla magnetic resonance imaging (MRI) scanner. APT imaging acquisition was performed with 3-dimensional turbo spin-echo imaging, using a 32-channel head coil and 2-channel parallel radiofrequency transmission. An off-resonance radiofrequency pulse was applied with a Sinc-Gauss pulse at a $B_{1,rms}$ amplitude of $1.2{\mu}T$ using a 2-channel parallel transmission. Saturation times of 3, 4, or 5 s were tested. The APT effect was quantified using the magnetization-transfer-ratio asymmetry at 3.5 ppm with respect to the water resonance (APT-weighted signal), and compared with the normal and ischemic regions. The result was then applied to an acute stroke patient to evaluate feasibility. Results: Visual detection of ischemic regions was achieved with the 3-, 4-, and 5-s protocols. Among the different saturation times at $1.2{\mu}T$ power, 4 s showed the maximum difference between the ischemic and normal regions (-0.95%, P = 0.029). The APTw signal difference for 3 and 5 s was -0.9% and -0.7%, respectively. The 4-s saturation time protocol also successfully depicted the pH-weighted differences in an acute stroke patient. Conclusion: For 3-tesla turbo spin-echo APT imaging, the maximal pH-weighted difference achieved when using the $1.2{\mu}T$ power, was with the 4 s saturation time. This protocol will be helpful to depict pH-weighted difference in stroke patients in clinical settings.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.522-527
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• 2001

37세 남자 환자로 경련발작을 주소로 본원에 내원하였고, 조직검사상 뇌실외 신경세포종으로 진단 받았으며, 방사선 치료를 받고 퇴원하였다. 11년후 언어장애, 우측 편마비를 주소로 다시 내원 하였다. 뇌 전산화 단층촬영과 뇌 자기공명영상에서 좌측 두정엽과 측두엽에 종양 크기의 증가, 뇌부종 및 석회화가 동반된 소견을 보여 종양 절제술을 시행 받았다. 조직검사상에서 1987년 처음 입원 시에는 투명세포질을 가진 작은 원형세포와 원섬유가 풍부하고 가유두상 양상을 보이는 중심 신경세포종으로 진단되었다. 그러나, 1998년 두 번째 조직 검사상에서 대부분의 종양세포는 심한 이형성을 보이는 신경교세포로 구성되었으며, 유사분열, 다형성핵 등이 관찰되었고, 면역염색상 glial fibrillary acidic protein에서 양성을 보였다. 일부에서는 작고 둥근 세포들의 군집이 보였으며, synaptophysin에 양성을 보였다. 중심 신경세포종은 젊은 성인에서 호발하고 주로 측뇌실이나 제 3 뇌실의 몬로공 주위에서 발생하는 비교적 드문 종양으로, 신경교 분화를 보이는 경우는 있으나 악성분화를 보이는 경우와 뇌실외 발생은 드물다. 본 교실에서는 11년전 중심 신경세포 종으로 진단 받은 후 악성 신경교 분화를 보이는 뇌실외 신경세포종을 경험하였기에 보고한다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2004년도 제29회 추계학술대회 발표논문집
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• pp.91-95
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• 2004

알츠하이머병에서는 전산화 단층촬영영상이나 자기공명영상을 이용하여 구조적, 비특이적 뇌 위축등의 병변을 진단할 수는 있으나 뇌 당대사 및 혈류 분포에 의한 이상 유무를 진단하기 위해서는 단일광자방출 단층촬영술 (single photon emission computed tomography, SPECT) 이나 양전자 방출 단층촬영술 (positron emission tomography, PET)을 이용한 국소 뇌혈류나 뇌 당대사 변화를 관찰한 진단이 필수적이다. 따라서 SEPCT나 PET영상 위에 직접 관심영역(region of interest, ROI)를 그려서 ROI를 관찰하여 해부학적 뇌위축과 국소 뇌혈류나 뇌 당대사 변화를 분석하였으나 ROI 방법은 주관적인 영향과 많은 분석 시간을 요하는 단점이 있다. 따라서 통계적 분석 방법을 이용한 맵핑방법으로 voxel based morphometry 방법을 수행하였고 MMSE 값을 분산분석변수로 하여 영상분석하여 $^{18}$F-labeled 2-deoxyglucose ($^{18}$F-FDG) positron emission tomography(PET)-CT 영상을 분석하였다. MMSE 값을 변수로 분석한 voxel based morphemetry 방법에서는 MMSE 값에 의한 대사저하의 변화는 무의미하였다. 알츠하이머병에서는 측두두정엽(temporoparietal cortex)의 cerebral blood flow, oxygen utilization, glucose metabolism은 줄어들고, 일차시각피질, 일차감각피질, 기저핵, 시상, 소뇌는 유지되며 voxel based morphometry 방법은 알츠하이머병을 분석하는데 유용한 분석방법이다.

• Clinical and Experimental Pediatrics
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• 제55권2호
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• pp.63-67
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• 2012

A 4-year-old girl with Panayiotopoulos syndrome presented with a history of 4 prolonged autonomic seizures. The clinical features of her seizures included, in order of occurrence, blank staring, pallor, vomiting, hemi-clonic movement on the right side, and unresponsiveness. A brain magnetic resonance imaging (MRI) showed a slightly high $T_2$ signal in the left hippocampus. Interictal electoencephalogram revealed spikes in the occipital area of the left hemisphere. We analyzed the current-source distribution of the spikes to examine the relationship between the current source and the high $T_2$ signal. The current source of the occipital spikes was not only distributed in the occipital area of both cerebral hemispheres, but also extended to the posterior temporal area of the left hemisphere. These findings suggest that the left temporal lobe may be one of the hyperexcitable areas and form part of the epileptogenic area in this patient. We hypothesized that the high $T_2$ signal in the left hippocampus of our patient may not have been an incidental lesion, but instead may be related to the underlying electroclinical diagnosis of Panayiotopoulos syndrome, and particularly seizure. This notion is important because an abnormal $T_2$ signal in the hippocampus may represent an acute stage of hippocampal injury, although there is no previous report of hippocampal pathology in Panayiotopoulos syndrome. Therefore, long-term observation and serial follow-up MRIs may be needed to confirm the clinical significance of the $T_2$ signal change in the hippocampus of this patient.

• Investigative Magnetic Resonance Imaging
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• 제12권2호
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• pp.170-177
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• 2008

목적 : 순차적인 뇌초음파 검사 후 신생아 중환자실을 퇴원하는 고위험 환아에서 시행한 자기 공명 영상의 유용성을 알아보고자 하였다. 대상 및 방법 : 총 121명의 신생아에서 시행한 412 초음파와 121 자기공명 영상을 후향적으로 분석하여 초음파 검사에서 발견된 뇌병변과 자기 공명영상에서 발견된 병변을 비교하였다. 뇌병변은 배아기질 출혈 및 뇌실 내 출혈, 그 밖의 여러 출혈과 뇌실질 손상을 중심으로 비교 분석하였다. 결과 : 총 242개의 측뇌실 중 30뇌실의 배아기질 출혈 (GMH)을 초음파로 진단하였고 자기공명영상으로 7개의 GMH를 추가로 진단할 수 있었으며 46개 뇌실의 출혈 (IVH)을 추가로 진단하였다. 출혈의 1/2/3/4 등급은 초음파에서 각각 24/8/13/0 뇌실에서 진단하였고 자기공명영상에서 3/49/10/2 뇌실에서 진단하였다. 그 외에 자기공명영상에서 대뇌 출혈 (4예), 소뇌 출혈(4예), 경막하 및 지주막하 출혈 (8예), 미만성 백질 신호강도 변화 (72예), 조직손실이 없는 작은 실질 병변 (4예), 뇌연화증 (2예), 그리고 뇌실확장 (5예)이 추가로 발견되었다. 결론 : 자기공명영상은 초음파 검사 후 두개강내 출혈과 뇌실질 손상을 추가적으로 진단하는 유용한 검사였으며 특히 뇌실 출혈과 백질 손상의 진단에 우수한 반면 배아기질 출혈은 초음파 추적검사가 더 유용할 것으로 생각한다.

• 의료법학
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• 제15권1호
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• pp.263-302
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• 2014

The court handed down meaningful rulings related to medical sectors in 2013. This paper presents the ruling that the care workers could be the performance assistants of the care-giving service although the duties of care worker are not included in the liability stipulated in the medical contract signed with the hospital for reason of clear distinction of duties between care workers and nurses within the hospital in connection with the contract which was entered into between the hospital and patients. In relation to negligence and causal relationship, the court recognized medical negligence associated with the failure to detect the brain tumor due to the negligent interpretation of MRI findings while rejecting the causal relationship with consequential cerebral hemorrhage. The court also recognized negligence based on the observation on the grounds of inadequate medical records in a case involving the hypoxic brain damage caused during the cosmetic surgery. In terms of the scope of compensation for damages, this paper presents the ruling that the compensation should be estimated based on causal relationship only in case the breach of the 'obligation of explanation' is recognized, however rejecting the reparation for de factor property damages in the form of compensation, and the ruling that the lawsuit could be instituted in case that the damages exceeded the agreed scope despite the agreement that the hospital would not be held responsible for any aftereffects of surgery from the standpoint of lawsuit, along with the ruling that recognized the daily net income by reflecting the unique circumstances faced by individual students of Korean National Police University and artists of Western painting. Many rulings were handed down with respect to medical certificate, prescription, etc., in 2013. This paper introduced the ruling which mentioned the scope of medical certificate, the ruling that related to whether the diagnosis over the phone at the issuance of prescription could constitute the direct diagnosis of patient, along with the ruling that required the medical certificate to be generated in the name of doctor who diagnosed the patients, and the ruling which proclaimed that it would constitute the breach of Medical Act if the prescription was issued to the patients who were not diagnosed. Moreover, this paper also introduced the ruling that related to whether the National Health Insurance Service could make claim to the hospitals for the reimbursement of the health insurance money paid to pharmacies based on the prescription in the event that the hospitals provided prescription of drugs to outpatients in violation of the laws and regulations.

• 대한유전성대사질환학회지
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• 제14권2호
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• pp.195-199
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• 2014

X 연관 부신백질이영양증(adrenoleukodystrophy, X-ALD)는 성염색체 Xq28에 위치한 ABCD1 유전자의 돌연변이에 의해 발생하며, 매우 긴 사슬 지방산(saturated very long chain fatty acids, VLCFA) 운반의 장애로 뇌와 척수의 백질과 부신 피질을 포함한 모든 조직에 VLCFA가 쌓이게 되어 중추와 말초 신경 조직 내에 탈수초(demyelination)가 진행되고, 부신 피질의 기능 저하가 나타나게 된다. X-ALD의 임상적 증상은 매우 다양하나, 크게 3가지 표현형으로 나누어 대뇌 부신백질형성 장애(cerebral ALD), 부신 척수 신경병증(adrenomyeloneuropathy), 부신 피질 기능 저하 즉 애디슨병(Addison's disease only ALD)으로 나눌 수 있다2). 부신 피질 기능 저하 증세만을 보이는 Addison's disease only ALD의 경우 주로 2세에서 7.5세에 발생하며, 증세는 구토, 위약, 혼수, ACTH 분비 증가에 따른 색소 과다 침착(hyperpigmentation)으로 나타나고 발생 당시에는 신경학적 증세가 동반되지 않는다. 저자들은 구역, 구토, 탈수, 저혈당 및 저혈압 등의 증상 없이 색소 과다 침착이 부신 피질 기능 저하의 유일한 증세였던 환아를 혈장 VLCFA 검사를 통해 X-ALD로 진단하였고, ABCD1 유전자 분석 검사에서 c.1992-2A>G 변이를 확인하였다. 국내에서 색소 과다 침착만을 보이는 환아가 X-ALD로 진단받은 보고는 찾을 수 없었으며, 국내에서 보고되지 않은 돌연변이로 이를 보고하는 바이다. X-ALD 환아의 장기적인 예후 예측과 자세한 상담을 위해서 유전자형과 표현형의 상관관계에 대한 더 많은 연구가 필요하며, 이를 위해 유전자형에 따른 증상과 예후에 대한 자료가 공유되어야 할 것이다.

• 대한한의학회지
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• 제17권1호
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• pp.345-360
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• 1996

Background and Purpose: To evaluate the blood flow velocity using doppler ultrasound of the carotid artery, vertebral artery, and basilar artery in stroke patients Material and Methods: To evaluate the blood flow, I measured the peak systolic velocity and mean velocity of the common carotid artery(CCA), internal carotid artery(ICA), external carotid artery (ECA). vertebral artery(VA), and basilar artery(BA) in 44 stroke patients and 15 healthy adults. To investigate the difference between ischemic stroke patients and normal healthy adults, I selected 44 ischemic stroke patients diagnosed by brain CT and brain MRI, and 15 healthy adults who did not have any symptoms of stroke, hypertension, heart disease, and diabetes melitus. Results: Peak velocity in normal adults was 50.6${\pm}$1.6cm/sec in the CCA, 67.2${\pm}$1.7cm/sec in the ICA, 62.5${\pm}$2.4cm/see in the ECA, 45.5${\pm}$1.9cm/sec VA. and 50.5${\pm}$3.5cm/sec in the BA. Mean velocity in normal adults was 26.9${\pm}$1.1cm/sec in the CCA, 43.7${\pm}$1.4cm/sec in the ICA, 26.7${\pm}$1.3cm/sec in the ECA. 31.6${\pm}$1.9cm/sec in the VA and 33.0${\pm}$2.6cm/sec in the BA. In this study, there was a significant increase in the velocity of ICA, ECA, and VA of ischemic stroke patients in comparison with normal healthy adults. And the blood flow velocity of this study in the CCA and ECA was different from other reported foreign values and the other known values in my country. Conclusion: There was a significant difference in the blood flow velocity between ischemic stroke patients and normal healthy adults. And the blood flow velocity of this study was different from other reported foreign values and the other known values in my country. Therefore, it needs more detailed studies about old aged Korean and ischemic stroke patients than previous studies.

• 한국임상수의학회지
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• 제24권3호
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• pp.406-409
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• 2007

12년령의 암컷 치와와 믹스견이 급성 시력 상실과 진행성 사지마비 증상으로 내원하였다. 두부 자기공명 영상 촬영 결과 뇌에서 다발성 병변이 확인되었고 뇌척수액 검사 결과에서는 단핵구 증가 소견이 나타났다. 이러한 결과들을 토대로 육아종성 뇌수막염이 강력하게 의심되었다. 뇌의 병변은 조직 병리 검사를 통해 최종적으로 육아종성 뇌수막염으로 진단되었고 면역 조직 염색 상에서 T-cell 항원에 양성을 나타내었다. 본 증례 보고는 노령견에서 육아종성 뇌수막염의 임상적인 증상, 진단 영상의 특징, 그리고 면역조직병리학적인 소견 등을 나타내고 있다. 또한 본 증례 보고는 뇌혈관 주위의 T 림프구 침착에 기인한 육아종성 뇌수막염의 임상 증상들에 관해 서술하고 있으며 T세포 매개 염증의 원인 규명에 관한 고찰이 더 필요하다.