• Journal of Korean Neurosurgical Society
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• 제61권3호
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• pp.363-375
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• 2018

Intraoperative monitoring (IOM) utilizes electrophysiological techniques as a surrogate test and evaluation of nervous function while a patient is under general anesthesia. They are increasingly used for procedures, both surgical and endovascular, to avoid injury during an operation, examine neurological tissue to guide the surgery, or to test electrophysiological function to allow for more complete resection or corrections. The application of IOM during pediatric brain tumor resections encompasses a unique set of technical issues. First, obtaining stable and reliable responses in children of different ages requires detailed understanding of normal age-adjusted brain-spine development. Neurophysiology, anatomy, and anthropometry of children are different from those of adults. Second, monitoring of the brain may include risk to eloquent functions and cranial nerve functions that are difficult with the usual neurophysiological techniques. Third, interpretation of signal change requires unique sets of normative values specific for children of that age. Fourth, tumor resection involves multiple considerations including defining tumor type, size, location, pathophysiology that might require maximal removal of lesion or minimal intervention. IOM techniques can be divided into monitoring and mapping. Mapping involves identification of specific neural structures to avoid or minimize injury. Monitoring is continuous acquisition of neural signals to determine the integrity of the full longitudinal path of the neural system of interest. Motor evoked potentials and somatosensory evoked potentials are representative methodologies for monitoring. Free-running electromyography is also used to monitor irritation or damage to the motor nerves in the lower motor neuron level : cranial nerves, roots, and peripheral nerves. For the surgery of infratentorial tumors, in addition to free-running electromyography of the bulbar muscles, brainstem auditory evoked potentials or corticobulbar motor evoked potentials could be combined to prevent injury of the cranial nerves or nucleus. IOM for cerebral tumors can adopt direct cortical stimulation or direct subcortical stimulation to map the corticospinal pathways in the vicinity of lesion. IOM is a diagnostic as well as interventional tool for neurosurgery. To prove clinical evidence of it is not simple. Randomized controlled prospective studies may not be possible due to ethical reasons. However, prospective longitudinal studies confirming prognostic value of IOM are available. Furthermore, oncological outcome has also been shown to be superior in some brain tumors, with IOM. New methodologies of IOM are being developed and clinically applied. This review establishes a composite view of techniques used today, noting differences between adult and pediatric monitoring.

• 비파괴검사학회지
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• 제31권5호
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• pp.466-471
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• 2011

광 단층촬영기법은 의료영상진단 기기로 최근에 주목받고 있는 분야이다. 현재 병원 초음파보다 공간 해상도가 10-100배 우수하지만 침투깊이가 조직 내에서 1-2 mm로 얇기 때문에 인체 내 장기 이미징을 위하여서 반드시 내시경 기법을 동반하여야 한다. 본 연구를 통하여 고속 광 단층촬영기법을 소개하고 초소형 기전공학 기술을 바탕으로 개발된 내시경을 사용하여 New Zealand white rabbit의 식도와 위장 벽을 3차원으로 이미징한 결과를 고찰하였다. 개발된 내시경에는, 2축 스캔 반사경이 정전기력에 의하여 구동하는 구 동부 위에 위치하여, 입력광을 2축으로 스캔할 수 있도록 하는 구조를 포함하고 있다. 내시경의 외경은 6 mm이며 스캔 반사경의 직경은 1.2 mm 였다. 3.5초 동안 스캔하면서 3차원 이미지를 획득하였다. 3차원 이미지는 200개의 2차원 이미지를 쌓아서 구현되었으며 각각의 2차원 단면이미지는 $200{\times}500$ 픽셀들로 구성되었다. 이미지의 공간해상도는 공기 중에서 8 ${\mu}m$ 였다.

• 대한세포병리학회지
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• 제17권2호
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• pp.120-125
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• 2006

Distinguishing small cell carcinoma from other lung malignancies is of great clinico-therapeutic significance. Small cell carcinoma is an aggressive tumor with a tendency to metastasize early. Survival time if untreated is low but this tumor is highly responsive to chemotherapy. We have occasionally experienced difficulties in differentiation between adenocarcinoma and small cell carcinoma of the lung in fine needle aspiration cytology (FNAC). The aim of this study was to investigate the possibility of distinguishing small cell carcinoma from adenocarcinoma of the lung in FNAC. We evaluated cytomorphological features of FNAC specimens from 62 small cell carcinomas and 57 adenocarcinomas from the lung that were confirmed by biopsy and/or immunohistochemistry on cell block. Cytomorphological details of the two tumors were compared. Nuclear smearing and nearly absent cytoplasm were the most distinct findings in small cell carcinoma compared to adenocarcinoma (p<0.05). Necrotic background, architecture and chromatin pattern, nuclear molding and nucleoli were significantly different (p<0.05). Nuclear size, nuclear membrane nature and nuclear size variation however were not helpful in distinguishing the two tumors. Combining several features described above, small cell carcinoma can be properly differentiated from adenocarcinoma on FNAC. FNAC is proposed as a diagnostic tool of small cell carcinoma of the lung in the case of inaccessibility to biopsy, and so may allow the proper therapeutic strategies to be determined in such cases

• 보건행정학회지
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• 제3권2호
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• pp.100-129
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• 1993

This study is designed to find out some intra-clinic factors affecting the content of practice provided by primary care physicians in Korea, and proposed factors in this study are characteristcs of each private clinc --- physician-related variables(age, sex, specialty), bfed-related variables for inpatient care, laboratory-related variables for precise diagnosis. We have tried to estimate the difference of disease entities cared by each primary care physician according to above factors by analyzin gdisease data claimed during one month(April, 1992) to National Federation of Medical Insurance. The diagnosis codes by ICD-9 in the research disease data were reclassified to 'diagnosis clusters' by virtue of clinical similarities for effective analyses. We have converted frequent-tsing ICD-9 codes to 86 diagnosis clusters, which incorporated 97.4 percents of all ambulatory visits to private clinics. This result means proposed diagnosis-cluster method is effective tool for analysis of the content of ambulatory medical care carried out by primary care physicians. Comparisons and analyses of multiple diagnosis-clusters made on the basis of presented factors were done and the results were as follows; - Major factors affecting the difference between diagnosis-cluster pattern by each variables were phyusician's age, sex, specialty and bed counts of each private clinic for inpatient care and the size of laboratories of each clinic. - Middle aged(30th to 40th) group physicians are providing more comprehensive care than 20th or above 50th aged groups. Male physicians are more adequate for comprehensive care than female physicians, because woman-doctors are providing narrow-spectrum care. The content of practice of obstetricians and gynecologists shows much difference from primary medical practice, and they cannot be included in primary care physician, this study suggested. Pediatricians are also providing short-spectum acre, and nearly all visits to pediatricians were incorporated only 2-3 diagnosis-clusters. General surgeons' practices are very similar to general practioners' or family physicians' practices, the means they are providing primary care rather than special surgical care. And small number of beds(under 5 beds) and only basic(2-3 sorts of)diagnostic apparatuses are sufficient for primary physicians' clinic to carry out primary care. In conclusion, to reinforce primary care department in Korea, there must be support with health policy to expand office-based primary care practice-- with small number of beds for inpatient care and only basic laboratories-- provided by general practitioner of family physician.

• The Korean Journal of Pain
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• 제30권4호
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• pp.281-286
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• 2017

Background: Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain. Methods: We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015. All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air. Results: The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later. Conclusions: Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.

• 유통과학연구
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• 제12권11호
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• pp.101-111
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• 2014

Purpose - This study aims to verify the construct of the service quality suitable to the characteristics of the business center, to develop the scale that can measure the service quality objectively, compare the diverse business centers in Korea, and present desirable methods of business center management and operation. Research design, data, and methodology - In the first stage, literature research and focus group interviews with current users and actual business experts of business centers were conducted. In addition, 69 early stage scale items were derived. In the second stage, a Delphi survey was conducted on the experts of business and academic circles. The measurement items in the early stage were supplemented and revised. The content validity rate (CVR) of 69 measures was computed and then the experts' opinions were used. As a result, the business center service quality scale, made up of 9 organizing factors and 36 measurement items, was constructed. In the third stage, a survey was conducted on the occupants who were currently using the business center. It was to confirm if the developed business center service quality scale could be actually utilized. The data of 435 samples collected were used. To refine the scale items, the exploratory factor analysis (EFA) was conducted repeatedly. Results - The business center service quality scale, made up of 8 factors and 33 items, was developed again. The 8 factors are reliability, speed, kindness, specialty, responsibility, appearance, convenience, and public interest. The reliability coefficient (Cronbach's Alpha) of each factor is greater than .7. Thus, it was confirmed that there was reliability in the measurement items. Further, the model suitability was verified using the confirmatory factor analysis (CFA), and the convergent validity and the discriminant validity were verified. This proved the construct validity. Through this process, the Korea Business Center Service Quality Scale was developed. Based on factor analysis, the developed business center service quality (BCSQ) scale consists of 4 aspects, 8 factors, and 33 items, comprising the "process quality" aspect: reliability (3 items), speediness (4 items), kindness (3 items) factors, the outcome quality aspect: expertise (3 items), responsibility (5 items) factors, the environment quality aspect: appearance (5 items), convenience (3 items) factors, and the public interest aspect: public interest (7 items) factor. However, according to CFA, the BCSQ scale consists of a total of 4 aspects, 8 factors, and 33 items, comprising the "process quality" aspect: reliability (3 items), speediness (3 items), kindness (3 items) factors, the outcome quality aspect: expertise (2 items), responsibility (4 items) factors, the environment quality aspect: appearance (3 items), convenience (2 items) factors, and the public interest aspect: public interest (3 items) factor. Conclusions - The BCSQ scale could serve as a diagnostic tool that will allow business center managers to determine service areas that are weak and in need of attention, and to improve the service quality of the business center.

• 한국자기공명학회논문지
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• 제7권1호
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• pp.1-15
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• 2003

PURPOSE - To investigate neurometabolism from the brain destructive lesions and striatal putamen-pallidus regions to the clinically worst side in patients with Parkinson's disease after stereotactic functional neurosurgery. METHODS - Using proton magnetic resonance spectroscopy ($^1$H MRS), fifteen patients (7 males and 8 females; mean age 56.5 years; age range 43-67 years) with Parkinson's disease (PD) were studied to measure N-acetylaspartate (NAA), creatine (Cr), choline-containing compounds (Cho) and lactate (Lac) levels on the neurosurgical lesions of thalamus, globus pallidus and striatal putamen-pallidus regions in a brain. RESULTS - Brain destructive lesion and striatal putamen-pallidus region in PD compared with controls were highly and significantly related to NAA/Cho ratios reduction, respectively (P =0.002, P =0.04), but showed no difference from the same regions of PD prior to neurosergery (P =0.06, P =0.77). Increased lactate peaks at 1.3 ppm were present in all the cerebral lesions, and these resonances were confirmed at a long TE =136 ms, indicating that these signals distinguished from lipids. CONCLUSIONS - Our results suggest that NAA/Cho ratios may provide as a neurometabolite marker for neurochemical changes in brain surgical lesion, and the ratios might be related to functional change of neuropathophysiological status in the striatal putamen-pallidus region of PD. Increase of lactate signals, being remarkable in surgical lesions, could be consistent with a common consequence of surgical necrosis. Therefore, MR spectroscopy could be a sensitive diagnostic tool in monitoring neurometabolic changes in PD with neurosurgical treatment.

• 대한한방부인과학회지
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• 제19권3호
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• pp.215-230
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• 2006

Purpose : To evaluate the clinical use of the menopause-specific quality of life questionnaire(MENQOL) for scoring menopausal symptoms by comparison with the conventional Kupperman's index. Methods : A population sample of 66 women was randomly selected from the female patients(aged 45-55) who had visited two oriental medical clinic in Seoul or Woo-Shin-Hwang oriental hospital from 1st April to 15th May in 2006. They completed both the MENQOL and the Kupperman's index and were asked a few additional questions. Results : 1. A degree of the Climacteric symptoms were not significantly related to either an education level or an income level. 2. A comparison of the MENQOL with the Kupperman's index produced a high positive correlation. 3. 41 of subjects (62.1%) answered that the MENQOL was more efficient for explaining their symptoms than the Kupperman's index. 49 (74.2%) of subject thought that both questionnaires are equally not difficult to fill out and 44(66.7%) of subject found no difficult questions to answer in any of questionnaires. Conclusion : The MENQOL is a valuable modern tool for the assessment of climacteric symptoms in place of the Kupperman's index. The MENQOL was excellent in applicability. The MENQOL could serve as an adequate diagnostic instrument for climacteric symptoms.

• 한국임상수의학회지
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• 제25권4호
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• pp.295-302
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• 2008

Two dogs were referred to Veterinary Medical Center, Chungbuk National University with the clinical signs of vomiting, diarrhea, anorexia, and jaundice. Both dogs were diagnosed as extrahepatic biliary tract obstruction(EHBO) with concurrent pancreatitis based on dilated common bile duct and hyperechoic or mixed-echoic pancreas in abdominal ultrasonographic examination and serum biochemical abnormalities, such as high serum bilirubin, cholesterol, and increased cholestatic enzyme activity. Percutaneous ultrasound-guided cholecytocentesis(PUCC) was performed to examine bile and decompress the gall bladder. After PUCC with medical therapy, both dogs were steadily improved clinical signs of jaundice and anorexia. Also, cholestatic enzyme activity and serum bilirubin concentration decreased. Any complications that have been described in previous studies, such as peritonitis resulting from bile leakage and hemorrhage, were not identified. It is assumed that percutaneous ultrasound guided cholecystocentesis may be an useful diagnostic and therapeutic tool in canine gallbladder disease and can be used easily and safely to gain bile for diagnosis of bacterial cholecytitis.

• 한국콘텐츠학회논문지
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• 제15권1호
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• pp.316-323
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• 2015

본 연구는 디지털 흉부 측와위 후전방향 검사 시 Ion chamber 설정과 관전압 변화에 따른 피폭선량과 변조전달함수를 측정하여 최적의 진단 영상을 획득하고 환자의 피폭선량을 최소화하는 방안에 대하여 제안하고자 하였다. 실험은 디지털 검출기를 이용하여 흉부 측와위 검사법 중 우측 측와위 상태를 가정하여 Ion chamber를 7가지 조합으로 설정하고, 관전압 변화(100, 110, 120, 130 kVp)에 따라 각 5회씩 촬영하여 표면선량을 측정한 후 평균값을 산출하였다. 실험에서 얻어진 표면선량 값을 몬테카를로 시뮬레이션 프로그램 인 PCXMC에 입력하여 장기선량 및 유효선량을 각각 산출하였고, 영상의 화질을 비교하기 위하여 MTF로 물리적 화질 평가를 하였다. 그 결과 관전압이 높을수록 표면선량이 감소하였으며, Ion chamber 변화에 따른 장기선량과 유효선량은 2번 Ion chamber 설정 시 가장 낮게 나타났으며, 1번 Ion chamber 설정 시 가장 높게 나타났다. MTF 결과는 관전압 120 kVp, 2번 Ion chamber를 설정 시 가장 우수하게 나타났다. 따라서 DR을 이용한 흉부 우측 측와위 촬영 시 화질의 저하 없이 피폭선량을 효과적으로 감소시키며 우수한 영상을 획득할 수 있는 최적의 조합은 관전압 120 kVp와 2번 Ion chamber를 설정하는 것이다.