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Surgical Approaches to the Middle Cranial Base Tumors (중두개와저 종양에 대한 수술적 치료)

  • Kim, Il Seub;Rha, Hyung Kyun;Lee, Kyung Jin;Cho, Kyung Keun;Park, Sung Chan;Park, Hae Kwan;Cho, Jeung Ki;Kang, Jun Ki;Choi, Chang Rhack
    • Journal of Korean Neurosurgical Society
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    • v.30 no.9
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    • pp.1079-1085
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    • 2001
  • Objective : We analysed various surgical approaches and surgical results of 28 middle cranial base tumors for the purpose of selecting optimal surgical approach to the middle cranial base tumor. Methods : In this retrospective review, 28 patients, including 16 meningioma, 6 trigeminal neurinoma, 2 pituitary adenoma, 2 craniopharyngioma, 1 facial neurinoma, and 1 metastatic tumor, underwent surgical treatment using skull base technique. Of theses, 16 tumors were mainly confined to middle cranial fossae, 5 tumors with extension into both anterior and middle fossa, and 7 tumors with extension into both middle and posterior fossa. Tumors that confined to the middle cranial fossa or extended into the anterior cranial fossa were operated with modified pterional, orbitozygomatic or Dolen'c approach, and tumors that extended into the posterior cranial fossa were operated with anterior, posterior or combined transpetrosal approach. Completeness of tumor resection, surgical outcome, postoperative complication, and follow up result were studied. Results : Total tumor removal was achieved in 9 tumors of 10 tumors that did not extended to the cavernous sinus, and was achieved in 7 tumors of 8 tumors that extended to the lateral wall of the cavernous sinus. Of 10 tumors that extended to the venous channel of the cavernous sinus, only 2 were removed totally. Surgical outcome was excellent in 14 patients, good in 10, fair in 2 and poor in 2. There were no death in this series. Dumbell type tumor which extended into both middle and posterior fossae showed tendency of poor prognosis as compared with tumors that confined middle cranial fossa and extended into both anterior and middle cranial fossa. Postoperative dysfunctions were trieminal hypesthesia in 3, oculomotor nerve palsy in 2, abducens nerve palsy in 2, hemiparesis in 2, cerebellar sign in 1, facial palsy in 1 and hearing impairment in 1. Conclusion : Based on our findings and a review of the literature, we conclude that, when selecting the surgical approach to the middle cranial fossa tumors, the most important factors to be considered were exact location of the tumor mass and existence of the cavernous sinus invasion by tumor mass. We recommend modified pterional or orbitozygomatic approach in cases with tumors located anterior and middle cranial base, without cavernous sinus invasion. In cases with tumors invading into cavernous sinus, we recommend Dolen'c or orbitozygomatic approach. And in lateral wall mass and the cavernous sinus, it is preferred to approach the tumor extradurally. For the tumor involing with middle fossa and posterior fossa(dumbell type) a combined petrosal approach is necessary. In cases with cavernous sinus invasion and internal carotid artery encasement, we recommend subtotal resection of the tumor and radiation therapy to prevent permanent postoperative sequele.

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Analysis on the Use Characteristics of Citizen based on Urban Green Spaces Type - Focuses on Suwon-City - (도시녹지 유형에 따른 도시민의 이용 특성 연구 - 수원시를 대상으로 -)

  • Kim, Yea Sung;Kim, Hyun;Ko, Jinsoo
    • Journal of the Korean Institute of Landscape Architecture
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    • v.42 no.5
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    • pp.31-40
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    • 2014
  • The importance of green spaces in the city is growing each day. Local governments are taking charge of park development works that are having difficulty in developing and managing urban parks due to high land value as well as a shortage in finances. This is even though an urban park is defined as an urban planning facility and the law provides park area per person. Civil residents, meanwhile, are using not only urban parks provided by law but also other green areas such as rivers, reservoirs, and school playgrounds because they recognize urban green areas by the concept of use. In this study, accordingly, urban green areas were sorted into two types, urban parks, parks provided by law, and other green areas, and the difference in use pattern and use satisfaction by type was analyzed. As a result of analysis, there was no remarkable difference between the two types. According to such results, it was found that it is necessary to include other green areas, such as rivers, reservoirs, school green areas, and apartment green areas in addition to the current park green areas provided by law when park area per person is calculated, and such calculation of urban green areas reflecting local characteristics can reduce local governments' financial burden and improve the effectiveness of future urban park policies. It is judged that such results can become a plan against the cancellation of unexecuted urban facilities. The fact that accessibility factors, such as road satisfaction, access convenience, and convenient movement, are affecting satisfaction with the use of urban parks suggests that it is important to improve urban park accessibilities rather than to quantitatively expand park area in order to improve satisfaction with urban parks. Considering that people travel to urban green areas mostly by walking, it is necessary for access convenience to conduct follow-up studies such as barrier-free and securing walking stability through analysis of routes to urban green areas.

Does the ADC Map have Additional Clinical Significance Compared to the DWI in the Brain Infarction? (뇌경색에서 확산강조영상과 비교하여 현성확산계수 지도의 부가적인 임상적 중요성이 있는가?)

  • Choi, Sunseob;Ha, Dong-Ho;Kang, Myong-Jin;Lee, Jin Hwa;Yoon, Seong Kuk
    • Investigative Magnetic Resonance Imaging
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    • v.17 no.4
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    • pp.267-274
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    • 2013
  • Purpose : To re-evaluate additional clinical significance of the apparent diffusion coefficient (ADC) map in the inference of infarction stage, authors studied the evolution patterns of the DWI and the ADC map of the brain infarction. Materials and Methods: In 127 patients with cerebral infarctions, including follow-up checks, 199 studies were performed. They were classified as hourly (117 studies)-, daily (108 studies)-, weekly (62 studies)-based groups. The signal intensity (SI) was measured at the core of the infarction and contralateral area with ROI of 0.3 $cm^2$ or more on the images of the DWI and the ADC map, and calculated the ratios of SI and ADC value of the infarction area / contralateral normal area, and compared the patterns of the change according to the evolution. Results: Infarction was detected as early as 1 hour after the attack, and the ratio of SI in the DWI became over than 2 after 12 hours, which showed a plateau until the 6th day. Thereafter, it decreased slowly to 1 on the 30th day, and changed to lower SI than the surrounding brain. The ratio in the ADC map became 0.46 in 24 hours after the attack, and increased slowly to 1 in the 15th day. Thereafter, it became a higher value than the surrounding brain. Overall, the ratio in the ADC map changed earlier than in the DWI, and the ratio curves showed inverse pattern each other according to the evolution of the infarction. Conclusion: The evolution patterns of infarction on the ADC map showed an inverse curve of DWI curve, which means that the ADC value is accurately predictable from DWI, and the ADC map joined with the DWI seems helpful in the determination of subacute infarction between 15 to 30 days.

Effects of the Forest-land Registry System of the Forest Law of 1980 on the Colonial Forest-land Policy used in Korea under the influence of Japanese Imperialism (삼림법(森林法)(1908)의 지적신고제도(地籍申告制度)가 일제(日帝)의 식민지(植民地) 임지정책(林地政策)에 미친 영향(影響)에 관(關)한 연구(硏究))

  • Bae, Jae Soo
    • Journal of Korean Society of Forest Science
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    • v.90 no.3
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    • pp.398-412
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    • 2001
  • The purpose of this study is to examine the roles of the forest-land registry system in the Forest Law of 1908 and the effects this system had on the colonial forest-land policy used in Korea under the influence of Japanese Imperialism. This was started under the Profit-sharing Forest System which was one of the policies for disposing of the Korean national forests. The purpose of this system was to establish forest-land ownership, a fundamental human right. This system was enforced by the Japanese Colonial Government without regard to the customary and important right of Koreans to use the forests, and without considering the distinction between national and private forests. Koreans understood that this system was a warning sign of a tax being imposing on forest-land owners. Furthermore, Koreans thought the Japanese were using this system to deprive them of their forest-land. The strata of Koreans reporting ownership were very limited and included the intellectual(upper-middle) class, higher officials in counties and townships, relatives and relations of these officials, and survey agents. In particular the actual owners could not submit a report registering their land in this system because the required survey cost more than the value of the forest-land. Within the time period specified by the Japanese Colonial Government, about 520,000 registries were reported involving 2.2 million Jung-bo(.9917 hectare) with most of these coming during the last five months of reporting period. Koreans made a reasonable request to extend the deadline, but it was refused. After the reporting period expired there were no follow-up measures such as verification of the reported registrations nor establishment of boundaries between national and private forests. According to Article 19 in the Forest Law of 1908 about 14 million Jung-bo, which was not registered within the reporting period was nationalized. The colonial forest-land policy used in Korea by the Japanese Colonial Government was as follows : (1) to create a large number of national forests in the early period of their rule, (2) to divide these national forests into indispensible national forests and dispensible national forests, and (3) to transfer ownership of the dispensible national forests to colonial Japanese. To achieve the latter, the occupational government needed a method to insure ownership. They devised a tree-planting scheme in which the national forests classified as disposable were "loaned" and then transferred to these Japanese. The actual Korean owners claimed title to this forest-land and asked for the eviction of the new owners but the Japanese occupation government rejected these suits using the excuse that previous Korean owners did not submit the required registration report within the specified time period. In short the Principle of Forest-land Registry was used as a means to consolidate the forest-lands of Korea and distribute large portions of it to Japanese citizens after seizing it from the rightful Korean owners.

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The Infertility Characteristics of Patients in the Obstetrics and Gynecology Specialized Hospital and Effect of Pregnancy on the Type of Assisted Reproductive Technology (산부인과 전문병원 내원환자의 난임 특성과 보조생식술 유형이 임신에 미치는 영향)

  • Kim, Yun-Jeong;Hwang, Byung-Deog
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.17 no.8
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    • pp.318-326
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    • 2016
  • This study was conducted to identify characteristics observed by staff during infertility treatment, and to analyze the relationship between the result of the treatment according to the ART infertility characteristics. In cooperation with an Obstetrics and Gynecology Hospital in Ulsan, data were collected from 344 people receiving infertility treatment from 2012-1013 and evaluated by cross-analysis, logistic regression analysis, and the ${\chi}^2$ test. Age 30 subjects (72.1%), no disease (70.9%), and no birth children (77.0%) were most common among patients. Causes of infertility factor is the higher the age, followed by uterine factors, ovarian factors were the lower the age.Were assisted reproduction are IUI (51.5%), IVF (23.0%), IUI + IVF (25.6%), assisted reproduction were age (p<.013) infertility period (p<.014), abortion Experience (p<.008) it was not statistically significant. ART pregnancies result was 34.9%, IUI was 49.2%, IVF was 50.8%. The average number of successful IVF treatment was 1.64, while it was 1.36 for IVF. IVF is 0.28 times lower than the IUI. Thus, low in order to increase the success rate of pregnancy according to the assisted reproduction age, nanim period is short, and if you do not have birth children choose artificial fertilization, and high age, IVF If there are nanim period is longer and birth child treatment and you must choose. This study analyzed all subjects who underwent fertility treatment to have research significance. However, it is difficult to generalize, locally called Sun City limits. If this one based on regional and national follow-up study of infertility therapist made it will help to prepare the way of effective treatment for infertility causes.

The Factors Influencing the Asthenopia of Emmetropia with Phoria (사위를 가진 정시안의 안정피로에 영향을 미치는 요인)

  • Kim, Jung-Hee;Lee, Dong-Hee
    • Journal of Korean Ophthalmic Optics Society
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    • v.10 no.1
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    • pp.71-82
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    • 2005
  • The aim of this study was to provide fundamental data for the factors influencing the asthenopia of emmetropia with phoria and alleviation of asthenopia. A total of 348 subjects, aged between 19 and 30 years old, who had no strabismus, an eye trouble or whole body disease, were examined using corrected visual acuity, corrected diopter, stereopsis and suppression tests from September of 2002 to September of 2004. We excluded 21 subjects for the following reasons: if they had an amblyopia affecting binocular vision or inaccurate data. After these exclusions, 327 subjects remained. We then individually measured the refractive error correction, pupillary distance, optical center distance, phoria, convergence, accommodation and the AC/A as well as the asthenopia during binocular vision using a questionnaire. After analysis of factors affecting asthenopia, we also examined the reductive effect of a prism on the asthenopia in subjects who had asthenopia. To determine the factors affecting asthenopia during binocular vision, statistic analyses were carried out using the Chi-square test and the multivariate Logistic regression model. The results of this study were as follow. For asthenopia during near binocular vision of emmetropia with phoria, in case of the lower the accommodation and convergence, a significantly higher rate of asthenopia was observed (p<0.001). When the AC/A is lower, the higher the rate of asthenopia was observed but not significantly and there was no association between phoria and asthenopia. When the multivariate logistic regression model was used to determine factors affecting binocular vision of emmetropia with phoria, in case of the lower accommodation and convergence, a significantly higher rate of asthenopia was observed. when the phoria is esophoria or higher exophoria, or when the AC/A is lower than normal, the higher the rate of asthenopia was observed but not significantly and there was no association between phoria. AC/A and asthenopia. Therefore accommodation and convergence could be predictive factors for asthenopia during near distance binocular vision. Prism was used among' subjects who had asthenopia during near distance binocular vision, the symptom of asthenopia was eased up to 74.2% in emmetropia with phoria.

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Responses and Toxicities of Risk-adapted Chemotherapy in Pediatric Intracranial Germ Cell Tumors (소아 두개 내 생식 세포종에서 위험군에 따른 화학요법의 치료 반응 및 독성)

  • You, Dong Kil;Lee, Soo Hyun;Yoo, Keon Hee;Sung, Ki Woong;Lim, Do Hoon;Shin, Hyung Jin;Koo, Hong Hoe
    • Clinical and Experimental Pediatrics
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    • v.48 no.2
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    • pp.186-190
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    • 2005
  • Purpose : The purpose of this study was to evaluate the responses and toxicities of risk-adapted chemotherapy in pediatric intracranial germ cell tumors(IC-GCT). Methods : Fourteen patients who were diagnosed as IC-GCT from October 2002 to December 2003 received chemotherapy as an initial treatment modality. The low risk(LR) group was defined as follows : Pure germinoma and normal AFP level. Beta-hCG level 50 mIU/mL or less. The others belonged to the high risk(HR) group. Chemotherapy was composed of cisplatin, cyclophosphamide, etoposide and vincristine. Double doses of cisplatin and cyclophosphamide was used in HR patients. Results : Pathologic confirmation was done in all but one. Median age at diagnosis was 11.6 yr (1.2-18.7 yr), and nine patients belonged to the HR group. Tumor markers were normalized after chemotherapy in all patients whose tumor markers had been elevated. Four LR patients(80 percent) and seven HR patients(77.8 percent) showed complete response(CR) at the end of chemotherapy. An additional two of the three patients with partial response(PR) achieved CR after radiation therapy (RT), and the remaining one relapsed before RT. Four LR and all HR patients experienced infectious episodes that required hospitalization. Four of the nine HR patients(44.4 percent) suffered from tinnitus, three of whom developed sensorineural hearing loss. All but one are surviving, event-free, with a median follow-up of 13.9 mo(8.1-22.3 mo). Conclusion : Risk-adapted cisplatin-based chemotherapy was effective even in HR patients, but regimen modification seems to be necessary to avoid an unacceptably high toxicity rate.

Allogeneic Hematopoietic Stem Cell Transplantation in Juvenile Myelomonocytic Leukemia (연소형 골수단구성 백혈병에서의 동종 조혈 모세포 이식)

  • Yoo, Keon Hee;You, Dong Kil;Lee, Soo Hyun;Sung, Ki Woong;Cho, Eun Joo;Koo, Hong Hoe
    • Clinical and Experimental Pediatrics
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    • v.48 no.2
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    • pp.178-185
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    • 2005
  • Purpose : The purpose of this study was to evaluate the outcome of children with juvenile myelomonocytic leukemia(JMML) treated with allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods : Eleven JMML patients aged 8-39 months underwent allo-HSCT. The sources of grafts were unrelated donors(n=7), HLA-matched siblings(n=3) and an HLA 1-antigen mismatched familial donor. All patients had received chemotherapy ${\pm}13$-cis-retinoic acid(CRA) before transplant, and CRA was used, posttransplant, in six patients. Results : Only three patients were in complete remission(CR) at the time of transplantation. Initial chimeric status revealed complete donor chimerism(CC) in five patients, mixed chimerism(MC) in five and autologous recovery(AR) in one. One patient with MC having persistent splenomegaly eventually turned to CC and CR after rapid tapering of cyclosporine, combined with daily use of CRA. An AR case relapsed shortly after transplant but was rescued with second, unrelated cord blood transplantation. Ultimately, six patients are alive, event-free, with a median follow-up of 15.5 months posttransplant. All three deaths occurred in patients who failed to achieve CC, leading to disease progression. Conclusion : We suggest that graft-versus-leukemia effect play an important role and CRA a possible role in posttransplant leukemic involution in JMML. In patients whose leukemic burden is still high with MC after transplant, early tapering of immunosuppressants and introduction of CRA might provide a chance of a cure for some patients.

Comparison of Rehospitalization during the First Year of Life in Normal and Low Birth Weight Infants Discharged from NICU (신생아 집중치료실에서 퇴원한 정상 체중아와 저출생 체중아의 재입원에 관한 비교)

  • Min, Sae Ah;Jeon, Myung Won;Yu, Sun Hee;Lee, Oh Kyung
    • Clinical and Experimental Pediatrics
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    • v.45 no.12
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    • pp.1503-1511
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    • 2002
  • Purpose : Although the short- and long-term outcomes of low birth weight(LBW) neonatal intensive care unit(NICU) survivors have been extensively studied, much less information is available for normal birth weight(NBW) infants(greater than 2,500 gm) who require NICU care. Methods : We retrospectively examined the neonatal hospitalizations and one year health status of 302 NBW and 131 LBW admissions to our NICU. Information on the neonatal hospitalization was obtained from a review of medical records. Postdischarge health status was collected by using telephone surveys and medical records. Results : After initial discharge, 21.2% of the NBW infants and 23% of the LBW infants required rehospitalization during the first year of life and there was no significant difference between the two groups. The reasons for rehospitalization of the NBW infants included respiratory disorders (32.1%), G-I problems(26.2%), genitourinary problems(11.9%), surgery(10.7%), cardiac problems(7.1%), and congenital/developmental problems(1.2%). For the LBW infants, the order of frequency was the same, with the percentages slightly different. Neonatal risk factors related to the rehospitalization of the NBW infants included mechanical ventilation, duration of mechanical ventilation, and congenital anomaly. But no positive significant correlation of neonatal risk factors with rehospitalization of LBW infants was found. Conclusion : Low and normal birthweight NICU survivors were rehospitalized at similar rates. The most common cause of rehospitalization was respiratory problems. Neonatal risk factors related to rehospitalization of NBW infants were mechanical ventilation, duration of mechanical ventilation, and congenital anomaly. However, no positive significant correlation of neonatal risk factors with rehospitalization of LBW infants was found. The data suggests that NBW infant survivors, as well as LBW infant NICU survivors, require close follow up.

The Effect of Postnatal Dexamethasone Treatment on Hypoxic-Ischemic Brain Injury in Neonatal Rats (신생쥐의 저산소성 허혈성 뇌손상에서 손상 후 덱사메타손의 투여 효과)

  • Park, Chang Ro;Park, Kyung Pil;Kim, Heng Mi;Sohn, Yoon Kyung
    • Clinical and Experimental Pediatrics
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    • v.46 no.10
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    • pp.989-995
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    • 2003
  • Purpose : Dexamethasone is frequently administered to prevent or treat chronic lung disease in human neonates who are also prone to hypoxic-ischemic(HI) insults. Recently, meta-analysis of the follow-up studies reveals a significantly increased odd ratio for the occurrence of cerebral palsy or an abnormal neurologic outcome, and there is conflicting evidence regarding the impact of dexamethasone exposure on HI brain injury. This study was conducted to explore the effect of post-HI dexamethasone administration on neuronal injury in neonatal rats. Methods : HI was produced in seven-day-old rats by right carotid artery ligation followed by two hours of 8% oxygen exposure. At the end of HI, the animals were injected intraperitoneally either with dexamethasone(0.5 mg/kg) or saline. Neuronal injury was assessed seven days after the HI by the area of infarction, TUNEL reactivity, Bcl-2 and Bax expression in brain. Results : Post-insult dexamethasone administration resulted in reduction of weight gain and a higher mortality rate during seven days after HI. Dexamethasone treatment revealed no effect on the size of brain infarction induced by HI. Bax protein expression increased in dexamethasone treated brain but Bcl-2 protein expression and TUNEL reactivity revealed no significant differences between dexamethasone treated and non treated brain. Increased Bax protein expression suggest upregulation of the apoptosis by dexamethasone. Conclusion : The result suggests the adverse role of Post-HI administration of dexamethasone in neonatal HI.