• Title/Summary/Keyword: GCS

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Locations and Clinical Significance of Non-Hemorrhagic Brain Lesions in Diffuse Axonal Injuries

  • Chung, Sang Won;Park, Yong Sook;Nam, Taek Kyun;Kwon, Jeong Taik;Min, Byung Kook;Hwang, Sung Nam
    • Journal of Korean Neurosurgical Society
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    • v.52 no.4
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    • pp.377-383
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    • 2012
  • Objective : Detection of focal non-hemorrhagic lesion (NHL) has become more efficient in diffuse axonal injury (DAI) patients using an MRI. The aims of this study are to find out the radiological distribution, progress of NHL and its clinical significance. Methods : Between September 2005 and October 2011, 32 individuals with NHLs on brain MRI were enrolled. NHLs were classified by brain location into 4 major districts and 13 detailed locations including cortical and subcortical, corpus callosum, deep nuclei and adjacent area, and brainstem. The severity of NHL was scored from grades 1 to 4, according to the number of districts involved. Fourteen patients with NHL were available for MRI follow-up and an investigation of the changes was conducted. Results : Thirty-two patients had 59 NHLs. The most common district of NHL was cortical and subcortical area; 15 patients had 20 NHSs. However the most common specific location was the splenium of the corpus callosum; 14 patients had 14 lesions. The more lesions patients had, the lower the GCS, however, this was not a statistically meaningful difference. On follow-up MRI in 14 patients, out of 24 lesions, 13 NHLs resolved, 5 showed cystic change, and 6 showed atrophic changes. Conclusion : NHLs were located most commonly in the splenium and occur frequently in the thalamus and the mesial temporal lobe. Because most NHS occur concomitantly with hemorrhagic lesions, it was difficult to determine their effects on prognosis. Since most NHLs resolve completely, they are probably less significant to prognosis than hemorrhagic lesions.

Clinical and Angiographic Results after Treatment with Combined Clipping and Wrapping Technique for Intracranial Aneurysm

  • Suh, Sang-Jun;Kim, Sang-Chul;Kang, Dong-Gee;Ryu, Kee-Young;Lee, Hyuk-Gee;Cho, Jae-Hoon
    • Journal of Korean Neurosurgical Society
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    • v.44 no.4
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    • pp.190-195
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    • 2008
  • Objective : There have been numerous follow-up studies of patients who had ruptured or unruptured intracranial aneurysms treated by wrapping technique using various materials have been reported. Our objective was to ascertain whether our particular wrapping technique using the temporalis muscle provides protection from rebleeding and any aneurysm configuration changes in follow-up studies. Methods : Clinical presentation, the location and shape of the aneurysm, outcomes at discharge and last follow-up, and any aneurysm configuration changes on last angiographic study were analyzed retrospectively in 21 patients. Reinforcement was acquired by clipping the wrapped temporalis muscle. Wrapping and clipping after incomplete clipping was also done. Follow-up loss and non-angiographic follow-up patient groups were excluded in this study. Results : The mean age was 53 years (range 29-67), and 15 patients were female. Among 21 patients, 10 patients had ruptured aneurysms (48%). Aneurysms in 21 patients were located in the anterior circulation. Aneurysm shapes were broad neck form (14 cases), fusiform (1 case), and bleb to adjacent vessel (6 cases). Five patients were treated by clipping the wrapped temporalis, and 16 patients by wrapping after partial clipping. The mean Glasgow coma scale (GCS) at admission was 14.2. The mean Glasgow outcome scale (GOS) at discharge was 4.8, and 18 patients were grade 5. The mean period between initial angiography and last angiography was 18.5 months (range 8-44). Aneurysm size was not increased in any of these patients and configuration also did not change. There was no evidence of rebleeding in any of these treated aneurysms. Conclusion : Our study results show that wrapping technique, using the temporalis muscle and aneurysm clip(s), for intracranial aneurysm treatment provides protection from rebleeding or regrowth.

Influence of Reaction Temperature on Bio-oil Production from Rice Straw by the Pyrolysis (볏짚으로부터 바이오오일 생산에 대한 열분해 반응온도의 영향)

  • Kang Bo-Sung;Park Young-Kwon;Kim Joo-Sik
    • Resources Recycling
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    • v.15 no.1 s.69
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    • pp.12-19
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    • 2006
  • Rice straw is one or the main renewable energy sources in Korea. Bio-oil is produced from rice straw with a lab-scale equipment mainly with a fluidized bed and a char removal system. It was investigated how the reaction temperature affected the production of bio-oil and the efficiency of a char removal system. To elucidate how the temperature depended on the production of bio-oil, experiments were conducted at $466^{\circ}C,\;504^{\circ}C\;and\;579^{\circ}C$, respectively. The mass balance was established in each experiment, and the produced gas and oil were analyzed with the aid of GCs and a GC-MS system. The char removal system is composed of a cyclone and a hot filter. Tn the experiments, we observed that the production of bio-oil was decreased with temperature, and the bio-oil contained very useful chemicals.

Plasma Post-operative miR-21 Expression in the Prognosis of Gastric Cancers

  • Ma, Guo-Jian;Gu, Rong-Min;Zhu, Ming;Wen, Xu;Li, Jin-Tian;Zhang, Yuan-Ying;Zhang, Xiao-Mei;Chen, Sen-Qing
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.12
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    • pp.7551-7554
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    • 2013
  • Tumor-associated microRNAs have been detected in serum or plasma, but whether plasma microRNA-21 (miR-21) could be a potential circulating biomarker for gastric cancer (GC) prognosis in Chinese is still uncertain. Real-time quantitative reverse transcription PCR (qRT-PCR) was employed in this study to compare the relative expression of miR-21 between pre-operative and post-operative paired plasmas from 42 patients with primary GCs. The results showed that the expression levels of miR-21 in the post-operative plasmas were significantly reduced by an average of 18.2 times in all patients when compared to the pre-operative plasmas, and by 22.1 times in the subgroup of patients without family history, while only 1.76 times in the subgroup of patients with a family history. With respect of clinicopathological characteristics, the plasma miR-21 expression was highly associated with differentiation degree and lymph node metastasis rate. The results suggested plasma miR-21 could be a novel potential biomarker for GC prognosis and evaluation of surgery outcomes, especially in patients without a family history.

Surgical Treatment for Acute, Severe Brain Infarction

  • Park, Je-On;Park, Dong-Hyuk;Kim, Sang-Dae;Lim, Dong-Jun;Park, Jung-Yul
    • Journal of Korean Neurosurgical Society
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    • v.42 no.4
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    • pp.326-330
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    • 2007
  • Objective : Stroke is the most prevalent disease involving the central nervous system. Since medical modalities are sometimes ineffective for the acute edema following massive infarction, surgical decompression may be an effective option when medical treatments fail. The present study was undertaken to assess the outcome and prognostic factors of decompressive surgery in life threatening acute, severe, brain infarction. Methods : We retrospectively analyzed twenty-six patients (17 males and 9 females; average age, 49.7yrs) who underwent decompressive surgery for severe cerebral or cerebellar infarction from January 2003 to December 2006. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : Of the 26 patients, 5 (19.2%) showed good recovery, 5 (19.2%) showed moderate disability, 2 (7.7%) severe disability, 6 (23.1%) persistent experienced vegetative state, and 8 (30.8%) death. In this study, the surgical decompression improved outcome for cerebellar infarction, but decompressive surgery did not show a good result for MCA infarction (30.8% overall mortality vs 100% mortality). The dominant-hemisphere infarcts showed worse prognosis, compared with nondominant-hemisphere infarcts (54.5% vs 70%). Poor prognostic factors were diabetes mellitus, dominant-hemisphere infarcts and low preoperative Glasgow Coma Scale (GCS) score. Conclusion : The patients who exhibit clinical deterioration despite aggressive medical management following severe cerebral infarction should be considered for decompressive surgery. For better outcome, prompt surgical treatment is mandatory. We recommend that patients with severe cerebral infarction should be referred to neurosurgical department primarily in emergency setting or as early as possible for such prompt surgical treatment.

Surgical Management of Massive Cerebral Infarction

  • Huh, Jun-Suk;Shin, Hyung-Shik;Shin, Jun-Jae;Kim, Tae-Hong;Hwang, Yong-Soon;Park, Sang-Keun
    • Journal of Korean Neurosurgical Society
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    • v.42 no.4
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    • pp.331-336
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    • 2007
  • Objective : The aim of this study was to analyze the treatment results and prognostic factors in patients with massive cerebral infarction who underwent decompressive craniectomy. Methods : From January 2000 to December 2005, we performed decompressive craniectomy in 24 patients with massive cerebral infarction. We retrospectively reviewed the medical records, radiological findings, initial clinical assessment using the Glasgow Coma Scale, serial computerized tomography (CT) with measurement of midline and septum pellucidum shift, and cerebral infarction territories. Patients were evaluated based on the following factors : the pre- and post-operative midline shifting on CT scan, infarction area or its dominancy, consciousness level, pupillary light reflex and Glasgow Outcome Scale. Results : All 24 patients (11 men, 13 women; mean age, 63 years; right middle cerebral artery (MCA) territory, 17 patients; left MCA territory, 7 patients) were treated with large decompressive craniectomy and duroplasty. The average time interval between the onset of symptoms and surgical decompression was 2.5 days. The mean Glasgow Coma Scale was 12.4 on admission and 8.3 preoperatively. Of the 24 surgically treated patients, the good outcome group (Group 2 : GOS 4-5) comprised 9 cases and the poor outcome group (Group1 : GOS 1-3) comprised 15 cases. Conclusion : We consider decompressive craniectomy for large hemispheric infarction as a life-saving procedure. Good preoperative GCS, late clinical deterioration, small size of the infarction area, absence of anisocoria, and preoperative midline shift less than 11mm were considered to be positive predictors of good outcome. Careful patient selection based on the above-mentioned factors and early operation may improve the functional outcome of surgical management for large hemispheric infarction.

Design and Implementation of Mobile Network Based Long-Range UAV Operational System for Multiple Clients (모바일 네트워크를 이용한 복수의 클라이언트용 무인항공기 원거리 운용 시스템 설계 및 구현)

  • Park, Seong-hyeon;Song, Joon-beom;Roh, Min-shik;Song, Woo-jin;Kang, Beom-soo
    • Journal of Advanced Navigation Technology
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    • v.19 no.3
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    • pp.217-223
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    • 2015
  • This paper describes the design and implementation of a network system for UAV for multiple clients that enables long-range operation based on a commercial mobile network. A prototype data modem is developed with a commercial embedded M2M module in order to provide an access to the mobile network. A central server with a database is constructed to record all of real-time flight and video data and communicate with a ground control system. A GCS is developed for the central control, the single UAV and the smart phone version to be used for different purposes. Performance tests were progressed for data delay, video frame rate and state of clients. Flight tests were also performed to verify the reliability of the modem with respect to altitude.

Clinical Analysis of Decompressive Craniectomy for Acute Massive Cerebral Infarction (악성 뇌경색증에 대한 감압 두개골절제술의 임상분석)

  • Kim, Seok-Chul;Lee, Jung-Kil;Kim, Jae-Sung;Kim, Tae-Sun;Jung, Shin;Kim, Jae-Hyoo;Kim, Soo-Han;Kang, Sam-Suk;Lee, Je-Hyuk
    • Journal of Korean Neurosurgical Society
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    • v.30 no.3
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    • pp.278-283
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    • 2001
  • Objective : Massive cerebral infarction could be accompanied by severe brain swelling and death secondary to transtentorial herniation. Approximately 10% to 15% of middle cerebral artery infarctions are associated with this phenomenon. However, the effectiveness and timing of decompressive surgery are still controversial. In this study, we present our results on the effect of decompressive craniectomy in life threatening cerebral infarction. Method : We retrospectively analyzed 15 patients who underwent decompressive craniectomy for massive cerebral infarction from January 1997 to April 1999. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : All 15 patients(five men, ten women ; mean age, 52.3 years ; right 11, left 4) were treated with wide craniectomy and duroplasty. The average time interval between onset of symptom and surgical decompression was 2.9 days. Clinical signs of uncal herniation(anisocoria, or fixed and dilated pupils) were presented in 13 of 15 patients. Mean Glasgow coma scale(GCS) was 12.4 points on admission, 8.1 points on preoperative state and 11.8 points postoperatively. Overall outcomes were favorable in 5 cases(Glasgow outcome scale : GOS I, II), unfavorable in 6 cases(Glasgow outcome scale : GOS III, IV) and dead in 4 cases. Conclusion : Early decompressive craniectomy before brain stem compression is considered as an effective lifesaving procedure for massive cerebral infarction unresponsive to aggressive medical therapy.

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Clinical Significance of Bifrontotemporal Decompressive Craniectomy in the Treatment of Severe Refractory Posttraumatic Brain Swelling (중증 외상성 뇌부종 환자에서 양측 전두-측두부 감압적 개두술의 의의)

  • Shin, Hyung Shik;Kim, Jin Yong;Kim, Tae Hong;Hwang, Yong Soon;Kim, Sang Jin;Park, Sang Keun
    • Journal of Korean Neurosurgical Society
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    • v.29 no.9
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    • pp.1179-1183
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    • 2000
  • Objective : The treatment of malignant posttraumatic brain swelling remains a frustrating endeavor for neurosurgeon. Mortality and morbidity rates remain high depite advances in medical treatment of increased intracranial pressure. If conventional therapy fails in patients suffering from intracranial hypertension, there is only small number of second-tier option left including decompressive craniectomy. The role of decompressive craniectomy in posttraumatic brain swelling remains controversial. We assessed the efficacy and indications of decompressive craniectomy. Methods : The authors performed decompressive bifrontotemporal craniectomy in 22 patients with malignant posttraumatic brain swelling. Epidural pressure monotoring was performed in all patients. The clnical data and surgical outcomes were reviewed retrospectively. Result : The favorable outcome(GOS score 4-5) was 59%(13 of 22 patients), whereas the mortality rate was 32% (7 of 22 patients). Two patients(9%) remained in severely disabled state. Increased rate of favorable outcome was seen in the patients who had 8 or more of GCS score at admission and exhibited B wave in ICP monitoring and who showed steady state or slow deterioration in clinical course. Conclusion : If conservative therapy fails, decompressive bifrontotemporal craniectomy should be considered in the management of malignant posttraumatic brain swelling before irreversible ischemic brain damage occur.

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A Clinical Analysis on Traumatic Subarachnoid Hemorrhage (두부외상 후 발생한 지주막하 출혈에 대한 임상분석)

  • Goo, Tae Heon;Kim, Han Sik;Mok, Jin Ho;Lee, Kyu Chun;Park, Yong Seok;Lee, Young Bae
    • Journal of Korean Neurosurgical Society
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    • v.29 no.1
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    • pp.108-112
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    • 2000
  • Objective : Many authors suggest that patients with traumatic subarachnoid hemorrhage(tSAH) visible on first CT after heve injury had a significantly worse prognosis than patients who do not. The aim of this study is to identify patients with tSAH who present with a bad prognosis by reviewing their clinicoradiological features and plan appropriate treatments. Patients and Methods : We reviewed and analysed the factors that influenced discharge outcomes in 172 patients with tSAH for a 3-year period. The outcome was divided into good(good recovery and moderate disability of glasgow outcome scale) and good(severe disability, vegetative state and death). Results : A regression analysis of statistical significant factors(p<0.05) among the clinical and CT features ranked them by descending order of contribution to Glasgow Outcome Scale(GOS) scores at the time of discharge from acute hospitalization as follows 1) clinical : admission Glasgow Coma Scale(GCS), hypotension, CT grade, abnormal APTT, skull fracture, hyperglycemia(>160mg/dl), hypoxia, operation, 2) CT : basal cistern effacement(BCE), mass lesion, cortical sulcal effacement(CSE), midline shift. Conclusion : We have also experienced that the CT grading scale proposed by Green et al is a simple and useful prognostic factor. The authors believe that the patients with high CT grade need adjuvant therapies as of well surgery but it seems mandatory to consider early identification and correction of hypotension, hyperglycemia, and hypoxia in emergency setting.

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