• Korean Journal of Psychosomatic Medicine
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• v.9 no.1
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• pp.58-65
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• 2001

Objectives : It is well known that pharmacologic and behavioral therapies of panic disorder show remarkable acute treatment outcome, however the course of panic disorder in clinical settings is often chronic and relapsing. The purpose of this study is to investigate the treatment outcome of panic disorder and the factors related to good treatment outcome by prospective follow-up study after 6 month in clinical settings. Methods : Twenty nine patients were diagnosed to have panic disorder by SCID(Structured Clinical Interview for DSM-III-R), among the patients who had visited the psychiatric out-patients clinic of the Asan Medical Center for the first time. We determined the initial clinical and demoraphic features of each patient and reevaluated them after 6 months, investigating the treatment outcome by anxiety, phobia, impairment scales. We looked into the rate of the patients who showed good treatment outcome and determined the factors that had relation with good treatment outcome among demographic and clinical features. Results : Nineteen out of 29 patients could be followed after 6 months. Among them, 10 patients 52.6%) on the impairment scale and phobia scale each, and 8 patients(42.1 %) on the anxiety scale showed good treatment outcome. 8 patients(42.1 %) showed good treatment outcome on the all three scales. High score in initial phobia scale had significant relation with good treatment outcome. Short duration of illness did not have significant relation with good treatment outcome however there was a trend(p=0.07). Conclusion : About half(42.1 %) of the panic disorder patients showed good treatment outcome on all three scales. Severe initial phobic symptom and short duration of illness were expected to have relation with good treatment outcome.

• Journal of the Korean Child Neurology Society
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• v.26 no.4
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• pp.240-245
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• 2018

Purpose: Early prediction of prognosis of children resuscitated from cardiac arrest is a major challenge. We investigated the utility of electroencephalography (EEG) and laboratory studies for predicting of neurologic outcome in children resuscitated from cardiac arrest. Methods: We retrospectively analyzed medical records of patients who were resuscitated from cardiac arrest from 2006 to 2015 at the Gil Medical Center. Patients aged one month to 18 years were included. EEG analysis included background scoring, reactivity and seizure burden. EEG background was classified score 0 (normal/organized), score 1 (slow and disorganized), score 2 (discontinuous or burst suppression), and score 3 (suppressed and featureless). Neurologic outcome was evaluated by Pediatric Cerebral Performance Category (PCPC) at least 6 months after cardiac arrest. Results: Total 26 patients were evaluated. Nine patients showed good neurologic outcome (PCPC 1, 2, 3) and 17 patients showed poor neurologic outcome (PCPC 4, 5, 6). Patients of poor neurologic outcome group showed EEG background score 3 in 88.2%, whereas 44.4% in patients of good neurologic outcome group (P=0.028). Electrographic ictal discharges except non-convulsive status epilepticus were presented in 44.4% of good neurologic outcome group and 5.9% of poor neurologic outcome group (P=0.034). Ammonia and lactate levels were higher and pH levels were lower in poor outcome group than good neurologic outcome group. Conclusion: Suppressed and featureless EEG background is associated with poor neurologic outcome and electrographic seizures are associated with good neurologic outcome.

• Journal of The Korean Society of Emergency Medicine
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• v.29 no.5
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• pp.493-499
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• 2018

Objective: This study aimed to identify the effects of serum potassium and lactate on neurologic outcomes in out-of-hospital post-cardiac arrest adult patients. Methods: This study was a single center, retrospective observational study. We recruited out-of-hospital post-cardiac arrest adult patients admitted to an intensive care unit from 2011 to 2017. Primary outcome was good neurologic outcome at discharge. To evaluate the prognostic impact of serum potassium and lactate, univariate and multivariate logistic regression analyses were performed. Results: A total of 57 patients were included in this study. The number of patients with good neurologic outcome was 19 (33.3%). In the univariate analysis, good neurologic outcome patients showed a higher smoking rate, shorter pre-hospital transportation time, higher rate of percutaneous coronary intervention, and lower severity score (all P<0.05). The good neurologic outcome patients also presented higher pH, lower partial pressure of carbon dioxide, and lower potassium regarding laboratory findings on the first hospital day (all P<0.05). In the multivariate analysis, the independent factors favoring good neurologic outcome were pre-hospital transportation time (adjusted odds ratio [aOR], 0.82; 95% confidence interval [CI], 0.69-0.97; P=0.019) and lower partial pressure of carbon dioxide on the first hospital day (aOR, 0.95; 95% CI, 0.91-0.99; P=0.034). Conclusion: Serum potassium and lactate were not significantly associated with good neurologic outcome in out-of-hospital post-cardiac arrest adult patients. The prognostic factors for good neurologic outcome were pre-hospital transportation time and initial partial pressure of carbon dioxide.

• Journal of Korean Neurosurgical Society
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• v.37 no.6
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• pp.405-409
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• 2005

Objective: The purpose of this study is to assess the factors related to the outcome of 84 patients who underwent surgery for anterior communicating Artery(ACoA) aneurysms. Methods: The authors review 84 patients who were undertaken from January 1998 to May 2004. In the management of ACoA aneurysms, the outcome was based on several factors: Clinical condition, Distribution of hemorrhage, Time between aneurysmal rupture and surgery, Direction and shape of the aneurysm. Results: The incidence rate of the ACoA aneurysm was 35%. Seventy four patients were classified as those having a good recovery, but 5 patients suffered from some morbidity and 5 patients died. The rate of good outcome for the patients with Hunt and Hess grade was as follows 100% in grade I, 95% in grade II, 80% in grade III, IV and V. The rate of good outcome for the patients with Fisher grade was as follows 98% in grade I, II and 81% in grade III, IV. Nineteen of 22 patients who underwent early surgery were rated as good, while twenty six of 30 patients for whom surgery was delayed showed a favorable result. The unfavorable outcomes were also attributed by vasospasm or other medical problems. Conclusion: For further improvement of the overall surgical outcome: First, early surgical intervention is recommended for good grade patients. Second, active management of poor grade patients should be scrutinized with early surgery. Third, it is also important to step up the effort to minimize the risk of medical complications to enhance surgical results on top of the mainstay of prevention efforts for vasospasm and rebleeding.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.26-31
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• 2006

Objective : The authors study on the clinical presentations and the surgical outcomes of the tumors in the ventricular system. Methods : 15 patients with ventricular tumor were studied. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. Tumors were classified into three groups based on their locations in MRI : lateral, third and fourth ventricle. Surgical methods were transcortical approach in eight patients, transcallosal approach in four, median suboccipital approach in two, and subfrontal approach in one. Gross total removal was achieved in 10 patients. Subtotal resections were performed in the rest. Glasgow outcome scale was used for evaluation of the surgical outcome. Results : Main clinical presentations were chronic headache in patients with the tumor in the lateral ventricular tumor and sudden onset of headache and consciousness change in patients with the tumor in the third and fourth ventricular tumor Development of hydrocephalus was more predominant in patients with the tumors in the third ventricle. Postoperatively, good outcome [Glasgow outcome scale IV, V] were in 73%, and better results was observed in patients with the tumors in the lateral ventricular tumor. The differences of outcome according to surgical approach were not recognized, even though it was not reliable statistically. Conclusion : In ventricular tumor, postoperative outcome is not good in patients with sudden development of headache, hydrocephalus, high grade tumor. Outcome is good in patients with the tumor in the lateral ventricle relatively. There is no difference in outcome according to the approach method to the tumors. And it is necessary to be aware of various approach methods to the tumors and anatomy surrounding the ventricle for avoidance of neurological complications.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.1
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• pp.18-25
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• 2020

Purpose: We studied the impact of arterial oxygen tension (PaO₂) on the long term neurologic outcome in patients with acute carbon monoxide poisoning. Methods: The study population included 311 patients who presented to emergency department with acute CO poisoning from January 2015 to January 2018. These patients underwent arterial blood gas testing at the time of presentation. The baseline demographic, clinical, laboratory, and clinical outcome data were recorded. The primary outcome of interest was the long term neurologic status. Results: The normoxia group was significantly older and it had a higher incidence of diffusion weighted MRI abnormality, and this group needed multiple HBO sessions compared to the group with moderate or severe hyperoxia. Also, the incidence of altered mentality at discharge was higher in the normoxia group than that of the moderate hyperoxia group. The incidence of a poor long term neurologic outcome was 11.3%. The incidence of a poor long term neurologic outcome decreased as the PaO₂ increased. The PaO₂ was significantly lower in patients with a poor long term neurologic outcome than that of the patients with a good outcome 198 (165.2 to 231.1) mmHg in the good outcome group vs. 154 (119-162) mmHg in poor outcome, p<0.001). In multivariate logistic regression analysis, PaO₂ was selected as an independent factor of the poor long-term neurologic outcome (OR 0.981 (95% CI: 0.968 to 0.995)) Conclusion: Higher PaO₂ was independently associated with a lower incidence of a poor long-term neurologic outcome.

• Journal of Korean Neurosurgical Society
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• v.59 no.2
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• pp.143-148
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• 2016

Objective : We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. Methods : A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Results : Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0-79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). Conclusion : This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.122-131
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• 2012

Purpose: Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI. Methods: Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities. Results: We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI. Conclusion: We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.

• Journal of Korean Neurosurgical Society
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• v.52 no.3
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• pp.179-186
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• 2012

Objective : Even in the patients with neurologically good outcome after intracranial aneurysm surgery, their perception of health is an important outcome issue. This study aimed to investigate the quality of life (QOL) and its predictors of patients who had a good outcome following anterior circulation aneurysm surgery as using the World Health Organization Quality of Life instrument-Korean version. Methods : We treated 280 patients with 290 intracranial aneurysms for 2 years. This questionnaire was taken and validated by 99 patients whose Glasgow Outcome Scale score was 4 and more and Global deterioration scale 3 and less at 6 months after the operation, and 85 normal persons. Each domain and facet was compared between the two groups, and a subgroup analysis was performed on the QOL values and hospital expenses of the aneurysm patients according to the type of craniotomy, approach, bleeding of the aneurysm and brain injury. Results : Aneurysm patients showed a lower quality of life compared with control patients in level of independence, psychological, environmental, and spiritual domains. In the environmental domain, there were significant intergroup differences according to the type of craniotomy and the surgical approach used on the patients (p<0.05). The hospital charges were also significantly different according to the type of craniotomy (p<0.05). Conclusion : Despite good neurological status, patients surgically treated for anterior circulation aneurysm have a low quality of life. The craniotomy size may affect the QOL of patients who underwent an anterior circulation aneurysm surgery and exhibited a good outcome.

• Investigative Magnetic Resonance Imaging
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• v.23 no.3
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• pp.241-250
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• 2019

Purpose: The purpose of this study was to determine the relation between quantitative magnetic resonance imaging biomarkers, and clinical performances in chronic phase of carbon monoxide intoxication. Materials and Methods: Eighteen magnetic resonance scans and cognitive evaluations were performed, on patients with carbon monoxide intoxication in chronic phase. Apparent diffusion coefficient (ADC) ratios of affected versus unaffected centrum semiovale, and corpus callosum were obtained. Signal intensity (SI) ratios between affected centrum semiovale, and normal pons in T2-FLAIR (fluid-attenuated inversion recovery) images were obtained. The Mini-Mental State Exam, and clinical outcome scores were assessed. Correlation coefficients were calculated, between MRI and clinical markers. Patients were further classified into poor-outcome and good-outcome groups based on clinical performance, and imaging parameters were compared. T2-SI ratio of centrum semiovale was compared, with that of 18 sex-matched and age-matched controls. Results: T2-SI ratio of centrum semiovale was significantly higher in the poor-outcome group, than that in the good-outcome group and was strongly inversely correlated, with results from the Mini-Mental State Exam. ADC ratios of centrum semiovale were significantly lower in the poor outcome group than in the good outcome group, and were moderately correlated with the Mini-Mental State Exam score. Conclusion: A higher T2-SI and a lower ratio of ADC values in the centrum semiovale, may indicate presence of more severe white matter injury and clinical impairment. T2-SI ratio and ADC values in the centrum semiovale, are useful quantitative imaging biomarkers for correlation with clinical performance in individuals with carbon monoxide intoxication.