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Effect of Bevacizumab Treatment in Cerebral Radiation Necrosis : Investigation of Response Predictors in a Single-Center Experience

  • Shin Heon Lee;Jung Won Choi;Doo-Sik Kong;Ho Jun Seol;Do-Hyun Nam;Jung-Il Lee
    • Journal of Korean Neurosurgical Society
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    • v.66 no.5
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    • pp.562-572
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    • 2023
  • Objective : Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. Methods : Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. Results : Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. Conclusion : The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.

Rotor Initial Polarity Detection Method of Single-Phase PMSM Considering Asymmetric Air-Gap Structure (단상 영구자석 동기 전동기의 비대칭 공극 구조를 고려한 회전자 초기 자극 검출 기법)

  • Seo, Sung-Woo;Hwang, Seon-Hwan;Park, Jong-Won;Kim, Yong-Hyu
    • The Transactions of the Korean Institute of Power Electronics
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    • v.27 no.1
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    • pp.80-83
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    • 2022
  • This paper proposes an initial rotor polarity detection algorithm of a single-phase permanent magnet synchronous motor (SP-PMSM) related to stable open-loop starting for sensorless operation. Generally, the SP-PMSM needs an asymmetric air-gap structure to can avoid the initial starting failure at zero torque point. Therefore, the rotor polarity information can be obtained by using the DC offset current direction of a stator current through a high frequency voltage injection into an SP-PMSM with an asymmetric air gap. In this paper, the proposed rotor initial polarity detection algorithm is verified through several experimental results.

The Investigation of Reaction Parameters on the Reactivity in the Preparation of SiC by SHS (자전연소합성법에 의한 SiC 분말 제조시 반응변수의 영향)

  • Shin, Chang-Yun;Won, Hyung-Il;Nersisyan, Hayk;Won, Chang-Whan
    • Journal of the Korean Ceramic Society
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    • v.43 no.7 s.290
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    • pp.427-432
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    • 2006
  • The preparation of SiC powder by SHS in the system of $SiO_2-Mg-C$ was investigated in this study. The effects of various processing parameters such as the initial pressure of inert gas in reactor, the content of Mg and C in mixture and the size of $SiO_2$ particles on the synthesis of SiC by SHS methode were investigated. The minimum initial pressure of inert gas in reactor for SHS reaction in this system was 5 atm, and as the pressure increased, and the concentration of unreacted Mg decreased. At 50 atm of the initial inert gas pressure in reactor, the optimum composition for the preparation of pure SiC was $SiO_2+2.5Mg+1.2C$. SiC powder synthesized in this condition had a mixture of ${\alpha}-SiC\;and\;{\beta}-SiC$ with an irregular shape and the particle size of $0.5{\sim}0.8{\mu}m$.

The Investigation of Reaction Parameters on the Reactivity in the Preparation of TiB2 by SHS (자전연소합성법에 의한 TiB2 분말의 제조에 있어 반응성에 대한 반응변수의 고찰)

  • Shin, Chang-Yun;Park, Young-Chul;Lee, Huk-Hee;Nersisyan, Hayk;Won, Chang-Whan
    • Journal of the Korean Ceramic Society
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    • v.43 no.1 s.284
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    • pp.16-21
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    • 2006
  • The preparation of $TiB_2$ by SHS in $B_2O_3-Mg-TiO_2$ system was investigated in this study. In the preparation of $TiB_2$, the effect on reactivity and reaction products of the initial pressure of inert gas in reactor, the content of Mg and $TiO_2$ in mixture was investigated. The minimum initial pressure of inert gas in reactor for SHS reaction in this system was 5atm, and as the pressure increased, the concentration of unreacted Mg decreased and combustion temperature increased. At the initial inert gas pressure in reactor of 50atm, the optimum composition for the preparation of pure $TiB_2$ was $B_2O_3+5Mg+TiO_2$. The $TiB_2$ synthesized in this condition had an irregular shape and the particle size of $1\~3{\mu}m$.

Initial and Recurrent Anterior Dislocation in Shoulder (견관절 초기 전방 탈구와 재발성 전방 탈구)

  • Kim Young-Kyu;Lee Jae-Hoon;Kim Hyun-Min;Lee Choong-Hoon
    • Clinics in Shoulder and Elbow
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    • v.8 no.2
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    • pp.148-153
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    • 2005
  • Purpose: To assess the usefulness of early stabilization for initial shoulder dislocation which is indicated in some patients by comparing the arthroscopic findings and the outcomes of Bankart repair in the initial and recurrent dislocation. Materials and Methods: The study was performed on 16 cases of initial dislocation and 44 cases of recurrent dislocation. The follow-up period was 25 months in the initial dislocation group and 28 months in the recurrent group. Bankart lesion and the adjacent tissues were compared, and the results were evaluated by the Rowe rating scale. Results: Detached labrum and capsular ligament of the initial dislocation group were elastic and unretracted. While in the recurrent dislocation those were inelastic, and displaced and adhesive in many cases. The outcomes were mean 95 points in the initial group and 91 points in the recurrent group. In the initial group, apprehension was detected in only 1 case(6%). In the recurrent group, instability was detected in 4 cases(9%). Conclusion: Our data suggest that Bankart lesion in the initial dislocation can be repaired readily by surgery, the recovery is efficient, and the recurrence would be reduced. Thus, in active young sports lovers as well as athletes, early stabilization surgery for initial shoulder dislocation may be more helpful.

Comparison of Clinical Characteristics and Prognosis by Initial Endoscopic Severity in Caustic Injury (부식제 음독 환자에서 초기 내시경 소견의 중증도에 따른 임상 소견 및 예후 비교)

  • Lee, Sang Min;Choi, Woo Ik;Kim, Sung Jin;Jin, Sang Chan
    • Journal of The Korean Society of Clinical Toxicology
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    • v.13 no.2
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    • pp.87-94
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    • 2015
  • Purpose: We investigated comparison of clinical characteristics and prognosis by initial endoscopic severity in caustic injury and then discussed predisposing factors which can be helpful in predicting the prognosis and determining the treatment. Methods: This study was a retrospective review of medical records from patients over the age of 15, who underwent initial endoscopy for caustic injury from April 2007 through November 2014. Patients were classified according to two groups based on the initial endoscopic finding by Zargar's classification: patients with grade 0, I, IIa at esophagus (low risk group) and patients with grade IIb, IIIa, IIIb at esophagus (high risk group). The two groups were then compared. Results: A total of 55 patients were included (low risk group [n=44] vs. high risk group [n=11]). Old age (p<0.001), large amount of ingestion (p<0.05), oropharyngeal symptoms (p<0.01), high SOFA score (p<0.001), high WBC count (p<0.05), low base excess (p<0.01), and HCO3 (p<0.05) were statistically significant factors in the high risk group. A poor prognosis was observed for hospital stay (p<0.001), ICU admission (p<0.001), mortality (p<0.01), and stricture (p<0.001) in the high risk group. Conclusion: Clinical characteristics including age, amount of ingestion, oropharyngeal symptoms, SOFA score, WBC count, base excess, and $HCO_3$ can be helpful in the decision to undergo initial endoscopy and risk assessment by initial endoscopic severity can be helpful in predicting prognosis and determining the treatment plan.

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Weight analysis of mastectomy specimens and abdominal flaps used for breast reconstruction in Koreans

  • Yun, Jiyoung;Jeong, Hyung Hwa;Cho, Jonghan;Kim, Eun Key;Eom, Jin Sup;Han, Hyun Ho
    • Archives of Plastic Surgery
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    • v.45 no.3
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    • pp.246-252
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    • 2018
  • Background Slim patients or those with large breasts may be ineligible for breast reconstruction with an abdominal flap, as the volume of the flap may be insufficient. This study aimed to establish that abdominal tissue-based breast reconstruction can be well suited for Korean patients, despite their thin body habitus. Methods A total of 252 patients who underwent postmastectomy breast reconstruction with an abdominal flap from October 2006 to May 2013 were retrospectively reviewed. The patients' age and body mass index were analyzed, and a correlation analysis was performed between the weight of the mastectomy specimen and that of the initial abdominal flap. Results The average weights of the mastectomy specimen and initial abdominal flap were 451.03 g and 644.95 g, respectively. The ratio of the weight of the mastectomy specimen to that of the initial flap was $0.71{\pm}0.23$. There was a strong positive linear relationship between the weight of the mastectomy specimen and that of the initial flap (Pearson correlation coefficient, 0.728). Thirty nulliparous patients had a final-to-initial flap weight ratio of $0.66{\pm}0.11$. The 25 patients who underwent a contralateral procedure had a ratio of $0.96{\pm}0.30$. The adjusted ratio of the final flap weight to the initial flap weight was $0.66{\pm}0.12$. Conclusions Breast weight had a strong positive relationship with abdominal flap weight in Koreans. Abdominal flaps provided sufficient soft tissue for breast reconstruction in most Korean patients, including nulliparous patients. However, when the mastectomy weight is estimated to be >700 g, a contralateral reduction procedure may be considered.

Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors

  • Choi, Chang-Hyuk;Kim, Seok-Jun;Chae, Seung-Bum;Lee, Jae-Keun;Kim, Dong-Young
    • Clinics in Shoulder and Elbow
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    • v.19 no.2
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    • pp.78-83
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    • 2016
  • Background: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. Methods: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. Results: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. Conclusions: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.

체외충격파를 이용한 결석의 치료

  • 김건상
    • Journal of Biomedical Engineering Research
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    • v.10 no.2
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    • pp.114-116
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    • 1989
  • A method has been proposed for the fully automatic detection of left ventricular endocardial boundary in 2D short axis echocardiogram using geometric model. The procedure has the following three distinct stages. First, the initial center is estimated by the initial center estimation algorithm which is applied to decimated image. Second, the center estimation algorithm is applied to original image and then best-fit elliptic model estimation is processed. Third, best-fit boundary is detected by the cost function which is based on the best-fit elliptic model. The proposed method shows effective result without manual intervention by a human operator.

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Predicting Factors Affecting Clinical Outcomes for Saccular Aneurysms of Posterior Inferior Cerebellar Artery with Subarachnoid Hemorrhage

  • Hong, Young-Ho;Kim, Chang-Hyun;Che, Gil-Sung;Lee, Sang-Hoon;Ghang, Chang-Gu;Choi, Yu-Seok
    • Journal of Korean Neurosurgical Society
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    • v.50 no.4
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    • pp.327-331
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    • 2011
  • Objective : The aim of this study is to investigate the clinical outcomes of surgery and coiling and analyze the predicting factors affecting the clinical outcomes of ruptured posterior inferior cerebellar artery (PICA) aneurysms. Methods : During the last 15 years, 20 consecutive patients with ruptured PICA aneurysms were treated and these patients were included in this study. The Fisher's exact test was used for the statistical significance of Glasgow Outcome Scale (GOS) according to initial Hunt-Hess (H-H) grade, treatment modalities, and the presence of acute hydrocephalus. Results : Eleven (55%) and nine (45%) patients were treated with surgical clipping and endovascular treatment, respectively. Among 20 patients, thirteen (65.0%) patients had good outcomes (GOS 4 or 5). There was the statistical significance between initial poor H-H grade, the presence of acute hydrocephalus and poor GOS. Conclusion : In our study, we suggest that initial H-H grade and the presence of acute hydrocephalus may affect the clinical outcome rather than treatment modalities in the ruptured PICA aneurysms.