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Image-guided surgery and craniofacial applications: mastering the unseen

  • Wang, James C.;Nagy, Laszlo;Demke, Joshua C.
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제37권
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    • pp.43.1-43.5
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    • 2015
  • Image-guided surgery potentially enhances intraoperative safety and outcomes in a variety of craniomaxillofacial procedures. We explore the efficiency of one intraoperative navigation system in a single complex craniofacial case, review the initial and recurring costs, and estimate the added cost (e.g., additional setup time, registration). We discuss the potential challenges and benefits of utilizing image-guided surgery in our specific case and its benefits in terms of educational and teaching purposes and compare this with traditional osteotomies that rely on a surgeon's thorough understanding of anatomy coupled with tactile feedback to blindly guide the osteotome during surgery. A 13-year-old presented with untreated syndromic multi-suture synostosis, brachycephaly, severe exorbitism, and midface hypoplasia. For now, initial costs are high, recurring costs are relatively low, and there are perceived benefits of imaged-guided surgery as an excellent teaching tool for visualizing difficult and often unseen anatomy through computerized software and multi-planar real-time images.

Acute Respiratory Distress Syndrome after Viscum album Pleurodesis for Primary Spontaneous Pneumothorax

  • Noh, Dongsub;Park, Joon Suk;Lee, Doo Yun
    • Journal of Chest Surgery
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    • 제50권1호
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    • pp.64-67
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    • 2017
  • A 52-year-old male patient who underwent multiple wedge resections experienced postoperative acute respiratory distress syndrome in both lungs after Viscum album pleurodesis. Despite initial rapid deterioration in clinical condition and rapid progression of bilateral lung infiltration, he exhibited a relatively smooth clinical recovery with marked response to glucocorticoid treatment. Our case report suggests that care must be taken to guard against the development of acute respiratory complications in the use of Viscum album for pleurodesis. However, in view of the clinically benign course, initial aggressive management of complications can prevent suffering and sequelae.

군집의 효율향상을 위한 휴리스틱 알고리즘 (Heuristic algorithm to raise efficiency in clustering)

  • 이석환;박승헌
    • 대한안전경영과학회지
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    • 제11권3호
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    • pp.157-166
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    • 2009
  • In this study, we developed a heuristic algorithm to get better efficiency of clustering than conventional algorithms. Conventional clustering algorithm had lower efficiency of clustering as there were no solid method for selecting initial center of cluster and as they had difficulty in search solution for clustering. EMC(Expanded Moving Center) heuristic algorithm was suggested to clear the problem of low efficiency in clustering. We developed algorithm to select initial center of cluster and search solution systematically in clustering. Experiments of clustering are performed to evaluate performance of EMC heuristic algorithm. Squared-error of EMC heuristic algorithm showed better performance for real case study and improved greatly with increase of cluster number than the other ones.

Failed Back Surgery Syndrome에서 만족스러운 치료 결과에 영향을 주는 요인들 (The Factors Affecting the Favorable Outcomes in the Treatment of the Failed Back Surgery Syndrome)

  • 이창명;윤승환;조준;문창택;장상근
    • Journal of Korean Neurosurgical Society
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    • 제29권2호
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    • pp.203-209
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    • 2000
  • Objective : The authors retrospectively analysed the factors affecting the favorable outcomes in the treatment of the Failed Back Surgery Syndrome(FBSS) or six years. Method : From March 1991 to December 1996, seventy-five patients were diagnosed as FBSS and its incidence was 3.4% of admitted patients with back pain in our department. We analysed the demographic data, etiologies, clinical menifestations, outcomes according to methods of operation, numbers of previous surgery, and time intervals between initial operation and final operation. Result : The most common etiology and previous surgical method of FBSS were insufficient surgery(54.7%) and partial laminectomy(53.3%). Patients were managed as followings ; Total laminectomy and spinal fusion with instrument in 41 cases(54.7%), total laminectomy without fusion in 23 cases(30.7%), and only partial laminectomy in 11 cases(14.7%). The overall treatment outcome was satisfactory in 48 cases(64%). Satisfactory results were observed in those patients who were treated by spinal fusion after complete laminectomy(34 cases), who had underwent only one operation previously(45 cases), and when the time interval between the initial operation and reoperation is shorter than 12 months(43 cases). Conclusion : The treatment outcome in FBSS was favorable in cases of the complete total laminectomy and spinal fusion with instrument, only one previous back surgery, and short time interval between initial and final operations.

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Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

  • Kim, Jae-Hong;Kang, Dong-Soo;Kim, Jung-Hee;Kong, Min-Ho;Song, Kwan-Young
    • Journal of Korean Neurosurgical Society
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    • 제50권2호
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    • pp.103-108
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    • 2011
  • Objective : There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods : Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results : The mean ages were $69.4{\pm}12.1$ and $55.6{\pm}9.3$ years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. Conclusion : Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique.

Comparison of Endovascular Treatments of Ruptured Dissecting Aneurysms of the Intracranial Internal Carotid Artery and Vertebral Artery with a Review of the Literature

  • Byoun, Hyoung Soo;Yi, Hyeong Joong;Choi, Kyu Sun;Chun, Hyoung Joon;Ko, Yong;Bak, Koang Hum
    • Journal of Korean Neurosurgical Society
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    • 제59권5호
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    • pp.449-457
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    • 2016
  • Objective : Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. Methods : The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. Results : Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. Conclusion : Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.

Construction of Microbial Fuel Cells Using Thermophilic Microorganisms, Bacillus licheniformis and Bacillus thermoglucosidasius

  • Choi, Young-Jin;Jung, Eun-Kyoung;Park, Hyun-Joo;Paik, Seung R.;Jung, Seun-Ho;Kim, Sung-Hyun
    • Bulletin of the Korean Chemical Society
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    • 제25권6호
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    • pp.813-818
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    • 2004
  • A systematic study of microbial fuel cells comprised of thermophilic Bacillus licheniformis and Bacillus thermoglucosidasius has been carried out under various operating conditions. Substantial amount of electricity was generated when a redox mediator was used. Being affected by operation temperature, the maximum efficiency was obtained at 50$^{\circ}C$ with an open circuit voltage of ca. 0.7 V. While a small change around the optimum temperature did not make much effect on the cell performance, the rapid decrease in performance was observed above 70$^{\circ}C$. It was noticeable that fuel cell efficiency and discharge pattern strongly depended on the kind of carbon sources used in the initial culture medium. In the case of B. thermoglucosidasius, glucose alone was utilized constitutively as a substrate in the microbial fuel cell irrespective of used carbons sources. When B. licheniformis was cultivated with lactose as a carbon source, best charging characteristics were recorded. Trehalose, in particular, showed 41.2% coulombic efficiency when B. thermoglucosidasius was cultured in a starch-containing medium. Relatively good repetitive operation was possible with B. thermoglucosidasius cells up to 12 cycles using glucose as a carbon source, when they were cultured with lactose as an initial carbon source. This study demonstrates that highly efficient thermophilic microbial fuel cells can be constructed by a pertinent modulation of the operating conditions and by carefully selecting carbon sources used in the initial culture medium.

Comparison of Positron Emission Tomography(PET) imaging-based initial in vivo pharmacokinetics by administration routes of [18F]FDG

  • Yiseul Choi;Jang Woo Park;Eun Sang Lee;Ok-Sun Kim;Hye Kyung Chung
    • 대한방사성의약품학회지
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    • 제7권2호
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    • pp.99-103
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    • 2021
  • In this study, the initial in vivo pharmacokinetic changes according to the routes of drug administration were investigated using bioimaging techniques. The purpose of this study was to quantify the degree of distribution of each major organ in normal mice over time by acquiring Positron Emission Tomography/Computed Tomography images while administering routes F-18 fluorodeoxyglucose such as intravenous, intraperitoneal and per oral, a representative diagnostic radiopharmaceutical. Dynamic Positron Emission Tomography images were acquired for 90 minutes after drug administration. Radioactivity uptake was calculated for major organs using the PMOD program. In the case of intravenous administration, it was confirmed that it spread quickly and evenly to major organs. Compared to intravenous administration, intraperitoneal administration was about three times more absorbed and distributed in the liver and intestine, and it was showed that the amount excreted through the bladder was more than twice. In the case of oral administration, most stayed in the stomach, and it was showed that it spread slowly throughout the body. In comparison with intravenous administration, it was presented that the distribution of kidneys was more than 9 times and the distribution of bladder was 66% lower. Since there is a difference in the initial in vivo distribution and excretion of each administration method, we confirmed that the determination of the administration route is important for in vivo imaging evaluation of new drug candidates.

Predictive Factors for Switched EGFR-TKI Retreatment in Patients with EGFR-Mutant Non-Small Cell Lung Cancer

  • Kwon, Byoung Soo;Park, Ji Hyun;Kim, Woo Sung;Song, Joon Seon;Choi, Chang-Min;Rho, Jin Kyung;Lee, Jae Cheol
    • Tuberculosis and Respiratory Diseases
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    • 제80권2호
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    • pp.187-193
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    • 2017
  • Background: Third-generation tyrosine kinase inhibitors of the epidermal growth factor receptor (EGFR-TKIs) have proved efficacious in treating non-small cell lung cancer (NSCLC) patients with acquired resistance resulting from the T790M mutation. However, since almost 50% patients with the acquired resistance do not harbor the T790M mutation, retreatment with first- or second-generation EGFR-TKIs may be a more viable therapeutic option. Here, we identified positive response predictors to retreatment, in patients who switched to a different EGFR-TKI, following initial treatment failure. Methods: This study retrospectively reviewed the medical records of 42 NSCLC patients with EGFR mutations, whose cancers had progressed following initial treatment with gefitinib or erlotinib, and who had switched to a different first-generation EGFR-TKI during subsequent retreatment. To identify high response rate predictors in the changed EGFR-TKI retreatment, we analyzed the relationship between clinical and demographic parameters, and positive clinical outcomes, following retreatment with EGFR-TKI. Results: Overall, 30 (71.4%) patients received gefitinib and 12 (28.6%) patients received erlotinib as their first EGFR-TKI treatment. Following retreatment with a different EGFR-TKI, the overall response and disease control rates were 21.4% and 64.3%, respectively. There was no significant association between their overall responses. The median progression-free survival (PFS) after retreatment was 2.0 months. However, PFS was significantly longer in patients whose time to progression was ${\geq}10months$ following initial EGFR-TKI treatment, who had a mutation of exon 19, or whose treatment interval was <90 days. Conclusion: In patients with acquired resistance to initial EGFR-TKI therapy, switched EGFR-TKI retreatment may be a salvage therapy for individuals possessing positive retreatment response predictors.