• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.29 no.2
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• pp.459-475
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• 1999

Objectives : The purpose of this study is to evaluate the computed tomographic (CT) images of the paranasal sinusitis(PNS). Materials and Methods : The author examined the extent and recurring patterns of the paranasal sinusitis and some important anatomic landmarks. The author analyzed PNS images retrospectively in 500 patients who visited Chonbuk National University Hospital between January 1996 and December 1997. Results : The most frequently affected sinus was maxillary sinus (82.9％), followed by anterior ethmoid sinus(67.9％), posterior ethmoid sinus(48.9％), frontal sinus(42.0％) and sphenoid sinus(41.4％). The characteristic features of CT images of the sinusitis were sinus opacification(22.4％), mucoperiosteal thickening(34.3％), and polyposis(2.0％). Sinonasal inflammatory diseases were categorized into 5 patterns according to Babber s classification. They were 1) infundibular(13.0％), 2) ostiomeatal unit(67.4％), 3) sphenoethmoidal recess (13.0％), 4) sinonasal polyposis (9.6％) and 5) unclassifiable patterns(18.0％). The incidences of contact between sinus and optic nerve were as follows ; the incidences of contact with posterior ethmoid sinus, sphenoid sinus. both posterior sinuses were 11.4％. 66.8％, 6.3％. respectively. The incidences of contact between sphenoid sinus and maxillary nerve, vidian nerve, internal carotid artery were 74.5％. 79.2％. 45.1％. respectively. The incidences of pneumatization of the posterior ethmoid sinus were as follows ; normal 70.6％ and overriding type 29.4％. The incidences of sphenoid sinus pneumatization were as follows; normal 56.9％ , rudimentary 12.5％, pterygoid recess 22.7％, anterior clinoid recess 2.7％, and both pterygoid and anterior clinoid recess type 5.2％. Conclusions : The inflammatory sinonasal diseases were classified into five patterns using the CT of PNS, which was proven to be an excellent imaging modality providing detailed information about mucosal abnormality, pathologic patterns, and the proximity of the important structures to the posterior paranasal sinuses. This result will aid in the interpretation of CT of PNS functionally and systemically.

• The Korea Journal of Herbology
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• v.29 no.6
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• pp.73-83
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• 2014

Objectives : This study was investigated the effects of the root of Polygala tenuifolia (POL) on learning and memory impairment induced by chronic cerebral hypoperfusion in rats. Methods : Chronic cerebral hypoperfusion was produced by permanent bilateral common carotid artery occlusion (pBCAO). POL was administered orally once a day (130 mg/kg of water-extract) for 28 days starting at 4 weeks after the pBCAO. The acquisition of learning and the retention of memory were tested on 9th week after the pBCAO using the Morris water maze. In addition, effects of POL on $A{\beta}$ generation and expressions of APP and BACE1 were observed in the hippocampus of rats. Results : POL significantly prolonged the swimming time spent in target quadrant and significantly reduced the swimming time spent in the quadrant far from the target. POL significantly increased the percentage of swim in the targer quadrant in the retention test, while POL was not effective on the escape latencies in the acquisition training trials. POL significantly reduced the levels of $A{\beta}_{(1-40)}$ and $A{\beta}_{(1-42)}$ in the cerebral cortex and the level of $A{\beta}_{(1-42)}$ in the hippocampus produced by chronic cerebral hypoperfusion. POL also significantly attenuated the up-regulation of APP and BACE1 expression in the hippocampus produced by chronic cerebral hypoperfusion. Conclusions : The results show that POL alleviated memory deficit and up-regulation of $A{\beta}$ and BACE1 expressions in the hippocampus. This result suggests that POL may exert ameliorating effect on memory deficit through inhibition of ${\beta}$-secretase activity and $A{\beta}$ generation.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1996.04a
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• pp.246-246
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• 1996

The glucuronide conjugates of morphine have been claimed to exert significant neuropharmacological effects. Morphine-6-glucuronide (M6G) may be a potent opioid agonist in vivo, and morphine-3-glucuronide (M3G) may act as a weak opioid antagonist. The present study addressed the permeability of the blood-brain barrier (BBB) for these metabolites compared to morphine. Tracers were prepared by enzymatic glucuronidation of U-methyl-$^3$H]-morphine. Brain uptake in rats was measured by the internal carotid artery perfusion technique and after i.v. bolus injections. In the perfusion experiments morphine showed a permeability-surface area product (PS) of 3.52${\pm}$0.61 ${\mu}$L min$\^$-1/ g$\^$-1/ Uptake seems to be mediated by passive diffusion and was not saturable by 100 ${\mu}$M morphine in the perfusate. The BBB permeability of [$^3$H]-M3G and [$^3$H]-M6G was too low to be quantified after 5 min of perfusion. Brain uptake of [$^3$H]-M3G and [$^3$H]-M6G 60 min after i.v. bolus injection reached 0.0060${\pm}$0.0003 and 0.0030${\pm}$0.0005% injected dose per g, respectively. From these brain concentrations and from the corresponding plasma concentration - time curves, BBB PS values of 0.14${\pm}$ 0.02 ${\mu}$L min$\^$-1/g$\^$-1/ and 0.11 ${\pm}$ 0.01 ${\mu}$L min$\^$-1/g$\^$-1/, respectively, were calculated. The ratio of BBB PS values is complementary to the analgesic potencies of morphine and M6G after different routes of administration. The low PS of MSG explains, why it is approximate]y equipotent to morphine after systemic injection, although it is about 2 orders of magnitude more potent than morphine after administration directly into the central nervous system.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.786-793
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• 2000

Objectives : A clinical analysis was performed to provide management strategy and to improve management outcome of elderly patients with intracranial aneurysm. Patients and Methods : We reviewed medical records of 746 consecutive patients with intracranial aneurysm who were admitted from July 1991 to December 1996. They were divided into two age groups : elderly(120 patients aged 65 years or older) and non-elderly(626 patients aged 64 years or younger). We investigated the differences between the two groups in clinical characteristics, management outcome and surgical results. Results : Female(80.0%), internal carotid artery aneurysm(48.9%), poor clinical grade(Hunt and Hess Grade IV, V : 39.8%), postoperative subdural fluid collection(38.2%), and postoperative hydrocephalus(39.7%) were more frequent in the elderly patients. There were no significant differences in the incidence of hypertension, multiple aneurysm, unruptured aneurysm, rebleeding, delayed ischemic neurological deficits, postoperative hemorrhage, and low density on the postoperative brain CT scan. In some cases, surgical clipping of ruptured aneurysm could not be performed due to moribund state or refusal of surgery by the elderly patient's family. Both management outcome and surgical results in elderly aneurysm patients at 3 months after rupture were worse than those of the non-elderly group. The most common reason of unfavorable outcome was poor clinical grade in both groups, while serious medical illness causing unfavorable outcome was more common in the elderly group. Conclusion : Surgical treatment of a ruptured aneurysm should not be avoided in elderly patient solely on the basis of advanced age. If the patients are in good clinical grade, early aneurysm surgery followed by early ambulation should be recommended. Further improvements in outcome may be achieved by thorough knowledge of poor resilience of brain, CSF flow dynamics, and diminished cardiopulmonary reserve in elderly patients with intracranial aneurysm.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.644-653
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• 2017

Objective : Paraclinoid aneurysms are a group of aneurysms arising at the distal internal carotid artery. Due to a high incidence of small, wide-necked aneurysms in this zone, it is often challenging to achieve complete occlusion when solely using detachable coils, thus stent placement is often required. In the present study, we aimed to investigate the effect of stent placement in endovascular treatment of paraclinoid aneurysms. Methods : Data of 98 paraclinoid aneurysms treated by endovascular approach in our center from August 2005 to June 2016 were retrospectively reviewed. They were divided into two groups : simple coiling and stent-assisted coiling. Differences in the recurrence and progressive occlusion between the two groups were mainly analyzed. The recurrence was defined as more than one grade worsening according to Raymond-Roy Classification or major recanalization that is large enough to permit retreatment in the follow-up study compared to the immediate post-operative results. Results : Complete occlusion was achieved immediately after endovascular treatment in eight out of 37 patients (21.6%) in the stent-assisted group and 18 out of 61 (29.5%) in the simple coiling group. In the follow-up imaging studies, the recurrence rate was lower in the stent-assisted group (one out of 37, 2.7%) compared to the simple coiling group (13 out of 61, 21.3%) (p=0.011). Multivariate logistic regression model showed lower recurrence rate in the stent-assisted group than the simple coiling group (odds ratio [OR] 0.051, 95% confidence interval [CI] 0.005-0.527). Furthermore there was also a significant difference in the rate of progressive occlusion between the stent-assisted group (16 out of 29 patients, 55.2%) and the simple coiling group (10 out of 43 patients, 23.3%) (p=0.006). The stent-assisted group also exhibited a higher rate of progressive occlusion than the simple coiling group in the multivariate logistic regression model (OR 3.208, 95% CI 1.106-9.302). Conclusion : Use of stents results in good prognosis not only by reducing the recurrence rate but also by increasing the rate of progressive occlusion in wide-necked paraclinoid aneurysms. Stent-assisted coil embolization can be an important treatment strategy for paraclinoid aneurysms when considering the superiority of long term outcome.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.152-158
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• 2012

Purpose : To compare the arterial and venous detection sites of triggering methods in contrast-enhanced-MR-venography (CE-MRV) for the evaluation of intracranial venous system. Materials and Methods: 41 healthy patients underwent CE-MRV with autotriggering at either the cavernous segment of internal carotid artery with an inserted time-delay of 6 seconds (n = 20) or the superior sagittal sinus without any timedelay (n = 21). 0.1 mmol/kg gadolinium-based contrast material ($Magnevist^{(R)}$, Schering, Germany) was intravenously injected by hand injection. A sagittal fast-spoiled-gradient-echo-sequence ranging from one ear to the other was performed (TR/TE5.2/1.5, Matrix $310{\times}310$, 124 sections in the 15-cm-thick volume). 17 predefined venous structures were evaluated on all venograms by two neuroradiologists and defined as completely visible, partially visible, or none visible. Results: The rate of completely visible structures were 272 out of 323 (84%) in the arterial triggering CE-MRV and 310 out of 340 (91%) in the venous triggering CE-MRV. The venous triggering CE-MRV demonstrated an overall superior visualization of the cerebral veins than the arterial triggering CE-MRV (Fisher exact test, p < 0.006). Conclusion: CE-MRV using venous autotriggering method provides higher-quality images of the intracranial venous structures compared to that of arterial.

• Investigative Magnetic Resonance Imaging
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• v.6 no.2
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• pp.158-165
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• 2002

Purpose : To evaluate the effect of Gd-DTPA on signal intensity of diffusion-weighted magnetic resonance(MR) image and apparent diffuse coefficient (ADC) in dog brain with hype racute stroke. Materials and methods : Experimental canine model of hyperacute cerebral infarction was made by selective intraarterial embolization with particulate embolic material. Diffusion-weighted MR imaging was performed in five dogs at 1 hour after the embolization of internal carotid artery. After intravenous bolus injection of Gd- DTPA, additional 11 diffusion-weighted MR images were serially obtained from 2 minutes to 90 minutes after injection in each dog. The author evaluated findings of hyperacute cerebral infarction on diffusion-weighted MR imaging, and calculated mean signal intensity and mean ADC in infarcted region and contralateral normal region. Statistical analysis of mean signal intensity, mean ADC and contrast-noise ratio before and after Gd-DTPA injection was performed. Results : Hyperacute cerebral infarction developed in all five dogs on diffusion-weighted MR images obtained 1 hour after embolization. The area of hyperacute infarction had steady increase in signal intensity on diffusion-weighted MR image and decrease in ADC. In normal perfusion area, decrease in signal intensity was observed at 2 minutes the Gd-DTPA injection, whereas ADC did not changed. Conclusion : Intravenous injection of Gd-DTPA had no influence on ADC in both hyperacute infarction and normally perfused are a, but caused initial transient signal reduction in normally perfused area on diffusion-weighted MR image due to susceptibility effect of Gd-DTPA. It is important to calculate ADC in evaluating the effect of diffusion after injection of Gd-DTPA.

• Journal of Korean Neurosurgical Society
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• v.47 no.2
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• pp.112-118
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• 2010

Objective : There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. Methods : A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 3D-day morbidity and mortality. Results : The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p=0.000), age (p=0.000), presence of symptom (p=0.003), and location of aneurysm (p=0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p=0.010), presence of symptoms (p=0.034), size (p=0.000) of aneurysm, and diabetes mellitus (p=0.000) were significant prognostic factors, while treatment modality was not. Conclusion : This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.40-44
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• 2019

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease of unknown etiology characterized by progressive stenosis at the terminal portion of the internal carotid artery and an abnormal vascular network at the base of the brain. The clinical presentations of MMD include transient ischemic attacks (TIA), ischemic stroke, hemorrhagic stroke, seizures, headache, and cognitive impairment. MMD is the most important cause of stroke or TIA in children in East Asian countries. A 5-year-3-month old boy with MMD experienced cerebral infarctions five times. Cerebrovascular anastomosis surgery was performed on him four years ago. He had dysphagia, developmental delay, hemiplegia, and strabismus. Besides, a number of dental caries in primary dentition were identified during clinical oral examination. Dental treatment under general anesthesia using sevoflurane was performed due to his lack of cooperation and underlying systemic disease. MMD is associated with various medical diseases requiring thoughtful consideration during dental treatment. Crying and hyperventilation in MMD patients may cause hypocapnia and have a cerebral vasoconstrictive effect. If dental treatment is required, control of pain and anxiety is very important. General anesthesia may be considered for dental treatment in uncooperative or very young patients with MMD.

• Korean Journal of Radiology
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• v.24 no.7
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• pp.681-689
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• 2023

Objective: Three-dimensional rotational angiography (3D-RA) is increasingly used for the evaluation of intracranial aneurysms (IAs); however, radiation exposure to the lens is a concern. We investigated the effect of head off-centering by adjusting table height on the lens dose during 3D-RA and its feasibility in patient examination. Materials and Methods: The effect of head off-centering during 3D-RA on the lens radiation dose at various table heights was investigated using a RANDO head phantom (Alderson Research Labs). We prospectively enrolled 20 patients (58.0 ± 9.4 years) with IAs who were scheduled to undergo bilateral 3D-RA. In all patients' 3D-RA, the lens dose-reduction protocol involving elevation of the examination table was applied to one internal carotid artery, and the conventional protocol was applied to the other. The lens dose was measured using photoluminescent glass dosimeters (GD-352M, AGC Techno Glass Co., LTD), and radiation dose metrics were compared between the two protocols. Image quality was quantitatively analyzed using source images for image noise, signal-to-noise ratio, and contrast-to-noise ratio. Additionally, three reviewers qualitatively assessed the image quality using a five-point Likert scale. Results: The phantom study showed that the lens dose was reduced by an average of 38% per 1 cm increase in table height. In the patient study, the dose-reduction protocol (elevating the table height by an average of 2.3 cm) led to an 83% reduction in the median dose from 4.65 mGy to 0.79 mGy (P < 0.001). There were no significant differences between dose-reduction and conventional protocols in the kerma area product (7.34 vs. 7.40 Gy·cm², P = 0.892), air kerma (75.7 vs. 75.1 mGy, P = 0.872), and image quality. Conclusion: The lens radiation dose was significantly affected by table height adjustment during 3D-RA. Intentional head off-centering by elevation of the table is a simple and effective way to reduce the lens dose in clinical practice.