• Journal of Chest Surgery
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• 제50권6호
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• pp.448-452
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• 2017

Background: Proper monitoring of cerebral perfusion during carotid artery surgery is crucial for determining if a shunt is needed. We compared the safety and reliability of near-infrared spectroscopy (NIRS) w ith transcranial Doppler (TCD) for cerebral monitoring. Methods: This single-center, retrospective review was conducted on patients who underwent carotid endarterectomy (CEA) using selective shunt-based TCD or NIRS at Daegu Catholic University Medical Center from November 2009 to June 2016. Postoperative complications were the primary outcome, and the distribution of risk factors between the 2 groups was compared. Results: The medical records of 74 patients (45 TCD, 29 NIRS) were reviewed. The demographic characteristics were similar between the 2 groups. One TCD patient died within the 30-day postoperative period. Postoperative stroke (n=4, p=0.15) and neurologic complications (n=10, p=0.005) were only reported in the TCD group. Shunt usage was 44.4% and 10.3% in the TCD and NIRS groups, respectively (p=0.002). Conclusion: NIRS-based selective shunting during CEA seems to be safe and reliable for monitoring cerebral perfusion in terms of postoperative stroke and neurologic symptoms. It also reduces unnecessary shunt usage.

• Journal of Korean Neurosurgical Society
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• 제61권1호
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• pp.114-119
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• 2018

Objective : The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique. Methods : Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed. Results : Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up. Conclusion : For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.428-432
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• 2010

Objective : An effective intervention has not yet been established for patients with acute occlusion of the internal carotid artery (ICA). The aim of our study was to investigate the feasibility, safety, and efficacy of emergent stent placement of carotid artery to improve neurologic symptoms and clinical outcome. Methods : Of 84 consecutive patients with severe ICA stenosis who were admitted to our institution from March 2006 to May 2009, 10 patients with acute ICA occlusion (11.9%) underwent emergency carotid artery stent placement. We reviewed their records for neurologic outcome using the National Institutes of Health Stroke Scale (NIHSS) score, before and at 7 days after stent placement; clinical outcome using the modified Rankin Scale score (mRS) and Glasgow Outcome Scale (GOS); frequency of procedure-related complications; and recurrence rate of ipsilateral ischemic stroke within 90 days. Results : Carotid lesions were dilated completely in all patients. Median NIHSS scores before emergency stent placement and at 7 days were 16.6 and 6, respectively, showing significant improvement. Eight patients (80%) had favorable outcomes (mRS score 0-2 and GOS 4-5). Complications occurred in two patients (20%): stent insertion failed in one and an intracerebral hemorrhage occurred in the other. Ipsilateral ischemic stroke did not recur within 3 months. Conclusion : Emergency carotid artery stent placement can improve the 7-day neurologic outcome and the 90-day clinical outcome in selected patients with acute cerebral infarction.

• Archives of Plastic Surgery
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• 제39권1호
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• pp.31-35
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• 2012

Background : Orbital roof fractures are frequently associated with a high energy impact to the craniofacial region, and displaced orbital roof fractures can cause ophthalmic and neurologic complications and occasionally require open surgical intervention. The purpose of this article was to investigate the clinical features and treatment outcomes of orbital root fractures combined with neurologic injuries after early reconstruction. Methods : Between January 2006 and December 2008, 45 patients with orbital roof fractures were admitted; among them, 37 patients were treated conservatively and 8 patients underwent early surgical intervention for orbital roof fractures. The type of injuries that caused the fractures, patient characteristics, associated fractures, ocular and neurological injuries, patient management, and treatment outcomes were investigated. Results : The patients underwent frontal craniotomy and free bone fragment removal, their orbital roofs were reconstructed with titanium micromesh, and associated fractures were repaired. The mean follow up period was 11 months. There were no postoperative neurologic sequelae. Postoperative computed tomography scans showed anatomically reconstructed orbital roofs. Two of the five patients with traumatic optic neuropathy achieved full visual acuity recovery, one patient showed decreased visual acuity, and the other two patients completely lost their vision due to traumatic optic neuropathy. Preoperative ophthalmic symptoms, such as proptosis, diplopia, upper eyelid ptosis, and enophthalmos were corrected. Conclusions : Early recognition and treatment of orbital roof fractures can reduce intracranial and ocular complications. A coronal flap with frontal craniotomy and orbital roof reconstruction using titanium mesh provides a versatile method and provides good functional and cosmetic results.

• 대한두경부종양학회지
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• 제15권2호
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• pp.200-204
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• 1999

Objectives: Injuries of neurologic structures during parotid surgery are sometimes unavoidable even in benign tumors. Since the major postoperative neurologic complications such as facial nerve palsy and Frey's syndrome give a serious and heavy burden to both patients and surgeons, it is very important to know detailed information concerning risk factors, the incidence of complication, possibility of recovery, and the term before complete recovery. Materials and Methods: This report was based on 95 patients with parotid gland tumor who had been treated and followed up over 1 year at department of surgery and otolaryngology, chonnam university hospital. Results: 1) Among total 95 cases, the facial nerve palsy developed in 18 cases(l8.9%) and Frey's syndrome in 6 cases(6,3%). 2) The incidence of facial nerve palsy increased in cases with large tumor size, and in those operated with bipolar method. However, we didn't find out relationships between the incidence of facial palsy, localization, and histologic type. 3) The incidence of Frey's syndrome showed an increasing tendency in the cases with large tumor size, benign nature, and in those underwent superficial lobectomy with posterior approach, without a statistical significance. Conclusions: Risk of facial nerve palsy, especially a transient form, seems to be related to tumor size and bipolar coagulation method. Although Frey's syndrome tends to develop easily in the cases treated with superficial lobectomy under the diagnosis of benign tumor, a futhermore study is suggested to obtain a statistical significance.

• Neonatal Medicine
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• 제15권2호
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• pp.160-165
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• 2008

목 적: 두혈종과 두개내 혈종의 연관성을 조사하여 두혈종이 있는 신생아에 대한 뇌영상의 필요성에 대하여 알아보고자 하였다. 방 법 : 2002년 1월부터 2006년 6월까지 경북대학교 병원 신생아집중치료실에 입원한 신생아 중 두혈종이 있어 두부 전산화단층촬영술이나 자기공명영상을 시행하였던 18명을 대상으로 후향적 의무기록 분석을 시행하였다. 결 과 : 뇌영상 검사상 18명 중 6명(33.3%)에서 두개내 혈종이 관찰되었고 이 중 4례는 경막외 혈종, 2례는 경막하 혈종이었다. 두개내 혈종이 있었던 6례 중 2례는 신경학적 증상과 함몰 골절이 없었다. 두개내 혈종이 있던 신생아와 혈종이 없던 신생아 사이에 재태주령, 출생시 체중, 두위 및 두혈종의 크기 및 분만력에 유의한 차이가 없었다. 또한 신경학적 증상과 숫구멍 융기 소견의 발현 빈도에도 차이를 보이지 않았으며 황달, 빈혈의 빈도 역시 차이를 보이지 않았다. 결 론 : 두혈종이 있는 신생아에서는 두개내 혈종, 특히 경막외 혈종이 문헌에 보고된 발생 빈도보다 많이 발견되었다. 또한 신경학적 증상이나 함몰 골절이 없는 경우에도, 다른 원인이 없는 황달, 빈혈 등의 소견이 두혈종과 동반된 경우 두혈종에 합병된 두개내 혈종에 대한 임상의 관심이 요구되며 적절한 뇌영상 검사를 고려할 필요가 있을 것으로 생각된다.

• 대한두경부종양학회지
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• 제37권1호
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• pp.29-32
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• 2021

Benign submandibular gland tumor is a common disease in the head and neck region and can be completely removed by transcervical approach. Typical submandibular gland resection can lead to neurological complications. The most common complications are damage to the marginal mandibular branch of the facial nerve and weakening of the lower lip. We report a case of ipsilateral lower lip twitching occurring 3 months after surgery. There was no difficulty during the operation, and there were no neurologic complications immediate after surgery. However, in the present case, the patient experienced lower lip twitching paradoxically after surgery which has not been reported in the literature yet. Therefore, we reported this case with a review of relevant literature.

• 대한한방내과학회지
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• 제43권4호
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• pp.606-624
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• 2022

Objective: The aim of this study was to compare the effects of different doses of Geumnyeonyijin-tang (GNYJT) water extracts with those of metformin (250 mg/kg) in mild diabetic-obese mice. Methods and Results: The 48 mice were divided into 1 normal pellet diet (NFD) group and 5 high-fat diet (HFD) groups. At the end of 12 weeks of oral administration of metformin (250 mg/kg) or GNYJT water extracts (400, 200, or100 mg/kg), the effects were evaluated. The HFD control mice showed noticeable increases in body weight, adipose tissue density, fat pad weight of the periovarian and abdominal wall, and insulin, blood glucose, and HbA1c levels, with decreases in serum HDL levels. Increases in the periovarian and dorsal abdominal fat pad, regions of steatohepatitis, adipocyte hypertrophy, and hepatocyte hypertrophy were also discovered. The HFD group showed a decline in glucose levels and elevation of hepatic gluconeogenesis, suggesting an HFD-induced AMPK downregulation related to glucose dysregulation, as well as lipid metabolism related to obese insulin-resistant type II diabetes, dyslipidemia, and oxidative stress related diabetic hepatopathy (non-alcoholic fatty liver disease, NAFLD). Conclusion: Assessment of the key parameters for inhibition of diabetes and related complications in HFD-fed diabetic-obese mice demonstrated that GNYJT water extracts have favorable ameliorating effects. The effect of GNYJT was manifested through the stimulation of AMPK upregulation of related hepatic glucose enzyme activities and expression of lipid metabolism-related genes. Therefore, appropriate oral dosages of GNYJT could be promising as a new preventive candidate for controlling diabetes and related complications. Further screening of biologically active compounds, elucidation of detailed mechanisms, and more animal studies are warranted.

• 대한한방내과학회지
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• 제23권2호
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• pp.313-320
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• 2002

Insomnia is defined as an experience of inadequate or poor-quality sleeping habit, coupled with more than one of the following symptoms : having difficulty sleeping, waking up too early in the morning or not having sound sleep. Insomnia is one of the most common complications that stroke patients experience, which interfere the patients' recovery. The authors observed two improved cases of insomnia in stroke patients by administrating traditional Korean medicine. The patients suffered from insomnia with nocturnal irritation, constipation, petechia of the tongue, thready or weak pulse. These symptoms, were diagnosed as blood stasis and we administered Hyulboochucke-tang three times a day, to improve blood circulation to remove blood stasis. After the administration, nocturnal irritation disappeared and the insomnia improved. Based on this experience, it is considered that enhancing blood circulation to remove blood stasis can be applied to the treatment of insomnia that stroke patients suffer.

• Annals of Clinical Neurophysiology
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• 제13권1호
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• pp.64-67
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• 2011

Shingles is a latent viral infection of the sensory ganglia. It can be accompanied by a variety of neurologic complications, including polyradiculitis and myelitis. A 66-year-old man with diabetes mellitus presented with progressive weakness, hypethesia and neuralgic pain in his right arm after herpes zoster infection in right C5 dermatome. He was diagnosed with zoster polyradiculomyelitis and treated with intravenous acyclovir and corticosteroid. It is a rare case of zoster neurologic complication in spite of oral acyclovir treatment.