• Investigative Magnetic Resonance Imaging
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• v.7 no.2
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• pp.124-131
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• 2003

Purpose : To reveal clinical usefulness of functional MRI (fMRI) using sensorymotor and language stimuli for demonstrating anatomic relationship between sensorimotor or language cortices and lesions in the planning of brain tumor surgery. Materials and Methods : This study included 12 right-handed patients with brain tumors in or around sensorimotor or language cortices. Eleven patients were evaluated with primary motor and sensory stimuli. Of these patients, six patients were also evaluated with language stimuli. One patient was evaluated with language stimuli only. For fMR imaging, a 1.5T scanner was used and the EPI BOLD technique was employed. For postprocessing image, the SPM99 program and a program made by our department was utilized. We evaluated whether sensorimotor and language stimuli activate sensorimotor and language cortices. And also, clinical efficacy of revealing anatomic relationship between cerebral cortices and lesions for planning neurosurgical operation were evaluated. Finally, we compared post-operative neurologic function with pre-operative neurologic function in same patients. Results : The fMRI examination was successful in identifying the functional cortices and depicting anatomic relationship between functional cortices and lesions in all patients. In nine patients of 11 patients with identified sensorimotor cortices, postoperative grade of manual motor test was not changed, compared with preoperative grade. Whereas postoperative improved than preoperative grade in one patient of remaining two patients, postoperative aggravated than preoperative grade in the other. This result was due to atherosclerotic lacunar infarction, regardless of tumor resection. Postoperative deficit of language function was not found in seven patients with identified language cortices. Conclusion : fMRI could be a helpful method for determining the best approach to neurosurgical treatment in patients with brain tumors in or around sensorimotor or language cortices.

• Journal of Yeungnam Medical Science
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• v.10 no.1
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• pp.114-126
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• 1993

The fractures of the cervical spine are relatively uncommon, but they may cause serious neurologic deficits temporarily or permanently. So, it is very important to treat the patients early by way of exact evaluation for the sites and the mechanisms of the injuries. The authors reviewed retrospectively 188 cervical spinal fractures in 100 patients from Sep. 1984 to Aug. 1990. Commonly involved levels were $C_5$ and $C_6$ in lower cervical level and $C_2$ in upper cervical level and the sites in each spine were body, lamina and odontoid process. The hyperflexion injury was the most common type of the cervical spinal fractures occupying 53% of all cervical fractures and cause more multiple fractures(2.26 fractures/patient) than in hyperextension(1.68 fractures/patient). In hyperflexion injuries, body, transverse and spinous process were commonly involved but lamina fracture was relatively common in hyperextension injury. The dislocations associated with fractures were developed most commonly in hyperflexion injury and 70% of these were anterior dislocation and the most commonly involved levels were $C_{5-6}$ and $C_{6-7}$. In conclusion, hyperflexion injury needs more close examination for the entire spinal levels than injuries of other mechanisms because it results in more severe fractures with or without dislocation and relatively frequent multiple fractures in different levels.

• Journal of Veterinary Clinics
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• v.23 no.4
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• pp.465-468
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• 2006

A 3-year-old, spayed female Shih-tzu dog was presented due to acute vomiting, diarrhea, and generalized weakness. The dog had generalized weakness, increased respiratory rate, and respiratory muscle effect. Neurologic examination revealed appendicular muscular weakness and decreased in tone of the anal sphincter. Megaesophagus was confirmed by radiographic examinations. Other than type 2 fiber atrophy, no specific abnormalities were identified in histopathologic examinations of muscle biopsies from the left pelvic limb. Serum acetylcholine receptor (AChR) antibody titer was increased (0.78 nmol/L reference range, less than 0.6 nmol/L), confirming a diagnosis of acute fulminating myasthenia gravis. The dog dramatically responded to pyridostigmine bromide and had marked improvement in muscle strength, megaesophagus, and respiratory function. The dog has been successfully managed for 7 months after initial treatment.

• Tuberculosis and Respiratory Diseases
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• v.79 no.1
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• pp.37-41
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• 2016

Iron supplements such as ferrous sulfate tablets are usually used to treat iron-deficiency anemia in some elderly patients with primary neurologic disorders or decreased gag reflexes due to stroke, senile dementia, or parkinsonism. While the aspiration of ferrous sulfate is rarely reported, it is a potentially life-threatening condition that can lead to airway necrosis and bronchial stenosis. A detailed history and high suspicion of aspiration are required to avoid delays in diagnosis and treatment. The diagnosis can be confirmed by bronchoscopic examination and a tissue biopsy. Early removal of the aspirated tablet prevents acute complications, such as bronchial necrosis, hemoptysis, and lobar consolidation. Tablet removal is also necessary to prevent late bronchial stenosis. We presented the first case in Korea of a ferrous sulfate tablet aspiration that induced severe endobronchial inflammation.

• Clinical and Experimental Pediatrics
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• v.46 no.11
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• pp.1112-1117
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• 2003

Purpose : Recent advances in the methods of treating cancer in young patients have led to both an increased frequency of CNS complications as well as prolonged life expectancy. We intend to analyze the clinical aspects and laboratory findings of patients with CNS complications during and after treatment. Methods : We reviewed the medical records of 174 childhood cancer patients treated with chemotherapy admitted to the Dept. of Pediatrics, Keimyung University Dongsan Hospital, from January 1995 to November 2002. Among them, 15 cases with CNS complications were investigated in this study. Results : CNS abnormalities were found in 13 patients by CT or MRI during treatment such as leukoencephalopathy(n=7), mineralizing microangiopathy(n=4), brain infarction(n=3), intracranial hemorrhage(n=1), and hypoxic ischemic encephalopathy(n=1). It was found that two patients had two or more CNS abnormalities. Two patients who had no imaging abnormalities had convulsions, possibly after the addition of intrathecal methotrexate. The patients with intracranial hemorrhage and brain infarction had rapid and fatal clinical courses. The hypoxic ischemic encephalopathy following electrolyte imbalance completely recovered after correction of electrolyte. Conclusion : The CNS complications that occur during and after chemotherapy influence prognoses significantly, and remain neurologic sequelae. Therefore early diagnosis and prophylaxis for CNS complications and regular physical examination of patients who have recieved cancer therapy are strongly recommended.

• The Korean Journal of Nuclear Medicine
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• v.29 no.1
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• pp.15-21
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• 1995

To evaluate availability of cerebral radionuclide imaging for diagnosis of brain death, we examined 25 patients with a suspected clinical diagnosis of brain death. 8 patients were studied by $^{99m}Tc$ DTPA and 15 patients were studied by $^{99m}Tc$ HMPAO (Hexamethyl propyleneamine oxime). Seven patients with $^{99m}Tc$ DTPA studies revealed absence of cerebral blood flow and sagittal sinus activity. All of 15 patients with $^{99m}Tc$ HMPAO studies revealed complete absence of cerebral perfusion. The results of the cerebral radionuclide studies of brain death correlated with other clinical conditions, such as intracranial pressure(ICP), EEG, transcranial doppler sonography(TCDS), and neurologic examination. The ICP of 8 patients, who are confirmed by brain death with $^{99m}Tc$ HMPAO study are elevated in all cases. In conclusion, cerebral radionuclide imaging for diagnosis of brain death is available. $^{99m}Tc$ HMPAO imaging is unequivocal, easily interpreted, well reflect the physiologic state of increased ICP, and provides adequate assessment of posterior fossa activity. In addition, the SPECT imaging with $^{99m}Tc$ HMPAO produces more accurate results due to it's superiority of image contrast and proper localization of radiopharmaceutical distribution than conventional planar imaging.

• The Journal of Dong Guk Oriental Medicine
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• v.3
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• pp.237-267
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• 1994

The purpose of this study is the approach to I.I.C.P. centered on the meaning of consciousness disorder and the pathological aspect of Kwul (Jose consciousness ; faint, fall into a coma). The meaning of consciousness disorder and apoplexy is evidently involved the definition of Kwul. 1. It is found that the etymological interpretation on Kwul which the energy rises back to go through blocked space and the meaning interpretation of regarding Kwul as apoplexy with medical viewpoint, are related with consciousness disorder and motor disturbance in IICP in the aspect of the rise of Kwul and the abnormal rising of vital energy and blood, In addtion, the overall of meaning of Kwul is showed in table <1-1> by reference to doctors of many generations, 2. The pathology of Kwul includes abnormal rising, sthenia-syndrome in the upper part and asthenia in the lower, the origin of Kwul, the lower, looking like Yin by too sthenic Yang and looking like Yang by too sthenic Yin. The headache, vomiting, papilledema, paralysis of nervi craniales, coma, blood pressure rising, tachycardia by I.I.C.P can be regarded as a conception of trouble of vital energy, sthenia-syndrome of Kwul. The pulse pressure, brachycardia, bradypnea can be regarded as the conception of looking like Yin by too sthenic Yang. 3. In the emergency of Kwul, the abnormal ternimal reversion of the Kwulyin channel, Kuyang channel, and three Yins are related with the phenomenon in I.I.C.P. It is considered that the reverse movement of materials, I.I.C.P. can be closely observed by giving meaning on the meridian of Kwul in Somunkwulron. And the content of phrases of Naelyung which includes consciousness disorder refered in the chapter of Kwul, is compared with I.I.C.P. 4. The followings should be considered; examination of optic symptom and abnormal posture in cerebral herniation ; understanding and working out counterplans of factors and symptoms of consciousness disorder by the observation of vital sign, check of general stages, neurologic inverstigation, clinical diagnosis, and subsidiary diagnosis; application of morphological change of opinion; addtion of the conception of demonstration centered on Yunkyung, Samyinkwulruk, asthenia and thenia of healthy energy in oriental medicine. 5. The similarity of Kwul and I.I.C.P. can be found from etiology and pathotenic factor. The similarity is clearly found by investigation of etiology, pathotenic factor, symptoms and thrapy of Kwul, disease symptom ar.d other symptoms.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.469-472
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• 2010

Purpose: Aplasia Cutis Congenita (ACC) is a rare disease characterized by the focal defect of the skin at birth, frequently involving scalp, but it may affect any region of the body. There are no etiology known but some conditions such as intrauterine vascular ischemia, amniotic adherences and viral infections are associated. The ideal treatment for the ACC is not known. Superficial and relatively small sized defects (< $3{\times}5\;cm$) may heal spontaneously and large defects related with risks of infection and bleeding may require aggressive surgical treatment. Hyalomatrix$^{(R)}$ is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. It has been used as a temporary dermal substitute to cover deep thickness skin defect and has physiological functions derive from the structural role in extracellular matrix and interaction with cell surface receptor. This material has been used for the wound bed pre-treatment for skin graft to follow and especially in uncooperative patient, like a newborn, this could be a efficient and aseptic way of promoting granulation without daily irritative wound care. For this reason, using Hyalomatrix$^{(R)}$ for the treatment of ACC was preferred in this paper. Methods: We report a case of a newborn with ACC of the vertex scalp and non-ossified partial skull defect. The large sized skin and skull defect ($6{\times}6\;cm$) was found with intact dura mater. No other complications such as bleeding or abnormal neurologic sign were accompanied. Escharectomy was performed and Hyalomatrix$^{(R)}$ was applied for the protection and the induction of acute wound healing for 3 months before the split-thickness skin graft. During the 3 months period, the dressing was renewed in aseptic technique for every 3 weeks. The skin graft was achieved on the healthy granulation bed. Results: The operative procedure was uneventful without necessity of blood transfusion. Postoperative physical examination revealed no additional abnormalities. Regular wound management was performed in out-patient clinic and the grafted skin was taken completely. No other problems developed during follow-up. Conclusion: Hyalomatrix$^{(R)}$ provides protective and favorable environment for wound healing. The combination of the use of Hyalomatrix$^{(R)}$ and the skin graft will be a good alternative for the ACC patients with relatively large defect on vertex.

• Journal of Veterinary Clinics
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• v.30 no.2
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• pp.142-145
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• 2013

Equine motor neuron disease (EMND) is a spontaneous neurologic disorder of horses, which results from the degeneration of motor neurons in the spinal cord and brain stem. An 8-year-old Jeju pony gelding presented with weight loss, muscle tremors, frequent recumbence, low head carriage, sweating, and standing with four limbs close together. The gelding has been on the same stable and limited access to pasture for several years. The gelding has been fed with dried hays and commercial concentrated feeds. Laboratory test revealed very low serum vitamin E level (0.14 ${\mu}g/mL$; reference range > 1.5 ${\mu}g/mL$), mildly elevated creatine kinase (402 IU/L; reference range 119-287 IU/L) and aspartate aminotransferase (876 IU/L; reference range 226-336 IU/L). Oral glucose absorption test showed decreased glucose absorption. Histopathologic examination using a biopsy specimen from sacrocaudalis dorsalis medialis muscle revealed atrophic and hypertrophic muscle fiber, centralization of nucleus, degenerating and necrotic muscle fibers. Taken together, the gelding was diagnosed as EMND. After oral vitamin E administrated for 5 weeks, the gelding showed normally improved stance, decreased periods of recumbency, improved head carriage and weight gain except consistent tremors. This is the first report that successfully treated EMND case occurred in a Jeju pony in Korea.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup1
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• pp.85-90
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• 2001

Objective : DREZotomy is effective for the treatment of deafferentation pain as a consequence of root avulsion, postparaplegic pain, posttraumatic syrinx, postherpetic neuralgia, spinal cord injury, and peripheral nerve injury. We performed microsurgical DREZotomy to the patients with deafferentation pain and relieved pain without any serious complication. The purpose of this study is to evaluate the usefulness of the microsurgical DREZotomy for deafferentation pain. Methods : We evaluated 4 patients with deafferntation pain who were intractable to medical therapy. Two of them were brachial plexus injury with root avulsion owing to trauma, one was axillary metastasis of the squamous cell carcinoma of the left forearm, and the last was anesthesia dolorosa after surgical treatment(MVD and rhizotomy) of trigeminal neuralgia. Preoperative evaluation was based on the neurologic examination, radiologic imaging, and electrophysiological study. In the case of anesthesia dolorosa, we produced two parallel lesions in cephalocaudal direction, 2mm in distance, from the C2 dorsal rootlet to the 5mm superior to the obex including nucleus caudalis, after suboccipital craniectomy and C1-2 laminectomy, with use of microelectrode. In the others, we confirmed lesion site with identification of the nerve root after hemilaminectomy. We performed arachnoid dissection along the posterolateral sulcus and made lesion with microsurgical knife and microelectrocoagulation, 2mm in depth, 2mm in distance, to the direction of 30-45 degrees in the medial portion of the Lissauer's tract and the most dorsal layers of the posterior horn at the one root level above and below the lesion. Results : Compared with preoperative state, microsurgical DREZotomy significantly diminished dosage of the drugs and relieved pain meaningfully. One patient showed tansient ipsilateral ataxia, but recovered soon. There was not any serious complication. Conclusion : It may be concluded that microsurgical DREZotomy is very useful and safe therapeutic modality for deafferentation pain, especially segmentally distributed intermittent or evoke pain. Complete preoperative evaluation and proper selection of the patients and lesion making device are needed to improve the result.