• Annals of Clinical Neurophysiology
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• 제6권2호
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• pp.92-97
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• 2004

Background: There were several studies comparing prognostic factors in Guillain-Barre syndrome treated with intravenous immunoglobulin and plasmapheresis. However, there were controversies in what were significant factors and there were few studies so far comparing the therapeutic outcomes in patients treated with immunoglobulin. This study was aimed to determine the prognostic factors which affected the therapeutic outcome of Guillain-Barre syndrome treated with intravenous immunoglobulin. Method: We retrospectively reviewed the medical records of patients with Guillain-Barre syndrome admitted to our hospital between January 1999 and March 2004. All patients were treated with intravenous immunoglobulin. Outcome and prognosis were followed up after four weeks using the overall disability sum score. Results: Thirty-six patients were enrolled in this study. According to the clinical and electrophysiological findings, 17 patients were AIDP, 10 were axonal forms, two were mixed and seven had electrophysiologically no evidence of abnormalities. At a follow-up of four weeks, disabilities at the nadir (p<0.001) and admission (P<0.012), initial manifestations of bulbar symptom (P<0.024) and electrodiagnostic features (P<0.013) were significantly correlated with outcome in patients treated with intravenous immunoglobulin. But only disabilities at the nadir (P<0.033) and electrodiagnostic features (P<0.018) were significant in the multivariate logistic regression analysis. Conclusion: Among the patient treated with intravenous immunoglobulin, the outcomes were significantly different according to the neurological status at the nadir. Therefore early diagnosis, administration of intravenous immunoglobulin and preventing complications during acute stages are essential to minimize neurological deficit and shorten the periods of recovery.

• 재활치료과학
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• 제7권2호
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• pp.9-16
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• 2018

목적 : 본 연구의 목적은 뇌손상 환자의 신경학적 변화 측정도구인 뇌전도의 측정도구 및 방법, 평가와 분석방법을 알아봄으로써 임상영역에서 뇌전도 측정 시 기초자료를 제시하는 것에 있다. 연구방법 : 전자 데이터 베이스인 Pubmed, Science Direct를 사용하였으며, 주요검색 용어로 'Electroencephalography', 'stroke', 'intervention OR training'을 사용하였다. 결과 : 뇌전도는 두뇌-컴퓨터 인터페이스(Brain-computer interface)를 이용하여 재활의 효과를 뇌의 활성화 상태 변화로 측정할 수 있는 도구로 기능적 뇌 재조직화 매커니즘을 확인할 수 있는 것으로 나타났다. 뇌전도 측정도구의 경우 다양한 채널, 전극의 형태 및 전극 부착 부위로 구성되어 있으며, 결과해석에 사용되는 주파수 또한 다양하게 나타났다. 결론 : 뇌전도는 중재에 대한 효과성을 신경학적으로 확인할 수 있을 뿐만 아니라 효율적인 작업치료를 위한 중재전략을 마련하는데 사용될 수 있을 것으로 사료된다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권2호
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• pp.121-127
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• 2015

Purpose: To evaluate clinical and laboratory profile of Wilson's disease (WD) in children. Methods: This cross sectional study was conducted at Bangabandhu Sheikh Mujib Medical University Hospital. Bangladesh, over a period of 3 years. One hundred consecutive children of WD between 3 to 18 years of age were evaluated. Results: Mean age was $8.5{\pm}1.5years$. Male female ratio was 2:1. Ninety-one percent of patients were Muslim and 9% Hindu. A total of 53% cases of hepatic WD presented between 5 to 10 years of age and most of the neurologic WD manifested in 10-15 years age group. Sixty-nine children presented only with hepatic manifestations, 6 only with neurological manifestations, 14 with both hepatic and neurological manifestation, 10 children was asymptomatic and 1 patient presented with psychiatric features. WD presented as chronic liver disease (CLD) in 42%, CLD with portal hypertension in 34%, acute hepatitis in 20% and fulminant hepatic failure in 4% cases. Stigmata of CLD were found in 18% patients. Keiser-Fleischser ring was found in 76% total patients. Elevated serum transaminase was found in 85% cases, prolonged prothrombin time in 59% cases and hypoalbuminaemia in 53% cases. A total of 73% patients had low serum ceruloplasmin, basal urinary copper of >$100{\mu}g/day$ was found in 81% cases and urinary copper following penicillamine challenge of >$1,200{\mu}g/day$ was found in 92% cases. Conclusion: Majority of studied WD children presented with hepatic manifestation of which 76% presented with CLD. Any child presented with jaundice after the age of 3 years should be investigated for WD.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1055-1062
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• 2000

Objectives : Burst fracture of the lower lumbar spine(L3-L5) is rare and has some different features compare to that of thoracolumbar junction. Lower lumbar spine is flexible segments located deeply, and has physiologic lordosis. All of these contribute to making surgical approach difficult. Generally, lower lumbar burst fracture is managed either anteriorly or posteriorly with various fixation and fusion methods. But there is no general guideline or consensus regarding the proper approach for such lesion. We have tried to find out the influencing factors for selecting the surgical approach through the analysis of lower lumbar burst fractures treated for last 4 years(1994.3-1998.3). Method : This study includes 15 patients(male : 10, female : 5, age range 20-59 years with mean age of 36.7 years, L3 : 8 cases, L4 : 5 cases, L5 : 2 cases). Patients were classified into anterior(AO) and posterior operated(PO) groups. We investigated clinical findings, injured column, operation methods, and changes in follow-up radiologic study (kyphotic angle) to determine the considerable factors in selecting the surgical approaches. Results : There were 5 AO and 10 PO patients. Anterior operation were performed with AIF with Kaneda or Z-plate and posterior operation were done with pedicle screw fixation with PLIF with cages or posterolateral fusion. Canal compression was 46.6% in AO and 38.8% in PO. The degree of kyphotic angle correction were 10.7 degree(AO) and 8.5 degree(PO), respectively. There was no statistical difference between anterior and posterior operation group. All patients showed good surgical outcome without complications. Conclusion : Anterior operation provided good in kyphotic angle correction and firm anterior strut graft, but it difficulty arose in accessing the lesions below L4 vertebra. While posterior approach showed less correction of kyphotic angle, it required less time and provided better results for accompanied adjacent lesion and pathology such as epidural hematoma. The level of injury, canal compression, biomechanics, multiplicity, and pathology are considered to be important factors in selection of the surgical approach.

• Journal of Korean Neurosurgical Society
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• 제52권3호
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• pp.200-203
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• 2012

Objective : The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist. Methods : In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis. Results : Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value= 0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist. Conclusion : The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.

• Journal of Preventive Medicine and Public Health
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• 제28권2호
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• pp.406-420
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• 1995

To study the health hazards and exposure status of manganese among female manganese workers, authors conducted airborne, blood and urine manganese concentration measurements, questionnaire and neurological examinations on 80 manganese-handling productive female workers(exposed group) in a manganese manufacturing facto in Pohang city and 127 productive female workers not handling manganese(control group) in other factories in the Pohang city. The results are; 1. Geometric mean concentrations of manganese in air and urine were $0.98mg/m^3\;and\;4.12{\mu}g/l$ and arithmetic mean concentration of manganese in blood was $6.94{\mu}g/dl$ in exposed group, significantly higher than those of control group(p<0.05). However, clinical and laboratory findings in exposed group were not statistically different from those of control group. 2. As age increase, positive rates of clinical symptoms also increased in the exposed group. However, in older aged group, the positive rates of symptoms and signs were statistically different from those of control group. We observed the same tendency in the positive rates of the neurological examinations. 3. There was statistically significant correlation between airborne and urine manganese concentrations(r=0.61, p<0.01) while there was no statistically significant correlation between airborne and blood manganese concentrations(r=0.29, p>0.05). The results suggest that urine manganese concentration was the best appropriate biomarker to estimate the exposure to manganese in respect to clinical symptoms and signs. In the analysis of correlation between urine and airborne manganese concentrations, it is required to adjust the present permissible exposure level(PEL) of airborne manganese.

• Nutrition Research and Practice
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• 제4권3호
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• pp.196-202
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• 2010

To investigate the neuroprotective effects of bovine colostrums (BC), we evaluate the ability of consuming BC after focal brain ischemia/reperfusion injury rat model to reduce serum cytokine levels and infarct volume, and improve neurological outcome. Sprague-Dawley rats were randomly divided into 4 groups; one sham operation and three experimental groups. In the experimental groups, MCA occlusion (2 h) and subsequent reperfusion (O/R) were induced with regional cerebral blood flow monitoring. One hour after MCAO/R and once daily during the experiment, the experimental group received BC while the other groups received 0.9% saline or low fat milk (LFM) orally. Seven days later, serum pro-inflammatory cytokine (IL-$1{\beta}$, IL-6, and TNF-${\alpha}$) and anti-inflammatory cytokine (IL-10) levels were assessed. Also, the infarct volume was assessed by using a computerized image analysis system. Behavioral function was also assessed using a modified neurologic severity score and corner turn test during the experiment. Rats receiving BC after focal brain I/R showed a significant reduction (-26%/-22%) in infarct volume compared to LFM/saline rats, respectively (P < 0.05). Serum IL-$1{\beta}$, IL-6, and TNF-${\alpha}$ levels were decreased significantly in rats receiving BC compared to LFM/saline rats (P < 0.05). In behavioral tests, daily BC intake showed consistent and significant improvement of neurological deficits for 7 days after MCAO/R. BC ingestion after focal brain ischemia/reperfusion injury may prevent brain injury by reducing serum pro-inflammatory cytokine levels and brain infarct volume in a rat model.

• Journal of Korean Neurosurgical Society
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• 제63권2호
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• pp.210-217
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• 2020

Objective : To analyze the accuracy of iliac screws using freehand technique performed by the same surgeon. We also analyzed how the breach of iliac screws was related to the clinical symptoms resulting in revision surgery. Methods : From January 2009 to November 2015, 100 patients (193 iliac screws) were analyzed using postoperative computed tomography scans. The breaches were classified based on the superior, inferior, lateral, and medial iliac wall violation by the screw. According to the length of screw extrusion, the classification grades were as follows : grade 1, screw extrusion <1 cm; grade II, 1 cm ≤ screw extrusion <2 cm; grade III, 2 cm ≤ screw extrusion <3 cm; and grade IV, 3 cm ≤ screw extrusion. We also reviewed the revision surgery associated with iliac screw misplacement. Results : Of the 193 inserted screws, 169 were correctly located and 24 were misplaced screws. There were eight grade I, six grade II, six grade III, and four grade IV screw breaches, and 11, 8, 2, and 3 screws violated the medial, lateral, superior, and inferior walls, respectively. Four revision surgeries were performed for the grade III or IV iliac screw breaches in the lateral or inferior direction with respect to its related symptoms. Conclusion : In iliac screw placement, 12.4% breaches developed. Although most breaches were not problematic, symptomatic violations (2.1%) could result in revision surgery. Notably, the surgeon should keep in mind that lateral or inferior wall breaches longer than 2 cm can be risky and should be avoided.

• 한국산학기술학회:학술대회논문집
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• 한국산학기술학회 2012년도 춘계학술논문집 1부
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• pp.22-24
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• 2012

The tools that classify the severity of patients based on the prediction of mortality include APACHE, SAPS, and MPM. Theses tools rely crucially on the evaluation of patients' general clinical status on the first date of their admission to ICU. Nursing activities are one of the most crucial factors influencing on the quality of treatment that patients receive and one of the contributing factors for their prognosis and safety. The purpose of this study was to identify the goodness-of-fit of CPSCS of critical patient severity classification system(CPSCS) and Glasgow coma scale(GCS) and the clinical usefulness of its death rate prediction. Data were collected from the medical records of 187 neurological patients who were admitted to the ICU of C University Hospital. The data were analyzed through $x^2$ test, t-test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and ROC curve. In accordance with patients' general and clinical characteristics, patient mortality turned out to be statistically different depending on ICU stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Homer-Lemeshow goodness-of-fit tests were CPSCS and GCS and the results of the discrimination test using the ROC curve were $CPSCS_0$, .734, $GCS_0$,.583, $CPSCS_{24}$,.734, $GCS_{24}$, .612, $CPSCS_{48}$,.591, $GCS_{48}$,.646, $CPSCS_{72}$,.622, and $GCS_{72}$,.623. Logistic regression analysis showed that each point on the CPSCS score signifies1.034 higher likelihood of dying. Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.

• Clinical and Experimental Pediatrics
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• 제51권5호
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• pp.538-541
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• 2008

멘케스병은 성염색체 열성으로 유전되는 질환으로 APT7A 유전자의 돌연변이에 의해 발생한다. 기전은 장에서의 구리 흡수와 운반에 결손이 있는 것으로 혈청 구리 및 ceruloplasmin 이 낮다. 특징적인 임상양상은 경련발작, 근육긴장저하, 저체온증을 나타내며 얼굴은 특징적으로 통통하며 저색소 피부색, 꼬이고 윤택이 없고 잘 부스러지는 머리카락을 보인다. 성장장애를 보이는 경우가 흔하며 심한 정신지체와 발달장애를 동반한다. 멘케스병에서 간비대가 간병증을 보이는 경우는 현재까지 보고되지 않았다. 저자들은 유전자 검사를 통해 멘케스병으로 확진된 4개월 소아가 영아연축, 발달장애, 머리카락 이상 외에도 이전에 잘 알려져 있지 않은 간비대를 보인 1례를 보고하는 바이다.