• Journal of Korean Neurosurgical Society
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• v.59 no.1
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• pp.17-25
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• 2016

Objective : Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods : Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results : All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ${\geq}2$ times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion : Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.

• Journal of Korean Neurosurgical Society
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• v.60 no.5
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• pp.550-559
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• 2017

Objective : Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micromotion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods : We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results : Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula : $subsidence=1.522+2.7{\times}sum\;pUPR$($R^2=0.133$, p=0.007). Receiver-operating characteristic analysis determined that sum $pUPR{\geq}0.38$ could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion : The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ${\geq}38%$, the possibility of subsidence increased.

• Journal of Radiation Industry
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• v.11 no.1
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• pp.47-54
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• 2017

Compared to other occupations, there is a greater risk of exposure to radiation due to the use of radioisotopes in nuclear medicine for diagnostic evaluations and therapy. To consider ways to reduce exposure dose for those in nuclear medicine involved in injection work and elution work among radiation workers as well as for sanitation workers and trainees among frequent workers an investigation into exposure dose and situational analysis from changes in yearly exposure dose evaluations, changes in work environment and changes in forms of inspection were conducted. Exposure dose measurements were taken by using EPD MK2 worn during working hours for one injection worker, one elution worker, two sanitation workers, and one trainee at a general hospital in the Seoul area for three days from July 18th to 20th 2016. Radiation from radioisotopes which are a part of nuclear medicine can significantly affect not only radiation workers who deal with radioisotopes directly but also frequency works as well. According to this study the annual dose limit for elution workers and injection workers were considered safe as the amount of exposure was not large enough to have a significant effect. The limits of this study consist in the duration of this study and the quantity of participants. Also there was a limitation of the measurement device involving accumulated exposure, where the EPD MK2 cannot check the changes in exposure according to a particular activity.

• Journal of the Korean Society of Radiology
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• v.13 no.4
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• pp.539-546
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• 2019

Liver biopsy is invasive and it is a risk of complications. Nevertheless, liver biopsy is gold standard for predicting liver fibrosis. To compensate for these shortcomings, in this study, the liver fibrosis stage was divided using Fibroscan(R) in 200 chronic hepatitis C patients. And, the usefulness and cut-off values of fibrosis index based on four factors(FIB-4), AST to platelet ratio index(APRI) and AST/ALT ratio(AAR) calculated as serum tests were investigated by analyzing ROC curve. As a result, using FIB-4 and APRI rather than AAR is appropriate for evaluation of liver fibrosis. And using APRI to predict significant Fibrosis(F2) and FIB-4 is considered useful for predicting cirrhosis(F4). By applying the advantages of the serum based liver fibrosis marker, which are convenient and repeatable, liver fibrosis follow-up term can be reduced, and furthermore, the prevalence of liver cirrhosis and hepatocellular carcinoma(HCC) can be reduced.

• Journal of Korean Neurosurgical Society
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• v.62 no.5
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• pp.603-609
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• 2019

Objective : The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions. Methods : The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On preop magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb's angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed. Results : Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846). Conclusion : In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

• The Journal of Internal Korean Medicine
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• v.40 no.1
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• pp.38-57
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• 2019

Objective: This study reviewed recent clinical research trends regarding the effects of herbal medicine treatment containing diuretic herbs on nonalcoholic fatty liver disease (NAFLD) in China. Methods: We reviewed clinical studies on NAFLD from the China Academic Journal of the China National Knowledge Infrastructure from January 1, 2016, to September 10, 2018. Results: Thirty-nine papers from 86 studies were reviewed. The most commonly used herbal prescriptions included Alismatis Rhizoma(澤瀉), Salviae miltiorrhizae Radix (丹蔘), Crataegii Fructus (山査), Polia Sclerotium (茯?), Bupleuri Radix (柴胡), and Cassiae Semen (決明子). The treatment effective rate, liver function test, serum lipid test, radiological examination, and symptom comparisons were used to analyze the treatments. In 32 of the papers, the effective treatment rate was 76.9%-100%, and the effectiveness in the experimental group was significantly higher than that in the control group (p<0.05). The risk ratio for the treatment effective rate was 1.26. The mean difference of ALT was -13.44 U/L (95% confidential interval, -24.45 U/L, -2.44 U/L, p=0.0166). Conclusion: Herbal medicine containing diuretic herbs has been demonstrated to be an effective and useful treatment for NAFLD. Clinical studies that are more scientific and systematic should be actively conducted in the future, and the results of the current study could be used as basic data in future clinical studies on herbal medicine treatment for NAFLD.

• Journal of the Korean Society of Radiology
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• v.15 no.2
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• pp.147-152
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• 2021

This study is a retrospective analysis of the results of tests at three general hospitals in Busan that perform mammography using digital mammography devices. There were 5,320 people in the study, and the results of their breast cancer screening were analyzed to verify the efficacy of breast cancer screening for digital mammography. The average age of patients who performed breast cancer screening was 57.7 years (range 30 to 87 years), and the cancer detection rate was 26, with 4.6 cases per 1,000 people. According to the cancer detection rate by risk factor in patients who conducted breast cancer screening, breast cancer was found in patients without underlying diseases more than in patients with underlying diseases. Additional ultrasound examinations show that the gastronomic rate identified is 3.6%, which is relatively very low compared to that of the Film-Screen system.

• Journal of Korean Neurosurgical Society
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• v.64 no.4
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• pp.619-630
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• 2021

Objective : The skull base reconstruction step, which prevents cerebrospinal fluid (CSF) leakage, is one of the most challenging steps in endoscopic skull base surgery (ESS). The purpose of this study was to assess the outcomes and complications of a reconstruction technique for immediate CSF leakage repair using multiple onlay grafts following ESS. Methods : A total of 230 consecutive patients who underwent skull base reconstruction using multiple onlay grafts with fibrin sealant patch (FSP), hydroxyapatite cement (HAC), and pedicled nasoseptal flap (PNF) for high-flow CSF leakage following ESS at three institutions were enrolled. We retrospectively reviewed the medical and radiological records to analyze the preoperative features and postoperative results. Results : The diagnoses included craniopharyngioma (46.8%), meningioma (34.0%), pituitary adenoma (5.3%), chordoma (1.6%), Rathke's cleft cyst (1.1%) and others (n=21, 11.2%). The trans-planum/tuberculum approach (94.3%) was the most commonly adapted surgical method, followed by the trans-sellar and transclival approaches. The third ventricle was opened in 78 patients (41.5%). Lumbar CSF drainage was not performed postoperatively in any of the patients. Postoperative CSF leakage occurred in four patients (1.7%) due to technical mistakes and were repaired with the same technique. However, postoperative meningitis occurred in 13.5% (n=31) of the patients, but no microorganisms were identified. The median latency to the diagnosis of meningitis was 8 days (range, 2-38). CSF leakage was the unique risk factor for postoperative meningitis (p<0.001). Conclusion : The use of multiple onlay grafts with FSP, HAC, and PNF is a reliable reconstruction technique that provides immediate and complete CSF leakage repair and mucosal grafting on the skull base without the need to harvest autologous tissue or perform postoperative CSF diversion. However, postoperative meningitis should be monitored carefully.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.88-99
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• 2021

Objective : The treatment of choice for spinal epidural abscess (SEA) generally is urgent surgery in combination with intravenous antibiotic treatment. However, the optimal duration of antibiotic treatment has not been established to date, although 4-8 weeks is generally advised. Moreover, some researchers have reported that bacteremia is a risk factor for failure of antibiotic treatment in SEA. In this study, we investigated the clinical characteristics of SEA accompanied by bacteremia and also determined whether the conventional 4-8 weeks of antibiotic treatment is sufficient. Methods : We retrospectively reviewed the medical records and radiological data of 23 patients with bacterial SEA who underwent open surgery from March 2010 to April 2020. All patients had bacteremia preoperatively and underwent weeks of perioperative antibiotic treatments based on their identified organisms until all symptoms of infection disappeared. All patients underwent microbiological studies of peripheral blood, specimens from SEA and concomitant infections. The mean follow-up duration was 35.2 months, excluding three patients who died. Results : The male : female ratio was 15 : 8, and the mean age was 68.9 years. The SEA most commonly involved the lumbar spinal segment (73.9%), and the mean size was 2.9 vertebral body lengths. Mean time periods of 8.4 days and 16.6 days were required from admission to diagnosis and from admission to surgery, respectively. Concomitant infections more frequently resulted in delayed diagnosis (p=0.032), masking the symptoms of SEA. Methicillin-sensitive Staphylococcus aureus was the most commonly identified pathogen in both blood and surgical specimens. Seventeen patients (73.9%) showed no deficits at the final follow-up. The overall antibiotic treatment duration was a mean of 66.6 days, excluding three patients who died. This duration was longer than the conventionally advised 4-8 weeks (p=0.010), and psoas or paraspinal abscess required prolonged duration of antibiotic treatment (p=0.038). Conclusion : SEA accompanied by bacteremia required a longer duration (>8 weeks) of antibiotic treatment. In addition, the diagnosis was more frequently delayed in patients with concomitant infections. The duration of antibiotic treatment should be extended for SEA with bacteremia, and a high index of suspicion is mandatory for early diagnosis, especially in patients with concomitant infections.

• Journal of Radiation Protection and Research
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• v.47 no.2
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• pp.67-76
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• 2022

Background: We conducted a cross-sectional study of residents within and outside Fukushima Prefecture to clarify their perceptions of the need for smartphone applications (apps) for explaining exposure doses. The results will lead to more effective methods for identifying target groups for future app development by researchers and municipalities, which will promote residents' understanding of radiological situations. Materials and Methods: In November 2019, 400 people in Fukushima Prefecture and 400 people outside were surveyed via a web-based questionnaire. In addition to basic characteristics, survey items included concerns about radiation levels and intention to use a smartphone app to keep track of exposure. The analysis was conducted by stratifying responses in each region and then cross-tabulating responses to concerns about radiation levels and intention to use an app by demographic variables. The intention to use an app was analyzed by binomial logistic regression analysis. Text-mining analyses were conducted in KH Coder software. Results and Discussion: Outside Fukushima Prefecture, concerns about the medical exposure of women to radiation exceeded 30%. Within the prefecture, the medical exposure of women, purchasing food products, and consumption of own-grown food were the main concerns. Within the prefecture, having children under the age of 18, the experience of measurement, and having experience of evacuation were significantly related to the intention to use an app. Conclusion: Regional and individual differences were evident. Since respondents differ, it is necessary to develop and promote app use in accordance with their needs and with phases of reconstruction. We expect that a suitable app will not only collect data but also connect local service providers and residents, while protecting personal information.