• Journal of Korean Neurosurgical Society
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• 제59권4호
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• pp.352-356
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• 2016

Objective : The efficacy and safety of manual aspiration thrombectomy using Penumbra in an acute occlusion of large intracranial arteries has been proven in many previous studies. Our study aimed to retrospectively assess the efficacy and safety of manual aspiration thrombectomy using Penumbra in patients with small vessel occlusions (M2 segment of the MCA). Methods : We conducted a retrospective review of 32 patients who underwent manual aspiration thrombectomy using the Penumbra 4 MAX Reperfusion Catheter for treatment of an M2 occlusion between January 2013 and November 2014. We evaluated immediate angiographic results and clinical outcomes through review of patient electronic medical records. Results : There were slightly more men in this study (M : F=18 : 14) and the median age was 72.5 (age range : 41-90). The rate of successful recanalization (TICI grade ${\geq}2b$) was 84% (27/32). NIHSS at discharge and favorable clinical outcomes at 3 months were significantly improved than baseline. Median initial NIHSS score was 10 (range : 4-25) and was 4 (range : 0-14) at discharge. Favorable clinical outcomes (mRS score ${\leq}2$ at 3 months) were seen in 25 out of 32 patients (78%). There were no procedure-related symptomatic intracerebral hemorrhages. One patient expired after discharge due to a cardiac problem. Conclusion : Manual aspiration thrombectomy might be safe and is capable of achieving a high rate of successful recanalization and favorable clinical outcomes in patients with distal cerebral vessel occlusion (M2).

• Journal of Chest Surgery
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• 제37권3호
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• pp.220-227
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• 2004

관상동맥 질환과 말초혈관 질환의 증가에 따라 직경 6 mm 이하의 소구경 혈관의 필요성이 증가하고 있다. 저자들은 조직공학적 방법을 이용하여 소구경 인공혈관을 제작하여 생체 실험을 시행하였다. 동종 판막을 얻어 이를 탈세포화시킨 후 피실험동물의 골수를 채취하여 탈세포화시킨 혈관용 지지체(scaffold) 위에 이식하였다. 이와 같이 하여 제작된 인공 혈관을 잡견의 양측 경동맥에 이식한 후 혈관이 막히거나, 8주가 되었을 때 이를 제거하여 조직학적 검사를 시행하였다. 자가 세포를 이식하지 않고 지지체만을 이식하였던 대조군 4마리 중 3마리의 혈관은 2주 이내에 모두 막힌 것을 확인하였고 나머지 한 마리의 혈관은 혈관류(aneurysm)가 발생하였다. 그러나 자가 세포를 이식한 실험군 4마리 중 2마리는 각각 4주와 6주까지 혈관의 개통성을 유지하였고, 나머지 2마리는 8주까지 혈관의 개통성을 유지하였다. 조직학적 검사 결과, 8주까지 개통성을 유지하였던 혈관은 정상의 혈관과 거의 유사한 조직학적 구조를 나타내었다. 자가 세포와 탈세포화된 지지체를 이용하여 제작한 인공혈관은 조직학적 검사 결과 정상과 유사한 구조로 재생이 가능함을 보여주었다.

• Journal of Korean Neurosurgical Society
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• 제48권1호
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• pp.53-58
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• 2010

Objective : The purpose of this study was to review the safety and durability of aneurysms treated with stent-assisted coiling of ruptured anterior communicating artery aneurysms with small parent vessels (< 2.0 mm). Methods : Retrospective review of all ruptured aneurysm treated with stent assisted endovascular coiling between March 2005 and March 2009 at our institution was conducted. We report 11 cases of the Neuroform stent placement into cerebral vessels measuring less than 2.0 mm in diameter (range, 1.3-1.9 mm) in anterior cerebral artery. Clinical follow-up ranged from 3 to 12 months and imaging follow-up was performed with cerebral angiography at 6 months and 12 months after discharge. Results : Complete occlusion was achieved in 10 patients, and a remnant neck was evident in one. No stent displacement or no dislodgement occurred during stent placement. There was no evidence of thromboembolic complication, arterial dissection and spasm during procedure. We performed follow-up angiography in all patients at 6 months and/or 12 months from the first procedure. The follow-up angiographic data showed successfully results except one in-stent stenosis case. All patients improved clinical performances except one patient with severe vasospasm who showed poor clinical condition initially. Conclusion : We have safely and successfully treated 11 vessels smaller than 2.0 mm in diameter with self-expanding stents with good short and intermediate term results. More clinical data with longer follow-ups are needed to establish the role of stent-assisted coiling in ruptured aneurysms with small parent vessels.

• BMB Reports
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• 제42권9호
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• pp.617-622
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• 2009

We investigated the genetic associations of ischemic stroke by identifying epistasis of its heterogeneous subtypes such as small vessel occlusion (SVO) and large artery atherosclerosis (LAA). Epistasis was analyzed with 24 genes in 207 controls and 271 patients (SVO = 110, LAA = 95) using multifactor dimensionality reduction and entropy decomposition. The multifactor dimensionality reduction analysis with any of 1- to 4-locus models showed no significant association with LAA (P > 0.05). The analysis of SVO, however, revealed a significant association in the best 3-locus model with P10L of TGF-$\beta{1}$, C1013T of SPP1, and R485K of F5 (testing balanced accuracy = 63.17%, P < 0.05). Subsequent entropy analysis also revealed that such heterogeneity was present and quite a large entropy was estimated among the 3 loci for SVO (5.43%), but only a relatively small entropy was estimated for LAA (1.81%). This suggests that the synergistic epistasis model might contribute specifically to the pathogenetsis of SVO, which implies a different etiopathogenesis of the ischemic stroke subtypes.

• Journal of Chest Surgery
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• 제41권2호
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• pp.160-169
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• 2008

배경: 혈관질환의 수술에 사용되는 인공 도관의 막힘과 문합부위의 좁아짐 등을 개선하기 위한 방법으로 조직공학적인 방법과 자가 세포를 이용한 인공혈관의 제작이 대안으로 대두되고 있다. 저자들은, 생흡수성이 있는 고분자 폴리머 지지체와 자가 골수세포를 이용한 인공혈관으로 생체실험을 시행하였다. 대상 및 방법: 생분해성 고분자 재료인 poly (lactide-co-${\varepsilon}$-caprolactone) (PLCL)과 poly(glycolic acid) (PGA) fiber로 혈관용 지지체를 제작한 후, 피실험 동물의 골수를 채취하여 혈관 내피 세포와 평활근 세포로 분열시켜 배양한 후 혈관 지지체위에 이식하였다. 만들어진 인공 혈관을 잡견의 복부대동맥에 이식한 후 3주 후에 혈관 조영술을 시행하고, 안락사 후에 혈관을 제거하여 조직학적 검사를 시행하였다. 결과: 6마리의 잡견 중 2마리에서 수술 후 10일에 혈관 지지체의 균열에 의한 대량 출혈로 사망하였다. 나머지 4마리의 잡견은 수술 후 3주까지 생존하였으며, 혈관 조영술상 혈관의 막힘이나 좁아짐은 발견되지 않았다. 인공 혈관의 내면은 작은 혈전들이 붙어 있었으며, 조직학 검사에서 정상 혈관과 유사한 3층의 구조를 나타내었다. 또한 면역화학 검사에서 혈관 내피세포와 혈관 평활근 세포가 재생된 것을 확인하였다. 결론: 고분자 폴리머와 자가 골수세포를 이용한 인공혈관은 생체 내에서 정상혈관과 유사한 모양으로 재생이 가능함을 보여주었다. 그러나, 동맥압력에 견디기 위해 혈관 지지체의 물성에 대한 개량과 충분한 양의 혈관 세포를 얻기 위한 연구가 더 필요할 것으로 생각된다.

• 대한한방내과학회지
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• 제28권4호
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• pp.896-901
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• 2007

Objectives : This study aimed to evaluate the characteristics of patients with single infarction and multiple infarctions. Method : We studied inpatients who were admitted from 2005/10/1 to 2007/3/30 at the KyungHee University Oriental Medical Center (KOMC) Department of Cardiovascular & Neurology (stroke center). We sorted small vessel occlusion patients and evaluated general characteristics of the patients along with the characteristics of single and multiple infarction patients. Result : We evaluated 262 inpatients, and did not find any significant difference in age, hypertension, diabetes, hyperlipidemia, diet, exercise, homocysteine, or Sasang constitution between single infarction and multiple infarction. However, there were more significant associations with patients' smoking and stress with multiple infarctions than single infarction. Conclusion : From this study we could roughly grasp the characteristics of Small Vessel Occlusion patients and evaluated the characteristics of patients with multiple infarction. However, due to the special circumstance of the KOMC inpatients it is difficult to generalize our results; further multiple center research with a larger study group is needed.

• 대한한방내과학회지
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• 제27권4호
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• pp.905-914
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• 2006

Background and Purpose : The purpose of this study was to classify according to the TOAST classification (Trial of Org 10172 in Acute Stroke Treatment) acute stroke patients (first-ever stroke) treated at the Department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital. Methods : In the time period Oct. 2005 to Oct. 2006. 101 patients with a first-ever stroke admitted to the Department of Internal Medicine of Kyungwon University In-cheon Oriental Medical Hospital were included. Patients were hospitalized within 14 days after the onset of stroke. They had neurological deficits for a time more than 24 hours. We classified patients according to the original TOAST classification (Trial of Org 10172 in Acute Stroke Treatment) Results : The incidence in males was 54.4%, in females was 45.6%. Ischemic stroke (86.l%) was more common than hemorrhagic stroke (13.9%). The results of TOAST classification in this study were as follows: small-vessel occlusion, 72.4% large-artery atherosclerosis. 14.9 % cardioembolism, 4.6% stroke of other determined etiology, 4.6%: stroke of undetermined etiology, 3.5%. Patients in the small-vessel occlusion subgroup in this study were the most frequent. The result of this study is that Korean stroke registry is not in accordance with western medicine. Conclusions : The TOAST classification system is the most widely accepted tool to categorize stroke subtypes in western medicine, but in oriental medicine, it is not yet widely accepted. The authors suggest the general use of the TOAST classification to determine adequate management for stroke patients, to predict the prognosis and recurrence of stroke and to develop a Korean standard of stroke in oriental medicine.

• 대한한방내과학회지
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• 제30권4호
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• pp.761-771
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• 2009

Objectives : The aim of this study was to assess the relationship between metabolic syndrome and erythrocyte deform ability in acute stroke patients. Methods : Among 88 of the recruited patients, 52 were diagnosed as metabolic syndrome. We assessed their general characteristics, risk factors. We compared the assessed variables between metabolic syndrome and control group. We analyzed the relationship between metabolic syndrome and erythrocyte deform ability. We analyzed relationship between cardiovascular risk factors and erythrocyte deformability. Results : The general characteristics waist and hip circumference, waist/hip ratio were higher in metabolic syndrome group. The metabolic syndrome group was also diagnosed with hypertension, DM, and hyperlipidemia more often than the control group. The blood test metabolic syndrome group showed higher triglycerides, total lipids, fasting blood sugar, and 2 hours postprandial plasma glucose level and lower HDL-cholesterol than the control group. There were more patients diagnosed with Dampness-Phlegm in the metabolic syndrome group. There were more patients showing lower erythrocyte deform ability in the metabolic syndrome group. The plasma homocysteine level was negatively correlated with erythrocyte deform ability. Conclusion : The results reconfirmed that the risk factors are more in metabolic syndrome group. The results indicated that metabolic syndrome lead to a lower erythrocyte deform ability in small vessel disease stroke patients. The Plasma homocysteine level was negatively correlated with erythrocyte deform ability.

• 한국임상수의학회지
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• 제24권3호
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• pp.426-431
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• 2007

5개월령 암컷 샤모에드종 개가 운동 불내성과 간성뇌증과 관련된 신경증상으로 내원하였다. 임상검사상 간헐적 발작, 빈혈, 식전/식후 담즙산 농도 상승, 저단백혈증 및 빌리루빈뇨증이 관찰되었다. 진단영상검사에서 간내 문정맥 문합이 확인되었다. 문합이 일어난 문맥혈관을 경정맥을 통한 embolization coil을 이용하여 성공적으로 폐색시켰다. 환자의 임상증상은 점진적으로 개선되었다. 본 증례는 대형품종 개에서 발생한 간내 문정맥 문합을 embolization coil을 이용하여 성공적으로 치료한 증례이다.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.454-457
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• 2006

Purpose: The anastomosis of hepatic artery to recipient vessel has a major role in a liver transplantation, so its occlusion is the most important cause of failure of liver transplantations. We made the study to reveal the peculiarities in pediatric liver transplantations compared with adult cases. Methods: From January 1999 to September 2005, we performed 99 cases of pediatric liver transplantation. The mean age at operation was 4.17 years of age. The hepatic vein and portal vein are anastomosed by the general surgeons and then the hepatic artery is anastomosed by the plastic surgeons. The Doppler ultrasonography and computed tomography were used for postoperative checkup for hepatic artery patency. Results: There were no immediate complications, but hepatic arterial occlusion was developed in 3 cases (2.8%). In pediatric patients, the anastomosis of hepatic artery is more difficult than adults because of the rapid respiratory and pulse rate, the small vascular diameter, and the large gap of diameter difference between the recipient and the donor vessels. Conclusion: We could confirm that pediatric liver transplantations are relatively safe but long learning curve was needed.