• Title/Summary/Keyword: Structural lesion

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Recent Advances in Surgery for Atrial Fibrillation (심방세동의 최신 외과적 치료)

  • Lee, Dong-Hyup;Jung, Tae-Eun
    • Journal of Yeungnam Medical Science
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    • v.22 no.1
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    • pp.13-26
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    • 2005
  • Atrial fibrillation (AF) is the most common cardiac rhythm disturbance, which carries significant cardiovascular morbidity and mortality. The medical treatment for AF is cumbersome and unsatisfactory, which has highlighted the need to develop alternative treatments for AF. The recent discovery that AF is often initiated by atrial ectopic beats has resulted in treatments designed to target the ectopic sources, particularly those within the pulmonary veins. Building on the pioneering work of Cox et al., a recent reported series demonstrated the feasibility of treating patients undergoing cardiac surgery for other structural heart diseases with limited, left-atrial ablation lesion sets using alternative energy sources. As less complex modifications of the Maze procedure have been developed, a number of energy sources have been introduced to create of electrically isolating lesions within the atria. These sources have been used both endocardially in arrest heart procedures as well as epicardially in a beating heart setting. This review summarizes the recent advances in surgery for AF that will aid in the development of an effective, minimally invasive surgical procedure to cure patients with AF.

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Clinical Application of $^{18}F-FDG$ PET in Epilepsy (간질에서의 $^{18}F-FDG$ PET의 임상 이용)

  • Kim, Yu-Kyeong
    • Nuclear Medicine and Molecular Imaging
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    • v.42 no.sup1
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    • pp.172-176
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    • 2008
  • FDG PET has been used as a diagnostic tool for localization of seizure focus for last 2-3 decades. In this article, the clinical usefulness of FDG PET in the management of patients with epilepsy has been reviewed, which provided the evidences to justify the medicare reimbursement for FDG PET in management of patients with epilepsy. Literature review demonstrated that FDG PET provides an important information in localization of seizure focus and determination whether a patients is a surgical candidate or not. FDG PET has been reported to have high diagnostic performance in localization of seizure focus in neocortical epilepsy as well as temporal lobe epilepsy regardless of the presence of structural lesion on MRI. Particularly, FDG PET can provide the additional information when the results from standard diagnositic modality such as interictal or video-monitored EEG, and MRI are inconclusive or discordant, and make to avoid invasive study. Furthermore, the presence of hypometabolism and extent of metabolic extent has been reported as an important predictor for seizure free outcome. However, studies suggested that more accurate localization and better surgical outcome could be expected with multimodal approach by combination of EEG, MRI, and functional studies using FDG PET or perfusion SPECT rather than using a single diagnostic modality in management of patients with epilepsy. Complementary use of FDG PET in management of epilepsy is worth for good surgical outcome in epilepsy patients.

A Comprehensive Anatomical Approach to Low Back Pain (요통의 해부학적 고찰)

  • Kim Yoing-Su
    • The Journal of Korean Physical Therapy
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    • v.10 no.2
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    • pp.149-159
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    • 1998
  • Normal lumbar vertebrae function only when soft tissues are in position, constituting vertebral body, discs and facet feints. Considering the mechanism of supporting bodily weight, the widest movement of vertebral column reaches a lumbar sacral joint to cause structural changes. The feet is proved that lumbago is the damage of lumbar vertebrae accompanied with the change of soft tissues surrounding lumbar vertebrae, rather than simple pain in a certain lesion. It is based on the mechanism of vertebral body and intervertebral discs in the anatomical structure of the lumbar region. In my opinion, it is necessary to prove more accurately the cause of lumbago, escaping from the conventional cause of the abnormality of disc.

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Clinical study on deviation of upper cervical of patients with cervical syndrome (경추 증후군 환자에서 상부경추변위에 대한 임상적 고찰)

  • Cho, Meoung-Jae;Kim, Dong-Il;Park, Koae-Hwan
    • Journal of Acupuncture Research
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    • v.17 no.3
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    • pp.188-198
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    • 2000
  • Objectives : We perform this study for help to recovery of cervical syndrome by analyzing structural deviation and cervical curvature in upper cervical vertebrae and definiting functional change through cervical body heat change in cevical lesion which is estimated by DITI. Methods : From sep. 1st. 1998 to aug, 31th. 1999, I make an experiment with the 102 OPD patients of this hospital vertebral-joint center, which were judged as a cervical syndrome and confirmed in upper cervical deviation by motion palpation and then were taken cervical simple X-ray and cervical thermograpy. Results : In the classfication of upper cervical deviation, AS deviation took 98% and abnormal cervical curvature took 68%. in the Chief complain neck-shoulder pain took 78%. In the results of DITI, average value of all objects show $032{\pm}0.18$ as a meaning result. Conclusions : In medical treatment of cervical syndrome, this result shows necessity of keeping pace with remedy of upper cervical deviation and medical treatment of functional change and We can learn necessity of detailed assessment through continual clinical examination.

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Electrical and Optical Properties of Cu(InGa)$Se_2$ Thin Films Prepared on Difference Substrates (이종기판에 형성된 Cu(InGa)$Se_2$ 박막의 전기.광학적 특성)

  • Kim, S.K.;Lee, J.C.;Kang, K.H.;Yoon, K.H.;Park, I.J.;Song, J.
    • Proceedings of the KIEE Conference
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    • 2000.07c
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    • pp.1625-1627
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    • 2000
  • Cu(InGa)$Se_2$(CIGS) thin film absorbers with various Cu/(In+Ga) atomic ratios were prepared by a three-stage process using a co-evaporation appartus. The effect of Na on the structural and electrical properties of CIGS films were studied and their effects on the CIGS/Mo thin film solar cells were investigated. Soda-lime glass and Corning glass were used as substrates to compare the effect of Na diffusion into CIGS film. The resistivity of CIGS films was not changed in the Cu-poor lesion due to diffusion of Na from soda-lime glass but was mainly determined by the surface resistivity controlled by excess Na.

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Histiocytoma of the Infarapatellar Fat Pad (슬개하 지방체에 발생한 조직구종)

  • Choi, Joong-Geun;Kim, Sook;Kim, Byung-Heum
    • The Journal of the Korean bone and joint tumor society
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    • v.8 no.2
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    • pp.43-47
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    • 2002
  • Benign fibrous histiocytoma of the infrapatella fat pad is very rare. We report one case of the benign fibrous histiocytoma involved between the patella fat pad and synovium. Diagnostic arthroscopic procedure was performed to investigate the retrobulging shape of synovium without specific synovial changes, and there was no meniscal structural deformity and abnormality of joint motion. The lesion was completely resected. At 24 monthes follow-up was performed, and the function of knee was to be sufficient.

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Clinical Pearls and Advances in Molecular Researches of Epilepsy-Associated Tumors

  • Phi, Ji Hoon;Kim, Seung-Ki
    • Journal of Korean Neurosurgical Society
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    • v.62 no.3
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    • pp.313-320
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    • 2019
  • Brain tumors are the second most common type of structural brain lesion that causes chronic epilepsy. Patients with low-grade brain tumors often experience chronic drug-resistant epilepsy starting in childhood, which led to the concept of long-term epilepsy-associated tumors (LEATs). Dysembryoplastic neuroepithelial tumor and ganglioglioma are representative LEATs and are characterized by young age of onset, frequent temporal lobe location, benign tumor biology, and chronic epilepsy. Although highly relevant in clinical epileptology, the concept of LEATs has been criticized in the neuro-oncology field. Recent genomic and molecular studies have challenged traditional views on LEATs and low-grade gliomas. Molecular studies have revealed that low-grade gliomas can largely be divided into three groups : LEATs, pediatric-type diffuse low-grade glioma (DLGG; astrocytoma and oligodendroglioma), and adult-type DLGG. There is substantial overlap between conventional LEATs and pediatric-type DLGG in regard to clinical features, histology, and molecular characteristics. LEATs and pediatric-type DLGG are characterized by mutations in BRAF, FGFR1, and MYB/MYBL1, which converge on the RAS-RAF-MAPK pathway. Gene (mutation)-centered classification of epilepsy-associated tumors could provide new insight into these heterogeneous and diverse neoplasms and may lead to novel molecular targeted therapies for epilepsy in the near future.

Neuropsychiatric Evaluation of Head-Injured Patients(II) : A Comparative Study of Brain-injured Patients with and without Abnormal Findings in the Structural Brain Imaging - Mainly in Relation to Functional Brain Studies and Psychological Evaluation (두부외상 환자의 신경정신의학적 평가(II) : 뇌의 구조적 영상검사상의 병변 유무에 따른 두부외상 환자군의 비교 - 기능적 및 심리적 검사소견과의 연관성을 중심으로)

  • Cho, Seoung Wook;Chang, Hwan-Il
    • Korean Journal of Biological Psychiatry
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    • v.3 no.1
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    • pp.66-74
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    • 1996
  • There has been an increase in head trauma due to rapid industralization and improvement in transportation. This poses difficulties in differentiating between neuropsychiatric disabilities resulting from real organic changes and those arising from compensation issues. It is the purpose of this study to seek out the differences between normal and abnormal finding group in the structural brain imaging studies via the results of the functional brain imaging studies and psychological tests. Out of 132 subjects, 62 comprised normal and 70 the abnormal finding group. EEG and SPECT were chosen for inspection of functional brain imaging. MMPI and K-WAIS were chosen for psychological test. The subjects were further divided into right hemispheric damage, left hemispheric damage, both hemispheric damage, diffuse damage group and negative group in order to find out whether any differences in the psychological lest results could be localized. The results are as follows : 1) The abnormal finding group, the EEG and SPECT were proven to be a good predictor of brain lesion. This implies that even in the functional brain studies, abnormalities are more easily detected if there are visible brain lesions. 2) The FSIQ of the abnormal finding group is lower than that of normal finding group. this difference is mainly due to low V1Q. The left hemispheric damage group lend to shaw low V1Q. This lowered in was the difference between left hemispheric damage group and negative group. Furthermore, there were no group differences in the PIQ. It is concluded that K-WAIS is effective as evaluator of VIQ mainly of those patients with left hemispheric damage and it is ineffective as a evaluator of PIQ. 3) In the MMPI profile, the both groups displayed high neurotic profiles. There was no difference in the psychotic profiles. The scores of the Depression and Hystery were high in abnormal finding group. This can be seen as one of the lypical findings of chronic head trauma patients. 4) The abnormal finding group tend to be diagnosed as organic mental disorder in the psychological tests more frequently.

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Surgical Strategy of Epilepsy Arising from Parietal and Occipital Lobes (두정엽 및 후두엽 간질에 대한 수술전략)

  • Sim, Byung-Su;Choi, Ha-Young
    • Journal of Korean Neurosurgical Society
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    • v.29 no.2
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    • pp.222-230
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    • 2000
  • Purpose : Resection of the epileptogenic zone in the parietal and occipital lobes may be relevant although only few studies have been reported. Methods : Eight patients with parietal epilepsy and nine patients with occipital epilepsy were included for this study. Preoperatively, all had video-EEG monitoring with extracranial electrodes, MRI, 3D-surface rendering of MRI using Allegro(ISG Technologies Inc., Toronto, Canada), and PET scans. Sixteen patients underwent invasive recording with subdural grid. Eight had parietal resection including the sensory cortex in two. Seven had partial occipital resection. Two underwent total unilateral occipital lobectomy. The extent of the resection was made based mainly on the data of invasive EEG recordings, MRI, and 3D-surface rendering of MRI, not on the intraoperative electrocorticographic findings as usually done. During resection, electrocortical stimulation was performed on the motor cortex and speech area. Results : Out of eight patients with parietal epilepsy, three had sensory aura, two had gustatory aura, and two had visual aura. Six of nine patients with occipital epilepsy had visual auras. All had complex partial seizures with lateralizing signs in 15 patients. Four had quadrantopsia. One had mild right hemiparesis. Abnormality in MRI was noticed in six out of eight parietal epilepsy and in eight out of nine occipital epilepsy. 3D-surface rendering of MRI visualized volumetric abnormality with geometric spatial relationships adjacent to the normal brain, in all of parietal and occipital epilepsy. Surface EEG recording was not reliable in localizing the epileptogenic zone in any patient. The subdural grid electrodes can be implanted on the core of the structural abnormality in 3D-reconstructed brain. Ictal onset zone was localized accurately by subdural grid EEGs in 16 patients. Motor cortex in nine and sensory speech area in two were identified by electrocortical stimulation. Histopathologic findings revealed cortical dysplasia in 10 patients ; tuberous sclerosis was combined in two, hamartoma and ganglioglioma in one each, and subpial gliosis in six. Eleven patients were seizure free at follow-up of 6 months to 37 months(mean 19.7 months) after surgery. Seizures recurred in two and were unchanged in one. Six produced transient sensory loss and one developed hemiparesis and tactile agnosia. One revealed transient apraxia. Two patients with preoperative quadrantopsia developed homonymous hemianopsia. Conclusion : This study suggests that surgical treatment was relevant in parietal and occipital epilepsies with good surgical outcome, without significant neurologic sequelae. Neuroimaging studies including conventional MRI, 3Dsurface rendering of MRI were necessary in identifying the epileptogenic zone. In particular, 3D-surface rendering of MRI was very helpful in presuming the epileptogenic zone in patients with unidentifiable lesion in the conventional MRI, in planning surgical approach to lesions, and also in making a decision of the extent of the epileptogenic zone in patients with identifiable lesion in conventional MRI. Invasive EEG recording with the subdural grid electrodes helped to confirm a core of the epileptogenic zone which was revealed in 3D-surface rendered brain.

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Open Techniques for Bone Defect in Anterior Shoulder Instability (골 결손이 동반된 전방 견관절 불안정성에서 개방적 수술 술기)

  • Lee, Bong-Gun;Rhee, Yong-Girl
    • Clinics in Shoulder and Elbow
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    • v.12 no.2
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    • pp.255-263
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    • 2009
  • Purpose: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. Materials and Methods: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. Results: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. Conclusion: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.