• Journal of the Korea Convergence Society
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• v.10 no.1
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• pp.339-351
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• 2019

This study was conducted to identify the factors associated with the ruptured intracranial aneurysm (RIA) among demographic, admission to hospital, clinical, aneurysym itself and lifestyle characteristics. Medical records of RIA patients and un-RIA patients which had been admitted to undergo treatment including surgery (From January to December 2016) were included into data analysis. Multiple logistic regression showed that two and more than warning signs (14.14 (CI: 1.25-159.40)) indicated the greatest odds ratio with RIA, was followed by headache more than 3 scores (13.95 (CI: 3.68-52.83)), the admission via emergency room (13.62 (CI: 4.85-38.26)), single marital status (9.72 (CI: 2.22-42.49)), 1 mmHg increased systolic blood pressure (1.04 (CI: 1.01-1.08)), 1 score increased GCS (0.58 (CI: 0.37-0.90)), arrythmia finding in electrocardiogram (3.70 (CI: 1.22-11.22)) and increased age (0.95 (CI: 0.91-0.99)). The risk groups having factors associated with RIA were identified. Preventive activities including routine assessment should be done before developing the rupture and urgent care should be needed after developing the rupture for risk groups.

• Investigative Magnetic Resonance Imaging
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• v.1 no.1
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• pp.94-102
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• 1997

Purpose: There have been some efforts to diagnose intracranial aneurysm through a non-invasive method using MRA, although the process may be difficult when the lesion is less than 3mm. The present study prospectively compares the results of high resolution, fast speed slice interpolation MRA and DSA thereby examing the potentiality of primary non-invasive screening test. Materials and Methods: A total of 26 cerebral aneurysm lesions from 14 patients with subarachnoid hemorrhage from ruptured aneurysm (RA) and 5 patients with unruptured aneurysm(UA). In all subjects, MRA was taken to confirm the vessel of origin, definition of aneurysm neck and the relationship of the aneurysm to nearby small vessels, and the results were compared with the results of DSA. The images were obtained with 1.5T superconductive machine (Vision, Siemens, Erlangen, Germany) on 4 slabs of MRA using slice interpolation. The settings include TR/TE/FA=30/6.4/25, matrix $160{\times}512$, FOV $150{\times}200$, 7minutes 42 seconds of scan time, effective thickness of 0.7 mm and an entire thickness of 102. 2mm. The images included structures from foramen magnum to A3 portion of anterior cerebral artery. MIP was used for the image analysis, and multiplanar reconstruction (MPR) technique was used in cases of intracranial aneurysm. Results: A total of 26 intracranial aneurysm lesions from 19 patients with 2 patients having 3 lesion, 3 patients having 2 lesions and the rest of 14 patients having 1 lesion each were examined. Among those, 14 were RA and 12 were UA. Eight lesions were less than 2mm in size, 9 lesions were 3-5mm, 7 were 6-9mm and 2 were larger than IOmm. On initial exams, 25 out of 26 aneurysm lesions were detected in either MRA or DSA showing 96% sensitivity. Specificity cannot be estimated since there was no true negative of false positive findings. When MRA and MPR were used concurrently for the confirmation of size and shape, the results were equivalent to those of DSA, while in the confirmation of aneurysm neck and parent vessels, the concurrent use of MRA and MPR was far superior to the sole use of either MRA or DSA. Conclusion: High resolution MRA using slice interpolation technique showed equal results as those of DSA for the detection of intracranial aneurysm, and may be used as a primary non-invasive screening test in the future.

• Journal of Korean Neurosurgical Society
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• v.30 no.9
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• pp.1065-1071
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• 2001

Object : This study was conducted to evaluate whether short-term intravenous infusion of tranexamic acid (AMCA) was able to improve the management outcome by preventing rebleeding without increasing vasospasm and hydrocephalus associated with the long-term administration of this agent in the patients with aneurysmal subarachnoid hemorrhage(SAH) who were planned for the early surgery. Methods : During the period from June, 1996 to May, 1998, 137 patients admitted within 3 days of their SAH and planned for early surgical intervention were subject to study population. Of these, 60 patients who had been treated with AMCA were classified as AMCA treated group and 77 patients without AMCA treatment as AMCA untreated group. Initially, prognostic factors for rebleeding, vasospasm, hydrocephalus and outcome following SAH including age, sex, clinical grade, CT grade, site of ruptured aneurysms, admission day after SAH, surgery day after SAH, number of aneurysms and hypertension history, were analyzed and compared between AMCA treated group and untreated group. Secondly, the incidence of rebleeding, symptomatic vasospasm and hydrocephalus were compared between the two groups. Also, the management outcome of the patients was compared between the two groups. Results : There were no significant differences in prognostic factors between the two groups. The rebleeding rate was 0% in the AMCA treated group whereas the rate was 7.8% in the untreated group. This difference was statistically significant. The incidences of symptomatic vasospasm and hydrocephalus were found not to be significantly different between the two groups. Of the treated group, 31.7% of patients developed hydrocephalus compared to 32.5% of those at the untreated group. Fourteen(23.3%) patients in treated group developed symptomatic vasospasm and 6 of them(10%) suffered stroke whereas incidences of these in untreated group were 25.9% and 11.7%, respectively. The AMCA treated group showed more favorable outcome than that of untreated group. There was no case of death by rebleeding in the AMCA treated group while one of the main causes of death in the untreated group was rebleeding. Conclusion : Short-term high-dose AMCA administration is considered beneficial in improving outcome and diminishing the risk of rebleeding in the patients who suffer from an aneurysmal SAH prior to early surgical intervention.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.370-377
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• 2009

Objective : There is no definite adjustment protocol for patients shunted with programmable valves. Therefore, we attempted to find an appropriate method to adjust the valve, initial valve-opening pressure, adjustment scale, adjustment time interval, and final valve-opening pressure of a programmable valve. Methods : Seventy patients with hydrocephalus of various etiologies were shunted with programmable shunting devices (Micro Valve with $RICKHAM^{(R)}$ Reservoir). The most common initial diseases were subarachnoid hemorrhage (SAH) and head trauma. Sixty-six patients had a communicating type of hydrocephalus, and 4 had an obstructive type of hydrocephalus. Fifty-one patients had normal pressure-type hydrocephalus and 19 patients had high pressure-type hydrocephalus. We set the initial valve pressure to $10-30\;mmH_2O$, which is lower than the preoperative lumbar tapping pressure or the intraoperative ventricular tapping pressure, conducted brain computerized tomographic (CT) scans every 2 to 3 weeks, correlated results with clinical symptoms, and reset valve-opening pressures. Results : Initial valve-opening pressures varied from 30 to $180\;mmH_2O$ (mean, $102{\pm}27.5\;mmH_2O$). In high pressure-type hydrocephalus patients, we have set the initial valve-opening pressure from 100 to $180\;mmH_2O$. We decreased the valve-opening pressure $20-30\;mmH_2O$ at every 2- or 3-week interval, until hydrocephalus-related symptoms improved and the size of the ventricle was normalized. There were 154 adjustments in 81 operations (mean, 1.9 times). In 19 high pressure-type patients, final valve-opening pressures were $30-160\;mmH_2O$, and 16 (84%) patients' symptoms had nearly improved completely. However, in 51 normal pressure-type patients, only 31 (61%) had improved. Surprisingly, in 22 of the 31 normal pressure-type improved patients, final valve-opening pressures were $30\;mmH_2O$ (16 patients) and $40\;mmH_2O$ (6 patients). Furthermore, when final valve-opening pressures were adjusted to $30\;mmH_2O$, 14 patients symptom was improved just at the point. There were 18 (22%) major complications : 7 subdural hygroma, 6 shunt obstructions, and 5 shunt infections. Conclusion : In normal pressure-type hydrocephalus, most patients improved when the final valve-opening pressure was $30\;mmH_2O$. We suggest that all normal pressure-type hydrocephalus patients be shunted with programmable valves, and their initial valve-opening pressures set to $10-30\;mmH_2O$ below their preoperative cerebrospinal fluid (CSF) pressures. If final valve-opening pressures are lowered in 20 or $30\;mmH_2O$ scale at 2- or 3-week intervals, reaching a final pressure of $30\;mmH_2O$, we believe that there is a low risk of overdrainage syndromes.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.606-613
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• 1996

Cardiac transplantation has been the treatment of patients with end-stage heart disease since it was first performed in 1967. In Korea the first case was performed in 1992 and 42 patients underwent heart trans- plantation so far. The purpose of this article is to report short-term result of cardiac transplantation at our center. Between April 1994 and September 1995, 14 patients had undergone orthotopic heart transplantations. There was 12 male and 2 female patients. Mea recipient age was 34 years(range 11 to 54 years) and mean donor age was 28.4 years(16 to 50 years). Mean graft ischemic time was 120.7minutes(80 to 280 minutes). The follow-up period after transplantation was 11 months(3 to 17 months). Recipient diagnosis included dilated cardiomyopathy in 10, ischemic cardiomyopathy in 2, valvular cardiomyopathy in 1, congenital complex heart disease in 1 patient. The preoperative status of the recipients were state I (50%) and ll (50%) by UNOS classification and class 111 (5 patients) and class IV (9) by NYHA functional class. All patients were treated with triple-drug immunosuppression (cyclosporine, azathioprine, steroid) and induction with RATG. The rejection episodes were 5 times in 3 patients during the follow-up. Causes of infection were aspergillosis (2), and hepes zoster (1), CMV pneumonitis (1). Permanent pace- maker was inserted in 1 patient. Currently 9 patients are alive with seven patients in WYHA functional class I and two in class l . The ejection fraction increased from preoperative value of 19.9 $\pm$ 3.4% to postoperative value of 69.0 $\pm$ 5.6%. The causes of death were cellular rejection (1),chronic graft failure due to size-mismatching (1),respirat- oxy insufficiency due to asthma attack (1), subarachnoid hemorrhage (1), and RIO humoral rejection (1).

• The Journal of the Society of Stroke on Korean Medicine
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• v.7 no.1
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• pp.11-16
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• 2006

Objectives : Transcranial Doppler (TCD) has been reported to be established as useful in detecting spasm after subarachnoid hemorrhage and to be probably useful in diagnosing stenosis or occlusion in intracranial arteries. In the detection of intracranial stenosis using TCD there have been reported some kinds of diagnostic criteria. This study was aimed to evaluate the accordance between TCD and magnetic resonance angiography (MRA) in detection of intracranial stenosis and to find out more accurate criteria for intracranial stenosis using TCD. Methods : Seventy-six stroke patients were evaluated by TCD and MRA. TCD criteria for middle cerebral artery (MCA) stenosis were used by 3 methods; ≥ 80cm/sec of mean velocity(Vm), ≥ 140 cm/sec of systolic velocity(Vs), and both. For stenosis of vertebral(VA) and basilar arteries(BA), the TCD criteria followed by 2 methods; ≥ 70 cm/sec of Vm and ≥ 100 cm/sec of Vs. The stenosis of intracranial artery in MRA followed by the interpretation of specialist in the department of radiology. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and kappa agreement were calculated in each criteria of TCD compared with the result of MRA. Results : The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy and kappa agreement using ≥ 80cm/sec of Vm for MCA stenosis were 55.6%, 81%, 34.5%, 91.0%, 77.1%, and 0.293, respectively. Using 140 cm/sec of Vs, those were 44.4%, 92.0%, 50.5%, 90.2%, 84.7%, 0.380, and using both criteria those were 44.4%, 95.0%, 61.5%, 90.5%, 87.3%, 0.445, respectively. Those using ≥ 70 cm/sec of Vm for VA and BA stenosis were 71.4%, 93.7%, 26.3%, 99.0%, 93.0%, 0.186 and using ≥ 100 cm/sec of Vs those were 71.4%, 97.3%, 45.5%, 99.1%, 96.5%, 0.539, respectively. Conclusion : These results suggested that for the diagnosis of MCA stenosis using TCD we should use the criteria of both ≥ 80cm/sec of Vm and 140 cm/sec of Vs, and for the VA and BA stenosis we adapt the criteria of ≥ 70 cm/sec of Vm.