• Journal of Chest Surgery
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• 제47권6호
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• pp.510-516
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• 2014

Background: Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI. Methods: We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was $68.8{\pm}9.5$ years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies. Results: There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions. Conclusion: Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.

• Journal of Chest Surgery
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• 제29권1호
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• pp.14-23
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• 1996

Circulatory arrest under deep hypothermia is an important auxiliary means for cardiac surgery, especially useful in pediatric patients. However, its clinical safety, particularly with regard to the neurologic outcome after long duration of circulatory arrest, is still not established. This study is a review of the eight years'clinical experience of hypothermic circulatory arrest at the Seoul national University Children's Hospital. During an eight-year period from January 1986 through December 1993, a total of 589 consecutive cardiac operations were done using circulatory arrest under deep hypothermia. Among them, 434 consecutive patients, in whom the duration of arrest was 20 minutes or more, are the subject of this study. The duration of arrest ranged from 20 minutes to 82 minutes (mean = 38.7 minutes) under rectal temperature in the range from 12.5$^{\circ}C$ to 25.8$^{\circ}C$. Early neurologic abnormalities occurred in 47 patients : seizure attacks in 28 patients, motor paralyses with or w thout seizure in 12, blindness in 2, and no recovery of consciousness in 5 patients. The rate of incidence of early neurologic abnormalities was calculated at 15.7%. 25 patients showed late neuropsychologic sequelae, such as motor paralysis (9 patients), recurrent seizures (6), developmental delay (8), and definitely low intelligence (2). The rate of incidence of late neurologic sequelae was 8.5%, By statistical analysis, the following factors were identified as the risk factors for post-arrest neurologic abnormalities ; 1) long duration of circulatory arrest, 2) lower-than-ideal body weight, 3) preexisting neurological abnormalities, 4) associated non-cardiovascular congenital anouialies, and 5) low blood pressure during the early post-arrest period. It is concluded that circulatory arrest under deep hypothermia is a relatively safe means for pediatric cardiac surgery with acceptable risk. However, to warrant maximal safety, it is desirable to limit the duration of arrest to less th n 40 minutes. In addition, it is our contention that the early post-arrest period is a very critical period during which maintenance of adequate perfusion pressure in important for the neurologic outcome.

• Korean Journal of Radiology
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• 제20권6호
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• pp.967-975
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• 2019

Objective: To evaluate whether the combination of magnetic resonance spectroscopy (MRS) and ¹¹C-methionine positron emission tomography (¹¹C-MET PET) could increase accurate diagnostic sensitivity for non-enhancing supratentorial gliomas. Materials and Methods: Between February 2012 and December 2017, 109 patients with non-enhanced supratentorial lesions on contrast-enhanced MRI were enrolled. Each patient underwent MRS and ¹¹C-MET PET before treatment. A lesion was considered to be a glioma when either the MRS or ¹¹C-MET PET results reached the diagnostic threshold. The radiological diagnosis was compared with the pathological diagnosis or medical diagnostic criteria. Results: The sensitivity and specificity were 60.0% and 50.0% for MRS and 75.8% and 50.0% for ¹¹C-MET PET, respectively. Upon combining the two modalities, the sensitivity and specificity of the imaging-based diagnosis prior to surgery reached 89.5% and 42.9%, respectively. Statistically significant differences in the sensitivities were observed between the combined and individual approaches (MRS alone, 89.5% vs. 60.0%, p < 0.001; ¹¹C-MET PET alone, 89.5% vs. 75.8%, p = 0.001). However, no significant differences in specificity were observed between the combined and individual modalities. Conclusion: The combination of MRS and ¹¹C-MET PET findings significantly increases accurate diagnostic sensitivity for non-enhancing supratentorial gliomas without significantly lowering the specificity. This finding suggests the potential of the combined MRS and ¹¹C-MET PET approach in clinical applications.

• Journal of Chest Surgery
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• 제34권12호
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• pp.948-951
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• 2001

본 43세 여환은 심장판막질환으로 진단 받은 후 별다른 치료 없이 지내던 중 내원 전 심해진 호흡곤란으로 입원 치료중 신경학적 이상이 발생되어 중복판막협착 및 폐쇄부전증, 뇌동맥 색전증의 진단 하에 수술 시행하였다. 수술시 좌심실 배부와 승모판막륜 주변에 유두상의 조직들이 다수 발견되었다. 술후 신경학적 이상은 더 이상 보이지 않았고 병리조직학적 검사상 류마치스성 판막소엽에 동반된 유두상 섬유탄력종이 진단되었다. 환자는 수술 후에 잘 회복하였으며, 현재 외래에서 추적 관찰중이다.

• Journal of Korean Neurosurgical Society
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• 제60권5호
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• pp.534-539
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• 2017

Objective : Patients with hematological malignancies frequently encounter spine-related symptoms, which are caused by disease itself or process of treatment. However, there is still lack of knowledge on their epidemiology and clinical courses. The purpose of this article is to review clinical presentations and surgical results for spinal involvement of hematologic malignancies. Methods : From January 2011 to September 2014, 195 patients (98 males and 97 females) suffering from hematological malignancies combined with spinal problems were retrospectively analyzed for clinical and radiological characteristics and their clinical results. Results : The most common diagnosis of hematological malignancy was multiple myeloma (96 patients, 49.7%), followed by chronic myeloid leukemia (30, 15.2%), acute myeloid leukemia (22, 11.2%), and lymphoma (15, 7.56%). The major presenting symptoms were mechanical axial pain (132, 67.7%) resulting from pathologic fractures, and followed by radiating pain (49, 25.1%). Progressive neurologic deficits were noted in 15 patients (7.7%), which revealed as cord compression by epidural mass or compressive myelopathy combined with pathologic fractures. Reconstructive surgery for neurologic compromise was done in 16 patients. Even though surgical intervention was useful for early paralysis (Frankel grade D or E), neurologic recovery was not satisfactory for the progressed paralysis (Frankel grade A or B). Conclusion : Hematological malignancies may cause various spinal problems related to disease progression or consequences of treatments. Conservative and palliative treatments are mainstay for these lesions. However, timely surgical interventions should be considered for the cases of pathologic fractures with progressive neurologic compromise.

• Journal of Chest Surgery
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• 제32권9호
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• pp.790-798
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• 1999

배경: 최근 관상동맥 우회수술의 조기 성적이 향상됨에 따라 뇌 경색을 비롯한 신경계 합병증이 수술 후 경과를 결정하는 중요한 합병증으로서 비중이 증가하고 있다. 이에 본 연구에서는 관상동맥 우회수술 후에 발생하는 신경계 합병증의 발생 양상을 분석하고 그 위험인자를 규명하고자 하였다. 대상 및 방법: 관상동맥 우회수술을 시행받은 351명의 환자를 대상으로 신경계 합병증의 발생 여부와 형태, 위험인자를 분석하였다. 신경계 합병증은 새로운 뇌 경색이 확진된 경우와 수술후 의식 및 지남력의 완전한 회복이 24시간 이상 지연된 경우로 정의하였다. 결과: 대상 환자중 18명(5.1%)에서 신경계 합병증이 발생하였으며 그 중 뇌 경색이 확진된 환자는 9명(2.6%)이었다. 운동마비를 동반한 뇌 경색이 4명에서 발생하였고 4명은 정신 지체나 지남력 장애의 형태로 나타났으며 뇌사 판정을 받은 환자가 1명 있었다. 나머지 9명은 뇌 경색의 증거는 발견되지 않았으나 의식 및 지남력의 완전 회복이 지연된 환자들이었다. 통계적 분석 결과 180분 이상의 심폐 바이패스, 수술중 상행 대동맥의 죽상경화반이 진단된 경우, 초음파 검사로 진단된 경동맥 협착, 뇌졸중이나 일과성 뇌허혈의 과거력 등이 단변량 및 다변량 분석 모두에서 의미있는 위험인자로 분석되었다. 그밖에 고령(65세 이상), 흉부 단순 촬영상 대동맥의 석회화가 발견된 경우, 수술중 심근 경색 등도 단변량 분석시 의미있는 위험인자였다. 대동맥궁 삽관이나 single clamp technique 등 신경학적 합병증의 예방에 기여할 것으로 기대되었던 수술 수기상의 변형은 합병증 발생 빈도에 별다른 영향을 미치지 않은 것으로 분석되었으며 경동맥 협착의 정도 역시 합병증 발생 빈도와 상관관계가 없었다. 결론: 이상의 결과로 관상동맥 우회수술 후의 신경계 합병증의 발생 원인은 복합적이긴 하지만 근본적으로는 동맥계의 동맥경화성 병변과 밀접한 관계가 있음을 확인하였다. 따라서 합병증의 예방을 위해서는 수술전 동맥경화성 병변에 대한 전신적인 평가와 함께 고위험군 환자들의 경우 적극적인 수술 수기의 변형을 검토할 필요가 있다고 판단된다.

• Archives of Plastic Surgery
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• 제36권6호
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• pp.799-802
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• 2009

Purpose: Schwannoma is one of common neoplasm in the central and peripheral nervous systems. However, schwannoma of sciatic nerve is rare, especially large schwannoma arising in sciatic nerve is extremely rare. This is a report of our experience with large schwannoma arising in sciatic nerve with minimal neurologic symptoms. Methods: A 65 - year - old man presented with palpable mass in middle portion of posterior thigh. No definitive neurologic deficits were detected on physical examinations. CT and sonography showed well - defined mass with large dimension. The mass was excised and confirmed histologically as a schwannoma. In postoperative period, NCS and EMG were followed. Results: The patient complained of difficulty in dorsiflexion of ipsilateral ankle joint postoperatively. NCS and EMG obtained immediately and showed sciatic neuropathy. After 2 months postoperatively, NCS and EMG were followed and abnormal findings of previous NCS and EMG were not found. Dorsiflexion of ankle joint was improved to normal range of motion. Conclusion: We report a rare case of large schwannoma arising in sciatic nerve with no definitive neurologic symptoms.

• Journal of Chest Surgery
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• 제26권4호
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• pp.329-332
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• 1993

Breakdown of the normal protective function of the larynx, either through primary or neurologic cause, leads to chronic aspiration, recurrent pneumonitis and possibly death. Lindemann`s tracheoesophageal diversion has three main advantages; first, it eliminates intractable aspiration in all patients who underwent the procedure, second, it preserves larynx, and third, if the underlying neurologic condition is recorved, the procedure can be reversed. We had performed tracheoesophageal diversion in two cases of intractable aspiration pneumonia patients. The postoperative courses were uneventful and they were receiving oral alimentation on the 22th and 9th postoperative days respectively, and could be discharged on 43th and 20th postoperative days respectively.

• Journal of Chest Surgery
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• 제44권5호
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• pp.332-337
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• 2011

Background: The optimal timing of surgery for infective endocarditis complicated by embolic stroke is unclear. We compared early versus delayed surgery in these patients. Materials and Methods: Between 1992 and 2007, 56 consecutive patients underwent open cardiac surgery for the treatment of infective endocarditis complicated by acute septic embolic stroke, 34 within 2 weeks (early group) and 22 more than 2 weeks (delayed group) after the onset of stroke. Results: The mean age at time of surgery was $45.7{\pm}14.8$ years. Stroke was ischemic in 42 patients and hemorrhagic in 14. Patients in the early group were more likely to have highly mobile, large (>1 cm in diameter) vegetation and less likely to have hemorrhagic infarction than those in the delayed group. There were two (3.7%) intraoperative deaths, both in the early group and attributed to neurologic aggravation. Among the 54 survivors, 4 (7.1%), that is, 2 in each group, showed neurologic aggravation. During a median follow-up of 61.7 months (range, 0.4~170.4 months), there were 5 late deaths. Overall 5-year neurologic aggravation-free survival rates were $79.1{\pm}7.0%$ in the early group and $90.9{\pm}6.1%$ in the delayed group (p=0.113). Conclusion: Outcomes of early operation for infective endocarditis in stroke patients were similar to those of the conventional approach. Early surgical intervention may be preferable for patients at high risk of life-threatening septic embolism.

• Archives of Plastic Surgery
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• 제35권1호
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• pp.13-19
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• 2008

Purpose: Human adipose tissue-derived mesenchymal stem cells(hATSCs) can be differentiated into multiple mesenchymal lineages, including bone, cartilage, and muscle. And growth hormone play important roles in the normal growth and development of the CNS. In this study, we explored whether the transplanted hATSCs and growth hormones could improve functional recoveries from rats with contusive spinal cord injury. Methods: We divided 30 female rats, which were subjected to a weight driven implant spinal cord injury, into 3 groups with 10 rats each; Group A as a control group, group B with hATSCs transplantation on injured region, and group C with hATSCs transplantation and GH administration for 7 days. Then, we researched their neurologic functional recoveries before and 2, 4, and 8 weeks after transplantation using Basso-Beattie-Bresnahan (BBB) locomotor rating scale. And we checked Y-chromosome positive cells by FISH(Fluorescent in situ hybridization) to identify the survival of transplanted mesenchymal stem cells. Results: After 4 weeks of transplantation, the group B and group C showed significant improvement of neurologic function on BBB locomotor rating scale in comparison with the group A(Group A: $13.1{\pm}0.58$, Group B: $14.6{\pm}0.69$, Group C: $14.9{\pm}0.56$). Moreover, the group C displayed meaningful recovery of neurologic function after 8 weeks in comparison with group B (Group B: $15.7{\pm}0.63$, Group C: $16.5{\pm}1.14$). The group A, the control one, improved for 5 weeks after injury, and had no more recovery. On the other hand, Group B and C showed the improvement of neurologic function continuously for 9 weeks after injury. Conclusion: In this study, we found out that hATSCs transplantation have an effect on neurologic functional recovery of spinal cord injured rat and GH injection seems to bring the synergistic results on this good tendency.