• Journal of Korean Neurosurgical Society
• /
• 제29권8호
• /
• pp.1019-1023
• /
• 2000

Objective : Endoscopic third ventriculostomy is gaining popularity as a minimally invasive surgical option for certain types of hydrocephalus as an alternative to shunting. The authors have tried to fenestrate down to the subdural space passing through the prepontine cistern to lessen or avoid the chance of redoing due to healing. Materials and Method : A 48-year-old male patient with several years of intractable headache was presented. Magnetic Resonance Image(MRI) of the brain revealed marked ventricular dilatation with stenotic cerebral aqueduct. A 2.3mm flexible steerable endoscope($Neuroview^{(R)}$) was introduced via precoronal route and accessed to the third ventricular floor. Using 3-French Fogarty balloon catheter, thin third ventricular floor and the arachnoid membrane of the prepontine cistern were fenestrated, so called "double fenestration". To confirm the fenestration, subdural compa-rtment of the left abducens nerve was identified during the procedure. Forceful pulsating flow through the orifice convinced the patency of the opening. Results : The patient was discharged on the third postoperative day without any postoperative complications. The postoperative follow-up MRI of the brain, at second and sixth months, clearly demonstrated the flow void through the third ventricular floor. Conclusions : Endoscopic third ventriculostomy was successfully performed on an adult hydrocephalus patient with aqueduct stenosis. The third ventricular floor and arachnoid membrane of the prepontine cistern were fenestrated to achieve double fenestration to minimize the chance for failure. The details of this procedure and results are described.

• Journal of Korean Neurosurgical Society
• /
• 제58권1호
• /
• pp.36-42
• /
• 2015

Objective : Complete sellar floor reconstruction is critical to avoid postoperative cerebrospinal fluid (CSF) leakage during transsphenoidal surgery. Recently, the pedicled nasoseptal flap has undergone many modifications and eventually proved to be valuable and efficient. However, using these nasoseptal flaps in all patients who undergo transsphenoidal surgery, including those who had none or only minor CSF leakage, appears to be overly invasive and time-consuming. Methods : Patients undergoing endoscopic endonasal transsphenoidal tumor surgery within a 5 year-period were reviewed. Since 2009, we classified the intraoperative CSF leakage into grades from 0 to 3. Sellar floor reconstruction was tailored to each leak grade. We did not use any tissue grafts such as abdominal fat and did not include any procedures of CSF diversions such as lumbar drainage. Results : Among 200 cases in 188 patients (147 pituitary adenoma and 41 other pathologies), intraoperative CSF leakage was observed in 27.4% of 197 cases : 14.7% Grade 1, 4.6% Grade 2a, 3.0% Grade 2b, and 5.1% Grade 3. Postoperative CSF leakage was observed in none of the cases. Septal bone buttress was used for Grade 1 to 3 leakages instead of any other foreign materials. Pedicled nasoseptal flap was used for Grades 2b and 3 leakages. Unused septal bones and nasoseptal flaps were repositioned. Conclusion : Modified classification of intraoperative CSF leaks and tailored repair technique in a multilayered fashion using an en-bloc harvested septal bone and vascularized nasoseptal flaps is an effective and reliable method for the prevention of postoperative CSF leaks.

• Journal of Korean Neurosurgical Society
• /
• 제56권5호
• /
• pp.390-394
• /
• 2014

Objective : In most patients with carpal tunnel syndrome (CTS), pain and/or paresthesia disappeared or decreased in a month after endoscopic carpal tunnel release (ECTR). However, subpopulation of patients showed delayed improvement following ECTR. We analyzed the delayed improvement hands to investigate the characteristics of those patients and to determine the predictable factors of delayed improvement. Methods : Single-portal ECTRs were performed in 1194 hands of 793 CTS patients from 2002 to 2011. Five-hundred seventy hands with minimal 1-year postoperative follow-up were included. We divided the 545 satisfied hands into early (group A) and delayed (group B) groups according to improvement period of 1 month. Demographic data, clinical severity and electrodiagnostic abnormality were compared between groups. Results : Group A included 510 hands and group B included 35 hands. In group B, 11 hands improved in 2 months, 15 hands in 3 months and 9 hands in 6 months, respectively. In group A/B, according to clinical severity, 60/1 hands were graded to I, 345/24 hands to II, 105/10 hands to III. In group A/B, based on electrodiagnostic abnormality, 57/3 hands were classified to mild, 221/11 hands to moderate and 222/21 hands to severe group. Statistical analysis between groups did not reach significance but electrodiagnostic or clinical severity had a tendency to affect the delayed response. Conclusion : It is difficult to predict the factors contributing to postoperatively-delayed response in subpopulation of CTS patients. However, we recommend that postoperative observation for at least 6 months is necessary in patients without symptomatic improvement.

• Journal of Korean Neurosurgical Society
• /
• 제53권4호
• /
• pp.218-222
• /
• 2013

Objective : To clarify the anatomical correlations of the sphenoid sinus with surrounding structures in the normal Korean population, and to identify surgical landmarks for safe sellar floor dissection in the anterior skull base by endoscopy and microscopy. Methods : We reviewed the 196 brain magnetic resonance imaging findings showing a normal appearance, and measured the distances between anatomical landmarks. Results : The mean distances from the base of the columella to the anterior wall of the sphenoid sinus and the sellar floor were $69.71{\pm}4.25$ mm and $86.26{\pm}4.57$ mm, respectively in the over 15 age group, and showed the smallest degree of variation among the measurements. The mean angles between the floor of the nasal cavity and the straight line connecting the base of the columella and the sellar floor were $29.45{\pm}3.25^{\circ}$ and $24.75{\pm}4.00^{\circ}$ in the over 15 and under 15 age groups, respectively. The mean values of both distances and angles increased with age until 15 years after which no further increases were evident. There were no significant differences in the measurements between males and females or among subjects with different degrees of pneumatization in the over 15 age group. Conclusion : The distances from the base of the columella to the sellar floor and the anterior wall of the sphenoid sinus, which were consistent among individuals, could be used as a surgical indicator to investigate the sellar floor in endoscopic or microscopic transsphenoidal approaches.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제21권2호
• /
• pp.147-153
• /
• 2018

Epstein-Barr virus (EBV) infection can be presented with various clinical manifestations and different levels of severity when infected. Infectious mononucleosis, which is most commonly caused by EBV infection in children and adolescents, is a clinical syndrome characterized by fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. But rarely, patients with infectious mononucleosis may present with gastrointestinal symptoms and complicated by gastritis, splenic infarction, and splenic rupture. We encountered a 16-year-old girl who presented with fever, fatigue, and epigastric pain. Splenic infarction and EBV-associated gastritis were diagnosed by using esophagogastroduodenoscopy and abdominal computed tomography. Endoscopy revealed a generalized hyperemic nodular lesion in the stomach, and the biopsy findings were chronic gastritis with erosion and positive in situ hybridization for EBV. As splenic infarction and acute gastritis are rare in infectious mononucleosis and are prone to be overlooked, we must consider these complications when an infectious mononucleosis patient presents with gastrointestinal symptom.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제23권5호
• /
• pp.439-446
• /
• 2020

Purpose: The evidence for an association between inflammatory bowel disease (IBD) and obesity is conflicting. Therefore, we set out to review the body mass index (BMI) at presentation of IBD to understand if the rise of the obesity rate in the general population, lead to an increase of obesity in patients with IBD at the time of diagnosis. Methods: Retrospective review of all patients with IBD seen at Children's Hospital and Medical Center from January 1st 2010 to December 31st 2014. From the initial visit and endoscopy, we obtained: age; sex; BMI; disease phenotype; disease severity. Results: We had a total of 95 patients, 35 patients were excluded due to incomplete data or referral being made after diagnosis was made. 28 were males and 32 were females, Age range was 2-17 years. A 37 had Crohn's disease, 19 ulcerative colitis, and 4 indeterminate colitis. Disease severity in 19 cases was mild, 29 moderate and 12 severe. BMI distribution was as follows-obese (5.0%), overweight (6.7%), normal weight (65.0%), mild malnutrition (8.3%), moderate malnutrition (15.0%), severe malnutrition (1.7%). Conclusion: Our data is consistent with other series. Showing most children had a normal BMI, regardless of disease severity or phenotypes. One confounding factor is the possibility of delay in referral to GI. This could mean some obese children may fall in the normal BMI range at the time of diagnosis due to ongoing weight loss. Future studies should include prospective cohort studies, comparing incidence of IBD in obese and non-obese patients, severity at presentation, duration of symptoms, and clinical outcomes.

• Journal of Chest Surgery
• /
• 제31권3호
• /
• pp.329-335
• /
• 1998

55세 남자환자가 흉부 불편감, 연하장애와 연하통을 주소로 입원하였다. 식도내압검사상 하부식도 괄약근의 이완이 전혀 관찰되지 않았다. 식도 조영술상 "double-barrelled 식도" 또는 점막 선조(mucosal stripe) 소견을 보였다. 내시경 검사상 상부 식도에 기관-식도누공의 형태를 보는 듯한 개구부가 있었다. 또한, 하부 식도에는 두군데의 점막 열창이 보였다. 이후 환자는 금식과 비경구적인 영양공급을 하면서 수주간 치료하였나, 증상의 호전을 볼수 없었다. 그래서 전신 마취하에 상부식도에 있던 가성내강의 개구부를 일차봉합하였다. 수술후 환자는 경한 연하곤란을 제외하고는 증상이 좋아졌다. 환자는 조심스런 경구섭취를 하고 퇴원하였다. 환자는 외래에서 추적검사상 발열이나 연하장애가 없었으며, 식도 조영술상 호전되는 양상을 보였다. 저자들은 보존적 치료와 수술적 치료를 시행했던 자발성 점막하 식도 박리의 특이한 경우를 치험하였다. 이에 관련된 문헌과 함께 보고하는 바이다. 보고하는 바이다.

• 대한불안의학회지
• /
• 제2권1호
• /
• pp.28-32
• /
• 2006

Objectives : Non-cardiac chest pain (NCCP) can be divided into gastroesophageal reflux disease (GERD) related NCCP and non-GERD related NCCP. Our study was designed to examine the differences in clinical characteristics and psychological mood states between the two clinical syndromes. Methods : After some cardiologic evaluations such as treadmill exercise, coronary angiography, and echocardiography, 27 patients with NCCP were enrolled in this study. They were divided into patients with GERD related NCCP (12 patients) and those with non-GERD related NCCP (15 patients) using the upper gastrointestinal endoscopy and the ambulatory 24 hour esophageal pH monitoring. Clinical characteristics such as typical reflux symptoms and psychological mood states were measured. Patients who showed scores more than 10 on the Beck Depression Inventory (BDI) or Beck Anxiety Inventory (BAI) were defined as depressed or anxious group. Anxiety sensitivity Index (ASI) was also measured in all patients. All parameters were compared between patients with GERD related NCCP and those with non-GERD related NCCP. Results : The two groups showed a difference in typical reflux symptoms. Patients with non-GERD related NCCP had higher scores on the BDI, BAI and ASI than those with GERD related NCCP. Among all NCCP patients, 14 patients (51.9%) were suggested to have possible depression or anxiety disorders. Conclusion : The non-GERD related NCCP was shown to be associated with psychological mood states such as anxiety and depression. Thus, we suggest that routine measurement of psychological mood states should be necessary in the evaluation and treatment of NCCP.

• Journal of Yeungnam Medical Science
• /
• 제30권2호
• /
• pp.141-144
• /
• 2013

Hyperplastic gastric polyps (HPPs) are the most common type of gastric polyps. They are assumed to be caused by chronic inflammation and regenerative proliferation, although this has not been clearly investigated yet. Many studies suggested the development of fundic gland polyps and carcinoid during long-term proton pump inhibitor (PPI) therapy, but the relationship between PPIs and HPPs is still unclear. We encountered a patient who showed aggravation of HPPs after long-term use of PPIs. A 58-year-old male patient with liver cirrhosis visited our hospital because of hematemesis. We started PPI medication after confirming esophageal variceal bleeding and duodenal ulcer with blood clot in its base via emergency endoscopy. He took PPIs for three years because of an intractable duodenal ulcer. There was a marked increase in the size of the pre-existing polyps and in the development of new polyps. We presumed that the PPIs caused the aggravation of the HPPs, so we stopped their administration. After five months, the HPPs shrank and the polyps were partially degraded. More prospective studies are needed to investigate the relationship between HPPs and PPIs.

• The Korean Journal of Pain
• /
• 제31권2호
• /
• pp.109-115
• /
• 2018

Background: Patients with lumbar disc herniation are treated with physiotherapy/medication and some with surgery. However, even after technically successful surgery some develop a failed back syndrome with persistent pain. Our aim was to evaluate the efficacy of epiduroscopy in patients who suffer chronic low back pain and/or radicular pain with or without surgery and the gender difference in outcome. Methods: A total of 88 patients were included with a mean age of 52 years (27-82), 54 women and 34 men. 66 of them were operated previously and 22 were non-operated. They all had persistent chronic back pain and radicular pain despite of medication and physical rehabilitation. Visual Analog Scale (VAS) for pain and Oswestry Disability Index (ODI) were evaluated preoperatively, after one month, six months and one-year after the epiduroscopy. Results: All patients, and also the subgroups (gender and operated/non-operated) improved significantly in pain (VAS) and disability (ODI) at one month. A significant improvement was also seen at one year. No differences were found between men and woman at the different follow-up times. A slight worsening in VAS and ODI was noticed over time except for the non-operated group. Conclusions: Epiduroscopy helps to improve the back and leg pain due to lumbar disc herniation in the early stage. At one year an improvement still exists, and the non-operated group seems to benefit most of the procedure.