• Title/Summary/Keyword: neurosurgery

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Postoperative Radiation Therapy of Craniopharyngioma (두개인두종의 수술후 방사선치료 성적)

  • Shin, Kyung-Hwan;Yun, Hyong-Geln;Kim, Il-Han;Park, Charn-Il;Cho, Byung-Kyu
    • Radiation Oncology Journal
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    • v.11 no.1
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    • pp.59-67
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    • 1993
  • Between December 1979 and September 1989, 23 patients with craniopharyngioma who underwent surgery and postoperative radiation therapy were retrospectively evaluated to assess the efficacy of this management at the Department of Therapeutic Radiology, Seoul National University Hospital. Total removal of tumor was attempted in all patients. Of these, surgeons tried total removal in eight patients, but revealed residual mass by postoperative CT, and partial removal was done in 15 patients. The morphology of tumor on the operative finding was grouped into three types: cystic 13 ($57{\%}$), solid 4 ($17{\%}$), and mixed 6 ($26{\%}$). Cystic type was predominant in$\leq$20 years old group. Actuarial overall survival rates at 5 and 10 years were $95{\%}$ and $81{\%}$ respectively and actuarial tumor control rates were $74{\%}$ and $50{\%}$. Surgical extent was not related to the survival rates (p=0.41). Pediatric and adolescent patients (age of$\leq$20 years) had a trend of better survival than that of adult patients (p=0.10). The results indicated that limited surgical excision followed by radiation therapy is recommended when total excision is not possible.

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Effect of Water Extract of Saussureae Radix in RANKL-induced Osteoclast Differentiation (파골세포 분화에 목향 물 추출물의 효과)

  • Lee, Myeung-Su;Kim, Jeong-Joong;Oh, Jae-Min;Choi, Min-Kyu;Song, Mi-Jin;Ahn, Yong-Hwan;Lee, Jeong-Hugh;Jeon, Byung-Hoon;Park, Kie-In;Jang, Sung-Jo
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.25 no.3
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    • pp.516-520
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    • 2011
  • Osteoporosis is social problem around the world, because fracture of old age may lead to critical medical condition. Osteoclast is a main target for prevention and treatment of osteoporosis due to their responsibility for bone resorption. Saussureae Radix has been known that has gastro-protective, bronchodilatory effect and has a anti-biotic effect. Saussureae Radix has been widely used in Oriental medicine. However, the effect of extract of Saussureae Radix in osteoclast differentiation remains unknown. Thus, we examined the effect of Saussureae Radix in receptor activator of nuclear factor-${\kappa}$B ligand (RANKL)-induced osteoclast differentiation. From the results of our study, Here we found that Saussureae Radix significantly inhibited osteoclast differentiation induced by RANKL. Saussureae Radix suppressed the activation of NF${\kappa}$B in bone marrow macrophages (BMMs) treated with RANKL. Also, Saussureae Radix significantly inhibited the mRNA expression of c-Fos, tartrate-resistant acid phosphatase (TRAP), osteoclast-associated receptor (OSCAR), nuclear factor of activated T cells (NFAT)c1 and cathepsin K in BMMs treated with RANKL. Particularly, Saussureae Radix greatly inhibited the protein expression of c-fos and NFATc1. especially in the case of NFATc1 expression, a master transcription factor of the differentiation of osteoclasts is very important step for osteoclastogenesis. These results demonstrate that Saussureae Radix may be useful treatment option of bone-related disease such as osteoporosis and rheumatoid arthritis.

A Case of Renovascular Hypertension Due to Renal Artey Stenosis Related to Moyamoya Disease (모야모야병과 동반된 신 동맥 협착에 따른 신성 고혈압을 보인 1례)

  • Kim, Joung-A;Kim, Seung;Kim, Hyo-Sun;Shin, Jae-Il;Jeong, Il-Cheon;Kim, Dong-Seok;Kim, Myung-Joon;Lee, Do-Yun;Lee, Jae-Seung
    • Childhood Kidney Diseases
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    • v.11 no.2
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    • pp.294-298
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    • 2007
  • Moyamoya disease is a progressive cerebrovascular disorder with stenosis or occlusion of the bilateral internal carotid arteries with abnormal vascular networks at the base of the brain. Previous reports have shown that there are extracranial vascular involvements in Moyamoya disease, especially in the renal artery. We report a 7-year-old patient with Moyamoya disease associated with renovascular hyper tension, who presented in infancy with seizures and hemiparesis. Renal angiography showed multiple stenoses of the right renal artery. Although renal artery stenosis in Moyamoya disease has been effectively treated with balloon angioplasty, stent implantation, or surgery, bat-loon angioplasty could not be done in this patient due to multiple stenoses. His blood pressure was successfully controlled with medical treatment, and remained normotensive during the follow up period of 6 months.

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Diagnostic Significance of Cytotoxic Genes Expression by Western blotting of Serum in Helicobacter pylori Infection (Helicobacter pylori 감염 환자에서 Western blot 법에 의한 혈청내 세포독성 유전자의 발현에 관한 연구)

  • Kim, Dae-In;Lee, Goo;Shu, Jung-Ill;Lee, Chang-Woo;Kim, Jung-Ran;Ha, Gyoung-Yim;Lee, Kyu-Chun;Nam, Kyung-Soo;Yang, Chang-Heon
    • Journal of Life Science
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    • v.10 no.6
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    • pp.630-639
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    • 2000
  • The gastric pathogen Helicobacter pylori(H. pylori) establishes long-term chronic infection that can lead to atrophic gastritis, intestinal metaplasia, and gastric cancer. H. pylori, which express cytotoxic genes is now recohnized as a cause of peptic ulcer and is also a major risk factor for the development of gastric adenocarcinoma. We performed this study 1) to assess the detection rate of H. pylori according to direct investigation of bacteria of gastric biopsy specimen and two serologic tests of GAP test and Helico blot 2.0 system in the symptomatic and non-symptomatic group 2) to evaluate and compare the efficacy of two serologic tests of GAP test and Helico blot 2.0 system for the diagnosis of H. pylori infection. Forty-nine patients were positive for H pylori infection based on direct investigation of bacteria by histology. The detection rates of H. pylori infection based on direct investigation of bacteria by histology. The detection rates of H. phlori were significantly lower in gastric cancer than in other gastroduodenal disease(p<0.05). The concordance of two serologic tests of GAP test and Helico blot 2.0 system is poor. There was no statistically significant difference between the expression rate of CagA and VacA in the symptomatic and non-symptomatic group. Although Helico blot 2.0 system may not displace GAP test, it was a very sensitive serologic test for the diagnosis of H. pylori infection and it was used to detect IgG antibodies to H. pylori-specific antigens, including CagA, VacA and the various urease subunit. Our data suggest that further investigation is needed to determine whether or not the serologic expression of cytotoxic gene may be clinical usefulness of diagnostic methods in the gastroduodenal disease.

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Selective Beam Shielding Method of Gamma-Knife Unit Using Various Plugging Patterns (다양한 Plugging 형태를 이용한 감마나이프의 선택적 빔 차폐 방법)

  • Jang Geon Ho;Lim Young Jin;Shin Dong Oh;Choi Doo Ho;Hong Seong Eon;Leem Won
    • Radiation Oncology Journal
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    • v.11 no.2
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    • pp.439-448
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    • 1993
  • The B-type gamma knife unit was installed at Kyung-Hee University Hospital in March 1992. The selective beam plugging method can be used to reduce the low percentage isodose profiles of normal sensitive organ and to modify the isodose curves of treatment volume for better shaping of the target volume. For representing the changes of the low percentage isodose profiles, the variations of dose distribution for several cases were discussed in this paper. The film dosimetry was peformed for the evaluation of calculated isodose profiles predicted by KULA dose planning system. The results were verified by RFA-3 automatic densitometry. The clinical application of selective beam shielding method was peformed in 17 patients in 100 patients who have undergone gamma knife radiosurgery for a year. The calculated and the measured isodose profiles for the high percentage regions were well consistent with each other. When the target of pituitary tumor is macro-size, the selective beam shielding method is the most applicable method. When the target size, however, is small, the correct selection of the proper helmet size is very important. All patients were exposed almost about 3~12 Gy for brain stem, and 3~11.2 Gy for optic apparatus. It is recommended that the same or other plugging patterns with multiple isocenters should be used for protection of the radiosensitive normal structures with precise treatment of CNS lesions.

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Dose Distributions for Ll NAC Radiosurgery with Dynamically Shaping Fields (선형가속기를 이용한 방사선 수술시 Dynamical Field Shaping에 의한 선량분포)

  • Suh Tae Suk;Yoon Sei Chul;Kim Moon Chan;Jang Hong Seok;PArk Yong Whee;Shinn Kyung Sub;Park Charn Il;Ha Sung Whan;Kang Wee Saing
    • Radiation Oncology Journal
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    • v.11 no.2
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    • pp.431-437
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    • 1993
  • An important problem in radiosurgery is the utilization of the proper beam parameters, to which dose shape is sensitive. Streotactic radiosurgery techniques for a linear accelerator typically, use circular radiation fields with multiple arcs to produce an spherical radiation distribution. Target volumes are irregular in shape for a certain case, and spherical distributions can irradiate normal tissues to high dose as well as the target region. The current improvement to dose distribution utilizes treating multiple isocenters or weighting various arcs to change treatment volume shape. in this paper another promising study relies upon dynamically shaping the treatment beam to fit the beam's eye view of the target. This conformal irradiation technique was evaluated by means of visual three dimensional dose distribution, dose volume histograms to the target volume and surrounding normal brain. It is shown that using even less arcs than multiple isocenter irradiation technique, the conformal therapy yields comparable dose gradients and superior homogeneity of dose within the target volume.

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A Comparison of the Independent Verification Methods for the Results of Leksell GammaPlan for Gamma Knife Predecessor with the Hemispherical Collimators (반구형 시준기를 가진 감마나이프에 대한 렉셀감마플랜 결과물의 독립적인 검증방법들의 비교)

  • Hur, Beong Ik
    • Journal of the Korean Society of Radiology
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    • v.10 no.7
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    • pp.521-529
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    • 2016
  • Since Gamma Knife(R) radiosurgery(GKRS) is based on a single-fraction high dose treatment strategy, independent verification for the results of Leksell GammaPlan(R) (LGP) is an important procedure in assuring patient safety and minimizing the risk of treatment errors. Several verification methods have been developed and reported previously. Thus these methods were tested statistically and tried on Leksell Gamma Knife(LGK) target treatments through the embodiment of the previously proposed algorithms(PPA). The purpose of this study was to apply and evaluate the accuracy of verification methods for LGK target treatments using PPA. In the study 10 patients with intracranial lesion treated by GKRS were included. We compared the data from PPA and LGP in terms of maximum dose, arbitrary point dose, and treatment time at the isocenter locations. All data were analyzed by Paired t-test, which is statistical method used to compare two different measurement techniques. No statistical significance in maximal dose at 10 cases was observed between PPA and LGP. Differences in average maximal dose ranged from -0.53 Gy to 3.71 Gy. The arbitrary point dose calculated by PPA and LGP was not statistically significant too. But we found out the statistical difference with p=0.021 between TMR and LGP for treatment time at the isocenter locations. PPA can be incorporated as part of a routine quality assurance(QA) procedure to minimize the chance of a wrong overdose. Statistical analyses demonstrated that PPA was in excellent agreement with LGP when considering the maximal dose and the arbitrary point dose for the best plan of GKRS. Due to the easy applicability we hope PPA can be widely used.

Interictal rCBF SPECT, MRI and Surgical Outcome of Intractable Temporal Lobe Epilepsy (난치성 측두엽간질의 발작간 뇌혈류 SPECT, MRI와 수술성과 비교)

  • Zeon, Seok-Kil;Joo, Yang-Goo;Lee, Sang-Doe;Son, Eun-Ik;Lee, Young-Hwan
    • The Korean Journal of Nuclear Medicine
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    • v.28 no.3
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    • pp.307-312
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    • 1994
  • Interictal single photon emission computed tomography of regional cerebral blood flow (rCBF SPECT) in 18 intractable temporal lobe epilepsy patients(8 male and 10 female patients: average 23.5 years old) were compared with 2.0 T magnetic resonance imaging (MRI). And surgical outcome was analysed with the findings, symptom duration and lateralization of temporal lobe. Preoperatively rCBF SPECT was done in all 18 patients with intravenous injection of 740 MBq 99mTc-HMPAO. MRI was also done preoperatively in 13 patients. Surgical outcome was classified by Engel's outcome classification(four-part classification recommended at the first Palm Desert conference). rCBF SPECT detected correctly lateralising abnormality of temporal lobe hypoperfusion in 13/18(72.2%), contralateral temporal lobe hypoperfusion in 2/18(11.1%) and showed no def-inite abnormality in 3/18(16.7%). The positive predictive value of unilateral temporal lobe hypoperfusion was 87%. MRI detected correct localising abnormality in 8/13(61.5%), such as hippocampal atrophy(7/13), asymmetric temporal horn(6/13), anterior temporal lobe atrophy(1/13), increased signal intensity from hippocampus(1/13) and calcific density(1/13), and no abnormal finding was noted in 5/13(38.5%). There was no false positive findings and the positive predictive value of MRI was 100%. Only 2 cases showed same lateralization findings in rCBF SPECT and MRI. There was no significant correlation between symptom duration and no abnormal findings on SPECT or MRI. Surgical outcome showed class I in 15/18(83.3%), and class II in 2/18(11.1%). One case of no abnormal finding in both SPECT and MRI showed class III surgical outcome. No class IV surgical outcome was noted. Surgical outcome, lateralization of epileptic focus in temporal lobe and abnormal findings in rCBR SPECT or MRI were not significantly correlated.

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Preparation and Characterization of Small Intestine Submucosa Powder Impregnated Poly(L-lactide) Scaffolds: The Application for Tissue Engineered Bone and Cartilage

  • Khang, Gilson;Rhee, John M.;Shin, Philkyung;Kim, In Young;Lee, Bong;Lee, Sang Jin;Lee, Young Moo;Lee, Hai Bang;Lee, Ilwoo
    • Macromolecular Research
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    • v.10 no.3
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    • pp.158-167
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    • 2002
  • In order to endow with new bioactive functionality from small intestine submucosa (SIS) powder as natural source to poly (L-lactide) (PLA) and poly (lactide-co-glycolide) (PLGA) synthetic biodegradable polymer, porous SIS/PLA and SIS/PLGA as natural/synthetic composite scaffolds were prepared by means of the solvent casting/salt leaching methods for the possibility of the application of tissue engineered bone and cartilage. A uniform distribution of good interconnected pores from the surface to core region was observed the pore size of 40~500 ${\mu}{\textrm}{m}$ independent with SIS amount using the solvent casting/salt leaching method. Porosities, specific pore areas as well as pore size distribution also were almost same. After the fabrication of SIS/PLA hybrid scaffolds, the wetting properties was greatly enhanced resulting in more uniform cell seeding and distribution. Five groups as PGA non-woven mesh without glutaraldehyde (GA) treatment, PLA scaffold without or with GA treatment, and SIS/PLA (Code No.3 ; 1 : 12 of salt content, (0.4 : 1 of SIS content, and 144 ${\mu}{\textrm}{m}$ of median pore size) without or with GA treatment were implanted into the back of nude mouse to observe the effect of SIS on the induction of cells proliferation by hematoxylin and eosin, and von Kossa staining for 8 weeks. It was observed that the effect of SIS/PLA scaffolds with GA treatment on bone induction are stronger than PLA scaffolds, that is to say, in the order of PLA/SIS scaffolds with GA treatment > PLA/SIS scaffolds without GA treatment > PGA nonwoven > PLA scaffolds only with GA treatment = PLA scaffolds only without GA treatment for the osteoinduction activity. The possible explanations are (1) many kinds of secreted, circulating, and extracellular matrix-bound growth factors from SIS to significantly affect critical processes of tissue development and differentiation, (2) the exposure of SIS to GA resulted in significantly calcification, and (3) peri-implant fibrosis due to covalent bonding between collagen molecule by crosslinking reaction. In conclusion, it seems that SIS plays an important role for bone induction in SIS/PLA scaffolds for the application of tissue engineering area.

Development of Predictive Model for Length of Stay(LOS) in Acute Stroke Patients using Artificial Intelligence (인공지능을 이용한 급성 뇌졸중 환자의 재원일수 예측모형 개발)

  • Choi, Byung Kwan;Ham, Seung Woo;Kim, Chok Hwan;Seo, Jung Sook;Park, Myung Hwa;Kang, Sung-Hong
    • Journal of Digital Convergence
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    • v.16 no.1
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    • pp.231-242
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    • 2018
  • The efficient management of the Length of Stay(LOS) is important in hospital. It is import to reduce medical cost for patients and increase profitability for hospitals. In order to efficiently manage LOS, it is necessary to develop an artificial intelligence-based prediction model that supports hospitals in benchmarking and reduction ways of LOS. In order to develop a predictive model of LOS for acute stroke patients, acute stroke patients were extracted from 2013 and 2014 discharge injury patient data. The data for analysis was classified as 60% for training and 40% for evaluation. In the model development, we used traditional regression technique such as multiple regression analysis method, artificial intelligence technique such as interactive decision tree, neural network technique, and ensemble technique which integrate all. Model evaluation used Root ASE (Absolute error) index. They were 23.7 by multiple regression, 23.7 by interactive decision tree, 22.7 by neural network and 22.7 by esemble technique. As a result of model evaluation, neural network technique which is artificial intelligence technique was found to be superior. Through this, the utility of artificial intelligence has been proved in the development of the prediction LOS model. In the future, it is necessary to continue research on how to utilize artificial intelligence techniques more effectively in the development of LOS prediction model.