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Surgical Treatment for Acute, Severe Brain Infarction

  • Park, Je-On;Park, Dong-Hyuk;Kim, Sang-Dae;Lim, Dong-Jun;Park, Jung-Yul
    • Journal of Korean Neurosurgical Society
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    • v.42 no.4
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    • pp.326-330
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    • 2007
  • Objective : Stroke is the most prevalent disease involving the central nervous system. Since medical modalities are sometimes ineffective for the acute edema following massive infarction, surgical decompression may be an effective option when medical treatments fail. The present study was undertaken to assess the outcome and prognostic factors of decompressive surgery in life threatening acute, severe, brain infarction. Methods : We retrospectively analyzed twenty-six patients (17 males and 9 females; average age, 49.7yrs) who underwent decompressive surgery for severe cerebral or cerebellar infarction from January 2003 to December 2006. Surgical indication was based on the clinical signs such as neurological deterioration, pupillary reflex, and radiological findings. Clinical outcome was assessed by Glasgow Outcome Scale (GOS). Results : Of the 26 patients, 5 (19.2%) showed good recovery, 5 (19.2%) showed moderate disability, 2 (7.7%) severe disability, 6 (23.1%) persistent experienced vegetative state, and 8 (30.8%) death. In this study, the surgical decompression improved outcome for cerebellar infarction, but decompressive surgery did not show a good result for MCA infarction (30.8% overall mortality vs 100% mortality). The dominant-hemisphere infarcts showed worse prognosis, compared with nondominant-hemisphere infarcts (54.5% vs 70%). Poor prognostic factors were diabetes mellitus, dominant-hemisphere infarcts and low preoperative Glasgow Coma Scale (GCS) score. Conclusion : The patients who exhibit clinical deterioration despite aggressive medical management following severe cerebral infarction should be considered for decompressive surgery. For better outcome, prompt surgical treatment is mandatory. We recommend that patients with severe cerebral infarction should be referred to neurosurgical department primarily in emergency setting or as early as possible for such prompt surgical treatment.

The Relative Effects of the Feedback Delivery Method(Face-to-Face vs. e-mail) and Reinforcement History on Quality Control Work Performance (피드백 제공방식과 강화 경험이 품질관리 수행에 미치는 효과)

  • Chae, Song-Hwa;Oah, She-Zeen
    • The Journal of the Korea Contents Association
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    • v.16 no.9
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    • pp.117-126
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    • 2016
  • This study examined the relative effects of different feedback delivery method (face-to-face vs. e-mail) and reinforcement history on work performance. Participants were asked to work on a simulated mobile phone assembly task. They performed for 30 minutes per session and attended 4 sessions. The dependents variable was the percentage of correctly completed work tasks. Of 100 participants recruited, 50 had a reinforcement history and another 50 had no reinforcement history with the feedback provider in this study. The participants in each group were randomly assigned into two experimental conditions: face-to-face feedback and e-mail feedback. The results showed that for the participants who had reinforcement history, the two feedback delivery methods did not produce a significant difference in the percentage of correctly completed work tasks. However, for those who had no reinforcement history, the two feedback methods did produce a significant difference.

The Effect of the Vitamin Protocol for Treating Sepsis or Septic Shock in Pediatric Intensive Care Unit (패혈증 및 패혈성 쇼크로 진단 받은 소아 중환자에서 vitamin protocol의 효과 비교)

  • Ko, Hyun Jung;Jung, Min Jae;Kim, Jae Song;Son, Eun Sun;Yu, Yun Mi
    • Korean Journal of Clinical Pharmacy
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    • v.30 no.3
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    • pp.161-168
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    • 2020
  • Background: Recently, a study comprising adult patients with sepsis admitted in the intensive care unit (ICU) was conducted. The patients were treated with high doses of intravenous ascorbic acid, thiamine, and hydrocortisone; the clinical outcomes demonstrated significant therapeutic benefits. The mortality rate in children with sepsis is approximately 25%. However, the effects of additional treatment with ascorbic acid and thiamine ("vitamin protocol") in children are rarely investigated. Methods: A retrospective analysis was performed using medical records of patients diagnosed with sepsis and admitted to the pediatric ICU (PICU) between September 2016 and June 2019. The control group received treatment only as per sepsis protocol, whereas the treated group received both sepsis protocol and the vitamin protocol. The primary endpoint was change in Vasoactive-Inotropic Score (VIS) for 5 days. The secondary endpoints included the length of stay in the PICU, duration of using mechanical ventilators and vasopressors, and mortality rate. Results: The number of patients in the treated and control groups was 33 and 24, respectively. The treated group showed greater decrease in their VIS for 5 days than the control group (44.4 vs 18.6); however, the difference was not statistically significant. The length of stay in the PICU was significantly longer for the treated group than for the control group [10.0 days (Interquartile range (IQR), 6-18) vs 4.5 days (IQR, 4-10.3); p=0.004]. Conclusions: No significant treatment benefits were observed following vitamin protocol administration to the pediatric patients with sepsis. Further studies are necessary for improving the efficacy and safety of the vitamin protocol.

Spade-Shaped Anastomosis Following a Proximal Gastrectomy Using a Double Suture to Fix the Posterior Esophageal Wall to the Anterior Gastric Wall (SPADE Operation): Case-Control Study of Early Outcomes

  • Han, Won Ho;Eom, Bang Wool;Yoon, Hong Man;Ryu, Junsun;Kim, Young-Woo
    • Journal of Gastric Cancer
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    • v.20 no.1
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    • pp.72-80
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    • 2020
  • Purpose: Proximal gastrectomy (PG) is a function-preserving surgery in cases of proximally located early-stage gastric cancer. Because gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall to the proximal part of the anterior stomach wall to produce an anti-reflux mechanism; we named this the SPADE operation. This study aimed to show demonstrate the clinical outcomes of the SPADE operation and compare them to those of previous PG cases. Materials and Methods: Case details of 56 patients who underwent PG between January 2012 and March 2018 were retrospectively reviewed: 30 underwent conventional esophagogastrostomy (CEG) anastomosis using a circular stapler, while 26 underwent the SPADE operation. Early postoperative clinical outcome-related reflux symptoms, endoscopic findings, and postoperative complications were compared in this case-control study. Results: Follow-up endoscopy showed more frequent reflux esophagitis cases in the CEG group than in the SPADE group (30% vs. 15.3%, P=0.19). Similarly, bile reflux (26.7% vs. 7.7%, P=0.08) and residual food (P=0.01) cases occurred more frequently in the CEG group than in the SPADE group. In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while 3 patients (10%) had severe reflux symptoms. In the SPADE group, 3 patients (11.5%) had mild reflux symptoms, while 1 had severe reflux symptoms (absolute difference, 31.8%; 95% confidence interval, 1.11-29.64; P=0.01). Conclusions: A novel modified EG, the SPADE operation, has the potential to decrease gastroesophageal reflux following a PG.

Prognostic Significance of Nestin Expression in pT1 High-Grade Bladder Urothelial Carcinoma Patients Treated with Intravesical BCG

  • Sen, Volkan;Bozkurt, Ozan;Demir, Omer;Tuna, Burcin;Yorukoglu, Kutsal;Ellidokuz, Hulya;Mungan, Ugur
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.24
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    • pp.10813-10817
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    • 2015
  • Background: Possible roles of nestin expression in terms of predicting intravesical BCG therapy response in T1 high grade bladder cancer patients were investigated. Materials and Methods: T1 high grade bladder cancer patients who were treated with intravesical BCG between 1990-2009 were included. Immunohistochemical staining for nestin expression was performed. Nestin(+) and nestin(-) patients were compared in terms of recurrence and progression rates. Results: Sixty-three patients were included and median follow-up time was twenty-five months. After staining; 33 patients (52.4%) were classified as nestin (+) and 30 (47.6%) as (-). Nestin (+) patients were more likely to recur compared to nestin (-) patients (60.6% vs. 30%, p<0.05). Progression rates were also higher in nestin (+) patients, although this result did not reach statistical significance (15.2 % vs. 10 %, p=0.710). Conclusions: Nestin expression, which seems effective in predicting recurrence, appears to have a potential role in the urothelial carcinoma tumorigenesis. Patients with high grade bladder cancer and positive nestin expression need close follow-up and might be informed about more tendency to recur. Further comprehensive studies including larger patient cohorts may clarify the role of nestin in bladder cancer.

The role of salvage radiotherapy in recurrent thymoma

  • Yang, Andrew Jihoon;Choi, Seo Hee;Byun, Hwa Kyung;Kim, Hyun Ju;Lee, Chang Geol;Cho, Jaeho
    • Radiation Oncology Journal
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    • v.37 no.3
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    • pp.193-200
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    • 2019
  • Purpose: To explore the role of salvage radiotherapy (RT) for recurrent thymoma as an alternative to surgery. Materials and Methods: Between 2007 and 2015, 47 patients who received salvage RT for recurrent thymoma at Yonsei Cancer Center were included in this study. Recurrent sites included initial tumor bed (n = 4), pleura (n = 19), lung parenchyma (n = 10), distant (n = 9), and multiple regions (n = 5). Three-dimensional conformal and intensity-modulated RT were used in 29 and 18 patients, respectively. Median prescribed dose to gross tumor was 52 Gy (range, 30 to 70 Gy), with equivalent doses in 2-Gy fractions (EQD2). We investigated overall survival (OS), progression-free survival (PFS), and patterns of failure. Local failure after salvage RT was defined as recurrence at the target volume receiving >50% of the prescription dose. Results: Median follow-up time was 83 months (range, 8 to 299 months). Five-year OS and PFS were 70% and 22%, respectively. The overall response rate was 97.9%; complete response, 34%; partial response, 44.7%; and stable disease, 19.1%. In multivariate analysis, histologic type and salvage RT dose (≥52 Gy, EQD2) were significantly associated with OS. The high dose group (≥52 Gy, EQD2) had significantly better outcomes than the low dose group (5-year OS: 80% vs. 59%, p = 0.046; 5-year PFS: 30% vs. 14%, p=0.002). Treatment failure occurred in 34 patients; out-of-field failure was dominant (intra-thoracic recurrence 35.3%; extrathoracic recurrence 11.8%), while local failure rate was 5.8%. Conclusion: Salvage RT for recurrent thymoma using high doses and advanced precision techniques produced favorable outcomes, providing evidence that recurrent thymoma is radiosensitive.

Studies on Development of Breeding Technique to Increase Hanwoo(Bos taurus coreanae) I. Survey of Reproductive Status and Effect of Intraovarian $\textrm{PGF}_{2a}$ Administration on Luteolysis and Subsequent Estrus Induction (한우의 신속한 증식을 위한 번식기술 개발에 관한 연구 I. 한우 번식실태 및 $\textrm{PGF}_{2a}$의 난소실질 내 투여효과)

  • 이병천
    • Journal of Embryo Transfer
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    • v.15 no.1
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    • pp.77-83
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    • 2000
  • The purpose of this study was to develop a breeding technique to increase Hanwoo of superior characteristics. In the present study, reproductive status of Hanwoo such as size of farm, breeding system and gestationi length was investigated. In addition, effect of low dose administration of prostaglandin F2$\alpha$(PGF2$\alpha$) on luteolysis was examined. The size of farm was classified by the total number of cows and the number of breeding stocks, respectively. The distribution of herd size of < 5, 6~10, 11~30, 31~50 and > heads was 31%, 15%, 39%, 4% and 11%, respectively. Furthermore, the distribution of breeding stock size of <5, 6~10, 11~30, 31~50 and > 50 heads was 36%, 28%, 31%, 3% and 3%, respectively. Average parity was 2.1 in breeding stock. In breeding pattern, artificial in semination(A.I), estrus synchronization-A.I and natural mating was 92.7%, 2.4% and 4.9% respectively. Gestational length of Hanwoo was ranged 253~316 days (average length : 285 days) after estrus( estrus=0). To induce luteolysis, PGF2$\alpha$ was injected into ovarian parenchyma by a modified ovarian injector. The effect of administration of 6mg PGF2$\alpha$ on luteolysis and estrus induction was betweer (P<0.01) when PGF2$\alpha$ was administered into ovarian parechyma than when administered intramuscluarly (71 vs. 91%). When PGF2$\alpha$ was injected into ovarian parenchyma, a decreased concentration to 3 mg did not significantly decreaed its luteolytic effect(92%). When AI was performed following PGF2$\alpha$ treatment, the intraovarian injection group yielded a higher pregnancy rate(69 vs. 88%) than the IM injection groups, regardless of the dosage. In conclusion these results suggest that increasing herd size and regular reproductive management are needed to improve reproductive efficiency in Hanwoo industry. Furthermore, intraovarian administration of PGF2$\alpha$ is effective way to induce luteolysis compared with intramuscular injection.

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Microalbuminuria in children with urinary tract infection

  • Kwak, Byung-Ok;Chung, So-Chung;Kim, Kyo-Sun
    • Clinical and Experimental Pediatrics
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    • v.53 no.9
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    • pp.840-844
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    • 2010
  • Purpose: Microalbuminuria is defined as increased urinary albumin excretion (30-300 mg/day) or microalbumin/creatinine ratio (30-300 mg/g) in a spot urine sample. Although microalbuminuria is a predictor of clinical nephropathy and cardiomyopathy, few studies have investigated microalbuminuria in children with urinary tract infection (UTI). Therefore, we compared the spot urine microalbumin/creatinine ratio in pediatric UTI patients with that of control subjects. Methods: We investigated the correlation between the ratio in children with UTI and age, height, weight, blood pressure, glomerular filtration rate (GFR), hematuria, vesicoureteral reflux, renal parenchymal defect, and renal scar, and its predictability for UTI complications. Results: We studied 66 patients (42 boys, 24 girls) and 52 healthy children (24 boys, 28 girls). The mean microalbumin/creatinine ratio in UTI patients was statistically significantly increased compared to the control group ($340.04{\pm}321.36mg/g$ vs. $225.68{\pm}154.61mg/g$, $P$=0.0141). The mean value of spot urine microalbumin/creatinine ratio ($384.70{\pm}342.22mg/g$ vs. $264.92{\pm}158.13mg/g$, $P$=0.0341) in 1-23 months age patient group showed statistically significant increase compared to control group. Microalbumin/creatinine ratio showed negative correlation to age (r=-0.29, $P$=0.0167), body surface area (BSA) (r=-0.29, $P$=0.0173) and GFR (r=-0.26, $P$=0.0343). The presence of hematuria ($P$=0.0169) was found to be correlated. Conclusion: The spot urine microalbumin/creatinine ratio in children with UTI was significantly greater than that in normal children, and it was positively correlated with GFR. This ratio is a potential prescreening and prognostic marker in UTI patients. Further studies are required to validate the predictability of microalbuminuria in pediatric UTI patients.

Gender Differences in the Relationship between Alcohol Use Behaviors and Metabolic Syndrome - Korean National Health and Nutrition Examination Survey (KNHANES) V 2010 - (성별에 따른 알코올사용행태와 대사증후군과의 관계 - 제5기 2010년 국민건강영양조사 자료를 이용하여 -)

  • Ryu, Ji Young;Kim, Dae-Hwan
    • Korean Journal of Health Education and Promotion
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    • v.30 no.1
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    • pp.83-93
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    • 2013
  • Objectives: The objective of this study was to assess the gender differences in the relationship between alcohol use behaviors and the risk of metabolic syndrome among Korean adult population. Methods: Data from the Korean National Health and Nutrition Examination Survey (5th, 2010) was analyzed. Using the Alcohol Use Disorders Identification Test, subjects were classified into 4 groups including non-drinking, low-risk drinking, medium-level alcohol problem, and high-level alcohol problem group. Metabolic syndrome and its components were compared among the alcohol behavior groups by gender. Results: The odds ratio vs. non-drinking group for metabolic syndrome was significantly higher in male medium and high-level alcohol problem group. In female, high-level alcohol problem group showed significantly higher odds ratio for metabolic syndrome. Blood pressure and HDL-cholesterol were likely to be higher with the excessive drinking behaviors in both men and woman. Triglyceride level in men was significantly higher in the medium and high-level alcohol problem group than non-drinking group. Although fasting glucose level did not show differences among drinking groups, the odd ratios vs. non-drinking group for the hyperglycemia (${\geq}$ 100mg/dl) were significantly higher in female drinking groups. Conclusions: Problematic alcohol drinking is likely to increase the risk of metabolic syndrome in Korean adults.

Thermal and Electrical Properties of Poly(vinylidenefluoride-hexafluoropropylene)-based Gel-Electrolytes (Poly(vinylidenefluoride-hexafluoropropylene)계 겔-전해질의 열적, 전기적 특성)

  • 김영완;최병구;안순호
    • Polymer(Korea)
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    • v.24 no.3
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    • pp.382-388
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    • 2000
  • Polymer electrolyte films consisting of poly(vinylidenefluoride-hexafluoropropylene) (PVdF-HFP), LiClO$_3$ and a mixture of ethylene carbonate (EC) and ${\gamma}$-butyrolactone (GBL) were examined in order to obtain the best compromise between high ionic conductivity, homogeniety, dimensional and electrochemical stability. Measurements of ionic conductivity, differential scanning calorimetry and linear sweep voltammetry have been carried out for various compositions. The highest conductivity of 3.8$\times$10$^{-3}$ S$cm^{-1}$ / at 3$0^{\circ}C$ were obtained for a film of 30(PVdF-HFP)+7.8LiClO$_4$+62.2EC/GBL. From the DSC study, it has been found that the PVdF-HFP gels are stable up to 10$0^{\circ}C$, and the salt lowers the melting temperature of crystalline part of PVdF by interacting sensitively with polymer segments. When Lithium metal is in contact with the gel films, it tends to undergo corrosion and the reaction products accumulate resulting in the formation of a passive film on Li electrode. As the aging time progresses, the interfacial resistance increases continuously. Anodic stability is measured to extend up to about 4.5 V vs. Li.

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