• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.216-231
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• 2007

Background : An acceleration or deceleration of the heart rate (HR), which reflects autonomic effects, is observed before the onset of paroxysmal atrial fibrillation (PAF). The purpose of this study was to assess the discrepancy in the autonomic interactions before the onset of PAF for different patterns of change in the HR. Materials and Methods : From 105 Holter tapes with the PAF recorded, 55 episodes (42 patients, 34 men, $58{\pm}12$ years) of PAF (>5 min), preceded by a sinus rhythm for more than 1 hour, were selected and submitted to time-domain and frequency-domain HR variability analyses. Fifty-five episodes were divided into 2 groups: group A PAF (n=30) with acceleration of the HR during the last 2 minutes before the PAF and group B (n=25) with deceleration of the HR. Results : A significant linear decrease in the mean R-R interval was observed in group A ($924{\pm}30$ to $835{\pm}28ms$, $P$=0.001) and an increase from $831{\pm}32$ to $866{\pm}31ms$ in group B PAF episodes ($P$=0.046). In the frequency-domain analyses, the LF/HF ratio exhibited a progressive linear increase before the PAF in group A ($P$=0.005). The HF normalized units (HFnu) and natural logarithm-transformed HF ($In$HF) values decreased from $30.8{\pm}4.0$ to $16.1{\pm}1.8$ ($P$=0.003) and $4.49{\pm}0.25$ to $4.07{\pm}0.22$ ($P$=0.001), respectively. Contrary to the results in group A, a significant increase in the HF components (HFnu and $In$HF) (from $22.6{\pm}3.2$ to $30.2{\pm}4.0$, $P$=0.005, and $4.27{\pm}0.27$ to 4.75 0.33, $P$=0.001, respectively) and a resultant decrease in the LF/HF ratio were observed in group B PAF episodes. No significant changes were observed in the LF components in either PAF group. Conclusion : Autonomic stimuli leading to an acceleration or deceleration of the HR before the onset of AF are due to parasympathetic modulation. Parasympathetic modulation plays a key role in the initiation of PAF.

• Tuberculosis and Respiratory Diseases
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• 제44권2호
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• pp.290-297
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• 1997

Background : Despite remarkable progress of understanding the pathophysiology and therapy of bronchial asthma, asthma morbidity and mortality are on the rise. Also hospitalization and attending rates of emergency department for asthma have been increasing gradually. We analyzed clinical characteristics and prognosis of patients who visited emergency room due to asthma attack in order to define clinical characteristics of these group of patients. Method : We reviewed 105 adult asthmatic patients who attended emergency department of Korea University Hospital between August 1995 and July 1996, retrospectively. Results : 103 patients(56 female, 47 males, mean age : 48.6 years) attended-68 self referral, 18 practitioner referral and 17 OPD transfer- and 86 patients(83.5%) were admitted. Attending emergncy department was clearly more frequent in December(13.6%) and May(12.6%). Time lag between onset of asthmatic attack and arrival at the hospital was $14.2{\pm}15.5$ hour and initial peak expiratory flow rate was $166.7{\pm}68.3L/min$.(43.3% predicted) The commonest cause for visiting emergency room was aggravation of asthma due to upper respiratory tract infection in mild asthmatics. About half of them had history of previous ER visits. Their prognosis was not bad, but after discharge, about half of patients escaped from OPD follow-up. Conclusion : As a group they merit detailed attention and follow up arrangement. Clinician need to monitor and review the treatment plans, the medications, the patient's management technique, and the level of asthma control. For this group, plans for longer term treatment, including asthma education program and adjustment of overall treatment plan should be made.

• The Korean Journal of Nuclear Medicine
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• 제34권4호
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• pp.312-321
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• 2000

Purpose: The aim of this study was to determine whether crossed cerebellar hyperperfusion (CCH) was helpful in discriminating mesial from lateral temporal lobe epilepsy (TLE) and what other factors were related in the development of CCH on ictal brain SPECT. Materials and Methods: We conducted retrospective analysis in 59 patients with TLE (M:41, F:18; $27.4{\pm}7.8$ years old; mesial TLE: 51, lateral TLE: 8), which was confirmed by invasive EEG and surgical outcome (Engel class I, II). All the patients underwent ictal Tc-99m HMPAO brain SPECT and their injection time from ictal EEG onset on video EEG monitoring ranged from 11 sec to 75 sec ($32.6{\pm}19.5sec$) in 39 patients. Multiple factors including age, TLE subtype (mesial TLE or lateral TLE), propagation pattern (hyperperfusion localized to temporal lobes, spread to adjacent lobes or contralateral hemisphere) and injection time were evaluated for their relationship with CCH using multiple logistic regression analysis Results: CCH was observed in 18 among 59 patients. CCH developed in 29% (15/51) of mesial TLE patients and 38% (3/8) of lateral TLE patients. CCH was associated with propagation pattern; no CCH (0/13) in patients with hyperperfusion localized to temporal lobe, 30% (7/23) in patients with propagation to adjacent lobes, 48% (11/23) to contralateral hemisphere. Multiple logistic regression analysis revealed that propagation pattern (p=0.01) and age (p=0.02) were related to the development of CCH. Conclusion: Crossed cerebellar hyperperfusion in ictal brain SPECT did not help differentiate mesial from lateral temporal lobe epilepsy. Crossed cerebellar hyperperfusion was associated with propagation pattern of temporal lobe epilepsy and age.

• The Journal of Korea Assosiation for Disability and Oral Health
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• 제9권1호
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• pp.51-55
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• 2013

Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is defined by generalized multiple type seizures, slowness of intellectual growth, and a specific EEG disturbance. Children affected might previously have infantile spasms or underlying brain disorder but etiology can be idiopathic. LGS seizures are often treatment resistant and the long term prognosis is poor. A 14-year-3-month old, 20.5 kg girl with LGS was scheduled for dental treatment under general anesthesia. The patient presented with multiple caries and heavy calculus. General anesthesia was induced and maintained with inhalation agent, Sevoflurane. And caries treatment, scaling, subgingival curretage were performed. LGS patients usually have poor oral hygiene due to mental retardation and have high risk of seizure during dental treatment. In dental treatment under general anesthesia for LGS, it must be considered of seizure control during peri-operative period. Also periodic recall check, instruction of oral hygiene must be performed.

• Clinical and Experimental Pediatrics
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• 제49권5호
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• pp.529-532
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• 2006

Purpose : To study the spectrum of epilepsy in children with cerebral palsy. Methods : A total of 93 consecutive patients with cerebral palsy(CP) were retrospectively suited. Criteria for inclusion were a follow-up period of at least 2 years. The study examined the correlation between the incidence of epilepsy and seizure types in the different forms of CP. Other factors associated with epilepsy, such as age of first seizure, occurrence of abnormalities on brain imaging, and electroencephalogram were also analyzed. Results : The overall prevalence of epilepsy in children with CP was 46.2 percent. The incidence of epilepsy was predominant in patients with mixed, diplegic, and quadriplegic palsies : 55.5 percent, 51.6 percent, and 50.0 percent in frequency. The first seizure occurred during the first year of life in 48.8 percent of patients with epilepsy. Generalized tonic-clonic seizures were the most common seizure type(44.2 percent), predominant in diplegic patients(64.3 percent). On the other hand, infantile spasms and myoclonic seizures were the main cause of seizures among quadriplegic children(60 percent and 40 percent, respectively). The occurrence of epilepsy was more popular in the group with abnormal brain imagings; especially encephalomalacia and cortical atrophy. All children with epilepsy in this study showed abnormal electroencephalogram(EEG) findings: Generalized abnormalities were observed in 55.8 percent of children with epilepsy; more dominantly in quadriplegic children(80.0 percent); and 40 percent of children with diplegia showed focal abnormalities. Conclusion : Cerebral palsy is associated with a higher incidence of seizure disorders, which, in the majority, has its onset in the first year of life; brain imaging and EEG are most effective in spotting epilepsy in children with CP.

• The Korean Journal of Nuclear Medicine
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• 제25권1호
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• pp.17-26
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• 1991

뇌 혈류의 기능적 영상화는 간질병소의 국소화에 이용되고 있으며 측두엽성간질의 편측화에 여러가지 진단 방법이 이용되고 있으나 만족할만한 결과를 보이지 못하고 있다. 최근 PET또는 SPECT를 이용하여 측두엽성간질에서 발작 간에 측두엽 병소의 대사율 및 혈류의 감소가 나타나며, 이러한 소견은 발작 유발 병소의 편측화에 매우 유용할것이라는 보고들이 있다. 저자들은 측두엽성간질에서 간질 병소를 편측화 하는데에 $^{99m}Tc-HMPAO$ SPECT의 유용성을 평가 하고자 측두엽성간질 31예에서 발작 간의 $^{99m}Tc-HMPAO$ SPECT 소견, 뇌파, 자기 공명 영상 및 전산화 단층 소견을 비교하였다. SPECT 소견에 따른 나이, 병력 기간과 병발시 나이 등의 임상 지수 간에는 유의한 차이가 없었다. 31예의 환자중 23예에서(74.2%) 국소 뇌 혈류 감소를 보였으며 17예(54.8%)에서 측두엽에 관류 감소가 관찰 되었다. 비인두 뇌파 표준 뇌파는 24예(77.4%)에서 측두엽에 편측화를 보였으며 SPECT와 뇌파 양자가 모두 편측화된 경우 일치도는 8/12예 (66.7%) 였다. 16예에서 시행된 전산화 단층 영상은 모두 편측화를 보이지 못했으며 27예에서 시행된 자기 공명 영상에서는 단지 1예에서 편측화를 보였다. 이상의 결과로서 발작 간의 $^{99m}Tc-HMPAO$ SPECT는 측두엽성간질 병소의 편측화에 유용한 보조 검사로 생각된다.

• The Korean Journal of Nuclear Medicine
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• 제29권4호
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• pp.445-450
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• 1995

The epileptogenic zones should be localized precisely before surgical resection of these zones in intractable epilepsy. The localization is more difficult in patients with neocortical epilepsy than in patients with temporal lobe epilepsy. This study aimed at evaluation of the usefulness of ictal brain perfusion SPECT for the localization of epileptogenic zones in neocortical epilepsy. We compared the performance of ictal SPECT with MRI referring to ictal scalp electroencephalography(sEEG). Ictal $^{99m}Tc$-HMPAO SPECT were done in twenty-one patients. Ictal EEG were also obtained during video monitoring. MRI were reviewd. According to the ictal sEEG and semiology, 8 patients were frontal lobe epilepsy, 7 patients were lateral temporal lobe epilepsy, 2 patients were parietal lobe epilepsy, and 4 patients were occipital lobe epilepsy. Ictal SPECT showed hyperperfusion in 14 patients(67%) in the zones which were suspected to be epileptogenic according to ictal EEG and semiology. MRI found morphologic abnormalities in 9 patients(43%). Among the 12 patients, in whom no epileptogenic zones were revealed by MRI, ictal SPECT found zones of hyperperfusion concordant with ictal SEEG in 9 patients(75%). However, no zones of hyperperfusion were found in 4 among 9 patients who were found to have cerebromalacia, abnormal calcification and migration anomaly in MRI. We thought that ictal SPECT was useful for localization of epileptogenic zones in neocortical epilepsy and especially in patients with negative findings in MRI.

• The Korean Journal of Nuclear Medicine
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• 제28권1호
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• pp.17-21
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• 1994

We studied 115 patients with seizure who had been performed brain SPECT, brain MRI or CT and EEG. To evaluate the pattern of brain SPECT in seizure patients 28 of them had secondary epilepsies, 87 had primary epilepsies. In primary epilepsies, 42 were generalized seizure and 45 were partial seizure. The causes of secondary epilepsies were congenital malformation, cerebromalacia, cerebral infarction, multiple sclerosis, AV-malformation, granuloma and etc, in order. In 28 secondary epilepsies, 25 of them, brain SPECT lesions was concordant with MRI or CT lesions, 3 were disconcordant. The brain SPECT findings of generalized seizure were normal in 22 patients, diffuse irregular decreased perfusion in 8, decreased in frontal cortex in 4, temporal in 5 and frontotemporal in 3. In 45 partial seizure, 19 brain SPECT were concordant with EEG (42.4%).

• Journal of Veterinary Clinics
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• 제28권3호
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• pp.323-327
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• 2011

A Jindo dog (8-month-old, intact male) was referred for hind limb lameness on the right side. The dog was diagnosed with a simple femoral fracture by radiological examination. After surgical fixation of the femoral fracture, tramadol: a narcotic-like synthetic analgesic was intravenously administrated for post-operative analgesia. After injection of the tramadol, generalized tonic clonic seizure was immediately occurred in the dog. Seventeen hours later, the dog died despite intensive care. We suspected that tramadol might induce the seizurogenic effect resulted in death. A necropsy was performed to examine the cause of the death. In consequence, the dog was diagnosed as necrotizing meningoencephalitis (NME) based on histopathological examination. We would be concerned that tramadol may be related to seizure activity in the NME patient. From this case, it is known that although tramadol has been proven to be a safe and effective agent for the control of pain in veterinary medicine, it would be carefully used to patient with history of neurological diseases including meningoencephalitis, hydrocephalus, and encephalopathy.

• Journal of Yeungnam Medical Science
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• 제18권2호
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• pp.267-276
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• 2001

Background: P wave dispersion(PWD) is defined as the difference between the maximum and minimal P wave duration in any of the 12 leads of the surface ECG. The prolongation of atrial conduction time and the inhomogeneous propagation of sinus impulse are known electrophysiologic features in patients with paroxysmal atrial fibrillation(PAF). The purpose of this study was to determine the role of P wave dispersion for the prediction of PAF and to evaluate the effectiveness of prophylactic antiarrhythmic therapy. Materials and Methods: The study population included 20 patients with a history of idiopathic PAF and 20 age and sex matched healthy control subjects. We measured the maximum P wave duration(P maximum) and P wave dispersion from 12 lead ECG. Results: P maximum and P dispersion in idiopathic PAF were significantly higher than normal control group($97.2{\pm}12$, $48.5{\pm}9$ msec vs, $76.5{\pm}11$, $21{\pm}8$ msec, respectively p<0.001, <0.001). After 12-month follow up period P maximum and P dispersion were significantly reduced than those of initial state($77.2{\pm}13$, $26.4{\pm}9$ msec vs. $97.2{\pm}12$, $48.5{\pm}9$ msec, respectively p<0.001,<0.001). Conclusion: P dispersion and P maximum were significantly different between patients with idiopathic PAF and healthy control group. Those are easily accessible, non-invasive simple electrocadiographic markers that could be used for the prediction and prognostic factors of idiopathic PAF.