• Investigative Magnetic Resonance Imaging
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• v.24 no.3
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• pp.132-140
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• 2020

Purpose: To retrospectively determine whether specialized magnetic resonance imaging (MRI) reading performed by an experienced radiologist affected the successful assessment of extraprostatic extension (EPE) in the presence of biopsy-related hemorrhage after prostate biopsy. Materials and Methods: Two hundred consecutive patients with biopsy-proven prostate cancer underwent MRI. General radiologist and subspecialized radiologist readings were unpaired and reviewed in random order by a radiologist who was blinded to patients' clinical details and histopathologic data. The extent of hemorrhage was assessed on T1-weighted (T1W) MRI using a 1-4 scale, and the likelihood of EPE was assessed for each of the four categories. Histopathologic specimens served as the reference standard. The area under the curve (AUC) of the standard reading was compared to that of the specialized reading. Results: Post-biopsy hemorrhage was subjectively graded as ≥ 3 in 101 patients (50.5%) by standard reading, and in 100 patients (50.0%) by specialized reading. The standard and specialized readings disagreed for 40 (20.7%) of the patients (kappa [κ] = 0.35; 95% CI, 0.14-0.48). Of these, specialized reading was the correct interpretation for 21 patients (52.5%). The sensitivity (75% vs. 44%; P = 0.002) and area under the receiver operating characteristics (AUROC) (0.83 vs. 0.67; P = 0.008) of the specialized readings were significantly higher than those of the standard readings, while there was no significant difference in specificity (84% vs. 87%; P = 0.434). Conclusion: The reinterpretation of MRI by experienced radiologists significantly improves the diagnosis of EPE in prostate cancer in the presence of post-biopsy hemorrhage.

• Journal of Korean Neurosurgical Society
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• v.52 no.5
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• pp.441-446
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• 2012

Objective : Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH. Methods : Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and ${\geq}70$ years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and ${\geq}70$ years of age). Results : Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (${\geq}70$ years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus. Conclusion : In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.51-59
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• 2021

Objective : Several studies have reported inconsistent findings among countries on whether off-hour hospital presentation is associated with worse outcome in patients with acute stroke. However, its association is yet not clear and has not been thoroughly studied in Korea. We assessed nationwide administrative data to verify off-hour effect in different subtypes of acute stroke in Korea. Methods : We respectively analyzed the nationwide administrative data of National Emergency Department Information System in Korea; 7144 of ischemic stroke (IS), 2424 of intracerebral hemorrhage (ICH), and 1482 of subarachnoid hemorrhage (SAH), respectively. "Off-hour hospital presentation" was defined as weekends, holidays, and any times except 8:00 AM to 6:00 PM on weekdays. The primary outcome measure was in-hospital mortality in different subtypes of acute stroke. We adjusted for covariates to influence the primary outcome using binary logistic regression model and Cox's proportional hazard model. Results : In subjects with IS, off-hour hospital presentation was associated with unfavorable outcome (24.6% off hours vs. 20.9% working hours, p<0.001) and in-hospital mortality (5.3% off hours vs. 3.9% working hours, p=0.004), even after adjustment for compounding variables (hazard ratio [HR], 1.244; 95% confidence interval [CI], 1.106-1.400; HR, 1.402; 95% CI, 1.124-1.747, respectively). Off-hours had significantly more elderly ≥65 years (35.4% off hours vs. 32.1% working hours, p=0.029) and significantly more frequent intensive care unit admission (32.5% off hours vs. 29.9% working hours, p=0.017) than working hours. However, off-hour hospital presentation was not related to poor short-term outcome in subjects with ICH and SAH. Conclusion : This study indicates that off-hour hospital presentation may lead to poor short-term morbidity and mortality in patients with IS, but not in patients with ICH and SAH in Korea. Excessive death seems to be ascribed to old age or the higher severity of medical conditions apart from that of stroke during off hours.

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.1-5
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• 2007

Objective : We studied whether frontal skull base fracture has an impact on the occurrence and recovery of anosmia and/or ageusia following frontal traumatic brain injury (TBI). Methods : Between May 2003 and April 2005, 102 consecutive patients who had hemorrhage or contusion on the frontal lobe base were conservatively treated. Relevant clinical and radiographic data were collected, and assessment of impaired smell and taste sensation were also surveyed up to at least 12 months post-injury. Results : Among 102 patients, anosmia was noted in 22 (21.6%), of whom 10 had ageusia at a mean 4.4 days after trauma. Bilateral frontal lobe injuries were noted in 20 of 22 patients with anosmia and in all 10 patients with ageusia. Frontal skull base fracture was noted in 41 patients, of whom 9 (21.4%) had anosmia and 4 (9.5%) had ageusia. There was no statistical difference in the occurrence of anosmia and ageusia between patients with or without fracture. Of the 22 patients with anosmia, recovery from anosmia occurred in nine (40.9%) at the interval of 6 to 24 months after trauma, of whom six had frontal skull base fracture and three were not associated with fracture. Recovery of anosmia was significantly higher in patients without fracture than those with fracture (p<0.05). Recovery from ageusia occurred in only two of 10 patients at the interval of 18 to 20 months after trauma and was not eminent in patients without fracture. Conclusion : One should be alert and seek possibile occurrence of the anosmia and/or ageusia following frontal TBI. It is suggested that recovery is quite less likely if such patients have fractures on the frontal base, and these patients should wait for at least 6 to 18 months to anticipate such recovery if there is no injury to the central olfactory structures.

• Clinical and Experimental Pediatrics
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• v.46 no.11
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• pp.1067-1072
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• 2003

Purpose : Non-accidental intracranial hemorrhage in children is not low in incidence and results in high mortality and serious sequelae. So, the authors have researched the distribution of sex and age, causes, symptoms and signs, hemorrhagic types, mortality rate and sequelae of the patients hospitalized with non-accidental intracranial hemorrhage at Hallym University Sacred Heart Hospital. Methods : The medical records of twenty patients, aged 15 or younger, and excluding neonatal patients, were analyzed retrospectively. The patients in this study were admitted with non-accidental intracranial hemorrhage from January 1999 to June 2002. Results : Of the twenty cases, the ratio of male to female was 1 : 0.8. The patients aged one or less and between 11 and 15 were discovered to be the most frequent cases. Shaken baby syndrome and arteriovenous malformation were found to be the most frequent causes. Seizure was most frequently found to be a symptom and a sign. Hemorrhagic type was classified into subdural hemorrhage eight, intracerebral hemorrhage five. There were three mortal cases. Twelve surviving patients, excluding five not-followed ones, were reclassified into six cases of complete recovery and six of sequalae. Conclusion : Non-accidental intracranial hemorrhage in children is not low in incidence, with a high mortality rate and a high incidence of serious sequelae after survival. Consequently, early diagnosis and appropriate treatment are required. In addition, appropriate rehabilitation after treatment is needed because the high survival rate due to advanced medical treatment results in an increasing number of neurologic sequelae.

• The Korean Journal of Physiology and Pharmacology
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• v.8 no.2
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• pp.89-94
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• 2004

The arterial pressure is regulated by the nervous and humoral mechanisms. The neuronal regulation is mostly carried out by the autonomic nervous system through the rostral ventrolateral medulla (RVLM), a key area for the cardiovascular regulation, and the humoral regulation is mediated by a number of substances, including the angiotensin (Ang) II and vasopressin. Recent studies suggest that central interleukin-1 (IL-1) activates the sympathetic nervous system and produces hypertension. The present study was undertaken to elucidate whether IL-1 and Ang II interact in the regulation of cardiovascular responses to the stress of hemorrhage. Thus, Sprague-Dawley rats were anesthetized and both femoral arteries were cannulated for direct measurement of arterial pressure and heart rate (HR) and for inducing hemorrhage. A guide cannula was placed into the lateral ventricle for injection of IL-1 $(0.1,\;1,\;10,\;20\;ng/2\;{\mu}l)$ or Ang II $(600\;ng/10\;{\mu}l)$. A glass microelectrode was inserted into the RVLM to record the single unit spike potential. Barosensitive neurons were identified by an increased number of single unit spikes in RVLM following intravenous injection of nitroprusside. I.c.v. $IL-1\;{\beta}$ increased mean arterial pressure (MAP) in a dose-dependent fashion, but HR in a dose-independent pattern. The baroreceptor reflex sensitivity was not affected by i.c.v. $IL-1\;{\beta}$. Both i.c.v. $IL-1\;{\alpha}\;and\;{\beta}$ produced similar increase in MAP and HR. When hemorrhage was induced after i.c.v. injection of $IL-1\;{\beta}$, the magnitude of MAP fall was not different from the control. The $IL-1\;{\beta}$ group showed a smaller decrease in HR and a lower spike potential count in RVLM than the control. MAP fall in response to hemorrhage after i.c.v. injection of Ang II was not different from the control. When both IL-1 and Ang II were simultaneously injected i.c.v., however, MAP fall was significantly smaller than the control, and HR was increased rather than decreased. These data suggest that IL-1, a defense immune mediator, manifests a hypertensive action in the central nervous system and attenuates the hypotensive response to hemorrhage by interaction with Ang II.

• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.281-287
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• 2011

Objective : Pituitary apoplexy is life-threatening clinical syndrome caused by the rapid enlargement of a pituitary tumor due to hemorrhage and/or infarction. The pathogenesis of pituitary apoplexy is not completely understood. We analyzed the magnetic resonance imaging (MRI) of pituitary tumors and subsequently correlated the radiological findings with the clinical presentation. Additionally, immunohistochemistry was also performed to determine whether certain biomarkers are related to radiological apoplexy. Methods : Thirty-four cases of pituitary adenoma were enrolled for retrospective analysis. In this study, the radiological apoplexy was defined as cases where hemorrhage, infarction or cysts were identified on MRI. Acute clinical presentation was defined as the presence of any of the following symptoms: severe sudden onset headache, decreased visual acuity and/or visual field deficit, and acute mental status changes. Angiogenesis was quantified by immunohistochemical expression of fetal liver kinase 1 (Flk-1), neuropilin (NRP) and vascular endothelial growth factor (VEGF) expression, while microvascular density (MVD) was assessed using Endoglin and CD31. Results : Clinically, fourteen patients presented with acute symptoms and 20 for mild or none clinical symptoms. Radiologically, fifteen patients met the criteria for radiological apoplexy. Of the fifteen patients with radiologic apoplexy, 9 patients presented acute symptoms whereas of the 19 patient without radiologic apoplexy, 5 patients presented acute symptoms. Of the five biomarkers tracked, only VEGF was found to be positively correlated with both radiological and nonradiological apoplexy. Conclusion : While pituitary apoplexy is currently defined in cases where clinical symptoms can be histologically confirmed, we contend that cases of radiologically identified pituitary hemorrhages that present with mild or no symptoms should be designated subacute or subclinical apoplexy. VEGF is believed to have a positive correlation with pituitary hemorrhage. Considering the high rate of symptomatic or asymptomatic pituitary tumor hemorrhage, additional studies are needed to detect predictors of the pituitary hemorrhage.

• The Journal of Internal Korean Medicine
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• v.39 no.2
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• pp.165-175
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• 2018

Purpose: To report on a patient with subarachnoid hemorrhage and deep vein thrombosis treated with a combination of Korean and Western medicine. Methods: A patient diagnosed with subarachnoid hemorrhage and deep vein thrombosis was treated with herbal medicine (加減淸熱瀉濕湯 (Gagam-cheongyeolsaseub-tang)), acupuncture (GV2, GB20, LI11, LI4, TE5, GB34, ST36, SP9, ST38, GB39, SP6, LR3), moxibustion (CV6, CV9), and Western medicine for deep vein thrombosis and subarachnoid hemorrhage. To evaluate edema, one of the classic symptoms of deep vein thrombosis, we measured leg circumference at a specified time. Results: After taking Gagam-cheongyeolsaseub-tang and being treated with acupuncture, moxibustion, and Western medicine, the patient showed improvement in leg edema. The left calf circumference decreased from 37.5 cm to 34.5 cm. Conclusions: Korean medicine, acupuncture, moxibustion, and Western medicine may provide effective treatment for deep vein thrombosis in patients with subarachnoid hemorrhage, but further study is needed.

• The Journal of Korean Medicine
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• v.15 no.2 s.28
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• pp.28-39
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• 1994

Clinical studies were made on 79 cases with thalamic hemorrhage diagnosed by computed tomographic scan and only localized on the thalamic area, were admitted to the Kyung San University Taegu Oriental Medical Hospital from August 1990 to March 1994. The age and sex distribution, sites of hematoma, recurrence rate, incidence of hypertension, inducing factor, prodromal syndroms, symptoms and neurologic signs on admission, relationship between the hospital course and many factors affecting the prognosis such as age, side of hematoma, level of consciousness, volume of the hematoma. ventricular hemorrhage were analysed. The results were summarized as follows; 1. The most prevalent age group was above 60 years of age with 50-59 years, 70-79 years, 40-49 years and 80-89 years of age in the order of frequency. Male to female ratio was 1:1.55. 2. The ratio of left hematoma to the right was 1.32:1. The recurrence rate of cerebrovascular accident was 17.7% 3. The incidence of hypertension was 69.6% and inducing factors of thalamic hemorrhage in the order of frequency were physical work(29.1%), drinking or eating(13.9%), walking(12.7%) and rest(12.7%), The prodromal syndroms were numbness of extremities(5.1%), headache(2.5%), fatigue(2.5%), dizziness(1.3%), insomnia(1.3%), but prodromal syndrom was not found in 89.9% of thalamic hemorrhage. 4. The symptoms and neurologic signs on admission in the order of frequency were motor disturbance(98.7%), dysarthria(82.3%), positive Babinski sign(78.5%), headache(69.6%), dizziness(62.0%). hemisensory deficit(48.1%). nausea or vomiting(39.2%), absent or sluggish light reflex(35.4%), changes of consciousness (35.4%), dysphagia (20.3%), voiding difficulty.(13.9%), facial palsy(6.3%), aphasia(3.8%), seizure(38%), 6th N. palsy(3.8%) and small pupil(1.3%). 5. The rate of improvement was found almost equally in the 4th, 5th and 6th decades, but it was shown with dramatic decrease in the over 7th decades. The hospital course had no relationship with the side of hematoma but the level of consciousness had influence upon the prognosis. 6, The small hematoma had better outcome than large in the volume of hematoma under 15cc, but volume of the hematoma had no influence upon the prognosis because the rate of improvement was 75.0% in the volume of hematoma over 15cc. The hospital course had no relationship with ventricular hemorrhage.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.117-124
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• 1976

Hemorrhage into the biliary system as a consequence of injury to the liver has been called "traumatic hemobilia," a term introduced by Sandblom in 1948. The source of gastrointestinal hemorrhage has been frequently misinterpreted, resulting in inadequate or inappropriate treatment, often with catastrophic results and needless fatalities. It is now being diagnosed with increasing frequency, due to more widespread knowledge of the syndrome and improved diagnostic means. we experienced 2 cases of hemobilia following blunt chest trauma, One patient had! multiple rib fractures on right chest by car traffic accident and 13 days later, suddenly massive melena was developed with nausea, vomiting, jaundice and severe pain on right upper quadrant. And so, he had operated on the ligation of Rt. hepatic artery and partial right hepatectomy for a traumatic hemobilia. The other one also revealed similar symptoms 20 days later following blunt chest injury by falling down accident. However, uneventful recovery was seen without any of surgical intervention in this case.