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Treatment of Unruptured Intracranial Aneurysms in South Korea in 2006 : A Nationwide Multicenter Survey from the Korean Society of Cerebrovascular Surgery

  • Kim, Jeong-Eun;Lim, Dong-Jun;Hong, Chang-Ki;Joo, Sung-Pil;Yoon, Seok-Mann;Kim, Bum-Tae
    • Journal of Korean Neurosurgical Society
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    • v.47 no.2
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    • pp.112-118
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    • 2010
  • Objective : There have been no clinical studies regarding the epidemiology and treatment outcome for unruptured intracranial aneurysm (UIA) in South Korea yet. Thus, The Korean Society of Cerebrovascular Surgery (KSCVS) decided to evaluate the clinical and epidemiological characteristics, and outcome of the treatment of UIA in 2006, using the nationwide multicenter survey in South Korea. Methods : A total of 1,696 cases were enrolled retrospectively over one year at 48 hospitals. The following data were obtained from all patients : age, sex, presence of symptoms, location and size of the aneurysm, treatment modality, presence of risk factors for stroke, and the postoperative 3D-day morbidity and mortality. Results : The demographic data showed female predominance and peak age of seventh and sixth decades. Supraclinoid internal carotid artery was the most common site of aneurysms with a mean size of 5.6 mm. Eight-hundred-forty-six patients (49.9%) were treated with clipping, 824 (48.6%) with coiling, and 26 with combined method. The choice of the treatment modalities was related to hospital (p=0.000), age (p=0.000), presence of symptom (p=0.003), and location of aneurysm (p=0.000). The overall 30-day morbidity and mortality were 7.4% and 0.3%, respectively. The 30-day mortality was 0.4% for clipping and 0.2% for coiling, and morbidity was 8.4% for clipping and 6.3% for coiling. Age (p=0.010), presence of symptoms (p=0.034), size (p=0.000) of aneurysm, and diabetes mellitus (p=0.000) were significant prognostic factors, while treatment modality was not. Conclusion : This first nation-wide multicenter survey on UIAs demonstrates the epidemiological and clinical characteristics, outcome and the prognostic factors of the treatment of UIAs in South Korea. The 30-day postoperative outcome for UIAs seems to be reasonable morbidity and mortality in South Korea.

Elliptical Centric Techniques and Tricks About the Usefulness of the Clinical Application (Elliptical Centric과 TRICKS 기법의 임상 적용에 관한 유용성 연구)

  • Kim, Sae-Ssak;Goo, Eun-Hoe;Dong, Kyung-Rae;Kweon, Dae-Chel;Lee, Jae-Seung;Cho, Jae-Hwan;Park, Chang-Hee
    • Korean Journal of Digital Imaging in Medicine
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    • v.13 no.2
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    • pp.83-90
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    • 2011
  • To prospectively determine the diagnostic performance a combination of standard bolus-chase magnetic resonance (MR) angiography and MR angiography with time-resolved imaging of contrast kinetics (TRICKS) for depicting severity of the head and neck vascular diseases. Over a period of two months, A total of 100 patients(average ages : $50{\pm}8$, male : 60, female : 40) with head and neck vascular diseases were performed on the GE excite 3.0 T units with 8-channel head coil and 4-channel NV coil. Imaging parameters for a typical study were as follow: SBC(TR/ TE/ FA/ SliceThicken./ Slab/ Freq./ FOV/ BW/Scan Time) = 5.4/ min/ 30/ 2/ zip2/ 70/ $224{\times}448$/ 30/ 62.50/ 28, TRICKS(TR/ TE/ FA/ Slice Thicken/Slab/ Freq./ FOV/ BW/ Temp Res./ Scan Time = 3.6/ min/ 25/ 4/ 30/ $160{\pm}384$, zip512/ 30/ 100/ 1 to 1.5/ 23). The analysis of all MR images, which have respect-ively classified two techniques into some diseases. The results of the former were divided into two groups(SBC, TRICKS)with 4 grading of two reader, respectively. Wilcoxon signed rank test was used to determine if a significant difference between imaging techniques existed(p < 0.05). In 33 of 100 patients, arterio-venous malformation was 11% at TRICKS, subclavian vein stenosis : 8%, fistular sinus : 4%, jugular vein stenosis:6%, Middle Cerebral Artery bypass surgery : 4%, p < 0.05). The rest of 67 patients were considered as the results of SBC(14% in the basilar artery stenosis, carotid stenosis : 16%, vertebral stenosis : 17%, central neuro-cytoma : 5%, meningioma : 5%, Not appliable : 10%, p < 0.05). Sensitivity and specificity of TRICKS MR angiography in SVS, FS, JVS, MCABS were improved compared with those at standard MR angiography. In SBS MR angiography which were improved in BAS, CS, VS, CN, Meningioma. In conclusion, TRICKS MR angiography of the SVS, FS, JVS, MCABS is superior to standard MR angiography regarding the number of diagnostic grading. The SBS MR angiography were improved in BAS, CS, VS, CN, Meningioma. and assessment of the degree of luminal narrowing on both TRICKS and SBS.

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Effect of Korean Red Ginseng Extract on Blood Circulation in Healthy Volunteers: A Randomized, Double-Blind, Placebo-Controlled Trial (건강한 지원자에서 홍삼농축액의 혈행 개선 효과: 무작위, 이중맹검, 위약-대조 시험)

  • Shin, Kyeong-Seob;Lee, Jung-Jin;Kim, Yeong-Il;Yu, Ji-Yeon;Park, Eun-Seok;Im, Ji-Hyun;You, Soon-Hyang;Oh, Ki-Wan;Lee, Myung-Koo;Wee, Jae-Joon;Kim, Young-Sook;Yun, Yeo-Pyo
    • Journal of Ginseng Research
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    • v.31 no.2
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    • pp.109-116
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    • 2007
  • Korean red ginseng has broad efficacious effects against hypertension, diabetes, nociception, and cancer, and it counteracts weakness. It has been reported that Korean red ginseng is able to normalize blood pressure, improve cholesterol and lower blood glucose levels. We have recently reported that Korean red ginseng extract (KRGE) significantly prevented rat carotid arterial thrombosis in vivo, and inhibited platelet aggregation ex vivo and in vitro in a dose-dependent manner. The purpose of this study was to examine the effects of KRGE on blood circulation in human by measuring ex vivo platelet aggregation, plasma coagulation and serum lipid profiles in healthy volunteers. Subjects were randomly divided into three groups (placebo-group, KRGE-low dose group, KRGE-high dose group). Administration of KRGE to subjects significantly inhibited ADP-induced platelet aggregations both in KRGE-low dose group from $72.79{\pm}20.53$ to $62.00{\pm}23.06%$ (p=0.0009), and in KRGE-high dose group from $75.14{\pm}21.86$ to $64.52{\pm}24.72%$ (p=0.0039), respectively. Administration of KRGE to subjects also significantly inhibited collagen-induced platelet aggregations both in KRGE-low dose group from $85.52{\pm}12.57$ to $79.62{\pm}20.47%$ (p=0.0916), and in KRGE-high dose group from $80.24{\pm}18.11$ to $70.31{\pm}25.93%$ (p=0.0565), respectively. Whereas, KRGE has no significant effects on coagulation system, such as prothrombin time (PT) and activated partial thromboplastin time (APTT), and serum lipid profiles, such as total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride. KRGE also has no significant effects on hematological and serum biochemical profiles. These results suggest that KRGE has a potential to improve blood circulation through antiplatelet activity in human, and KRGE intake may be beneficial for the individuals with high risks of thrombotic and cardiovascular diseases.

NON SURGICAL TREATMENT OF SOFT PALATE LACERATION (연구개 열창의 비외과적 처치술)

  • Chae, Kyu-Ho;Choi, Byung-Jai;Choi, Hyung-Jun;Son, Heung-Kyu
    • Journal of the korean academy of Pediatric Dentistry
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    • v.29 no.3
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    • pp.450-454
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    • 2002
  • Laceration of soft palate and oropharynx is relatively common in children. Soft palate laceration has been reported patients of all ages, ranging from new born to geriatric patients. However, young children often place objects their mouth, they may fall on the object or receive a direct force on the object which then perforates the soft palate tissue. Most frequently affected site is the left supra-tonsillar area. Lesions are predominately in the soft palate with-out perforation. Linear and superficial wounds are frequent. A typical injury is the flat- U-, or V-shaped with apex directed anteriorly. In those cases without any through-and-through lacerations or any tissue loss, suture is not necessary. Furthermore, suture of the affected site may hinder wound healing. Healing of the wound should be complete by three weeks with minimal scarring. There have been reports of carotid artery injury due to soft palate laceration causing neurologic complications. For such reasons, traumatized child must be in close observation for 2-3days, and if symptoms of complication are noticed consultation with oromaxillofacial surgeons, E.N.T., or neurologist is required. These are two reports of boys 2 and 3 years of age who had soft palate laceration caused by a falling-down-in jury with an object in their mouth. They were treated non-surgically and neurologic evaluation was carried out for 1 week with complete healing.

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A Study on Images of the Pulse Diagnosis (맥진(脈診)에 관한 도상(圖像)연구)

  • Han, Bong-Jae
    • Korean Journal of Oriental Medicine
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    • v.15 no.2
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    • pp.101-109
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    • 2009
  • The Pulse diagnosis is in the boundary of the Four Examinations, and it is called 切診, or palpation. It has a great impact on people in reminding of the Traditional Medicine that it is probably the first thing that people think of when they hear about Traditional Medicine. Hu-Jun quoted in the Treasured Mirror of Eastern Medicine "東醫寶鑑" that the doctor finds out the deficiency and the excess of the meridian of the patiant through the pulse, and that it is of the utmost necessity to know the "deficiency and the excess" of the meridian to decide the formula (君臣佐使) of the herbal medicine and the acupuncture/moxibustion treatment. The research on the studies of pulse diagnosis have been concentrated on the origin, history, and the theory of the pulse diagnosis throughout the years; however, the number of research on the image from the classics on pulse diagnosis have been less. With this in mind, this paper was written to study more on the origin and the history of the pulse diagnosis as well as to study on the image of pulse diagnosis shown on the classics on Traditional Medicine in China and Korea. The history of the pulse diagnosis has its root on the attempt to find out what is happening inside the body through the indication of the small changes of the pulse that is shown on the outer boundaries of the body. There were various kinds of pulse diagnosis including "Three positions and nine indicators method" and "Carotid pulsation and wrist pulse method" in the ancient period, and wrist pulse-taking method became the most popular since the completion of studying on palpation by 初보. The image of the palpation helps the rudimentary practitioners of Traditional Medicine. They are divided into two large categories, which are the area of diagnosis and the shape of the pulse itself. The historical classics including the image of the pulse diagnosis can be found since the Song Dynasty of China. There are various kinds of image of pulse diagnosis in the classic such as "The picture of the hand meridian" from "脈訣指掌病式圖說", "The picture of the image of meridian" from "察病指南", "The picture of the Seven exterior and Eight interior" from "校正圖注脈訣", and "The picture of the six parts of meridian" from Treasured Mirror of Eastern Medicine "東醫寶鑑". The Treasured Mirror of Eastern Medicine "東醫寶鑑" have analyzed the basic theories and made up the standards of pulse diagnosis by establishing "The picture of the six parts of meridian" based on "The method of placing the viscera and bowels corresponding to cun-guan-qi, or the meridian".

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The Analysis of Cerebral Aneurysm's Prone position Using Computed Tomography Equipment (전산화단층촬영장치를 이용한 뇌동맥류의 호발부위 분석)

  • Lee, Seon-Tae;Lim, Jong-Soo;Park, Jeong-Kyu
    • Journal of Digital Contents Society
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    • v.12 no.3
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    • pp.271-277
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    • 2011
  • This research studied 249 patients who has an aneurysm and went through computerized CT angiography at S University Hospital in Northern Kyung-sang area from October 1st 2008 to September 30th 2010, and the results are the following. Among total 249 of research objects, 159 women (63.9%) showed higher distribution than 90 men (36.1%) The order of the distribution of aneurysm classified by blood vessel is the following. Posterior communicating artery 34.9% as the highest, internal carotid artery 21.7%, middle cerebral artery of 15.7%, anterior communicating artery 14.5%, posterior cerebral artery and posterior cerebral artery channel 3.6% each, anterior cerebral artery and vertebral artery 2.4% each, and posterior inferior cerebellar artery 1.2%. As a result of analysis of distribution of aneurysm classified by gender, there was no case of posterior cerebral artery and posterior cerebral artery channel among men, and there was no case of posterior inferior cerebellar artery among women. Distribution of aneurysm classified by vessel according to gender showed no statistic significance. (p<0.05). And distribution of aneurysm classified by vessel according to the age, showed no statistic significance. (p>0.05), After applying post analysis to understand the group with age difference, the significance was the highest among the group of 61-70, (4.21), and the group of the age under 30 was the lowest. (2.0) There was statistic significance on the distribution of aneurysm classified by vessel according to the season. (p<0.05). After applying post-analysis in order to understand the groups with difference between seasons, it was found that fall was the highest (4.55) and spring was the lowest. (2.50)

Effects of Crude Saponin and Saponin-free Fraction of Korea Red Ginseng on the Skin and Cerebral Blood Flow in the Rats (백서의 피부 및 뇌혈류에 미치는 고려홍삼 사포닌 및 비사포닌의 영향)

  • Kim, Shin-Hee;Kim, Cuk-Seong;Park, Jin-Bong;Han, Chan-Soo;Kim, Kwang-Jin;Kim, Shin-Hye;Kim, Se-Hoon;Nam, Ki-Yeul;Jeon, Byeong-Hwa
    • Journal of Ginseng Research
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    • v.26 no.3
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    • pp.132-138
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    • 2002
  • To study the effect of Korea red ginseng (KCG) on the skin and cerebral blood flow, we evaluated the change of skin perfusion rate and cerebral perfusion rate after the intravenous, intraperitoneal, and oral administration of crude saponin (CS) and saponin-free fraction (SFF) of KRG in the rats. The change of skin perfusion rate and cerebral perfusion rate was measured laser doppler flowmetry. The intravenous injections of CS or SFF of KRG and intraperitoneal injection of SFF of KRG did not change the relative skin and cerebral blood flow in the rats. When the rats were treated by the intraperitoneal injection of CS of KRG, relative cerebral blood flow was significantly increased with a time-dependent manner, however, relative skin blood flow was not influenced by the them. Oral administration of CS of KRG slightly increased skin blood flow in the rats. Also, the change of cerebral blood flow by transient bilateral carotid arterial clamp in the CS-treated rats was significantly decreased, compared with control groups. From the above results, it was suggested that Korea red ginseng have a increasing property of cerebral blood flow in the rats.

Cerebral Blood Flow as Measured by TCD in Hyperlipidemic Group (TCD를 이용한 정상군과 고지혈증군의 혈류측정에 관한 비교연구)

  • Park, Sun-Mi;Kim, Young-Kyun;Kwon, Jung-Nam;Shin, Woo-Jin;Son, Yeon-Hui;Jeong, Hyun-Yun;Han, Hyun-Young;Park, Ga-Young
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.23 no.6
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    • pp.1513-1520
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    • 2009
  • The purpose of this study was to compare cerebral blood flow between hyperlipidemic patient group and normal healthy aldult group using transcranial doppler ultrasonography(TCD). I investigated cerebral blood flow of 63 hyperlipidemic patients and 42 healthy adults. To evaluate the cerebral blood flow, I measured the systolic peak velocity(Vs) and mean flow velocity(Vm) of the milddle cerebral artery(MCA), anterior cerebral artery(ACA), posterior cerebral artery(PCA), basilar artery(BA), internal carotid artery(ICA) in the two groups using TCD. In normal healthy adults, subjects showed a decerease in Vs and Vm with advancing in age. There was a significant difference in the Vm of ICA. There was no significant differences in the Vm of ACA and ICA. In normal healthy adults, females showed high velocities of all examined vessel. There was a significant difference in the Vs of ICA. There was a significant differences in the Vm of MCA and ICA. Normal healthy adults higher than hyperlipidemic patients in the Vs of MCA, ACA, PCA. There was no significant difference in the Vs of all exmined vessels. Hyperlipidemic patientsincrease higher than normal healthy adults in the Vm of ACA. There was a significant difference in the Vs of BA. In the patients aged under 50's, normal healthy adults higher than hyperlipidemic patients in the Vs and Vm except BA. But there was no significant difference in all exmined vessels. In the patients aged over 50's, hyperlipidemic patients higher than normal healthy adults in all examined vessel expect PCA. There was a significant difference in the Vs of BA and ICA. And hyperlipidemic patients higher than that normal healthy adults in all exmined vessels. There was a significant difference in BA and ICA. In this study, visible differences in blood flow between hyperlipidemic patient group and normal healthy aldult group were shown. However, these results do not come up to the previous values that were reported and known worldwide.

Rheographic View of the Change in the Renal Blood Flow in Acute Hemorrhage (Rheogram으로 본 실혈시 신장혈액유통 변화)

  • Chang, Se-Gu;Shin, Dong-Hoon
    • The Korean Journal of Physiology
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    • v.5 no.1
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    • pp.59-69
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    • 1971
  • Studies were undertaken on the changes in the renal blood flow by relating them with the alterations in the amplitudes in the rheogram of rabbits. The changing pattern of the electrical conductivity was recorded by means of the needle electrodes inserted into the kidney and the surrounding aluminium foil which was grounded. The Impedance Rheograph manufactured by the Narco Company was used. The small artifact which persisted after ligation of the renal vessels was subtracted from the value obtained in each pulsatile wave in the rheogram. The animals were nembutalized intravenously, 30 mg/kg. A plastic canule was inserted into the carotid artery and the arterial blood pressure was monitored continuously with the pressure transducer connected to the physiograph. Stepwise bleedings were performed on the animal. The first bleeding was between 13 to 18 ml in the amount, and it was folowed by consecutive hemorrhages, 5 or 10 ml each time. The total amount of bleeding was summed as much as 1.5-2% of the body weight. Two minutes fter each bleeding th arterial blood pressure, ECG and the rheogram were taken. That was the necessary time to obtain the stabilized picture of each parameter. After closing the bleeding process, the shed blood was retransfused into the animal and the response in the renal blood flow was observed as well as the arterial blood pressure. Particularly the presence or absence of the autoregulatory mechanism in the situation of the hemorrhage was also studied. The results obtained were as follows: 1. In 7 cases out of 22, that was about one third of the total number of experiments, the autoregulatory mechanism of the renal blood flow persisted even in acute hemorrhage, and the decreases in the renal blood flow were less than 10% of the control values even when the arterial blood pressure dropped to 66-87% of the original value obtained before the bleeding. 2. Because of the stepwise bleeding the exact blood pressure at which the renal blood flow reduced as much as one third of the control value could not be obtained. However, the results revealed that the approximate pressure, expressed as percentage of the control value, was 50-60% in 3 cases, 61-70% in 4 cases and 71-80% in 8 cases. In one case the decrease in the renal blood flow exceeded one third of the control value before the pressure dropped to 80% of the control. 3. In 19 cases the decreases in the renal blood flow exceeded one half of the control values by hemorrhage. Then the arterial blood pressure revealed less than 40% of the control value in 6-cases. In 2 cases the pressure was 51-60% of the control pressure. In 5 cases the range of bleed pressure was 61-70%, and in e remaining 6 cases the pressure ranged from 71 to 80% of e control value. 4. Out of 15 cases of retransfusion after definite decreases in the renal blood flow loller·ing the hemorrhage, 9 cases restored their renal blood flow. On the contrary 6 cases showed low values even when the shed blood was retransfused. 5. Theories concerning the mechanism of the autoregulation of the renal blood flow were reviewed for the purpose of explanation of the results obtained. However, there are much to be done before greater satisfaction

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Drug Delivery into the Blood-Brain Barrier by Endogenous Substances-A Role of Amine and Monocarboxylic Acid Carrier Systems for the Drug Transport- (내인성물질의 수송계를 이용한 혈액-뇌관문에의 약물송달V-약물의 혈액-뇌관문 투과성에 대한 염기성 아민 및 모노카르본산 수송계의 역할-)

  • Kang, Young-Sook
    • Journal of Pharmaceutical Investigation
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    • v.20 no.4
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    • pp.223-228
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    • 1990
  • The contribution of endogenous transport systems to the blood-brain barrier (BBB) transport of basic and acidic drugs was studied by using a carotid injection technique in rats and an isolated bovine cerebrovascular disease state were compared between the normotensive rats (WKY) and stroke-prone spontaneously hypertensive rats (SHRSP) which have been well established as an animal model with pathogenic similarities to humans. Basic drugs such as eperisone, thiamine and scopolamine inhibited, in a concentration dependent manner the in vivo uptake of $[{^3}H]choline$ through BBB, whereas amino acids and acidic drugs such as salicylic acid and valproic acid did not inhibit the uptake. The uptake of $[^3H]choline$ by B-CAP increased with time and showed a remarkable temperature dependency. The uptake of $[^3H]choline$ by B-CAP showed the very similar inhibitory effects as observed in the in vivo brain uptake, and was competitively inhibited by a basic drug, eperisone. The in vivo BBB uptakes of $[^3H]acetic$ acid and $[^{14}C]salicylic$ acid were dependent on pH of the injectate and the concentration of drugs. Several acidic drugs such such as salicylic acid, benzoic acid and valproic acid inhibited the in vivo uptake of $[^3H]acetic$ acid, whereas amino acid, choline and a basic drug such as eperisone did not inhibit the uptake. The uptake of acetic acid by B-CAP was competitively inhibited by salicylic acid. The permeability surface area product (PS) through BBB for $[^3H]choline$ in SHRSP was significantly lower than that in WKY. The concentration of choline in the brain dialysate in SHRSP was about half of that in WKY, while no significant difference was observed in the plasma concentration of choline between SHRSP and WKY. No significant difference was observed in the transport of monocarboxylic acids, glucose and neutral amino acid through BBB between SHRSP and WKY. From these results, it was concluded that BBB transport system of choline contributes to the transport of basic drugs through BBB, that acidic drugs can be transported via a moncarboxylic acid BBB transport system and that the specific dysfuntion of the BBB choline transport in SHRSP was ascribed to the reduction of the maximum velocity of choline concentration in the brain interstitial fluids.

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