• Journal of Korean Neurosurgical Society
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• 제49권5호
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• pp.287-289
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• 2011

Thalamoperforating artery aneurysms are rarely reported in the literature. We report an extremely rare case of ruptured distal anterior thalamoperforating artery aneurysm which was treated by endovascular obliteration in a patient with occlusion of both the internal carotid arteries (ICAs) : A 72-year-old woman presented with severe headache and loss of consciousness. Initial level of consciousness at the time of admission was drowsy and the Glasgow Coma Scale score was 14. Brain computed tomography (CT) scan was performed which revealed intracerebral hemorrhage in right basal ganglia, subarachnoid hemorrhage, and intraventricular hemorrhage. The location of the aneurysm was identified as within the globus pallidus on CT angiogram. Conventional cerebral angiogram demonstrated occlusion of both the ICAs just distal to the fetal type of posterior communicating artery and the aneurysm was arising from right anterior thalamoperforating artery (ATPA). A microcatheter was navigated into ATPA and the ATPA proximal to aneurysm was embolized with 20% glue. Post-procedural ICA angiogram demonstrated no contrast filling of the aneurysm sac. The patient was discharged without any neurologic deficit. Endovascular treatment of ATPA aneurysm is probably a more feasible and safe treatment modality than surgical clipping because of the deep seated location of aneurysm and the possibility of brain retraction injury during surgical operation.

• 대한골관절종양학회지
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• 제12권2호
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• pp.136-140
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• 2006

골반골은 악성 골종양의 원발 병소 중 예후가 가장 나쁜 위치이다. 그 중에서도 치골결합 주위에서 발생한 악성 골종양은 그 자체가 극히 드물며, 이곳에 발생한 연골육종은 크기가 작은 경우에도 해부학적인 위치 때문에 절제에 어려움이 있다. 저자들은 치골에 생긴 골반강내 연골육종을 양측 치골지의 절골술 후 도달법으로 전 절제가 가능하였으며, 술후 양호한 기능적 결과를 보였기에 보고하는 바이다.

• 대한방사선치료학회지
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• 제22권2호
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• pp.75-83
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• 2010

목 적: 간과 간 내에 생긴 암이 위내의 크기, 위치변화에 따라 종양의 위치변화와 경향성을 평가하기 위함이다. 방법 및 고찰: 2009년 3월부터 2010년 4월까지 강남세브란스병원을 내원한 간 종양을 가진 환자 중 CT-simulation (컴퓨터 단층촬영을 이용한 모의치료)을 하기 전 2주 내에 컴퓨터단층촬영이나 양전자컴퓨터단층촬영영상을 가진 환자 9명을 대상으로 하였으며, CT-simulation는 6시간 공복을 유지하고, 영상융합을 위한 컴퓨터단층촬영이나 양전자컴퓨터단층촬영은 촬영직전에 240~260 cc 가량의 물을 섭취하도록 하였다. 두 종류의 영상은 RTP (Radiation Treatment Planning, Pinnacle 8.0 h)에서 각각 환자의 뼈 구조를 중심으로 영상융합을 하였다. 결 과: 물 섭취양은 240~260 cc로 일정하였으나 물 섭취 후 위장의 크기는 259.3 cc부터 495.4 cc로 다양하였으며, 두 가지 다른 상태에서 찍은 컴퓨터단층촬영들에서 나타난 위장의 부피변화는 개인의 차이는 있지만, 평균 130 cc 정도의 부피증가가 측정되었으며, 이는 평균 174%의 증가에 해당된다. 종합적인 종양 중심점의 절대거리는 0.52 cm에서 3.04 cm으로 평균 1.52 cm의 움직임을 보였으며, 머리-다리(Cranial-Caudal)방향으로는 0.1 cm에서 1.35 cm으로 평균 0.44 cm의 움직임을 보였고, 왼-오른(Left-Right)방향으로는 0.05 cm에서 2.75 cm으로 평균 1.22 cm의 움직임을 보였고, 배-등(Ventral-Dorsal)방향으로는 0.05 cm에서 1.85 cm으로 평균 0.33 cm의 움직임을 보였다. 결 론: 개인차가 커서 위장의 운동을 관찰하여 종양의 움직임을 예측하는 것은 힘들지만 위장이 채워짐에 따라, 복잡한 경로를 통해 간 종양의 위치가 오른쪽으로 치우치는 것이 관찰되었다. 이에 간종양 치료 시 치료 정확도를 확보하기 위하여 공복상태를 유도하는 것을 권장한다. 반면 공복상태가 어려울 경우 환자의 위장의 부피와 움직임을 측정하여 치료계획 시 간 종양의 움직임을 고려하여 방사선 치료를 할 것을 권장한다.

• 보건행정학회지
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• 제4권1호
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• pp.123-137
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• 1994

The objectives of this research is to find the factors which determined hospital profitability. The unit of analysis is hospital, and the data is collected from two sources. One source is derived from Ministry of Health and Social Affairs(4 years' data from 134 hospitals), and another source is derived from Sam-II Accounting Co.(1 year's data from 37 hospitals). Hospital profitability, which is dependent variable in our research, is measured with financial ration, such as ROI(reture on investment). The major findings are as follows; 1) The hospital profitability is determined with not hospital type itself but management-incentives associated with hospital type. 2) The maximum profitability is obtained in 775 bed-size. 3) The hospital location isn't a factor to determine profitability 4) The internal control and management, such as account receivables, inventory, fixed assert investment, is major factor to hospital profitability.

• 디지털융복합연구
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• 제14권3호
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• pp.261-267
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• 2016

전 세계적으로 사물인터넷(IoT) 기술이 주목을 받으면서 사물 인터넷 기반의 헬스케어, 스마트 시티, 농업, 국방 등의 다양한 서비스 개발이 진행되고 있다. 그러나, IoT를 적용한 헬스케어 서비스는 환자의 생체정보가 제3자에게 유출되어 환자의 생명을 위협하는 상황이 발생할 수 있는 문제가 존재한다. 본 논문에서는 사물 인터넷 기반의 헬스케어 서비스를 제공받는 환자의 생체정보를 제3자에게 유출되지 않으면서 센싱된 데이터 및 자원을 이용하여 치료/행정 처리의 시간 및 절차를 간소화하기 위한 위치추적 센서 기반의 IoT 헬스케어 서비스 관리 모델을 제안한다. 제안 모델은 환자의 위치 정보를 이용하여 병원내 의료진들이 환자의 위치를 실시간으로 확인하고 응급상황이 발생했을 경우에도 신속하게 대응할 수 있다. 또한, 병원 내 의료장비에도 위치추적 센서를 부착해 치료에 필요한 장비들의 위치도 즉각적으로 확인 가능하기 때문에 의료서비스의 시간 및 절차를 최소화할 수 있는 장점이 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권1호
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• pp.347-350
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• 2013

The aim of the present study was to determine whether allogeneic red blood cell transfusions showed a deleterious effect and what might be preoperative risk factors for blood transfusion in patients with TNM stage II colon cancer. Total 470 patients who fulfilled inclusion criteria were selected for a further 10-year follow-up study. We found that there were statistical significance between non-transfused and transfused group in mortality (P=0.018), local recurrence (P=0.000) and distant metastasis (P=0.040). Local recurrence and distant metastasis between 1 to 3 units and more than 3 units group did not show any significant differences. There was no difference in survival rate between non-transfused and 1 to 3 units group (log rank=0.031, P=0.860). The difference between different blood transfusion volume in transfused patients was found (78.77% vs 63.83%, P=0.006). Meanwhile, the significant difference of survival rate was existed between non-transfused group and more than 3 units group (84.83% vs 63.83%, P=0.002 ). Univariate analysis showed the following 3 variables to be associated with an increased risk of allogeneic blood transfusions: preoperative CEA level (P<0.05), location of tumor (P<0.01) and diameter of tumor (P<0.01). Multivariate analysis revealed that location of tumor and diameter of tumor are two independent factors for requirement of perioperative transfusions. Therefore, allogeneic transfusion increase the postoperative tumor mortality, local recurrence and distant metastasis in patients with stage II colon cancer. The postoperative tumor mortality, local recurrence and distant metastasis were not associated with the blood transfusion volume. The blood transfusion volume was associated with the survival rate. Location of tumor and diameter of tumor were the independent preoperative risk factors for blood transfusion.

• Korean Journal of Radiology
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• 제20권1호
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• pp.171-179
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• 2019

Objective: For localization of the motor cortex, seed-based resting-state functional MRI (rsfMRI) uses the contralateral motor cortex as a seed. However, research has shown that the location of the motor cortex could differ according to anatomical variations. The purpose of this study was to compare the results of rsfMRI using two seeds: a template seed (the anatomically expected location of the contralateral motor cortex) and a functional seed (the actual location of the contralateral motor cortex determined by task-based functional MRI [tbfMRI]). Materials and Methods: Eight patients (4 with glioma, 3 with meningioma, and 1 with arteriovenous malformation) and 9 healthy volunteers participated. For the patients, tbfMRI was performed unilaterally to activate the healthy contralateral motor cortex. The affected ipsilateral motor cortices were mapped with rsfMRI using seed-based and independent component analysis (ICA). In the healthy volunteer group, both motor cortices were mapped with both-hands tbfMRI and rsfMRI. We compared the results between template and functional seeds, and between the seed-based analysis and ICA with visual and quantitative analysis. Results: For the visual analysis, the functional seed showed significantly higher scores compared to the template seed in both the patients (p = 0.002) and healthy volunteers (p < 0.001). Although no significant difference was observed between the functional seed and ICA, the ICA results showed significantly higher scores than the template seed in both the patients (p = 0.01) and healthy volunteers (p = 0.005). In the quantitative analysis, the functional seed exhibited greater similarity to tbfMRI than the template seed and ICA. Conclusion: Using the contralateral motor cortex determined by tbfMRI as a seed could enhance visual delineation of the motor cortex in seed-based rsfMRI.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1171-1176
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• 2012

Objective: The current study aimedto screen for possible factors which affect prognosis of chondrosarcoma. Methods: Thirty seven cases were selected and analyzed statistically. The patients received surgical treatment at our hospital between December 2005 and March 2008. All of them had complete follow-up data. The survival rates were calculated by univariate analysis using the Kaplan-Meier method and tested by Log-rank. ${\chi}^2$ or Fisher exact tests were carried out for the numeration data. The significant indexes after univariate analysis were then analyzed by multivariate analysis using COX regression model. Based on the literature, factors of gender, age, disease course, tumor location, Enneking grades, surgical approaches, distant metastasis and local recurrence were examined. Results: Univariate analysis showed that there were significant differences in Enneking grades, surgical approaches and distant metastasis related to the patients' 3-year survival rate after surgery (P<0.001). No significant difference was not found in gender, age, disease course, tumor location or local recurrence (P>0.05). Multivariate analysis showed that Enneking grade (P=0.007) and surgical approaches (P=0.010) were independent factors affecting the prognosis of chondrosarcoma, but distant metastasis was not (P=0.942). Conclusion: Enneking grades, surgical approaches and distant metastasis are risk factors for prognosis of chondrosarcoma, among which the former two are independent factors.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.855-860
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• 2014

Background: The purpose of this study was to assess the relationship between different sonographic features of papillary thyroid carcinoma (PTC) on high-frequency ultrasound and cervical lymph node metastasis (CLNM). Materials and Methods: We enrolled 548 patients who underwent initial surgery for PTC between May 2011 and December 2012 in our hospital at diagnosis. The sonographic features of 513 PTC nodules in 513 eligible patients, who had single PTC nodules in their thyroid glands, were retrospectively investigated. All patients with a suspect malignant nodule (d<0.5cm) among multiple nodules were initially diagnosed by fine-needle aspiration biopsy (FNAB) to ascertain if the suspect nodule was PTC. The final diagnosis of all the thyroid nodules and existence of CLNM were based on postoperative pathology. Patients were divided into two groups: a positive group with CLNM (224 nodules) and a negative group without CLNM (289 nodules). The following factors were investigated: gender, age, echogenicity, echotexture, size, shape, location, margin, contour, calcification morphology, distance between the nodule and pre- or post-border of the thyroid capsule, vascularity and the differences between the two groups. Results: Correlation analysis showed that shorter distances between the nodule and pre- or postborder of thyroid capsule resulted in greater risk of CLNM (Spearman correlation coefficient=-0.22, p<0.0001). The significant factors in multivariate analysis were age<45yrs, larger size (d>1cm), "wider than tall" shape, extrathyroid extension and mixed flow (internal and peripheral) (p<0.05, OR=0.406, 2.093, 0.461, 1.610, 1.322). Conclusions: Significant sonographic features of PTC nodules in preoperative high-frequency ultrasound are crucial for predicting CLNM.

• Journal of Korean Neurosurgical Society
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• 제52권6호
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• pp.523-527
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• 2012

Objective : The incidence of spontaneous spinal epidural hematoma (SSEH) is rare. Patients with SSEH, however, present disabling neurologic deficits. Clinical outcomes are variable among patients. To evaluate the adequate treatment method according to initial patients' neurological status and clinical outcome with comparison of variables affecting the clinical outcome. Methods : We included 15 patients suffered from SSEH. Patients were divided into two groups by treatment method. Initial neurological status and clinical outcomes were assessed by the American Spinal Injury Association (ASIA) impairment scale. Also sagittal hematoma location and length of involved segment was analyzed with magnetic resonance images. Other factors such as age, sex, premorbid medication and duration of hospital stay were reviewed with medical records. Nonparametric statistical analysis and subgroup analysis were performed to overcome small sample size. Results : Among fifteen patients, ten patients underwent decompressive surgery, and remaining five were treated with conservative therapy. Patients showed no different initial neurologic status between treatment groups. Initial neurologic status was strongly associated with neurological recovery (p=0.030). Factors that did not seem to affect clinical outcomes included : age, sex, length of the involved spinal segment, sagittal location of hematoma, premorbid medication of antiplatelets or anticoagulants, and treatment methods. Conclusion : For the management of SSEH, early decompressive surgery is usually recommended. However, conservative management can also be feasible in selective patients who present neurologic status as ASIA scale E or in whom early recovery of function has initiated with ASIA scale C or D.