• Journal of Chest Surgery
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• v.31 no.9
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• pp.877-883
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• 1998

Background: Cardiopulmonary bypass(CPB), a standard adjunct for open heart surgery, can also play an important role in treating patients with noncardiac diseases. Material and Method: We report a collective analysis of noncardiac applications of cardiopulmonary bypass experienced at Seoul National University Hospital from 1969 to 1996. Out of a total of 20 patients, 8 were treated for membranous obstruction of inferior vena cava(MOVC), 5 for malignant melanoma, 3 for pulmonary embolism, 1 for double lung transplantation, 1 for intracranial giant aneurysm(GA), 1 for renal cell carcinoma(RC), and 1 for liposarcoma. CPB was used to induce profound hypothermia with circulatory arrest in 6 patients(MOVC 4, GA 1, RC 1). Result: CPB time was 113 mins on average for MOVC, 161 mins for GA, and 156 mins for RC, while the lowest rectal temperature was 26$^{\circ}C$ on average in MOVC, and 19$^{\circ}C$ in GA and RC. Postoperative recovery was good in all MOVC patients. The patient with GA, who underwent reoperation for the removal of hematoma, died 14 days postoperatively. The patient with RC recovered from the operation in a good condition but died from metastatic spread 6 months later. CPB was instituted for pulmonary embolectomy in 3 patients, in whom postoperative courses were uneventful, except in 1 patient who showed transient neurologic symptoms. CPB was used in a patient with double-lung transplantation for hemodynamic and ventilatory support. The patient was weaned successfully from CPB but died from low output and septicemia 19 days postoperatively. CPB without circulatory arrest was used to treat in 4 patients with MOVC. These patients showed good postoperative courses. CPB was used to administer high concentrations of chemotherapeutic agents to the extremities in 6 patients(malignant melanoma 5, recurrent liposarcoma 1). CPB time was 153 mins on average. No complications such as edema and neurologic disability were found. Conclusion: Although CPB has a limited indication in noncardiac diseases, if properly applied, it can be a very useful adjunct in a variety of surgical cases.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.193-198
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• 2002

Purpose : Oligodendrogliomas (ODG) are a rare, slow growing, tumor in the brain, which can be cured by complete surgical resection, but as yet it is not known if postoperative adjuvant radiation therapy (RT) is essential, We analyzed the treatment results of patients with irradiated ODG to investigate the efficacy of RT in terms of survival rates and other influencing prognostic factors. Methods and Materials : Between March 1983 and December 1997, 42 patients with ODG were treated with RT at our hospital. The RT was peformed dally at a dose of $1.8\~2.0\;Gy$, at 5 fractions per week, to a total dose of between 39.6 Gy and 64.8 Gy (mean 53.3 Gy). The ages of the patients ranged between 5 and 62 years, with a median age of 39 years. The mean follow-up period was 63.4 months (8-152 months). The Kaplan-Meier method was used to assess the survival, and 5 year survival rates (5-YSR). Log rank tests and Cox regression analyses were used to define the significance of prognostic factors. Results : The majority of ODG in this study were located in the cerebral hemisphere $(83.3\%)$. ODG are slightly more common in men than women, and commonly occurs in middle age, between the 3rd and 4th decades. It has been recommended that RT is commenced within 4 weeks following surgery (5-YSR; $86\%\;vs.\;49\%;\;p<0.03$). Histologically well differentiated, as opposed to poorly differentiated, tumors were found to have a more favorable prognosis (p<0.02). The actuarial 5-YSR was $65.3\%$ (median survival 90 months). 5-YSR for the various extents of surgical excision, followed by external RT, was superior to that of biopsy only followed by external RT $(69.9\%\;vs.\;25.6\%,\;p<0.01)$. Tumor size and location, overall elapsed irradiation days, age, sex, whole brain irradiation as a course of treatment and chemotherapy, had no influence on the 5-YSR (p>0.05). Conclusion : A local involved field irradiation with conventional fractionation, commencing within 4 weeks following surgical excision of the tumor, was beneficial for the 5-YSR, but a total radiation dose exceeding 60 Gy did not improve the 5-YSR.

• Journal of Genetic Medicine
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• v.4 no.1
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• pp.38-44
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• 2007

Purpose : Menkes disease is an X-linked recessively inherited disorder caused by the mutation of the ATP7A gene encoding copper-transporting P-type AT Pase. The phenotypic features are progressive neurological degeneration, mental retardation, loose skin, and vascular complications. Early diagnosis and treatment are very important for the prognosis of Menkes disease. Here, we describe nov el mutations of the ATP7A gene and prenatal diagnosis by mutation analysis. Methods : Five unrelated Korean Menkes patients were included in this study. They presented with depigmented wool-like hair, progressive neurologic deterioration, and hypotonia in infancy. Serum copper and ceruloplasmin levels w ere decreased. Brain magnetic resonance imaging revealed tortuous intracranial vessels. Mutation analysis has been carried out using cDNA from cultured skin fibroblasts or genomic DNA from peripheral leukocytes. Prenatal diagnosis was performed in two cases using chorionic villi samples or amniocytes. Results : Four novel mutations have been identified from four different families; c.3511+1G>A (p.E1099_N1171delinsMfsX 18), c.4005+5 G>A (p.V1268_R1335del), c.1870_2172del (p.S624_Q724del), and c.3352 G>A (p.G1118S). T he remaining one was previously reported (c.1933 C>T (p.V 1268_R1335del)). On prenatal DNA analysis, one w as diagnosed as normal, while the other turned out to be a female heterozygote with p.S624_Q724del mutation of the ATP7A gene. Conclusion : We identified 4 novel mutations of the ATP7A gene. Prenatal diagnosis in families at risk is critical in order to choose preventiv e options including an early treatment with copper-histidine therapy or therapeutic termination. Most mutations of the ATP7A gene were frame-shift mutations and prenatal diagnosis has been successfully carried out.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.4
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• pp.267-274
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• 2008

Purpose: Transient neurological deterioration (TND) is one of the complications after extracranial-intracranial bypass surgery, and it has been assumed to be caused by postoperative transient hyperperfusion. This study was performed to evaluate the relationship between TND and preoperative and postoperative cerebral perfusion status on brain perfusion SPECT following superficial temporal artery - middle cerebral artery (STA-MCA) anastomosis surgery. Materials and Methods: A total of 60 STA-MCA anastomosis surgeries of 56 patients (mean age: $50{\pm}16$ yrs; M:F=29:27; atherosclerotic disease: 33, moyamoya disease: 27) which were done between September 2003 and July 2006 were enrolled. The resting cerebral perfusion and cerebral vascular reserve (CVR) after acetazolamide challenge were measured before and 10 days after surgery using 99mTc-ethylcysteinate dimer (ECD) SPECT. Moreover, the cerebral perfusion was measured on the third postoperative day. With the use of the statistical parametric mapping and probabilistic brain atlas, the counts for the middle cerebral artery (MCA) territory were calculated for each image, and statistical analyses were performed. Results: In 6 of 60 cases (10%), TND occurred after surgery. In all patients, the preoperative cerebral perfusion of affected MCA territory was significantly lower than that of contralateral side (p=0.002). The cerebral perfusion on the third and tenth day after surgery was significantly higher than preoperative cerebral perfusion (p=0.001, p=0.02). In TND patients, basal cerebral perfusion and CVR on preoperative SPECT were significantly lower than those of non-TND patients (p=0.01, p=0.05). Further, the increases in cerebral perfusion on the third day after surgery were significant higher than those in other patients (p=0.008). In patients with TND, the cerebral perfusion ratio of affected side to contralateral side on third postoperative day was significantly higher than that of other patients (p=0.002). However, there was no significant difference of the cerebral perfusion ratio on preoperative and tenth postoperative day between patients with TND and other patients. Conclusion: In patients with TND, relative and moderate hyperperfusion was observed in affected side after bypass surgery. These finding may help to understand the pathophysiology of TND.

• Journal of Korean Neurosurgical Society
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• v.30 no.sup2
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• pp.289-293
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• 2001

Objectives : The optimal treatment of craniopharyngioma is controversial. Despite recent advances in microsurgical management, complete surgical removal of craniopharyngioma remains very difficult. Radiation added to surgery is effective, but radiation therapy resulted in untoward side effect in young patient. Gamma knife radiosurgery offers the theoretical advantage of a reduced radiation dose to surrounding structures during the treatment of residual or recurrent craniopharyngioma compared with fractionated radiotheraphy. We described retrospective analysis of tumor size and clinical symptoms of patients after gamma knife radiosurgery in residual or recurrent craniopharyngioma were performed. Material and Methods : From September 1990 to January 2000, 18 patients of craniopharyngioma were treated by gamma knife radiosurgery. All patient had undergone surgery, but residual or recurrent tumor was found and all of them treated postoperative gamma knife radiosurgery. The mean age was 19(from 6 to 66) and male to female ratio was 10 to 8 and 8 patients were below 15 years old. In young age group(below age 15), the average volume of the tumor was $2904.8mm^3$ and mean maximal gamma knife dose was 34.9Gy. In old age group(older than 15), the average volume of the tumor was $2590.4mm^3$ and mean maximal gamma knife dose was 45.2Gy. The size of the tumor was average $2730.1mm^3$($88-12000mm^3$), mean average radiation dose was 40.7Gy and the mean prescription dose was 17.6 Gy(4-35Gy) delivered to a median prescription 50.7% isodose. Results : The follow up was from 1 year to 9 years(mean 59.1 months) after gamma knife radiosurgery. The tumor was controlled in 13(72.2%) patients. The tumor decreased in 9 patients and not changed in 4 patients. The tumor size increased in 4(22.2%) patients during follow up period. In two cases the tumor size increased because of its cystic portion was increased, but their solid portion of the tumor was not changed. In another two patients, the solid portion of the tumor was increased. So, one patient underwent reoperation and the other patient underwent operation and repeated gamma knife radiosurgery. The tumor recurred in one case(5.6%) that is a outside of irradiated site. The presenting symptoms were improved in 4 patients(improved visual acuity in 1, controlled increased intracranial presure sign in 3 patients). In one case, visual acuity decreased after gamma knife radiosurgery. The endocrine symptoms were not influenced by gamma knife radiosurgery. Conclusion : Craniopharyngioma can be treated successfully by gamma knife radiosurgery. Causes of the tumor regrowth are inadequate dose planning because of postoperatively poor margination of the tumor, close approximation of optic nerve and residual tumors outside the target lesion. Recurrence can develop 4 years after gamma knife radiosurgery. Volume is important, but the accurate targeting is more important to prevent tumor recurrence. If the tumor definition is not clear during planning gamma knife surgery, long-term image follow up is required.

• Korean Journal of Food Science and Technology
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• v.51 no.2
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• pp.160-168
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• 2019

This study aimed to determine whether double-processed ginseng berry extract (PGBC) could improve learning and memory in an $A\hat{a}42$-induced Alzheimer's mouse model. Passive avoidance test (PAT) and Morris water-maze test (MWMT) were performed after mice were treated with PGBC, followed by acetylcholine (ACh) measurement and glial fibrillary acidic protein (GFAP) detection for brain damage. Furthermore, acetylcholinesterase (AChE) activity and choline acetyltransferase (ChAT) expression were analyzed using Ellman's and qPCR assays, respectively. Results demonstrated that PGBC contained a high amount of ginsenosides (Re, Rd, and Rg3), which are responsible for the clearance of $A{\hat{a}} 42$. They also helped to significantly improve PAT and MWMT performance in the $A{\hat{a}} 42-induced$ Alzheimer's mouse model when compared to the normal group. Interestingly, ACh and ChAT were remarkably upregulated and AChE activities were significantly inhibited, suggesting PGBC to be a palliative adjuvant for treating Alzheimer's disease. Altogether, PGBC was found to play a positive role in improving cognitive abilities. Thus, it could be a new alternative solution for alleviating Alzheimer's disease symptoms.

• Journal of the Korean Society of Radiology
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• v.82 no.5
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• pp.1258-1273
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• 2021

Purpose The balloon-stent technique (BST) has certain strengths as an assisted technique for the treatment of complex aneurysms. After Atlas release, the BST can be executed without an exchange maneuver of the balloon to the stent-delivery catheter. The purpose of this article is to share our experience with the BST using the Scepter-Atlas combination. Materials and Methods Device inspection led us to a simple method to avoid failure in loading Atlas to the Scepter. From March 2018 to December 2019, 57 unruptured distal internal carotid artery (dICA) aneurysms were treated with coil embolization; among which, 25 aneurysms in 23 patients were treated with BST. Clinical and angiographic data were retrospectively collected and reviewed. Results The technical success rate of the Scepter-Atlas combination increased from 50% to 100% after careful inspection. BST angiographic results were comparable to the stent-assisted coil (SAC) group treated during the immediately post-embolization same period (modified Raymond-Roy classification [MRRC] 1 & 2 84% in BST, 96.3% in SAC) and during short-term follow-up (MRRC 1 & 2 95.8% in BST, 88.4% in SAC). A small number of patients showed periprocedural complications, but none had clinical consequences. Conclusion BST using the Scepter-Atlas combination can provide an effective and safe method for the treatment of dICA aneurysms. Scepters can be used as delivery catheters for Atlas.

• Korean Journal of Radiology
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• v.24 no.2
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• pp.145-154
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• 2023

Objective: We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. Materials and Methods: In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b-3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b-3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0-2 at 3 months. Results: Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninety-nine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0-35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0-2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0-2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13; 95% confidence interval, 1.59-10.8; p = 0.004). Conclusion: Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0-2, even in patients with successful recanalization.

• Radiation Oncology Journal
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• v.18 no.1
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• pp.1-10
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• 2000

Purpose : Although using the high energy Photon beam with conventional Parallel-opposed beams radiotherapy for nasopharyngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patients. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherapy (3-D CRT) in an effort to prevent the radiation-induced xerostomia. Materials and Methods : We peformed three different planning for four clinically node-negative nasopharyngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dose was 70.2 Gy to the isocenter. For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy and afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54 Gy was delivered by 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator; shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was peformed. And bilateral posterior necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistics (Dmax, Dmin, Dmean, D95, DO5, V95, VOS, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. Results : For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 98, 69$\%$ for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96$\~$100$\%$, 79$\~$99$\%$, 51$\~$72$\%$ for each plan-A, B and C). Conclusion : We conclude that the new technique employing 3-D conformal radiotherapy at the beginning of radiotherapy and cone down using non-coplanar beams with early spinal cord block is highly recommended to spare parotid glands for node-negative nasopharygeal cancer patients.