• Clinical and Experimental Pediatrics
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• v.62 no.10
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• pp.386-394
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• 2019

Background: Preterm infants have difficulty maintaining body temperature after birth. However, clinical guidelines advocate that neonatal body temperature should be maintained at 36.5℃-37.5℃. Purpose: We aimed to investigate the incidence of admission hypothermia in very low birth weight (VLBW) infants and to determine the association of admission temperature with in-hospital mortality and morbidities. Methods: A cohort study using prospectively collected data involving 70 neonatal intensive care units (NICUs) that participate in the Korean Neonatal Network. From registered infants born between January 2013 and December 2015, 5,343 VLBW infants born at less than 33 weeks of gestation were reviewed. Results: The mean admission temperature was 36.1℃±0.6℃, with a range of 31.9℃ to 38.4℃. Approximately 74.1% of infants had an admission hypothermia of <36.5℃. Lower birth weight, intubation in the delivery room and Apgar score <7 at 5 minutes were significantly related to admission hypothermia. The mortality was the lowest at 36.5℃-37.5℃ and adjusted odd ratios for all deaths increased to 1.38 (95% confidence interval [CI], 1.04-1.83), 1.44 (95% CI, 1.05-1.97) and 1.86 (95% CI, 1.22-2.82) for infants with admission temperatures of 36.0℃-36.4℃, 35.0℃-35.9℃, and <35.0℃, respectively. Admission hypothermia was also associated with high likelihoods of bronchopulmonary dysplasia, pulmonary hypertension, proven sepsis, pulmonary hemorrhage, air-leak, seizure, grade 3 or higher intraventricular hemorrhage and advanced retinopathy of prematurity requiring laser therapy. Conclusion: A large portion of preterm infants in Korea had hypothermia at NICU admission, which was associated with high mortality and several important morbidities. More aggressive interventions aimed at reducing hypothermia are required in this high-risk population.

• Journal of Korean Neurosurgical Society
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• v.58 no.1
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• pp.83-88
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• 2015

Organized hematoma is a rare complication that can develop following gamma knife radiosurgery (GKS) for cerebral arteriovenous malformation (AVM). Here, we describe 5 patients with growing organized hematomas that developed from completely obliterated AVMs several years after GKS. The patients were 15, 16, 30, 36, and 38 years old at the time of GKS, respectively, and 3 patients were female. Four AVMs were located in the lobe of the brain, and the remaining AVM were in the thalamus. Between 2-12 years after GKS, patients developed progressive symptoms such intractable headache or hemiparesis and enhancing mass lesions were identified. Follow-up visits revealed the slow expansion of the hematomas and surrounding edema. Steroids were ineffective, and thus surgery was performed. Histology revealed organized hematomas with a capsule, but there was no evidence of residual AVMs or vascular malformation. After surgery, the neurological symptoms of all patients improved and the surrounding edema resolved. However, the hematoma continued to expand and intraventricular hemorrhage developed in 1 patient whose hematoma was only partially removed. GKS for cerebral AVM can be complicated by growing, organized hematomas that develop after complete obliteration. Growing hematomas should be surgically evacuated if they are symptomatic. Radical resection of the hematoma capsule is also strongly recommended.

• Journal of Korean Neurosurgical Society
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• v.44 no.1
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• pp.1-7
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• 2008

Objective : The purpose of this study was to investigate the factors affecting the surgical outcome and to compare the surgical results between transsylvian and transcortical approaches in patients with putaminal hematomas. Methods : Retrospective review of charts and CT scan images was conducted in 45 patients (20 transsylvian and 25 transcortical approaches) who underwent open surgical evacuation of putaminal hematomas. Mean Glasgow coma scale (GCS) score and hematoma volume were $7.5{\pm}3.2$ and $78.1{\pm}29.3\;cc$, respectively. The factors affecting the functional mortality were investigated using a multivariate logistic regression analysis. In addition, surgical results between transsylvian and transcortical approaches were compared. Results : None of the patients had a good recovery after the surgery. Overall functional survival rate and mortality were 37.7% and 31%, respectively. The only risk factor for functional mortality was GCS motor score after controlling age, history of hypertension, side of hematoma, hematoma amount midline shift, presence of intraventricular hemorrhage and surgical approach (p=0.005). Even though a transcortical approach was shorter in operative time (4.4 versus 5.1 hour) and showed a higher mortality rate (40% versus 20%) and lower functional survival (45% versus 35%) compared to the transsylvian approach, the differences were not statistically significant between the two groups. Conclusion : In patients who have large amounts of hematoma and require open surgical evacuation, the only significant risk factor for functional survival is the preoperative GCS score. Cortical incision methods such as transsylvian and transcortical approaches have no influence on the surgical outcome. To decompress the swollen brain rapidly, transcortical approach seems to be more suitable than transsylvian approach.

• The Journal of Korean Physical Therapy
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• v.25 no.3
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• pp.132-135
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• 2013

We presented with a patient who showed injury of the cingulum and fornix by penetration of a foreign body into the brain on diffusion tensor tractography (DTT). A 63-year-old man suffered a brain injury by a part of a power saw blade that was suddenly detached from a power saw during work. A part of the power saw blade penetrated his right frontal skull and advanced to the right posterior horn of the lateral ventricle. This penetration caused traumatic intracerebral hemorrhage in the right frontal lobe and intraventricular hemorrhage in the lateral ventricle. He underwent craniotomy and removal of intracranial foreign bodies (bony pieces and saw blade). The patient's Memory Assessment Scale scores were 74 (4%ile) for global memory, 78 (7%ile) for verbal memory, and 80 (9%ile) for visual memory. DTTs showed disruptions in the anterior portion of the fornical body, right fornical crus, the anterior portion of the right cingulum, and the middle portion of the left cingulum, compared to the control. It seems that the sustained memory impairment of this patient might be related to injury of the cingulum and fornix.

• Journal of Oriental Neuropsychiatry
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• v.33 no.4
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• pp.453-462
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• 2022

Objectives: The purpose of this clinical case study was to report the effect of Korean medicine treatment on a stroke patient with cognitive impairment, dysuria, and gait disturbance. Methods: The patient was treated with Korean medicine, including herbal medicine, acupuncture, moxibustion, and cupping. We administered the Korean version of the Mini-Mental Status Examination (MMSE-K) Global Deterioration Scale (GDS) and Manual Muscle Test (MMT) and investigated the frequency of nocturia to evaluate the effectiveness of the treatment and improvement in symptoms. Results: After Korean medicine treatment, the patient's symptoms were significantly improved. according to the MMSE-K, frequency of nocturia, and MMT results. Conclusions: This clinical case study suggests that Korean medicine treatment, including Wuchasinkihwan-gagam could be an effective treatment for stroke patients with symptoms of cognitive impairment, dysuria, and gait disturbance.

• Neonatal Medicine
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• v.17 no.1
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• pp.34-43
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• 2010

Purpose : The aim of this study was to examine whether hypercapnia during the first seven days of life was associated with severe intraventricular hemorrhage (IVH) in preterm infants requiring mechanical ventilation. Methods : A matched pair analysis was performed for 19 preterm infants with severe IVH(grade$\geq$3) and 38 infants with no severe IVH (normal or grade 1), who required mechanical ventilation for more than seven days. The univariate and multivariate analysis of severe IVH with maximal and minimal $PaCO_2$, averag $PaCO_2$, SD of $PaCO_2$, and difference in the $PaCO_2$ were assessed. The major perinatal factors and maximal ventilator index (VI) were also compared. Results : Infants with severe IVH had a higher maximal $PaCO_2$ (86.1$\pm$18.4 mmHg vs. 60.1$\pm$ 11.6 mmHg, P <0.001) and mean $PaCO_2$ (47.5$\pm$5.6 mmHg vs. 41.2$\pm$6.3 mmHg, P=0.004) and a larger SD or difference in $PaCO_2$ (14.0$\pm$4.4 mmHg vs. 9.0$\pm$2.4 mmHg; 60.3$\pm$20.9 mmHg vs. 35.5$\pm$11.8 mmHg, P <0.001). However the minimal $PaCO_2$ values did not differ between the groups. Disseminated intravascular coagulation, pulmonary hemorrhage, and the air leak syndrome were more frequent in the IVH group than in the controls. The maximal VI on each day was higher in the IVH group. The multivariate logistic regression analysis after controlling for bleeding tendency showed that the air leak syndrome, maximal VI, and maximal $PaCO_2$ were independently associated with severe IVH [OR, 1.324 (95% CI, 1.011-1.733; P=0.041)]. Conclusion : Extreme hypercapnia was significantly associated with severe IVH in preterm infants, after adjustment for major perinatal risk factors. Frequent monitoring of the $PaCO_2$ may be important for early detection of inadvertent hypercapnia and prompt correction of high PaCOS levels.

• Journal of Yeungnam Medical Science
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• v.14 no.1
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• pp.77-84
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• 1997

We measured the blood flow velocity of the anterior cerebral artery via anterior fontanelle approach of fifty five preterm neonates with duplex Doppler sonography and analyzed the waveform and calculated pulsatility index, resistive index. Intracranial velocities and pulsatility indexes were increased with increasing gestational age, birth weight, and age of the neonate, but resistive indices decreased. In sick babies, characteristic resistive index increment were seen in patients with intraventricular hemorrhage, but no statistical difference was seen in patients with respiratory distress syndrome. Our results suggest that duplex Doppler sonography is a useful noninvasive means of monitoring cerebrohemodynamics in normal preterm neonates and flow change of sick babies.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.815-821
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• 2000

Parasplenial arteriovenous malformations(AVMs) are rare vascular malformations which have distinct clinical and anatomical features. They are situated at the confluence of the hippocampus, isthmus of the cingulate gyrus and the gyrus occipitotemporalis medialis. These lesions are anterior to the calcarine sulcus and their apex extends towards the medial surface of the trigonum. Posterolaterally, these lesions are in close proximity to the visual cortex and optic radiation. The objectives in the surgery of parasplenial AVMs are complete resection of the lesions and preservation of vision. These objectives must be achieved with comprehensive understanding of the following anatomical features :1) the deep central location of the lesions within eloquent brain tissue ; 2) the lack of cortical representation of the AVMs that requires retraction of visual cortex ; 3) deep arterial supply ; 4) deep venous drainage ; 5) juxtaposition to the choroid plexus with which arterial supply and venous drainage are shared. A 16-year-old female student presented with intraventricular hemorrhage from a right parasplenial-subtrigonal AVM. The lesion, fed by posterior cerebral artery and drained into the vein of Galen, was successfully treated by the inter-hemispheric parietooccipital approach. To avoid visual field defect a small incision was made on precuneus anterior to the calcarine sulcus. In this report, the authors describe a surgical approach with special consideration on preservation of visual field.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1657-1663
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• 2000

The authors report a case of a 72-year-old woman who presented with intraventricular and subarachnoid hemorrhage of Hunt and Hess grade IV after the rupture of a giant aneurysm arising from the right internal carotid artery. The aneurysm was clipped successfully with the aid of cardiopulmonary bypass(closed chest method), deep hypothermic circulatory arrest, and cerebral protection with barbiturate resulting in moderate disability. We discuss the usefulness and problems related to technique of circulatory arrest and cardiopulmonary bypass using closed chest method, and suggest the possible benefits of open chest method in elderly people and the importance of preoperative plan to coordinate anesthesia and operation.

• Tuberculosis and Respiratory Diseases
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• v.77 no.3
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• pp.145-148
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• 2014

Valproic acid is one of the most common antiepileptic drugs used for the treatment of several seizure disorders. A 20-year-old man presented with a sudden decline of consciousness. He had a neurosurgery operation for intracranial and intraventricular hemorrhage. Following surgery, antiepileptic medication was administered to the patient in order to control his seizure events. On valproic acid treatment, he began to complain of fever and dyspnea. His symptoms persisted despite receiving empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. A high-resolution computed tomography scan of the chest revealed predominantly dependent consolidation and ground-glass opacities in both lower lobes. The primary differential was drug associated with interstitial lung disease. Therefore, we discontinued valproic acid treatment and began methylprednisolone treatment. His symptoms and radiologic findings had significantly improved after receiving steroid therapy. We propose that clinicians should be made aware of the potential for valproic acid to induce lung injury.