• 대한장애인치과학회지
• /
• 제15권1호
• /
• pp.40-44
• /
• 2019

본 증례는 다수의 치아우식증을 주소로 내원한 모야모야병 환자의 전신마취 하 치과치료에 대한 보고이다. 모야모야병은 치과치료 동안 상당히 주의를 필요로 하는 다양한 전신질환과 관련이 있다. 여러 과의 의사들과 협진이 필요하고, 치과 예방치료에 초점을 맞추면서 적절한 시기에 치료하는 것이 중요하다. 모야모야 환자에서 울음과 과호흡은 저칼륨혈증을 일으킬 수 있고, 대뇌 혈관 수축 효과를 일으킬 수 있다. 치과치료 시 뇌졸중 발생을 예방하기 위해서 통증과 불안을 조절하는 것이 매우 중요하다. 비협조적이거나 매우 어린 모야모야병 환자에게 치과치료를 하기 위해서는 전신마취가 필요할 수 있다.

• Journal of Korean Neurosurgical Society
• /
• 제67권1호
• /
• pp.73-83
• /
• 2024

Objective : The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. Methods : Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. Results : The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. Conclusion : After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

• Journal of Preventive Medicine and Public Health
• /
• 제31권2호
• /
• pp.167-182
• /
• 1998

The purpose of this study was to identify the major health components and measurements to be conducted in National Health Examination Survey(KNHES). The prevalence and severity of disease, acceptability of population and the possibility of standardization of measurement were considered as guideline for selecting the components. On the base of magnitude and severity of disease, chronic liver disease, hepatic cancer, gastric ulcer, stomach cancer, essential hypertension, cerebrovascular disease, ischemic heart disease, pulmonary tuberculosis, lung cancer, DM, breast cancer, cervical cancer, arthritis and intervertebral disc disorder were selected as the preliminary target diseases. Questionnaire survey for 648 persons in 'K' city and medical specialists in five clinical societies were conducted for evaluation the acceptability of general population for the measurements and the possibility of standardization for the procedures. In conclusion, the major target diseases were chronic liver disease, hypertension and DM and the total cholesterol, high density lipoprotein, triglyceride, total protein, albumin, hemoglobulin, hematocrit, platlet count, anti-HBs, HBsAg, height and weight were selected for basic physical components.

• 대한한의학회지
• /
• 제15권2호
• /
• pp.46-91
• /
• 1994

l. Backgrounds of Studies Cerebrovascular accident. one of the three major causes of death among audults with cardiopathy and malignancy, has been on the increase in korea while it is on the decrease in European countries and Japan. Types of stroke undergo changes caused by prolongment of life expectancy. and social and economic variety. More patients of ischemic stroke show a tendency to increase now than those of hemorrhagic stroke in the past. Many clinical studies on medical cerebrovascular and oriental stroke of paralysis have been published. but few clinical studies on therapeutics of integrated oriental and western medicine are to be found. So I have made an attempt to study clinical observations and therapeutic responses of ischemic stroke under integrated oriental and western medicine. 2.Methods. Among the patients admitted into the clinic of Joong-Poong, Woo-Suk University Hospital from May 1. 1993 until April 30. 1994 those 56 patients who were diagnosed as ischemic stroke on Computed Tomography(CT) and showed no dubious symptom after examination of coagulation and bleeding time were classified into the following six steps and treated: l)diagnosis 2)emergency treatment 3)basic treatment 4)treatment of risk and provoking factors. and preceeding disease 5)complications and conservative therapy 6)rehabilitation. For a period of basic treatment both herb medication and urokinase therapy were applied at the same time. Intravenous injection has been given at a unit of 300.000 dosage a day as urokinase therapy during basic treatment. If they showed any dubious symptom in glucose tolerance test. fructose 500ml and urokinase 300.000 dosage were mixed and injected. In case of no symptom 5% DW 500ml was mixed with urokinase 300.000 unit. and injected at a speed of 15gtt per minute. 3. Results and Conclusions 1) The level of ambulation has been improved from 42.9% when admitted to 73.2% when discharged in the degree of recovery. The level of severe function disorder has been remarkably decreased from 55.4% when admitted to 19.6% when discharged. 2) The treatment effect on the basis of therapeutic response of clinical and subjective symptom shows as follows: 7.1% Excellent. 35.7% Good. 37.5% Effective. 10.7% Stationary. and 8.9% Aggravated. The total recovery above effective shows 80.3%. Judging from the above results I think it proper to develop the model of better preventing and treating ischemic stroke through effective therapeutic and clinical studies of integrated oriental and western medicine.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제39권6호
• /
• pp.289-291
• /
• 2013

Moyamoya disease is a rare neurovascular disorder that involves constriction of certain arteries in the brain. In patients with moyamoya disease, it is very important to prevent cerebral ischemic attacks and intracerebral bleeding caused by fluctuating blood pressure and increased respiration. A 40-year-old woman with moyamoya disease was scheduled for extraction of her right upper and lower impacted wisdom teeth. Her lower impacted wisdom tooth was situated close to the inferior alveolar nerve. We decided to continue her oral antiplatelet therapy and planned intravenous sedation with analgesic agents administered approximately five minutes prior to extraction of the root of the mandibular wisdom tooth. Oral analgesic medications were regularly administered postoperatively to alleviate pain and anxiety. During the perioperative period, no cerebrovascular event occurred, and the wisdom teeth were successfully extracted as per the planned procedure. It is thought that the perioperative risks of wisdom tooth extraction in patients with moyamoya disease can be minimized with the use of our protocols.

• Journal of Chest Surgery
• /
• 제41권6호
• /
• pp.718-723
• /
• 2008

배경: 최근 20년간 수술적인 기법, 마취 기술, 심폐기 운용, 중환자실 관리의 발전으로 심장수술의 사망률과 합병증은 상당히 감소하였지만 심장수술이 중추신경계에 상당한 위험 요소가 되는 것은 널리 알려진 바이다. 이 연구는 두경부 MRA를 통해 심장 수술 대상자에서 불현성 뇌혈관계 질환의 유병률과 두경부 MRA 상에서 비정상적인 소견을 보인 환자의 치료 방침의 변화를 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2008년 6월까지 두경부 MRA 촬영에 동의한 107명의 심장수술 예정자(21세에서 83세까지의 연령분포를 보인 남자 71명과 여자 36명)를 대상으로 하였다. 이 환자들 중에서 신경학적인 고위험군의 비율과 그 환자들의 치료 방침의 변화를 관찰하였다. 결과: 신경학적으로 고위험군 환자의 비율은 15.7% (17예)였으며, 이중 11예는 허혈성 심질환, 6예는 판막 질환이였으며, 이 중 2예의 환자만이 이전에 신경학적인 병력이 있었다. 14명(13.1%)의 환자에서 치료 방침에 변화가 있었다. 결론: 심장수술 대상자에 있어 불현성 뇌혈관계 질환은 비교적 높은 것으로 생각되며, 이를 밝히는 데 있어 두경부 MRA가 의미 있는 것으로 생각된다.

• 대한한의학방제학회지
• /
• 제30권4호
• /
• pp.293-304
• /
• 2022

Objectives : Sagunja-Tang is a famous prescription used in Korean medicine for the purpose of promoting vital energy, and there are few studies using Sagunja-Tang on cerebrovascular diseases yet. As previous studies confirmed that Sagunja-tang is highly likely to be used effectively for stroke, this study was intended to predict the mechanism through which Sagunja-tang would act effectively on stroke. Methods : In this study, a network pharmacology analysis method was used, and oral bioavailability (OB), drug likeness (DL), Caco-2 and BBB permeability were utilized to select compounds with potential activity. For the values of each variable used in this study, OB ≥ 30%, DL ≥ 0.18, Caco-2 ≥ 0, and BBB ≥ 0.3 were applied. Using the above variables, the relations between target genes and diseases that are presumed to be involved in the selected bioavailable compounds were constructed in a network format, and proteins thought to play a major role were identified. Results : Among the compounds included in Sagunja-Tang, 26 bioavailable compounds were selected and it was confirmed that these compounds can be effectively used in cerebrovascular diseases such as Alzheimer's disease and stroke. These compounds are considered to act on proteins related in cell death and growth. The most important mechanism of action was predicted to be apoptosis, and the protein that is thought to play the most key action in this mechanism was caspase-3. Conclusions : In our future study, Sagunja-Tang will be used in an ischemic stroke mouse model, and the mechanism of action will be explored focusing on apoptosis and cell proliferation.

• Journal of Preventive Medicine and Public Health
• /
• 제53권3호
• /
• pp.198-204
• /
• 2020

Objectives: This study aimed to analyze the mortality of heart disease (HD), ischemic heart disease (IHD), and cerebrovascular disease (CeVD) through an age-period-cohort (APC) analysis. Methods: We used data on mortality due to cardiovascular disease from 1995 to 2018 in Japan, as determined by Vital Statistics. Age groups from 0 years to 99 years were defined by 5-year increments, and cohorts were defined for each age group of each year with a 1-year shift. We used Bayesian APC analysis to decompose the changes in the diseases' mortality rates into age, period, and cohort effects. Results: The period effects for all diseases decreased during the analyzed periods for both men and women. The cohort effects for men increased substantially in cohorts born from around 1940 to the 1970s for all types of cardiovascular diseases. The cohort effects of HD decreased in the cohorts born in the 1970s or later for both men and women. Regarding IHD and CeVD, either a non-increase or decrease of cohort effects was confirmed for cohorts born in the 1970s or later for men, but the effects for women showed a continuously increasing trend in the cohorts born in the 1960s or later. Conclusions: The cohort effects for IHD and CeVD showed increasing trends in younger generations of women. This suggests that preventive approaches against cardiovascular diseases are needed, particularly for women.

• Journal of Korean Neurosurgical Society
• /
• 제62권2호
• /
• pp.136-143
• /
• 2019

Moyamoya disease (MMD) is a progressive cerebrovascular disease with unknown etiology, characterized by bilateral steno-occlusive changes at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD has an intrinsic nature to convert the vascular supply for the brain from internal carotid (IC) system to the external carotid (EC) system, as indicated by Suzuki's angiographic staging. Insufficiency of this 'IC-EC conversion system' could result not only in cerebral ischemia, but also in intracranial hemorrhage from inadequate collateral anastomosis, both of which represent the clinical manifestation of MMD. Surgical revascularization prevents cerebral ischemic attack by improving cerebral blood flow, and recent evidence further suggests that extracranial-intracranial bypass could powerfully reduce the risk of re-bleeding in MMD patients with posterior hemorrhage, who were known to have extremely high re-bleeding risk. Although the exact mechanism underlying the hemorrhagic presentation in MMD is undetermined, most recent angiographic analysis revealed the characteristic angio-architecture related to high re-bleeding risk, such as the extension and dilatation of choroidal collaterals and posterior cerebral artery involvement. We sought to update the current management strategy for hemorrhagic MMD, including the outcome of surgical revascularization for hemorrhagic MMD in our institute. Further investigations will clarify the optimal surgical strategy to prevent hemorrhagic manifestation in patients with MMD.

• 동의신경정신과학회지
• /
• 제18권1호
• /
• pp.185-196
• /
• 2007

Objective : This experimental Study was designed to investigate the effects of FOENICULI FRUCTUS(FF) on the change of inhibition lactate dehydrogenase(LDH) activity in neuronal cells and cytokines production in serum of cerebral ischemic rats. Method : FOENICULI FRUCTUS(FF)freeze dry powder and FF on the LDH activity in neuronal cells. Changes of FF on the physiological parameters(PaO2, PaCO2, MABP and HR) in crerbral ischemic rats. Effects of FF on the IL-1beta production, $TNF-{\alpha}$ production, $TGF-{\beta}$ production, and IL-10 in serum of cerebral ischemic rats. MCAO :. cytokines production of serum by drawing from femoral arterial blood after MCAO 1 hr. Reperfusion : cytokines production of serum by drawing from femoral arterial blood after reperfusion 1 hr. Results and Conclusion : 1. FF did not inhibit lactate dehydrogenase(LDH) activity in neuronal cells. 2. In serum by drawing from femoral arterial blood after middle cerebral arterial occlusion(MCAO) 1 hr and reperfusion 1 hr, sample group was significantly decreased $IL-l{\beta}$ production compared with control group 3. In serum by drawing from femoral arterial blood after MCAO 1 hr and reperfusion 1 hr, sample group was significantly decreased $TNF-{\alpha}$ production compared with control group. 4. In serum by drawing from femoral arterial blood after MCAO 1 hr and reperfusion 1 hr, sample group was significantly increased $TGF-{\beta}$ production compared with control group. 5. In serum by drawing from femoral arterial blood after reperfusion 1 hr, sample group was significantly increased IL-10 production compared with control group. This results were suggested that FF had inhibitive effect on the brain damage by inhibited LDH activity, $IL-l{\beta}$ and $TNF-{\alpha}$production, but accelerated $TGF-{\beta}$ production and IL-10 production.