A 58-year-old man was admitted after suffering dyspnea and pleuritic chest pain on his right side for one week. A chest X-ray revealed necrotizing pneumonia and a lung abscess on right upper lobe. Despite of antibiotics and supportive care, a complicated parapneumonic effusion developed on his right side. Closed thoracostomy was performed for drainage. However, after the thoracostomy, a bronchopleural fistula (BPF) occurred with a continuous air leak. After 30 days intensive therapy, the underlying necrotizing pneumonia and lung abscess resolved, but the BPF continued. Bronchoscopic treatment was performed because the patient was a poor candidate for surgery. After localizing the BPF with a systemic occlusion of the segmental bronchi, small strips of Gelfoam were placed in the suction channel of the flexible bronchoscopy, and either flushed with a saline solution or inserted with forceps until the cessation of air leak. The patient was discharged 10 days after the bronchoscopic treatment.
Rhee, Jong Joo;Ahn, Jae Sung;Jeon, Sang Ryong;Kim, Jeong Hoon;Ra, Young Shin;Kim, Chang Jin;Lee, Jung Kyo;Kwun, Byung Duk
Journal of Korean Neurosurgical Society
/
v.30
no.sup2
/
pp.221-227
/
2001
Objective : The therapeutic impact of tumor resection in glioblastomas is poorly defined and still questionable. Therefore, we conducted the current study to verify the role of tumor resection in the treatment of these highly malignant tumors. Methods : A retrospective study was performed(1990-1999) to compare the treatment results of surgical resection plus radiotherapy(130 patients) with those of stereotactic biopsy plus radiotherapy(19 patients) in glioblastomas. Only adult patients with supratentorial, de novo glioblastoma located in one lobe were included. Survival time/rate was analysed with Kaplan-Meier method, and prognostic variables were obtained from the univariate log-rank test and the multivariate Cox's proportional hazards model. Results : The resection group and the biopsy group did not differ in terms of age, gender, duration of symptoms, presenting symptoms, tumor location, tumor side, tumor size, and the frequency of midline shift. Patients in the biopsy group more often were found to have worse preoperative Karnofsky performance status(KPS)(p=0.001). On univariate analysis, age, KPS, and tumor side were associated with survival(p=0.0053, 0.0001, and 0.0331 respectively). Median survival time and 1-year survival rate were also statistically improved by tumor resection ; resection group - 13 months and 61.2%, and biopsy group - 8 months and 19.7%, respectively(p=0.0001). In patients with midline shift of the tumor, resection was highly effective comparing to biopsy(p=0.0001), but in patients without midline shift, external beam radiation alone was as effective as tumor resection(p=0.0605). Other prognostic variables did not affect survival. On multivariate analysis after variable selection, survival was independently associated with KPS(p=0.001), but not the surgical resection(p=0.2837). Even in biopsy group with midline shift of the tumor, survival rate was not different from that seen after tumor resection(p=0.3505). Conclusions : Radiotherapy alone was as effective as tumor resection plus radiotherapy in patients without midline shift of the tumor. Although there was not statistically significant, tumor resection looked like effective in patients with midline shift. For supratentorial, lobar glioblastoma patients without mass effect of the tumor, biopsy with radiotherapy is one of rational treatment strategies. We consider that tumor resection should be performed in patients with pretreatment midline shift.
Objective: This study investigated two cases of Korean medical treatment for visual field impairment after stroke: Case 1, a 56-year-old male with a posterior cerebral artery infarction and right homonymous hemianopsia, and Case 2, a 46-year-old male with an intracerebral hemorrhage in the left parietal lobe and right homonymous hemianopsia. Methods: Case 1 was treated with acupuncture, electroacupuncture, and herbal medicine (Mangeum-tang) for two months, and Case 2 was treated with acupuncture, electroacupuncture, and herbal medicine (Oryeong-san) for 40 days. Results: Following treatment, for Case 1, the Humphrey visual field test showed improvement. The visual field indexes (VFIs) for the left and right eyes improved from 44% to 55% and 49% to 64% respectively, and the mean deviations (MDs) for the left and right eyes improved from -21.11 dB to -19.91 dB and -17.45 dB to -13.89 dB, respectively. The mean visual sensitivities (MVSs) of the left and right eyes also improved from 8.67 dB to 11.33 dB and 1.67 dB to 9.67 dB, respectively, with no side effects. For Case 2, the VFI for the left eye improved from 36% to 64% and that for the right eye remained unchanged. The MDs for the left and right eyes also improved from -22.02 dB to -14.47dB and -22.11 dB to -21.34 dB, respectively, with no side effects. Conclusions: This study suggests that Korean medical treatment may improve visual impairment after stroke, but further research is needed.
Kee-Hyun Chang;Hong Dae Kim;Sun-Won Park;In Chan Song;In Kyu Yu;Moon Hee Han;Sang Kun Lee;Chun-Kee Chung;Yang Hee Park
Korean Journal of Radiology
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v.1
no.1
/
pp.25-32
/
2000
Objective: The purpose of our study was to determine the ability of H-1 MR spectroscopy (MRS) to lateralize the lesion in patients with hippocampal sclerosis. Materials and Methods: Twenty healthy volunteers and 25 patients with intractable temporal lobe epilepsy whose MR imaging diagnosis was unilateral hippocampal sclerosis were included. This diagnosis was based on the presence of unilateral atrophy and/or high T2 signal intensity of the hippocampus. Single-voxel H-1 MRS was carried out on a 1.5-T unit using PRESS sequence (TE, 136 msec). Spectra were obtained from hippocampal areas bilaterally with volumes of interest (VOIs) of 6.0 cm3 and 2.25 cm3 in healthy volunteers, and of either 6.0 cm3 (n = 14) or 2.25 cm3 (n = 11) in patients. Metabolite ratios of NAA/Cho and NAA/Cr were calculated from relative peak height measurements. The capability of MRS to lateralize the lesion and to detect bilateral abnormalities was compared with MR imaging diagnosis as a standard of reference. Results: In healthy volunteers, NAA/Cho and NAA/Cr ratios were greater than 0.8 and 1.0, respectively. In patients, the mean values of these ratios were significantly lower on the lesion side than on the contralateral side, and lower than those of healthy volunteers (p < .05). The overall correct lateralization rate of MRS was 72% (18/25); this rate was lower with a VOI of 6.0 cm3 than of 2.25 cm3 (64% versus 82%, p < .05). Bilateral abnormalities on MRS were found in 24% (6/25) of cases. Conclusion: Although its rate of correct lateralization is low, single-voxel H-1 MRS is a useful and promising diagnostic tool in the evaluation of hippocampal sclerosis, particularly for the detection of bilateral abnormalities. To improve the diagnostic accuracy of H-1 MRS, further investigation, including the use of a smaller VOI and measurement of the absolute amount of metabolites, are needed.
Objectives : This study was aimed to investigated the warning signs and its relationship with the other characteristics in acute stroke patients. Methods : 225 acute stroke patients were recruited at the Department of Cardiovascular and Neurologic Diseases (Stroke Center) of Kyung Hee University Oriental Hospital from October 2005 to September 2006. We evaluated their stroke type with brain MRI, their warning signs, and general characteristics such as age, sex, past history, risk factors, etc. Results : 225 subjects were included in the final analysis. In the subjects' general characteristics, the most common etiology of stroke was small vessel occlusion. In the assessment of the subjects' warning signs, the frequency of tension felt at the cervical area was highest followed by blepharospasm, sensory dysfunction (one side of numbness, tingling sensation, dead sensation), one side paralysis or weakness, etc. After analyzing etiology, cerebral hemorrhage had more facial spasm sign and hypertension than cerebral infarction. On the other hand, cerebral infarction had more diabetes and sensory dysfunction (one side of numbness, tingling sensation, dead sensation) than cerebral hemorrhage. Among stroke locations, subjects with their brain lesion in the cortex had more warning sings of motor dysfunction such as one side paralysis, or weakness. Multiple lesions showed a close relationship with smoking habit and were more common in males than in females. The under 65 years old group were more commonly associated with alcohol consumption, accidental mental stress and blepharospam than the over 65 years old group. In the group of under 65 years old, males more commonly had lesions in occipital lobe, alcohol consumption and smoking habit than females. Otherwise, females more commonly had vision dysfunction and blepharospasm than males. In the group of over 65 years old, males more commonly had cortex lesion than females. On the other hand, Females more commonly had accidental mental stress than males. Conclusions : We observed various warning signs and their distribution in acute stroke patients. The subjects' brainlesions and their etiology seemed to affect the features of the warning signs. Hypertension, diabetes and hyperlipidemia were also related to etiology of stroke and some habitual problems such as smoking and drinking seemed to reduce the age of stroke ictus. Although a concrete conclusion can hardly be drawn from this study, it reminds physicians of the importance of warning signs which appear among their patients.
The Journal of Korean Institute of Electromagnetic Engineering and Science
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v.13
no.7
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pp.667-678
/
2002
In this paper, a new radiating structure with a multi-layered two-dimensional metallic disk array was proposed for shaping the flat-topped element pattern. It is an infinite periodic planar array structure with metallic disks finitely stacked above the radiating circular waveguide apertures. The theoretical analysis was in detail performed using rigid full-wave analysis, and was based on modal representations for the fields in the partial regions of the array structure and for the currents on the metallic disks. The final system of linear algebraic equations was derived using the orthogonal property of vector wave functions, mode-matching method, boundary conditions and Galerkin's method, and also their unknown modal coefficients needed for calculation of the array characteristics were determined by Gauss elimination method. The application of the algorithm was demonstrated in an array design for shaping the flat-topped element patterns of $\pm$20$^{\circ}$ beam width in Ka-band. The optimal design parameters normalized by a wavelength for general applications are presented, which are obtained through optimization process on the basis of simulation and design experience. A Ka-band experimental breadboard with symmetric nineteen elements was fabricated to compare simulation results with experimental results. The metallic disks array structure stacked above the radiating circular waveguide apertures was realized using ion-beam deposition method on thin polymer films. It was shown that the calculated and measured element patterns of the breadboard were in very close agreement within the beam scanning range. The result analysis for side lobe and grating lobe was done, and also a blindness phenomenon was discussed, which may cause by multi-layered metallic disk structure at the broadside. Input VSWR of the breadboard was less than 1.14, and its gains measured at 29.0 GHz. 29.5 GHz and 30 GHz were 10.2 dB, 10.0 dB and 10.7 dB, respectively. The experimental and simulation results showed that the proposed multi-layered metallic disk array structure could shape the efficient flat-topped element pattern.
Lee, Kyu Ha;Yoon, Min Jung;Han, Mi Young;Chung, Sa Jun;Kim, Soo Cheol
Clinical and Experimental Pediatrics
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v.50
no.6
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pp.588-591
/
2007
Left ventricular thrombus is mainly caused by anterior myocardial infarction or severe cardiac wall dysfunction of the apex, and is rarely caused by a complication of acute myocarditis. A 12-year-old female who developed symptoms of motor dysphasia and incomplete hemiparesis of the right side was admitted to the hospital. The brain MRI taken on the day of her admission showed acute cerebral infarction in the left basal ganglia and the frontoparietal lobe. The echocardiogram showed a movable thrombus, which was $19{\times}28mm$ sized and located in the apex of the left ventricle. So in order to prevent further thromboembolic event we performed open cardiac surgery via the atrium and removed the thrombus of the left ventricle. After the removal of the thrombus her symptoms improved and she was discharged from the hospital. Thrombus formation in acute viral myocarditis are considered to be related with endocardial injury and blood flow stasis. Treatment with anticoagulants in left ventricular thrombosis may not be effective and may even cause a major thromboembolism. When the thrombus is laminar and fixed, one should consider anticoagulant therapy. But if the thrombus is pedunculated and movable, which means that there are higher possibilities of major embolism or there may be already one, one should consider surgical removal. We report a 12-year-old girl who required surgical removal of a left ventricular thrombus caused by acute viral myocarditis.
Kim, Cheol-Bok;Jang, Jae-Sam;Lee, Ho-Sang;Kim, Jae-Hoon;Park, Seong-Bae;Lee, Mun-Soo
Journal of the Institute of Electronics Engineers of Korea TC
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v.45
no.11
/
pp.45-54
/
2008
In this paper, we use particle swarm optimization (PSO) to design a randomly excited and randomly spaced linear array with either the lowest side lobe level (SLL) or the narrowest beamwidth. The positions and the excitation amplitudes of the array elements are considered as variables to be controlled. The beam pattern is optimized by controlling the two variables simultaneously and randomly. The best beam patterns are obtained using PSO in the fitness function where performance is improved by the random assignment of weight coefficients to each angular sector of the beam Pattern. The weight coefficients and angles are obtained through several trial runs. Also, an extra term, ${\beta}{\ast}BW$, is added to the fitness function to account for the beamwidth as well as the SLL. Is produces the best result for the beam pattern with either the lowest SLL or the narrowest beamwidth. In the former case, the SLL and beamwidth are about -43dB and $32.2^{\circ}$, respectively, with only 10 elements. In the latter case, the SLL and beamwidth are about -26dB and $24.2^{\circ}$, respectively.
Kim, Ji-Yun;Hong, Hyun-Woo;Kim, Jae-Yeon;Kim, Ki-Tak;Heo, Tae-Yool;Park, Dong-Il;Gam, Chul-Woo
The Journal of Internal Korean Medicine
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v.26
no.4
/
pp.806-819
/
2005
Objective : The purpose of this study is to investigate clinical characteristics and remedial value oriental medical therapy for sufferers of severe headache. Methods : On the authority of DongEuiBoCam, patients were classified into three groups: migraine, qi-syncope headache and phlegm-headache. All patients wert treated with acupuncture therapy and herb medicines. After that inquiry was made into the extent of improvement of headache. Results : 1. In accordance with the statistics, 56 cases(50.5%) had phlegm-syncope headache, 28 cases(25.2%) had qi-syncope headache and 27 cases(24.3%) had migraine. 2. The ratio between males and females was about 1:4. Most patients were in their forties. 3. 12 cases(31.6%) with migraine had pain only on the right side of the head, 20 cases(26.3%) with phlegm-syncope and 17 cases(45.6%) with qi-syncope headache suffered from the frontal lobe headache. 4. 8 cases(29.6%) with migraine had been suffering for a week or less, 12 cases(21.4%) with phlegm-syncope headache had been suffering for over six months and under one year and 6 cases(21.4%) with qi-syncupe headache had suffered over one year and under five. 5. Overwork and stress was deemed the main cause of migraine. Phlegm-syncope headache was also attributed to stress and tense situations. Qi-syncope headache was believed to be variously caused by traffic accident, noise, blood pressure and other reasons. 6. 46 cases(30%) felt dull headache and 32 cases(20.9%) felt dizzy. The common associated symptoms of migraine and qi-syncope headache included back, neck and shoulder pain and other pains. Dizziness was an especially prevalent symptom of phlegm-syncope headache. 7. After the oriental medical therapy, 12 cases(10.8%) almost entirely recovered, 50 cases(45%) were in about half as much pain, 45 cases(40.5%) improved little and 4 cases(3.6%) felt no improvement. Conclusions : The results support a role for oriental medical therapy in treatment of headache.
cis-Dichlorodiammineplatinum (II) (cis-Platin), a metallic compound, has widely been used as an effective anticancer chemotherapeutic agent. The precise mechanism of action of this agent is still unknown, but it is postulated that cis-Platin may act on the cancer cell like bifunctional alkylating agents. Although this agent is very beneficial to the patients with cervical cancer, germinoma of testis, neuroblastoma and others, it may also damage to the normal cell so that many side effects; severe hemorrhagic enterocolitis, bone marrow depression, renal damage and liver damage will develope. This experiment has been undertaken to pursue the cytotoxic effects of the cis-Platin on the ultrastructures of the interalveolar septum in the mouse lung. A total of 55 healthy male mice of ICR strain were used as experimental animals and divided into 5 mice of normal control group and 50 mice of cis-Platin treated group. The mice of cis-Platin treated group were sacrificed by carotid exsanguination at 6, 12, 24 hours, 3 days and 7 days after intraperitoneal injection of 6.0 mg of cis-Platin ($Abiplatin^R$ Abic Co. Ltd.) per kg of mouse body weight. The specimen obtained from the lower lobe of left lung were sliced into $1mm^3$ and prefixed with 2% glutaraldehyde -2.5% paraformaldehyde solution prepared with Millonig's phosphatae buffer solution (pH 7.4) at $4^{\circ}C$ for 3-4 hours. After postfixation with 1% osmium tetroxide solution all specimens were embedded in Epon 812. Ultrathin sections about $600-800{\AA}$ in thickness were stained with uranyl acetate and lead citrate and observed with Hitachi-600 electron microscope. The results obtained were as follows: 1. Local swellings with increase of electron density and number of pinocytic vesicles in the cytoplasms of the type I pneumocyte and endothelial cell of the blood air barrier in interalveolar septum of cis-platin treated mice were observed. 2. Cisternae of rough endoplasmic reticulum were dilated and sacculated in association with detachment of membrane bound ribosomes of the type II pneumocyte in interalveolar septum of cis-Platin treated mice. 3. Swollon mitochondria with uneven electron density of their matrix were observed in the type II pneumocyte of interalveolar septum in the cis-Platin treated mice. 4. The lamellae of lammelar bodies in type II pneumocyte of interalveolar septum in cis-Platin treated mice were devoided or transformed into homogeneous electron dense material. It is consequently suggested that cis-Platin would induce the cellular edema of type I pneumocyte and endothelial cell, and degenerative changes of cytoplasmic organelles of the type II pneumocyte in the interalveolar septum of the mouse lung.
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