[Show abstract][Hide abstract] ABSTRACT: Neurological deficits after brain surgery are not uncommon, and correct and prompt differential diagnosis is essential to initiate appropriate treatment. We describe a patient suffering from loss of consciousness due to hyperammonemia, following valproic acid treatment after surgery for an unruptured cerebral aneurysm. A 57-year-old female patient underwent successful aneurysmal neck clipping to correct an unruptured aneurysm. Her postoperative course was good, and she received anti-epileptic therapy (valproic acid) and a soft diet. Within a few days the patient experienced mental deterioration. Her serum valproic acid reached toxic levels (149.40 mg/L), and serum ammonia was fifteen times the upper normal limit (553 mmol/L; normal range, 9-33 mmol/L). After discontinuation of valproic acid and with conservative treatment, the patient recovered without any complications. Valproate-induced hyperammonemic encephalopathy is an unusual but serious neurosurgical complication, and should not be disregarded as a possible cause of neurological deficits after neurovascular surgery. Early diagnosis is crucial, as discontinuation of valproic acid therapy can prevent serious complications, including death.
Journal of Korean Neurosurgical Society 09/2015; 58(2):159-162. DOI:10.3340/jkns.2015.58.2.159 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Copeptin, the C-terminal part of provasopressin, has emerged as a novel prognostic marker after hemorrhagic or ischemic stroke. The aim of this study was to quantitatively assess the prognostic significance of plasma copeptin level on functional outcome and mortality in patients with acute stroke using a meta-analysis of the available evidence. Thirteen relevant studies from 2,746 patients were finally included in our study. An elevated plasma copeptin level was associated with an increased risk of unfavorable outcome and mortality after stroke (OR 1.77; 95% CI, 1.44-2.19 and OR 3.90; 95% CI 3.07-4.95, respectively). The result of the pooled measure on standardized mean difference (SMD) was that plasma copeptin levels were found to be significantly higher in patients who died compared to survivors (SMD 1.70; 95% CI, 1.36-2.03). A stratified analysis by study region showed significant differences in SMD of copeptin, and the heterogeneity among studies was significantly decreased. However, the positive association of copeptin with poor prognosis after stroke was consistent in each stratified analysis. The present meta-analysis suggests that early measurement of plasma copeptin could provide better prognostic information about functional outcome and mortality in patients with acute stroke.
[Show abstract][Hide abstract] ABSTRACT: Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0×3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH.
[Show abstract][Hide abstract] ABSTRACT: Resorption of autologous bone flap grafts is a known long-term complication of cranioplasty following decompressive craniectomy (DC). We analyzed our data to identify risk factors for bone flap resorption (BFR) following cranioplasty.
[Show abstract][Hide abstract] ABSTRACT: This study is to investigate the actual using patterns and clinical effects of topiramate in patients with neurosurgical disease as antiepileptic drugs (AEDs) in 94 korean multicenters.
A total of 7,152 patients who had taken topiramate for at least 3 months between August 2008 and February 2009 were eligible to participate in this study. We evaluated demographic data, disease entities, duration of topiramate administration, initial and subsequent dosage adjustment, concomitant AEDs, the frequency of seizure reduction, and adverse events.
Topiramate was commonly prescribed in stroke (38%) and head trauma group (36%). In the dosage of topiramate, the mean initial dosage was 65 mg/day, and the mean maintenance dosage was adjusted into 105 mg/day. The mean duration of the initial dosage for topiramate administration was 24 days, and the mean duration of the maintenance dosage was 125 days, respectively. Among groups with prophylactic administration, 98% did not develop convulsion and among groups with therapeutic administration, 2% was ineffective to control seizure. After taking topiramate, 2% patients showed adverse events, that sensory aberration was the most common.
These results suggest that topiramate prescribe widely in diverse neurosurgical disorders, and effective in reduction of seizure frequency, and does not cause serious adverse effects comparable with old AEDs.
[Show abstract][Hide abstract] ABSTRACT: To determine an ideal stimulation site of the medial antebrachial cutaneous nerve (MACN) using ultrasound measurement and to compare the efficiency of the new stimulation site with the conventional stimulation site on the nerve conduction study.
Both arms of 15 healthy participants were measured using ultrasound. The MACN was identified in the transverse view at each 0, 2, 4, 6, and 8 cm proximal sites from the medial epicondyle, and the distances to the median nerve and to the skin from the MACN were measured. The ideal stimulation site should be located at the level which can give the shortest distance from the skin and the longest distance from the median nerve in terms of volume conduction. To confirm the efficiency of the ideal site, we measured the amplitude of the MACN conduction study at the ideal site against one at the 4 cm proximal to the medial epicondyle (conventional site).
The ultrasound showed the ideal stimulation site for the MACN could be the elbow crease line. However, the nerve conduction study revealed that the amplitudes of the MACN were significantly larger at the 4 cm proximal to the medial epicondyle compared with ones at the ideal site.
The ideal stimulation site based on the ultrasound did not permit better stimulation site for the nerve conduction study of the MACN compared with the conventional site. Careful adjustment of the stimulation site on the basis of this study would contribute to an accurate conduction study of the MACN.
Annals of Rehabilitation Medicine 12/2014; 38(6):836-42. DOI:10.5535/arm.2014.38.6.836
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the potential of using phase-contrast radiography to detect early changes in articular cartilage in a mouse model of osteoarthritis.
An iodoacetate-induced mouse model of osteoarthritis was used. Mice with iodoacetate-induced osteoarthritis were euthanized at 1 and 2 wks after injection. Specimens were obtained by sectioning mouse tissue into 5-mm-thick slices. Sections were examined using synchrotron x-rays from the 7B2 beamline at the Pohang Light Source. Magnified microradiographic images, obtained by phase-contrast radiography, were used to identify changes in articular cartilage and the subchondral bone.
Refraction-enhanced phase-contrast radiography enabled detailed microscopic and macroscopic observation of articular cartilage by a noninvasive technique. Detailed microscopic images revealed partially damaged articular cartilage, containing an irregular trilaminar zone, at 1 wk after injection. At 2 wks after injection, a necrotic cleft was clearly visible, along with collapse of the trilaminar zones. Shrunken chondrocytes and chondrocyte clusters of variable sizes were also observed.
Phase-contrast radiography is a feasible technique for the early detection of osteoarthritis and is capable of detecting microstructural changes in articular cartilage.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists 11/2014; 94(8). DOI:10.1097/PHM.0000000000000232 · 2.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Accurate modelling of a chip is a very important factor when analysing and predicting radio-frequency (RF) receiver sensitivity. Chip modelling based on the tangential electromagnetic (EM) field from the near-field measurement just above the top surface of the chip is introduced, and a methodology utilising three-dimensional (3D) EM simulation, for predicting receiver sensitivity generated by the chip-noise of a mobile phone, is suggested. It is worth noting here that the calculation of absolute coupling values between a noise source and an antenna is possible by using the real measured data source to obtain reliable results.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this clinical practice guideline (CPG) is to provide current and comprehensive recommendations for the medical and surgical management of primary intracerebral hemorrhage (ICH). Since the release of the first Korean CPGs for stroke, evidence has been accumulated in the management of ICH, such as intracranial pressure control and minimally invasive surgery, and it needs to be reflected in the updated version. The Quality Control Committee at the Korean Society of cerebrovascular Surgeons and the Writing Group at the Clinical Research Center for Stroke (CRCS) systematically reviewed relevant literature and major published guidelines between June 2007 and June 2013. Based on the published evidence, recommendations were synthesized, and the level of evidence and the grade of the recommendation were determined using the methods adapted from CRCS. A draft guideline was scrutinized by expert peer reviewers and also discussed at an expert consensus meeting until final agreement was achieved. CPGs based on scientific evidence are presented for the medical and surgical management of patients presenting with primary ICH. This CPG describes the current pertinent recommendations and suggests Korean recommendations for the medical and surgical management of a patient with primary ICH.
Journal of Korean Neurosurgical Society 09/2014; 56(3):175-87. DOI:10.3340/jkns.2014.56.3.175 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Benign triton tumor (BTT) or neuromuscular hamartoma is an uncommon tumor composed of mature neural and well-differentiated striated muscular elements. Its development is exceptionally rare in the adult and head region. This report describes a case of adulthood BTT that occurred in the orbit. The patient was a 53-year-old woman who presented with right periorbital swelling and pain in eyeball over 2 months. Magnetic resonance imaging revealed a well-enhancing mass surrounding optic nerve and ocular muscles in the right retrobulbar area. The tumor was subtotally removed via transcranial approach. Its pathological diagnosis was confirmed to be a neuromuscular hamartoma. She developed diplopia postoperatively. Adulthood BTT should be considered in the differential diagnosis of head and neck tumors. It is also important to make adequate therapeutic strategy to avoid postoperative neural dysfunction.
Journal of Korean Neurosurgical Society 08/2014; 56(2):146-8. DOI:10.3340/jkns.2014.56.2.146 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
It has been known that ADH1B*2 allele has a protective effect against the development of alcohol dependence. However, the protection mechanism is still unknown. We investigated whether ADH1B gene polymorphism affects ethanol (EtOH) metabolism.Methods
In a parent study, we conducted a randomized crossover trials on 24 healthy male subjects who were selected by genotyping: 12 with ALDH2*1/*1 (active form) and 12 with ALDH2*1/*2 (inactive form). In the present study, the 24 subjects were reclassified into 2 groups of 11 with ADH1B*1/*2 and 13 with ADH1B*2/*2 according to the ADH1B genotypes. Each subject was administered 1 of 3 doses of EtOH (0.25, 0.5, 0.75 g/kg) or a placebo in 4 trials. After the administration of alcohol, blood EtOH and acetaldehyde concentrations were measured 9 times over 4 hours.ResultsIn the case of EtOH, the area under the concentration-time curve from 0 to 4 hours (AUC0–4) and the peak blood concentration of EtOH (Cmax) in subjects with ADH1B*2/*2 were significantly higher than those in subjects with ADH1B*1/*2 at all 3 dosages before stratifying by ALDH2 genotype. However, after stratifying by ALDH2 genotype, a statistically significant difference between ADH1B*2/*2 and ADH1B*1/*2 was found only at the 0.5 g/kg dosage regardless of ALDH2 genotype. In the case of acetaldehyde, the AUC0–4 and Cmax of acetaldehyde of ADH1B*2/*2 after administration of 0.25 g/kg alcohol and the AUC0–4 of acetaldehyde of ADH1B*2/*2 at 0.5 g/kg were significantly higher than corresponding values of ADH1B*1/*2 only in the group of ALDH2*1/*2.Conclusions
Our findings indicate that the blood EtOH concentrations of ADH1B*2/*2 group are higher than those of ADH1B*1/*2 group regardless of ALDH2 genotype, and the blood acetaldehyde concentrations of ADH1B*2/*2 are also higher than those of ADH1B*1/*2 only in the ALDH2*1/*2 group. To our knowledge, this is the first report to demonstrate the association of ADH1B*2 allele with blood EtOH and acetaldehyde levels in humans, and these results suggest that higher blood EtOH and acetaldehyde concentrations in ADH1B*2/*2 may constitute the mechanism of protection against alcoholism by ADH1B*2/*2.
Alcoholism Clinical and Experimental Research 05/2014; 38(6). DOI:10.1111/acer.12427 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.
Journal of Korean Neurosurgical Society 04/2014; 55(4):205-7. DOI:10.3340/jkns.2014.55.4.205 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study is to investigate the gastric emptying and gastrointestinal transit improvement effect of DL-methionine methylsulfonium chloride (MMSC) in functional dyspepsia animal models. Cisplatin causes nausea, vomiting, and inhibition of gastric emptying. Rats were divided into four groups: G1 (normal group), G2 (gastric emptying induced by cisplatin), G3 (gastric emptying induced by cisplatin with itopride 30 mg/kg pretreatment), and G4 (gastric emptying induced by cisplatin with MMSC 4 mg/kg pretreatment). Immediately after an oral administration of a liquid meal (phenol red), delayed gastric emptying was induced by cisplatin (10 mg/kg (i.p.)). After 20 min in the cisplatin administration, the animals were sacrificed. In rats treated with cisplatin, the gastric emptying rate was significantly reduced. On the other hand, MMSC reversed the reduction of gastric emptying induced by cisplatin. And also, MMSC caused to travel FITC-dextran more significantly longer distance than the control, which is based on the values of the mean geometric center in the atropine driven delayed gastrointestinal transit animal models. Furthermore, MMSC drastically increased the gastrointestinal transit in rats, considerably increased the values of the mean geometric center (MGC), compared to the control, which was comparable to that of mosapride. These results suggest that MMSC could be an effective component for the treatment of functional dyspepsia.
Journal of the Korean Society of Food Science and Nutrition 12/2013; 42(12). DOI:10.3746/jkfn.2013.42.12.2076
[Show abstract][Hide abstract] ABSTRACT: From the basic structure of a red organic light-emitting device (OLED) with peak wavelength of 624 nm, blue emission with peak wavelength of 457 nm could be obtained by simply excluding an emissive layer of the red device. This technology makes it possible to fabricate two color OLEDs of red and blue simultaneously so that the manufacturing cost can be greatly reduced in the application devices due to simple structure and saving of the used materials. The experimental results showed the maximum current efficiencies of 16.7 cd/A and 4.8 cd/A and the luminance of 4600 cd/m2 and 7300 cd/m2 at 8V in the red and blue devices, respectively.
[Show abstract][Hide abstract] ABSTRACT: Although surgical techniques for clipping paraclinoid aneurysms have evolved significantly in recent times, direct microsurgical clipping of large and giant paraclinoid aneurysms remains a formidable surgical challenge. We review here our surgical experiences in direct surgical clipping of large and giant paraclinoid aneurysms, especially in dealing with anterior clinoidectomy, distal dural ring resection, optic canal unroofing, clipping techniques, and surgical complications.
Between September 2001 and February 2012, we directly obliterated ten large and giant paraclinoid aneurysms. In all cases, tailored orbito-zygomatic craniotomies with extradural and/or intradural clinoidectomy were performed. The efficacy of surgical clipping was evaluated with postoperative digital subtraction angiography and computed tomographic angiography.
Of the ten cases reported, five each were of ruptured and unruptured aneurysms. Five aneurysms occurred in the carotid cave, two in the superior hypophyseal artery, two in the intracavernous, and one in the posterior wall. The mean diameter of the aneurysms sac was 18.8 mm in the greatest dimension. All large and giant paraclinoid aneurysms were obliterated with direct neck clipping without bypass. With the exception of the one intracavenous aneurysm, all large and giant paraclinoid aneurysms were occluded completely.
The key features of successful surgical clipping of large and giant paraclinoid aneurysms include enhancing exposure of proximal neck of aneurysms, establishing proximal control, and completely obliterating aneurysms with minimal manipulation of the optic nerve. Our results suggest that internal carotid artery reconstruction using multiple fenestrated clips without bypass may potentially achieve complete occlusion of large paraclinoid aneurysms.
Journal of Korean Neurosurgical Society 12/2013; 54(6):477-83. DOI:10.3340/jkns.2013.54.6.477 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
The aim of this study was to make correlations between ultrasonographic measurements of thenar muscle and flexor retinaculum and nerve conduction studies (NCS) in carpal tunnel syndrome (CTS).
Ultrasound and NCS were performed on 92 wrists with CTS and on 40 wrists from healthy individuals. Ultrasound of thenar and hypothenar muscles, flexor retinaculum, and median nerve were assessed. The ultrasonographic findings were compared between the 2 groups, and correlation analyses between median latency and ultrasonographic findings were performed.
Motor latency correlated positively with flexor retinaculum thickness (FRT) and negatively with the ratio of thenar to hypothenar muscle. FRT and motor latency were found to be increased significantly in CTS. The ratio of thenar to hypothenar muscle was found to be decreased significantly in CTS compared with controls.
The ultrasonographic findings of FRT and thenar muscle reflect the severity of disease in patients with CTS and are valuable for the diagnosis of CTS.
[Show abstract][Hide abstract] ABSTRACT: This paper introduces the power management schemes that control DVFS (Dynamic Voltage and Frequency Scaling) and core shutdown considering the characteristics of an application for the commercial application processors. Most power management schemes used in commercial application processors only monitor the CPU utilization to adjust the CPU frequency. Since recent application processors adopt multi-core CPU, the power management scheme, such as Hotplug, is necessary to manage the power state of the cores. However, none of the schemes mentioned above looks into the application characteristics for the power management. In this paper, we show that considering application characteristics is more beneficial for power management of recent commercial application processors.
2013 International Soc Design Conference (ISOCC); 11/2013