Your browser doesn't support javascript.
loading
Montrer: 20 | 50 | 100
Résultats 1 - 20 de 32
Filtre
1.
Brain Tumor Research and Treatment ; : 266-270, 2023.
Article Dans Anglais | WPRIM | ID: wpr-999764

Résumé

Recurrence of Rathke’s cleft cysts (RCC) following surgery is not uncommon. We present a 33-yearold male patient with chronic headache and visual disturbances whose MRI showed mostly cystic, suprasellar mass with peripheral enhancement. Endoscopic extended transsphenoidal approach and tumor resection was performed and RCC was pathologically confirmed postoperatively. Early recurrence was first suspected at 3 months following surgery, and his serial MRIs showed a recurred mass without associated clinical symptoms. Upon further histopathological study, extensive squamous metaplasia and high Ki-67 were seen. Also, in this study, we discuss important factors associated with cyst recurrence following surgery.

2.
Epidemiology and Health ; : e2022009-2022.
Article Dans Coréen | WPRIM | ID: wpr-937573

Résumé

OBJECTIVES@#The purpose of this study was (1) to examine whether the addition of resting heart rate (RHR) to the existing undiagnosed diabetes mellitus (UnDM) prediction model would improve predictability, and (2) to develop and validate UnDM prediction models by using only easily assessable variables such as gender, RHR, age, and waist circumference (WC). @*METHODS@#Korea National Health and Nutrition Examination Survey (KNHANES) 2010, 2012, 2014, 2016 data were used to develop the model (model building set, n=19,675), while the data from 2011, 2013, 2015, 2017 were used to validate the model (validation set, n=19,917). UnDM was defined as a fasting glucose level ≥126 mg/dL or glycated hemoglobin ≥6.5%; however, doctors have not diagnosed it. Statistical package for the social sciences logistic regression analysis was used to determine the predictors of UnDM. @*RESULTS@#RHR, age, and WC were associated with UnDM. When RHR was added to the existing model, sensitivity was reduced (86 vs. 73%), specificity was increased (49 vs. 65%), and a higher Youden index (35 vs. 38) was expressed. When only gender, RHR, age, and WC were used in the model, a sensitivity, specificity, and Youden index of 70%, 67%, and 37, respectively, were observed. @*CONCLUSIONS@#Adding RHR to the existing UnDM prediction model improved specificity and the Youden index. Furthermore, when the prediction model only used gender, RHR, age, and WC, the outcomes were not inferior to those of the existing prediction model.

3.
Asian Oncology Nursing ; : 225-234, 2022.
Article Dans Anglais | WPRIM | ID: wpr-966347

Résumé

Purpose@#The purpose of this study is to explore defecation functions related quality of life (QoL) according to the location of cancer in colorectal cancer survivors. @*Methods@#A total of 120 colorectal cancer survivors (67 colon vs. 53 rectum, mean age: 55.3±10.3 years, 46.7% male) who completed treatment were recruited from a tertiary hospital. QoL and defecation function related QoL were surveyed using the European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) and EORTC QLQ- colorectal cancer specific core (CR29) questionnaire. Physical activity (PA) levels of participants were surveyed using a global PA questionnaire. @*Results@#There was no statistical difference in general QoL according to the location of cancer, but significant differences were observed in defecation function related QoL. When cancer location is closer to the anus, survivors experience more defecation dysfunction, negatively associated with QoL (Hemicolectomy: 67.71±14.07, anterior resection: 92.22±15.18, lower anterior resection: 151.85±17.20, and ultra-low anterior resection: 263.73±42.69). @*Conclusion@#When location of cancer is closer to the anus, colorectal survivors experience significantly more defecation dysfunction and poorer QoL. Strategies to reduce defecation dysfunction according to the location of cancer among colorectal cancer patients should be developed.

4.
Journal of Korean Neurosurgical Society ; : 163-170, 2020.
Article | WPRIM | ID: wpr-833442

Résumé

Objective@#: Milk fat globule-epidermal growth factor VIII (MFG-E8) may play a key role in inflammatory responses and has the potential to function as a neuroprotective agent for ameliorating brain injury in cerebral infarction. This study aimed to determine the role of MFG-E8 in brain injury in the subacute phase of cerebral ischemia in a rat model. @*Methods@#: Focal cerebral ischemia was induced in rats by occluding the middle cerebral artery with the modified intraluminal filament technique. Twenty-four hours after ischemia induction, rats were randomly assigned to two groups and treated with either recombinant human MFG-E8 or saline. Functional outcomes were assessed using the modified Neurological Severity Score (mNSS), and infarct volumes were evaluated using histology. Anti-inflammation, angiogenesis, and neurogenesis were assessed using immunohistochemistry with antibodies against ionized calcium-binding adapter molecule 1 (Iba-1), rat endothelial cell antigen-1 (RECA-1), and bromodeoxyuridine (BrdU)/doublecortin (DCX), respectively. @*Results@#: Our results showed that intravenous MFG-E8 treatment did not reduce the infarct volume; however, the mNSS test revealed that neurobehavioral deficits were significantly improved in the MFG-E8-treated group than in the vehicle group. Immunofluorescence staining revealed a significantly lower number of Iba-1-positive cells and higher number of RECA-1 in the periinfarcted brain region, and significantly higher numbers of BrdU- and DCX-positive cells in the subventricular zone in the MFG-E8-treated group than in the vehicle group. @*Conclusion@#: Our findings suggest that MFG-E8 improves neurological function by suppressing inflammation and enhancing angiogenesis and neuronal proliferation in the subacute phase of cerebral infarction.

5.
Tissue Engineering and Regenerative Medicine ; (6): 695-704, 2020.
Article Dans Anglais | WPRIM | ID: wpr-896326

Résumé

BACKGROUND@#Mannitol increases blood–brain barrier permeability and can improve the efficiency of systemically administered stem cells by facilitating stem cell entry from the periphery into the injured brain. The aim of this study was to elucidate the neuroprotective effects of a combination of mannitol pretreatment and stem cell transplantation on strokeinduced neural injury. @*METHODS@#The experimental rats were randomly assigned to three groups 24 h after middle cerebral artery occlusion and reperfusion. One group received intravenous (IV) injections of phosphate-buffered saline (vehicle), another group received IV injections of human adipose-derived stem cells (hADSCs), and the last group received IV injections of hADSCs 10 min after IV mannitol injections. Neurobehavioral functions and infarct volume were compared. Immunohistochemistry (IHC) analyses were performed using antibodies against ionized calcium binding adapter-1 (IBA-1), rat endothelial antigen-1 (RECA-1), and bromodeoxyuridine/doublecortin (BrdU/DCX). @*RESULTS@#PKH-26 labeling revealed no difference in the number of stem cells that had migrated into the injured brain, and hADSC transplantation did not improve the infarct volume. However, neurobehavioral functions improved in the mannitol group. IHC showed higher numbers of RECA-1-positive cells in the peri-infarcted brain and BrdU-/DCXcolocalized cells in the subventricular zone in the mannitol group. IBA-1-positive cell number decreased in the hADSConly and mannitol-pretreatment groups compared with the vehicle group even though there was no difference between the former two groups. @*CONCLUSION@#Combinatorial treatment with mannitol and hADSC transplantation may have better therapeutic potential than hADSC monotherapy for ischemic stroke.

6.
Tissue Engineering and Regenerative Medicine ; (6): 695-704, 2020.
Article Dans Anglais | WPRIM | ID: wpr-904030

Résumé

BACKGROUND@#Mannitol increases blood–brain barrier permeability and can improve the efficiency of systemically administered stem cells by facilitating stem cell entry from the periphery into the injured brain. The aim of this study was to elucidate the neuroprotective effects of a combination of mannitol pretreatment and stem cell transplantation on strokeinduced neural injury. @*METHODS@#The experimental rats were randomly assigned to three groups 24 h after middle cerebral artery occlusion and reperfusion. One group received intravenous (IV) injections of phosphate-buffered saline (vehicle), another group received IV injections of human adipose-derived stem cells (hADSCs), and the last group received IV injections of hADSCs 10 min after IV mannitol injections. Neurobehavioral functions and infarct volume were compared. Immunohistochemistry (IHC) analyses were performed using antibodies against ionized calcium binding adapter-1 (IBA-1), rat endothelial antigen-1 (RECA-1), and bromodeoxyuridine/doublecortin (BrdU/DCX). @*RESULTS@#PKH-26 labeling revealed no difference in the number of stem cells that had migrated into the injured brain, and hADSC transplantation did not improve the infarct volume. However, neurobehavioral functions improved in the mannitol group. IHC showed higher numbers of RECA-1-positive cells in the peri-infarcted brain and BrdU-/DCXcolocalized cells in the subventricular zone in the mannitol group. IBA-1-positive cell number decreased in the hADSConly and mannitol-pretreatment groups compared with the vehicle group even though there was no difference between the former two groups. @*CONCLUSION@#Combinatorial treatment with mannitol and hADSC transplantation may have better therapeutic potential than hADSC monotherapy for ischemic stroke.

7.
Yonsei Medical Journal ; : 273-278, 2018.
Article Dans Anglais | WPRIM | ID: wpr-713093

Résumé

PURPOSE: We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV). MATERIALS AND METHODS: Between August 1980 and May 2013, 1187 patients underwent PMV at Severance Hospital, Seoul, Korea. A total of 742 patients who underwent regular clinic visits for more than 10 years were retrospectively analyzed. The endpoints consisted of repeated PMV, mitral valve (MV) surgery, and cardiovascular-related death. RESULTS: The optimal result, defined as a post-PMV mitral valve area (MVA) >1.5 cm² and mitral regurgitation ≤Grade II, was obtained in 631 (85%) patients. Over a mean follow up duration of 214±50 months, 54 (7.3%) patients underwent repeat PMV, 4 (0.5%) underwent trido-PMV, and 248 (33.4%) underwent MV surgery. A total of 33 patients (4.4%) had stroke, and 35 (4.7%) patients died from cardiovascular-related reasons. In a multivariate analysis, echocardiographic score [p=0.003, hazard ratio=1.56, 95% confidence interval (CI): 1.01–2.41] and post-MVA cut-off (p 8 and post-MVA ≤1.76 cm² were independent predictors of poor long-term clinical outcomes after PMV, including MV reintervention, stroke, and cardiovascular-related death.


Sujets)
Adulte , Femelle , Humains , Mâle , Cathétérisme , Échocardiographie , Études de suivi , Estimation de Kaplan-Meier , Sténose mitrale/imagerie diagnostique , Analyse multifactorielle , Modèles des risques proportionnels , République de Corée , Facteurs temps , Résultat thérapeutique
8.
Tissue Engineering and Regenerative Medicine ; (6): 653-665, 2017.
Article Dans Anglais | WPRIM | ID: wpr-657088

Résumé

Liver failure is one of the main risks of death worldwide, and it originates from repetitive injuries and inflammations of liver tissues, which finally leads to the liver cirrhosis or cancer. Currently, liver transplantation is the only effective treatment for the liver diseases although it has a limitation due to donor scarcity. Alternatively, cell therapy to regenerate and reconstruct the damaged liver has been suggested to overcome the current limitation of liver disease cures. Several transplantable cell types could be utilized for recovering liver functions in injured liver, including bone marrow cells, mesenchymal stem cells, hematopoietic stem cells, macrophages, and stem cell-derived hepatocytes. Furthermore, paracrine effects of transplanted cells have been suggested as a new paradigm for liver disease cures, and this application would be a new strategy to cure liver failures. Therefore, here we reviewed the current status and challenges of therapy using stem cells for liver disease treatments.


Sujets)
Humains , Cellules de la moelle osseuse , Thérapie cellulaire et tissulaire , Cellules souches hématopoïétiques , Hépatocytes , Inflammation , Cirrhose du foie , Maladies du foie , Défaillance hépatique , Régénération hépatique , Transplantation hépatique , Foie , Macrophages , Cellules souches mésenchymateuses , Transplantation de cellules souches , Cellules souches , Donneurs de tissus
9.
Brain Tumor Research and Treatment ; : 145-149, 2016.
Article Dans Anglais | WPRIM | ID: wpr-27922

Résumé

When treating childhood acute lymphoblastic leukemia (ALL), secondary neoplasms are a significant long term problem. Radiation is generally accepted to be a major cause of the development of secondary neoplasms. Following treatment for ALL, a variety of secondary tumors, including brain tumors, hematologic malignancies, sarcomas, thyroid cancers, and skin cancers have been reported. However, oligodendroglioma as a secondary neoplasm is extremely rare. Herein we present a case of secondary oligodendroglioma occurring 13 years after the end of ALL treatment.


Sujets)
Tumeurs du cerveau , Santé mondiale , Tumeurs hématologiques , Leucémies , Oligodendrogliome , Leucémie-lymphome lymphoblastique à précurseurs B et T , Sarcomes , Tumeurs cutanées , Tumeurs de la thyroïde , Organisation mondiale de la santé
10.
Korean Journal of Medicine ; : 524-527, 2016.
Article Dans Coréen | WPRIM | ID: wpr-77229

Résumé

A 68-year-old woman presented with chest pain and dyspnea and was diagnosed with a massive pulmonary embolism. Bleeding colon cancer was detected incidentally during anticoagulation therapy. After stabilization, she underwent surgical resection of the cancer with insertion of an inferior vena cava filter and was treated with rivaroxaban as antithrombotic therapy thereafter. Unexpectedly, thrombotic obstruction of the filter was revealed on a computed tomography scan taken in preparation for removing the device. After switching to warfarin, the obstruction had resolved at the 4-week follow-up examination. We discuss what to consider when performing antithrombotic therapy in patients with an inferior vena cava filter.


Sujets)
Sujet âgé , Femelle , Humains , Douleur thoracique , Tumeurs du côlon , Dyspnée , Études de suivi , Hémorragie , Embolie pulmonaire , Rivaroxaban , Thrombose , Filtres caves , Veine cave inférieure , Warfarine
11.
Korean Journal of Medicine ; : 528-532, 2016.
Article Dans Coréen | WPRIM | ID: wpr-77228

Résumé

A 60-year-old man visited the hospital after experiencing dyspnea after exertion for 2 weeks. An electrocardiogram showed sinus arrest with junctional escape rhythm at 40 beats/min. Transthoracic echocardiography showed that the right ventricular systolic pressure (RVSP) was approximately 71 mmHg and that the left ventricular ejection fraction was preserved. The ratio of peak early diastolic transmitral inflow velocity to early diastolic peak mitral annular velocity (E/E') was 29. Cardiac catheterization revealed a systolic pulmonary artery pressure (SPAP) of 63 mmHg, a mean pulmonary artery pressure of 27 mmHg, and a pulmonary capillary wedge pressure of 22 mmHg with a rhythm of 40 beats/min. The patient was diagnosed with pulmonary hypertension (group 2) due to sick sinus syndrome. SPAP decreased to 48 mmHg during atrial pacing at 60 beats/min. After permanent pacemaker insertion, RVSP decreased from 71 mmHg to 44 mmHg. In this case, passive group 2 pulmonary hypertension occurred due to sick sinus syndrome.


Sujets)
Humains , Adulte d'âge moyen , Pression sanguine , Cathétérisme cardiaque , Sondes cardiaques , Dyspnée , Échocardiographie , Électrocardiographie , Hypertension pulmonaire , Artère pulmonaire , Pression artérielle pulmonaire d'occlusion , Maladie du sinus , Débit systolique , Nations Unies
12.
Korean Circulation Journal ; : 344-347, 2015.
Article Dans Anglais | WPRIM | ID: wpr-211251

Résumé

Implantable cardioverter-defibrillator (ICD) therapy is acknowledged as a valid treatment method for the effective prevention of sudden cardiac death, which is a major cause of mortality in adult congenital heart disease patients. But ICD implantation by the conventional transvascular approach is not always possible in patients who have undergone palliative surgery due to congenital and structural heart disease. Here, we report a case in which an ICD was transvascularly implanted in an arrhythmogenic right ventricular cardiomyopathy patient who had undergone a one-and-a-half ventricle repair.


Sujets)
Adulte , Humains , Dysplasie ventriculaire droite arythmogène , Mort subite cardiaque , Défibrillateurs implantables , Procédure de Fontan , Cardiopathies congénitales , Cardiopathies , Mortalité , Soins palliatifs
13.
Yonsei Medical Journal ; : 582-585, 2015.
Article Dans Anglais | WPRIM | ID: wpr-38890

Résumé

There are several reports to demonstrate that rifampicin, a major anti-tuberculosis agent, is associated with some adverse renal effects, with a few cases of rifampicin-induced minimal change disease (MCD). In the present case, a 68-year-old female presented with nausea, vomiting, foamy urine, general weakness and edema. She had been taking rifampicin for 4 weeks due to pleural tuberculosis. The patient had no proteinuria before the anti-tuberculosis agents were started, but urine tests upon admission showed heavy proteinuria with a 24-h urinary protein of 9.2 g/day, and serum creatinine, albumin, and total cholesterol levels were 1.36 mg/dL, 2.40 g/dL, and 283 mg/dL, respectively. MCD was diagnosed, and the patient achieved complete remission after cessation of rifampicin without undergoing steroid therapy.


Sujets)
Sujet âgé , Femelle , Humains , Antibiotiques antituberculeux/effets indésirables , Oedème/étiologie , Tests de la fonction rénale , Glomérule rénal/anatomopathologie , Nausée/étiologie , Néphrose lipoïdique/induit chimiquement , Protéinurie , Induction de rémission , Rifampicine/effets indésirables , Résultat thérapeutique , Tuberculose pleurale/traitement médicamenteux
14.
Journal of Korean Neurosurgical Society ; : 34-41, 2014.
Article Dans Anglais | WPRIM | ID: wpr-114568

Résumé

OBJECTIVE: The purpose of this study was to describe the clinical characteristics, treatment outcomes, and prognostic factors in patients with brain abscesses treated in a single institute during a recent 10-year period. METHODS: Fifty-one patients with brain abscesses who underwent navigation-assisted abscess aspiration with antibiotic treatment were included in this study. Variable parameters were collected from the patients' medical records and radiological data. A comparison was made between patients with favorable [Glasgow Outcome Scale (GOS) > or =4] and unfavorable (GOS or =13) and 24 patients (47%) had predisposing factors. The offending microorganisms were identified in 25 patients (49%), and Streptococcus species were the most commonly isolated bacteria (27%). The mean duration of antibiotic administration was 42 days. At discharge, 41 patients had a favorable outcome and 10 had an unfavorable outcome including 8 deaths. The decreased level of consciousness (GCS or =140 mg/dL) was an independent risk factor for prolonged antibiotic therapy (p=0.032). CONCLUSION: We found that the level of consciousness at admission was associated with treatment outcomes in patients with brain abscesses. Furthermore, initial hyperglycemia was closely related to the long-term use of antibiotic agents.


Sujets)
Femelle , Humains , Mâle , Abcès , Bactéries , Abcès cérébral , Causalité , Conscience , Échelle de coma de Glasgow , Échelle de suivi de Glasgow , Hyperglycémie , Dossiers médicaux , Facteurs de risque , Streptococcus
15.
Brain Tumor Research and Treatment ; : 39-42, 2014.
Article Dans Anglais | WPRIM | ID: wpr-106233

Résumé

Dermoid cysts are rare congenital tumors that occur primarily at the midline at a characteristic intradural location. However, dermoid cysts located at extradural and lateral regions have been rarely reported until now. In the present study, the authors demonstrate the unusual instance of an intracranial extradural dermoid cyst at the lateral sphenoid ridge. A 53-year-old woman admitted because of progressive headache and dizziness. The patient had no neurologic deficits, and magnetic resonance imaging with no contrast enhancement revealed a mass at the right sphenoid ridge. The mass was accompanied with sphenoid bone erosion visible on computed tomography. The patient underwent right pterional craniotomy, and the tumor including the capsule was totally resected. Presence of a dermoid cyst was confirmed with histopathological examination. The patient had no complications during the postoperative period. This study suggests that dermoid cyst should be considered for differential diagnosis of extradural and lateral intracranial masses.


Sujets)
Femelle , Humains , Adulte d'âge moyen , Craniotomie , Kyste dermoïde , Diagnostic différentiel , Sensation vertigineuse , Céphalée , Imagerie par résonance magnétique , Manifestations neurologiques , Période postopératoire , Os sphénoïde
16.
Journal of Korean Neurosurgical Society ; : 152-156, 2014.
Article Dans Anglais | WPRIM | ID: wpr-57666

Résumé

Intracisternal accessory nerve schwannomas are very rare; only 18 cases have been reported in the literature. In the majority of cases, the tumor origin was the spinal root of the accessory nerve and the tumors usually presented with symptoms and signs of intracranial hypertension, cerebellar ataxia, and myelopathy. Here, we report a unique case of an intracisternal schwannoma arising from the cranial root of the accessory nerve in a 58-year-old woman. The patient presented with the atypical symptom of hoarseness associated with recurrent laryngeal neuropathy which is noted by needle electromyography, and mild hypesthesia on the left side of her body. The tumor was completely removed with sacrifice of the originating nerve rootlet, but no additional neurological deficits. In this report, we describe the anatomical basis for the patient's unusual clinical symptoms and discuss the feasibility and safety of sacrificing the cranial rootlet of the accessory nerve in an effort to achieve total tumor resection. To our knowledge, this is the first case of schwannoma originating from the cranial root of the accessory nerve that has been associated with the symptoms of recurrent laryngeal neuropathy.


Sujets)
Femelle , Humains , Adulte d'âge moyen , Nerf accessoire , Ataxie cérébelleuse , Électromyographie , Enrouement , Hypoesthésie , Hypertension intracrânienne , Aiguilles , Neurinome , Maladies de la moelle épinière , Racines des nerfs spinaux
17.
Journal of Korean Neurosurgical Society ; : 125-127, 2013.
Article Dans Anglais | WPRIM | ID: wpr-85118

Résumé

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.


Sujets)
Sujet âgé , Femelle , Humains , Astrocytome , Noyaux gris centraux , Hémorragie des ganglions de la base , Biopsie , Encéphale , Tumeurs du cerveau , Hémorragie cérébrale , Dysarthrie , Gadolinium , Gliome , Hémorragie , Hydrocéphalie , Hypertension artérielle , Hémorragie intracrânienne hypertensive , Imagerie par résonance magnétique , Parésie , Dérivation ventriculopéritonéale
18.
Journal of Korean Neurosurgical Society ; : 293-296, 2013.
Article Dans Anglais | WPRIM | ID: wpr-162923

Résumé

The aneurysm arising from fenestrated proximal anterior cerebral artery (ACA) is considered to be unique. The authors report a case of a 59-year-old woman who presented with a subarachnoid hemorrhage (SAH) secondary to a ruptured aneurysm originating from the fenestrated A1 segment of right ACA. The patient had another unruptured aneurysm which was located at the right middle cerebral artery bifurcation. She was successfully treated with surgical clipping for both aneurysms. From the previously existing literatures, we found 18 more cases (1983-2011) of aneurysms associated with fenestrated A1 segment. All cases represented saccular type of aneurysms, and 79% of the patients had SAH. There were three subtypes of the fenestrated A1 aneurysms depending on the anatomical location, relative to the fenestrated segment. The most common type was the aneurysms located on the proximal end of fenestrated artery (82%). Azygos ACA and hypoplastic A1 were frequently accompanied by the aneurysm (33% and 31%, respectively), and multiple aneurysms were shown in three cases (16%). Considering that fenestrated A1 segment is likely to develop an aneurysm, which has high risk of rupture, early management may benefit patients with aneurysms accompanied by fenestrated proximal ACA.


Sujets)
Femelle , Humains , Anévrysme , Rupture d'anévrysme , Artère cérébrale antérieure , Artères , Anévrysme intracrânien , Artère cérébrale moyenne , Rupture , Hémorragie meningée , Instruments chirurgicaux
19.
Journal of Korean Neurosurgical Society ; : 172-178, 2012.
Article Dans Anglais | WPRIM | ID: wpr-22529

Résumé

OBJECTIVE: The aim of this study was to determine the role of intra-arterial (IA) nimodipine injections for cerebral vasospasm secondary to ruptured subarachnoid hemorrhage (SAH) and to investigate the factors that influence vasodilation and clinical outcomes. METHODS: We enrolled 29 patients who underwent aneurysm clipping for ruptured cerebral aneurysms between 2009 and 2011, and who received IA nimodipine after subsequently presenting with symptomatic vasospasm. The degree of vasodilation shown in angiography was measured, and the correlation between the degree of vasodilation and both the interval from SAH to cerebral vasospasm and the interval from clipping to cerebral vasospasm was determined. The change in blood flow rate after IA injection was assessed by transcranial Doppler ultrasound. Multiple clinical parameters were completed before and after IA nimodipine injection to evaluate any improvements in clinical symptoms. RESULTS: For eight patients, Glasgow Coma Scale (GCS) scores increased by two or more points. The regression analysis demonstrated a positive correlation between the change in GCS scores after IA nimodipine injection and the change in blood vessel diameter (p=0.025). A positive correlation was also observed between the interval from SAH to vasospasm and the change in diameter (p=0.040); and the interval from clipping to vasospasm and the change in diameter (p=0.022). CONCLUSION: IA nimodipine injection for SAH-induced vasospasm led to significant vasodilation in angiography and improvement in clinical symptoms without significant complications. Our findings suggest that IA nimodipine injection should be utilized when intractable vasospasm develops despite rigorous conservative management.


Sujets)
Humains , Anévrysme , Rupture d'anévrysme , Angiographie , Vaisseaux sanguins , Échelle de coma de Glasgow , Glycosaminoglycanes , Injections artérielles , Anévrysme intracrânien , Nimodipine , Hémorragie meningée , Vasodilatation , Vasospasme intracrânien
20.
Journal of Korean Neurosurgical Society ; : 541-546, 2012.
Article Dans Anglais | WPRIM | ID: wpr-178295

Résumé

OBJECTIVE: The prefabrication of customized cranioplastic implants has been introduced to overcome the difficulties of intra-operative implant molding. The authors present a new technique, which consists of the prefabrication of implant molds using three-dimensional (3D) printers and polymethyl-methacrylate (PMMA) casting. METHODS: A total of 16 patients with large skull defects (>100 cm2) underwent cranioplasty between November 2009 and April 2011. For unilateral cranial defects, 3D images of the skull were obtained from preoperative axial 1-mm spiral computed tomography (CT) scans. The image of the implant was generated by a digital subtraction mirror-imaging process using the normal side of the cranium as a model. For bilateral cranial defects, precraniectomy routine spiral CT scan data were merged with postcraniectomy 3D CT images following a smoothing process. Prefabrication of the mold was performed by the 3D printer. Intraoperatively, the PMMA implant was created with the prefabricated mold, and fit into the cranial defect. RESULTS: The median operation time was 184.36+/-26.07 minutes. Postoperative CT scans showed excellent restoration of the symmetrical contours and curvature of the cranium in all cases. The median follow-up period was 23 months (range, 14-28 months). Postoperative infection was developed in one case (6.2%) who had an open wound defect previously. CONCLUSION: Customized cranioplasty PMMA implants using 3D printer may be a useful technique for the reconstruction of various cranial defects.


Sujets)
Humains , Conception assistée par ordinateur , Craniectomie décompressive , Études de suivi , Champignons , Méthacrylate de méthyle , Poly(méthacrylate de méthyle) , , Crâne , Tomodensitométrie hélicoïdale
SÉLECTION CITATIONS
Détails de la recherche