ELECTRODE POSITION DETERMINED BY FUSED IMAGES OF PREOPERATIVE AND POSTOPERATIVE MAGNETIC RESONANCE IMAGING AND SURGICAL OUTCOME AFTER SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION

Paek, Sun Ha,Han, Jung Ho,Lee, Jee-Young,Kim, Cheolyoung,Jeon, Beom Seok,Kim, Dong Gyu Oxford University Press 2008 Neurosurgery Vol.63 No.5

<B>Abstract</B><B>OBJECTIVE</B><P>The electrode position is important to the surgical outcome after subthalamic nucleus (STN) deep brain stimulation (DBS). The aim of this study was to compare the surgical outcome of bilateral STN DBS with the electrode position estimated using fused magnetic resonance imaging.</P><B>METHODS</B><P>Bilateral STN DBS was performed in 60 patients with advanced Parkinson's disease. Patients were evaluated with the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, Schwab and England Activities of Daily Living, L-dopa equivalent dose, and Short Form-36 Health Survey before and at 3 and 6 months after surgery. Brain magnetic resonance imaging (1.5-T) was performed in 53 patients at 6 months after STN DBS. The electrode position was estimated in the fused pre- and postoperative magnetic resonance images and correlated with the surgical results.</P><B>RESULTS</B><P>As a group, the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr staging, Schwab and England Activities of Daily Living, and Short Form-36 Health Survey scores improved at 3 and 6 months after STN DBS. The L-dopa equivalent dose decreased by 60% at 3 and 6 months after STN DBS. The electrode position was divided into 6 types according to its relationship to the STN and the red nucleus. Most off-medication Unified Parkinson's Disease Rating Scale motor subscale scores improved regardless of the type of electrode position. The off-medication speech subscale score improved only in the patients whose electrodes were correctly positioned in the STN bilaterally.</P><B>CONCLUSION</B><P>The electrodes accurately positioned in the STN led to improved speech after bilateral STN DBS. An effort should be made in each patient to document the electrode position to monitor surgical performance and to improve the surgical outcome after STN DBS.</P>

Clinical Application of 7.0 T Magnetic Resonance Images in Gamma Knife Radiosurgery for a Patient with Brain Metastases

Paek, Sun Ha,Son, Young Don,Chung, Hyun-Tai,Kim, Dong Gyu,Cho, Zang-Hee The Korean Academy of Medical Sciences 2011 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.26 No.6

<P>In the study we assessed the distortion of 7.0 T magnetic resonance (MR) images in reference to 1.5 T MR images in the radiosurgery of metastatic brain tumors. Radiosurgery with Gamma Knife Perfexion® was performed for the treatment of a 54-yr-old female patient with multiple brain metastases by the co-registered images of the 7.0 T and 1.5 T magnetic resonance images (MRI). There was no significant discrepancy in the positions of anterior and posterior commissures as well as the locations of four metastatic brain tumors in the co-registered images between 7.0 T and 1.5 T MRI with better visualization of the anatomical details in 7.0 T MR images. This study demonstrates for the first time that 7.0 T MR images can be safely utilized in Perfexion® Gamma Knife radiosurgery for the treatment of metastatic brain tumors. Furthermore 7.0 T MR images provide better visualization of brain tumors without image distortion in comparison to 1.5 T MR images.</P>

Early Experience of Pre- and Post-Contrast 7.0T MRI in Brain Tumors

Paek, Seung Leal,Chung, Young Seob,Paek, Sun Ha,Hwang, Jae Ha,Sohn, Chul-Ho,Choi, Seung Hong,Son, Young Don,Kim, Young Bo,Kim, Dong Gyu,Lee, Kendall H.,Cho, Zang-Hee The Korean Academy of Medical Sciences 2013 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.28 No.9

<P>We investigated the safety and clinical applicability of 7.0 Tesla (T) brain magnetic resonance imaging (MRI) in patients with brain tumors. Twenty-four patients with intraaxial or extraaxial brain tumors were enrolled in this study. 7.0T MRIs of T2*-weighted axial and T1-weighted coronal or sagittal images were obtained and compared with 1.5T brain MRIs. The T2*-weighted images from 7.0T brain MRI revealed detailed microvasculature and the internal contents of supratentorial brain tumors better than that of 1.5T brain MRI. For brain tumors located in parasellar areas or areas adjacent to major cerebral vessels, flow-related artifacts were exaggerated in the 7.0T brain MRIs. For brain tumors adjacent to the skull base, susceptibility artifacts in the interfacing areas of the paranasal sinus and skull base hampered the aquisition of detailed images and information on brain tumors in the 7.0T brain MRIs. This study shows that 7.0T brain MRI can provide detailed information on the intratumoral components and margins in supratentorial brain tumors. Further studies are needed to develop refined MRI protocols for better images of brain tumors located in the skull base, parasellar, and adjacent major cerebrovascular structures.</P>

Primary Culture of Central Neurocytoma: A Case Report

Paek, Sun Ha,Shin, Hye Young,Kim, Jin Wook,Park, Sung-Hye,Son, Jin H.,Kim, Dong Gyu The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.5

<P>A seventeen-year-old female patient was admitted with sudden-onset of headache and vomiting. Brain magnetic resonance imaging demonstrated a heterogeneously enhancing tumour in the left lateral ventricle. The tumour was removed and confirmed as a central neurocytoma (CN). For the residual tumour in the left lateral ventricle, gamma knife stereotactic radiosurgery was done at fifteen months after the initial surgery. Tumour recurred in the 4th ventricle at 5 yr after initial surgery. The tumour was removed and proved as a CN. In vitro primary culture was done with both tumours obtained from the left lateral ventricle and the 4th ventricle, respectively. Nestin, a neuronal stem cell marker was expressed in reverse Transcriptase-Polymerase Chain Reaction of both tumors. Both tumours showed different morphology and phenotypes of neuron and glia depending on the culture condition. When cultured in insulin, transferrin selenium and fibronectin media with basic fibroblast growth factors, tumour cells showed neuronal morphology and phenotypes. When cultured in the Dulbeco's Modified Essential Media with 20% fetal bovine serum, tumors cells showed glial morphology and phenotypes. It is suggested that CN has the characteristics of neuronal stem cells and potential to differentiate into mature neuron and glial cells depending on the environmental cue.</P>

Contrast-enhanced Magnetic Resonance Imaging of Brain Metastases at 7.0T versus 1.5T: A Preliminary Result

Paek, Sun Ha,Kim, Jhi-Hoon,Choi, Sung-Hong,Yoon, Tae-Jin,Son, Young Don,Kim, Dong Gyu,Cho, Zang-Hee,Sohn, Chul-Ho Korean Society of Magnetic Resonance in Medicine 2015 Investigative Magnetic Resonance Imaging Vol.19 No.1

Purpose: To compare the depiction of brain metastases on contrast-enhanced images with 7.0 tesla (T) and at 1.5T MRI. Materials and Methods: Four consecutive patients with brain metastases were scanned on 7.0T whole-body scanner and 1.5T MRI. A 3D T1-weighted gradient echo sequence (3D T1-GRE) at 1.5T (voxel size = $0.9{\times}0.9{\times}1.5mm^3$ after double-dose, gadoterate meglumine, Gd-DOTA) was compared to a 7.0T 3D T1-GRE sequence (voxel size = $0.4{\times}0.4{\times}0.8mm^3$, single-dose Gd-DOTA) in four patients after a 5 minute delay. The number of contrast-enhancing metastases in MPRAGE images was compared in each patient by two radiologists in consensus. We measured contrast ratio of enhancing brain metastases and white matter in 1.5T and 7.0T. Results: In all four patients 7.0T 3D T1-GRE images after single-dose Gd-DOTA and 1.5T after double-dose Gd-DOTA depicted 11 brain metastases equally. In the quantitative analysis of contrast ratios of enhancing brain metastases and white matter, the 1.5T 3D T1-GRE after double-dose showed an increased contrast ratio compared to 7.0T 3D T1-GRE after single-dose ($0.961{\pm}0.571$ versus $0.885{\pm}0.494$; n = 11 metastases). But this difference was not statistically significant (P = 0.711). Conclusion: Our preliminary results indicate that 7.0T single-dose Gd-enhanced images were not different to 1.5T double-dose Gd-enhanced images for the detection of brain metastases.

Electrode Position and the Clinical Outcome after Bilateral Subthalamic Nucleus Stimulation

Paek, Sun Ha,Lee, Jee-Young,Kim, Han-Joon,Kang, Daehee,Lim, Yong Hoon,Kim, Mi Ryoung,Kim, Cheolyoung,Jeon, Beom Seok,Kim, Dong Gyu The Korean Academy of Medical Sciences 2011 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.26 No.10

<P>We compared the surgical outcome with electrode positions after bilateral subthalamic nucleus (STN) stimulation surgery for Parkinson's disease. Fifty-seven patients treated with bilateral STN stimulations were included in this study. Electrode positions were determined in the fused images of preoperative MRI and postoperative CT taken at six months after surgery. The patients were divided into three groups: group I, both electrodes in the STN; group II, only one electrode in the STN; group III, neither electrode in the STN. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage, and activities of daily living scores significantly improved at 6 and 12 months after STN stimulation in both group I and II. The off-time UPDRS III speech subscore significantly improved (1.6 ± 0.7 at baseline vs 1.3 ± 0.8 at 6 and 12 months, <I>P</I> < 0.01) with least L-dopa equivalent daily dose (LEDD) (844.6 ± 364.1 mg/day at baseline; 279.4 ± 274.6 mg/day at 6 months; and 276.0 ± 301.6 mg/day at 12 months, <I>P</I> < 0.001) at 6 and 12 months after STN deep brain stimulation (DBS) in the group I. Our findings suggest that the better symptom relief including speech with a reduced LEDD is expected in the patients whose electrodes are accurately positioned in both STN.</P>

Sodium Valproate(Depakine^(�)) 정맥주사의 임상적 효능에 관한 연구 : 신경외과 수술후 1주일간의 간질억제효과와 안전성 Antiepileptic Effect and Safety Assessment During the Postoperative Seven Days in Neurosurgical Patients

백선하,왕규창,오창완,정천기,김동규,정희원,김현집,조병규,최길수,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.7

Diphenylhydantoin(DPH) has been used intravenously as a drug of choice in conditions which seizure patients are incapable of oral Teeding or in a state of status epilepticus However, its clinical use has limitations because of its serious side effects o# cardiac depression or systemic hypotension In Western countries. the recently do- veloped intravenous sodium valproate has been reported as safe and e#Tective for seizure control in such patients To assess the safety and effectiveness in seizure control we investigated the serum levels of the drug at f4 hours 48 hours and 7 days after intravenous administration of sodium valproate(Depakine른. occurrence of seizures in the perioperative period and the side eT#ects of the drugs in 30 neurosurgical patients older than 3 years of age The mean serum concentrations of valproic acid after bolus injection To IS mg/kg followed by continuous infusion with the rate To OSmg/kg/hour, were over 450 rg/ml . 좌S 0± IS 3 ff/ml at 운4 hours, 504±fl 0 f(g/ml at 좌』 hours and 58 9±tO 7 賠,/1 at 7 days aTter the sta「t of the adinistration All the Patients whose se「u vaIProic acid levelwas witHin the therapeutic range(40-100 rr/ml). had never experienced an episode of seizure attack during the perioperative days There was no evidence of elevated liver enzyme activity, but there were evidence of some tendencyof decreased platelet count in the peripheral blood at f days a#ter the administration of intravenous Yalproic acid Four patients experienced episodes of mild nausea and/or vomiting in conclusion per'ioperat'ive intravenous administration of valproic acids in neurosurgical patients was safe and effective in seizure control However it must be used precauciously in the patients with compromized coagulation system

한국인의 호기중 일산화질소(NO)의 농도

하태규,이선화,김상섭,백도명 서울대학교 보건대학원 2001 서울大學校 保健環境硏究所論叢 Vol.11 No.1

Nitric oxide has been found to be increased with the exacerbation of inflammatory state such as asthma or irritable bowel syndrome, and it has been suggested as a marker of inflammation. As yet no measurement of exhaled NO has been made for Koreans, and this was to describe the pattern of exhaled NO among general population. Exhaled NO was measured by chemiluminescence NO analyser (Ecophysic CLD 77 AM sp) with NO free gas. Subjects were instructed to blow slowly to the analyser at the rate of 100 ml/s. In total 493 subjects had participated with the age range of under 10 to over 70 year old. The average exhaled NO concentration was 7.86 ppb. The level was significantly higher for males than females, and when stratified by 10-year age group the level was highest for teens and lowest for 30's. FEVI/FVC was significantly associated with exhaled NO, and as FEVI/FVC got smaller the NO concentration got higher. The results of this study shows that exhaled NO is a convenient and reproducible measurement, and it is significantly associated with airway narrowing or possibly airway inflammation. Further study of potential factors of NO production and excretion is required.

두개인두종의 임상양상 및 수술적 치료성적 : 102례의 분석 Analysis of 102 Cases

백선하,오창완,정영섭,양희진,한대희,조병규,왕규창,정희원,김현집,최길수 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.7

The Magnitude of Mortality from Ischemic Heart Disease Attributed to Occupational Factors in Korea - Attributable Fraction Estimation Using Meta-analysis

Ha, Jae-Hyeok,Kim, Soo-Geun,Paek, Do-Myung,Park, Jung-Sun Occupational Safety and Health Research Institute 2011 Safety and health at work Vol.2 No.1

Objectives: Ischemic heart disease (IHD) is a major cause of death in Korea and known to result from several occupational factors. This study attempted to estimate the current magnitude of IHD mortality due to occupational factors in Korea. Methods: After selecting occupational risk factors by literature investigation, we calculated attributable fractions (AFs) from relative risks and exposure data for each factor. Relative risks were estimated using meta-analysis based on published research. Exposure data were collected from the 2006 Survey of Korean Working Conditions. Finally, we estimated 2006 occupation-related IHD mortality. Results: For the factors considered, we estimated the following relative risks: noise 1.06, environmental tobacco smoke 1.19 (men) and 1.22 (women), shift work 1.12, and low job control 1.15 (men) and 1.08 (women). Combined AFs of those factors in the IHD were estimated at 9.29% (0.3-18.51%) in men and 5.78% (-7.05-19.15%) in women. Based on these fractions, Korea's 2006 death toll from occupational IHD between the age of 15 and 69 was calculated at 353 in men (total 3,804) and 72 in women (total 1,246). Conclusion: We estimated occupational IHD mortality of Korea with updated data and more relevant evidence. Despite the efforts to obtain reliable estimates, there were many assumptions and limitations that must be overcome. Future research based on more precise design and reliable evidence is required for more accurate estimates.