Association of Low Blood Pressure with White Matter Hyperintensities in Elderly Individuals with Controlled Hypertension

Jun Sung Kim,LEESUBIN,Seung Wan Suh,Jong Bin Bae,Ji Hyun Han,Seonjeong Byun,Ji Won Han,Jae Hyoung Kim,Ki Woong Kim 대한뇌졸중학회 2020 Journal of stroke Vol.22 No.1

Background and Purpose Both hypertension and hypotension increase cerebral white matter hyperintensities. However, the effects of hypotension in individuals with treated hypertension are unknown. We analyzed the association of low blood pressure with the location and amount of white matter hyperintensities between elderly individuals with controlled hypertension and those without hypertension. Methods We enrolled 505 community-dwelling, cognitively normal elderly individuals from the participants of the Korean Longitudinal Study on Cognitive Aging and Dementia. We measured blood pressure three times in a sitting position using a mercury sphygmomanometer and defined low systolic and diastolic blood pressure as ≤110 and ≤60 mm Hg, respectively. We segmented and quantified the periventricular and deep white matter hyperintensities from 3.0 Tesla fluidattenuated inversion recovery magnetic resonance images. Results Low systolic blood pressure was independently associated with larger volume of periventricular white matter hyperintensity (P=0.049). The interaction between low systolic blood pressure and hypertension was observed on the volume of periventricular white matter hyperintensity (P=0.005). Low systolic blood pressure was associated with the volume of periventricular white matter hyperintensity in individuals with controlled hypertension (F1,248=6.750, P=0.010), but not in those without hypertension (P=0.380). Low diastolic blood pressure was not associated with the volumes of white matter hyperintensities regardless of presence of controlled hypertension. Conclusions Low systolic blood pressure seems to be associated with larger volume of periventricular white matter hyperintensity in the individuals with a history of hypertension but not in those without hypertension.

Endovascular Treatment of "Kissing Aneurysms" at the Anterior Communicating Artery

Suh, Sang-Jun,Kang, Dong-Gee,Ryu, Kee-Young,Cho, Jae-Hoon The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.44 No.3

Kissing aneurysms are the rare type of multiple aneurysms. They are adjacent aneurysms of different origin arteries in the same region, which require great care in diagnosis and treatment. We report a case of kissing aneurysms at the anterior communicating artery (AcomA) which were treated by endovascular coil embolization.

Clinical and Angiographic Results after Treatment with Combined Clipping and Wrapping Technique for Intracranial Aneurysm

Suh, Sang-Jun,Kim, Sang-Chul,Kang, Dong-Gee,Ryu, Kee-Young,Lee, Hyuk-Gee,Cho, Jae-Hoon The Korean Neurosurgical Society 2008 Journal of Korean neurosurgical society Vol.44 No.4

Objective : There have been numerous follow-up studies of patients who had ruptured or unruptured intracranial aneurysms treated by wrapping technique using various materials have been reported. Our objective was to ascertain whether our particular wrapping technique using the temporalis muscle provides protection from rebleeding and any aneurysm configuration changes in follow-up studies. Methods : Clinical presentation, the location and shape of the aneurysm, outcomes at discharge and last follow-up, and any aneurysm configuration changes on last angiographic study were analyzed retrospectively in 21 patients. Reinforcement was acquired by clipping the wrapped temporalis muscle. Wrapping and clipping after incomplete clipping was also done. Follow-up loss and non-angiographic follow-up patient groups were excluded in this study. Results : The mean age was 53 years (range 29-67), and 15 patients were female. Among 21 patients, 10 patients had ruptured aneurysms (48%). Aneurysms in 21 patients were located in the anterior circulation. Aneurysm shapes were broad neck form (14 cases), fusiform (1 case), and bleb to adjacent vessel (6 cases). Five patients were treated by clipping the wrapped temporalis, and 16 patients by wrapping after partial clipping. The mean Glasgow coma scale (GCS) at admission was 14.2. The mean Glasgow outcome scale (GOS) at discharge was 4.8, and 18 patients were grade 5. The mean period between initial angiography and last angiography was 18.5 months (range 8-44). Aneurysm size was not increased in any of these patients and configuration also did not change. There was no evidence of rebleeding in any of these treated aneurysms. Conclusion : Our study results show that wrapping technique, using the temporalis muscle and aneurysm clip(s), for intracranial aneurysm treatment provides protection from rebleeding or regrowth.

Effects of Noradrenaline on the Spontaneous Contraction and Ionic Current in the Antral Circular Muscle of Guinea-pig Stomach

Jun, Jae-Yeoul,Lee, Sang-Jin,Kim, Sung-Joon,Suh, Jae-Yul,So, In-Suk,Hwang, Sang-Ik,Kim, Ki-Whan The Korean Physiological Society 1993 대한생리학회지 Vol.27 No.2

There is evidence that noradrenaline enhances spontaneous contractions dose-dependently in guinea-pig antral circular muscle. To investigate the mechanism of this excitatory action, slow waves and membrane currents were recorded using conventional microelectrode techniques in muscle strips and the whole cell patch clamp technique in isolated gastric myocytes. On recording slow waves, noradrenaline $(10^{-5}\;M)$ induced the hyperpolarization of the membrane potential, although the shape of the slow waves became tall and steep. Also, spike potentiaIs occurred at the peaks of slow waves. These changes were completely reversed by administration of phentolamine $(10^{-5}\;M),\;an\;{\alpha}-adrenoceptor$ blocker. Noradrenaline-induced hyperpolarization was blocked by apamin $(10^{-7}\;M)$, a blocker of a class of $Ca^{2+}\;-dependent\;K^+$ channels. To investigate the mechanisms for these effects, we performed whole cell patch clamp experiments. Norndrenaline increased voltage-dependent $Ca^{2+}$ currents in the whole range of test potentials. Noradrenaline also increased $Ca^{2+}\;-dependent\;K^+$\;currents, and this effects was abolished by apamin. These results suggest that the increase in amplitude and the generation of spike potentials on slow waves was caused by the activation of voltage-dependent $Ca^{2+}$ channel via adrenoceptors, and hyperpolarization of the membrane potential was mediated by activation of apamin-sensitive $Ca^{2+}\;-dependent\;K^+\;channels$.

The efficacy and safety of intraoral 2940 nm er: yag smooth mode on facial tightening: a preliminary report

( Sang Jun Lee ),( Dong Hye Suh ),( Kye Yong Song ),( So Min Kim ),( Sang Hyun Cho ),( Jeong Deuk Lee ),( Hei Sung Kim ) 대한피부과학회 2015 대한피부과학회 학술발표대회집 Vol.67 No.2

Background: Facial skin rejuvenation has long been the most highly desired aesthetic procedure. The demand for no-downtime procedures in skin rejuvenation has guided researchers to develop newer non-invasive procedures based on thermal effects that result in collagen remodeling. Objectives: The purpose of this prospective pilot study was to assess the effectiveness and safety of intraoral treatment with Er: YAG laser using a non-ablative mode. Methods: Nine patients were treated with a 2940 nm Er:YAG laser using the intra-oral technique. All received three sessions of treatment. Wrinkles severity (the nasolabial fold and the perioral wrinkles) was assessed by two independent evaluators before and after each treatment using the Modified Fitzpatrick Wrinkle Scale. A skin biopsy was also performed before and 3 months afterthe final session. Results: The mean patient age was 52 years. A significant reduction of perioral wrinkles was observed after treatment. The therapy was also very well tolerated by all patients, with no discomfort described. Histologic evaluation showed greater dermal collagen with thickening of the dermis and straightening of elastic fibers in the reticular dermis after treatment. Conclusion: Through this pilot study, we describe a new non-invasive intraoral method using Er: YAG in a non-ablative mode for efficient reduction of perioral wrinkles, with no down time and no adverse effects observed.

Transumbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method

Jun Suh Lee,Young Il Choi,Sung Ho Lim,Tae Ho Hong 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.83 No.4

Purpose: Single port laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of transumbilical single port laparoscopic appendectomy (TUSPLA) and conventional laparoscopic appendectomy (CLA) in a Korean military hospital. Methods: This single-center retrospective study of 63 patients who received laparoscopic appendectomy was conducted between May 2011 and October 2011. Nineteen patients received TUSPLA and 44 patients received CLA. Clinical outcomes such as operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. Results: There were no statistically significant differences between TUSPLA and CLA patients, respectively, in operation time (58.9 minutes vs. 52.3 minutes, P = 0.262), duration of hospitalization (10.2 days vs. 10.6 days, P = 0.782), mean visual analogue scale score (2.6 vs. 2.5, P = 0.894), and return to diet (1.6 days vs. 1.7 days, P = 0.776). There were two cases (10.5%) of short-term complications in the TUSPLA group and four cases (9.1%) of short-term complications in the CLA group. All patients were fully recovered at discharge. Conclusion: TUSPLA is a feasible alternative for CLA. When a glove port is used, no special instruments are needed. Thus, it can be performed in a hospital equipped with basic laparoscopic surgical instruments.

The activation of α₂-adrenergic receptor in the spinal cord lowers sepsis-induced mortality

Sung-Su Kim,Soo-Hyun Park,Jae-Ryung Lee,Jun-Sub Jung,Hong-Won Suh 대한생리학회-대한약리학회 2017 The Korean Journal of Physiology & Pharmacology Vol.21 No.5

The effect of clonidine administered intrathecally (i.t.) on the mortality and the blood glucose level induced by sepsis was examined in mice. To produce sepsis, the mixture of D-galactosamine (GaLN; 0.6 g/10 ml)/lipopolysaccharide (LPS; 27 µg/27 µl) was treated intraperitoneally (i.p.). The i.t. pretreatment with clonidine (5 µg/5 µl) increased the blood glucose level and attenuated mortality induced by sepsis in a dose-dependent manner. The i.t. post-treatment with clonidine up to 3 h caused an elevation of the blood glucose level and protected sepsis-induced mortality, whereas clonidine post-treated at 6, 9, or 12 h did not affect. The pre-treatment with oral D-glucose for 30 min prior to i.t. post-treatment (6 h) with clonidine did not rescue sepsis-induced mortality. In addition, i.t. pretreatment with pertussis toxin (PTX) reduced clonidine-induced protection against mortality and clonidine-induced hyperglycemia, suggesting that protective effect against sepsis-induced mortality seems to be mediated via activating PTX-sensitive G-proteins in the spinal cord. Moreover, pretreatment with clonidine attenuated the plasma tumor necrosis factorα (TNF-α) induced by sepsis. Clonidine administered i.t. or i.p. increased p-AMPKα1 and p-AMPKα2, but decreased p-Tyk2 and p-mTOR levels in both control and sepsis groups, suggesting that the up-regulations of p-AMPKα1 and p-AMPKα2, or down-regulations of p-mTOR and p-Tyk2 may play critical roles for the protective effect of clonidine against sepsis-induced mortality.

Clinical significance of type I endoleak on completion angiography

Suh Min Kim,Hwan Do Ra,Sang-Il Min,Hwan Jun Jae,Jongwon Ha,Seung-Kee Min 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.2

Purpose: Type I endoleak is known to be associated with sac enlargement and occasional rupture, therefore, the treatment of type I endoleak is recommended at the time of diagnosis. The aim of this study was to identify the significance of early type I endoleak found on completion angiography. Methods: Between January 2000 and December 2012, a total of 86 patients underwent endovascular abdominal aortic aneurysm repair (EVAR) and 10 patients (11.6%) were diagnosed with type Ia endoleak on completion angiography. Clinical and radiologic data were reviewed retrospectively. Results: Of the 10 patients, two underwent EVAR with custom-made stent-grafts in the initial stage and both of them needed immediate treatment: one case involved open repair while the other involved insertion of an additional stentgraft. In 8 patients, the amount of leakage decreased after repeated balloon molding. They were managed conservatively and followed up with computed tomography angiography within 2 weeks after EVAR. In 7 of the 8 cases, type Ia endoleaks disappeared. In one patient with a persistent endoleak and a folded posterior wall of the stent-graft, coil embolization was performed 1 week after EVAR. With a median follow-up of 12 months (range, 1?61 months), no patients showed recurrence of type I endoleak or sac expansion. Conclusion: Type I endoleaks diagnosed on completion angiography sealed spontaneously in 7 of 10 patients (70.0%). In cases of decreased amounts of leakage after balloon molding, simple observation may be an alternative to repetitive procedures. The long-term follow-up of patients with self-sealed type I endoleaks is mandatory.

Poster Session:PS 0229 ; Gastroenterology : Acute Viral Hepatitis after Recovering from Neutropenic Fever

( Sang Jun Suh ),( Young Kul Jung ),( Sun Young Yim ),( Ji Hye Je ),( Yang Jae Yoo ),( Hae Rim Kim ),( Sung Hee Kang ),( Ji Hoon Kim ),( Yeon Seok Seo ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Soon Ho 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Among the patients with hematologic malignancy, hepatitis occurs after recovering from neutropenic fever. Clinical course is decided according to appropriate treatment to causative pathogen. Various organisms can cause acute hepatitis in immunecompromised host, early inspection to the causative pathogen is essential. We investigated which pathogen cause acute hepatitis after recovering from neutropenic fever in patients with hematologic malignancy. Methods: From January 2011 to april 2014, we included the patients with acute hepatitis (elevated Aspartate transaminase and/or total bilirubin above 2 times upper limit of normal range) within two weeks after recoverinig from neutropenic fever. We excluded the patients with acute hepatitis within two weeks after infused by chemoagent or hepatotoxic drugs. Results: Neutropenic fever was occurred in 173 patients, and 43 patients were appropriate to acute hepatitis of above criteria. Male gender was 28 patients, mean age was 51 years. Causative pathogen was identifi ed in 22 patients. The pathogen was aspergillus 5, infl uenza 4, O.tsutsugamushi 2, varicella zoster virus 1, hepatitis E virus 1 pateint, and other 9 patients were bacterial infection. Among 43 patients, 13 patients occurred septic shock and 11 patients were died. Among survived 2 patients, 1 patient was diagnosed as pulmonary aspergillosis and recovered after therapy with voriconazole, other 1 patients was recovered after therapy with broad-spectrum antibiotics under diagnosis of unknown origin pathegen. Conclusions: Acute hepatitis occur in about 25% after recovering from neutropenic fever, and mortality rate was 25% in the patients with acute hepatitis. Early investigation is essential to such patients, and test for aspergillus and infl uenza would be essential.

Cyanoacrylate Injection versus Band Ligation for the Treatment of Bleeding from Cardiac Varices on Lesser Curvature Side of the Stomach

( Sang Jung Park ),( Yeon Seok Seo ),( Seung Woon Park ),( Han Ah Lee ),( Tae Hyung Kim ),( Sang Jun Suh ),( Young Kul Jung ),( Ji Hoon Kim ),( Hyung Joon Yim ),( Jong Eun Yeon ),( Kwan Soo Byun ),( S 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Practice guidelines recommend endoscopic band ligation (EBL) for the treatment of bleeding from cardiac varices on lesser curvature side of the stomach (CVs). However, endoscopic variceal obturation (EVO) using cyanoacrylate has been reported more effective than EBL for fundal variceal bleeding and considering that the mucosa covering cardiac varices is more thickened than esophageal varices and being exposed to gastric acids or food materials continuously, EVO could be more effective than EBL for the treatment of bleeding from CVs. This study was performed to compare the efficacy between EVO and EBL for the treatment of bleeding from CVs. Methods: All patients who were treated EBL or EVO for bleeding from CVs were enrolled. The patients diagnosed with hepatocellular carcinoma or treated with endoscopic injection therapy were excluded. Results: A total of 77 patients treated with bleeding from CVs were enrolled. Age was 56.4±10.6 years and 67 patients (87.0%) were men. Fifty-one and 26 patients were treated with EBL and EVO, respectively. Hemostasis were achieved in 73 patients (94.8%). Hemostasis rates did not differ between EBL (47 patients, 92.2%) and EVO (26 patients, 100%) groups. Varices rebled in 13 patients during follow-up. Rebleeding rate was significantly higher in EBL group compared to EVO group (P=0.044). During follow-up, 12 patients died (10 in EBL group, 2 in EVO group). Mean survival time was 310.4±13.5 days, which did not differ between two groups (P=0.142). Conclusions: Hemostasis success rate and survival did not differ between the EBL and EVO groups. However, rebleeding rate was significantly lower in EVO group compared to EBL group. EVO could be better option for the treatment of bleeding from CVs on lesser curvature side of the stomach.