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전상범,권순억,박중철,이덕희,윤성철,Yeon-Jung Kim,안재성,Byung Duk Kwun,강동화,H. Alex Choi,Kiwon Lee,김종성 대한뇌졸중학회 2016 Journal of stroke Vol.18 No.3
Background and Purpose Hemicraniectomy is a decompressive surgery used to remove a large bone flap to allow edematous brain tissue to bulge extracranially. However, early indicators of the decompressive effects of hemicraniectomy are unclear. We investigated whether reduction of midline shift following hemicraniectomy is associated with improved consciousness and survival in patients with malignant middle cerebral artery infarctions. Methods We studied 70 patients with malignant middle cerebral artery infarctions (MMI) who underwent hemicraniectomies. Midline shift was measured preoperatively and postoperatively using computed tomography (CT). Consciousness level was evaluated using the Glasgow Coma Scale on postoperative day 1. Patient survival was assessed six months after stroke onset. Results The median time interval between preoperative and postoperative CT was 8.3 hours (interquartile range, 6.1–10.2 hours). Reduction in midline shift was associated with higher postoperative Glasgow Coma Scale scores (P<0.05). Forty-three patients (61.4%) were alive at six months after the stroke. Patients with reductions in midline shifts following hemicraniectomy were more likely to be alive at six months post-stroke than those without (P<0.001). Reduction of midline shift was associated with lower mortality at six months after stroke, after adjusting for age, sex, National Institutes of Health Stroke Scale score, and preoperative midline shift (adjusted hazard ratio, 0.71; 95% confidence interval, 0.62–0.81; P<0.001). Conclusions Reduction in midline shift following hemicraniectomy was associated with improved consciousness and six-month survival in patients with MMI. Hence, it may be an early indicator of effective decompression following hemicraniectomy.
Critical Care for Patients with Massive Ischemic Stroke
전상범,고윤석,H. Alex Choi,이기원 대한뇌졸중학회 2014 Journal of stroke Vol.16 No.3
Malignant cerebral edema following ischemic stroke is life threatening, as it can cause inadequate blood flow and perfusion leading to irreversible tissue hypoxia and metabolic crisis. Increased intracranial pressure and brain shift can cause herniation syndrome and finally brain death. Multiple randomized clinical trials have shown that preemptive decompressive hemicraniectomy effectively reduces mortality and morbidity in patients with malignant middle cerebral artery infarction. Another life-saving decompressive surgery is suboccipital craniectomy for patients with brainstem compression by edematous cerebellar infarction. In addition to decompressive surgery, cerebrospinal fluid drainage by ventriculostomy should be considered for patients with acute hydrocephalus following stroke. Medical treatment begins with sedation, analgesia, and general measures including ventilatory support, head elevation, maintaining a neutral neck position, and avoiding conditions associated with intracranial hypertension. Optimization of cerebral perfusion pressure and reduction of intracranial pressure should always be pursued simultaneously. Osmotherapy with mannitol is the standard treatment for intracranial hypertension, but hypertonic saline is also an effective alternative. Therapeutic hypothermia may also be considered for treatment of brain edema and intracranial hypertension, but its neuroprotective effects have not been demonstrated in stroke. Barbiturate coma therapy has been used to reduce metabolic demand, but has become less popular because of its systemic adverse effects. Furthermore, general medical care is critical because of the complex interactions between the brain and other organ systems. Some challenging aspects of critical care, including ventilator support, sedation and analgesia, and performing neurological examinations in the setting of a minimal stimulation protocol, are addressed in this review.
개방교합과 과개교합에서 구치의 근원심 치축경사도에 관한 두부방사선계측학적 연구
전상범,김진범,손우성 대한치과교정학회 1993 대한치과교정학회지 Vol.23 No.3
For the purpose of investigating mesiodistal axial inclination of posterior teeth in normal occlusion group, open bite and deep bite group and investigating the correlationship between the axial inclination of posterior teeth and overbite of anterior teeth, a cephalometric study was performed on the subjects consisted of normal occlusion group(40), open bite group(71 : Angle's Class Ⅰ 21, Class Ⅱ, division 1 25, Class Ⅲ 25) and deep bite group(64 : Angle's Class Ⅰ 23, Class Ⅱ, division 1 21, Class Ⅲ 20). Mesiodistal axial inclination of posterior teeth to occlusal, mandibular and palatal plane were measured. The findings of this study were as follows : 1. Upper and lower posterior teeth were more mesially inclined to occlusal plane in open bite group than in deep bite group. 2. Lower posterior teth were more mesially inclined in deep bite group than in open bite group in Angle's Class Ⅱ, division 1 malocclusion but there were no significant differences in Angle's Class Ⅰ and Class Ⅲ malocclusion. 3. There was no significant correlationship between the axial inclination of posterior teeth to each plane and overbite of anterior teeth in open bite group. 4. There was a significant correlationship between the axial inclination of upeer and lower second premolar to occlusal plane and overbite of anterior teeth in Angle's Class Ⅰ, Class Ⅱ, division 1 and Class Ⅲ malocclusion.