A Case Report of Preoperative and Postoperative 7.0T Brain MRI in a Patient with a Small Cell Glioblastoma

백선하,황재하,김동규,최승홍,손철호,박성혜,손영돈,김영보,조장희 대한의학회 2014 Journal of Korean medical science Vol.29 No.7

A 45-yr-old female patient was admitted with one-month history of headache andprogressive left hemiparesis. Brain magnetic resonance imaging (MRI) demonstrated a masslesion in her right frontal lobe. Her brain tumor was confirmed as a small cell glioblastoma. Her follow-up brain MRI, taken at 8 months after her initial surgery demonstrated tumorrecurrence in the right frontal lobe. Contrast-enhanced 7.0T brain magnetic resonanceimaging (MRI) was safely performed before surgery and at the time of recurrence. Compared with 1.5T and 3.0T brain MRI, 7.0T MRI showed sharpened images of the braintumor contexture with detailed anatomical information. The fused images of 7.0T and 1.5Tbrain MRI taken at the time of recurrence demonstrated no significant discrepancy in thepositions of the anterior and the posterior commissures. It is suggested that 7.0T MRI canbe safely utilized for better images of the maligant gliomas before and after surgery.

Optimal systolic blood pressure in noncritically ill patients with acute kidney injury: A retrospective cohort study

백선하,신호준,Ki Young Na,Dong-Wan Chae,김세중 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.3

Background: Few data showed the optimal blood pressure (BP) in noncritically ill patients with acute kidney injury (AKI) relative to mortality or severe AKI. We therefore sought to analyze the data that exist for the ideal target range for BP in noncritically ill patients with AKI. Methods: We performed a retrospective cohort study involving 1,612 hospitalized patients who were diagnosed with AKI using the Kidney Disease: Improving Global Outcomes definition based on serum creatinine measurements for a period of 1 year. The average systolic BP (SBP) was categorized into 10-mmHg increments (within 48 hours after the development of AKI). The primary outcome was a composite of severe AKI or 90-day mortality. Results: The composite outcome rate in patients was 18.7% (302/1,612). The relationship between BP and the composite outcome followed a U-shaped curve, with an increased event rate observed at both low and high BP values. The average SBP after AKI predicted the composite outcome after adjusting for baseline variables (reference SBP: 120-129 mmHg; < 100 mmHg: hazard ratio [HR] 1.84, P = 0.015; 100-109 mmHg: HR 1.56, P = 0.038; 110-119 mmHg: HR 1.15, P = 0.483; 130-139 mmHg: HR 1.51, P = 0.045; ≥ 140 mmHg: HR 1.73, P = 0.005). Conclusion: Among noncritically ill patients with AKI, a U-shaped curve association was observed between the average SBP within 48 hours after AKI and the composite primary outcome of this study, with the lowest event rate for SBP ranging from approximately 110 to 129 mmHg.

Circulating renalase predicts all-cause mortality and renal outcomes in patients with advanced chronic kidney disease

백선하,차란희,강신욱,박철희,차대룡,김성균,윤선애,김세중,한상엽,박정환,장재현,임춘수,김연수,나기영 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.4

Background/Aims: Patients with chronic kidney disease (CKD) have been found to show markedly increased rates of end-stage renal disease, major adverse cardiovascular and cerebrovascular events (MACCEs), and mortality. Therefore, new biomarkers are required for the early detection of such clinical outcomes in patients with CKD. We aimed to determine whether the level of circulating renalase was associated with CKD progression, MACCEs, and all-cause mortality, using data from a prospective randomized controlled study, Kremezin STudy Against Renal disease progression in Korea (K-STAR; NCT 00860431). Methods: A retrospective analysis of the K-STAR data was performed including 383 patients with CKD (mean age, 56.4 years; male/female, 252/131). We measured circulating renalase levels and examined the effects of these levels on clinical outcomes. Results: The mean level of serum renalase was 75.8 ± 34.8 μg/mL. In the multivariable analysis, lower hemoglobin levels, higher serum creatinine levels, and diabetes mellitus were significantly associated with a higher renalase levels. Over the course of a mean follow-up period of 56 months, 25 deaths and 61 MACCEs occurred. Among 322 patients in whom these outcomes were assessed, 137 adverse renal outcomes occurred after a mean follow-up period of 27.8 months. Each 10- μg/mL increase in serum renalase was associated with significantly greater hazards of all-cause mortality and adverse renal outcomes (hazard ratio [HR] = 1.112, p = 0.049; HR = 1.052, p = 0.045). However, serum renalase level was not associated with the rate of MACCEs in patients with CKD. Conclusions: Our results indicated that circulating renalase might be a predictor of mortality and adverse renal outcomes in patients with CKD.

Electrode Position and the Clinical Outcome after Bilateral Subthalamic Nucleus Stimulation

백선하,이지영,김한준,강대희,임용훈,김미령,김철영,전범석,김동규 대한의학회 2011 Journal of Korean medical science Vol.26 No.10

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, P < 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, P < 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.

뇌심부자극술: 기전, 수술방법, 임상 적응증

백선하,황재하,전범석 대한의사협회 2013 대한의사협회지 Vol.56 No.8

Advances in deep brain stimulation (DBS) in relation to neuroimaging techniques and with intraoperative electrophysiological microrecordings and stimulations have replaced ablative procedures for medication-refractory movement disorders such as Parkinson’s disease, dystonia,and essential tremor. DBS is an effective surgical treatment for these conditions and is now being extended to psychiatric diseases such as obsessive-compulsive disorder, depression, and addiction. Despite the proven clinical improvement by DBS, its precise mechanism of action remains unclear. Clinical improvement depends on the selection of the appropriate patients and the precise implantation of the stimulation electrodes, which is based on careful stereotactic targeting and extensive electrophysiological monitoring of the target area. Further studies are being performed to better understand the mechanism of action and identify new anatomical targets and clinical applications of DBS. We briefly introduce the surgical procedure and current clinical applications of DBS in this review.

지주막하 출혈후 따른 뇌혈관 연축으로 인한 신경손상에 대한 니모디핀의 방지 효능 및 내약성 연구 : Effect on the Short-Term Outcome and Safety Assessment

백선하,오창완,한대희 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.12

From January 1995 to September 1995, we enrolled 30 patients with a clinical status over Hunt and Hess grade Ⅳ, presenting within 5 days after spontaneous subarachnoid hemorrhage to determine the effectiveness in early intervention of nimodipine on short-term outcome and its safety. The blood cell count and chemistry were performed before and 7 days after nimodipine treatment, and at discharge. The clinical outcome of the patients was assessed at discharge according to the Glasgow outcome scale. There was no evidence of abnormal change in blood chemistry including liver enzyme activity during the study. Four patients experienced episodes of decreased blood pressure : in one of them, drug administration was discontinued transiently. There was no significant difference in the short-term outcome between the nimodipine treated patients in this study and aneurysmal patients treated without nimodipine in our previous study. However, four of five patients experiencing symptomatic vasospasm in this study showed good outcome at discharge. In conclusion. administration of nimodipine in the patients with spontaneous subarachnoid hemorrhage was safe and nimodipine seeemed to have beneficial effect in protecting the patients with symptomatic vasospasm from severe ischemic damages.

토끼의 뇌혈관 연축 모델에서 혈관확장제 및 혈관수축제에 대한 기저동맥의 감수성 변화

백선하,한대희,Paek, Sun Ha,Han, Dae Hee 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.4

Objective : This experiment is aimed at clarifying the characteristics of spasmodic basilar arteries in the rabbits of subarachnoid hemorrhage(SAH) with observation of vascular response to nitric oxide(NO) and endothelin-1. Material and Methods : Seventy-nine New Zealand white rabbits were divided into 4 groups : control(n=17), sham operation(n=13), postictal-2-day(n=25), and postictal-7-day group(n=24). Rabbits in the postictal-2-day group and postictal-7-day group underwent transfemoral vertebral angiography 2 days and 7 days after SAH respectively. A vascular ring of spasmodic basilar artery was harvested and suspended in organ chamber($37^{\circ}C$) to observe isometric tension changes in response to NO and endothelin-1 under both high(95% $O_2$/5% $CO_2$) and low(95% $N_2$/5% $CO_2$) $O_2$ tension. To investigate the vascular response to NO, acetylcholine from $10^{-7}M$ to $3{\times}10^{-4}M$ concentration was applied to basilar artery ring precontracted with histamine $10^{-6}-10^{-5}M$ in the organ chamber. The vascular response to endothelin-1 was observed by applying endothelin-1 from $10^{-11}M$ to $3{\times}10^{-8}M$ concentration into organ chamber. Results : Seven of 15 live rabbits which underwent angiography 2 days after SAH, were confirmed to develop vasospasm($64.3{\pm}11.2%$) whereas seven of 13 live rabbits which underwent angiography 7 days after SAH, were confirmed to develop vasospasm($64.9{\pm}10.9%$). In all groups, hypoxia significantly reduced the vascular relaxation of basilar arteries to NO. However, hypoxia made no influence on the vascular contraction of basilar arteries to endothelin-1 in all groups. In vascular relaxation of basilar arteries to NO under high $O_2$ tension between groups, the maximum relaxation of basilar arteries in the postictal-7-day group was significantly reduced compared to the postictal-2-day group. In vascular contraction of basilar arteries to endothelin-1 under high $O_2$ tension between groups, the maximum contraction of basilar arteries in the postictal-7-day group was significantly reduced compared to the postictal-2-day group. Conclusions : This experiment suggests that the characteristics of vascular response to NO and endothelin-1 in the spasmodic basilar arteries of rabbits observed 2 days after SAH is different from those observed 7 days after SAH.

뇌종양에서 17번 염색체 단완부 소실에 관한 분자유전학적 연구

백선하,김은상,김동규,정희원,김현집,조병규,한대희,이승훈,김종현 대한신경외과학회 1992 Journal of Korean neurosurgical society Vol.21 No.1

With the methods of restriction fragment length polymorphisms(RFLPs) and southern blot analysis, gene deletion of chromosome 17p in 16 cases of brain tumors, was investigated. There were 4 cases of glioblastoma multiforme, 1 case of anaplastic astrocytoma, 4 cases of low grade astrocytoma, 3 cases of oligodendroglioma, and 4 cases of meningioma. Among restriction fragment length polymorphism(RFLP) DNA located in chromosome 17p, p144D 6 and p SNZ 22 were imployed as the probes. In eight of 16 cases(50%) constitutional heterozygosity was observed for p144 D6 probe on the short arm of chromosome 17, and in nine of 16 cases(56%) for PYNZ 22.1 probe. With both probes constitutional heterozygosity was observed in thirteen of 16 cases(81%). And the loss of constitutional heterozygosity was detected in two of 14 informative cases. Although, with the malignant gliomas, including 4 cases of glioblastoma multiforme and 1 case of anaplastic astrocytoma, two of 4 informative cases showed loss of constitutional heterozygosity. None of 9 informative cases showed loss of heterozygosity with the other brain tumors(low grade astrocytoma, oligodendroglioma, and meningioma).

Primary Culture of Central Neurocytoma: A Case Report

백선하,신혜영,김진욱,박성혜,손형진,김동규 대한의학회 2010 Journal of Korean medical science Vol.25 No.5

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.

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

백선하,손영돈,정현태,김동규,조장희 대한의학회 2011 Journal of Korean medical science Vol.26 No.6

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.