Endovascular Treatment Using Multiple Stents for Symptomatic Intracranial Vertebral Artery Dissecting Aneurysm.

OBJECTIVE: Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion for treating intracranial vertebral artery dissections. However, complete aneurysm obliteration after single stent placement is often not accomplished. The aim of the study was to evaluate the safety and efficacy of placing multiple stents in intracranial vertebral dissecting aneurysms. METHODS: We retrospectively reviewed 8 patients who underwent stent angioplasty with placing multiple stents for treating intracranial vertebral dissecting aneurysms. There were 5 male patients and 3 female patients with a mean age of 54 years (age range, 37-71 years). Three patients presented with subarachnoid hemorrhage (SAH), 1 presented with ischemic events and 4 presented with headache. Follow-up angiogram was performed in 8 patients within 6~12 months to determine whether or not the affected segment was occluded. RESULTS: Eight patients with intracranial vertebral artery dissections were treated by placing multiple stents, 6 were treated by double stent placement and the others were treated by triple and quadruple stent placement. Although immediate complete occlusion was not shown in any cases, the follow-up angiogram revealed complete occlusion in 5 cases (62.5%) within 6-12 months. There were 2 complications (25%, temporary vasospasm during the procedure and acute thrombosis). On the modified Rankin scale applied during follow-up, 6 patients were ssessed as functionally improved or of a stable clinical status, 1 patient expired due to cardiopulmonary complications, and 1 was lost to follow-up). CONCLUSION: Intracranial vertebral artery dissections can be treated by the endovascular method with placing multiple stents and the morbidity is acceptable. However, further study is needed since the treatment of patients presenting with SAH using multiple stent placement can be controversialope

요추 후방 융합술 후 종판 변성에 유형에 따른 임상적 및 방사선학적 결과

Dept. of Medicine/석사The vertebral end plate changes (Modic changes) are suggested as a one of the source of low back pain. And posterior lumbar interbody fusion (PLIF) is effective for the treatment of low back pain due to degenerative disc disease associated with the vertebral end plate changes. This study was designed to evaluate the efficacy of PLIF with posterior pedicle screw fixation in chronic degenerative disc disease with Modic changes.A total of 320 patients who underwent single level spinal fusion operation (PLIF with posterior pedicle screw fixation) from January 2003 and December 2007 and followed up more than 12 months were enrolled in this study. The patient’s mean age was 55.6±10.7 years old and mean follow-up was 28.52±17.1 months. Patients were classified into 4 categories (Modic 0 to 3) according to Modic changes based on pre-operative lumbar magnetic resonance images. Factors such as patient’s age, smoking habit, osteoporosis that may affect fusion rate were also analyzed. Clinical data were analyzed with 10-point visual analog scale (VAS) and Oswestry Disability Index (ODI).The overall bone fusion rate was 86.6% and 88.7% in Modic type 0, 81.2% in Modic 1, 86.0% in Modic 2 and 75.0% in Modic type 3. There were no significant differences between Modic groups (p = 0.220). Patient’s age (p = 0.242), smoking habit (p = 0.095), osteoporosis (p = 0.270), operated level (p = 0.966) and diagnosed disease (p = 0.988) also did not show significant differences. In all groups, significant post-operative clinical improvements (p = 0.000) were shown and there were significant differences between Modic types. In conclusion, PLIF with additional posterior pedicle screw fixation seems to be an effective procedure in regarding of clinical outcome and bone fusion rate.ope

(The) justification of education : from the viewpoint of M. Oakeshott`s `Conversation`

학위논문(석사) --서울대학교 대학원 :교육학과(교육학전공),2009.8.Maste

개화 계몽 시대 서사양식의 장르 분화

개화 계몽 시대 서사양식은 폐쇄적인 조선 사회가 개항과 함께 이질적인 외래문화와 충돌하면서 새로운 근대화 과정에 돌입하는 시기에 형성된 것이다. 흔히 개화기라는 말로 지칭하고 있는 이 시기에는 대내적인 면에서 반봉건운동을, 대외적으로는 반외세운동을 주축으로 하는 개화 계몽운동이 사회 전체의 근대적인 변혁을 추구하는 커다란 힘으로 자리 잡기 되었다. 이 과정 속에서 전통적인 서사양식이 문학적 규범과 가치, 방법과 정신의 변화를 드러내기 시작하였다. 서사양식이 문학적 규범과 가치, 방법과 정신의 변화를 드러내기 시작하였다. 서사양식의 창작과 그 수용 방식이 사회적인 변화에 따라 크게 바뀌게 되었으며, 주제와 기법과 문체와 표현 방법 등도 서사 양식 자체의 새로운 규범을 확립하기 위해 다양한 변화와 충동을 드러내게 되었다. 이러한 변화 현상은 전통적인 문학 형태가 새로운 방향으로 해체되어 가는 변혁 과정과, 외래적인 문학의 요소가 전통적인 문학 속으로 수용되어 토착화하는 과정을 동시에 보여주고 있다