Epidural Blood Patch on Cerebrospinal Fluid Leakage Caused by Iatrogenic Dural Injury After Transforaminal Lumbar Interbody Fusion / 대한신경손상학회지

A 65-year-old woman who underwent transforaminal lumbar interbody fusion at L4-5 for very severe spinal stenosis combined with a hard disc and instability presented with a headache on postoperative day (POD) 3 and cerebrospinal fluid (CSF) leakage on POD 5. Follow-up lumbar spine computed tomography (CT) was performed on POD 7, and fluid collection at the operation site was observed on CT images. Under the diagnosis of iatrogenic dural injury, absolute bed rest and lumbar drain catheter insertion at the L2-3 level were performed for three days, but the patient continued to complain of severe headache until POD 10. We reoperated on POD 10 and observed a dural defect with CSF leakage. The surgery was completed after ensuring that the CSF leakage was resolved by dural repair. However, 10 days after the reoperation, the amount of hemovac drainage still did not decrease and was measured to be more than 250 mL. There was no improvement in the patient’s symptoms. Twenty days after the first surgery, an epidural blood patch was applied to the epidural space at the site of dural injury, and the patient’s symptoms improved.

A Comparative Study on the Treatment of Osteoporotic Vertebral Compression Fractures With Early Ambulation and at Least 1 Week of Absolute Bed Rest / 대한신경손상학회지

Objective@#This study aimed to determine whether absolute bed rest (ABR) is essential for the conservative treatment of osteoporotic vertebral compression fractures (OVCFs). @*Methods@#This study included 115 patients diagnosed with OVCFs. The patients in group A were allowed to ambulate as soon as possible, while those in group B underwent ABR for at least 1 week. X-ray images at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after trauma were obtained from both groups for assessment. In each group, ABR-related complications including constipation, indigestion, Foley catheter insertion, urinary tract infection, cough/sputum, dizziness, and neurasthenia were investigated. @*Results@#In both groups, the compression rates, Cobb angles, and visual analog scale scores did not differ significantly at baseline and the first, second, third, fourth, and fifth follow-ups. In terms of constipation, indigestion, dizziness, and neurasthenia, group A reported a significantly higher complication rate than group B (p<0.05). @*Conclusion@#The prognosis did not differ significantly between patients who underwent ABR for at least 1 week and those who started walking as soon as possible. The incidence of complications due to ABRs was lower in the early ambulatory group. Therefore, it may be helpful to start walking as early as possible during the conservative treatment of OVCFs.

Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chronic Subdural Hematomas

OBJECTIVE: To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. METHODS: We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. RESULTS: Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. CONCLUSION: Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.

A Case of Congenital Self-Healing Reticulohistocytosis with Skull Involvement / 대한피부과학회지

Congenital self-healing reticulohistiocytosis(CSHRH) consists of multiple disseminated papulonodular skin lesions of varying sizes and regress spontaneously in several weeks to months with little or no scarring, and until recently it has been regarded as a benign cutaneous disease without systemic involvement. However, involvement of organ systems other than the skin has been described occasionally and recurrence of disease at sites distant from the skin has been documented. We present a case of CSHRH in a full termed, normal spontaneous vaginal delivered male neonate. He had reddish colored nodules on the whole body without systemic symptoms. Four weeks later, the skin lesions cleared concurrently with bony involvement of the skull. Because multiple organ systems can be involved and recurrences are possible, long-term follow-up of these patients is indicated.

Skin Lesions Developing in Renal Transplantation Recipients / 대한피부과학회지

BACKGROUND: As the renal transplantation is rapidly becoming a standard treatment of end stage renal disease, a varieties of skin lesions in renal transplant recipients are being encountered in Korea. However, there have been little studies concerning the incidence and clinical feature of skin lesions has not been well addressed yet. OBJECTIVE: We examined the skin manifestations in renal transplant recipients. METHOD: We attempted to assess the dermatologic problems in 58 renal transplant recipients, who had been managed at Keimyung University Medical center between December, 2001, and July, 2002. RESULTS: The results are summarized as follows; Among the 58 patients, the number of male and female patients were 31(53.4%) and 27(46.6%) respectively. The mean age was 38.3 years and the mean duration of renal transplatant was 38.7 months. They had one more skin lesions. Among the 58 patients, skin infection was found in 61(105%), drug-associated skin lesions in 31(53.4%), malignant skin tumor in 0(0%) and other skin lesions in 6(10.3%). Viral infections were VZV infection(15 cases, 25.9%), HPV infection(11 cases, 19%), HSV infection(7 cases, 12.1%) and molloscum contagiosum(2 cases, 3.4%). Fungal infections were superficial mycosis(16cases, 27.6%) and deep mycosis(1 case, 1.7%). Bacterial infection was found in 5(8.6%). Drug-associated skin lesions were hypertrichosis(17 cases, 29.3%), acne(11 cases, 19%), xerosis(7 cases, 12.1%), facial flusing, purpura and gingival hyperplasia(3 cases, 5.2%), respectively, telangiectasis and urticaria(2cases, 3.4%) respectively and alopecia(1 case, 1.7%). Other skin lesions included seborrheic dermatitis(8 cases, 13.8%), nummular dermatitis(3 cases, 5.2%), prurigo nodularis, scleredema, seborrheic keratosis and toxic erythema(1 case, 1.7%). CONCLUSION: Long term use of immunosuppresive agents is associated with high incidences of skin disease. Education of patients and medical staff for early detection and treatment of skin lesions is important.