Importance of Hemoglobin A1c Levels for the Detection of Post-Surgical Infection Following Single-Level Lumbar Posterior Fusion in Patients with Diabetes / 대한신경손상학회지

OBJECTIVE: Several studies have reported that patients with diabetes mellitus (DM) are vulnerable to infection. However, the mechanism underlying this remains unclear. We hypothesized that preoperative blood glucose levels in patients with DM may be a risk factor for surgical site infection (SSI). We aimed to investigate the relationship between hemoglobin A1c (HbA1c) level and SSI incidence following single-level spinal fusion surgery. METHODS: Patients with DM who underwent single-level lumbar posterior fusion surgery were retrospectively reviewed. Ninety-two patients were included and classified into the SSI and SSI-free groups. Clinical data with demographic findings were obtained and compared. The HbA1c cut-off value was defined using receiver operating characteristic (ROC) and area under the curve (AUC) analyses, which showed a significantly increased SSI risk. Potential variables were verified using multiple logistic regression analysis. RESULTS: Among the enrolled patients, 24 had SSI and 68 did not within 1 year. The preoperative HbA1c level was higher in patients with SSI (6.8%) than in the non-infected patients (6.0%; p=0.008). ROC analysis showed that if the HbA1c level is higher than 6.9%, the risk of SSI significantly increases (p=0.003; AUC, 0.708; sensitivity, 62.5%; specificity, 70.6%). The preoperative HbA1c level was significantly correlated with SSI incidence, after adjusting for potential variables (p=0.008; odds ratio, 4.500; 95% confidence interval, 1.486–13.624). CONCLUSION: The HbA1c level, indicating glycemic control, in patients with DM may be a risk factor for SSI in single-level lumbar spine posterior fusion.

Effect of Modic Changes in Cervical Degenerative Disease

OBJECTIVE: Modic changes are signal intensity changes in adjacent vertebral bone marrow on magnetic resonance imaging. Few studies have investigated these changes with regard to the cervical spine. In this study, we investigated the associations between cervical degenerative disease and Modic changes. METHODS: We conducted a retrospective collection of radiological data in patients with neck pain at Pusan National University Yangsan Hospital from January 2010 to December 2014. A total of 169 patients were included in this study. Disc herniation grade, disc space height and global cervical lordosis (C2–C7 Cobb angle) were measured and analyzed. If Modic changes were present, we recorded the Modic change type based on the literature, vertebral level, age, sex, and surgical requirement. RESULTS: Sixty-six patients exhibited Modic changes in the cervical spine. Out of these 66 patients, Modic change type II (56 patients, 84.8%) and C5–6 vertebral level (23 patients, 34.8%) were the most predominant categories. Patients with Modic change showed worse outcomes in regard to disc herniation grade, disc space height and global cervical lordosis than patients without (p<0.01). Among 169 patients, 18 patients had undergone anterior cervical discectomy with fusion (ACDF). Patients with Modic changes (10 of 66 patients, 15.1%) had a greater probability of undergoing ACDF than those without (8 of 103 patients, 7.8%; p<0.01). CONCLUSION: Modic changes refer cervical degenerative changes, and incidence of ACDF is higher when the Modic changes are occurred.

Prevalence and Risk Factors of Early-Stage Age-Related Macular Degeneration in Patients Examined at a Health Promotion Center in Korea

We evaluated the prevalence and risk factors for early age-related macular degeneration (AMD) in Koreans 50 yr of age or older who were examined at a single health promotion center. We retrospectively reviewed the records of 10,449 subjects who visited the center over a 6-month period. Fundus photography was performed on all subjects, and systematic risk factor analysis was conducted using a structured questionnaire. All patients (n = 322) were initially diagnosed with drusen or early AMD using fundoscopy; the control group (n = 10,127) were those yielding normal fundoscopy findings. The age- and gender-adjusted prevalence of early AMD was 3.08%. Advanced age, male gender, smoking status, hyperlipidemia, working outdoors, and residence in rural areas were all significantly associated with an increased risk for development of early AMD. Higher-level ingestion of fruit or herbal medication and an increased amount of exercise were associated with a lower risk of early AMD development. In our Korean cohort, consisting principally of relatively healthy, middle-class urban adults, the prevalence of early AMD was 3.08% that is similar to that reported in earlier epidemiological studies. Several modifiable risk factors such as smoking and hyperlipidemia are associated with the prevalence of early AMD in our cohort.

Comparison of Posterior Fixation Alone and Supplementation with Posterolateral Fusion in Thoracolumbar Burst Fractures

OBJECTIVE: We compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation. METHODS: From January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb's method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated using the modified Mcnab criteria at the final follow-up. RESULTS: The demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction between the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period. CONCLUSION: We suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation.

The Role of Hyperthyroidism as the Predisposing Factor for Superior Sagittal Sinus Thrombosis

Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism.

Moyamoya Disease Initially Presenting Transient Visual Loss

PURPOSE: To report a case of moyamoya disease initially presenting transient visual loss in a healthy young subject. CASE SUMMARY: A 20-year-old male with no history of systemic disease or trauma visited our clinic due to sudden onset visual loss in the right eye. There were no accompanying symptoms, including headache, seizure, paresis, or paresthesia. Best corrected visual acuity at the first visit was hand movement in the right eye and 20/20 in the left eye. No abnormal finding was revealed in the anterior segment. On fundus examination, whitening at post pole was found in the right eye. In fluorescein angiography, a choroidal and retinal artery filling delay in the posterior pole was noted. The patient's visual acuity began to improve gradually and was recovered to 20/20 by the next day. Moyamoya disease was diagnosed based on magnetic resonance angiography of the brain and transfemoral cerebral angiography as well as stenosis of the internal carotid artery and middle cerebral artery with collateral vessel networks. CONCLUSIONS: Moyamoya disease should be considered as a possible cause of transient visual loss in healthy young subjects.

Discriminating Ability of Scanning Laser Polarimetry with Variable Corneal Compensation in Normal and Glaucomatous Eyes

PURPOSE: We investigated the diagnostic ability of scanning laser polarimetry with variable corneal compensation (GDx VCC) parameters to distinguish glaucomatous eyes with different degrees of visual field abnormality from normal eyes. METHODS: Subjects were divided into a control group (n=47) and an early to moderate glaucoma group (n=100). The latter included 53 early glaucoma patients (mean deviation > -6dB with a Humphrey Field Analyzer). Using a receiver operating characteristic (ROC) curve, the diagnostic power of GDx VCC parameters was analyzed and the correlations between those parameters and Humphrey Field Analyzer (HFA) indices were statistically analyzed. RESULTS: Nerve fiber indicator (NFI) provided the best discriminating ability with the highest area under the ROC curve (AUROC) value for detecting eyes with early to moderate perimetric glaucoma. TSNIT average showed the highest AUROC value for detecting eyes with early perimetric glaucoma. The optimal NFI cut-off value to discriminate between the control group and early to moderate group was 22, offering the best combination of sensitivity (88.0%) and specificity (83.0%). The optimal TSNIT average cut-off value to discriminate between the control group and early glaucoma group was 53.49 micrometer, providing the best combination of sensitivity (84.9%) and specificity (85.1%). Most of the thickness parameters showed higher AUROC values than those of the ratio or modulation parameters. A statistically significant correlation was found between the GDx VCC parameters and HFA indices. CONCLUSIONS: Measurement of the retinal nerve fiber layer (RNFL) by scanning laser polarimetry with variable corneal compensation is useful in discriminating between normal and glaucomatous eyes.

Acquired Simulated Brown Syndrome following Surgical Repair of Medial Orbital Wall Fracture

Simulated Brown syndrome is a term applied to a myriad of disorders that cause a Brown syndrome-like motility. We encountered a case of acquired simulated Brown syndrome in a 41-year-old man following surgical repair of fractures of both medial orbital walls. He suffered from diplopia in primary gaze, associated with hypotropia of the affected eye. We performed an ipsilateral recession of the left inferior rectus muscle as a single-stage intraoperative adjustment procedure under topical anesthesia, rather than the direct approach to the superior oblique tendon. Postoperatively, the patient was asymptomatic in all diagnostic gaze positions.

Accuracy of Automated Wrist Blood Pressure Meter

BACKGROUND: A reliable, well-validated home blood pressure(BP) self measurement device could have an important role in the management of hypertension. Rigorous assessment of such a device have not performed well, particularly in the hypertensive range. METHODS: We assessed the National EW274W device(oscillometric) for home messurem of BP according to the standards set out by the British Hypertension Society protocol and American Association for the Advancement of Medical Instrumentation(AAMI). The device was compared with sequential measurements using a standard mercury sphygmomanometer in the same arm in 105 patients aged 16-79 years. The BP of subjects was measured three times at least a week apart. These data were analysed using Pearson's correlation and paired t-test. RESULTS: The device was highly correlated to mercury sphygmomanometer in mean systolic BP(SBP) and mean diastolic BP(DBP) (r=0.93, r=0.93, P<0.05). The device was satisfactory over the whole BP range(SBP 106-182mmHg, DBP 56-116mmHg), with a B grade for SBP and a A grade for DBP(British Hypertension Society protocol) and a PASS for both SBP and DBP(AAMI). Sensitivity and specificity are 84.2%, 93.0%(mean SBP) and 100%, 96.9% (mean DBP). CONCLUSIONS: We concluded the wrist blood pressure meter(National EW274W) for home BP measurement is highly satisfactory and is suitable for clinical use.

Accuracy of the sphygmomanometer for measuring of blood pressure

BACKGROUND: Recently, it is substituted automatic sphygmomanometer for mercury sphygmomanometer. But it seems to be insufficient for data of its accuracy. A sample accurate automatic sphygmomanometer could have an important role in the management of hypertension. The aim of this study is to assess the accuracy of the automatic sphygmomanometer that is used common practice and at home. METHODS: We collected 247 patients who visited the department of Famiiy Practice of Taegu medical center from April to August 1996. BP was measured sequentially same arm by standard device(mercury. sphygmomanometer), test device A(A&D TM-2650), test device B(seine SE-2000). We assessed the automatic sphygmomanometer according to the standards set out by the British Hypertension Society(BHS) protocol and the American Association for the Advancement of Medical Instrumentation(AAMI). These data were analysed using pearson' correlation and paired t-test. RESULTS: Test device A was highly correlated to mercury sphygmomanometer in systolic and diastolic BP(r=0.90, r=0.88). Also test device B was highly correlated to that(r=0.90, r=0.87). The mean difference between BP value obtained by the standard device and those obtained by the test device A were 0.59+/-7.66mmHg systole(mean+/-SD) and 3.83+/-6.43mmHg diast.ole, whereas the difference between the former and those obtained by the test device B were 1.70+/-7.99mmHg systole.and 5.58+/-6.38mmHg diastole. Comparing to standard device, there were a signifioant difference except systolic BP of test device A(P<0.05). According to the criteria of the AAMI, the diastolic BP of test device B was not enough and according to the criteria of the BHS, the diastolic BP of both test device were not enough. CONCLUSIONS: Both test device were highly correlated to mercury sphygmomanometer. But according to the criteria of the BHS and AAMI, there were not enough. Because the use of automatic sphygmomanometer was popularized, I think that further study will be required to assess of accuracy.