Trends in Brain Imaging Research on Refugees with Post-Traumatic Stress Disorder: A Scoping Review

Purpose@#The purpose of this study was to analyze research trends and find whether Post-Traumatic Stress Disorder (PTSD) of refugees could affect structural or functional changes of brains of those under MRI, focusing on volumes, functional connectivities, and metabolites. @*Methods@#A literature search was done using PubMed, Embase, RISS, and KMBase to identify studies that matched our research purpose. A total of eight studies were identified using Prisma flow diagram by two reviewers independently. @*Results@#Eight studies were identified. Three studies were on North Korean defectors as subjects. The number of studies that observed structural changes, functional changes, and metabolite changes in brains was 2, 5, and 2, respectively. Although each study observed various parts of the brain, anterior cingulate cortex (ACC) was observed commonly in three studies. The PTSD group showed reduction of ACC volume and N-acetyl-aspartate (NAA) metabolite in ACC compared to the non- PTSD group. When exposed to negative stimuli, the PTSD group showed higher neural activity than the non-PTSD group, but not vice versa. @*Conclusion@#ACC showed significant difference in volume, neural activity, and NAA metabolite between the PTSD and the non-PTSD group, resulting in significant differences in structural changes, functional changes, metabolite changes, respectively. This study showed the need for conducting more research using various biomarkers to clarify the relationship between PTSD of refugees and their brain changes.

Trends in Brain Imaging Research on Refugees with Post-Traumatic Stress Disorder: A Scoping Review

Purpose@#The purpose of this study was to analyze research trends and find whether Post-Traumatic Stress Disorder (PTSD) of refugees could affect structural or functional changes of brains of those under MRI, focusing on volumes, functional connectivities, and metabolites. @*Methods@#A literature search was done using PubMed, Embase, RISS, and KMBase to identify studies that matched our research purpose. A total of eight studies were identified using Prisma flow diagram by two reviewers independently. @*Results@#Eight studies were identified. Three studies were on North Korean defectors as subjects. The number of studies that observed structural changes, functional changes, and metabolite changes in brains was 2, 5, and 2, respectively. Although each study observed various parts of the brain, anterior cingulate cortex (ACC) was observed commonly in three studies. The PTSD group showed reduction of ACC volume and N-acetyl-aspartate (NAA) metabolite in ACC compared to the non- PTSD group. When exposed to negative stimuli, the PTSD group showed higher neural activity than the non-PTSD group, but not vice versa. @*Conclusion@#ACC showed significant difference in volume, neural activity, and NAA metabolite between the PTSD and the non-PTSD group, resulting in significant differences in structural changes, functional changes, metabolite changes, respectively. This study showed the need for conducting more research using various biomarkers to clarify the relationship between PTSD of refugees and their brain changes.

Ten Cases of Taenia saginata Infection Confirmed by Analysis of the Internal Transcribed Spacer 1 rDNA Region in the Republic of Korea

From October 2015 to August 2018, tapeworm proglottids were obtained from 10 patients who were residents of Daegu and Gyeongbuk provinces and had a history of raw beef consumption. Most of them had no overseas travel experience. The gravid proglottids obtained from the 10 cases had 15–20 lateral uterine branches. A part of internal transcribed spacer 1 (ITS1) DNA of the 10 cases, amplified by polymerase chain reaction (PCR) and digested with AleI restriction enzyme, produced the same band pattern of Taenia saginata, which differentiated from T. asiatica and T. solium. Sequences of ITS1 and cytochrome c oxidase subunit 1 (cox1) showed higher homology to T. saginata than to T. asiatica and T. solium. Collectively, these 10 cases were identified as T. saginata human infections. As taeniasis is one of the important parasitic diseases in humans, it is necessary to maintain hygienic conditions during livestock farming to avoid public health concerns.

Working Memory Span in Normal Control, Mild Cognitive Impairment and Alzheimer's Disease

OBJECTIVE: The purposes of this study were to compare the working memory span between mild cognitive impairment (MCI) and Alzheimer's disease (AD) in the Korean elderly population and to evaluate the effectiveness of the working memory span tests. METHODS: 32 normal controls (NC), 26 patients with MCI and 28 AD patients at a mild stage were participated in this study. We used newly devised working memory span tests (Word span test and Dot matrix) according to the components of working memory ;central executive, phonological loop, and visuospatial sketchpad. And the results were compared with the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K). To evaluate the effectiveness of the working memory tests and CERAD-K to screen MCI and AD, receiver operating characteristic curves were plotted. RESULTS: All subsets of the two working memory span tests showed significant decline in verbal and visuospatial working memory in AD. But there was no significant difference between NC and MCI. Compared to CERAD-K, the two working memory tests showed good effectiveness to discriminate AD. CONCLUSION: This study showed that working memory span tests could be effective diagnosing tools for detecting AD. But for the MCI, the working memory impairment was not prominent than episodic memory impairment. This is supposed to result from the various kinds of working memory components, especially the episodic buffer.

A case of full mouth rehabilitation with orthodontic treatment in patient with extensive tooth erosion and wear using monolithic zirconia prostheses / 대한치과보철학회지

Extensive dental erosion and wear will cause serious loss of function and aesthetics in the mouth. In order to recover this condition, careful analysis of the patient's bite relationship is required. In particular, a treatment plan should be established considering the possibility of reproduction of the vertical dimension and centric relation, and appropriateness of the occlusal plane and anterior guidance. Also, the choice of prosthetic materials is an important consideration in patients with severe wear. In this case, patients with overall wear and erosion on tooth was established anterior guidance by orthodontic treatment and fully restored with monolithic zirconia, without increasing vertical dimension.

Diversity of vir Genes in Plasmodium vivax from Endemic Regions in the Republic of Korea: an Initial Evaluation

Variant surface antigens (VSAs) encoded by pir families are considered to be the key proteins used by many Plasmodium spp. to escape the host immune system by antigenic variation. This attribute of VSAs is a critical issue in the development of a novel vaccine. In this regard, a population genetic study of vir genes from Plasmodium vivax was performed in the Republic of Korea (ROK). Eighty-five venous blood samples and 4 of the vir genes, namely vir 27, vir 21, vir 12, and vir 4, were selected for study. The number of segregating sites (S), number of haplotypes (H), haplotype diversity (Hd), DNA diversity (π and Θw), and Tajima’s D test value were conducted. Phylogenetic trees of each gene were constructed. The vir 21 (S=143, H=22, Hd=0.827) was the most genetically diverse gene, and the vir 4 (S=6, H=4, Hd=0.556) was the opposite one. Tajima’s D values for vir 27 (1.08530, P>0.1), vir 12 (2.89007, P0.1) were positive, and that of vir 4 (−1.32162, P>0.1) was negative. All phylogenetic trees showed 2 clades with no particular branching according to the geographical differences and cluster. This study is the first survey on the vir genes in ROK, providing information on the genetic level. The sample sequences from vir 4 showed a clear difference to the Sal-1 reference gene sequence, whereas they were very similar to those from Indian isolates.

Attenuation of pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum in laparoscopic cholecystectomy / 영남의대학술지

BACKGROUND: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient's hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. METHODS: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. RESULTS: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). CONCLUSION: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient's hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

Nutritional Status and Body Composition in Korean Myopathy Patients

In myopathy patients, fat mass increases as the disease progresses, while lean body mass decreases. The present study aimed to investigate the overall nutritional status of Korean myopathy patients through surveys of diet and dietary habits, bioelectrical impedance analysis (BIA), and biochemistry tests, as well as the examination of related factors, for the purpose of using such findings as a basis for improving the nutritional status in myopathy patients. The energy intake of all participants was found to be insufficient at only 44.5% of Dietary Reference Intakes for Koreans 2010 (KDRIs 2010), whereas protein intake was sufficient at 89.8% of KDRIs 2010. Dietary fiber intake was found to be 58.4% of sufficient dietary fiber intake for adults according to KDRIs 2010. Calcium intake was found to be 55.0% and magnesium was 14.9% of the recommended calcium and magnesium intake for adults according to KDRIs 2010. With respect to quality of life (QOL), overall increase in QOL domain score showed significant positive correlations with vegetable fat intake (p < 0.05), vegetable protein intake (p< 0.05), and dietary fiber intake (p < 0.05). With respect to BIA, the mean phage angle of all participants was found to be 2.49 +/- 0.93degrees, which was below the cutoff value. As a study that examined nutrient analysis and dietary habits of myopathy patients in Korea, the present study is meaningful in providing the basic data for future studies that aim to present dietary guidelines for patients suffering from myopathy.

Wound Healing Effects of Rose Placenta in a Mouse Model of Full-Thickness Wounds

BACKGROUND: Rosa damascena, a type of herb, has been used for wound healing in Eastern folk medicine. The goal of this study was to evaluate the effectiveness of rose placenta from R. damascena in a full-thickness wound model in mice. METHODS: Sixty six-week-old C57BL/6N mice were used. Full-thickness wounds were made with an 8-mm diameter punch. Two wounds were made on each side of the back, and wounds were assigned randomly to the control and experimental groups. Rose placenta (250 microg) was injected in the experimental group, and normal saline was injected in the control group. Wound sizes were measured with digital photography, and specimens were harvested. Immunohistochemical staining was performed to assess the expression of epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), transforming growth factor-beta1 (TGF-beta1), and CD31. Vessel density was measured. Quantitative analysis using an enzyme-linked immunosorbent assay (ELISA) for EGF was performed. All evaluations were performed on postoperative days 0, 2, 4, 7, and 10. Statistical analyses were performed using the paired t-test. RESULTS: On days 4, 7, and 10, the wounds treated with rose placenta were significantly smaller. On day 2, VEGF and EGF expression increased in the experimental group. On days 7 and 10, TGF-beta1 expression decreased in the experimental group. On day 10, vessel density increased in the experimental group. The increase in EGF on day 2 was confirmed with ELISA. CONCLUSIONS: Rose placenta was found to be associated with improved wound healing in a mouse full-thickness wound model via increased EGF release. Rose placenta may potentially be a novel drug candidate for enhancing wound healing.

A Case of Occupational Hypersensitivity Pneumonitis Associated with Trichloroethylene / 결핵및호흡기질환

Trichloroethylene (TCE) is a toxic chemical commonly used as a degreasing agent, and it is usually found in a colorless or blue liquid form. TCE has a sweet, chloroform-like odor, and this volatile chlorinated organic chemical can cause toxic hepatitis, neurophysiological disorders, skin disorders, and hypersensitivity syndromes. However, the hypersensitivity pneumonitis (HP) attributed to TCE has rarely been reported. We hereby describe a case of HP associated with TCE in a 29-year-old man who was employed as a lead welder at a computer repair center. He was installing the capacitors on computer chip boards and had been wiped down with TCE. He was admitted to our hospital with complaints of dry coughs, night sweats, and weight losses for the past two months. HP due to TCE exposure was being suspected due to his occupational history, and the results of a video-associated thoracoscopic biopsy confirmed the suspicions. Symptoms have resolved after the steroid pulse therapy and his occupational change. TCE should be taken into consideration as a potential trigger of HP. Early recognition and avoidance of the TCE exposure in the future is important for the treatment of TCE induced HP.

A Case of Successful Endoscopic Clipping for Iatrogenic Colon Perforation Induced by Peritoneal Catheter Insertion / 대한소화기학회지

Advanced cancer patients with refractory ascites often do not respond to conventional treatments including dietary sodium restriction, diuretics, and repeated large volume paracentesis. In these patients, continuous peritoneal drainage by an indwelling catheter may be an effective option for managing refractory ascites with a relative low complication rate. Peritoneal catheter-induced complications include hypotension, hematoma, leakage, cellulitis, peritonitis, and bowel perforation. Although bowel perforation is a very rare complication, it can become disastrous and necessitates emergency surgical treatment. Herein, we report a case of a 57-year-old male with refractory ascites due to advanced liver cancer who experienced iatrogenic colonic perforation after peritoneal drainage catheter insertion and was treated successfully with endoscopic clipping.

Early-onset Pericardial Effusion after Autologous Hematopoietic Stem Cell Transplantation in a Child with Neuroblastoma / 임상소아혈액종양

Pericardial effusion (PcE) is one of the uncommon complications after hematopoietic stem cell transplantation (HSCT). Although many causes are related with PcE after HSCT, PcE after HSCT is usually late-onset and can be presented as a sign of acute or chronic graft-versus-host disease in allogeneic transplantation. Previous reports of PcE after autologous HSCT are very uncommon. Transplantation-associated thrombotic microangiopathy (TA-TMA) is a kind of renal microvascular complications after HSCT, which is similar to thrombotic thrombocytopenic purpura. The authors report a case of early-onset PcE, which maybe resulted from TA-TMA, after high-dose chemotherapy and autologous peripheral blood HSCT in a 4-year-old child with neuroblastoma.

Early-onset Pericardial Effusion after Autologous Hematopoietic Stem Cell Transplantation in a Child with Neuroblastoma / 임상소아혈액종양

Pericardial effusion (PcE) is one of the uncommon complications after hematopoietic stem cell transplantation (HSCT). Although many causes are related with PcE after HSCT, PcE after HSCT is usually late-onset and can be presented as a sign of acute or chronic graft-versus-host disease in allogeneic transplantation. Previous reports of PcE after autologous HSCT are very uncommon. Transplantation-associated thrombotic microangiopathy (TA-TMA) is a kind of renal microvascular complications after HSCT, which is similar to thrombotic thrombocytopenic purpura. The authors report a case of early-onset PcE, which maybe resulted from TA-TMA, after high-dose chemotherapy and autologous peripheral blood HSCT in a 4-year-old child with neuroblastoma.

Early-onset Pericardial Effusion after Autologous Hematopoietic Stem Cell Transplantation in a Child with Neuroblastoma / 임상소아혈액종양

Pericardial effusion (PcE) is one of the uncommon complications after hematopoietic stem cell transplantation (HSCT). Although many causes are related with PcE after HSCT, PcE after HSCT is usually late-onset and can be presented as a sign of acute or chronic graft-versus-host disease in allogeneic transplantation. Previous reports of PcE after autologous HSCT are very uncommon. Transplantation-associated thrombotic microangiopathy (TA-TMA) is a kind of renal microvascular complications after HSCT, which is similar to thrombotic thrombocytopenic purpura. The authors report a case of early-onset PcE, which maybe resulted from TA-TMA, after high-dose chemotherapy and autologous peripheral blood HSCT in a 4-year-old child with neuroblastoma.

Long-Term Outcomes After an Arterial Switch Operation for Simple Complete Transposition of the Great Arteries

BACKGROUND AND OBJECTIVES: Although coronary artery obstruction, aortic insufficiency (AI), and pulmonary stenosis (PS) have been reported after arterial switch operation (ASO), limited long-term studies on ASO exist. Our study aimed to examine long-term outcomes after ASO for simple complete transposition of the great arteries (TGA). SUBJECTS AND METHODS: All 108 patients with simple complete TGA who underwent ASO at Seoul National University Children's Hospital between 1987 and 2004 were enrolled. We retrospectively reviewed the patients' medical records and the results of various functional and imaging studies. RESULTS: Among 108 cases of ASO for simple TGA, 96 have been followed-up through the present time (mean follow-up duration was 11.7+/-8.6 years: range= 4 to 23 years). The 20-year rates of freedom from significant AI, PS, and coronary obstruction were 78.6%, 67.8%, and 95.8%, respectively. AI showed a tendency to progress as follow-up time increased in 21.4% of the population studied (p=0.014); however, AS, PS, and PI showed no such progression. Late coronary artery occlusion was not associated with the initial coronary arterial pattern. Re-operations were done for 13 patients (13.5%) at an average of 8+/-4.3 years after ASO. The survival rate was 96%, while the re-operation-free was 90% at 10 years and 83% at 20 years. Most patients showed normal physical growth with good activity {98%; New York Heart Association (NYHA) class 1 activity} and normal development (96%). CONCLUSION: Although most patients showed normal physical growth and development after successful ASO, meticulous long-term follow-up is necessary because of progressive AI and coronary complications.

Pediatric Emergency Room Presentation of Congenital Heart Disease

BACKGROUND AND OBJECTIVES: Only a few studies have specifically investigated the reasons for emergency room (ER) visits in patients with congenital heart disease (CHD). The aim of this study was to identify the major reasons for ER presentation among patients with CHD that were acutely and seriously ill at a tertiary medical center in Korea. SUBJECTS AND METHODS: All 368 admissions of patients with CHD via the ER from 2003 to 2008 were enrolled. We conducted a retrospective study with review of the medical records. RESULTS: Eighty two patients were newly diagnosed as having CHD. Their major presentations were: symptoms of heart failure (41.5%), murmur (31.7%), and cyanosis (18.3%). There were 286 visits that were cases with known CHD. Their major presentations were respiratory tract infection (24.1%, 2.7+/-4.1 years of age), dysrhythmia (16.4%, 16.7+/-9.5 years), symptoms of heart failure (14.3%, 7.6+/-9.4 years), aggravated cyanosis (5.6%, 0.8+/-1.4 years), protein-losing enteropathy (4.9%), hemoptysis (4.5%), drug side effects (4.1%), and infective endocarditis (3.0%). There were significant correlations between the age distributions and major modes of presentation. Surgical treatments were required within 1 month in 38%, and 2.7% of all patients died during hospitalization. The patient group with respiratory infections and CHD showed the highest mortality (5.8%). Atrial flutter was the most frequent arrhythmia (70.2%) and 70% of these patients were post-Fontan surgery condition. The causes of heart failure in the patients with previous surgical repair were: pulmonary hypertension, myocardial dysfunction, valve regurgitation, and uncorrected lesions. CONCLUSION: Improved understanding of the common problems in the ER can help prepare clinicians to manage patients that present with CHD.

Pulmonary Hypertension in Preterm Infants With Bronchopulmonary Dysplasia

BACKGROUND AND OBJECTIVES: With the increasing survival of preterm infants, pulmonary hypertension (PH) related to bronchopulmonary dysplasia (BPD) has become an important complication. The aim of this study was to investigate the characteristics and outcome of PH in preterm infants with BPD and to identify the risk factors for PH. SUBJECTS AND METHODS: We reviewed the records of 116 preterm infants with BPD cared for at a single tertiary center between 2004 and 2008. RESULTS: Twenty-nine (25%) infants had PH >2 months after birth. PH occurred initially at a median age of 65 days (range, 7-232 days). Severe BPD, a birth weight <800 g, long-term ventilator care and oxygen supplementation, a high ventilator setting, infection, and a patent ductus arteriosus (PDA) were related to PH based on univariate analysis (p<0.05). The infants who had longer oxygen supplementation were significantly more likely to have PH (odds ratio, 18.5; 95% confidence interval, 4.1-84.6; p<0.001). PH was improved in 76% of infants after a median of 85 days (range, 20-765 days). Four infants (14%) died. The death of 3 infants was attributed to PH. CONCLUSION: BPD was frequently complicated by PH. Although PH resolved in the majority of infants, PH in preterm infants with BPD can be fatal. Regular screening for PH and adequate management are required.

Dexrazoxane for Preventing Anthracycline Cardiotoxicity in Children with Solid Tumors

This study attempted to assess the incidence and outcome of anthracycline cardiotoxicity and the role of dexrazoxane as a cardioprotectant in childhood solid tumors. The dexrazoxane group included 47 patients and the control group of historical cohort included 42. Dexrazoxane was given in the 10:1 ratio to doxorubicin. Fractional shortening and systolic and diastolic left ventricular diameters were used to assess the cardiac function. The median follow-ups were 54 months in the dexrazoxane group and 86 months in the control group. The mean cumulative doses of doxorubicin were 280.8+/-83.4 mg/m2 in the dexrazoxane group and 266.1+/-75.0 mg/m2 in the control group. The dexrazoxane group experienced significantly fewer cardiac events (27.7% vs. 52.4%) and less severe congestive heart failure (6.4% vs. 14.3%) than the control group. Thirteen cardiotoxicities including one cardiac death and 2 congestive heart failures occurred in the dexrazoxane group, and 22 cardiotoxicities including 2 cardiac deaths and 4 congestive heart failures, in the control group. Five year cardiac event free survival rates were 69.2% in the dexrazoxane group and 45.8% in the control group (P=0.04). Dexrazoxane reduces the incidence and severity of early and late anthracycline cardiotoxicity in childhood solid tumors.

Analysis of Factors Affecting the Change in Axial Length of Premature Infant's Eye

PURPOSE: To analyze the effect of presence with or absent of retinopathy of prematurity (ROP) and its stage, birth weight, conceptual age and associated diseases on the axial length of premature infants' eye. METHODS: A total of 102 eyes of 51 premature infants less than 36 weeks of conceptual age were evaluated in this study. Fundus examination for ROP and axial length measurement were conducted at 40, 52 and 64 weeks of postconceptual age. The medical records were reviewed retrospectively. Independent t-test analysis, simple regression analysis, and one-way ANOVA were performed to assess the influence of each factor on axial length. RESULTS: The mean axial length at 40, 52 and 64 weeks were 17.35, 18.80 and 19.78 mm, respectively. The mean axial length with and without ROP at 40 weeks were 17.10 mm and 17.54 mm, respectively, which were statistically significant (p=0.000). There was a significant decrease in axial length at 40 weeks in the higher ROP stage (p<0.05). Axial length and birth weight showed positive correlation with statistical significance at 40 weeks, while these parameters showed no significant correlation at 64 weeks. Axial length and conceptual age showed a positive correlation with statistical significance at 40 weeks (p=0.000), yet a negative correlation at 64 weeks with no statistical significance (p=0.306). A significant difference was not observed between sex and the associated diseases. CONCLUSIONS: The factors that affect the axial length of an infants'eye at 40 weeks were ROP and its stage, birth weight, and conceptual age. Additionally, there was no significant relationship between sex and the associated diseases.

Analysis of Incomplete Occlusion of Cerebral Aneurysm by Intraoperative Indocyanine Green Videoangiography / 대한뇌혈관외과학회지

OBJECTIVE: This study aimed to investigate factors associated with incomplete occlusion of a cerebral aneurysm detected by indocyanine green videonangiography (ICG-VA) following aneurysm clipping. METHODS: We performed surgery on 135 patients with 151 intracranial aneurysms over a 1-year period. Included was an aneurysm more than 3 mm in size, the dome of which was sufficiently exposed and clipped permanently with one clip. Following ICG-VA, aneurysms were divided into a delayed-filling group and a no-filling group. Retrospective comparisons of the clip force, blade length and width, neck and dome size of the aneurysm, diameter of the parent artery, presence of atherosclerosis in the aneurysm neck, and systolic blood pressure during ICG-VA were made between the two groups. RESULTS: Eight of 31 aneurysms in 29 patients showed delayed filling of contrast. The clip force in the delayed-filling group was lower than in the no-filling group and the atherosclerosis of the aneurysm neck differed between the two groups (P<0.05). Blade width in the delayed-filling group was also significantly lower than in the no-filling group (P<0.05). Following adjustment for atherosclerosis of the aneurysm neck, clip force and blade width in the delayed-filling group was even lower. Incomplete passage of the clip tip was observed in four aneurysms, weak clip force in three, and a slit between clip blades in one. After booster clipping or clip reposition, neither aneurysm regrowth nor recanalization was observed during 6 months of follow-up. CONCLUSION: Closing force, blade width, tip position, and remnant slit are important for incomplete occlusion of an aneurysm.