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1.
Article | WPRIM | ID: wpr-837090

ABSTRACT

Parvimonas micra is a non-spore-forming anaerobic gram-positive coccus and a known commensal of the skin, gums, vagina, and gastrointestinal tract. It is rarely associated with severe infections, which typically follow invasive procedures such as dental treatment. We describe a case of a brain abscess caused by P. micra in an immunocompetent 11-year-old boy without periodontal disease. He presented with a 7-day history of headaches and vomiting, and complained of diplopia that began on the day of presentation. He did not have any recent dental treatment or specific past medical history. A brain abscess in the left frontoparietal lobe was noted on brain magnetic resonance imaging. P. micra was cultured from brain abscess aspirate. He was successfully treated with surgical drainage and combined antibiotic therapy with ceftriaxone and metronidazole for 6 weeks.

2.
Cancer Research and Treatment ; : 1041-1049, 2020.
Article | WPRIM | ID: wpr-831152

ABSTRACT

Purpose@#The aim of this study is to evaluate the survival rate and prognostic factors of anaplastic gliomas according to the 2016 World Health Organization classification, including extent of resection (EOR) as measured by contrast-enhanced T1-weighted magnetic resonance imaging (MRI) and the T2-weighted MRI. @*Materials and Methods@#The records of 113 patients with anaplastic glioma who were newly diagnosed at our institute between 2000 and 2013 were retrospectively reviewed. There were 62 cases (54.9%) of anaplastic astrocytoma, isocitrate dehydrogenase (IDH) wild-type (AAw), 18 cases (16.0%) of anaplastic astrocytoma, IDH-mutant, and 33 cases (29.2%) of anaplastic oligodendroglioma, IDH-mutant and 1p/19q-codeleted. @*Results@#The median overall survival (OS) was 48.4 months in the whole anaplastic glioma group and 21.5 months in AAw group. In multivariate analysis, age, preoperative Karnofsky Performance Scale score, O6-methylguanine-DNA methyltransferase (MGMT) methylation status, postoperative tumor volume, and EOR measured from the T2 MRI sequence were significant prognostic factors. The EOR cut-off point for OS measured in contrast-enhanced T1-weighted MRI and T2-weighted MRI were 99.96% and 85.64%, respectively. @*Conclusions@#We found that complete resection of the contrast-enhanced portion (99.96%) and more than 85.64% resection of the non-enhanced portion of the tumor have prognostic impacts on patient survival from anaplastic glioma.

3.
Hip & Pelvis ; : 166-173, 2019.
Article in English | WPRIM | ID: wpr-763972

ABSTRACT

PURPOSE: To analyze prognostic factors for the treatment of periprosthetic femoral fractures (PFFs) using the cable-plate construct. MATERIALS AND METHODS: A retrospective review of a consecutive series of 41 PFFs treated by osteosynthesis using the cable-plate system. The mean age of patients was 67.3±12.1 years (range, 42-86 years) and the mean follow-up period was 31.5±11.6 months (range, 12–58 months). Fresh frozen cortical strut allografts were leveraged in three cases for additional stability. Prognostic factors that may potentially affect clinical outcomes were analyzed. RESULTS: At the time of final follow-up, fracture union was obtained in 29 hips (70.7%; Group I) after an average of 13.5 weeks (range, 12–24 weeks). Healing failure after surgical treatment was observed in 12 cases (29.3%; Group II), including delayed union (n=10) cases and nonunion (n=2). Factors significantly associated with fracture union included fracture pattern (P=0.040), plate overlap percentage to stem length (P<0.001) and T-score at the preoperative bone mineral density (P=0.011). Transverse-type fractures around or just distal to a well-fixed femoral stem were observed in six cases (50.0%) of Group II. CONCLUSION: The cable-plate osteosynthesis of PFFs should be performed with caution in transverse-type fractures or in cases with severe osteoporosis. Fixation with sufficient plate overlap to stem length may be critical to prevent healing failure.


Subject(s)
Allografts , Arthroplasty, Replacement, Hip , Bone Density , Femoral Fractures , Follow-Up Studies , Hip , Humans , Osteoporosis , Periprosthetic Fractures , Retrospective Studies
4.
Article in English | WPRIM | ID: wpr-763112

ABSTRACT

BACKGROUND: There was no practical guideline for the management of patients with central nervous system tumor in Korea in the past. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, developed the guideline for glioblastoma successfully and published it in Brain Tumor Research and Treatment, the official journal of KSNO, in April 2019. Recently, the KSNO guideline for World Health Organization (WHO) grade III cerebral glioma in adults has been established. METHODS: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searches in PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords. Scope of the disease was confined to cerebral anaplastic astrocytoma and oligodendroglioma in adults. RESULTS: Whenever radiological feature suggests high grade glioma, maximal safe resection if feasible is globally recommended. After molecular and histological examinations, patients with anaplastic astrocytoma, isocitrate dehydrogenase (IDH)-mutant should be primary treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy whereas those with anaplastic astrocytoma, NOS, and anaplastic astrocytoma, IDH-wildtype should be treated following the protocol for glioblastomas. In terms of anaplastic oligodendroglioma, IDH-mutant and 1p19q-codeletion, and anaplastic oligodendroglioma, NOS should be primary treated by standard brain radiotherapy and neoadjuvant or adjuvant PCV (procarbazine, lomustine, and vincristine) combination chemotherapy. CONCLUSION: The KSNO's guideline recommends that WHO grade III cerebral glioma of adults should be treated by maximal safe resection if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors.


Subject(s)
Adult , Astrocytoma , Brain , Brain Neoplasms , Central Nervous System , Drug Therapy , Drug Therapy, Combination , Glioblastoma , Glioma , Humans , Isocitrate Dehydrogenase , Korea , Lomustine , Oligodendroglioma , Radiotherapy , World Health Organization
5.
Article in English | WPRIM | ID: wpr-763111

ABSTRACT

BACKGROUND: There was no practical guideline for the management of patients with central nervous system tumor in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has developed the guideline for glioblastoma. Subsequently, the KSNO guideline for World Health Organization (WHO) grade II cerebral glioma in adults is established. METHODS: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords regarding diffuse astrocytoma and oligodendroglioma of brain in adults. RESULTS: Whenever radiological feature suggests lower grade glioma, the maximal safe resection if feasible is recommended globally. After molecular and histological examinations, patients with diffuse astrocytoma, isocitrate dehydrogenase (IDH)-wildtype without molecular feature of glioblastoma should be primarily treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy (Level III) while those with molecular feature of glioblastoma should be treated following the protocol for glioblastomas. In terms of patients with diffuse astrocytoma, IDH-mutant and oligodendroglioma (IDH-mutant and 1p19q codeletion), standard brain radiotherapy and adjuvant PCV (procarbazine+lomustine+vincristine) combination chemotherapy should be considered primarily for the high-risk group while observation with regular follow up should be considered for the low-risk group. CONCLUSION: The KSNO's guideline recommends that WHO grade II gliomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors and clinical characteristics of patients.


Subject(s)
Adult , Astrocytoma , Brain , Central Nervous System , Drug Therapy , Drug Therapy, Combination , Follow-Up Studies , Glioblastoma , Glioma , Humans , Isocitrate Dehydrogenase , Korea , Oligodendroglioma , Radiotherapy , World Health Organization
6.
Article in English | WPRIM | ID: wpr-739672

ABSTRACT

BACKGROUND: There has been no practical guidelines for the management of patients with central nervous system (CNS) tumors in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, started to prepare guidelines for CNS tumors from February 2018. METHODS: The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. RESULTS: First, the maximal safe resection if feasible is recommended. After the diagnosis of a glioblastoma with neurosurgical intervention, patients aged ≤70 years with good performance should be treated by concurrent chemoradiotherapy with temozolomide followed by adjuvant temozolomide chemotherapy (Stupp's protocol) or standard brain radiotherapy alone. However, those with poor performance should be treated by hypofractionated brain radiotherapy (preferred)±concurrent or adjuvant temozolomide, temozolomide alone (Level III), or supportive treatment. Alternatively, patients aged >70 years with good performance should be treated by hypofractionated brain radiotherapy+concurrent and adjuvant temozolomide or Stupp's protocol or hypofractionated brain radiotherapy alone, while those with poor performance should be treated by hypofractionated brain radiotherapy alone or temozolomide chemotherapy if the patient has methylated MGMT gene promoter (Level III), or supportive treatment. CONCLUSION: The KSNO's guideline recommends that glioblastomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to the individual comprehensive condition of the patient.


Subject(s)
Brain , Central Nervous System , Chemoradiotherapy , Diagnosis , Drug Therapy , Glioblastoma , Humans , Korea , Radiotherapy
7.
Article in English | WPRIM | ID: wpr-205881

ABSTRACT

BACKGROUND: Although Gamma Knife radiosurgery (GKRS) can provide beneficial therapeutic effects for patients with brain metastases, lesions involving the eloquent areas carry a higher risk of neurologic deterioration after treatment, compared to those located in the non-eloquent areas. We aimed to investigate neurological change of the patients with brain metastases involving the motor cortex (MC) and the relevant factors related to neurological deterioration after GKRS. METHODS: We retrospectively reviewed clinical, radiological and dosimetry data of 51 patients who underwent GKRS for 60 brain metastases involving the MC. Prior to GKRS, motor deficits existed in 26 patients (50.9%). The mean target volume was 3.2 cc (range 0.001–14.1) at the time of GKRS, and the mean prescription dose was 18.6 Gy (range 12–24 Gy). RESULTS: The actuarial median survival time from GKRS was 19.2±5.0 months. The calculated local tumor control rates at 6 and 12 months after GKRS were 89.7% and 77.4%, respectively. During the median clinical follow-up duration of 12.3±2.6 months (range 1–54 months), 18 patients (35.3%) experienced new or worsened neurologic deficits with a median onset time of 2.5±0.5 months (range 0.3–9.7 months) after GKRS. Among various factors, prescription dose (>20 Gy) was a significant factor for the new or worsened neurologic deficits in univariate (p=0.027) and multivariate (p=0.034) analysis. The managements of 18 patients were steroid medication (n=10), boost radiation therapy (n=5), and surgery (n=3), and neurological improvement was achieved in 9 (50.0%). CONCLUSION: In our series, prescription dose (>20 Gy) was significantly related to neurological deterioration after GKRS for brain metastases involving the MC. Therefore, we suggest that careful dose adjustment would be required for lesions involving the MC to avoid neurological deterioration requiring additional treatment in the patients with limited life expectancy.


Subject(s)
Brain , Follow-Up Studies , Humans , Life Expectancy , Motor Cortex , Neoplasm Metastasis , Neurologic Manifestations , Prescriptions , Radiation Dosage , Radiosurgery , Retrospective Studies , Therapeutic Uses
8.
Article in English | WPRIM | ID: wpr-26701

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the impact of continuous renal replacement therapy (CRRT) on survival and relevant factors in patients who underwent CRRT after traumatic brain injury (TBI). METHODS: We retrospectively reviewed the laboratory, clinical, and radiological data of 29 patients who underwent CRRT among 1,190 TBI patients treated at our institution between April 2011 and June 2015. There were 20 men and 9 women, and the mean age was 60.2 years. The mean initial Glasgow Coma Scale score was 9.2, and the mean injury severity score was 24. Kaplan-Meier method and Cox regression were used for analysis of survival and relevant factors. RESULTS: The actuarial median survival time of the 29 patients was 163 days (range, 3-317). Among the above 29 patients, 22 died with a median survival time of 8 days (range, 3-55). The causes of death were TBI-related in 8, sepsis due to pneumonia or acute respiratory distress syndrome (ARDS) in 4, and multi-organ failure in 10. Among the various factors, urine quantity of more than 500 mL for 24-hours before receiving CRRT was a significant and favorable factor for survival in the multivariate analysis (p=0.026). CONCLUSION: According to our results, we suggest that early intervention with CRRT may be beneficial in the treatment of TBI patients with impending acute renal failure (ARF). To define the therapeutic advantages of early CRRT in the TBI patients with ARF, a well-designed and controlled study with more cases is required.


Subject(s)
Acute Kidney Injury , Brain Injuries , Cause of Death , Early Intervention, Educational , Female , Glasgow Coma Scale , Humans , Injury Severity Score , Intracranial Pressure , Male , Methods , Multivariate Analysis , Pneumonia , Renal Replacement Therapy , Respiratory Distress Syndrome , Retrospective Studies , Sepsis
9.
Korean Journal of Spine ; : 175-180, 2009.
Article in English | WPRIM | ID: wpr-68057

ABSTRACT

OBJECTIVE: The purpose of this study was to analyze the clinical and radiological outcomes of dynamic stabilization with DIAM implants. METHODS: We evaluated 24 cases in which lumbar decompressive surgery was performed with dynamic stabilization using DIAM and having more than 24 months of follow up. Indications consisted of spinal stenosis with or without a herniated disc and transition level stenosis of the instrumented fusion segment. Operative data, clinical outcome, and plain and flexion/extension radiographs were obtained and compared to preoperative and postoperative data. RESULTS: The mean age at operation was 56.2 years(range 47-68); the mean follow-up duration was 28.4 months(range 24-37 months).The mean pain and function scores improved significantly from baseline to follow-up, as follows: back pain VAS score from 6.2 to 2.5, leg pain VAS score from 7.2 to 2.4, and Prolo's economic and functional rating score from 5.8 to 8.2. Radiological data demonstrated that the heights of the intervertebral foramen and the posterior disc increased significantly after the procedure. There were no implant-associated complications except for two spinous process fractures which occurred during DIAM insertion, and one case of wound infection. Flexion instability and spondylolisthesis occurred in two cases during the follow-up period. CONCLUSION: These mid-term results suggest that DIAM is a safe and effective alternative surgical option in the treatment of degenerative lumbar stenosis without flexion instability. Careful follow-up is needed to watch for the development of flexion instability and spondylolisthesis.


Subject(s)
Back Pain , Constriction, Pathologic , Follow-Up Studies , Intervertebral Disc Displacement , Leg , Spinal Stenosis , Spondylolisthesis , Wound Infection
10.
Korean Journal of Spine ; : 221-224, 2009.
Article in Korean | WPRIM | ID: wpr-53621

ABSTRACT

We performed combined spondylectomy for 2 patients of malignant tumors invading spinal column and chest wall. For one patient with Pancoast tumor, anterolateral thoracotomy, apical lobectomy, chest wall resection, and hemispondylectomy were performed. For another patient with solitary metastatic tumor from nasopharyngeal cancer, posterolateral thoracotomy, chest wall resection, and total en bloc spondylectomy were performed with anterior and posterior instrumentation. The tumor including invaded chest wall and spinal column werewas removed completely in both patients. No local recurrence was found at 18 months follow-up evaluation in both patients.


Subject(s)
Follow-Up Studies , Humans , Nasopharyngeal Neoplasms , Pancoast Syndrome , Recurrence , Spine , Thoracic Wall , Thoracotomy , Thorax
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