Combined Interlaminar and Paraisthmic Approach for Co-existing Intracanal and Foraminal Lesion

OBJECTIVE: Stenosis or herniated nucleus pulposus (HNP) occupying lumbar intracanal and foraminal area is an important cause of double radicular symptoms. Using the combined interlaminar and paraisthmic approach, we performed decompression surgery in patients with co-existing intracanal and foraminal lesions. The objective of this study is to describe usefulness and outcome of combined interlaminar and paraisthmic approach surgery and to analysis the cause of poor outcome. METHODS: Between Apr 2009 and Apr 2014, 78 patients (42 males and 36 females) with intracanal and foraminal lesions were enrolled in this study. Patients with a vacuum disc, spondylolisthesis, instability or an isthmic defect on the preoperative dynamic view radiograph were excluded from this study. All patients underwent surgery through a combined approach for discectomy and decompression. The outcome of surgery was evaluated and classified into excellent, good, fair and poor. RESULTS: The results were excellent in 53 patients, good in 9, fair in 6 and poor in 10 during the follow-up. The outcome of the combined approach was excellent to fair in 87% (68 of 78) patients in our study. In the poor outcome group, three patients complained of early-onset relapsed pain (3 months). CONCLUSION: Combined approach for both intracanal and foraminal area lesions may be useful if selectively performed on patients whose facet joint is relatively intact, and that it is worthy of consideration as an alternative to fusion surgery; however, further studies are needed.

Concept Analysis of Gratitude / 정신간호학회지

PURPOSE: The purpose of this study was to analyze and clarify the concept of gratitude. METHODS: A review of the literature was conducted using several databases. The databases were searched using the following keywords: gratitude, positive psychology, concept analysis. Literatures related to gratitude was reviewed using the framework of Walker and Avant's conceptual analysis process. RESULTS: Gratitude can be defined by the following attributes: 1) expression of interaction, 2) power of drawing positive change, and 3) growth of phases by training and habit. The antecedents of gratitude are as follows: 1) soothing one's anger, 2) decreasing complaints, and 3) increasing expressions of gratitude. The consequences of gratitude are as follows: 1) positive change in oneself, 2) positive change in others, and 3) positive change in the environment. CONCLUSION: The theoretical definition for gratitude will provide a common understanding of this concept and differentiate it from other types of gratitude in the nursing. This clarification and conceptualization of the concept will assist further research of the concept and advance the boundaries of practical applications in nursing for various people.

First Report of Sclerotium Rot on Cymbidium Orchids Caused by Sclerotium rolfsii in Korea

Sclerotium rot was found on Cymbidium orchids at Seosan-si, Chungcheongnam-do, Korea, in July, 2010. Symptoms occurred on low leaves, which turned yellowish, after which the entire plant wilted. Severely infected plants were blighted and eventually died. White mycelial mats and sclerotia appeared on pseudobulbs. Based on the mycological characteristics and pathogenicity, the causal fungus was identified as Sclerotium rolfsii. This is the first report of new Sclerotium rot on Cymbidium spp. caused by S. rolfsii in Korea.

Radiological Apoplexy and Its Correlation with Acute Clinical Presentation, Angiogenesis and Tumor Microvascular Density in Pituitary Adenomas

OBJECTIVE: Pituitary apoplexy is life-threatening clinical syndrome caused by the rapid enlargement of a pituitary tumor due to hemorrhage and/or infarction. The pathogenesis of pituitary apoplexy is not completely understood. We analyzed the magnetic resonance imaging (MRI) of pituitary tumors and subsequently correlated the radiological findings with the clinical presentation. Additionally, immunohistochemistry was also performed to determine whether certain biomarkers are related to radiological apoplexy. METHODS: Thirty-four cases of pituitary adenoma were enrolled for retrospective analysis. In this study, the radiological apoplexy was defined as cases where hemorrhage, infarction or cysts were identified on MRI. Acute clinical presentation was defined as the presence of any of the following symptoms: severe sudden onset headache, decreased visual acuity and/or visual field deficit, and acute mental status changes. Angiogenesis was quantified by immunohistochemical expression of fetal liver kinase 1 (Flk-1), neuropilin (NRP) and vascular endothelial growth factor (VEGF) expression, while microvascular density (MVD) was assessed using Endoglin and CD31. RESULTS: Clinically, fourteen patients presented with acute symptoms and 20 for mild or none clinical symptoms. Radiologically, fifteen patients met the criteria for radiological apoplexy. Of the fifteen patients with radiologic apoplexy, 9 patients presented acute symptoms whereas of the 19 patient without radiologic apoplexy, 5 patients presented acute symptoms. Of the five biomarkers tracked, only VEGF was found to be positively correlated with both radiological and nonradiological apoplexy. CONCLUSION: While pituitary apoplexy is currently defined in cases where clinical symptoms can be histologically confirmed, we contend that cases of radiologically identified pituitary hemorrhages that present with mild or no symptoms should be designated subacute or subclinical apoplexy. VEGF is believed to have a positive correlation with pituitary hemorrhage. Considering the high rate of symptomatic or asymptomatic pituitary tumor hemorrhage, additional studies are needed to detect predictors of the pituitary hemorrhage.

Spontaneous Pneumocephalus Associated with Pneumosinus Dilatans

The majority of cases of pneumocephalus are secondary to trauma or medical intervention. Spontaneous, non-traumatic pneumocephalus is an uncommon condition. Most cases of spontaneous pneumocephalus require surgery. However, if there is no evidence of infection or cerebrospinal fluid leak, bed rest and follow-up imaging is an alternative treatment. Herein, we report a 31-year-old man with spontaneous pneumocephalus associated with pneumosinus dilatans.