Comparison between Lateral Supraorbital Approach and Pterional Approach in the Surgical Treatment of Unruptured Intracranial Aneurysms

OBJECTIVE: The lateral supraorbital (LSO) approach is a modified method of the classic pterional approach and it has advantages of short skin incision and small craniotomy compared with the pterional approach. This study was designed to compare the two approaches in the surgical treatment of unruptured intracranial aneurysms. METHODS: We retrospectively reviewed 122 patients with 137 unruptured intracranial aneurysms treated by clipping, from July 2009 to April 2011. Between August 2010 and April 2011, 61 patients were treated by clipping via the lateral supraorbital approach and the same number of patients treated by clipping via the pterional approach were retrospectively enrolled. We analyzed the two groups and compared demographic, radiologic and clinical variables. RESULTS: The mean age of patients in the two groups was 54.6 years (LSO group) and 55.7 years (Pterion group). The mean duration of hospitalization was shorter in the LSO group than in the Pterion group (7.9 days vs. 9.0 days, p=0.125) and the mean operation time was also significantly shorter in the LSO group (117.1 minutes vs. 164.3 minutes, p<0.001). Furthermore, the mean craniotomy area was much smaller in the LSO group (1275.4 mm2 vs. 2858.9 mm2, p<0.001). The two groups showed similar distributions of aneurysm location and postoperative complications. CONCLUSION: The lateral supraorbital approach for the clipping of unruptured intracranial aneurysm could be a good alternative to the classic pterional approach.

The News on Moyamoya Disease: Review Article / 대한뇌혈관외과학회지

Moyamoya disease is a rare idiopathic cerebrovascular disease which is known to cause ischemic or hemorrhagic strokes in association with progressive stenosis of intracranial major arteries and subsequent formation of fragile collateral vessels. In this review, we have provided an update on the epidemiology, pathophysiology, clinical presentation, diagnosis, treatment and prognosis of moyamoya disease.

Myelography Induced Fatal Complications; Seizure and Rhabdomyolysis

Myelography has been generally regarded as a safe procedure. However, epidural hematoma and some allergic reactions have been reported, although rarely, as complications of myelography. Herein, we report a patient who experienced seizure and rhabdomyolysis after iopamidol injection with a review of the pertinent literature. A 75-year-old man with no medical history of seizure underwent lumbar spine myelography for the evaluation of the lumbar spine stenosis. After several hours following injection with water-soluble nonionic contrast medium(Iopamidol), he had a generalized tonic-clonic seizure, which progressed into a complex partial. In spite of the efforts of injecting anti-seizure medications, intermittent short-lasting seizure activity continued for hours and brain computed tomographic scan showed a large amount of hyperdense iopamidol in the subarachnoid space. As a consequence, he suffered from rhabdomyolysis-induced acute renal failure. The patient recovered from the contrast-induced acute renal failure after several days of treatment in the intensive care unit and hemodialysis. Fatal complications, such as seizure and rhabdomyolysis, can occur after myelography. Prompt diagnosis and treatment are needed.

Aneurysmal Rebleeding : Factors Associated with Clinical Outcome in the Rebleeding Patients

OBJECTIVE: Aneurysmal rebleeding is a major cause of death and disability. The aim of this study is to investigate the incidence of rebleeding, and the factors related with patient's outcome. METHODS: During a period of 12 years, from September 1995 to August 2007, 492 consecutive patients with aneurysmal subarachnoid hemorrhage (SAH) underwent surgery at our institution. We reviewed the patient's clinical records, radiologic findings, and possible factors inducing rebleeding. Also, we statistically analyzed various factors between favorable outcome group (FG) and unfavorable outcome group (UG) in the rebleeding patients. RESULTS: Rebleeding occurred in 38 (7.7%) of 492 patients. Male gender, location of aneurysm (anterior communicating artery) were statistically significant between rebleeding group and non-rebleeding group (p = 0.01 and p = 0.04, respectively). Rebleeding occurred in 26 patients (74.3%) within 2 hours from initial attack. There were no statistically significant factors between FG and UG. However, time interval between initial SAH to rebleeding was shorter in the UG compared to FG (FG = 28.71 hrs, UG = 2.9 hrs). CONCLUSION: Rebleeding occurs more frequently in the earlier period after initial SAH. Thus, careful management in the earlier period after SAH and early obliteration of aneurysm will be necessary.

Bioelectrical Impedance Analysis (BIA) of the Estimation of Total Body Water and Lean Body Mass in Patients with Renal Failure / 대한신장학회잡지

Bioelectrical impedance analysis (BIA) was used to determine total body water (TBW) and lean body mass (LBM) in patients with renal failure. The body's electrical resistance (R) was measured by the voltage to current ratio, injecting an 800microA alternating current with a frequency of 50KHZ and detecting a voltage drop between the wrist and the ankle. Impedance index (Height2/Resistance) compared favorably with TBW measured by deuterium (D2O) dilution method as the reference, giving the correlation coefficient (r) of 0.966 and standard error estimation (SEE) of 2.71 liter. The index was compared with LBM determined by dual-energy x-ray absorptiometry (DEXA) as the reference, giving r of 0.970 and SEE of 3.00kg. The r of 0.985 and SEE of 2.15kg were found between the reference method. BIA appeared to have a somewhat lower accuracy than those of the reference method. However, it is a useful clinical tool for estimating body composition, because it is easy, rapid and non-invasive. The existing BIA method is based on an extremely simple conductor model of the body. The accuracy may be improved further, based on a more realistic model for the body.

Segmental Bioelectrical Impedance Analysis(SBIA) for Determining Body Composition / 대한지역사회영양학회지

A new bioelectrical impedance method has been developed and evaluated. The electrodes; were made of stainless steel and electrical interfaces were created by an upright subject gripping hand electrodes and stepping onto foot electrodes. Eight tactile electrodes were in contact with surfaces of both hands and feet; thumb, palm and fingers, front sole, and rear sole. Automatic on-off switches were used to change current pathways and to measure voltage differences for target segments. Segmental body resistances and whole body resistance(RWHOLE)were measured in 60 healthy subjects. Segmental resistances of right arm(RRA), left arm(RLA), trunk(RT), right leg(RRL) and left leg(RLL)were310.0+/-61.6 omega, 316.9+/-64.6 omega, 25.1+/-3.4 omega, 236.8+/-31.2 omega and 237.6+/-30.4 omega, respectively. Individual segmental impedance indexes(Ht2/RRA, Ht2/RT, and Ht2 /RLA) were closely related to lean body mass(LBM)as measured by densitometry ranged from r=0.925 to 0.960. Ht2/(RRA+RT+RLA) predicted LBM slightly better(r=0.969) than the traditional index, Ht2/RWHOLE(r=0.964), supporting the accuracy of the segmental measurement. A multiple regression equation utilizing Ht2/RRA, Ht2/RT and Ht2/RRL predicted LBM with r=0.971. Ht2/RRA term of the regression contributed to more than 40% of the LBM prediction, indicating that lean mass of arm represented whole body LBM more closely than other body segments. The new bioimpedance method was characterized by upright posture, eight tactile electrodes, segmental measurements and utilization of electronic switches in comparison with the traditional method. The measurement with this new method was extremely reproducible, quick and easy to use.

A Study on Obesity-promoting Factors for the Elementary School Chirdren / 대한지역사회영양학회지

The purpose of this study is to examine the relationships among body composition, dietary intake, exercise, and life style in children(M=80, f=102) of the 5th and 6th grades of elementary school. Anthropometry and multifrequency bioelectrical impedance analysis were conducted to estimate body composition. Dietary intake, exercise, and life style were determined by using . When obesity was classified greater than 120% of the ideal body weight, the prevalence rates of obesity were 31.2% for boy and 20.6% for girl. There were significant differences in body composition between nonobese(NO) and obese(OB) groups. Mean fat mass(FM) and lean body mass(LBM) were 8.6 kg and 27.7 kg for NO group and 16.7 kg and 32.3 kg for OB group, respectively. Also a significant difference was found in hydration rate(TBW/body weight)between groups(<0.01). No significant difference was found I total calorie intake and nutrient intakes between groups. No difference was found in the frequency and duration of outdoor exercise and indoor activities. Mean sleeping hours was 8-9hours for 62% of nonobese children and for 59% of obese children. However, calorie intake per body weight was significantly lower inobese children than in nonobese. The present study showed that significant differences existed in their body size and composition between NO and OB groups, while no differences existed in daily calorie intake, excercise, and life style. This may indicate that important obesity-promoting factors of early onset obesity may rely on other factors such as hereditary or environmental factors besides factors considered. Further studies are required to understand obesity-promoting factors in children.