Progressive Multifocal Leukoencephalopathy With Hyper-IgM Syndrome in a 6-Year-Old Boy

Hyper-immunoglobulin (Ig) M syndrome is a congenital immunodeficiency disorder characterized by increased serum IgM with low serum IgG, IgA, and IgE. We report the case of a 6-year-old boy with hyper-IgM syndrome as an underlying disease who showed progressive multifocal leukoencephalopathy findings on brain magnetic resonance imaging after visiting the hospital due to left upper extremity muscle weakness, gait disturbance, and speech impairment. At the time of hospitalization, he was treated with steroids and intravenous immunoglobulin, and his condition improved somewhat, but 6 months later, he visited the hospital with rapid deterioration.

Modified Supraorbital Keyhole Approach to Anterior Circulation Aneurysms

OBJECTIVE: To select a surgical approach for aneurysm clipping by comparing 2 approaches. MATERIALS AND METHODS: 204 patients diagnosed with subarachnoid hemorrhage treated by the same neurosurgeon at a single institution from November 2011 to October 2013, 109 underwent surgical clipping. Among these, 40 patients with Hunt and Hess or Fisher grades 2 or lower were selected. Patients were assigned to Group 1 (supraorbital keyhole approach) or Group 2 (modified supraorbital approach). The prognosis according to the difference between the two surgical approaches was retrospectively compared. RESULTS: Supraorbital keyhole approach (Group 1) was performed in 20 aneurysms (50%) and modified supraorbital approach (Group 2) was used in 20 aneurysms. Baseline characteristics of patients did not differ significantly between two groups. Total operative time (p = 0.226), early ambulation time (p = 0.755), length of hospital stay (p = 0.784), Glasgow Coma Scale at discharge (p = 0.325), and Glasgow Outcome Scale scores (p = 0.427) did not show statistically significant differences. The amount of intraoperative hemorrhage was significantly lower in the supraorbital keyhole approach (p < 0.05). CONCLUSION: The present series demonstrates the safety and feasibility of the two minimal invasive surgical techniques for clipping the intracranial aneurysms. The modified supraorbital keyhole approach was associated with more hemorrhage than the previous supraorbital keyhole approach, but did not exhibit differences in clinical results, and provided a better surgical view and convenience for surgeons in patients with Hunt and Hess or Fisher grades 2 or lower.

Cosmetic Lateral Canthoplasty: Preserving the Lateral Canthal Angle

Cosmetic lateral canthoplasty, in which the size of the eye is increased by extending the palpebral fissure and decreasing the degree of the eye slant, has become a prevalent procedure for East Asians. However, it is not uncommon for there to be complications or unfavorable results after the surgery. With this in mind, the authors have designed a surgical method to reduce complications in cosmetic lateral canthoplasty by preserving the lateral canthal angle. We discuss here the anatomy required for surgery, the surgical methods, and methods for reducing complications during cosmetic lateral canthoplasty.

L-Shaped Columellar Strut in East Asian Nasal Tip Plasty

BACKGROUND: Nasal tip support is an essential consideration for rhinoplasty in East Asians. There are many techniques to improve tip projection, and among them, the columellar strut is the most popular technique. However, the conventional design is less supportive for rotating the tip. The amount of harvestable septal cartilage is relatively small in East Asians. For an optimal outcome, we propose an L-shaped design for applying the columellar strut. METHODS: To evaluate the anthropometric outcomes, the change in nasal tip projection and the columella-labial angle were analyzed by comparing preoperative and postoperative photographs. The anthropometric study group consisted of 25 patients who underwent the same operative technique of an L-shaped strut graft using septal cartilage and were followed up for more than 9 months. RESULTS: There were statistically significant differences between the preoperative and postoperative values in the nasal tip projection ratio and columella-labial angle. We did not observe any complications directly related to the L-shaped columellar strut in the anthropometric study group. CONCLUSIONS: The L-shaped columellar strut has advantages not only in the controlling of tip projection and rotation, but in that it needs a smaller amount of cartilage compared to the conventional septal extension graft. It can therefore be an alternative technique for nasal tip plasty when there is an insufficient amount of harvestable septal cartilage.

Effect of Traumatic Brain Injury on Healing of Femur shaft Fracture / 대한정형외과연구학회지

PURPOSE: Among the fracture patients, there is a tendency to form more callus and get fracture united earlier in groups with traumatic brain injury. This retrospective study is to evaluate the factors that might accelerate the bone formation by comparing two groups in serologic tests, clinical and radiologic results. MATERIALS AND METHODS: From March 2001 to July 2009, femur shaft fracture patients were divided in two groups 1) without traumatic brain injury (32cases), 2) fracture with traumatic brain injury combined (30cases). We evaluated the routine serologic exams, amount of callus formations during the follow up period. RESULTS: There was no statistical difference in WBC, CRP, total calcium, LDH level between two groups, except Alkaline phosphatase level. Amount of callus formation on AP radiograph at the last follow up period was 74.9% in study, 42.6% in control group. Lateral radiograph showed 73.2% of callus formation rate in study group and 32.0% in control group. CONCLUSION: Two groups had no significant difference with the routine serologic exam except Alkaline phosphatase. Group with traumatic brain injury had much more amount of callus formation but there was no evidence of traumatic brain injury accelerate the fracture healing.

Correlations between the Clinical Results and Radiologic Evaluation after Surgical Treatment of Calcaneal Fracture / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out the correlation factors for prognosis of calcaneal fractures. MATERIALS AND METHODS: 120 cases (feet) of calcaneal fractures, all of them followed up for more than 1 year after surgical procedures, consisted of 101 men (105 feet) and 13 women (15 feet) were reviewed retrospectively. The collected clinical data were as follows : injury mechanism, surgical procedures, time to procedure, time to work and the radiologic data: Bohler angle, heel width, displacement of posterior facet. AOFAS hindfoot score and VAS score were checked. With ANOVA test and multiple regression analysis, the data processed statistically. RESULTS: According Sanders classification, type II was 37 cases (31%), type III 66 cases (55%), and type IV 17 cases (14%). On plane radiography, the Bohler angle improved to average 28.4 degree from 5.6 degree, and the displacement of posterior facet was corrected to average 1.2 mm. AOFAS hindfoot score was checked average 81.7 points postoperatively, and the meaningful difference existed between types of Sanders classification. The Bohler angle represented the outline of the calcaneus had the better correlation with the clinical outcome of calcaneal fractures rather than the anatomical reduction of the posterior facet did. And the width of calcaneus had good correlation with the clinical score. CONCLUSION: We should also concern about the outline of calcaneus, the width of calcaneus and the Bohler angle representing anatomical reduction, not only the acute reduction of the posterior facet.