The Septic Knee Arthritis Caused by Klebsiella pneumoniae in a Patient with Type 2 Diabetes Mellitus and Osteoarthritis of the Knee / 대한정형외과학회잡지

Klebsiella pneumoniae causes that liver abscess mostly, also spread to pneumonia, meningitis, urinary tract infections. Septic arthritis caused by K. pneumoniae is a quite rare and has not been reported in Korea. Therefore, the authors report a case of the septic arthritis in the knee joint caused by K. pneumoniae in a patient with type 2 diabetes mellitus and osteoarthritis of the knee that successfully treated by early detection and arthroscopic synovectomy.

Spinal Cord Hemangioblastomas in von Hippel-Lindau Disease: Management of Asymptomatic and Symptomatic Tumors

PURPOSE: Standard treatment of asymptomatic spinal cord hemangioblastoma in von Hippel-Lindau (VHL) disease has yet to be established. The purpose of this study was to propose guidelines for the treatment of asymptomatic spinal cord hemangioblastomas in VHL disease. MATERIALS AND METHODS: VHL disease patients treated for spinal cord hemangioblastomas between 1999 and 2009 were included. All spinal cord hemangioblastomas were divided into three groups: Group 1, asymptomatic tumors at initial diagnosis followed with serial imaging studies; Group 2, asymptomatic tumors at initial diagnosis that were subsequently resected; and Group 3, symptomatic tumors at initial diagnosis, all of which were resected. RESULTS: We identified 24 spinal cord hemangioblastomas in 12 patients. Groups 1, 2 and 3 comprised 13, 4 and 7 tumors, respectively. Group 1 exhibited a smaller tumor volume (257.1 mm3) and syrinx size (0.8 vertebral columns) than those of Group 2 (1304.5 mm3, 3.3 vertebral columns) and Group 3 (1787.4 mm3, 6.1 vertebral columns). No difference in tumor volume or syrinx size was observed between Groups 2 and 3. Five tumors in Group 1 were resected during follow-up because symptoms had developed or the tumor had significantly grown. Finally, among 17 asymptomatic tumors at the initial diagnosis, nine tumors were resected. Only one tumor of these nine tumors resulted in neurological deficits, while five of seven symptomatic tumors caused neurological deficits. CONCLUSION: Selective resection of asymptomatic tumors before they cause neurological deficits might bring about better outcomes.

Surgical Outcomes of Spine Disorders in Patients with Parkinson's Disease

PURPOSE: Patients with Parkinson's disease also commonly have movement disorders, osteoporosis, and other comorbidities. These patients are more likely to have complications after spinal surgery. The aim of the present study is to show the relation ship between complications of spinal surgery and Parkinson's disease. METHODS: A computerized search using diagnostic and procedural codes identified 13 patients with Parkinson's disease who underwent spinal surgery between January 1998 and December 2010. Their medical records and imaging studies were reviewed and recent updatesfor all patients were done by telephone interview. RESULTS: Retrospectively, 13 consecutive patients were reviewed. The mean age was 63.8 (range 44~87) years old and the mean durationof Parkinson's disease was 7.6 (range 1~22) years at the time of the index procedure. The mean T score of the lumbar spine on Dual-energy X-ray absorptiometry (DEXA) scan bone mineral density (BMD) was -2.5 (range -1.0~-5.1). These patients had nine lumbar lesions, two thoracic lesions, one cervical lesion, and one thoracolumbar lesion. Nine patients required no more surgical treatment for lesions which had been previously operated on (index level). However, four patients (30.8%) needed at least one more operation related to their index procedure; segmental degeneration on the adjacent levels in two, retropulsion of an intervertebral cage with screw loosening in one, and pedicle fracture in one. CONCLUSION: It has been reported that patients with Parkinson's disease have high complication rates in spinal surgery. Spine surgeons should be aware of the risk of complications and need to conduct careful follow-up after the surgery.

Risk Factors of Seizures Associated with the Management of Ruptured Cerebral Aneurysms / 대한뇌혈관외과학회지

OBJECTIVE: This study was designed to to analyze the associated risk factors of seizure after aneurysmal subarachnoid hemorrhage (SAH) for providing guidelines of prophylactic antiepileptic drug administration. METHOD: We retrospectively reviewed the programmed clinical database and radiographic findings of the patients with aneurysmal SAH who were treated from March 1996 to August 2004 and followed up for more than one year. RESULT: A total of 512 patients were enrolled. 20 patients (3.9%) presented with seizures. Aneurysm location and size were not associated with seizures. The incidence of seizure was significantly different in the Hunt & Hess Grade IV patients (8.6%) and V patients (23.1%). Fisher Grade IV was associated with a significantly higher risk of the seizure (12.2%). The incidence of seizure was higher in patients with hydrocephalus (6.7%), intracerebral hematoma (8.8%), and decompressive lobectomy (14.3%). CONCLUSION: The overall incidence of seizures was 3.9%. Risk factors of seizures were poor clinical grade (Hunt &Hess Grade IV and V), higher Fisher Grade (IV), hydrocephalus, intracerebral hematoma, and decompressive lobectomy.

Cerebral Aneursyms Associated with the Behcet's Disease / 대한뇌혈관외과학회지

We report two cases of ruptured cerebral aneurysms associated with Behcet's disease. One was from right superior cerebellar artery and treated by intra-aneurysmal coil embolization. The other was from the bifurcation of right middle cerebral artery and treated by clipping. Both patients showed good result.