Epidural Blood Patch on Cerebrospinal Fluid Leakage Caused by Iatrogenic Dural Injury After Transforaminal Lumbar Interbody Fusion.

A 65-year-old woman who underwent transforaminal lumbar interbody fusion at L4-5 for very severe spinal stenosis combined with a hard disc and instability presented with a headache on postoperative day (POD) 3 and cerebrospinal fluid (CSF) leakage on POD 5. Follow-up lumbar spine computed tomography (CT) was performed on POD 7, and fluid collection at the operation site was observed on CT images. Under the diagnosis of iatrogenic dural injury, absolute bed rest and lumbar drain catheter insertion at the L2-3 level were performed for three days, but the patient continued to complain of severe headache until POD 10. We reoperated on POD 10 and observed a dural defect with CSF leakage. The surgery was completed after ensuring that the CSF leakage was resolved by dural repair. However, 10 days after the reoperation, the amount of hemovac drainage still did not decrease and was measured to be more than 250 mL. There was no improvement in the patient's symptoms. Twenty days after the first surgery, an epidural blood patch was applied to the epidural space at the site of dural injury, and the patient's symptoms improved.

A Comparative Study on the Treatment of Osteoporotic Vertebral Compression Fractures With Early Ambulation and at Least 1 Week of Absolute Bed Rest.

Objective: This study aimed to determine whether absolute bed rest (ABR) is essential for the conservative treatment of osteoporotic vertebral compression fractures (OVCFs). Methods: This study included 115 patients diagnosed with OVCFs. The patients in group A were allowed to ambulate as soon as possible, while those in group B underwent ABR for at least 1 week. X-ray images at baseline and 1 week, 2 weeks, 1 month, 3 months, and 6 months after trauma were obtained from both groups for assessment. In each group, ABR-related complications including constipation, indigestion, Foley catheter insertion, urinary tract infection, cough/sputum, dizziness, and neurasthenia were investigated. Results: In both groups, the compression rates, Cobb angles, and visual analog scale scores did not differ significantly at baseline and the first, second, third, fourth, and fifth follow-ups. In terms of constipation, indigestion, dizziness, and neurasthenia, group A reported a significantly higher complication rate than group B (p<0.05). Conclusion: The prognosis did not differ significantly between patients who underwent ABR for at least 1 week and those who started walking as soon as possible. The incidence of complications due to ABRs was lower in the early ambulatory group. Therefore, it may be helpful to start walking as early as possible during the conservative treatment of OVCFs.

Monitoring and Control of Aedes albopictus, a Vector of Zika Virus, Near Residences of Imported Zika Virus Patients during 2016 in South Korea.

Zika virus (ZIKV) is an arthropod-borne virus mainly transmitted by Aedes species. A total of nine of the 16 imported ZIKV reported cases during the mosquito season in the Republic of Korea (ROK), following the return of local nationals from foreign ZIKV endemic countries, were surveyed for Aedes albopictus. Surveillance and vector control of Ae. albopictus, a potential vector of ZIKV, and related species are critical for reducing the potential for autochthonous transmission in the ROK. Surveillance and vector control were coordinated by Korean Centers for Disease Control & Prevention (KCDC) and conducted by local health authorities within 200 m of imported ZIKV patients' residences. After diagnosis, thermal fogging (3 × week × 3 weeks), residual spray for homes and nearby structures (1 × week × 3 weeks), and larval control (3 × week × 3 weeks) were conducted in accordance with national guidelines developed by KCDC in early 2016. Of the nine residences surveyed using BG Sentinel traps, Ae. albopictus trap indices (TIs) for the three (3) patients' residences located near/in forested areas were significantly higher than the six patients' residences located inside villages/urban areas or low-lying farmland without trees. Overall, Ae. albopictus TIs in forested areas decreased by 90.4% after adult and larval control, whereas TIs decreased by 75.8% for residences in nonforested areas. A total of 3,216 Aedes and Ochlerotatus spp. were assayed by real-time polymerase chain reaction for ZIKV, dengue, and chikungunya virus. Both species collected before and after vector control were negative for all viruses. Vector control within 200 m of residences of imported ZIKV patients, conducted in accordance with established guidelines, may have effectively reduced human-mosquito-human transmission cycle by competent vectors in South Korea.

Repellency of zerumbone identified in Cyperus rotundus rhizome and other constituents to Blattella germanica.

The compounds 1,8-cineole and zerumbone (ZER) from the Cyperus rotundus rhizome along with another 11 previously identified rhizome essential oil constituents and α-humulene, which lacks the only carbonyl group present in ZER, as well as binary mixtures of ZER and seven active compounds were tested for repellency to male B. germanica. The results were compared to N,N-diethyl-3-methylbenzamide (deet). In filter-paper choice tests, ZER was the most repellent compound, and α-humulene was ineffective, which indicates that the α,ß-unsaturated carbonyl group of ZER is a prerequisite component for repellency. At 81.5 µg cm-2, enhanced repellency was produced by binary mixtures of ZER and 1,8-cineole, (+)-dihydrocarvone or (R)-(+)-limonene (70:30, 50:50 and 30:70 ratios by weight). These mixtures were very effective against male B. germanica within 24 h and were more repellent than a single compound or deet alone. The optimum ZER content was determined to be more than 50%. In Ebeling choice box tests at 652.4 µg cm-2, these compounds and deet resulted in complete repellency to intact male B. germanica, while they exhibited 35-47% repellency to antennectomized male one. Mixtures formulated from the active constituents of the C. rotundus rhizome could be useful as potential repellents for controlling B. germanica.

Comparison of the Indications and Treatment Results of Burr-Hole Drainage at the Maximal Thickness Area versus Twist-Drill Craniostomy at the Pre-Coronal Point for the Evacuation of Symptomatic Chronic Subdural Hematomas.

OBJECTIVE: To analyze the clinical data and surgical results from symptomatic chronic subdural hematoma (CSDH) patients who underwent burr-hole drainage (BHD) at the maximal thickness area and twist-drill craniostomy (TDC) at the precoronal point. METHODS: We analyzed data from 65 symptomatic CSDH patients who underwent TDC at the pre-coronal point or BHD at the maximal thickness area. For TDC, we defined the pre-coronal point to be 1 cm anterior to the coronal suture at the level of the superior temporal line. TDC was performed in patients with CSDH that extended beyond the coronal suture, as confirmed by preoperative CT scans. Medical records, radiological findings, and clinical performance were reviewed and analyzed. RESULTS: Of the 65 CSDH patients, 13/17 (76.4%) with BHD and 42/48 (87.5%) with TDC showed improved clinical performance and radiological findings after surgery. Catheter failure was seen in 1/48 (2.4%) cases of TDC. Five patients (29.4%) in the BHD group and four patients (8.33%) in the TDC group underwent reoperations due to remaining hematomas, and they improved with a second operation, BHD or TDC. CONCLUSION: Both BHD at the maximal thickness area and TDC at the pre-coronal point are safe and effective drainage methods for symptomatic CSDHs with reasonable indications.