Efficacy of intraoperative neuromonitoring (IONM) and intraoperative indocyanine green videoangiography (ICG-VA) during unruptured anterior choroidal artery aneurysm clipping surgery

Objective@#The aim of this study was to investigate the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) and intraoperative neuromonitoring (IONM) to prevent postoperative ischemic complications during microsurgical clipping of unruptured anterior choroidal artery (AChA) aneurysms. @*Methods@#We retrospectively reviewed the clinical and radiological records of all patients who had undergone microsurgical clipping for unruptured AChA aneurysms at our institution between April 2001 and December 2019. We compared the postoperative complication rate of the group for which intraoperative ICG-VA and IONM were utilized (group B; n=324) with that of the group for which intraoperative ICG-VA and IONM were not utilized (group A; n=72). @*Results@#There were no statistically significant differences in demographic data between the two groups. Statistically significant differences were observed in the rate of overall complications (p=0.014) and postoperative ischemic complications related to AChA territory (p=0.039). All the cases (n=4) in group B who had postoperative infarctions related to AChA territory showed false-negative results of intraoperative ICG-VA and IONM. @*Conclusions@#Preserving the patency of the AChA is essential to minimize postoperative complications. Intraoperative monitoring tools including ICG-VA and IONM can greatly contribute to lowering complication rates. However, their pitfalls and false-negative results should always be considered.

Utility of sentinel lymph node biopsy in papillary thyroid microcarcinoma

Purpose@#There are many studies on sentinel lymph node (SLN) biopsy in thyroid carcinoma but SLN biopsy (SLNB) in papillary thyroid carcinoma (PTC) remains open to debate. Therefore in this retrospective study, the usefulness of SLNB in thyroid carcinoma patients who had micro-PTC without cervical lymphadenopathy was assessed. @*Methods@#SLNB was performed in 114 patients who were diagnosed with micro-PTC in a single lobe without palpable or ultrasound-detected lymph node at the tertiary center between January 2012 and December 2013. After SLNB, all patients underwent total thyroidectomy and central neck dissection or thyroid lobectomy and central neck dissection of the single side. @*Results@#SLNs were identified in 112 of 114 patients with 41 positive SLNs and 71 negative SLNs on intraoperative frozen sections. However, eight negative patients were found to be positive in the final pathology. Sentinel node identification rate and false negative value of SLNB were 98.2% and 11.3%, respectively. In the univariate analysis, higher lymph node metastasis was detected in men than in women. Higher detection number of SLN showed higher probability of lymph node metastasis. @*Conclusion@#SLNB may be helpful in papillary thyroid cancer, especially in male patients. Also, it is useful for the staging of nodal status and clearance of persistent disease.

Thyrotropin suppression therapy for papillary thyroid carcinoma with a huge recurred neck lymph node

Differentiated thyroid cancer (DTC) originating from thyroid tissue is affected by thyrotropin (TSH). TSH suppression therapy is usually recommended after thyroidectomy in cases of DTC. A 57-year-old woman who harbored a very huge recurred lymph node underwent TSH suppression therapy because of the risk of surgical complications. After TSH suppression, the huge neck lymph node exhibited a response and decreased in size. She had been followed up for 144 months. TSH suppression therapy could be considered as an alternative treatment option in a recurred DTC patient with a high perioperative risk.

Thyrotropin suppression therapy for papillary thyroid carcinoma with a huge recurred neck lymph node

Differentiated thyroid cancer (DTC) originating from thyroid tissue is affected by thyrotropin (TSH). TSH suppression therapy is usually recommended after thyroidectomy in cases of DTC. A 57-year-old woman who harbored a very huge recurred lymph node underwent TSH suppression therapy because of the risk of surgical complications. After TSH suppression, the huge neck lymph node exhibited a response and decreased in size. She had been followed up for 144 months. TSH suppression therapy could be considered as an alternative treatment option in a recurred DTC patient with a high perioperative risk.

High Spontaneous Resolution Rates of Severe Primary Vesicoureteral Reflux and Minimal Development of New Renal Scars

PURPOSE: The previous reports regarding VUR resolution were not precise due to early frequent surgical intervention. We evaluated the spontaneous resolution (SR) rate and the incidence of new renal scars in primary VUR, focusing on severe reflux. METHODS: Medical records of 334 patients with primary VUR who were on medical prophylaxis without surgery for 1 to 9 years, were retrospectively reviewed. Medical prophylaxis was initiated with low-dose antibiotic prophylaxis or probiotics. Radioisotope cystourethrography was performed every 1 to 3 years until SR of reflux. New renal scar was evaluated with follow-up 99mTc DMSA renal scan. RESULTS: The SR rates decreased as VUR grades were getting higher (P=0.00). The overall and annual SR were 58.4% and 14.9%/yr in grade IV reflux and 37.5% and 9.3%/yr in grade V reflux. The median times of SR were 38 months in grade IV reflux and 66 months in grade V reflux. The probable SR rates in grade IV and V reflux were 7.8% and 8.9% in the 1st year, 46.0% and 30.8% in the 3rd year and 74.4% and 64.4% in the 5th year. The incidences of new renal scars between low to moderate reflux and severe reflux showed no significant difference (P=0.32). CONCLUSION: The SR rates of severe primary VUR were higher than previously reported and most new renal scars were focal and mild.

The Impact of the Amount of Displacement of Percutaneous Osteotomy on the Clinical Result in Bunionette / 대한족부족관절학회지

PURPOSE: The purpose of this study was to report impacts of the amount of displacement of percutaneous osteotomy on the clinical and radiologic results in the treatment of bunionette deformities. MATERIALS AND METHODS: We retrospectively reviewed 36 cases of bunionette deformities treated with percutaneous modified Kramer osteotomies from 2009 to 2013. We measured amounts of displacement on anteroposterior and lateral plain radiographs as well as multiple parameters which represent degrees of the bunionette deformities. We also recorded radiological healing time, clinical healing time, residual symptoms, and the time of returning to daily activity. RESULTS: No meaningful correlation was found between severity of preoperative deformity and amount of displacement of the osteotomy. The amount of displacement on a horizontal plane did not affect the healing time, duration of symptoms, or time of returning to daily activity. However, large sagittal displacement was related to duration of postoperative symptoms. CONCLUSION: Findings of this study suggest that the displacement in percutaneous osteotomy for bunionette deformity does not affect clinical results and healing time. We believe that we do not need to be excessively cautious about how large the displacement we make during the percutaneous modified Kramer osteotomy for the bunionette deformity.

Atypical Kawasaki Disease Presenting as Acute Kidney Injury in a Patient with Influenza B Virus Infection / 이화의대지

Influenza virus infection is a common respiratory disease in children. Renal complications of influenza infection were not commonly encountered until the 2009 H1N1 influenza pandemic, when acute kidney injury (AKI) frequently developed in severely ill patients. Kawasaki disease (KD) is another rare association in pandemic influenza virus infections. There are some reports about KD coincident with influenza A H1N1/09 infection. However, simultaneous AKI and KD in influenza A or B virus infections have never been reported. Herein, we report the first case of influenza B virus infection that initially presented as AKI but was subsequently diagnosed as atypical KD.

Clinical Guideline for Childhood Urinary Tract Infection (Second Revision)

To revise the clinical guideline for childhood urinary tract infections (UTIs) of the Korean Society of Pediatric Nephrology (2007), the recently updated guidelines and new data were reviewed. The major revisions are as follows. In diagnosis, the criterion for a positive culture of the catheterized or suprapubic aspirated urine is reduced to 50,000 colony forming uits (CFUs)/mL from 100,000 CFU/mL. Diagnosis is more confirmatory if the urinalysis is abnormal. In treating febrile UTI and pyelonephritis, oral antibiotics is considered to be as effective as parenteral antibiotics. In urologic imaging studies, the traditional aggressive approach to find primary vesicoureteral reflux (VUR) and renal scar is shifted to the targeted restrictive approach. A voiding cystourethrography is not routinely recommended and is indicated only in atypical or complex clinical conditions, abnormal ultrasonography and recurrent UTIs. 99mTc-DMSA renal scan is valuable in diagnosing pyelonephritis in children with negative culture or normal RBUS. Although it is not routinely recommended, normal scan can safely avoid VCUG. In prevention, a more natural approach is preferred. Antimicrobial prophylaxis is not supported any more even in children with VUR. Topical steroid (2-4 weeks) to non-retractile physiologic phimosis or labial adhesion is a reasonable first-line treatment. Urogenital hygiene is important and must be adequately performed. Breast milk, probiotics and cranberries are dietary factors to prevent UTIs. Voiding dysfunction and constipation should be properly treated and prevented by initiating toilet training at an appropriate age (18-24 months). The follow-up urine test on subsequent unexplained febrile illness is strongly recommended. Changes of this revision is not exclusive and appropriate variation still may be accepted.

Results of Microfracture in the Osteoarthritic Knee with Focal Full-Thickness Articular Cartilage Defects and Concomitant Medial Meniscal Tears

PURPOSE: To evaluate the efficacy of arthroscopic microfracture in patients with focal full-thickness cartilage defects in the osteoarthritic knee. MATERIALS AND METHODS: Seventy-six patients were enrolled in this study. They were divided into group I (n=38) who underwent microfracture plus meniscectomy and group II (n=38) who underwent only meniscectomy. Clinical and radiological evaluations were performed. RESULTS: At the time of the three-year follow-up, a total of five failures (6.6%) were reported: four patients in group I and one in group II. The two groups showed no significant difference in the Lysholm score, the Tegner activity score and the visual analog pain scale score at three years after surgery. However, at the time of the three-month follow-up, group II showed significantly more improvement in the Tegner activity and the visual analog pain score compared with group I. CONCLUSIONS: In the osteoarthritic knee, additional microfracture did not confer any additional benefit to meniscectomy.

The Clinical Use of Routine Urinalysis

Routine urinalysis is a simple, economical, and useful test that facilitates the detection of urinary system diseases and monitoring of renal disease progression. It consists of 4 parts of specimen evaluation, gross examination, a dipstick urinalysis, and a sediment microscopic urinalysis. Urine specimens should first be evaluated in terms of acceptability, and thereafter, the gross appearance is examined for color, turbidity, and odor. In particular, a dipstick urinalysis is an easy and rapid test that provides information on the multiple physicochemical properties of the urine sample. Moreover, although a sediment microscopic urinalysis is time-consuming, it provides information on the cells, microorganisms, casts, and crystals. In the present report, the clinical significance of the routine urinalysis and the problems concerning interpretation are summarized.

Preventive Effects of Lactobacillus Mixture on Experimental E. coli Urinary Tract Infection in Infant Rats

PURPOSE: Urinary tract infection (UTI) is an ascending infection of fecal uropathogens, urogenital lactobacilli are suggested to play a role in the prevention of UTI. This study was to investigate whether lactobacillus mixture (LM) could prevent the experimental infantile UTI. MATERIALS AND METHODS: The LM were composed of three lactobacillus strains (L. gasseri, L. rhamnosus, and L. reuteri). Mother rats were grouped as lactobacillus (LB) group I (LB I, n=22), II (LB II, n=24) and control (n=20). LB I and LB II were fed with LM (1 mL/day) and control with phosphate-buffered saline (PBS) from late pregnancy through lactation. All newborn rats were breast-fed and their urine and stool were collected at the end of the 3rd week to compare lactobacillus colony. Then, infant rats from LB II were treated with intravesical instillation of LM. Infant rats from LB I and control were instilled with PBS. Twenty-four hours later, experimental UTI was introduced by intravesical instillation of standard E. coli strain. After 72 hours later, the infant rats were sacrificed for histologic examination. RESULTS: Lactobacilli colonies in urine and stool were not statistically different among the three groups. The incidence of pyelonephritis in the LB II was 16.7% (4/24), LB I 72.7% (16.22) and control 75.0% (15/20) (p=0.015). The incidence of cystitis was not significantly different among the three groups. CONCLUSION: The intravesically instilled LM significantly prevented experimental pyelonephritis in infant rats, however, LM administered orally to the pregnant and lactating mother rats did not.

Relationship between Change of Median Nerve Cross-Sectional Area Measured by Ultrasonography and Prognosis after Carpal Tunnel Release / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate cross-sectional area of the median nerve using ultrasound in patients with carpal tunnel syndrome before and after endoscopic intervention, and to verify the level at which it can be used in prediction of outcome. MATERIALS AND METHODS: A prospective study was conducted in 21 patients who underwent endoscopic carpal tunnel release from March 2011 to March 2012. Median nerve cross-sectional area was measured before the operation and three months after the operation at the level of lunate, pisiform and hamate. The Boston questionnaire was evaluated before the operation and three months after the operation, and then allocated as two groups (group I: symptom improvement of more than 25%, group II: symptom improvement less than 25%). Then, differences of cross-sectional area between preoperative measurement and postoperative measurement on three levels were compared between the two groups. RESULTS: Nineteen patients were females and two were males ranging in age between 35-79 years (mean, 55.4 years). Significant differences were observed between the two groups at the lunate level. However, at the level of pisiform and hamate, no differences were observed between the two groups. CONCLUSION: Measurement of median nerve cross-sectional area at the lunate level showed significant correlation with outcome of carpal tunnel release.

Surgical Removal of Calcific Lesions in the Hand

PURPOSE: Calcific lesion of the hand is infrequently recognized, presenting with severe pain and swelling of the affected joint. The purpose of this study is to describe clinical features associated with this condition by reviewing surgically treated patients. MATERIALS AND METHODS: A retrospective study was carried out in 11 patients who had operation clinical and radiographic data were collected by medical records. RESULTS: Eight patients were females and three were males with age ranging between 27-75 years (mean: 48 years). By location, five cases of interphalangeal joint, three cases of metacarpophalangeal joint of thumb, two cases of carpal tunnel and one case of distal ulna area were noted. Interval between symptom presentation and operation was 9.4 month (range: 6-18 month). During 10 month follow-up (range: 6-12 month), recurrence had not occurred. CONCLUSION: Although the prevalence of calcific lesion of hand and wrist is low, it may cause severe pain and swelling. If conservative treatment fails or any nerve compression symptom develops, surgical removal of the calcific lesion is recommended.

Primary Spinal Cord Astrocytoma Presenting as Intracranial Hypertension: A Case Report

Increased intracranial pressure (IICP) is rarely seen in association with primary spinal tumors. We describe a 58-year-old man who was diagnosed with a primary spinal cord astrocytoma, who first presented with hypesthesia, followed by intracranial hypertension, papilledema and blurred vision. On first admission, he presented with hypesthesia but without paraparesis, headache or blurred vision. Spinal MRI showed a relatively well-enhanced solid mass with a cystic portion at the cervico-thoracic level, shown histologically to be a grade I pilocytic astrocytoma. After gross total resection of the tumor, the patient had no significant neurological changes. Nine months later, the patient was admitted with headache, blurred vision and paraparesis. An ophthalmologic examination showed papilledema and lumbar tapping revealed IICP. A spinal MRI showed recurrence of the tumor which was found to be a glioblastoma after reexplorative debulking surgery. After resection, his headaches and blurred vision improved, but his paraparesis did not. These findings show that a primary spinal cord astrocytoma may cause IICP.

Escherichia coli pap Genes as well as Adenovirus Type 11 and Type 21, and BK Virus were Involved with Severe Urinary Tract Infection in Infants

In infants, urinary tract infections (UTIs) are quite common and primarily caused by bacterial pathogens. However, little research has been conducted regarding the relationship between uropathogenic bacteria, virulent genes, and uropathogenic viruses that might induce UTIs in infants. In this study, we evaluated infants with UTIs to determine the influence of bacterial virulent genes and type of viral infections on clinical aspects. First, we detected 44 cases of bacterial UTI from 600 suspected cases in infants and children. We detected E. coli urovirulence genes (kps, usp, pap, ireA, and cnf), two enteropathogenic E. coli genes (bfpA, and eae) and four S. aureus and S. epidermidis genes (mecA, pvl, bbp, and icaA) in urine samples from infant UTI cases. We also simultaneously detected hematuria-related adenovirus type 11, 21, and BK virus (BKV) in urine samples by PCR. As a result, E. coli was the most prevalent bacteria and in Dimercaptosuccinic acid (DMSA)-positive UTI cases, the uropathogenic E. coli virulence factor pap was significantly high. We found that BKV detection was significantly higher in DMSA-positive UTI infants (89%) compared with 50% of non-UTI (no bacteria detected) cases. These results are indicative of combined multiple bacterial and viral infections and show severe infant pyelonephritis.

Retraction: Compressive Technique for Treatment of Auricular Hematoma Using Dental Impression Material / 대한이비인후과학회지

No abstract available.

Retraction: The Clinical Characteristics and Treatment Results of Bilateral Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

No abstract available.

Enterovirus 71-associated hand, foot and mouth diseases with neurologic symptoms, a university hospital experience in Korea, 2009 / 소아과

PURPOSE: Hand-foot-mouth disease (HFMD) is a common viral illness in children, which is usually mild and self-limiting. However, in recent epidemics of HFMD in Asia, enterovirus 71 (EV71) has been recognized as a causative agent with severe neurological symptoms with or without cardiopulmonary involvement. HFMD was epidemic in Korea in the spring of 2009. Severe cases with complications including death have been reported. The clinical characteristics in children with neurologic manifestations of EV71 were studied in Ewha Womans University Mokdong Hospital. METHODS: Examinations for EV71 were performed from the stools, respiratory secretion or CSF of children who presented neurologic symptoms associated with HFMD by realtime PCR. Clinical and radiologic data of the patients were collected and analyzed. RESULTS: EV71 was isolated from the stool of 16 patients but not from respiratory secretion or CSF. Among the 16 patients, meningitis (n=10) was the most common manifestation, followed by Guillain-Barre syndrome (n=3), meningoencephalitis (n=2), poliomyelitis-like paralytic disease (n=1), and myoclonus (n=1). Gene analysis showed that most of them were caused by EV71 subgenotype C4a, which was prevalent in China in 2008. CONCLUSION: Because EV71 causes severe complications and death in children, a surveillance system to predict upcoming outbreaks should be established and maintained and adequate public health measures are needed to control disease.

Comparison of Mechanical Property of Conventional Rods versus Growing Rods for Pediatric Early Onset Scoliosis

STUDY DESIGN: This is a mechanical study. OBJECTIVES: We wanted to investigate the mechanical properties of newly developed dual growing rods for obtaining approval for their clinical application. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective for controlling progressive early onset scoliosis, and it allows for spinal growth and improving lung development. MATERIALS AND METHODS: We investigate the yield load and ultimate load during compression, tension and torsion of the growing rods and the conventional rods assembly using UHMWPE blocks, and the diameter of the rods was 6.0 mm and they expanded 5cm long. We also performed a fatigue test with growing rods, and the diameter of which was 6.0 mm and it expanded 2.5cm long. The guideline for the American Society for Testing Materials was followed during the entire mechanical test. With the growing rods and conventional rods, we tested for each mechanical property7 times with the new rods and blocks. RESULTS: The yield load of the growing rods and conventional rods were 845.2+/-18.2 (N) and 812.9+/-29.9 (N), respectively, and the ultimate load of the growing rods and conventional rods were 961.9+/-31.1 (N) and 914.9+/-25.6 (N), respectively, when compression force was applied. The yield load and ultimate load of the growing rods were statistically higher than those of the conventional rods (p0.05). The yield loads of the growing rods and conventional rods were 11.56+/-0.59 (Nm) and 12.46+/-0.71 (Nm), respectively, the ultimate loads of the growing rods and conventional rods were 16.97+/-0.94 (Nm) and 17.42+/-2.66 (Nm) during the torsion, respectively. The yield load and ultimate load of the growing rods were statistically lower than that of the conventional rods (p<0.05). CONCLUSIONS: The newly developed growing rods have a higher yield load and ultimate load under compression, a similar ultimate load under tension and a lower yield load and ultimate load under torsion. The differences of the yield load and ultimate load under torsion were minimal, and so the growing rods and conventional rods have similar mechanical properties.

Giant Serpentine Aneurysm of the Middle Cerebral Artery

Giant serpentine aneurysms are rare and have distinct angiographic findings. The rarity, large size, complex anatomy and hemodynamic characteristics of giant serpentine aneurysms make treatment difficult. We report a case of a giant serpentine aneurysm of the right middle cerebral artery (MCA) that presented as headache. Treatment involved a superficial temporal artery (STA)-MCA bypass followed by aneurysm resection. The patient was discharged without neurological deficits, and early and late follow-up angiography disclosed successful removal of the aneurysm and a patent bypass graft. We conclude that STA-MCA bypass and aneurysm excision is a successful treatment method for a giant serpentine aneurysm.