Osteoporosis is a worldwide problem and it mainly affects postmenopausal women. Osteoporosis associated with pregnancy or lactation is a rare condition. The incidence and mechanism of this phenomenon has not been clarified, but it can cause one or more vertebral compression fractures with severe, prolonged back pain in the affected women. We experienced this uncommon case, treated it with percutaneous vertebroplasty. A 35-old-woman visited our hospital with complaints of severe back pain and flank pain 2 months after normal vaginal delivery. She was diagnosed with osteoporotic vertebral compression fractures on the T5, 8, 9 and 11 vertebral bodies and we performed percutaneous vertebroplasty on the T8, 9 and 11 vertebrae with a good result. We present here an unusual case of pregnancy-associated compression fractures treated by percutaneous vertebroplasty.
Back Pain ; Female ; Flank Pain ; Fractures, Compression ; Humans ; Incidence ; Lactation ; Osteoporosis ; Pregnancy ; Spine ; Vertebroplasty

Osteoporotic patients who undergo percutaneous vertebroplasty (PVP) have the risk of a repeated collapse of their adjacent vertebral body due to alteration of load transfer into the adjacent vertebral body. The authors have experienced a rare case of repeated osteoporotic vertebral compression fractures (VCF) resulting in extreme multi-level PVP. A 74-year-old female developed severe back pain after slipping down one month ago. Her X-ray and MR images indicated a T11 VCF. She underwent successful PVP with polymethylmethacrylate (PMMA). Two weeks later, she returned to our hospital due to a similar back pain. Repeated X-ray and MR images showed an adjacent VCF on T12. A retrial of PVP was performed on T12, which provided immediate pain relief. Since then, repeated collapses of the vertebral body occurred 12 times in 13 levels within a 24-month period. Each time the woman was admitted to our hospital, she was diagnosed of newly developed VCFs and underwent repeated PVPs with PMMA, which finally eased back pain. Based on our experience with this patient, repeated multiple PVP is not dangerous because its few and minor complications. Therefore, repeated PVP can serve as an effective treatment modality for extreme-multi level VCFs.
Aged ; Back Pain ; Female ; Fractures, Compression ; Humans ; Polymethyl Methacrylate ; Vertebroplasty

Background: Conventional modality requires several days observation by Holter monitor to differentiate atrial fibril‑ lation (AF) between Paroxysmal atrial fibrillation (PAF) and Non-paroxysmal atrial fibrillation (Non-PAF). Rapid and practical differentiating approach is needed. Objective: To develop a machine learning model that observes 10-s of standard 12-lead electrocardiograph (ECG) for real-time classification of AF between PAF versus Non-PAF. Methods: In this multicenter, retrospective cohort study, the model training and cross-validation was performed on a dataset consisting of 741 patients enrolled from Severance Hospital, South Korea. For cross-institutional validation, the trained model was applied to an independent data set of 600 patients enrolled from Ewha University Hospital, South Korea. Lasso regression was applied to develop the model. Results: In the primary analysis, the Area Under the Receiver Operating Characteristic Curve (AUC) on the test set for the model that predicted AF subtype only using ECG was 0.72 (95% CI 0.65–0.80). In the secondary analysis, AUC only using baseline characteristics was 0.53 (95% CI 0.45–0.61), while the model that employed both baseline characteris‑ tics and ECG parameters was 0.72 (95% CI 0.65–0.80). Moreover, the model that incorporated baseline characteristics, ECG, and Echocardiographic parameters achieved an AUC of 0.76 (95% CI 0.678–0.855) on the test set. Conclusions Our machine learning model using ECG has potential for automatic differentiation of AF between PAF versus Non-PAF achieving high accuracy. The inclusion of  Echocardiographic parameters further increases model per‑ formance. Further studies are needed to clarify the next steps towards clinical translation of the proposed algorithm.

We report a rare case of chondrosarcoma arising from the dorsum sellae as it mimicked sellar and suprasellar mass. A 36 year-old man visited our hospital for his decreasing visual acuity. Brain magnetic resonance(MR) image revealed round a sellar and suprasellar mass showing mottled enhancement with internal cystic material. The MR image favored the diagnosis of craniopharyngioma, most likely, while plain skull X-ray showed sellar floor erosion and widening, which favored pituitary adenoma. The patient underwent trans-sphenoidal approach less than a week of admission and evaluation because his visual acuity was at a risk of blindness. In the operation, sellar mass was totally removed but some of suprasellar mass was inevitably remained due to limited surgical field. The pathologic diagnosis was chondrosarcoma. Six months from the first operation, pterional approach was performed to remove the remaining suprasellar mass, which didn't come down to sellar area. Intraoperative findings confirmed that the mass was originated from dorsum sellae.
Adult ; Blindness ; Brain ; Chondrosarcoma* ; Craniopharyngioma ; Diagnosis ; Humans ; Pituitary Neoplasms ; Skull ; Visual Acuity

OBJECTIVE: For the treatment of osteoporotic vertebral compression fracture, percutaneous vertebroplasty (PVP) is currently widely used as an effective and relatively safe procedure. However, some patients do not experience pain relief after PVP. We performed several additional PVP procedures in those patients who did not have any improvement of pain after their initial PVP and we obtained good results. Our purpose is to demonstrate the effective results of an additional PVP procedure at the same previously treated level. METHODS: We reviewed the medical records and the radiologic data of the PVP procedures that were performed at our hospital from November 2005 to May 2008 to determine the patients who had undergone additional PVP. We identified ten patients and we measured the clinical outcomes according to the visual analogue scale (VAS) score and the radiologic parameters, including the anterior body height and the kyphotic angulation. RESULTS: The mean volume of polymethylmethacrylate injected into each vertebrae was 4.3 mL (range: 2-8 mL). The mean VAS score was reduced from 8 to 2.32. The anterior body height was increased from 1.7 cm to 2.32 cm. The kyphotic angulation was restored from 10.14 degrees to 2.32 degrees. There were no complications noted. CONCLUSION: The clinical and radiologic outcomes suggest that additional PVP is effective for relieving pain and restoring the vertebral body in patients who have unrelieved pain after their initial PVP. Our study demonstrates that additional PVP performed at the previously-treated vertebral levels could provide therapeutic benefit.
Body Height ; Fractures, Compression ; Humans ; Medical Records ; Polymethyl Methacrylate ; Spine ; Vertebroplasty

OBJECTIVE: Avascular necrosis (AVN) of the vertebral body is known as a relatively uncommon phenomenon in a vertebral compression fracture (VCF). The outstanding radiologic findings of AVN are intravertebral vacuum phenomenon with or without fluid collection. Several reports revealed that PVP or balloon kyphoplasty might be the effective treatment modalities for AVN. We also experienced excellent results when using PVP for the treatment of AVN of the vertebral body, and intend to describe the treatment's efficacy in this report. METHODS: Thirty-two patients diagnosed with AVN of the vertebral body were treated with PVP. We measured the pre- and post-operative anterior body height and kyphotic angulation. The visual analogue scale (VAS) was used to determine the relief of back pain. RESULTS: The anterior body height (pre-operative : 1.49 cm, post-operative : 2.22 cm) and kyphotic angulation (pre-operative : 14.47 degrees, post-operative : 6.57 degrees) were significantly restored (p<0.001). VAS was improved from 8.9 to 3.7. Pseudoarthrosis was corrected in all cases, which was confirmed by dynamic radiographs. Fluid collection was found in sixteen cases and was aspirated with serous nature. No organism and tumor cell were noted. CONCLUSION: PVP proved to be an effective procedure for the treatment of AVN of the vertebral body, which corrected dynamic instability and significantly restored the anterior body height and kyphotic angulation.
Back Pain ; Body Height ; Fractures, Compression ; Humans ; Kyphoplasty ; Necrosis ; Pseudarthrosis ; Vacuum ; Vertebroplasty

A staphylococcal brain abscess admixed with aspergillosis occurred after operation for the olfactory groove meningioma at remote site. We report the rare case and consider the clinical pathogenesis. Bifrontal craniotomy for the olfactory groove meningioma was done in a 61-year-old female. She was bedridden for one month after craniotomy. During that period, panhypopituitarism occurred and was corrected with hormonal replacement. Sore in the occipital scalp which had occurred during the bedridden state was cared by dressing. After 60 days of treatment, he was discharged with ambulatory status. During postoperative period, we found left parieto-occipital brain abscess in the brain computed tomography(CT) at 3 months. And then craniotomy and abscess resection was performed. Vancomycin and itraconazole antibiotic therapy was instituted after the identification of staphylococcus and aspergillus in the cystic fluid, and aspergillus hyphae in the solid wall portion of the abscess. After the confirmation of resolution of brain abscess on the postoperative 3 weeks' brain CT, the patient was discharged with oral itraconazole medication.
Abscess ; Aspergillosis ; Aspergillus* ; Bandages ; Brain Abscess* ; Brain* ; Coinfection* ; Craniotomy ; Female ; Humans ; Hyphae ; Itraconazole ; Meningioma ; Middle Aged ; Postoperative Period ; Scalp ; Staphylococcus* ; Vancomycin

OBJECTIVE: Spinal myeloma has been treated with radiation therapy and chemotherapy. However, the role of surgery was not fully evaluated. This study is performed to evaluate the efficacy of surgery in the treatment of spinal myeloma. METHODS: 22 patients who were treated with surgery for spinal myeloma from August 1999 to April 2003 were analyzed. Radiological finding, surgical methods and result were reviewed in retrospective study. For compression fracture due to myeloma infiltration, percutaneous vertebroplasy(PVP) was done. Decompression surgery with or without fixation was performed for patients with neurologic deficit. The modalities of surgery consist of PVP (14 cases), corpectomy and fixation (7 cases), and laminectomy and epidural mass removal (3 cases). To evaluate clinical outcome, visual analogue pain score and Frankel neurological scale were used. RESULTS: In 14 cases of PVP, total 57 vertebral segments were treated including 21 thoracic vertebral bodies and 36 lumbar vertebral bodies. Pain relief was achieved in all cases. The pain score changed from 7.7 (preoperatively) to 2.5 (postoperatively). And pain relief effect was maintained over than one year. Frankel grade improved in decompression cases. CONCLUSION: Surgical treatment can alleviate pain and improve neurologic deficit immediately in spinal myeloma patients.
Decompression ; Drug Therapy ; Fractures, Compression ; Humans ; Laminectomy ; Neurologic Manifestations ; Retrospective Studies