It is well known that spinal instability should be evaluated in the standing lateral position. Standing dynamic flexion and extension radiographs are usually used to assess spinal instability. Here, we report a patient who experienced distraction instability while in the supine position rather than the standard standing position. To our knowledge, this is the first report of lying-down instability undetected on standing dynamic flexion and extension radiographs. We discuss the pathophysiological mechanism of this uncommon but possible entity and provide a review of the literature.
Deception* ; Humans ; Supine Position

Besides lung transplantation, pulmonary thromboembolectomy is the only effective therapeutic option for chronic thromboembolic pulmonary hypertension. It is however associated with a considerably high hospital mortality between 6.6 to 23%. Proper patient selection is critical when considering a patient for pulmonary thromboembolectomy. And It cannot be overemphasised that the key to the success of the operation is complete endarterectomy of the entire pulmonary arterial tree. We report that pulmonary thromboendarterectomy under total circulatory arrest was an effective and safe method in the surgical correction of the chronic thromboembolic pulmonary hypertension and enabled complete removal of superimposed peripheral organized thrombi in a good operative field.
Endarterectomy* ; Hospital Mortality ; Humans ; Hypertension, Pulmonary ; Lung Transplantation ; Patient Selection ; Pulmonary Embolism

These are natural inhibitors of coagulation, and deficiencies of any of these factors is referred to as thrombophilia. The identified main causes of thrombophilia are deficiencies of antithrombin III, protein C, or protein S, resistance to actived protein C associated with Factor V Leiden mutation, and inherited hyperhomocystinemia. Inherited and acquired thrombophilias may also contribute to pathophysiological processes involved in recurrent pregnancy loss, fetal death, intrauterine growth restriction, placental abruption, placental infarction, and pre-eclampsia. Various therapeutic protocols with low-molecular-weight heparin (LMWH) were used. because it is associated with a low incidence of osteoporosis and thrombocytopenia. We experienced the two cases of successful deliveries by Cesarean section following a successful pregnancy maintenance in thrombophilia. we administered LMWH to prevent thromboembolism. one patient was the primi-gravidarum, with inherited thrombophilia, who has the familial history of pulmonary embolism and deep vein thrombosis. the other was the multi-gravidarum, with acquired thrombophilia, who has the past medical history of pulmonary embolism.
Abruptio Placentae ; Antithrombin III ; Cesarean Section ; Factor V ; Female ; Fetal Death ; Heparin, Low-Molecular-Weight ; Humans ; Incidence ; Infarction ; Osteoporosis ; Pre-Eclampsia ; Pregnancy Maintenance ; Pregnancy* ; Protein C ; Protein S ; Pulmonary Embolism ; Thrombocytopenia ; Thromboembolism ; Thrombophilia* ; Venous Thrombosis

PURPOSE: To evaluate the clinical outcome of vertebroplasty, and to analyze the causes of poor results. MATERIALS AND METHODS: The radiological and clinical results of thirty-eight patients who were followed for more than one year after vertebroplasty for painful osteoporotic compression fractures were retrospectively analyzed. RESULTS: There were 10 recollapses and 6 fractures of adjacent vertebrae. Most of these occurred in the thoracolumbar junction (9 and 5 respectively). Pain was significantly improved in the immediate postoperative period, that is, from 9.3+/-0.7 points on a 10-point pain scale preoperatively to 2.0+/-0.7 points postoperatively (p<0.001). However, at the last follow-up, this was aggravated to 3.9+/-3.3, and eleven (29%) patients had moderate (5-7 points) or severe (8-10) pain. The main causes of aggravation of pain were recollapses (5 cases) and/or fractures of adjacent vertebrae (5). CONCLUSION: Vertebroplasty resulted in excellent relief from pain in the immediate postoperative period, but the more-than-one-year follow-up results were less satisfactory, and this was particularly true in the thoracolumbar junction. The possibility of recollapse or of fractures of adjacent vertebrae must be kept in mind.
Follow-Up Studies ; Fractures, Compression ; Humans ; Osteoporosis ; Postoperative Period ; Retrospective Studies ; Spine ; Vertebroplasty*

PURPOSE: The purpose of this study was to classify the patterns of cement leakage that occurs during vertebroplasty for osteoporotic compression fractures, to evaluate the diagnostic values of simple radiographs for detecting leaks, and to find signs on simple radiographs that suggest leaks into the spinal canal. MATERIALS AND METHODS: First, leakage was classified based on the findings of CT scans and radiographs of 76 vertebrae in 49 patients. Second, the diagnostic values of simple radiographs for detecting leaks were evaluated by comparing the results of a review of simple radiographs with those of CT scans. Finally, warning signs of leakage into the spinal canal on lateral views were identified, and their positive predictive values assessed. RESULTS: Cement leaks were classified into three types according to their routes. Only 66% (50/76) of all leaks were found on simple radio-graphs. Of these, only 8% (2/25) of leaks into the spinal canal were correctly interpreted. Among the four identified warning signs, cement in the neural foramina was found to have the highest positive predictive value (86%). CONCLUSION: Since the sensitivity of radiographs for detecting leakage into the spinal canal is low, careful attention should be paid to identify it early. The four suggested warning signs help early detection.
Fractures, Compression* ; Humans ; Osteoporosis ; Spinal Canal ; Spine ; Tomography, X-Ray Computed ; Vertebroplasty*

Objective: : Stent-assisted coil embolization (SAC) has been increasingly used to treat various types of intracranial aneurysms. Delayed thromboembolic complications are major concerns regarding this procedure, so dual antiplatelet therapy with aspirin and clopidogrel is needed. However, clinicians vary the duration of dual antiplatelet therapy after SAC, and no randomized study has been performed. This study aims to compare the safety and efficacy of long-term (12 months) dual antiplatelet therapy and shortterm dual antiplatelet therapy (6 months) after SAC for patients with unruptured intracranial aneurysms (UIAs). Methods: : This is a prospective, randomized and multicenter trial to investigate the optimal duration of dual antiplatelet therapy after SAC in patients with UIAs. Subjects will receive dual antiplatelet therapy for 6 months (short-term group) or 12 months (longterm group) after SAC. The primary endpoint is the assessment of thromboembolic complications between 1 and 18 months after SAC. We will enroll 528 subjects (264 subjects in each group) and perform 1 : 1 randomization. This study will involve 14 topperforming, high-volume Korean institutions specializing in coil embolization. Results: : The trial will begin enrollment in 2022, and clinical data will be available after enrollment and follow-up. Conclusion : This article describes that the aim of this prospective randomized multicenter trial is to compare the effect of short-term (6 months) and long-term (12 months) dual antiplatelet therapy on UIAs in patients undergoing SAC, and to find the optimal duration.

Objective: Endovascular coil embolization is the primary treatment modality for intracranial aneurysms. However, its long-term durability remains of concern, with a considerable proportion of cases requiring aneurysm reopening and retreatment. Therefore, establishing optimal follow-up imaging protocols is necessary to ensure a durable occlusion. This study aimed to develop guidelines for follow-up imaging strategies after endovascular treatment of intracranial aneurysms. Methods: A committee comprising members of the Korean Neuroendovascular Society and other relevant societies was formed. A literature review and analyses of the major published guidelines were conducted to gather evidence. A panel of 40 experts convened to achieve a consensus on the recommendations using the modified Delphi method. Results: The panel members reached the following consensus: 1. Schedule the initial follow-up imaging within 3-6 months of treatment. 2. Noninvasive imaging modalities, such as three-dimensional time-of-flight magnetic resonance angiography (MRA) or contrast-enhanced MRA, are alternatives to digital subtraction angiography (DSA) during the first follow-up. 3. Schedule mid-term follow-up imaging at 1, 2, 4, and 6 years after the initial treatment. 4. If noninvasive imaging reveals unstable changes in the treated aneurysms, DSA should be considered. 5. Consider late-term follow-up imaging every 3–5 years for lifelong monitoring of patients with unstable changes or at high risk of recurrence. Conclusions The guidelines aim to provide physicians with the information to make informed decisions and provide patients with high-quality care. However, owing to a lack of specific recommendations and scientific data, these guidelines are based on expert consensus and should be considered in conjunction with individual patient characteristics and circumstances.