Objective: The surgical method for treating spontaneous intracranial hemorrhage (ICH) is not well established despite ICH’s high prevalence and poor prognosis. Minimally invasive surgery has recently received attention; however, literature on this method is scarce. In particular, the appropriate location of the catheter in the hematoma has not been described. We examined whether the catheter position affects the hematoma reduction in a hematoma ＞50 cc. Methods: We investigated the prognoses of 36 patients with ICH who underwent stereotactic aspiration and hematoma drainage using urokinase from January 2010 to December 2018 and the hematoma reduction rates according to the tube position. Two methods evaluated the position of the catheter. In the first method, the hematoma was an imaginary sphere. The center point was set as the operation target. We evaluated the catheter position by determining whether it was in the deep part or the outer part of the half point from that location to the hematoma margin. In the second method, we evaluated whether the catheter was located 1 cm inside the hematoma margin. Results: In both the first and second evaluations, there were no differences in age, midline shift, intraventricular hemorrhage status, hematoma volume on admission, Glasgow Coma Scale score on admission, time to operation after symptom onset, and systolic blood pressure. The rates of decrease in bleeding and the prognoses were also not significantly different. Conclusions If the catheter is in the hematoma, the rate of hematoma reduction at any position is similar.

Diarrheagenic Escherichia coli (E. coli) is a main cause of diarrhea worldwide. This study reports the investigation on the occurrence of enterotoxigenic E. coli (ETEC) serotype O27:H7-associated foodborne gastrointestinal disease that occurred at two schools, one middle school and one high school, in Seoul, Korea in June 2015. The immediate government investigation in 1,216 students and 19 food handlers in these two schools revealed that 116 students, 32 students in the middle school and 84 students in the high school, and 2 food handlers, one from middle school and the other from high school, developed gastrointestinal illness symptoms including diarrhea. Following lab investigation identified 29 ETEC serotype O27:H7 strains, 27 from 116 students and 2 from 19 food handlers. Pattern of pulsed-field gel electrophoresis analysis of ETEC isolates suggested that ETEC serotype O27:H7 caused the diarrheal outbreak in June 2015 in Seoul, Korea was a specific clone. In addition, these ETEC serotype O27:H7 isolates were highly resistance to the several antibiotics. The results from the present study provide the evidence that ETEC serotype O27:H7 can be an important cause of domestic foodborne outbreak in Korea.
Anti-Bacterial Agents ; Clone Cells ; Diarrhea ; Electrophoresis, Gel, Pulsed-Field ; Enterotoxigenic Escherichia coli* ; Escherichia coli ; Gastrointestinal Diseases ; Humans ; Korea ; Seoul ; Serogroup

OBJECTIVE: Endovascular treatment is one of the most important treatments along with open craniotomy for cerebrovascular surgery. The successful treatment of endovascular disease relies on appropriate instruments and the surgeon's skill. Endovascular treatment needs to provide safe and stable access to the catheter cavity. Additionally, it is important to maintain a round shape without changing to an oval shape. The catheter for endovascular treatment has to be flexible and accommodate at least 0.027 inches of inner diameter. The 6-Fr Navien™ Intracranial Support Catheter (formerly the ReFlex Intracranial Catheter; Covidien Vascular Therapies, Mansfield, MA, USA) provides 0.072 inches of inner diameter. MATERIALS AND METHODS: We reviewed 61 cases for 56 cases of endovascular treatment with a Navien catheter. A triaxial system was used for all procedures with femoral arterial access. The Navien catheter was placed in the petrous segment of the internal carotid artery or third segment of the vertebral artery. The patients had various shapes of intracranial arteries, including tortuous vessels. RESULTS: The Navien catheter was used for 61 cases of endovascular treatment. We had 59 cases of coil embolization at unruptured and ruptured aneurysms and two cases of stent insertion into the middle cerebral artery. All the cases were successful without any catheter-related complications. CONCLUSION: The Navien catheter is a recently developed catheter that has several strengths compared with previously developed catheters. It provides a more stable environment for endovascular treatment. It provides a cavity sufficient for endovascular treatment devices. Additionally, it is sufficiently flexible to approach tortuous vessels.
Aneurysm, Ruptured ; Arteries ; Carotid Artery, Internal ; Catheters* ; Craniotomy ; Embolization, Therapeutic ; Endovascular Procedures ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Reflex ; Stents ; Vascular Access Devices ; Vertebral Artery

OBJECTIVE: Researchers and clinicians have been unable to fully elucidate the natural course of and proper treatment for unruptured intracranial aneurysms (UIAs) smaller than or equal to 5 mm, particularly with regard to whether close observation or surgery is more appropriate. In this retrospective study, we evaluated the safety and efficacy of endovascular coil embolization of small (≤ 5 mm) asymptomatic UIAs by analyzing outcomes and complications associated with the procedure. MATERIALS AND METHODS: We analyzed data from 150 patients with small asymptomatic UIAs (≤ 5 mm) treated with coil embolization between January 2011 and December 2015. Three-dimensional angiography was used to measure aneurysm size. We evaluated procedure-related morbidity and mortality, immediate post-operative angiographic results, brain computed thomography follow-up results on post-operative day one, and clinical progress. RESULTS: UIAs occurred primarily in the anterior circulation area (142 cases, 94.67%), though eight patients exhibited UIAs of the posterior circulation. Following coil embolization, aneurysms with complete occlusion were observed in 137 cases (91.3%). Partial occlusion occurred in five cases (3.33%), while the procedure had failed in eight cases (5.33%). Procedure-related morbidity and mortality were five cases (3.33%) and zero cases, respectively. CONCLUSION: The endovascular treatment of small asymptomatic UIAs is associated with good short-term outcomes without permanent neurologic complications as well as low overall complication and morbidity rates. Thus, the procedure should be considered for patients with smaller asymptomatic UIAs.
Aneurysm ; Angiography ; Brain ; Embolization, Therapeutic* ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Mortality ; Retrospective Studies

It is essential to predict possibility of difficulties beforehand in ventilating or intubating the patient for the safe airway management and anesthetic maintenance. Even if there is no internal invasion, external compression of an enlarged neck mass can cause tracheal stenosis. The patient with nontoxic goitor had symptoms of dysphagia, exertional dyspnea and wheezing. There was difficulty in endotracheal passage of small bronchoscope through the compressed portion of the trachea during preoperative bronchoscopic examination. We premolded an armored endotracheal tube to fit the patient's trachea based on chest radiography, computed tomography and brochoscopic findings. Endotracheal intubation and thyroidectomy was successful and the patient discharged without any complication. We report a new method of intubation in patient with nontoxic goiter that obstructs the trachea by compression.
Airway Management ; Bronchoscopes ; Deglutition Disorders ; Dyspnea ; Goiter ; Humans ; Intubation ; Intubation, Intratracheal ; Neck ; Respiratory Sounds ; Thorax ; Thyroidectomy ; Trachea ; Tracheal Stenosis

We experienced a case of bilateral vocal cord palsy following general anesthesia for craniotomy. The patient was a 43-year-old woman undergoing tumor resection for falx meningioma on frontal lobe. She had no laryngeal symptoms prior to operation. Spontaneous ventilation resumed after reversal of neuromuscular blockade. Following extubation, she showed signs of airway obstruction and dyspnea. Reintubation was done and symptoms improved. Three days after operation, we confirmed bilateral vocal cord palsy by fiberoptic laryngoscopy. We suggested that possible causes of bilateral vocal cord paralysis were hyperflexion of neck and long operating time.
Adult ; Airway Obstruction ; Anesthesia, General ; Craniotomy ; Dyspnea ; Female ; Frontal Lobe ; Humans ; Laryngoscopy ; Meningioma ; Neck ; Neuromuscular Blockade ; Ventilation ; Vocal Cord Paralysis ; Vocal Cords

PURPOSE: The study was to evaluate the localization of the abnormal gyral and sulcal patterns obtained by means of brain surface rendering imaging. MATERIALS AND METHODS: Nineteen patients with cortical dysplasia who underwent brain surface rendering MR imaging were included in this study. We acquired MP-RAGE sequence and created the 3-D surface rendering MR images by using VoxelPlus(R). Anatomical locations and configurations of abnormal gyri and sulci were reviewed. RESULTS: Abnormal gyral and sulcal patterns were seen 18 in 19 patients. The configuration and orientation of affected gyri and sulci were clearly evaluated in the brain surface rendering images. In a lissencephaly, the a cortex was not delineated and showed markedly thick and smooth gyral pattern. In a schizencephaly, there were wheel shaped broad gyral pattern around the cleft. In a hemimegalencephaly, an affected hemisphere were enlarged and displayed thick and wide gyral pattern. In CBPS, the insular cortex was exposed and the gyri of the lesion were thickened. In focal cortical dysplasia, there were irregular serrated or thick and enlarged gyri. CONCLUSION: Brain surface rendering MR imaging is useful for the evaluation of a detailed gyral pattern and accurate involvement site of abnormal gyri.
Brain ; Humans ; Lissencephaly ; Malformations of Cortical Development ; Orientation

PURPOSE: Although it's been known for half a century that unique structures have evolved in the cerebellum and they then became greatly enlarged in the human brain, the function of these structures still remains unknown. The purpose of this study was to assess cerebellar activation during motor, sensory, word generation, listening comprehension, and working memory tasks with using functional magnetic resonance imaging (fMRI). MATERIALS AND METHODS: Eleven healthy right-handed subjects (Male: female, 6:5, mean age: 27.4years) were imaged on a Siemens 1.5T scanner. Whole brain functional maps were acquired using BOLD EPI sequences in the axial plane. Each paradigm consisted of five epochs of activation vs. the control condition. The activation tasks consisted of left finger complex movement, sensory stimulation of the left hand, word generation, listening comprehension, and working memory tasks. The reference function was a boxcar waveform. The activation maps were thresholded at p = 0.001. SPM 5 evaluated the activated areas and responses within the cerebellum. RESULTS: Cerebellar activation was observed on motor task, word generation task, and working memory task. There were 949 activated areas and the mean fitted and adjusted response was 0.68 during the motor task. There were 319 activated areas and the mean fitted and adjusted response was 0.15 during the word generation task. There were 330 activated areas and the mean fitted and adjusted response was 0.26 during the working memory task. CONCLUSION: Our results suggest that the cerebellum is involved in a variety of functional tasks, including motor, word generation, and working memory tasks. However, during the motor task, the cerebellum showed a large activated area and a high response. Cerebellar function can be evaluated by fMRI.
Brain ; Cerebellum ; Comprehension ; Female ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Memory, Short-Term

The azygous anterior cerebral artery (ACA) is a rare type of ACA anomaly. In the conventional angiography, cognition of its realm is difficult without considerable reading. Clinically, misreading its nature causes confusion during the surgical approach to its associated cerebral aneurysm. We report this rare clinical experience with an angiographic and surgical review.
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Cerebral Angiography ; Cognition ; Intracranial Aneurysm

OBJECTIVE: We wanted to determine the technical and clinical efficacy of using a PTFE-covered self-expandable nitinol stent for the palliative treatment of malignant biliary obstruction. MATERIALS AND METHODS: Thirty-seven patients with common bile duct strictures caused by malignant disease were treated by placing a total of 37 nitinol PTFE stents. These stents were covered with PTFE with the exception of the last 5 mm at each end; the stent had an unconstrained diameter of 10 mm and a total length of 50-80 mm. The patient survival rate and stent patency rate were calculated by performing Kaplan-Meier survival analysis. The bilirubin, serum amylase and lipase levels before and after stent placement were measured and then compared using a Wilcoxon signed-rank test. The average follow-up duration was 27.9 weeks (range: 2-81 weeks). RESULTS: Placement was successful in all cases. Seventy-six percent of the patients (28/37) experienced adequate palliative drainage for the remainder of their lives. There were no immediate complications. Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic biliary drainage) irrigation. Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of follow-up, respectively. Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent insertion in 11 patients in spite of performing endoscopic sphincterotomy (4/6). The bilirubin levels were significantly reduced one week after stent insertion (p < 0.01). The 30-day mortality rate was 8% (3/37), and the survival rates were 49% and 27% at 20 and 50 weeks, respectively. The primary stent patency rates were 85%, and 78% at 20 and 50 weeks, respectively. CONCLUSION: The PTFE-covered self-expandable nitinol stent is safe to use with acceptable complication rates. This study is similar to the previous studies with regard to comparing the patency rates and survival rates.
Adenocarcinoma/*complications ; Aged ; Aged, 80 and over ; Alloys/adverse effects/*therapeutic use ; Cholestasis, Extrahepatic/etiology/*surgery ; Coated Materials, Biocompatible/*therapeutic use ; Common Bile Duct/radiography/surgery ; Digestive System Neoplasms/*complications ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Palliative Care/methods ; Pilot Projects ; Polytetrafluoroethylene/adverse effects/*therapeutic use ; Postoperative Complications/diagnosis/epidemiology ; Prospective Studies ; *Stents/adverse effects ; Survival Analysis ; Treatment Outcome