Objective: Autologous bone grafting for cranioplasty is associated with a high infection rate and bone absorption. Synthetic implant materials for cranioplasty have been developed. In this study, we evaluated the efficacy of titanium mesh-type patient-specific implants (PSIs) for patients with skull defects using the dice similarity coefficient (DSC), clinical outcomes, and artifacts caused by implants. Methods: This retrospective study included 40 patients who underwent cranioplasty with a titanium mesh PSI at our institution. Based on preoperative and postoperative computed tomography scans, we calculated DSC and artifacts. Results: The calculated DSC of 40 patients was 0.75, and the noise was 13.89% higher in the region of interest (ROI) near the implanted side (average, 7.64 hounsfield unit [HU]±2.62) than in the normal bone (average, 6.72 HU±2.35). However, the image signal-to-noise ratio did not significantly differ between the ROI near the implanted side (4.77±1.78) and normal bone (4.97±1.88). The patients showed no significant perioperative complications that required a secondary operation. Conclusion Titanium mesh-type PSIs for cranioplasty have excellent DSC values with lower artifacts and complication rates.

OBJECTIVE: Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA. METHODS: The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome. RESULTS: Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability. CONCLUSION: Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.
Aneurysm ; Aneurysm, Dissecting* ; Carotid Artery, Internal* ; Humans ; Hypertension ; Retrospective Studies ; Rupture ; Subarachnoid Hemorrhage ; Vertebral Artery*

OBJECTIVE: Chronic subdural hematoma (CSDH) is common in elderly patients. So, with an increasing number of elderly people in the general population, there is a need to investigate risk factors which increase recurrence rate. In this study, factors affecting the postoperative recurrence are investigated based on the reoperative CSDH cases. METHODS: Total of ninety-seven patients was enrolled in this study who had have operation for CSDH. In all patients, one burr hole trephination and drainage was the method of choice for the initial treatment of CSDH. We retrospectively evaluated several factors which affect to recurrence of CSDH. RESULTS: Retrospective analysis was performed in 97 patients. Sixteen patients experienced reoperation within 3 months (16/97, 16.5%) for recurrence of CSDH. And, when hematoma was divided by internal architecture, heterogeneous density group seems to be have close relationship with recurrence more significantly than homogeneous density group (p=0.002). Hypertension, diabetes mellitus, early removal of drainage tube, bilaterality of hematoma also have significant relationship with recurrence. CONCLUSION: Recurrence rate of CSDH treated with one burr hole drainage is related with some various factors. There was statistically significant difference between recurred group and non-recurred group. Not only demographic factors but also internal architecture on preoperative brain computed tomography is a significant predicting factor of recurrence in CSDH patients who underwent a surgery. In this study, heterogeneous type hematoma have significantly related with recurrence of CSDH. We should give attention to these predicting factors for more effective care.
Aged ; Brain ; Demography ; Diabetes Mellitus ; Drainage* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Hypertension ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors ; Trephining

OBJECTIVE: Post-traumatic cerebral infarction (PTCI) is one of the most severe secondary insults after traumatic brain injury (TBI), and is known to be associated with poor outcome and high mortality rate. We assessed the practical incidence and risk factors for the development of PTCI. METHODS: We conducted retrospective study on 986 consecutive patients with TBI from the period May 2005 to November 2012 at our institution. The definition of PTCI was made on non-enhanced CT scan based on a well-demarcated or fairly discernible region of low attenuation following specific vascular territory with normal initial CT. Clinical and radiological findings that related to patients' outcome were reviewed and statistically compared. RESULTS: PTCI was observed in 21 (2.1%) patients. Of various parameters, age (p=0.037), initial Glasgow coma scale score (p<0.01), brain herniation (p=0.044), and decompressive craniectomy (p=0.012) were significantly higher in patients with PTCI than patients who do not have PTCI. Duration between accident and PTCI, patterns of TBI and vascular territory of PTCI were not specific. The mortality rates were significantly higher in patients with PTCI than without PTCI. CONCLUSION: The development of PTCI is rare after TBI, but it usually results in serious outcome and high mortality. Early recognition for risks and aggressive managements is mandatory to prevent PTCI.
Brain ; Brain Injuries* ; Cerebral Infarction* ; Craniocerebral Trauma ; Decompressive Craniectomy ; Glasgow Coma Scale ; Hernia ; Humans ; Incidence* ; Mortality ; Retrospective Studies ; Risk Factors* ; Tomography, X-Ray Computed

OBJECTIVE: Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. METHODS: We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. RESULTS: In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). CONCLUSION: Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery.
Aged ; Chronic Disease ; Comorbidity ; Humans ; Judgment ; Life Expectancy ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Spinal Diseases ; Spinal Fusion ; Spine ; Stress, Psychological

A 56-year-old woman was admitted for management of low back pain from compression fracture on L3 vertebral body. Vertebroplasty was performed, and she discharged without any neurologic deficit. She revisited our institute with low back pain with sciatica but without myelopathy after three months. At admission image studies revealed fractured bony particles caused canal encroachment on the same level vertebrae. Surgical management was perfor- med including wide posterior decompression and transpedicular screw fixation on L2, L3, and L4 with posterolateral bony fusion. Authors present a rare case of post-augmentation fracture led to spinal fusion. Additionally, we suggest that filling material for vertebroplasty or kyphoplasty should be, as much as possible, inserted into the posterior half of vertebral body to prevent the refracture or burst fracture.
Decompression ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Low Back Pain ; Middle Aged ; Neurologic Manifestations ; Sciatica ; Spinal Cord Diseases ; Spinal Fusion ; Spine ; Vertebroplasty

BACKGROUND: The prevalence of the hepatitis B virus (HBV) carrier state in Korean children is markedly reduced after the introduction of routine HBV vaccination program. The aims of this study were to evaluate the recent changing patterns of acute HBV infection, and to elucidate the diagnostic value of IgM anti-HBc in distinguishing acute hepatitis B from acute exacerbation in chronic HBV infection (CHB). METHODS: Fifty seven patients with acute hepatitis B and ninety nine patients with acute exacerbation in CHB were included. The titer of IgM anti-HBc was measured and the distribution of age was analyzed retrospectively. Signal to cut off ratio (S/CO ratio) of IgM anti-HBc was calculated in each IgM anti-HBc positive cases. RESULTS: The peak age of acute hepatitis B was 30~39 years old in 2000's. IgM anti-HBc was positive in 25.3% of CHB with acute exacerbation and the peak age of this group was also 30-39 years old. Mean(+/-SD) value of S/CO ratio was 8.3+/-9.1 in CHB group, while 22.9+/-18.7 in acute hepatitis group. The difference was significant between two groups (p value=0.001). However, S/CO ratio in 43.6% of CHB group was greater than 3. CONCLUSIONS: The incidence of acute hepatitis in Korea was highest in 30-39 years old recently. Therefore, catch-up vaccination is better to be recommended in adults. As the peak age of distribution of acute hepatitis B and CHB with acute exacerbation overlaps, much more caution is needed to differentiate these two conditions from each other by IgM anti-HBc only.
Adult ; Carrier State ; Child ; Epidemiology ; Hepatitis B virus ; Hepatitis B* ; Hepatitis* ; Humans ; Immunoglobulin M ; Incidence ; Korea* ; Prevalence ; Retrospective Studies ; Vaccination

BACKGROUND/AIMS: Hepatolithiasis is a common disease in East Asia and presents as a histological feature of proliferative glands containing mucin. 5-10% of hepatolithiasis is known to be associated with cholangiocarcinoma. Recent studies reported that epidermal growth factor receptor (EGFR) could be activated through heparin binding- EGF cleavage by metalloproteinases. Matrix metalloproteinases (MMPs) which digest the extracellular matrix are required for cancer cell invasion and the expression of MMP-9 is known to be increased in cholangiocarcinoma. However, there has been few studies on the expressions and roles of EGFR and MMP in hepatolithiasis. This study was performed to clarify and compare the expressions of EGFR, erbB2 and MMP-9 in hepatolithiasis and cholangiocarcinoma. METHODS: Surgically resected liver tissues with hepatolithiasis (n=14), cholangiocarcinoma (n=20) and trauma (n=2 as controls) were included. The expressions of EGFR, erbB2 and MMP-9 in tissue samples were examined by immunohistochemistry using respective monoclonal antibodies. RESULTS: In traumatic livers, the expressions of EGFR, erbB2 and MMP-9 were all negative. The expression of EGFR was increased in hepatolithiasis group (79%, 11/14) compared with cholangiocarcinoma group (25%, 5/20) (p<0.05). The expression of erbB2 was detected only in cholangiocarcinoma (25%, 5/20). MMP-9 was increased in both hepatolithiasis (79%, 11/14) and cholangiocarcinoma (95%, 19/20) (p>0.05). CONCLUSIONS: EGFR expression appears to be the dominant component in periductular hyperplasia of hepatolithiasis and MMP-9 is upregulated not only in cholangiocarcinoma but also in hepatolithiasis. This study suggests that EGFR and MMP-9 are associated with cholangiocarcinoma and hepatolithiasis.
Adult ; Bile Duct Neoplasms/*metabolism ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*metabolism ; English Abstract ; Female ; Gelatinase B/*analysis ; Humans ; Lithiasis/*metabolism ; Liver Diseases/*metabolism ; Male ; Middle Aged ; Receptor, Epidermal Growth Factor/*analysis ; Receptor, erbB-2/analysis ; Up-Regulation

Pseudomelanosis duodeni is a rare benign condition in which dark pigments accumulate in macrophages located in the lamina propria of the duodenal mucosa. Most reported cases had hypertension with or without chronic renal failure, and were taking antihypertensive agents and iron supplements. Therefore, it has been assumed that pseudomelanosis duodeni is associated with these medications. Our case was a 77 year-old female patient diagnosed as having hypertension, congestive heart failure, iron deficiency anemia, and depression, who had been treated with antihypertensive agents and iron supplement. Upper gastrointestinal endoscopy revealed many tiny discrete dark macules scattered throughout the first and second portions of the duodenum. Endoscopic mucosal biopsy disclosed macrophages with Prussian blue and Fontana-Masson stain positive pigments, which suggested that the nature of pigment was iron sulfide.
Aged ; Anemia, Iron-Deficiency ; Antihypertensive Agents ; Biopsy ; Depression ; Duodenum ; Endoscopy, Gastrointestinal ; Female ; Heart Failure ; Humans ; Hypertension ; Iron ; Kidney Failure, Chronic ; Macrophages ; Mucous Membrane

BACKGROUND/AIMS: Recent experience with endoscopic transmural drainage of pancreatic pseudocysts prompted the use of a similar technique for the primary treatment of infected pancreatic fluid collection (PFC) such as pancreatic abscess and infected pancreatic necrosis (IPN). The aim of this study was to determine the safety and effectiveness of endoscopic transmural drainage for the primary treatment of infected PFC complicating acute pancreatitis. METHODS: In 11 patients, a total of 13 infected PFC (11 pancreatic abscesses and 2 IPNs) compressing the stomach, duodenum, or both were drained endoscopically by means of an endoscopic fistulization followed by stent (s) placement alone or additional nasopancreatic catheter insertion. Complete resolution of PFC was defined as the absence of symptoms and no residual collection on the follow-up computed tomography. RESULTS: Complete resolution was achieved in 12 infected PFC (92%) (10 pancreatic abscesses and 2 IPNs) after stent placement for a mean duration of 31 days. For IPN and 2 pancreatic abscess, insertion of a nasopancreatic catheter was required to irrigate thick pus or necrotic debris. There was 1 case of bleeding (8%) but no mortality. CONCULSIONS: Endoscopic transmural drainage is an effective therapy with minimal morbidity for infected pancreatic fluid collection compressing the gut lumen and is a valuable alternative to surgical drainage.
Abscess ; Catheters ; Drainage* ; Duodenum ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Necrosis ; Pancreatic Pseudocyst ; Pancreatitis ; Stents ; Stomach ; Suppuration