BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage* ; Emergencies ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms* ; Retrospective Studies ; Ventriculostomy

No abstract available.

The glomus tumor is a distinct neoplasm composed of modified perivascular smooth-muscle cells identical to those described in the glomus body. Malignant glomus tumor, also referred to as glomangiosarcoma, is exceedingly rare. It has been subdivided into locally infiltrative glomus tumor, glomangiosarcoma arising in a benign glomus tumor, and glomangiosarcoma arising in de novo. A few cases of malignant glomus tumor arising in a benign glomus tumor have been reported. A 55-year-old man underwent resection of a solitary nodule in the right shoulder area. The tumor was biphasic with a typical benign glomus tumor at the periphery and the central sarcomatous area composed of oval to elongated pleomorphic cells with a single prominent nucleolus and occasional mitotic figures. Both tumor components showed intense staining for vimentin, smooth muscle actin, and muscle specific actin. Herein, we report a case of a malignant glomus tumor arising in a benign glomus tumor with an immunohistochemical study and a review of literatures.
Actins ; Glomus Tumor* ; Humans ; Middle Aged ; Muscle, Smooth ; Shoulder ; Vimentin

BACKGROUND: Because specific chromosomal abnormalities are associated with certain hematologic disorders, cytogenetic studies can help classifing the diseases, providing the clues of disease progression and being used to monitor remission after chemotherapy. In this study, cytogenetic analysis was performed. In acute and chronic leukemic patients in Korea and the results were compared with foreign cytogenetic reports, and the typical acute lymphocytic leukemia (ALL) and acute myelocytic leukemia (AML) associated chromosome aberrations were analysed by some calculated parameters to clarify if the specific chromosomal abberations in the specific types or subtypes of leukemias had diagnostic value or not. METHOD: Chromosome studies were done in bone marrow or peripheral blood samples by high resolution banding technique. Sensitivity, specificity, and positive and negative predictive values of finding or not finding a given aberration were calculated for followings : for the differential diagnosis between ALL and AML when a patient is known to have acute leukemia, for the differential diagnosis among AML and ALL FAB subtypes in a patient with known AML and ALL. RESULTS: The high positive predictive values (1.0) in the AML versus ALL comparison were found for -7, del(7) (q11-34q22-36), +8s, t(8;21) (q22;q22), t(15;17) (q22;q11), inv (16) (q13;q22) and -Y. Among the AML subtypes, the highest sensitivity, positive and negative predictive values were 0.85, 0.97, 0.94 for t(15;17) (q22;q11) in M3, respectively. The high positive predictive values and specificity in the ALL versus AML comparison were found for t(1;19) (q23;p13) ,t(4;11) (q21 ;23) and t(8; 14) (q24;q32) Among the ALL subtypes, the highest negative predictive value was 0.99 for t (8;14) (q24;q32) in L3. Among 398 CML cases, Philadelphia chromosome positive CML were shown in 81.9% that were classic t(9;22) (q34;all) (94.5%), complex variant traslocation(1.8%) and additional secondary chromosome aberrations (3.7%) . CONCLUSION: Total chromosomal aberration rate in acute and chronic leukemia in Korea was lower than that in foreign reports, but the patterns of chromosome aberrations were similar except for t(15;17) (q22;q11) in AML patients. Quantitativly calculated data of sensitivity, specificity and positive and negative predictive values in the specific chromosomal aberration might be used for diagnostic markers of acute leukemia.
Bone Marrow ; Chromosome Aberrations ; Cytogenetic Analysis ; Cytogenetics* ; Diagnosis, Differential ; Disease Progression ; Drug Therapy ; Humans ; Korea* ; Leukemia ; Leukemia, Myeloid, Acute ; Philadelphia Chromosome ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Sensitivity and Specificity

PURPOSE: The purpose of this study was to explore the experiences of family caregivers who care for the elderly under Long-term Care Insurance. METHODS: Data were collected using focus group interviews and analyzed using a phenomenological approach. The four focus groups consisted of eight caregivers, two social workers and three nurses in B city, Korea. RESULTS: Five themes were identified: 'Obtaining a care-helper certification for employment', 'Taking care of the elderly in their homes', 'Difficulties due to life changes', 'Difficulties due to reduced wages' and 'Dissatisfaction with the Long-term Care Insurance operating system'. CONCLUSION: The results of this study demonstrate that the long-term care system for family caregivers faces many systematic challenges in providing care for the elderly harmoniously in their home. To help them succeed in their tasks, Long-term Care Insurance system must offer respite and support programs to family caregivers.
Aged ; Caregivers ; Certification ; Focus Groups ; Humans ; Insurance ; Insurance, Long-Term Care ; Long-Term Care ; Qualitative Research ; Social Workers

No abstract available.

OBJECT: This study was undertaken to assess the reliability of aspect ratio (AR: the maximum dimension of the dome/width of the neck of an aneurysm) in predicting aneurysm rupture. The authors sought to evaluate the utility of these measures for differentiating ruptured and unruptured aneurysms. METHODS: Patients were retrospectively selected for this study based on the availability of angiograms and a clear diagnosis of an unruptured or ruptured aneurysm. 106 patients with 140 aneurysms were included. 19 patients harbored only unruptured lesions, 70 patients only ruptured lesions, and 17 both ruptured and unruptured lesions. The size of the aneurysms and their ARs were determined by examining the angiographic films. Patient's age and sex, and the location of the aneurysm were also recorded. RESULTS: The ruptured aneurysms were larger and had greater ARs. The mean size of unruptured aneurysms was 4.94 mm and that of ruptured ones was 5.53 mm; the corresponding mean ARs were 1.50 and 1.96, respectively. The odds ratio for rupture rose progressively only for the AR. Only 38.3% of ruptured aneurysms had an AR less than 1.80 compared with 74.0% of unruptured lesions. The odds of rupture were 28-fold greater when the AR was larger than 2.07 compared with an AR with an AR less than or equal to 1.30. Only 9.3% of ruptured aneurysms had and AR less than 1.30 compared with 48.1% of unruptured lesions. CONCLUSION: A high AR might reasonably influence the decision to treat actively an unruptured aneurysm independent of its maximum size, so great care should be taken for patients with unruptured intracranial aneurysms with AR of more than 1.80.
Aneurysm* ; Aneurysm, Ruptured ; Diagnosis ; Humans ; Intracranial Aneurysm ; Neck ; Odds Ratio ; Retrospective Studies ; Rupture

Cerebrovascular complications are of the most frequent intracranial complications of bacterial meningitis. Most of the previous reports suggest that the prognosis for the pafients with cerebrovascular complications was unfavorable. We recently experienced a case of meningococcal meningitis with fulminant meningococcemia associated with multifocal non-enhancing lesions on, initial brain MRI. These lesions were hyperintense on T2weighted image and were located in left basal ganglia, both medial thalami, periventricular white matter, left cerebellar hemisphere, and right midbrain and were considered to be resulted from small vessel involvement. Gram negative diplococci were detected by Gram staining of specimens from skin lesion. After antimicrobial therapy and glucocorticoid replacement the patient was recovered without any neurologic sequelae. After one month, follow-up MRI showed resolution of all the ischemic lesions except in midbrain. Additionally there was a small focal hemtoma formation in left basal ganglia. The small hematoma was considered to be resulted from rupture of microaneurysm and disappeared on follow up MRI performed after 3 months. This case suggests that the cerebrovascular complications in meningococcal mningitis might be treated successfully.
Basal Ganglia ; Brain ; Follow-Up Studies ; Hematoma* ; Humans ; Magnetic Resonance Imaging ; Meningitis* ; Meningitis, Bacterial ; Meningitis, Meningococcal ; Mesencephalon ; Prognosis ; Rupture ; Skin

Intradiploic epidermoid cysts, like epidermoid cysts in other cranial locations, are rare. Approximately 100 intradiploic epidermoids have been reported, involving all of the cranial bones in proportion to their relative sizes1). Over half erode through both tables of the cranium, creating variably sized areas of unprotected brain beneath the soft tumor. We report a case of an intradiploic epidermoid cyst of the right parietal bone that was found after minor head trauma.
Brain ; Craniocerebral Trauma ; Cytochrome P-450 CYP1A1 ; Epidermal Cyst* ; Parietal Bone ; Skull*

OBJECTIVE: During the last two decades, detection of unruptured intracranial aneurysms has increased because of the improving diagnostic methods, but the management of unruptured intracranial aneurysm is still controversial. We analyzed the angiographic characteristics to compare ruptured aneurysms with unruptured aneurysms. METHODS: The patients were retrospectively selected for this study based on the availability of angiograms and a clear diagnosis of an unruptured or ruptured aneurysm. One hundred sixty nine patients with 209 aneurysms were included in the study. Sixty-one patients harbored only unruptured lesions, 85 only ruptured lesions and 27 had both ruptured and unruptured lesions. RESULTS: The mean age of all the patients was 55.3 years, and it was 53.34 years for those with ruptured aneurysms. It was found that 42.0% of the ruptured aneurysms were on the anterior communicating artery, compared with 10.3% of the unruptured aneurysms. None of the ophthalmic artery aneurysms were ruptured. The mean dome size, depth and aspect ratio of the ruptured aneurysms, except for the neck size, were significantly larger than that of the unruptured aneurysms, but the mean neck size of the ruptured and unruptured aneurysms showed no significant difference. A daughter sac was present in 7.2% of the unruptured aneurysms and in 17.0% of the ruptured aneurysms. CONCLUSION: We suggest that the morphologic features and location of aneurysms should be considered when making decisions regarding whether to treat unruptured aneurysms.
Aneurysm* ; Aneurysm, Ruptured ; Arteries ; Diagnosis ; Humans ; Intracranial Aneurysm ; Neck ; Nuclear Family ; Ophthalmic Artery ; Retrospective Studies ; Rupture*