• Journal of Trauma and Injury
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• v.29 no.4
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• pp.161-166
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• 2016

Purpose: Bleeding is the primary cause of death after severe pelvic fracture. Transcatheter arterial embolization (TAE) is the mainstay of treatment for arterial bleeding. This study aimed to determine the frequency of bleeding by angiography of blush-positive pelvic fractures on computed tomography (CT) images. The bleeding arteries that were involved were investigated by pelvic angiography. Methods: This retrospective cohort study evaluated 83 pelvic fracture patients who were treated in the intensive care unit of the author's trauma center between January 01, 2013 and April 30, 2015. Results: Overall mortality was 9 of 83 patients (10.8%). Blush was observed in 37 patients; blush-positive patients had significantly higher mortality (24.3%) than blush-negative patients (0%). Twenty-four of the 83 patients (28.9%) underwent pelvic angiography. Bleeding was showed in 22 of 24 patients in pelvic angiography. TAE was successfully performed in 21 (95.5%) of the bleeding 22 patients. Angiography was performed in 23 of 37 blush-positive patients, and arterial bleeding was identified in 21 (91.3%). A total 33 bleeding arteries were identified in 22 angiography-positive patients. The most frequent origin of bleeding was internal iliac artery (69.7%) followed by the external iliac artery (18.2%) and lumbar arteries (12.1%). Conclusion: The vascular blush observed in CT scans indicates sites of ongoing bleeding in pelvic angiography. TAE is an excellent therapeutic option for arterial bleeding and has a high success rate with few complications.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.262-270
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• 2015

Objective : Long-term oral anticoagulation or antiplatelet therapy has been used with increasing frequency in the elderly. These patients are at increased risk of morbidity and mortality from expansion of intracranial hemorrhage. We conducted a single-center retrospective case control study to evaluate risk factors associated with outcomes and to identify the differences in outcome in traumatic brain injury between preinjury anticoagulation use and without anticoagulation. Methods : A retrospective study of patients who underwent craniotomy or craniectomy for acute traumatic cerebral hemorrhage, between January 2005 and December 2014 was performed. Results : A consecutive series of 50 patients were evaluated. The factors significantly differed between the two groups were initial Prothrombin Time-International Normalized Ratio, initial platelet count, initial Glasgow Coma Scale score, and postoperative intracranial bleeding. Mean Glasgow Outcome Scale (GOS) score were similar between the two groups. In the patient with low-energy trauma only, no significant differences in GOS score, postoperative bleeding and many other factors were observed. The contributing factors to postoperative bleeding was preinjury anticoagulation and its adjusted odds ratio was 12 [adjusted odds ratio (OR), 12.242; p=0.0070]. The contributing factors to low GOS scores, which mean unfavorable neurological outcomes, were age (adjusted OR, 1.073; p=0.039) and Rotterdam scale score for CT scans (adjusted OR, 3.123; p=0.0020). Conclusion : Preinjury anticoagulation therapy contributed significantly to the occurrence of postoperative bleeding. However, preinjury anticoagulation therapy in the patients with low-energy trauma did not contribute to the poor clinical outcomes or total hospital stay. Careful attention should be given to older patients and severity of hemorrhage on initial brain CT.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.461-466
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• 2013

Objective : Although curcumin has a protective effect on bone remodeling, appropriate therapeutic concentrations of curcumin are not well known as therapeutic drugs for osteoporosis. The purpose of this study was to compare the bone sparing effect of treatment of low-dose and high-dose curcumin after ovariectomy in rats. Methods : Forty female Sprague-Dawley rats underwent either a sham operation (the sham group) or bilateral ovariectomy (OVX). The ovariectomized animals were randomly distributed among three groups; untreated OVX group, low-dose (10 mg/kg) curcumin administered group, and high-dose (50 mg/kg) curcumin group. At 4 and 8 weeks after surgery, serum biochemical markers of bone turnover were analyzed. Bone histomorphometric parameters of the 4th lumbar vertebrae were determined by micro-computed tomography (CT). In addition, mechanical strength was determined by a three-point bending test. Results : High-dose curcumin group showed significantly lower osteocalcin, alkaline phosphatase, and the telopeptide fragment of type I collagen C-terminus concentration at 4 and 8 weeks compared with the untreated OVX group as well as low-dose curcumin group. In the analyses of micro-CT scans of 4th lumbar vertebrae, the high-dose curcumin treated group showed a significant increase in bone mineral densities (p=0.028) and cortical bone mineral densities (p=0.036) compared with the low-dose curcumin treated group. Only high-dose curcumin treated group had a significant increase of mechanical strength compared with the untreated OVX group (p=0.015). Conclusion : The present study results demonstrat that a high-dose curcumin has therapeutic advantages over a low-dose curcumin of an antiresorptive effect on bone remodeling and improving bone mechanical strength.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.494-498
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• 2015

Objective : To describe a novel spinous process-splitting hemilaminoplasty technique for the surgical treatment of intradural and posterior epidural lesions that promotes physiological restoration. Methods : The spinous process was split, the area of the facet lamina junction was drilled, and en bloc hemilaminectomy was then performed. After removing intradural and posterior epidural lesions, we fitted the previously en bloc-removed bone to the pre-surgery same shape, and held it in place with non-absorbable sutures. Surgery was performed on 16 laminas from a total of nine patients between 2011 and 2014. Bony union of the reconstructed lamina was assessed using computed tomography (CT) at 6 months after surgery. Results : Spinous process-slitting hemilaminoplasty was performed for intradural extramedullary tumors in eight patients and for ossification of the ligament flavum in one patient. Because we were able to visualize the margin of the ipsilateral and contralateral dura, we were able to secure space for removal of the lesion and closure of the dura. None of the cases showed spinal deformity or other complications. Bone fusion and maintenance of the spinal canal were found to be perfect on CT scans. Conclusion : The spinous process-splitting hemilaminoplasty technique presented here was successful in creating sufficient space to remove intradural and posterior epidural lesions and to close the dura. Furthermore, we were able to maintain the physiological barrier and integrity after surgery because the posterior musculature and bone structures were restored.

• Journal of Korean Neurosurgical Society
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• v.39 no.5
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• pp.335-339
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• 2006

Objective : The authors present eight cases of immediate post-operative epidural hematomas[EDHs] adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. Methods : Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. Results : In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography[CT] scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. Conclusion : Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.

• Journal of Korean Neurosurgical Society
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• v.58 no.6
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• pp.534-538
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• 2015

Objective : To correct apical vertebral rotation for adolescent idiopathic scoliosis (AIS), direct vertebral derotation (DVD) or simple rod rotation (SRR) might be considered. The aim of the present study is to introduce the surgical experiences of AIS by a Korean neurosurgeon and to evaluate the effectiveness of SRR for apical vertebral rotation. Methods : A total of 9 patients (1 male and 8 females) underwent scoliosis surgery by a neurosurgeon of our hospital. The Lenke classifications of the patients were 1 of 1B, 2 of 1C, 1 of 2A, 1 of 2C, 3 of 5C and 1 of 6C. Surgery was done by manner of simple rod rotation on the concave side and in situ coronal bending. Coronal Cobb's angles, vertebral rotation angles and SRS-22 were measured on a plain standing X-ray and CT before and after surgery. Results : The mean follow up period was 25.7 months (range : 5-52). The mean number of screw positioning level was nine (6-12). The mean age was 16.4 years (range : 13-25) at surgery. The mean Risser grade was $3.7{\pm}0.9$. The apical vertebral rotation measured from the CT scans was $25.8{\pm}8.5^{\circ}$ vs. $9.3{\pm}6.7^{\circ}$ (p<0.001) and the Coronal Cobb's angle was $53.7{\pm}10.4^{\circ}$ vs. $15.4{\pm}6.5^{\circ}$ (p<0.001) preoperatively and postoperative, respectively. The SRS-22 improved from 71.9 preoperatively to 90.3 postoperatively. There were no complications related with the operations. Conclusion : SRR with pedicle screw instrumentation could be corrected successfully by axial rotation without complications. SRR might serve as a good option to correct AIS deformed curves of AIS.

• Journal of Korean Neurosurgical Society
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• v.50 no.3
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• pp.231-234
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• 2011

Objective : Infection and bone resorption are major complications of cranioplasty and have been well recognized. However, there are few clinical series describing the epidural fluid collection (EFC) as complication of cranioplasty. This study was planned to identify the predictive factors and fate of EFC after cranioplasty. Methods : We reviewed retrospectively the demographic, clinical, and radiographic data in 59 patients who underwent a first cranioplsty following decompressive craniectomy during a period of 6 years, from January 2004 to December 2009. We compared demographic, clinical, and radiographic factors between EFC group and no EFC group. The predictive factors associated with the development of EFC were assessed by logistic regression analysis. Results : Overall, 22 of 59 patients (37.3%) suffered from EFC following cranioplasty. EFC had disappeared (n=6, 31.8%) or regressed (n=6, 31.8%) over time on follow up brain computed tomographic (CT) scans. However, 5 patients (22.7%) required reoperation due to symptomatic and persistent EFC. Predictive factors for EFC were male [odds ratio (OR), 5.48; 95% CI, 1.26-23.79], air bubbles in the epidural space (OR, 12.52; 95% CI, 2.26-69.28), and dural calcification on postoperative brain CT scan (OR, 4.21; 95% CI, 1.12-15.84). Conclusion : The most of EFCs could be treated by conservative therapy. Air bubble in the epidural space and dural calcification are proposed to be the predictive factors in the formation of EFC after cranioplasty.

• The korean journal of orthodontics
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• v.42 no.2
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• pp.56-63
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• 2012

Objective: To identify the right and left difference of the facial soft tissue landmarks three-dimensionally from the subjects of normal occlusion individuals. Materials and Methods: Cone-beam computed tomography (CT) scans were obtained in 48 normal occlusion adults (24 men, 24 women), and reconstructed into 3-dimensional (3D) models by using a 3D image soft ware. 3D position of 27 soft tissue landmarks, 9 midline and 9 pairs of bilateral landmarks, were identified in 3D coordination system, and their right and left differences were calculated and analyzed. Results: The right and left difference values derived from the study ranged from 0.6 to 4.6 mm indicating a high variability according to the landmarks. In general, the values showed a tendency to increase according to the lower and lateral positioning of the landmarks in the face. Overall differences were determined not only by transverse differences but also by sagittal and vertical differences, indicating that 3D evaluation would be essential in the facial soft tissue analysis. Conclusions: Means and standard deviations of the right and left difference of facial soft tissue landmarks derived from this study can be used as the diagnostic standard values for the evaluation of facial asymmetry.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.262-266
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• 2015

Plasmacytomas are extramedullary accumulations of plasma cells originating from soft tissue. Mediastinal plasmacytoma is a rare presentation. A 67-year-old man recovered after antibiotic treatment for community-acquired pneumonia. However, on convalescent chest radiography after 3 months, mass like lesion at the right lower lung field was newly detected. Follow-up chest computed tomography (CT) revealed an increase in the extent of the right posterior mediastinal mass that we had considered to be pneumonic consolidations on previous CT scans. Through percutaneous needle biopsy, we diagnosed IgG kappa type extramedullary plasmacytoma of the posterior mediastinum.

• Archives of Craniofacial Surgery
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• v.18 no.1
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• pp.30-36
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• 2017

Background: Nasal fractures have a tendency of resulting in structural or functional complications, and the results can vary according to the type of nasal bone fracture. The aim of this study was to evaluate the objective postoperative results according to the type of nasal bone fractures. Methods: We reviewed 313 patients who had a closed reduction of nasal bone fracture. The classification of nasal bone fracture by Stranc and Robertson was used to characterize the fracture type: frontal impact group type I (FI), frontal impact group type II (FII), lateral impact group type I (LI), lateral impact group type II (LII), and comminuted fracture group (C). For each patient, we tried to use the same axial image section of computed tomographic (CT) scans before and immediately after operation. Postoperative outcomes were classified into 4 grades: excellent (E), good (G), fair (F), and poor (P). We also analyzed postoperative complications by fracture type. Results: Regarding the postoperative CT images, 189 subjects showed E results, 99 subjects showed G, 18 subjects showed F, and 7 subjects showed P reduction. The rate of operation results graded as E by each fracture type was 66.67% in FI, 52.0% in FII, 64.21% in LI, 62.79% in LII, and 21.74% in C. Complications of FI (7.14%), LII (13.95%), and C (13.04%) groups occurred more than in the FII (4.00%) and LI (4.21%) groups. Conclusion: It seems that the operation result by fracture type was better in the FI, LI, and LII type than the FII and C type; after one month, however, LII type showed more complications than other types. The septal fracture can be thought to affect early reduction results in nasal bone fractures.