Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00367
Chan Hee Shin, S. Hwang, J. Kim, S. Yoon, B. Cho
Considering the advancement of bone graft substitution, the authors aimed to achieve clinical safety by simultaneously using one bioactive ceramic spacer (NovoMax) and a conventional polyetheretherketone (PEEK) cage at first use. We compared the results between different cages, even in the same disc space and to the control group using only conventional PEEK cages. Methods This retrospective analysis included data from patients who underwent posterior lumbar interbody fusion surgery between 2015 and 2017. The hybrid group (H group) included 19 patients with 21 lumbar disc levels, and the control group was defined as the PEEK group (P group), which included 16 patients with 18 disc levels. The degree of fusion was confirmed on computed tomography based on the fusion grade system and dynamic X-rays. We analyzed the fusion rate between the two groups using Cox proportional hazard model. Results There were 14 cases (72.2%) in Group P and 15 cases (71.4%) in Group H with confirmed complete union during the observation period (p=0.62). The relative hazard of incomplete fusion with osteolysis in both the P and H groups was increased by 5.41 times (p=0.004, confidence interval 1.704–17.204). In the H group, significant instrument-related complications, such as fragmentation, slippage, subsidence, and osteolysis were observed in the Novomax cage. Conclusions Using NovoMax could result in osteolysis, cage migration, fragmentation, or subsidence. The use of NovoMax is expected to be compatible for bone fusion surgery, but close attention should be paid to some problems that may accompany it.
{"title":"A Retrospective Comparative Study to Evaluate the Clinical Efficacy Using a Bioactive Glass Ceramic Spacer in Posterior Lumbar Interbody Fusion","authors":"Chan Hee Shin, S. Hwang, J. Kim, S. Yoon, B. Cho","doi":"10.32587/jnic.2021.00367","DOIUrl":"https://doi.org/10.32587/jnic.2021.00367","url":null,"abstract":"Considering the advancement of bone graft substitution, the authors aimed to achieve clinical safety by simultaneously using one bioactive ceramic spacer (NovoMax) and a conventional polyetheretherketone (PEEK) cage at first use. We compared the results between different cages, even in the same disc space and to the control group using only conventional PEEK cages. Methods This retrospective analysis included data from patients who underwent posterior lumbar interbody fusion surgery between 2015 and 2017. The hybrid group (H group) included 19 patients with 21 lumbar disc levels, and the control group was defined as the PEEK group (P group), which included 16 patients with 18 disc levels. The degree of fusion was confirmed on computed tomography based on the fusion grade system and dynamic X-rays. We analyzed the fusion rate between the two groups using Cox proportional hazard model. Results There were 14 cases (72.2%) in Group P and 15 cases (71.4%) in Group H with confirmed complete union during the observation period (p=0.62). The relative hazard of incomplete fusion with osteolysis in both the P and H groups was increased by 5.41 times (p=0.004, confidence interval 1.704–17.204). In the H group, significant instrument-related complications, such as fragmentation, slippage, subsidence, and osteolysis were observed in the Novomax cage. Conclusions Using NovoMax could result in osteolysis, cage migration, fragmentation, or subsidence. The use of NovoMax is expected to be compatible for bone fusion surgery, but close attention should be paid to some problems that may accompany it.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130423054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00416
Jae Hyun Park, T. Roh, J. Kim, Se-Hyuk Kim
Pituitary adenomas are among the most common intracranial tumors, accounting for 10–15% of all intracranial tumors. Nonfunctioning pituitary adenomas require surgical management when they are expected to show symptoms attributed to mass effect. The majority of pituitary adenomas originate from the anterior pituitary gland; that is, majority of pituitary adenomas grow within the sella turcica. Furthermore, pituitary adenomas may dilate the diaphragm and extend beyond the suprasellar area. On rare occasions, they may be present in extra-sellar sites not continuous with the pituitary gland, with or without an adenoma in the pituitary gland. First described by Erdheim in 1909 and predominantly described in case reports, such cases may be referred to as ectopic pituitary adenomas (EPAs). Though most pituitary adenomas are found in continuity with the gland, such ectopic forms of pituitary adenomas are usually Pituitary adenomas within the pituitary stalk, without pituitary gland involvement, are extremely rare. To date, only six cases of pituitary adenomas confined to the pituitary stalk have been reported in English publications; all of which were functional tumors suspected to originate from the pars tuberalis. Herein, we report a case of a non-functioning pituitary adenoma thought to originate from and confined within the pituitary stalk. The patients had normal hormone levels during the initial evaluation and underwent surgery using the endonasal trans-sphenoidal approach. Histopathological examination was performed to confirm the diagnosis. A careful review of the literature was also performed.
{"title":"Pituitary Adenoma Confined Within the Pituitary Stalk: A Case Report and Literature Review","authors":"Jae Hyun Park, T. Roh, J. Kim, Se-Hyuk Kim","doi":"10.32587/jnic.2021.00416","DOIUrl":"https://doi.org/10.32587/jnic.2021.00416","url":null,"abstract":"Pituitary adenomas are among the most common intracranial tumors, accounting for 10–15% of all intracranial tumors. Nonfunctioning pituitary adenomas require surgical management when they are expected to show symptoms attributed to mass effect. The majority of pituitary adenomas originate from the anterior pituitary gland; that is, majority of pituitary adenomas grow within the sella turcica. Furthermore, pituitary adenomas may dilate the diaphragm and extend beyond the suprasellar area. On rare occasions, they may be present in extra-sellar sites not continuous with the pituitary gland, with or without an adenoma in the pituitary gland. First described by Erdheim in 1909 and predominantly described in case reports, such cases may be referred to as ectopic pituitary adenomas (EPAs). Though most pituitary adenomas are found in continuity with the gland, such ectopic forms of pituitary adenomas are usually Pituitary adenomas within the pituitary stalk, without pituitary gland involvement, are extremely rare. To date, only six cases of pituitary adenomas confined to the pituitary stalk have been reported in English publications; all of which were functional tumors suspected to originate from the pars tuberalis. Herein, we report a case of a non-functioning pituitary adenoma thought to originate from and confined within the pituitary stalk. The patients had normal hormone levels during the initial evaluation and underwent surgery using the endonasal trans-sphenoidal approach. Histopathological examination was performed to confirm the diagnosis. A careful review of the literature was also performed.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"64 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133390430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00395
Sol-ji Jung, Ja Myoung Lee, T. An, In Sung Park
Pneumonia is a very serious medical complication in patients with hemorrhagic stroke such as spontaneous intracerebral hemorrhage and subarachnoid hemorrhage. In the case of hemorrhagic stroke patients, hospital-acquired pneumonia increases morbidity, mortality and medical costs in addition to the already poor prognosis of hemorrhagic stroke. The purpose of this study was to identify risk factors for hospital-acquired pneumonia in hemorrhagic stroke patients treated in the intensive care unit. Methods Our study was a retrospective review of 112 hemorrhagic stroke patients treated in an intensive care unit who were hospitalized in the neurosurgery department of Gyeonsang National University Hospital from August 2019 to July 2020. The data included basic demographic data, the underlying disease, lifestyle factors, neurological evaluation results, severity of the condition and other characteristics. The radiological data and medical records of the patients were retrospectively analyzed. Results A total of 97 patients were included in the study, and 10 of them met the diagnostic criteria for hospital-acquired pneumonia. Diabetes mellitus, a high simplified acute physiology score 3 (SAPS3), a low glasgow coma scale (GCS) score, mechanical ventilation, tracheostomy, dysphagia and nasogastric tube feeding were identified as risk factors for the development of hospital-acquired pneumonia (p<0.05). Six of 10 bacterial pathogens isolated from sputum were identified as multidrug-resistant pathogens. Hospital-acquired pneumonia led to further antibiotic treatment and general deterioration, which in turn increased the intensive care unit length of stay (p<0.001). Conclusion We found that mechanical ventilation, tracheostomy, dysphagia, tube feeding, a high SAPS3, and a low GCS score were risk factors for hospital-acquired pneumonia (HAP) in hemorrhagic stroke patients. Efforts will be needed to prevent pneumonia by understanding the risk factors for HAP identified in our study.
{"title":"Risk Factors for Hospital-Acquired Pneumonia in Hemorrhagic Stroke Patients Treated in the Intensive Care Unit","authors":"Sol-ji Jung, Ja Myoung Lee, T. An, In Sung Park","doi":"10.32587/jnic.2021.00395","DOIUrl":"https://doi.org/10.32587/jnic.2021.00395","url":null,"abstract":"Pneumonia is a very serious medical complication in patients with hemorrhagic stroke such as spontaneous intracerebral hemorrhage and subarachnoid hemorrhage. In the case of hemorrhagic stroke patients, hospital-acquired pneumonia increases morbidity, mortality and medical costs in addition to the already poor prognosis of hemorrhagic stroke. The purpose of this study was to identify risk factors for hospital-acquired pneumonia in hemorrhagic stroke patients treated in the intensive care unit. Methods Our study was a retrospective review of 112 hemorrhagic stroke patients treated in an intensive care unit who were hospitalized in the neurosurgery department of Gyeonsang National University Hospital from August 2019 to July 2020. The data included basic demographic data, the underlying disease, lifestyle factors, neurological evaluation results, severity of the condition and other characteristics. The radiological data and medical records of the patients were retrospectively analyzed. Results A total of 97 patients were included in the study, and 10 of them met the diagnostic criteria for hospital-acquired pneumonia. Diabetes mellitus, a high simplified acute physiology score 3 (SAPS3), a low glasgow coma scale (GCS) score, mechanical ventilation, tracheostomy, dysphagia and nasogastric tube feeding were identified as risk factors for the development of hospital-acquired pneumonia (p<0.05). Six of 10 bacterial pathogens isolated from sputum were identified as multidrug-resistant pathogens. Hospital-acquired pneumonia led to further antibiotic treatment and general deterioration, which in turn increased the intensive care unit length of stay (p<0.001). Conclusion We found that mechanical ventilation, tracheostomy, dysphagia, tube feeding, a high SAPS3, and a low GCS score were risk factors for hospital-acquired pneumonia (HAP) in hemorrhagic stroke patients. Efforts will be needed to prevent pneumonia by understanding the risk factors for HAP identified in our study.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132316036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00409
S. Rho, Hyo Joon Kim
Moyamoya disease is characterized by progressive peripheral stenosis of the internal carotid artery (ICA) and its proximal branches and can cause both ischemic and hemorrhagic strokes. However, its underlying pathophysiology has not yet been fully elucidated, and this poor knowledge reflects the uncertainty and heterogeneity of patient management. To date, no pharmacological treatment has been found to reverse the gradual loss in the ICA. Antiplatelet agents are commonly prescribed for ischemic moyamoya disease, although the coexistence of bleeding risk should be considered. Allergy-induced anaphylactic reactions can result in vasodilation, hypotension, bronchospasm, and angioedema, and are characterized by a rapid onset of respiratory and circulatory disturbances. This can lead to cerebrovascular collapse; however, such cases are rarely reported. In this case report, an allergic reaction was found A patient who ate peaches and developed urticaria complained of left sided weakness within minutes. Upon admission, the vital signs and breathing pattern became stable without evidence of anaphylaxis. After magnetic resonance imaging evaluation, the patient was diagnosed with acute ischemic stroke in the right pons, and cerebral angiography revealed moyamoya disease. Reports regarding an allergic reaction without anaphylaxis causing a stroke were extremely limited; however, no study has reported that allergy can cause a stroke in patients with moyamoya to date. Therefore, an ischemic stroke may occur in a patient with moyamoya only with an allergic reaction considered and reported as something that should be considered significant in the daily routine and medication for a patient with moyamoya.
{"title":"Allergic Reaction Induced Brainstem Stroke in a Patient With Moyamoya Disease: A Case Report","authors":"S. Rho, Hyo Joon Kim","doi":"10.32587/jnic.2021.00409","DOIUrl":"https://doi.org/10.32587/jnic.2021.00409","url":null,"abstract":"Moyamoya disease is characterized by progressive peripheral stenosis of the internal carotid artery (ICA) and its proximal branches and can cause both ischemic and hemorrhagic strokes. However, its underlying pathophysiology has not yet been fully elucidated, and this poor knowledge reflects the uncertainty and heterogeneity of patient management. To date, no pharmacological treatment has been found to reverse the gradual loss in the ICA. Antiplatelet agents are commonly prescribed for ischemic moyamoya disease, although the coexistence of bleeding risk should be considered. Allergy-induced anaphylactic reactions can result in vasodilation, hypotension, bronchospasm, and angioedema, and are characterized by a rapid onset of respiratory and circulatory disturbances. This can lead to cerebrovascular collapse; however, such cases are rarely reported. In this case report, an allergic reaction was found A patient who ate peaches and developed urticaria complained of left sided weakness within minutes. Upon admission, the vital signs and breathing pattern became stable without evidence of anaphylaxis. After magnetic resonance imaging evaluation, the patient was diagnosed with acute ischemic stroke in the right pons, and cerebral angiography revealed moyamoya disease. Reports regarding an allergic reaction without anaphylaxis causing a stroke were extremely limited; however, no study has reported that allergy can cause a stroke in patients with moyamoya to date. Therefore, an ischemic stroke may occur in a patient with moyamoya only with an allergic reaction considered and reported as something that should be considered significant in the daily routine and medication for a patient with moyamoya.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126415986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00388
J. Lee, Y. Shim, Sung-Tae Kim, W. Lee, K. Lee, S. Paeng, S. Pyo
Cranioplasty is required to restore the appearance of the skull, Objective To analyze the outcomes of using a customized artificial skull bone flap made with a three-dimensional (3D) printing technique for cranioplasty and compare them with those of the autobone technique. Method Between December 2018 and February 2020, 24 cranioplasties were performed for 24 hemispheres using a customized artificial bone flap made by 3D printing. Simultaneously, 19 cranioplasties for 19 hemispheres were performed using an autobone. Three patients underwent cranioplasty using both a customized artificial bone flap and autobone for each hemisphere. Patient’s demographics, reason for craniectomy, interval between craniectomy and cranioplasty, surface area of the skull defect and bone flap, bone flap coverage of the defect, cranioplasty-related factors, and clinical outcome were assessed. Results Forty patients who underwent cranioplasty (bone flap, 21; autobone flap, 16; and artificial bone/ autobone flaps, 3) were enrolled. The artificial bone flap covered more skull defects than the autobone flap (98.6% vs. 90.9%, p=0.000). There were two and six operation-related complications in the artificial bone flap and autobone flap groups, respectively (P=0.061). The subtemporal area was completely covered in the artificial bone flap group. Two patients had an infection of the autobone flap and had it replaced by a 3D printing flap. No patient showed a reduction in the modified Rankin Scale score after surgery, and the clinical course was confirmed to have improved. Conclusions Cranioplasty using customized artificial bone flap made by 3D printing technique was effective for covering the skull defect and tends to have a low complication rate compared to the autobone.
{"title":"Clinical Outcomes of Cranioplasty Using a Customized Artificial Bone Flap Made by a 3D Printing Technique","authors":"J. Lee, Y. Shim, Sung-Tae Kim, W. Lee, K. Lee, S. Paeng, S. Pyo","doi":"10.32587/jnic.2021.00388","DOIUrl":"https://doi.org/10.32587/jnic.2021.00388","url":null,"abstract":"Cranioplasty is required to restore the appearance of the skull, Objective To analyze the outcomes of using a customized artificial skull bone flap made with a three-dimensional (3D) printing technique for cranioplasty and compare them with those of the autobone technique. Method Between December 2018 and February 2020, 24 cranioplasties were performed for 24 hemispheres using a customized artificial bone flap made by 3D printing. Simultaneously, 19 cranioplasties for 19 hemispheres were performed using an autobone. Three patients underwent cranioplasty using both a customized artificial bone flap and autobone for each hemisphere. Patient’s demographics, reason for craniectomy, interval between craniectomy and cranioplasty, surface area of the skull defect and bone flap, bone flap coverage of the defect, cranioplasty-related factors, and clinical outcome were assessed. Results Forty patients who underwent cranioplasty (bone flap, 21; autobone flap, 16; and artificial bone/ autobone flaps, 3) were enrolled. The artificial bone flap covered more skull defects than the autobone flap (98.6% vs. 90.9%, p=0.000). There were two and six operation-related complications in the artificial bone flap and autobone flap groups, respectively (P=0.061). The subtemporal area was completely covered in the artificial bone flap group. Two patients had an infection of the autobone flap and had it replaced by a 3D printing flap. No patient showed a reduction in the modified Rankin Scale score after surgery, and the clinical course was confirmed to have improved. Conclusions Cranioplasty using customized artificial bone flap made by 3D printing technique was effective for covering the skull defect and tends to have a low complication rate compared to the autobone.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"139 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125426768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.32587/jnic.2021.00381
A. A. Chacón-Aponte, É. A. Durán-Vargas, I. Lozada‐Martínez, M. Bolaño-Romero, L. Moscote-Salazar, Tariq Janjua, O. J. Díaz-Castillo
imately 350 per 100,000 person-years and is a leading cause of death and disability in trauma patients. The presentation of TBI varies from mild alterations of consciousness to a comatose state and death. However, despite the existence of many classification systems, the simplest includes mild, moderate, and severe TBI, in which the nature of the injury and the impact on the patient's clinical condition is considered. In the last decade, a clear trend has been demonstrated towards deterioration in patients with severe TBI, in which the whole brain is affected precisely because of the characteristics and degree of injury. This deterioration may be associated with a loss of autoregulation due to the lack of reactivity of cerebral vascular pressure, resulting in hyperemia, interstitial edema and subsequent intracranial hypertension (ICH). Normal intracranial pressure in adults is less than 15 mm Hg, values that remain above 20 mm Hg are considered pathological and are an indication for intensified treatment in patients with TBI. It is important to consider that ICH can result from primary injury (hematoma expansion) or secondary damage (water accumulation, impaired autoregulation, ischemia, and contusion expansion). This is associated with high mortality rates, so multiple early, stepwise, and rescue management strategies have been proposed for its control, which is aimed at preventing secondary injury by avoiding hypotension, hypoxia and maintaining adequate cerebral perfusion pressure (CPP). Targeted treatment is essential and may include cerebrospinal fluid (CSF) drainage, use of hyperosmolar therapies, induction of hypothermia, hyperventilation, administration of barbiturates, or performance of decompressive surgery. Therapeutic hypothermia (TH) is one of the few neuroprotectants that has moved from preclinical work to clinical use. For example, it was previously used to prevent brain damage during cardiac surgical procedures, but more recently it has also been used to improve both neurological and physical outHypothermia for the Management of Intracranial Hypertension in Severe Brain Trauma: The Paradigm is Broken?
{"title":"Hypothermia for the Management of Intracranial Hypertension in Severe Brain Trauma: The Paradigm is Broken?","authors":"A. A. Chacón-Aponte, É. A. Durán-Vargas, I. Lozada‐Martínez, M. Bolaño-Romero, L. Moscote-Salazar, Tariq Janjua, O. J. Díaz-Castillo","doi":"10.32587/jnic.2021.00381","DOIUrl":"https://doi.org/10.32587/jnic.2021.00381","url":null,"abstract":"imately 350 per 100,000 person-years and is a leading cause of death and disability in trauma patients. The presentation of TBI varies from mild alterations of consciousness to a comatose state and death. However, despite the existence of many classification systems, the simplest includes mild, moderate, and severe TBI, in which the nature of the injury and the impact on the patient's clinical condition is considered. In the last decade, a clear trend has been demonstrated towards deterioration in patients with severe TBI, in which the whole brain is affected precisely because of the characteristics and degree of injury. This deterioration may be associated with a loss of autoregulation due to the lack of reactivity of cerebral vascular pressure, resulting in hyperemia, interstitial edema and subsequent intracranial hypertension (ICH). Normal intracranial pressure in adults is less than 15 mm Hg, values that remain above 20 mm Hg are considered pathological and are an indication for intensified treatment in patients with TBI. It is important to consider that ICH can result from primary injury (hematoma expansion) or secondary damage (water accumulation, impaired autoregulation, ischemia, and contusion expansion). This is associated with high mortality rates, so multiple early, stepwise, and rescue management strategies have been proposed for its control, which is aimed at preventing secondary injury by avoiding hypotension, hypoxia and maintaining adequate cerebral perfusion pressure (CPP). Targeted treatment is essential and may include cerebrospinal fluid (CSF) drainage, use of hyperosmolar therapies, induction of hypothermia, hyperventilation, administration of barbiturates, or performance of decompressive surgery. Therapeutic hypothermia (TH) is one of the few neuroprotectants that has moved from preclinical work to clinical use. For example, it was previously used to prevent brain damage during cardiac surgical procedures, but more recently it has also been used to improve both neurological and physical outHypothermia for the Management of Intracranial Hypertension in Severe Brain Trauma: The Paradigm is Broken?","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125379364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-23DOI: 10.32587/jnic.2019.00185
Kwang-Ui Hong, Jong-myung Jung, S. Hyun, Ki-Jeong Kim, T. Jahng
A 10-year-old boy had a neuromuscular cervicothoracic kyphosis and kyphotic deformity got worse as he grew. He underwent posterior spinal fusion from T6 to pelvis two years ago. However, kyphosis progressed gradually, and difficulty occurred in breathing with a ventilator. We perform deformity correction with vertebral column resection at T5 and posterior fixation from T2 to T9 and posterior onlay fusion. Surgical correction is offered to stop the kyphosis progression, and finally to maintain the airway. After surgery, the patient transferred to an intensive care unit for respiratory care. The patient’s breathing was much better than before surgery, and the patient was transferred to the general ward. We report the importance of postoperative care in spinal deformity patient with respiratory distress.
{"title":"Critical Care in Patient with Neuromuscular Cervicothoracic Kyphosis","authors":"Kwang-Ui Hong, Jong-myung Jung, S. Hyun, Ki-Jeong Kim, T. Jahng","doi":"10.32587/jnic.2019.00185","DOIUrl":"https://doi.org/10.32587/jnic.2019.00185","url":null,"abstract":"A 10-year-old boy had a neuromuscular cervicothoracic kyphosis and kyphotic deformity got worse as he grew. He underwent posterior spinal fusion from T6 to pelvis two years ago. However, kyphosis progressed gradually, and difficulty occurred in breathing with a ventilator. We perform deformity correction with vertebral column resection at T5 and posterior fixation from T2 to T9 and posterior onlay fusion. Surgical correction is offered to stop the kyphosis progression, and finally to maintain the airway. After surgery, the patient transferred to an intensive care unit for respiratory care. The patient’s breathing was much better than before surgery, and the patient was transferred to the general ward. We report the importance of postoperative care in spinal deformity patient with respiratory distress.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130965760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-23DOI: 10.32587/jnic.2019.00178
Jeong Hwa Kim, C. Jang, Jae Whan Lee, K. Park, Joonho Chung
{"title":"Preliminary Experience of Lvis Blue in the Internal Carotid Artery for The Treatment Of Wide-Necked Intracranial Aneurysms","authors":"Jeong Hwa Kim, C. Jang, Jae Whan Lee, K. Park, Joonho Chung","doi":"10.32587/jnic.2019.00178","DOIUrl":"https://doi.org/10.32587/jnic.2019.00178","url":null,"abstract":"","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"199 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132129457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-19DOI: 10.32587/jnic.2019.00206
Young-Jin Kim, J. Yeon, Jong-Soo Kim, Seung-Chyul Hong
We aimed to determine the “significant crescent signs” associated with delayed thromboembolic events (DTE) after changes in antiplatelet medication and to evaluate their incidence and natural course. Methods Between April 2009 and April 2011, 105 consecutive patients underwent stent-assisted coil embolization for unruptured intracranial aneurysms (n=107) in a single tertiary hospital. Sixty-three cases fulfilled the inclusion criteria and were included in this study. Crescent sign was evaluated through follow-up magnetic resonance angiography (MRA) immediately (<48 hours), 6 to 12 months, 1 to 2 years, and 2 to 4 years and correlated with the occurrence of DTE. Results Crescent signs were identified in 26 (41.3%) of 63 cases on immediate follow-up MRA. During the mean radiological follow-up of 53 months, the crescent signs (larger than 5 mm in length) persisted for more than 1 year in 11 (42.3%) of 26 cases. The crescent signs on follow-up MRA showed decreased size in 10 of 26 cases and disappeared in 5 cases. DTE occurred in 6 (9.5%) of 63 cases. In these 6 cases, all DTE occurred when the antiplatelet regimen was changed or stopped. Five of these six cases exhibited a crescent sign measuring over 5 mm in length, at the time of stroke. Conclusions Crescent signs may be associated with DTE. When crescent signs are larger than 5 mm in length and continuously identified on follow-up MRA, continued dual antiplatelet treatment is required.
{"title":"Crescent Sign Following Enterprise-Stent assisted Coil Embolization of Distal Internal Carotid Artery Aneurysms","authors":"Young-Jin Kim, J. Yeon, Jong-Soo Kim, Seung-Chyul Hong","doi":"10.32587/jnic.2019.00206","DOIUrl":"https://doi.org/10.32587/jnic.2019.00206","url":null,"abstract":"We aimed to determine the “significant crescent signs” associated with delayed thromboembolic events (DTE) after changes in antiplatelet medication and to evaluate their incidence and natural course. Methods Between April 2009 and April 2011, 105 consecutive patients underwent stent-assisted coil embolization for unruptured intracranial aneurysms (n=107) in a single tertiary hospital. Sixty-three cases fulfilled the inclusion criteria and were included in this study. Crescent sign was evaluated through follow-up magnetic resonance angiography (MRA) immediately (<48 hours), 6 to 12 months, 1 to 2 years, and 2 to 4 years and correlated with the occurrence of DTE. Results Crescent signs were identified in 26 (41.3%) of 63 cases on immediate follow-up MRA. During the mean radiological follow-up of 53 months, the crescent signs (larger than 5 mm in length) persisted for more than 1 year in 11 (42.3%) of 26 cases. The crescent signs on follow-up MRA showed decreased size in 10 of 26 cases and disappeared in 5 cases. DTE occurred in 6 (9.5%) of 63 cases. In these 6 cases, all DTE occurred when the antiplatelet regimen was changed or stopped. Five of these six cases exhibited a crescent sign measuring over 5 mm in length, at the time of stroke. Conclusions Crescent signs may be associated with DTE. When crescent signs are larger than 5 mm in length and continuously identified on follow-up MRA, continued dual antiplatelet treatment is required.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"159 8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128943005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-19DOI: 10.32587/jnic.2019.00192
Kwang-Ui Hong, Jong-myung Jung, S. Hyun, Ki-Jeong Kim, T. Jahng
Objective Conventional cervical MRI is the gold standard exam for diagnosis of cervical myelopathy, but cannot detect dynamic cord compression. This study aims to evaluate radiologic factors suggesting dynamic spinal cord compression. Methods We retrospectively reviewed the patients who examined dynamic MRI in addition to conventional MRI. A total of 50 patients were included in this study, comprised of 36 in the group P (aggravation of spinal cord compression on dynamic MRI) and 14 in the group N (non-aggravation of spinal cord compression on dynamic MRI). Radiologic factors were compared. Results The following factors were analyzed: age, cervical canal diameter (CCD), spinal cord diameter (SCD), subarachnoid space (SAS), cervical lordosis (CL), cervical ROM, anterior length of cervical cord (ALCC), posterior length of cervical cord (PLCC), length of anterior column (LAC), and length of posterior column (LPC), Significant differences were found in age, CCD, SAS, CL, LPC (p<0.05). In ROC curves, age (AUC 0.813, cut-off value 54), CCD (AUC 0.858, cut-off value 10.32), and SAS (AUC 0.884, cut-off value 3.25) were a significant factor in predicting deterioration of spinal cord compression during the dynamic posture. Conclusion Dynamic MRI is more useful for the diagnosis of dynamic spinal cord compression in the following conditions: age is 54 years or older, CCD average is less than 10.32 mm, SAS average is less than 3.25 mm, CL is -1.98 ̊ or LPC is less than 105.45 mm.
{"title":"Radiologic Factors for Predicting Dynamic Spinal Cord Compression in Conventional Cervical MRI","authors":"Kwang-Ui Hong, Jong-myung Jung, S. Hyun, Ki-Jeong Kim, T. Jahng","doi":"10.32587/jnic.2019.00192","DOIUrl":"https://doi.org/10.32587/jnic.2019.00192","url":null,"abstract":"Objective Conventional cervical MRI is the gold standard exam for diagnosis of cervical myelopathy, but cannot detect dynamic cord compression. This study aims to evaluate radiologic factors suggesting dynamic spinal cord compression. Methods We retrospectively reviewed the patients who examined dynamic MRI in addition to conventional MRI. A total of 50 patients were included in this study, comprised of 36 in the group P (aggravation of spinal cord compression on dynamic MRI) and 14 in the group N (non-aggravation of spinal cord compression on dynamic MRI). Radiologic factors were compared. Results The following factors were analyzed: age, cervical canal diameter (CCD), spinal cord diameter (SCD), subarachnoid space (SAS), cervical lordosis (CL), cervical ROM, anterior length of cervical cord (ALCC), posterior length of cervical cord (PLCC), length of anterior column (LAC), and length of posterior column (LPC), Significant differences were found in age, CCD, SAS, CL, LPC (p<0.05). In ROC curves, age (AUC 0.813, cut-off value 54), CCD (AUC 0.858, cut-off value 10.32), and SAS (AUC 0.884, cut-off value 3.25) were a significant factor in predicting deterioration of spinal cord compression during the dynamic posture. Conclusion Dynamic MRI is more useful for the diagnosis of dynamic spinal cord compression in the following conditions: age is 54 years or older, CCD average is less than 10.32 mm, SAS average is less than 3.25 mm, CL is -1.98 ̊ or LPC is less than 105.45 mm.","PeriodicalId":356321,"journal":{"name":"Journal of Neurointensive Care","volume":"1148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117089349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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