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Invasive Klebsiella pneumoniae syndrome is defined as community-acquired liver abscess and metastatic infections in the lung, soft tissue, and central nervous system (CNS) caused by hypervirulent Klebsiella pneumoniae. Metastatic CNS infection in invasive Klebsiella pneumoniae syndrome shows rapid clinical deterioration and a high mortality rate. We present a case of ventriculitis caused by invasive Klebsiella pneumoniae syndrome successfully treated with a timely diagnosis, immediate surgical intervention, and administration of antibiotics.

Purpose The minimally invasive percutaneous endoscopic discectomy (PED) was developed in the 20th century. Recently, the interest in minimally invasive surgery and the number of PEDs has increased. The incidence of postoperative retroperitoneal hematoma following percutaneous endoscopic discectomy was reported at 0.1 ~ 1%. We report a case of spontaneous healing of retroperitoneal hematoma following injury to a lateral branch of the lumbar spinal artery after percutaneous endoscopic discectomy. Methods A 58-year-old male underwent percutaneous endoscopic resection of the L4-5 disc via a transforaminal approach. After 2 h, he complained of rigid abdominal pain with hypotension. Abdominal computerized tomography (CT) revealed large hematoma (1300 mL) on the right retroperitoneum. A small pseudoaneurysm was detected at a lateral muscular branch of the 4th lumbar spinal artery on angiography without contrast leakage, with no additional treatment of this lesion. Results We performed conservative treatment at an intensive care unit. Two weeks later (POD 14 days), the patient was discharged with the hematoma almost well absorbed and small despite with bruise dorsally, without other complications. The abdominal CT obtained from the outpatient department (OPD) showed absorption of retroperitoneal hematoma without any signs of pseudo-aneurysm. Conclusions We report a case of retroperitoneal hematoma following injury to a lateral branch of spinal artery during percutaneous transforaminal endoscopic lumbar discectomy (PELD). Bleeding occurs external to the cannulation site, and is therefore, difficult to detect it, warranting extra precaution during surgery.

Arteriovenous fistula of the scalp is relatively rare disease. We report a traumatic arteriovenous fistula of the scalp treated with complete surgical excision and review the literature with regard to etiology, pathogenesis, and management of these unusual lesions.

The present study is designed to explore an anti-tumor activity on crude extracts of Oplopanax elatus. Water extractions of Oplopanax elatus were performed at 100℃(OeE-100). OeE-100 doses up to 62.5 ㎍/㎖ had no cytotoxicity on the tumor cell lines in vitro. In experimental lung metastasis of colon26-M3.1 carcinoma or B16-BL6 melanoma, the prophylactic intravenous (4~100 ㎍/mouse) or oral (2 ㎎/mouse) administration of OeE-100 significantly inhibited tumor metastasis as compared with tumor controls. Peritoneal macrophages stimulated with OeE-100 produced various cytokines such as TNF-α, IL-6 and IL-12. In an analysis of NK-cell activities, i.v. administration of OeE-100 (10~100 ㎍/mouse) significantly augmented the cytotoxicity to YAC-1 tumor cells. Vaccination of mice with boiling-treated tumor cells (BT-vaccine) in combination with OeE-100 (100 ㎍/mouse) showed higher inhibitions in tumor metastasis when compared with the mice of BT-vaccine treatment. In addition, the splenocytes from OeE-100 admixed BT-vaccine immunized mice secreted a higher concentration of Th1 type cytokine such as IFN-γ. These results suggested that the OeE-100 stimulated immune system and was a good candidate adjuvant of anti-tumor immune responses. Key words: Macrolepiota procera, macrophage, NK-cell, metastasis, synergistic activity

OBJECTIVE To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. METHODS We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. RESULTS A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR ≥0.2 and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p

Background Aneurysms arising from the proximal anterior cerebral artery (ACA) are quite rare. Here, we report upon such a case of aneurysms located at the proximal ACA and anterior communicating artery associated with middle cerebral artery (MCA) aplasia. Case Description A 64-year-old woman complained of severe headache. Brain computed tomography scans demonstrated acute subarachnoid hemorrhage. Angiograms showed 2 aneurysms located at the anterior communicating artery and proximal ACA, but did not show an MCA shadow on the lesion side. Instead, multiple collateral vessels ran toward the sylvian fissure and supplied the MCA territory, together with hypertrophied perforating branches. The operative findings confirmed that the cordlike rudimentary MCA had no internal blood flow. The 2 aneurysms were secured by neck clipping. Conclusion The combined effects of these anomalies on the hemodynamic equilibrium of the arteries and the genesis of the aneurysms are noteworthy.

Electrodes were fabricated by activated carbon powders such as BP-20 and YP-17, conducting agents such as polypyrrole (Ppy), Super P, vapor grown carbon fiber (VGCF) and acetylene black (AB), and binders such as poly-(vinylidenefluoride-hexafluoropropylene) [P(VdF- co -HFP)] and polyvinyl-pyrrolidone (PVP). In the electrode fabrication of unit cells, it was noted that electrochemical characteristics, mechanical strength and flexibility were greatly increased with 90 wt.% of BP-20, 5 wt.% of Ppy and 5 wt.% of P(VdF- co -HFP)/PVP mixed binder. The electrochemical characteristics of unit cell with Ppy were as follows: 37.6 F/g of specific capacitance, 0.98 Ω of AC-ESR, 2.92 Wh/kg and 6.05 Wh/L of energy density, and 754 W/kg and 1562 W/L of power density. According to the impedance measurement of the electrode with conducting agent, we found that it was possible to charge rapidly by the fast steady-state current convergence due to low equivalent series resistance (AC-ESR), fast charge-transfer rate at interface between electrode and electrolyte and low RC time constant. It was also concluded that the specific capacitance originated from the complex phenomena of the faradaic capacitance by oxidation–reduction of conducting agent and the non-faradaic capacitance by adsorption–desorption of activated carbon, as compared with the plateau portion of cyclic voltammogram (CV) curve and scan rate. The self-discharge of unit cell showed that diffusion process was controlled by the ion concentration difference of initial electrolyte due to the characteristics of EDLC charged by ion adsorption in the beginning, but current leakage through the double-layer at the electrode/electrolyte interface had a minor effect and voltages of curves remained constant except Ppy. We found that the high capacitance EDLC could be applied to industrial usage showing the constant DC-ESR by IR drop regardless of discharge current, although the specific capacitance was decreased when compared with that of unit cell. The electrochemical characteristics of 2.3 V/3000 F grade EDLC were as follows: 0.35 mΩ of DC-ESR (100 A discharge), 0.14 mΩ of AC-ESR (ac amplitude 100 mV), 2.80 Wh/kg (3.73 Wh/L) of energy density and 4.64 kW/kg (6.19 kW/L) of power density. Power output was compatible with electric vehicle applications, uninterrupted power supply and engine starter, in due consideration of Ragone relations.

BACKGROUND Spinal subdural hematomas (SSH) are a rare cause of spinal cord compression. SSH following clipping of an aneurysm has only been reported once. We now report such a case and discuss the mechanism of SSH development after aneurysmal neck clipping. CASE DESCRIPTION A 32-year-old man complained of lumbago 7 days after craniotomy for the clipping of an aneurysm. Neurologic examination revealed no abnormality, but magnetic resonance imaging (MRI) demonstrated a lumbosacral spinal subdural hematoma. He received conservative management and his lumbago showed improvement. An MRI taken 19 days after surgery revealed a residual hematoma. CONCLUSION The downward movement of blood from the cranial subdural compartment under the influence of gravity is the most appropriate explanation for SSH following craniotomy.

The incidence of Brucellosis is increasing in Korea. Spondylitis is the most frequent complication, but it is difficult to diagnose because its clinical symptoms are non-specific. It should therefore be included in the differential diagnosis of back pain. We report three rare cases of brucellar spondylitis successfully treated by medical and surgical therapy.

Calcifying psuedoneoplasm of the spine is a rare non-neoplastic lesion of unknown origin. Radiologic and histologic manifestations are very variable and clinical symptoms include isolated pain, myelopathy, and radiculopathy. Surgical resection is the preferred option of treatment. This report describes three cases of calcifying pseudoneoplasm in the spine. The first case is a 77-year-old female with pain in both legs. The second case is a 67-year-old woman who presented as right leg pain. The third case is a 78-year-old woman with isolated back pain. The involved sites of each of cases were T12, L2-3, and L1, respectively. Surgical resection of the involved masses relieved symptoms.

The indications for operative treatment and type of stabilization procedures for the treatment of thoracolumbar burst fracture remain controversial. As surgical reconstruction for the thoracolumbar burst fracture, both long-segment pedicle screw fixation and short-segment pedicle screw fixation including fractured vertebral body have been used widely. The present study evaluated the efficacy of short-segment fixation compared with that of long-segment fixation in terms of the radiological and clinical outcomes in unstable thoracolumbar burst fractures. From January 2007 to December 2012, 76 patients with thoracolumbar burst fracture underwent posterior pedicle screw fixation consecutively in our hospital. These patients were divided into two groups: the short-segment group, which included patients who underwent short-segment pedicle screw fixation including the fractured vertebral body, and the long-segment group, which included patients who underwent long-segment pedicle screw fixation (2 levels above and 1 level below the fractured vertebral body). There were 44 and 32 patients in the long-segment and short-segment group, respectively. Radiological assessment of the kyphotic angle was performed using the Cobb method immediately after the operation and at 3, 6, and 12 months postoperatively. The clinical outcomes were evaluated using the modified Mcnab criteria at the last follow-up. The sex ratio, mean age of patients, and composition of the fractured vertebral body were similar in both groups. In the long-segment and short-segment group, 37 (84.1%) and 26 (81.3%) cases showed excellent or good outcomes, respectively. The mean kyphotic angle at the immediate postoperative period was 7.3° ± 5.8° and 0.6° ± 11.9° in the long-segment and short-segment group, respectively. The average loss of kyphosis correction was 5.4° ± 4.4°, 8.6° ± 6.2°, and 10.5° ± 4.8° in the long-segment group and 4.1° ± 3.6°, 6.2° ± 5.2°, and 7.5° ± 4.4° in the short-segment group at 3, 6, and 12 months postoperatively, respectively. There was no statistically significant difference in the average loss of kyphosis correction between the two groups (p > 0.05). In conclusion, short-segment pedicle screw fixation including the fractured vertebral body might be as effective as long-segment pedicle screw fixation for the treatment of unstable thoracolumbar spinal burst fracture.

Cerebral cavernous malformation with giant cysts is rare and literature descriptions of its clinical features are few. In this case study, the authors describe the clinical symptoms, radiological findings, and pathological diagnosis of cerebral cavernous malformations with giant cysts, reviewing the relevant literature to clearly differentiate this from other disease entities. The authors present a case of a 19-year-old male with a giant cystic cavernous malformation, who was referred to the division of neurosurgery due to right sided motor weakness (grade II/II). Imaging revealed a large homogenous cystic mass, 7.2×4.6×6 cm in size, in the left fronto-parietal lobe and basal ganglia. The mass had an intra-cystic lesion, abutting the basal portion of the mass. The initial diagnosis considered this mass a glioma or infection. A left frontal craniotomy was performed, followed by a transcortical approach to resect the mass. Total removal was accomplished without post-operative complications. An open biopsy and a histopathological exam diagnosed the mass as a giant cystic cavernous malformation. Imaging appearances of giant cavernous malformations may vary. The clinical features, radiological features, and management of giant cavernous malformations are described based on pertinent literature review.

Objective The purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea. Methods We retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed. Results In this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results. Conclusion Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery.

Superior sagittal sinus thrombosis (SSST) is an uncommon cause of stroke, whose symptoms and clinical course are highly variable. It is frequently associated with a variety of hypercoagulable states. Coagulation abnormalities are commonly seen in patients with hyperthyroidism. To the best of our knowledge, there are few reports on the association between hyperthyroidism and cerebral venous thrombosis. We report on a 31-year-old male patient with a six-year history of hyperthyroidism who developed seizure and mental deterioration. Findings on brain computed tomography (CT) showed multiple hemorrhages in the subcortical area of both middle frontal gyrus and cerebral digital subtraction angiography (DSA) showed irregular intra-luminal filling defects of the superior sagittal sinus. These findings were consistent with hemorrhagic transformation of SSST. Findings on clinical laboratory tests were consistent with hyperthyroidism. In addition, our patient also showed high activity of factors IX and XI. The patient received treatment with oral anticoagulant and prophylthiouracil. His symptoms showed complete improvement. A follow-up cerebral angiography four weeks after treatment showed a recanalization of the SSS. In conclusion, findings of our case indicate that hypercoagulability may contribute to development of SSST in a patient with hyperthyroidism.

Objective : We compared the radiological and clinical outcomes between patients who underwent posterior fixation alone and supplemented with fusion following the onset of thoracolumbar burst fractures. In addition, we also evaluated the necessity of posterolateral fusion for patients treated with posterior pedicle screw fixation. Methods : From January 2007 to December 2009, 46 consecutive patients with thoracolumbar burst fracture were included in this study. On the basis of posterolateral fusion, we divided our patients into the non-fusion group and the fusion group. The radiological assessment was performed according to the Cobb’s method, and results were obtained at immediately, 3, 6, 12 months after surgery. The clinical outcomes were evaluated using the modified Mcnab criteria at the final follow-up. Results : The demographic data and the mean follow-up period were similar between the two groups. Patients of both groups achieved satisfactory clinical outcomes. The mean loss of kyphosis correction showed that patients of both groups experienced loss of correction with no respect to whether they underwent the posterolateral fusion. There was no significant difference in the degree of loss of correction at any time points of the follow-up between the two groups. In addition, we also compared the effect of fixed levels (i.e., short versus long segment) on loss of correction be tween the two groups and there was no significant difference. There were no major complications postoperatively and during follow-up period. Conclusion : We suggest that posterolateral fusion may be unnecessary for patients with thoracolumbar burst fractures who underwent posterior pedicle screw fixation.

Objective : We investigated the clinical and radiological advantages of unilateral laminectomy in posterior lumbar interbody fusion (PLIF) procedure comparing with bilateral laminectomy, under the same procedural condition including bilateral instrumentation and insertion of two cages, in patients with degenerative lumbar disease with unilateral leg symptoms. Methods : We retrospectively reviewed 124 consecutive cases of PLIF via unilateral or bilateral approach between January 2006 and April 2010. In 80 cases (bilateral group), two cages were inserted via bilateral laminectomy, and in 44 cases (unilateral group), via unilateral laminectomy. The average follow-up duration was 29.5 months. The clinical outcomes were evaluated with the Visual Analogue Scale (VAS) and the Oswestry disability index (ODI). The fusion rates and disc space heights were determined by dynamic standing radiographs and/or computed tomography. Operative times, intra-operative and post-operative blood losses and hospitalization periods were also evaluated. Results : In clinical evaluation, the VAS and ODI scores showed excellent outcomes in both groups. There were no significant differences in term of fusion rate, but the perioperative blood loss and the operative time of the unilateral group were lower than that of the bilateral group. Conclusion : Unilateral laminectomy can minimize the operative time and perioperative blood loss in PLIF procedure. However, the different preoperative disc height between two groups is a limitation of this study. Despite this limitation, solid fusion and satisfactory symptomatic improvement could be achieved uniquely by our surgical method. This surgical method can be an alternative surgical technique in patients with unilateral leg pain.

Objective : This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. Methods : From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients’ medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. Result : Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). Conclusion : Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.

Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but significant spinal condition. Urgent surgical evacuation of a hematoma is generally indicated to prevent serious permanent neurological deficits. We encountered three cases of spontaneous spinal epidural hematomas associated with motor weakness that were treated successfully by surgical intervention.

Objective : The purpose of this study was to evaluate the efficacy and safety of the surgical treatment for lumbar spinal stenosis in elderly patients. Methods : The authors reviewed the medical records of 49 patients older than 65 years of age with lumbar spinal stenosis who underwent surgical treatment from January 2002 to December 2004 in our institute. Results : Average age of patients was 70 years old (32 women, 17 men). Twenty-four patients had chronic medical disorders. All patients were operated under the general anesthesia of these, 29 patients underwent decompressive laminectomy and decompressive laminectomy with instrumentation and fusion in 20 patients. The mean operation time was 193.5 minutes, mean estimated blood loss was 378cc and mean postoperative hospital stay length was 15.3 days. The mean follow-up duration was 11.9 months. The evaluation of outcome was assessed by Macnab classification. At first month after operation, the outcome showed excellent in 7 (14.3%), good in 35 (71.4%), fair in 5 (10.2%), and poor in 2 (4.1%). And at 6 months after operation, 17 patients were lost in follow-up, the outcome showed excellent in 4 (12.5%), good in 25 (78.1%), fair in 3 (9.4%), and no poor cases. There was no significant difference between outcome of laminectomy alone and that of laminectomy with fusion. Six patients (12.2%) experienced postoperative complications which included wound infection (3), nerve root injury (1), disc herniation (1), and reoperation due to insufficient decompression (1). There were no deaths related to operation. Conclusion : We conclude that the surgical treatment for lumbar spinal stenosis in elderly patients can provide good results with acceptable morbidity when carefully selected. In addition, decision on lumbar spinal fusion should not be against solely on advanced age.

Most posttraumatic cerebrospinal fluid (CSF) leakage is noticed by the patients with the first symptom, rhinorrhea. A 38-year-old woman presented with frequent clear continuous rhinorrhea and otorrhea for 5 years after basilar skull fracture. After this, meningitis was developed with subsequent CSF fistula. Her clinical symptom was improved by medical treatment. The dural defect and CSF leakage were not detected by computerized tomography (CT) cisternography. We report a rare case of persistent posttraumatic CSF fistula that continued for five years.