Temperature change of epidural space by radiofrequency use in biportal endoscopic lumbar surgery: safety evaluation of radiofrequency.

PURPOSE: Articles evaluating radiofrequency (RF) safety are insufficient. Thus, the purpose of this study was to investigate RF safety during biportal endoscopic lumbar decompressive laminotomy by measuring epidural temperature after RF use. METHODS: Both in vitro cadaveric study and in vivo study were performed. The epidural temperature was measured at epidural space after RF use in three cadavers. The epidural temperature was measured and analysed according to RF mode, RF power, RF usage time, and saline irrigation patency. In the in vivo study, the epidural temperature was measured after biportal endoscopic surgery. Epidural temperatures were measured around ipsilateral and contralateral traversing nerve roots after 1-s use of RF. RESULTS: In the in vivo study, epidural space temperature was increased by 0.31 ± 0.16 °C ipsilaterally and 0.29 ± 0.09° contralaterally after RF use in coagulation mode 1. The epidural temperature of epidural space was increased by 0.21 ± 0.13 °C ipsilaterally and 0.15 ± 0.21 °C contralaterally after RF use in high mode 2. In the in vitro study, epidural temperature was significantly increased with a long duration of RF use and a poor patency of irrigation fluid. CONCLUSION: The use of RF in biportal endoscopic spine surgery might be safe. In order to reduce indirect thermal injuries caused by RF use, it might be necessary to reduce RF use time and maintain continuous saline irrigation patency well.

Indications, Contraindications, and Complications of Biportal Endoscopic Decompressive Surgery for the Treatment of Lumbar Stenosis: A Systematic Review.

BACKGROUND: Biportal endoscopic spine surgery is gaining popularity in managing degenerative lumbar diseases and has optimal indications and contraindications. The perioperative complications related to the biportal endoscopic approach affect the postoperative outcomes. Therefore, this study aimed to review the indications, contraindications, and complications of biportal endoscopic decompression for lumbar stenosis. METHODS: For this systematic review, articles on biportal endoscopic decompressive surgery for lumbar stenosis, including central, lateral recess and foraminal stenoses, were searched for and reviewed. Additionally, the complications, indications, and contraindications of biportal endoscopic surgery for lumbar stenosis were reviewed. RESULTS: Forty-one articles were included in this study. The indications for biportal endoscopic decompression are central lumbar stenosis, central stenosis with lipomatosis, lateral recess stenosis, foraminal stenosis, and the far-out syndrome. The contraindications include trauma, infection, tumor, instability, high-grade spondylolisthesis, isthmic spondylolisthesis, and severe scoliosis. Perioperative complications are typically minor; major complications include durotomy, epidural hematoma, incomplete decompression, infection, facet joint injury, neural injury, increased epidural pressure, and postoperative instability. CONCLUSIONS: Favorable indications for a biportal endoscopic approach are central lumbar, lateral recess, foraminal, extraforaminal stenoses, and the Bertolotti syndrome. Incidental durotomy and postoperative epidural hematomas are common complications of biportal endoscopic decompression.

Water Dynamics in Unilateral Biportal Endoscopic Spine Surgery and Its Related Factors: An In Vivo Proportional Regression and Proficiency-Matched Study.

BACKGROUND: Stable water dynamics during endoscopic spine surgery improves the surgeon's comfort and patient's outcomes. We aimed to measure the water dynamics during spinal surgery and identify the factors that facilitate stable water dynamics. METHODS: This open-label, prospective, proficiency-matched, in vivo study included patients with single-level degenerative spinal disease. After assessing their heights and balancing the matched instrument, we measured the irrigation fluid pressure in various situations. We performed multiple regression analysis based on odds ratio (OR), confidence interval (CI), and relationships (proficiency-matched) with possible instrumental and physical characteristics. The instrumental factors were the presence and length of a rigid cannulation, and the physical characteristics were body mass index (body mass index [BMI]), skin-to-dura depth, height (interaction with BMI), and body weight (interaction with BMI). RESULTS: Of the 36 patients, 29 were included. The mean pressure of the operation cavity was 16.66 ± 9.12 cm H2O (12.25 ± 6.71 mm Hg). Water pressure with the rigid cannulation (9.41 ± 2.94 cm H2O [6.92 ± 2.16 mm Hg]) was significantly lower than that without cannulation (23.43 ± 7.57 cm H2O [17.26 ± 5.57 mm Hg], P < 0.01). Water pressure correlated with cannular length (OR = -1.08, CI = -1.79, -0.37, P < 0.01) and BMI (OR = 0.56, CI = 0.12, 0.99, P < 0.01). BMI showed a proportional relationship (r = 0.84, P < 0.01). CONCLUSIONS: During biportal endoscopy, we suggest maintaining water pressure between 4.41 cm H2O (2.41 mm Hg) and 31.00 cm H2O (22.83 mm Hg). Compared to physical characteristics, placement of the cannula and appropriate cannula length are important factors that affect water dynamics.

Novel Instruments for Percutaneous Biportal Endoscopic Spine Surgery for Full Decompression and Dural Management: A Comparative Analysis.

BACKGROUND: Post-laminectomy syndrome is a common cause of dissatisfaction after endoscopic interlaminar approach. Our aim was to evaluate the efficacy and safety of our two newly designed instruments for laminotomy, a dural protector attached to the scope and a knot pusher for water-tight suturing of the incidental dural tears. MATERIAL AND METHODS: This was a multicenter evaluation. Efficacy was quantified as the pre-to-postoperative improvement in pain (visual analog scale), disability (Oswestry Disability Index), patient satisfaction (modified MacNab score), and length of hospital stay. Safety was quantified by the incidence and location of dural tears, rate of revision, and radiological outcomes. Outcomes were evaluated between the control (before instrument development) and experimental (after instrument development) groups. RESULTS: There was a significant improvement in leg pain in the experimental group (p = 0.03), with greater patient satisfaction in the control group (p < 0.01). There was no incidence of dural tears in the area of the traversing and exiting nerve roots in the experimental group. Water-tightness of sutures was confirmed radiologically. CONCLUSION: The novel dural protector and the knot pusher for water-tight sutures improved the efficacy and safety of decompression and discectomy; however, a prolonged operative time was a drawback.

Technique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion.

Biportal endoscopic transforaminal lumbar interbody fusion (TLIF) may have advantages of minimally invasive fusion surgery as well as those of endoscopic surgery. The purpose of this study was to present the biportal endoscopic TLIF technique along with video presentations and a review of the literature on this technique. Basically, the biportal endoscopic TLIF technique is similar to minimally invasive TLIF with a tubular retractor. There were 2 options in the biportal endoscopic TLIF procedures. The first was the insertion of one long TLIF cage and the other was the insertion of 2 short posterior lumbar interbody fusion (PLIF) cages. After the interbody fusion procedures, percutaneous pedicles screw fixation was performed. Biportal endoscopic TLIF achieved complete neural decompression through laminectomy and facetectomy like conventional TLIF. Endplate preparation was performed completely under a clear and magnified endoscopic view. It was also feasible to insert a large TLIF cage or 2 cages for PLIF without exiting nerve root injury. Biportal endoscopic TLIF might have the advantages of endoscopic surgery as well as minimally invasive fusion surgery. Direct neural decompression, endplate preparation under endoscopic guidance, and the insertion of a large TLIF cage or 2 PLIF cages may be the merits of biportal endoscopic lumbar fusion procedures.

Inula britannica fermented with probiotic Weissella cibaria D30 exhibited anti-inflammatory effect and increased viability in RAW 264.7 cells.

The objective of this study was to increase the bioavailability of Inula britannica (IB) through fermentation with probiotic Weissella cibaria D30, and to evaluate the chemical composition, viability, and anti-inflammatory effect of fermented I. britannica (FIB). IB was fermented with W. cibaria D30 at 37 °C for 24 h. FIB increased total phenolic content and decreased total flavonoid content of IB. 1-O-acetylbritannilactone and ergolide production, which are associated with the viability, increased from 1.38 to 4.13 µg/mg, and decreased from 5.24 to 0.94 µg/mg, in the control and FIB, respectively. In addition, the cell viability of RAW264.7 cells increased when pretreated with 400 µg/mL FIB. FIB inhibited the production of nitric oxide and proinflammatory cytokines by inhibiting NF-κB and MAPKs pathways. Therefore, FIB with W. cibaria D30 reduced the toxicity and increased the anti-inflammatory properties. These results indicate that FIB is a potential beneficial bioactive agent for functional foods.

Investigation of Brassica juncea, Forsythia suspensa, and Inula britannica: phytochemical properties, antiviral effects, and safety.

BACKGROUND: General antiviral agents such as oseltamivir are associated with certain adverse effects and the emergence of resistance. This study investigated the phytochemical properties, antiviral activities, and safety of three herbs used in traditional Korean medicine. METHODS: Extracts of three medicinal herbs (Brassica juncea, Forsythia suspensa, and Inula britannica) were prepared using ethanol or water. The total phenolic, flavonoid, and saponin content, condensed tannin content, and reducing sugar content of the herb extracts were determined via phytochemical screening. Tandem mass analysis was performed using an ultra-performance liquid chromatography (UPLC)-electrospray ionization (ESI)-Q/Orbitrap instrument. Virus titrations were determined via tissue culture infective dose (TCID50) and cytotoxicity assays. Hemolysis and hepatotoxicity were measured to determine safety. RESULTS: Among the three medicinal herbs, F. suspensa showed the highest concentration of phenolic compounds, flavonoids, and saponins. The number of phytochemical compounds detected via tandem mass analysis of B. juncea, F. suspensa, and I. britannica was 5 (including sinigrin, m/z [M-H] = 358.02), 14 (including forsythoside A, m/z [M-H] = 623.19), and 18 (including chlorogenic acid, m/z [M-H] = 353.20), respectively. The antiviral effects of the B. juncea extracts (ethanol and water) and I. britannica extract (ethanol) were further investigated. The ethanol extract of B. juncea showed a 3 Log TCID50/25 µL virus titration reduction and the water extract showed a selectivity index of 13.668 against infected influenza H1N1 virus A/NWS/33. The B. juncea extracts did not show hemolysis activities and hepatotoxicity (< 20%). The ethanol extract of I. britannica showed the most effective virus titration decrease, whereas its hemolytic and hepatotoxicity values were the most significantly different compared to the control. Despite the high concentration of phytochemicals detected in F. suspensa, the extract showed approximately 1 Log TCID50/25 µL at the highest concentration. CONCLUSION: B. juncea may show antiviral effects against H1N1 in a host. In addition, B. juncea may also show decreased disadvantages compared to other antiviral agents.

Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis.

BACKGROUND: The unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. A new endoscopic technique that uses a UBE approach has been applied to conventional arthroscopic systems for the treatment of spinal disease. In this study, we aimed to compare and evaluate the perioperative parameters and clinical outcomes, including recovery from surgery, pain and life quality modification, patient's satisfaction, and complications, between UBE and open lumbar microdiscectomy (OLM) for single-level discectomy procedures. METHODS: This study included 141 patients with degenerative disc disease requiring discectomy at a single level from L2-L3 to L5-S1. A total of 60 and 81 patients underwent UBE and OLM, respectively. Analysis was based on comparison of perioperative metrics, operation time (OT); estimated blood loss (EBL); length of hospital stay (HS); clinical outcomes, including assessment using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI); patient satisfaction (the MacNab score); and the incidence of reoperation and complications. RESULTS: The study cohort was 56.7% women, and the mean patient age was 50.98 ± 18.23 years. The mean VAS (the back and leg), MacNab score, and ODI improved significantly from the preoperative period to the last follow-up (12.92 ± 3.92) in both groups (p < 0.001). One week after operation, the back VAS score in the UBE group showed significantly more improvement than that in the OLM group. However, the 1-week, 3-month, and 12-month VAS (the back and leg), ODI improvement, modified MacNab score, and OT were not significantly different between the two groups. In the UBE group, EBL (34.67 ± 16.92) was smaller and HS (2.77 ± 1.2) was shorter than that of the OLM group (140.05 ± 57.8, 6.37 ± 1.39). However, OT (70.15 ± 22.0) was longer in the UBE group than in the OLM group (60.38 ± 15.5), and the difference was statistically significant. Meanwhile, the differences in the rate of surgical conversion and complications between the two groups were not statistically significant. CONCLUSIONS: The UBE for single-level discectomy yielded similar clinical outcomes to OLM, including pain control, functional disability, and patient satisfaction, but incurred minimal EBL, HS, and postoperative back pain. TRIAL REGISTRATION: Not applicable.

Trends and Cut-Point Changes in Obesity Parameters by Age Groups Considering Metabolic Syndrome.

BACKGROUND: Non-communicable diseases (NCDs) are an important issue worldwide. Obesity has a close relationship with NCDs. Various age-related changes should be considered when evaluating obesity. METHODS: National representative cohort data from the National Health Insurance Service National Sample Cohort from 2012 to 2013 were used. Sex-specific and age group-specific (10-year intervals) means for body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WtHR) were calculated. Optimal cut-points for obesity parameters were defined as the value predicting two or more components of metabolic syndrome (except WC). RESULTS: The mean value and optimal cut-point for BMI decreased with age for men. The mean BMI value for women increased with age, but optimal cut-points showed no remarkable difference. The mean WC of men increased with age, but the optimal cut-points were similar for age groups. For women, the mean value and optimal cut-point for WC increased with age. Regarding WtHR, the mean value and optimal cut-point increased with age for men and women. Differences across age groups were larger for women. CONCLUSION: The mean values of the obesity indices and the optimal cut-points were changed according to age groups. This study supports the necessity of applying age group-specific cut-points for the various obesity parameters.

Using temporal bone computed tomography to predict sensorineural hearing loss in otic capsule-sparing temporal bone fracture.

OBJECTIVES: The purpose of this study was to investigate the efficacy of otic capsule-sparing (OCS) length for the prediction of sensorineural hearing loss (SNHL) in patients with OCS temporal bone fracture. METHODS: Thirty-four patients with OCS temporal bone fracture were enrolled, and their temporal bone computed tomography (TBCT), audiogram, and medical records were reviewed. The TBCT measured the shortest length between the otic capsule and fracture line. This length was referred to as the OCS length and was used to predict SNHL. Ossicular dislocation and fracture were also evaluated. Patients were divided into two groups according to the presence of SNHL. Univariate and multivariate analyses were performed for age, gender, brain hemorrhage, mean bone conduction threshold on the contralesional side, OCS length, and ossicular dislocation and fracture on TBCT. A receiver operating characteristic (ROC) curve was produced to evaluate the efficacy of OCS length for the prediction of SNHL. To determine an association between degree of SNHL and OCS length, regression analysis was conducted in the SNHL group. RESULTS: The mean OCS lengths of the SNHL and non-SNHL groups were 4.42±1.67mm and 8.00±5.71mm, respectively. In the univariate analysis, a relatively significant association (P <0.20) was found between SNHL and age, brain hemorrhage, mean bone conduction threshold on the contralesional side, OCS length, and incus dislocation. Multivariate analysis was performed using these factors. On multivariate analysis, OCS length (P=0.030, odds ratio=0.598; 95% confidence interval 0.375-0.952) was the only independent factor associated with SNHL. The area under the curve (AUC) was 0.747. When the cut-off value of OCS length was 5.27mm, the sensitivity and specificity for the prediction of SNHL were 71.4% and 69.2%, respectively. In the regression analysis, OCS length showed a significant association with degree of SNHL in the SNHL group (P=0.025, ß=-12.822, SE=5.282). CONCLUSIONS: The major finding of our study was that OCS length was significantly associated with SNHL in patients with OCS temporal bone fracture. Such patients with a short OCS length had a higher likelihood of SNHL.

Clinical implication of cervical vestibular evoked myogenic potentials in benign paroxysmal positional vertigo.

OBJECTIVES: To evaluate the value of cervical vestibular evoked myogenic potential (cVEMP) as a prognostic factor for benign paroxysmal positional vertigo (BPPV). METHODS: We reviewed 65 patients with BPPV who underwent cVEMP. Patients were divided into two groups according to resistance to the repositioning maneuver. Univariable and multivariable analyses were performed with age, gender, affected semicircular canal, affected side and cVEMP parameters to find the associated factors for resistance to the repositioning maneuver. RESULTS: From univariable analysis, cVEMP interaural amplitude difference (IAD) ratio, the affected semicircular canal and the affected side showed a better association (p<0.10) with resistance to the repositioning maneuver. With multivariable analysis, decreased cVEMP IAD ratio at the affected side (⩽-25%) (p=0.043, OR=4.934) and the posterior semicircular canal (p=0.049, OR=3.780) remained as associated factors. CONCLUSIONS: Decreased cVEMP IAD ratio at the affected side is associated with resistance to the repositioning maneuver. BPPV patients with decreased cVEMP IAD ratio at the affected side have a higher likelihood of their BPPV persisting after a single repositioning maneuver. SIGNIFICANCE: cVEMP test may provide a prognosis of BPPV. A decreased cVEMP IAD ratio at the affected side may be prognostic of BPPV not resolving after a single repositioning maneuver.

Self-reported health status as a predictor of functional decline in a community-dwelling elderly population: Nationwide longitudinal survey in Korea.

AIM: As the elderly population is increasing, the prediction and prevention of functional decline in older adults are of great concern. The present study aimed to evaluate whether poor self-reported health status (SRHS) could predict functional decline after 2 years in the elderly population. METHODS: Data from the Korean Longitudinal Study of Aging panel, a national representative sample of aging Koreans, were used. Participants of the investigation were the elderly population aged 65 years or more without disability in carrying out activities of daily living (ADL) at baseline. The survey asked respondents about their subjective health status. Setting the respondents who stated their health status as "very good" or "good" as the reference group, multivariable logistic regression analysis was carried out to compare functional decline according to the baseline SRHS. RESULTS: A total of 2824 participants were included in the analysis. Among them, 138 (4.9 %) reported functional decline of at least one of the seven ADL components after 2 years. In multivariable logistic regression analysis, SRHS was significantly associated with subsequent functional decline in respondents who chose "Bad" (odds ratio 3.32, 95% confidence interval 1.71-6.44) or "Very bad" (OR 4.75, 95% CI 2.12-10.66). Furthermore, poorer SRHS was significantly associated with subsequent impairment in each ADL component. Also, SRHS predicted overall subsequent impairment in the instrumental ADL. CONCLUSIONS: SRHS predicted functional decline after 2 years in older adults without baseline disabilities. SRHS can be a good predictor of future functional decline in the elderly population. Geriatr Gerontol Int 2017; 17: 885-892.

Impact of control of blood glucose level during treatment of sudden deafness in diabetics: relationship with prognosis.

The objective of this study is to investigate the impact of control of blood glucose level during treatment of sudden deafness. A retrospective study was performed involving 197 patients from January, 2011 to September, 2015. All patients were administrated prednisolone (Pharmaprednisolone tab®, 5 mg/T; KoreaPharma) p.o under the following regimen: 60 mg/day for 4 days, 40 mg/day for 2 days, 30 mg/day for 1 day, 20 mg/day for 1 day, and 10 mg/day for 2 days. During treatment, pure tone audiometry and blood glucose level were investigated for each patient and the results were statistically analyzed. Mean hearing improvement was 19.2 dB for the non-diabetes group and 24.8 dB for the diabetes group. The greater improvement for diabetics was not statistically significant (p = 0.146). Hearing improvement was 25.1 dB for subjects with mean blood glucose <200 mg/dl and 24.6 dB for subjects with mean blood glucose >200 mg/dl; the difference was not statistically significant (p = 0.267). Mean blood glucose level was 200.8 mg/dl for subjects with hearing improvement >20 dB and 181.8 mg/dl for subjects with hearing improvement <20 dB; the difference was not statistically significant (p = 0.286). Control of blood glucose level during treatment of sudden deafness does not have a direct effect on prognosis.

The correlation of serum eosinophil cationic protein level with eosinophil count, and total IgE level in Korean adult allergic rhinitis patients.

BACKGROUND: Eosinophil cationic protein (ECP) is present in eosinophil granules. It has been associated with eosinophil-associated disorders. OBJECTIVE: We compared serum ECP levels in allergic and non-allergic rhinitis patients and evaluated the association with the eosinophil count and the total IgE level. METHOD: We retrospectively reviewed medical records and categorized enrolled patients into the allergic (AR) and non-allergic rhinitis (NAR) groups. ECP, eosinophil count, and total IgE levels were reviewed in both groups. The association between ECP and the eosinophil count and total IgE level was further evaluated according to commonly detected specific antigens. RESULTS: Six hundred and ten adults were included in the study. In the AR group (n=349), the median age was 27.0(23.0-42.0) years and the female:male ratio was 0.26:1. In the NAR group (n=261), the median age was 32.0(24.0-45.5) years and the female:male ratio was 0.33:1. We found that ECP (AR: 18.8(9.9-31.4), NAR: 14.8(8.2-24.9), p=0.003), eosinophil count (AR: 191.0(112.0-308.5), NAR: 149.0(91.0-249.0), p=0.002) and total IgE (AR: 166.0(58.4-422.5), NAR: 68.8(24.5-141.0), p<0.001) were higher in AR than in NAR patients. The ECP level was associated with the eosinophil count in both the AR (p<0.001) and NAR groups (p<0.001). A significant correlation between the ECP level and eosinophil count was demonstrated in AR patients who were skin test positive against house dust mite, animal and pollen allergens. CONCLUSIONS: We suggest that ECP could be an important mediator in the pathogenesis of AR. The level of serum ECP was positively correlated with eosinophilia in AR patients regardless of the type of allergen sensitization. However, further study is warranted to verify the role of ECP in the clinical management of allergic rhinitis.

The Potential Significance of Concha Bullosa During Nasotracheal Intubation.

The authors experienced a case of severe epistaxis caused by accidental partial middle turbinectomy during nasotracheal intubation, which the patient had bilateral concha bullosa narrowing the nasal airway. Although anesthesiologist checked nasal airway through subjective symptoms and the size of both nostrils, they tend to overlook common anatomic variation, concha bullosa, and can injure turbinate structures. Therefore, preoperative computed tomography images should be carefully evaluated for the possibility of concha bullosa, which narrows nasal airway and induces the traumatic injury or epistaxis during nasotracheal intubation.

Eradication of Mycoplasma synoviae from a multi-age broiler breeder farm using antibiotics therapy.

Mycoplasma synoviae (MS) is a common respiratory pathogen in the poultry industry. Eradication of MS from broiler breeder flocks is important for reducing economic losses caused by MS-associated diseases on broiler farms. An outbreak of MS infection was detected on a multi-age Korean broiler breeder farm that implements a flock replacement program every 3 to 6 months and uses A-type cages. Continuous administration of tilmicosin after 2 rounds of intensive antibiotics treatment with chlortetracycline, doxycycline, and enrofloxacin reduced MS shedding from the MS-positive flocks and eventually eradicated MS from the farm. Flock 3 was the last MS-positive flock by both PCR and enzyme-linked immunosorbent assay (ELISA), while flocks introduced to the farm after flock 3 were MS-negative by both PCR and ELISA at the time of depletion. This is the first report of successful eradication of MS from a multi-age broiler breeder farm using continuous antibiotic treatments.

Underestimation of Rhinogenic Causes in Patients Presenting to the Emergency Department with Acute Headache.

OBJECTIVES: Differential diagnosis is essential, since secondary headache due to paranasal sinus lesions are similar in headache characteristics to primary headache. However, since patients visiting the emergency department due to acute severe headache are primarily treated by neurologists, paranasal sinuses lesions and anatomical variations of the nasal cavity causing the headache are commonly overlooked because of the clinician's lack of knowledge about rhinosinugenic headache. This study investigated the prevalence of paranasal sinus lesions and anatomical variations that may cause secondary headaches in patients who were diagnosed as primary headache and treated by neurologists in the emergency room. METHODS: A retrospective study was done involving 1235 patients who visited the emergency department from January 2008 to December 2012 and who were diagnosed with primary headache. From the axial view of brain computed tomography, examination of sinusitis, mucosal contact points, concha bullosa, isolated sphenoid lesion, and osteoma were done, and location and morphology was analyzed. METHODS: Three hundred fifty-five of 1235 (28.7%) patients had sinusitis, mucosal contact points, concha bullosa, isolated sphenoid lesion, and osteoma as possible causes for secondary headaches. CONCLUSION: Differential diagnosis of primary headaches requires knowledge of paranasal sinus lesions including rhinosinusitis or anatomical variations. Also, interdisciplinary evaluation of acute headache presenting to the emergency room is necessary for accurate diagnosis and proper management.

Leptomeningeal carcinomatosis of gastric cancer misdiagnosed as vestibular schwannoma.

Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics. To our knowledge, LC from gastric cancer is very rare. In conclusion, our experience with this case suggests that clinicians should consider the possibility of delayed leptomeningeal metastasis when treating patients with gastric cancer.

Prevalence and characterization of Salmonella species in entire steps of a single integrated broiler supply chain in Korea.

The purpose of this study was to investigate the distribution of Salmonella species in an integrated broiler supply chain in Korea. A total of 1,214 samples from various steps of an integrated broiler production company including broiler breeder farms, broiler farms, broiler trucks, slaughterhouse, and retail chicken meats were collected and investigated. Salmonella was detected in 195 of the samples. The highest prevalence of Salmonella was observed in broiler transporting trucks (71.43%), followed by the slaughterhouse (63.89%) and broiler farms (16.05%). Salmonella Hadar was the most frequently isolated serotype (83.08%). All Salmonella Hadar isolates investigated in this study with pulsed-field gel electrophoresis showed the same XbaI pulsed-field gel electrophoresis pulsotype.