Gender differences in adult traumatic brain injury according to the Glasgow coma scale: A multicenter descriptive study / 中华创伤杂志(英文版)

PURPOSE@#Patients' gender, which can be one of the most important determinants of traumatic brain injury (TBI) outcomes, is also likely to interact with many other outcome variables of TBI. This multicenter descriptive study investigated gender differences in epidemiological, clinical, treatment, mortality, and variable characteristics in adult TBI patients.@*METHODS@#The selection criteria were defined as patients who had been diagnosed with TBI and were admitted to the hospital between January 1, 2016 and December 31, 2018. A total of 4468 adult TBI patients were enrolled at eight University Hospitals. Based on the list of enrolled patients, the medical records of the patients were reviewed and they were registered online at each hospital. The registered patients were classified into three groups according to the Glasgow coma scale (GCS) score: mild (13-15), moderate (9-12), and severe (3-8), and the differences between men and women in each group were investigated. The risk factors of moderated and severe TBI compared to mild TBI were also investigated.@*RESULTS@#The study included 3075 men and 1393 women and the proportion of total males was 68.8%. Among all the TBI patients, there were significant differences between men and women in age, past history, and GCS score. While the mild and severe TBI groups showed significant differences in age, past history, and clinical symptoms, the moderate TBI group showed significant differences in age, past history, cause of justice, and diagnosis.@*CONCLUSION@#To the best of our knowledge, this multicenter study is the first to focus on gender differences of adult patients with TBI in Korea. This study shows significant differences between men and women in many aspects of adult TBI. Therefore, gender differences should be strongly considered in TBI studies.

Surgical Resection of Non-Glial Tumors in the Motor Cortex

BACKGROUND: Direct surgery to resect tumors in the motor cortex could improve neurological symptoms or cause novel motor weakness. The present study describes the neurological outcomes of patients after the surgical resection of non-glial tumors in the primary motor cortex. METHODS: The present study included 25 patients who had pathologically confirmed non-glial tumors in the motor cortex for which they underwent surgery. Tumor location was verified using anatomical landmarks on preoperative magnetic resonance imaging scans. All surgeries involved a craniotomy and tumor resection, especially use of the sulcal dissecting approach for intra-axial tumors. RESULTS: Of the 25 patients, 10 exhibited metastasis, 13 had a meningioma, and 2 had a cavernous malformation. Motor weakness and seizures were the most common symptoms, while 3 patients experienced only a headache. The tumor size was less than 20 mm in 4 patients, 20–40 mm in 14, and greater than 40 mm in seven. Of the 25 patients, 13 exhibited motor weakness prior to the operation, but most of these symptoms (76.9%) improved following surgery. On the other hand, eight patients experienced seizures prior to the surgery, and in three of these patients (37.5%), the seizures were not controlled after the surgery. In terms of surgical complications, a postoperative hematoma developed in one of the meningioma patients, and the patient's hemiparesis was aggravated. CONCLUSION: The present findings show that careful and meticulous resection of non-glial tumors in the motor cortex can improve preoperative neurological signs, but it cannot completely control seizure activity.

Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage / 대한신경손상학회지

OBJECTIVE: Although twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option. METHODS: CSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed. RESULTS: Of the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC. CONCLUSION: When the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

Perfusion Study for Internal Carotid Artery Trapping of a Traumatic Pseudoaneurysm in an Unconscious Patient / 대한신경손상학회지

Perfusion study should be preoperatively required for the trapping of an internal carotid artery (ICA) in the traumatic pseudoaneurysm in the petrous ICA. A 23-year-old man was admitted with a semicomatose consciousness after a passenger traffic accident. A fracture on the right petrous apex and a pseudoaneurysm in the right petrous ICA was found in the brain computed tomography (CT) angiogram. The size of aneurysm grew in the catheter angiogram at the 3rd day of trauma. One-day protocol of brain single photon emission CT (SPECT), which the first scan with 20 mCi of technetium-99m-ethyl cysteinate diethylester ((99m)Tc-ECD) and the second scan with 40 mCi in double dose at 15 minutes during the balloon test occlusion (BTO) at the same day, was done for the perfusion evaluation before trapping the right ICA. Perfusion asymmetry was aggravated of 21% at the post-occlusion scan in the right frontal cortex. So, he got a superficial temporal artery-middle cerebral artery anastomosis and then ICA trapping. After the surgery, he recovered consciousness and went back to his normal life. He has not developed new neurologic symptom for 8 years. Brain SPECT with double-dose injection of (99m)Tc-ECD may be a useful tool to be performed with BTO.

A Case of Fungal Arthritis by Blastoschizomyces capitatus / 감염

Blastoschizomyces capitatus (formerly Trichosporon capitatus) causes piedra and sometimes invasive infections in immunocompromised hosts. Arthritis by B. capitatus in a previously healthy person has not been reported. Herein we experienced a case of pyogenic arthritis of the knee joint in a farmer and reported the clinical course and literature review. A 68-year old man was adimitted because of swelling and painful left knee joint. Under the impression of septic arthritis of the left knee, empiric antibiotic treatment was initially done. On fifth admission day, B. capitatus was reported in joint fluid culture for the first time. Arthroscopic finding revealed infected synovium and pus-like fluid collection on patello-femoral joint. Amphotericin B was tried but discontinued due to hypokalemia after 7 day use. Secondary arthroscope showed subchondral destruction on medial femoral condyle and medial tibial plateau. Eight week treatment with parenteral fluconazole (daily 100 mg) and oral ketoconazole (200 mg daily) resulted in complete resolution of the patient's symptom. But knee joint ankylosis was remained.

Unipolar Versub Bipolar Hip Hemiarthroplasty for Fractures of Femoral Neck in the Dlderly / 대한정형외과학회잡지

Among the 85 cases of prosthetic replacement of femoral neck fracture which had been operated at Department of Orthopaedic Surgery, Korea Veterans Hospital from January, 1982 to May, 1990, 32 cases (15 unipolar hemiarthroplasty and 17 bipolar hemiarthroplasty) were examined clinically and radiologically at an average 7.7 years postoperatively. And the results were as follows; 1. The group I (Unipolar hip hemiarthroplasty without cement) had Harris hip score - average 79.4. The group II (Unipolar hip hemiarthroplasty with cement) had Harris hip score average 87.3. The group III (Bipolar hip hemiarthroplasty without cement) had Harris hip score average 80.5. The group IV (Bipolar hip hemiarthroplasty with cement) had Harris hip score average 86. 2. There were 2 cases of stem loosening (13%) among 15 cases in unipolar hip hemiarthroplasty and 1 case (6%) among 17 cases in bipolar hip hemiarthroplasty. 3. The movement of two components in bipolar hip hemiarthroplasty was noted in all cases and the movement of the outer bearing joint was more active than that of the inner. And the movement of the two components was not correlated with the use of cement. But Harris hip score was superior cement stem group to noncement stem group. 4. Unipolar hip hemiarthroplasty showed the similar clinical and radiological results with bipolar hip hemiarthroplasty of femoral neck fracture in the elderly. As a result, unipolar and bipolar hip hemiarthroplasty were considered the proper treatment method of the femoral neck fracture in the elderly.

Ankle Arthrodesis by Chevron Osteotomy: Report of 16 cases / 대한정형외과학회잡지

The Marcus ankle arthrodesis was carried out in 16 patients at department of orthopaedic surgery of Korea Veterans Hospital from January 1989 to December 1993. All of patients were reviewed and evaluated with subjective and functional rating scales according to the Mazur scoring system. The average follow up was 23 months, ranging from 12 months to 60 months. The Marcus ankle arthrodesis involves a chevron osteotomy, tibial onlay graft medially, internal fixation with staples and screws. According to the Mazur score, the results were 6 cases of Excellent, 7 cases of Good. The average Mazur score was 75.1. There were 4 cases of complication, a non-union, a superficial wound infection, a bursitis, and a tendon injury. In summary the Marcus ankle arthrodesis by chevron osteotomy seems to be a good procedure, which gives solid bony union with short duration, relief of pain, normal looking ankle configuration without leg length discrepancy and good function with few complications.

The Treatment of Infected Total Hip Arthroplasty: Report of 12 Cases / 대한정형외과학회잡지

Deep infection is the most serious complication of total hip arthroplasty with difficulty to treat and occasionally results into catastrophic consequences. The treatment methods are antibiotics, incision & drainage of the hip, debridement & modified Girdlestone resection arthroplasty, one stage revision to total hip arthroplasty, two stage revision and hip disarticulation. The purpose of this report is to consider the treatment of the infected total hip arthroplasty. Since 1979, we have treated 12 cases of infected arthroplasty including 6 cases from other hopital. Duration of interval between primary hip arthroplasty and diagnosis of infection were average 42,4 months(minimum 2 months to maximum 16 years). The results were as follows; 1. The incidence rate of the infected total hip arthroplasty was 1.3%. 2. By Fitzgerald classification, 2 cases were in acute stage, 6 cases in delayed stage and 4 cases in late stage. 3. The causative organisms were coagulase negative Staphylococcus aureus in 6 cases, Staphylococcus hemolyticus in 2 cases, Pseudomonas in 1 case and negative culture in 3 cases. 4. Increased uptake on Bone Scan in all 12 cases and increased ESR ranged from 28mm/hr to 82mm/hr. 5. Our treatment methods were secondary revision to total hip arthroplasty with cement bead insertion in 4 cases, primary revision in 1 case, incision & drainage of hip in 1 case, debridement & modified Girdlestone resection arthroplasty in 2 cases and hip disarticulation in 2 cases. And the rest 2 cases have been followed up after modified Girdlestone resection arthroplasty because of the remained infection. In our experience, two stage revision to total hip arthroplasty with antibiotics mixed cement bead was more useful in the treatment of the infected total hip arthroplasty.

Spinal Stenosis in Paget's Disease: 1 Case Report / 대한정형외과학회잡지

In the paget's disease involving the vertebra, the symptom and sign of compression come from encroachment on the spinal cord due to the enlarging vertebral bodies, pedicles and laminae. The cord compression appears to be preceded by a long insidious period of noncharacteristic clinical symptoms with minor neurologic dysfunction. The lumbar syndrome of Paget's disease is classified according to its severity, clinical findings, biochemical factors and radiologic patterns. The severity of neurologic complication in Paget's disease involving the vertebra varies according to the level involved. The outcome depends on the suddeness of symptom onset and the effectiveness of decompression. We have experienced a case of Paget's disease involving long bones and lumbar spine in 56 year old male patient, in which surgical decompression produced improvement. We report a case of spinal stenosis in paget's disease with brief review of literature.

Surgical Decompression for the Impingement Syndrome of the Shoulder / 대한정형외과학회잡지

The impingement syndrome has an anatomical character that occur against the anterior edge and the undersurface of anterior third of the acromion, coracoacromial ligament and acromioclavicular joint. The treatment consists of conservative and surgical things. We consider the surgical intervention only in cases fail to control pain by conservative treatment over 3 months(from Feb. 1990 to Jan. 1994). The author experienced 15 cases (14 pts) in positive impingement sign & test and evaluated by shoulder arthrography in all cases. 1. The mean age was 60 years ranged from 48 to 68 years and the average symptom duration was 23 months. 2. There were all positive impingement sign & test clinically. 3. There were partial tear of rotator cuff in 3 cases and complete tear in 12 cases radiologically. 4. The anterior acromioplasty with division of coracoacromial ligament was performed in all cases, additional rotator cuff repair in 3 cases and bicipital tenodesis in 2 cases. 5. At the follow up based on UCLA shoulder rating scale, results were excellent & good in 13(86%) and unsatisfactory in 2(14%) cases.

Total Ankle Arthroplasty: Report of 6 cases / 대한정형외과학회잡지

Ankle arthrodesis has been regarded as a good operative treatment for post traumatic and rheumatoid arthritis of ankle, and ankle arthroplasty has been also developed with several types, from 1970, by Lord & Marotte. Ankle arthroplasty is more functional & less cosmetic troublesome than arthrodesis, and with more developed prosthesis design, more good result will come. The authors operated 6 cases of total ankle arthroplasty for posttraumatic and rheumatoid arthritis of ankle, which were also indications of arthrodesis, and introduce the results and operative problems of ankle arthroplasty.

Treatment of Chronic Osetomyelitis by Saucerization and Gentamicin / 대한정형외과학회잡지

Chronic osteomyelitis continue to be a therapeutic challenge. The osteomyelitis also implies chronic ischemia of the diseased bone ; thus systemic antibiotic treatment may not be as effective as we want. In 1972, Klemm developed a new procedure to supplement saucerization in the treatment of chronic osteomyelitis, alternative to irrigation and suction-drainage, i.e., Gentamicin-PMMA Beads. The authors analysed 35cases of the chronic osteomyelitis which were admitted and treated by sauceriztion and Gentamicin-PMMA Beads in Department of Orthopaedic Surgery, Korea Veterans Hospital from Aug. 1984 to Jan. 1988.