Comparison of 2D Thin Section Dixon, 3D Isotropic SPACE, and 2D T2-Weighted Sequences in Ankle MRI

Purpose@#This study aimed to conduct a comparison between 2D thin section intermediate-weighted Dixon turbo spin echo (TSE), 3D intermediate-weighted SPACE (sampling perfection with application-optimized contrasts using flip angle evolutions) TSE, and 2D fat-suppressed T2-weighted TSE in terms of their image quality and diagnostic performance for ankle ligament evaluation. @*Materials and Methods@#Thirty-eight ankle MRI studies were retrospectively analyzed. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the multiplanar reformation images of the sequences were obtained. For each sequence, the subjective image quality and the diagnostic performance for ankle ligament tear were analyzed. @*Results@#The Dixon demonstrated the highest CNR both between ligament and fluid and between ligament and bone marrow. The 3D SPACE showed the highest SNR of the ligament. Regarding subjective image quality, it was significantly higher in the T2-weighted image than it was in the SPACE (p < 0.05), while there was no significant difference between the Dixon and the SPACE. The Dixon showed the highest sensitivity for anterior talofibular ligament (ATFL) tear (80.0%; 95% confidence interval [CI], 64.4–92.3) and deep deltoid ligament (DL) tear (86.4%; 95% CI, 65.1–97.1), and it showed the highest specificity for ATFL tear (70.2%; 95% CI, 59.3–79.7). The interobserver agreement was moderate to good (intraclass correlation coefficient [ICC], 0.50–0.93) in most cases except for the SNR of deep DL (ICC of 0.35–0.62). @*Conclusion@#For ankle ligament evaluation, the 2D thin section Dixon provides adequate image quality with high SNR and CNR and the highest sensitivity for detecting tears.

Diagnosis of Lateral Ankle Ligament Injury in the Evaluation of Chronic Lateral Ankle Instability

Chronic lateral ankle instability (CLAI) is a major complication of acute ankle sprain that can cause discomfort in both daily and sports activities and may lead to degenerative changes in the ankle joint as the long-term sequelae. The precise cause of CLAI remains debatable and is most probably multifactorial. However, identifying chronic lateral ankle ligament injury is critical in determining the primary etiology and formulating an appropriate treatment plan. This review discusses the features and effectiveness of various imaging techniques in diagnosing chronic lateral ankle ligament injury.

Pharmacokinetic properties and bioequivalence of gefitinib 250 mg in healthy Korean male subjects

Gefitinib is an anti-cancer drug used to treat non-small cell lung cancer. The objective of this study was to compare the pharmacokinetics and evaluate the bioequivalence of 2 orally administered gefitinib 250 mg tablets in healthy Korean subjects. A randomized, openlabel, single-dose, crossover bioequivalence study was conducted. A total of 50 healthy male volunteers were randomized into 2 sequence groups. During each treatment, the subjects received the test or reference formulation of 250 mg gefitinib with a washout period of 21 days. The plasma samples were collected at pre-dose and up to 144 hours post-dose, and plasma drug concentrations were measured using validated liquid chromatography-tandem mass spectrometry. Pharmacokinetic parameters were calculated, and the formulations were considered as bioequivalent if the 90% confidence intervals (CIs) of the geometric mean ratios were within the bioequivalence limits of 0.8 to 1.25. Forty-one subjects completed the study and were included in the pharmacokinetic analysis. The 90% CIs of the geometric mean ratios of the test formulation to the reference formulation were 0.8115 to 0.9993 for maximum plasma concentration and 0.9119 to 1.0411 for area under the plasma concentration versus time curve from dosing to the last measurable concentration. There were no serious or unexpected adverse events during the study. In healthy Korean adult subjects, the test and reference formulations of gefitinib 250 mg had similar pharmacokinetic parameters and similar plasma concentration-time profiles. The test formulation of gefitinib met the regulatory criteria for assuming bioequivalence. Both formulations were safe and well-tolerated.

Triaging deep vein thrombosis using ultrasonography after lower-extremity orthopedic surgery: analysis of a single-center experience

Purpose@#This study aimed to stratify risk factors and vein levels for postoperative deep vein thrombosis (DVT) after lower-extremity orthopedic surgery. @*Methods@#Ninety-nine patients who underwent Doppler ultrasonography after lower-extremity orthopedic surgery were enrolled. Medical records were reviewed for anesthesia duration, type of surgery, body weight, height, and cardiovascular risk factors (including history of smoking, diabetes mellitus or hypertension, blood pressure, and total cholesterol and high-density lipoprotein [HDL] cholesterol levels), and the DVT treatment. Ultrasound diagnosis of DVT was made according to a routine protocol. The relationships between selected factors and the presence of DVT were assessed using univariate and multivariate regression analyses. @*Results@#Thirty-three (33%) patients were found to have calf DVT. The mean age, weight, and height of the non-DVT and postoperative DVT patients were 55.1 years versus 65.4 years, 70.5 kg versus 61.2 kg, and 163.3 cm versus 157.0 cm, respectively. Total cholesterol/HDL levels in the non-DVT and DVT patients were 70.6/20.7 mg/dL and 90.8/26.0 mg/dL, retrospectively. Systolic and diastolic blood pressure in the non-DVT and DVT patients were 133.6/80.2 mm Hg and 132.2/78.1 mmHg, respectively. The mean duration of anesthesia was 173.9 versus 199.9 minutes, and the operative time was 136.4 minutes versus 161.0 minutes. Older age (P=0.005) and lower body weight (P=0.002) were significantly associated with postoperative DVT. No other significant between-group differences were found (P>0.05). The patients with ultrasound-identified DVT received antithrombotic treatment. None of them had distant thromboembolism. @*Conclusion@#After lower-extremity orthopedic surgery, the calf veins in elderly patients with low body weight are susceptible to thrombosis; they would most likely benefit from postoperative ultrasonography.

Factors influencing clinical nurses’ advocacy for people with disability / 한국간호교육학회지

Purpose@#Clinical nurses are the ideal health care providers to advocate for vulnerable and underserved populations such as people with disability. This study aimed to understand factors influencing nursing advocacy for people with disability among clinical nurses. @*Methods@#The subjects of this study were 186 clinical nurses who were working in three hospitals in B and D cities. Self-report questionnaires were used to collect the data. Data were analyzed using IBM SPSS Statistics 25 with descriptive statistics, t-test, one-way ANOVA, Pearson’s correlation coefficients, and multiple regression analysis. @*Results@#Clinical experience and esthetical nursing competency have positive correlations with nursing advocacy, and optimism-human rights has a negative correlation with nursing advocacy. Factors influencing nursing advocacy for people with disability were identified as patient directivity (β=0.36, p=.001), optimism-human rights (β=-0.18, p=.008) and clinical experience (≥10) (β=0.14, p=.036). The final model consisting of these factors explained 19% of the variance of nursing advocacy (F=14.99, p=.001). @*Conclusion@#The findings of this study indicate the importance of developing and implementing nursing interventions that can improve patient directivity and optimism-human rights toward people with disability among clinical nurses. These nursing advocacy interventions can be provided as part of continuing education as well as the nursing curriculum.

MRI Evaluation of Suspected Pathologic Fracture at the Extremities from Metastasis: Diagnostic Value of Added Diffusion-Weighted Imaging

OBJECTIVE: To assess the diagnostic value of combining diffusion-weighted imaging (DWI) with conventional magnetic resonance imaging (MRI) for differentiating between pathologic and traumatic fractures at extremities from metastasis. MATERIALS AND METHODS: Institutional Review Board approved this retrospective study and informed consent was waived. This study included 49 patients each with pathologic and traumatic fractures at extremities. The patients underwent conventional MRI combined with DWI. For qualitative analysis, two radiologists (R1 and R2) independently reviewed three imaging sets with a crossover design using a 5-point scale and a 3-scale confidence level: DWI plus non-enhanced MRI (NEMR; DW set), NEMR plus contrast-enhanced fat-saturated T1-weighted imaging (CEFST1; CE set), and DWI plus NEMR plus CEFST1 (combined set). McNemar's test was used to compare the diagnostic performances among three sets and perform subgroup analyses (single vs. multiple bone abnormality, absence/presence of extra-osseous mass, and bone enhancement at fracture margin). RESULTS: Compared to the CE set, the combined set showed improved diagnostic accuracy (R1, 84.7 vs. 95.9%; R2, 91.8 vs. 95.9%, p 0.05). In cases of absent extra-osseous soft tissue mass and present fracture site enhancement, the combined set showed improved accuracy (R1, 82.9–84.4% vs. 95.6–96.3%, p < 0.05; R2, 90.2–91.1% vs. 95.1–95.6%, p < 0.05) and specificity (R1, 68.3–72.9% vs. 92.7–95.8%, p < 0.005; R2, 83.0–85.4% vs. 97.6–98.0%, p = 0.07). CONCLUSION: Combining DWI with conventional MRI improved the diagnostic accuracy and specificity while retaining sensitivity for differentiating between pathologic and traumatic fractures from metastasis at extremities.

Introduction to in silico model for proarrhythmic risk assessment under the CiPA initiative

In 2005, the International Council for Harmonization (ICH) established cardiotoxicity assessment guidelines to identify the risk of Torsade de Pointes (TdP). It is focused on the blockade of the human ether-à-go-go-related gene (hERG) channel known to cause QT/QTc prolongation and the QT/QTc prolongation shown on the electrocardiogram. However, these biomarkers are not the direct risks of TdP with low specificity as the action potential is influenced by multiple channels along with the hERG channel. Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative emerged to address limitations of the current model. The objective of CiPA is to develop a standardized in silico model of a human ventricular cell to quantitively evaluate the cardiac response for the cardiac toxicity risk and to come up with a metric for the TdP risk assessment. In silico working group under CiPA developed a standardized and reliable in silico model and a metric that can quantitatively evaluate cellular cardiac electrophysiologic activity. The implementation mainly consists of hERG fitting, Hill fitting, and action potential simulation. In this review, we explained how the in silico model of CiPA works, and briefly summarized current overall CiPA studies. We hope this review helps clinical pharmacologists to understand the underlying estimation process of CiPA in silico modeling.

Quantitative analysis of acetylsalicylic acid in human blood using volumetric absorptive microsampling

Volumetric absorptive microsampling (VAMS) is a novel sampling technique that allows for the collection of an accurate volume of blood by dipping a microsampler tip. The purpose of this study is to compare the requirement of a stabilizing reagent for the conventional venous blood sampling method versus VAMS in the analytical measurement of the concentration of acetylsalicylic acid. A high-performance liquid chromatography with mass spectrometry (LC-MS/MS) method was developed and validated for the accurate determination of acetylsalicylic acid in human blood. The blood samples spiked with acetylsalicylic acid with and without stabilizing reagent were absorbed into VAMS tips. In the whole blood sample, the same concentration was shown regardless of the addition of the stabilizing reagent, but the concentration decreased when the stabilizing reagent was not added to the VAMS sample. To apply the VAMS technology as a new blood sampling method, stabilizing reagents should be added before the analysis of acetylsalicylic acid concentration.

Pharmacokinetics of fixed-dose combination of rosuvastatin 20 mg and ezetimibe 10 mg compared to concurrent administration of individual tablets in healthy Korean subjects

This study aimed to compare the pharmacokinetics of fixed-dose combination (FDC) tablet of rosuvastatin 20 mg/ezetimibe 10 mg with that of concurrent administration of individual rosuvastatin 20 mg tablet and ezetimibe 10 mg tablet in healthy subjects. A randomized, open label, single-dose, two-way crossover study was conducted. Subjects randomly received test formulation (FDC tablet of rosuvastatin 20 mg/ezetimibe 10 mg) or reference formulation (co-administration of rosuvastatin 20 mg tablet and ezetimibe 10 mg tablet). After 2 weeks of washout, subjects received the other treatment. Blood samples were collected up to 72 hours post-dose in each period. Plasma concentrations of rosuvastatin, ezetimibe and total ezetimibe (ezetimibe + ezetimibe glucuronide) were analyzed by liquid chromatography-tandem mass spectrometry (LC/MS/MS). The geometric mean ratio (GMR) of Cmax and AUClast (90% confidence interval, CI) for rosuvastatin was 1.036 (0.979–1.096) and 1.024 (0.981–1.070), respectively. The corresponding values for ezetimibe were 0.963 (0.888–1.043) and 1.021 (0.969–1.074), respectively. The corresponding values for total ezetimibe were 0.886 (0.835–0.940) and 0.983 (0.946–1.022), respectively. FDC tablet containing rosuvastatin 20 mg and ezetimibe 10 mg is bioequivalent to the co-administration of commercially available individual tablets of rosuvastatin and ezetimibe as GMR with 90% CI of Cmax and AUClast of rosuvastatin, ezetimibe and total ezetimibe were contained within conventionally accepted bioequivalence criteria.

The first step to the powers for clinical trials: a survey on the current and future Clinical Trial Management System

A clinical trial management system (CTMS) is a comprehensive program that supports an efficient clinical trial. To improve the environment of clinical trials and to be competitive in the global clinical trials market, an advanced and integrated CTMS is necessary. However, there is little information about the status of CTMSs in Korea. To understand the utilization of current CTMSs and requirements for a future CTMS, we conducted a survey on the subjects related to clinical trials. The survey was conducted from July 27 to August 16, 2017. The total number of respondents was 596, and 531 of these responses were used. Almost half of the respondents were from hospitals (46%). The proportion of respondents who are currently using a CTMS was the highest for contract research organizations at 59%, whereas the proportion used by investigators was 39%. The main reason for not using a CTMS was that it is unnecessary and expensive, but it showed a difference between workplaces. Many respondents frequently used CTMSs to check the clinical trial schedule and progress status, which was needed regardless of workplace. While two-thirds of users tended to be satisfied with their current CTMS, there were many users who felt their CTMS was inconvenient. The most requested function for a future CTMS was one that could be used to manage the project schedule and subject enrollment status. Additionally, a systematic linkage to electronic medical records, including prescription and laboratory test results, and a function to confirm the participation history of subjects in other hospitals were requested.

Pharmacokinetics comparison of solifenacin tartrate and solifenacin succinate: a randomized, open-label, single-dose, 2-way crossover study in healthy male volunteers

Solifenacin is a muscarinic antagonist indicated for the treatment of overactive bladder with symptoms. Solifenacin tartrate is a newly developed salt formulation of solifenacin. This study compared the pharmacokinetic and safety properties after single-dose administration of solifenacin tartrate (test formulation) and solifenacin succinate (reference formulation) in healthy male volunteers. A total of 36 subjects were enrolled in this randomized, open-label, single-dose, two-way crossover study. During each treatment period, subjects received the test formulation or reference formulation. Plasma samples were collected at pre-dose and at 1, 2, 3, 4, 5, 6, 7, 8, 10, 12, 24, 48 and 72 hours post-dose. Safety was assessed by adverse events, physical examinations, laboratory assessments, 12-lead electrocardiograms, and vital signs. Thirty-three subjects completed the study and were included in the pharmacokinetic analysis. The mean (standard deviation) values of AUC(last) for the test and reference formulations were 486.98 (138.47) and 469.07 (128.29) h·ng/mL, respectively. The mean (standard deviation) values of C(max) for the test and reference formulations were 14.66 (3.85) and 14.10 (3.37) ng/mL, respectively. The 90% confidence intervals for AUC(last) and C(max) were 0.9702 to 1.1097 and 0.9779 to 1.0993, respectively. All adverse events were mild or moderate, and there were no serious adverse events. The pharmacokinetic properties of solifenacin tartrate were similar to those of solifenacin succinate and met the acceptance criteria for bioequivalence. Both formulations were safe, and no significant difference was observed in the safety assessments of the formulations.

Intra-Rater and Inter-Rater Reliability of Brain Surface Intensity Model (BSIM)-Based Cortical Thickness Analysis Using 3T MRI

PURPOSE: Brain surface intensity model (BSIM)-based cortical thickness analysis does not require complicated 3D segmentation of brain gray/white matters. Instead, this technique uses the local intensity profile to compute cortical thickness. The aim of the present study was to evaluate intra-rater and inter-rater reliability of BSIM-based cortical thickness analysis using images from elderly participants. MATERIALS AND METHODS: Fifteen healthy elderly participants (ages, 55-84 years) were included in this study. High-resolution 3D T1-spoiled gradient recalled-echo (SPGR) images were obtained using 3T MRI. BSIM-based processing steps included an inhomogeneity correction, intensity normalization, skull stripping, atlas registration, extraction of intensity profiles, and calculation of cortical thickness. Processing steps were automatic, with the exception of semiautomatic skull stripping. Individual cortical thicknesses were compared to a database indicating mean cortical thickness of healthy adults, in order to produce Z-score thinning maps. Intra-class correlation coefficients (ICCs) were calculated in order to evaluate inter-rater and intra-rater reliabilities. RESULTS: ICCs for intra-rater reliability were excellent, ranging from 0.751-0.940 in brain regions except the right occipital, left anterior cingulate, and left and right cerebellum (ICCs = 0.65-0.741). Although ICCs for inter-rater reliability were fair to excellent in most regions, poor inter-rater correlations were observed for the cingulate and occipital regions. Processing time, including manual skull stripping, was 17.07 +/- 3.43 min. Z-score maps for all participants indicated that cortical thicknesses were not significantly different from those in the comparison databases of healthy adults. CONCLUSION: BSIM-based cortical thickness measurements provide acceptable intra-rater and inter-rater reliability. We therefore suggest BSIM-based cortical thickness analysis as an adjunct clinical tool to detect cortical atrophy.

Comparison of Clinical Manifestation and Prognosis of Preterm and Full-Term Infants with Down Syndrome

PURPOSE: To investigate and compare the clinical manifestation and prognosis of preterm and full-term infants with Down syndrome (DS). METHODS: We retrospectively reviewed 80 patients diagnosed with DS and confirmed by chromosomal study at the Samsung Medical Center between January 1994 and July 2014. Data on demographic characteristics, associated anomalies, treatment, prognosis and cause of death were compared between preterm and full-term DS infants. RESULTS: Of the 80 confirmed DS patients, there were 49 (61%) full-term and 31 (38%) preterm DS infants. The mean gestational age of full-term DS infants was 38(+1)+/-0(+2) weeks (range, 37(+0)-40(+0) weeks) and the mean birth weight was 3,007+/-418 g (range, 1,930-4,100 g). The mean gestational age of preterm infants was 34(+1)+/-2(+1) weeks (range, 29(+1)-36(+6) weeks) and the mean birth weight was 2,181+/-598 g (range, 890-3,500 g). There were no differences in demographics, associated anomalies, mortality or related factors, or the rate of active treatment between full-term and preterm DS infants. CONCLUSION: In this single center study, the mortality rate of preterm DS infants was comparable to that of full-term DS infants. Larger national cohort studies might be needed to further investigate the prognosis of preterm DS infants.

Effect of Imaging Time in the Magnetic Resonance Detection of Intracerebral Metastases Using Single Dose Gadobutrol

OBJECTIVE: To compare the effect of imaging time delay on the MR detection of intracerebral metastases using single dose gadobutrol. MATERIALS AND METHODS: Twenty-one patients with intracerebral metastases underwent contrast-enhanced MR with three-dimensional T1-weighted sequence at 1 minute, 5 minutes and 10 minutes after a single dose injection of gadobutrol. One hundred index metastatic lesions (1 to 30 mm; median, 7 mm) were chosen for the analysis. For the qualitative analysis, lesion conspicuity were assessed on a 1 (worst) to 5 (best) scale of the index lesions by an expert reader. For the quantitative analysis, signal intensity (SI) of enhancing lesions and normal parenchyma was measured to determine the contrast rate (CR, %) ([postcontrast SI lesion - postcontrast SI white matter] x 100 / postcontrast SI white matter) and the enhancement rate (ER, %) ([postcontrast SI lesion - baseline SI gray matter] x 100 / baseline SI gray matter). Statistical comparisons were made between three different time delays. RESULTS: Lesion conspicuity did not differ significantly among the three time delays (p = 0.097). Although the SI, CR and ER of lesions did not reveal any significant difference between 1 minute and 5 minutes delayed images, both the 1 minute and 5 minutes delayed images showed significantly higher CRs of lesions compared with the 10 minutes delayed images (p = 0.004 and p = 0.001, respectively). CONCLUSION: With single dose gadobutrol, imaging time delay did not have an effect on lesion conspicuity. Both 1-minute and 5-minute-delayed imaging after gadobutrol injection appears to be effective for the detection of intracerebral metastases.

Clinical Outcome of Infants Who Underwent Tracheostomy in Neonatal Intensive Care Unit: 16 years' Experience in a Single Center

PURPOSE: This study was designed to review the clinical outcome of infants who underwent tracheostomy in the neonatal intensive care unit (NICU) of a single center in Korea during 16 years. METHODS: We retrospectively reviewed medical records of 33 patients who underwent tracheostomy in NICU of Samsung Medical Center between January, 1997 and December, 2013. We collected data on timing, indications, clinical outcomes, and complications of tracheostomy in the study patients. We also compared these variables with those in another single center study (study A) recently showing the outcome of infants who underwent tracheostomy in a NICU of USA during 10 years. RESULTS: The median gestational age and birth weight of the study patients were 35 weeks, and 3,200 g, respectively. Gestational age of the study patients was greater than that of study A (35 weeks vs. 27 weeks). The most common indication for tracheostomy was airway disease (69.7%) in our study. Bronchopulmonary dysplasia (9%) was less frequent indication for tracheostomy in our study when compared with in the study A (41%). Granuloma formation was the most common complication of tracheostomy (48%) and decannulation was accomplished in nine patients (27.3%). Although the mortality rate was 12.1%, no patient died from tracheostomy-related complications. CONCLUSION: Main causes of tracheostomy in our NICU are airway problems and neuromuscular diseases rather than bronchopulmonary dysplasia itself. For better clarification of clinical courses and outcomes related to tracheostomy performed in NICU in Korea, further study in a larger population will be needed.

Effects of male silkworm pupa powder on the erectile dysfunction by chronic ethanol consumption in rats / 한국실험동물학회지

Erectile dysfunction (ED) is a highly prevalent disorder that affects millions of men worldwide. ED is now considered an early manifestation of atherosclerosis, and consequently, a precursor of systemic vascular disease. This study was designed to investigate the effects of male silkworm pupa powder (SWP) on the levels of nitric oxide synthase (NOS) expression, nitrite, and glutathione (GSH); lipid peroxidation; libido; and erectile response of the corpus cavernosum of the rat penis. We induced ED in the study animals by oral administration of 20% ethanol over 8 weeks. The SWP-treated male rats were divided into 3 groups that were orally administered 200, 400, and 800 mg/kg. The libido of the SWP-administered male rats was higher than that of the ethanol control group. In addition, the erectile response of the corpus cavernosum was restored in males on SWP administration, to a level similar to that of the normal group without ED. The testosterone concentration did not increase significantly. The lipid peroxidation in the corpus cavernosum of the male rats administered SWP decreased significantly. In contrast, compared to the ethanol group, SWP-administered male rats showed increased GSH levels in the corpus cavernosum. The level of nitrite and NOS expression in the corpus cavernosum of SWP-administered male rats increased significantly. These results indicated that SWP effectively restored ethanol-induced ED in male rats.

Effects of Ficus carica paste on constipation induced by a high-protein feed and movement restriction in beagles / 한국실험동물학회지

Constipation is one of the most common functional digestive complaints worldwide. We investigated the laxative effects of figs (Ficus carica L) in a beagle model of constipation induced by high protein diet and movement restriction. The experiments were consecutively conducted over 9 weeks divided into 3 periods of 3 weeks each. All 15 beagles were subjected to a non-treatment (control) period, a constipation induction period, and a fig paste treatment period. We administered fig paste (12 g/kg daily, by gavage) for 3 weeks following a 3-week period of constipation induction in dogs. Segmental colonic transit time (CTT) was measured by counting radiopaque markers (Kolomark) using a radiograph performed every 6 h after feeding Kolomark capsules, until capsules were no longer observed. Fig paste significantly increased fecal quantity in constipated dogs, and segmental CTT was also reduced following fig paste administration. There were no significant differences in feed intake, water intake, body weight, or blood test results, between the constipation and fig paste administration periods. Our results demonstrate that fig is an effective treatment for constipation in beagles. Specifically, stool weight increased and segmental CTT decreased. Fig pastes may be useful as a complementary medicine in humans suffering from chronic constipation.

Influence of Lamina Terminalis Fenestration on the Occurrence of the Shunt-Dependent Hydrocephalus in Anterior Communicating Artery Aneurysmal Subarachnoid Hemorrhage

Recently, it was reported that fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal subarachnoid hemorrhage (SAH). The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus in the ruptured anterior communicating artery (ACoA) aneurysms. The data of 71-ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. Group I (n=36) included the patients with microsurgical fenestration of LT during surgery, Group II (n=35) consisted of patients in whom fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factors. Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 patients (25.4%). The conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. However, there was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms because of the microsurgical fenestration of LT can play a negative role in reducing the incidence of chronic hydrocephalus.

Epidermoid Cyst of the Fourth Ventricle

The authors describe a case of intracranial epidermoid cyst with fourth ventricle involvement. A 43-year-old woman presented with progressive aggravating headache and cerebellar syndrome due to a large tumor in the fourth ventricle, that extended into the left side of foramen of Luschka. The histopathological workup following gross total removal of tumor had revealed the typical features of an epidermoid cyst. Four months after surgery, the cerebellar sings recovered to normal with a remarkable improvement of headache. Epidermoid cysts involving the fourth ventricle have been known to be one of the most rare diseases in the central nervous system. This rare case is discussed and a review of the relevant literature is presented.

Influence of Lamina Terminalis Fenestration on the Occurrence of the Shunt-Dependent Hydrocephalus in Anterior Communicating Artery Aneurysmal Subarachnoid Hemorrhage / 대한뇌혈관외과학회지

OBJECTIVES: Recently, it was reported that microsurgical fenestration of the lamina terminalis (LT) may reduce the incidence of shunt-dependent hydrocephalus in aneurysmal SAH. The authors investigated the efficacy of the LT opening on the incidence of shunt-dependent hydrocephalus especially in the ruptured anterior communicating artery (ACoA) aneurysms. METHODS: The data of 71 ruptured ACoA aneurysm patients who underwent aneurysmal clipping in acute stage were reviewed retrospectively. The patients were divided into two groups according to the use of intraoperative microsurgical opening of the LT. Group I (n=36) included the patients with microsurgical fenestration of LT during routine pterional approach, Group II (n=35) consisted of patients in whom microsurgical fenestration of LT was not feasible. The rate of shunt-dependent hydrocephalus was compared between two groups by logistic regression to control for confounding factor. RESULTS: Ventriculo-peritoneal shunts were performed after aneurysmal obliteration in 18 (25.4%) patients. Overall conversion rates from acute hydrocephalus on admission to chronic hydrocephalus in each group were 29.6% (Group I) and 58.8% (Group II), respectively. There was no significant correlation between the microsurgical fenestration and the rate of occurrence of shunt-dependent hydrocephalus (p>0.05). CONCLUSION: Although this study cannot provide a definitive answer, the microsurgical fenestration of LT can play a negative role for reducing the incidence of chronic hydrocephalus. Surgeons should carefully decide the concomitant use of LT fenestration during surgery for the ruptured ACoA aneurysms.