Infectious spondylitis, an infection of the vertebral body, intervertebral disc,
or paraspinal tissues, poses diagnostic and therapeutic challenges. This review
examines the clinical approach and management of infectious spondylitis in
Korea. The incidence of pyogenic spondylitis has increased, primarily due to the
aging population, more frequent use of invasive procedures, and higher
prevalence of immunocompromising conditions. Conversely, tuberculous spondylitis
has declined, reflecting shifts in population demographics and medical
practices.
, Hee Won Kang, Young Min Youn, So-Yeon Shim, Eun Ae Park, Su Jin Cho To compare the epidemiology, clinical presentation, laboratory findings, seasonality and hospital course of enteroviral meningitis (EM) and non-enteroviral meningitis (NEM) cases in infants under 3 months of age.
A retrospective chart review was performed of infants under 3 months of age or less with viral meningitis admitted to Ewha Womans University Mokdong Hospital between January 2010 and December 2016.
EM patients were more likely to have siblings compared with NEM. Most of EM was diagnosed during the summer season. Almost 80% of EM was diagnosed between July and September. Fever lasted longer in EM patients compared to NEM. White blood cell count (WBC) from the cerebrospinal fluid was higher in EM patients compared with NEM patients. WBC in blood were lower in EM patients compared with NEM patients. C-reactive protein was lower in EM patients compared with NEM patients. Most of the patients were initially started on antibiotics therapy to rule out bacterial meningitis. EM patients received shorter duration of antibiotic treatment compared with NEM patients.
This study was conducted to augment the understanding of the incidence, epidemiology, transmission in infants, clinical presentation, laboratory findings, seasonality and hospital courses of enteroviral meningitis compared to NEM. Early recognition, rapid diagnosis and proper clinical management can reduce duration of antibiotic treatment.
Citations
, Hyun-Jung Kim, Tae-Hee Han, Min Kwan Kwon, Soo Ya Bae, Young Jin Yuh Myeloid sarcoma is a rare tumor mass consisting of immature granulocytic cells occurring in an extramedullary site or in a bone. It has often been observed during the course of an acute leukemia, myelodysplastic syndrome or myeloproliferative neoplasms, and it can involve any site of the body. However, it rarely present in the absence of bone marrow infiltration, especially for the isolated spinal myeloid sarcoma. In this report, we describe a case of isolated myeloid sarcoma that showed spinal compression. A 66-year-old male, with no underlying disease or medication history, presented with a progressive back pain and numbness in bilateral lower extremities that had begun two weeks before. He was diagnosed with myeloid sarcoma with no evidence of bone marrow involvement. Tumor cells were positive for CD34, c-KIT, and Bcl-2 on the immunohistochemical stain. He was treated with systemic chemotherapy with daunorubicin plus cytosine arabinoside and achieved a partial response.
Cervical spine injury is a commonly encountered entity in most neurosurgical practice and is increasing with social environment. Universally accepted treatment modality for acute cervical spine injuries do not exist and several areas of controversy surround the issue of surgical intervention in the management of trauma to the cervical spine.
A retrospective study of 86 injured cervical spine patients who admitted and carried out a surgical treatment at Dong Dae Moon Hospital between Sep.92 and Aug.96 for the past four-year-period.
The author analyzed 86 patients with traumatic cervical spine injuries for the past 4 years. The incidence was highest in middle aged men(ratio : 6.8) and the traffic accident was the most common exclusive cause(68%). In 9 cases of C1-2 spine injury, they underwent posterior approach. In 74 cases of mid-lower(C3-7) cervical injury, the anterior approach was used in 57 patients, the posterior approach was used in 13 patients and the combined approach was used in 4 patients. The surgical complication rate was 15%(13 cases).
Internal fixation with variety of devices has become a popular procedure for cervical spine injuries.
In this study, the rate of re-operation and complications following initial surgical procedures were found to be higher than previous report of other authors. It could be concluded that choosing the most proper surgical approach for cervical spine injuries with minimal risks and adhering to stringent criteria are much important than simply selecting new fancy devices over the traditional one.
, Eun Chul Chung The purpose of this study was to analyze the MR findings of intramedullary tumors and review the literatures for evaluating of characteristic findings of each intramedullary tumors.
We experienced eight intramedullary tumors from March 1993 to February 1995, including four astrocytomas two ependymoma, one hemangioblastoma, and one cavernoma. MR images were get by 1.5T GE Signa and analized retrospectively.
Intramedullary tumor was demonstrated by MR images in eight patients. They were five men and three women ranging in age from 3 to 56 years and complained both motor and sensory changes and symptom duration was between 6 months and 3 years. Ependymoma showed diffuse homogenous enhancing mass at the level of thoracic cord(T2-3) and thoracolumbar level(T11-L2) without cystic change, One had hemorrhage within the mass and massive leptomeningeal metastasis at all spinal cord and brain. Among astrocystomas, one case at the cervical cord unusually revealed hemorrhage in the mass and regional large syrinx. The other one occured at the conus medullaris portion and showed well-defined mass and intratumoral cystic change. We also experienced rare intramedullary hemangioblastoma, which demonstrated typical signal voided vascular structures revealed homogenous enhancing mass. A very rare intramedullary cavernoma at the level of cervical cord showed typical dark signal hemosiderin rim and variable staged hemorrhage in the mass.
Although, MR imaging appearance of intramedullary tumors is nonspecific, and it is often impossible to differentiate with certainty between the various possible tumors, especially ependymomas and astrucystomas. However, MR findings of hemangioblastoma and cavernoma are specific and possible to diagnose. MR imaging is the unquestioned technique of choice in demonstrating and differentiating the intramedullary tumors.
The concepts of hydrocephalus can be applied at all conditions in which the intracranial volume of the cerebrospinal fluid is abnormally largd in relation to the volume of the brain. Most patients suffering from hydrocephalus has increased significantly with the advent of more sophisticated diagmostic tools sucy as CT, MRI and with rapid technical advances in shunt equipment. Since intracranial pressure is variable parameter depending on the factors as that some shunt complication are related to too much or to little cerebrospinal fluid drainage. In this report, the author analyzes post shunt complications of 46 patients from Jan, 1990 to Dec, 1994.
The rate of post shunt complications was 30% and the most common things were underdrtainage(16%), infction(10%), and shunt malfunction(6%).
The object of this investigation was to study the effects of Naloxone on histopathological changes in cats subjected thoracic cord contusion. Twenty cats were divided 4 groups : The first group was sham control(3 Cats). The second group was the impact group that was induced by T9 cord injury without treatment(6 Cats). The third group was the saline group that was induced by T9 cord injury and treatment with Saline(6 Cats). The fourth group was the Naloxone group that was induced by T9 cord injury and treatment with Naloxone(6 Cats). The histopathological evaluation of the injured spinal cords in Naloxone-treated Cats had less tissue damage than would be observed in time-matched standards. The histopathology in Saline-treated group had slightly better than typical of what we would expect in impact group.
This study was undertaken in order to define the beneficial action of methylprednisolone sodium succinate on the lactate metabolism in injuried spinal cord. The spinal cord was exposed by dorsal laminectomy from L2 to L5 under the operating microscope. A 400gm - cm injury was produced at the L2 vertebral level of the cord. The lactate content peaked at 2 ours of the injury, and remained significantly elevated for 8 hours compared to uninjuried normal cord. The changes of tissue lactate in the spinal cord following injury are consistent with marked reduction in blood flow in the injuried spinal cord tissue following blunt contusion trauma. The elevation in lactate observed at 1 hour, 2 hour and 4 hour after the injury were prevented by intravenous administration of single 30 mg/kg dose of menthylprednisolone at 30 minutes after the injury. The results suggest that the beneficial effect of the intravenous administration of a 30 mg/kg dose of methylprednisolone may improve blood flow to the injuried tissue of spinal cord.
, Dong Been Park, Kyu Man Shin For the purpose of ascertaining the role and magnitude of ischemia of the spin-al cord following trauma the authors determine the lactate concentrations in cere-brospinal fluid(CSF). Laminectomies were performed at L2 under general anes-thesia with aseptic techniques. Paraplegia was produced by 400 gm-cm impact injury with impounder. Significant increases in CSF lactate levels occurring at Day 5. The prolonged elevation of CSF lactate indicates that tissue hypoxia plays a role in spinal cord damage and that there is a continuing hypoxia of metabolically active spinal cord tissue for several days post injury.
, Eun Chi Bang, Eun Ah Yang, Hyun Sook Lee, Yong In Kang, Kyung Sook Cho, Su Yeon Kim To compare the clnical data of general and regional anesthesia for cesarean section in patients with systemic hypertension.
We conducted a retrospective survey with the medical records of the patients with hypertensive disorders in pregnancy, who under went cesarean section from January 1998 to December 2012. We collected data including patients' demographics, anesthesia and maternal and neonatal outcome. According to anesthetic method, the subjects were divided into general anesthesia and regional anesthesia group and the clinical outcome were compared. We reclassified the patients according to the use of magnesium sul fate (MgSO4) and compared the clinical outcomes.
Of the 1,050 hypertensive parturients, 848 (80.8%) patients went through cesarean section. Three hundred and sixty three patients (42.8%) underwent epidural anesthesia, general and spinal anesthesia were used in 268 (31.6%), and 217 (25.6%) patients, respectively. There was no significant difference in maternal and neonatal outcome according to anesthetic method. In the patients administered MgSO4, 1 minute Apgar score was lower and maternal gestational age and birth weight were less than the patients not receiving MgSO4.
Anesthetic methods did not have effect on outcome of cesarean section of the patients with hypertensive disorder of pregnancy.
Citations
, Eun Chi Bang, Dong-Wook Shin, Dae Eun Kweon, Su Yeon Kim, Hyun Sook Lee, Kyung Sook Cho, Su Yeon Lee Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block.
Bupivacaine (0.5%) 9 mg with fentanyl 10 µg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine.
Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn't influence on the onset and level of sensory block and didn't reduce the incidence of hypotension. But onset of hypotension was delayed.
Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.
Spectral analysis of heart rate variability(HRV) resulted in a characteristic power spectrum with two main regions, a high frequency at 0.15-0.5Hz(HFP) corresponding to the parasympathetic system and a low frequency at 0.017-0.l5Hz(LFP) corresponding to both parasympathetic and sympathetic influences. The ratio of low : high frequency(LFP/HFP) has been postulated as an index of sympathetic activation. We propose that the LFP/HFP ratio will provide important information concerning autonomic nervous system activity during spinal anesthesia especially geriatric patients.
LFP, HFP and LFP/HFP were checked in 30 patients at the baseline and 5, 10, 15, 20, 25 and 30 minutes after subarachnoidal block. We divided patients into two groups: group 1 is 15 patients under 60 years old and group 2 is 15 patients over 65 years old, and we compared those parameters in both groups.
Spinal anesthesia did produce a significant decrease in LFP and HFP in both groups. But sympathetic-parasympathetic balance(LFP/HFP) increased at 5 minutes after spinal block. In group 1, LFP/HFP decreased at 10 minutes after spinal block, thereafter increased gradually. In group 2, LFP/HFP decreased at 10, 15 and 20 minutes and increased at 25 and 30 minutes after spinal block.
These data suggest that autonomic tone decreased with spinal anesthesia and sympathetic-parasympathetic balance decreased for a long time in geriatric patients.
Spinal stenosis is one of the degenerative diseases of spine, and frequently involves several segments. However, symptom may be provided by pathology in only one or two segments. Therefore, it is very important to select symptomatic segments when we treat patients with multilevel stenosis surgically. Decompression may be done limitedly to prevent high morbidity and complications associated with extensive decompression and posterolateral fusion. The purpose of this study is to evaluate the effectiveness of limited decompression of selective segments in spinal stenosis. From September, 1993 to August, 1996, 21 patients who underwent limited decompression of only symptomatic segments, were followed up for more than 1 ysar, and the results were assessed according to the criteria of Kim & Kim. The indications of surgery were definite neurologic symptoms, failure of conservative treatments, and no instability. The segments for operation were chosen by symptom, physical examination and radiographic study, and sometimes root block or electromyography were done in case of necessity. The results were followed as: 4 excellent(19%), 13 good(62%), 3 fair(14%), and 1 poor(5%). 1 superficial wound infection developed and was treated without suquelae. Conclusively, limited decompression of selective segments in multilevel spinal stenosis is considered to be useful if selection of level and extent of decomperssion are carefully determined.
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