Tae Seok Jeong

Association between the daily temperature range and occurrence of spontaneous intracerebral hemorrhage.

Objective We have observed, anecdotally, that the incidence of primary spontaneous intracerebral hemorrhage (sICH), as well as spontaneous subarachnoid hemorrhage, varies in accordance with seasonality and meteorological conditions. This retrospective single-hospital-based study aimed to determine the seasonality of sICH and the associations, if any, between the occurrence of sICH and meteorological parameters in Incheon city, which is a northwestern area of South Korea. Methods Electronic hospital data on 708 consecutive patients admitted with primary sICH from January 2008 to December 2010 was reviewed. Traumatic and various secondary forms of ICHs were excluded. Average monthly admission numbers of sICH were analyzed, in relation with the local temperature, atmospheric pressure, humidity, and daily temperature range data. The relationships between the daily values of each parameter and daily admission numbers of sICH were investigated using a combination of correlation and time-series analyses. Results No seasonal trend was observed in sICH-related admissions during the study period. Furthermore, no statistically significant correlation was detected between the daily sICH admission numbers and the meteorological parameters of temperature, atmospheric pressure and humidity. The daily temperature range tended to correlate with the number of daily sICH-related admissions (p = 0.097). Conclusion This study represents a comprehensive investigation of the association between various meteorological parameters and occurrence of spontaneous ICH. The results suggest that the daily temperature range may influence the risk of sICH.

Factors related to the development of shunt-dependent hydrocephalus following subarachnoid hemorrhage in the elderly

AIMnSurgical procedures for aneurysmal subarachnoid hemorrhage (SAH) are increasing among the elderly as the population ages. Chronic shunt-dependent hydrocephalus is a recognized complication of SAH. The aim of this study was to identify predictive factors for the development of shunt-dependent hydrocephalus among elderly patients with SAH.nnnMATERIAL AND METHODSnWe retrospectively studied 878 patients, including 275 patients ? 65 years old, with SAH treated between 2005 and 2015 to identify factors contributing to the development of shunt-dependent hydrocephalus. The relationships between shunt-dependent hydrocephalus and the causative factors were analyzed using univariate and multivariate analysis; the causative factors were based on the results of previous studies.nnnRESULTSnIn the 878 patients with SAH, there was a significant difference in the incidence of shunt-dependent hydrocephalus between patients < 65 years old and those ? 65 years old (p=0.021). In the 275 patients ? 65 years old, the following were associated with shunt-dependent hydrocephalus on univariate analysis: 1) Hunt and Hess grade (p=0.005), 2) Fisher grade (p < 0.001), 3) intraventricular hemorrhage (p < 0.001), 4) acute hydrocephalus (p=0.003), 5) aneurysm location (p=0.001), and 6) external ventricular drain placement (p < 0.001). On multivariate analysis, only 1) intraventricular hemorrhage (p < 0.001) and 2) a ruptured aneurysm located in the distal posterior circulation (p=0.014) were related to an increased risk for the development of shunt-dependent hydrocephalus.nnnCONCLUSIONnEvaluating risk factors can help identify patients at high risk of developing shunt-dependent hydrocephalus. Identifying these risk factors may help neurosurgeons to provide optimal therapy and improve outcomes in patients with SAH.

Identification of Missing Proteins in Human Olfactory Epithelial Tissue by Liquid Chromatography–Tandem Mass Spectrometry

We performed proteomic analyses of human olfactory epithelial tissue to identify missing proteins using liquid chromatography-tandem mass spectrometry. Using a next-generation proteomic pipeline with a < 1.0% false discovery rate at the peptide and protein levels, we identified 3731 proteins, among which five were missing proteins (P0C7M7, P46721, P59826, Q658L1, and Q8N434). We validated the identified missing proteins using the corresponding synthetic peptides. No olfactory receptor (OR) proteins were detected in olfactory tissue, suggesting that detection of ORs would be very difficult. We also identified 49 and 50 alternative splicing variants mapped at the neXtProt and GENCODE databases, respectively, and 2000 additional single amino acid variants. This data set is available at the ProteomeXchange consortium via PRIDE repository (PXD010025).

Predictive Values of Magnetic Resonance Imaging Features for Tracheostomy in Traumatic Cervical Spinal Cord Injury

Objective To evaluate the magnetic resonance (MR) imaging features that have a statistically significant association with the need for a tracheostomy in patients with cervical spinal cord injury (SCI) during the acute stage of injury. Methods This study retrospectively reviewed the clinical data of 130 patients with cervical SCI. We analyzed the factors believed to increase the risk of requiring a tracheostomy, including the severity of SCI, the level of injury as determined by radiological assessment, three quantitative MR imaging parameters, and eleven qualitative MR imaging parameters. Results Significant differences between the non-tracheostomy and tracheostomy groups were determined by the following five factors on multivariate analysis : complete SCI (p=0.007), the radiological level of C5 and above (p=0.038), maximum canal compromise (MCC) (p=0.010), lesion length (p=0.022), and osteophyte formation (p=0.015). For the MCC, the cut-off value was 46%, and the risk of requiring a tracheostomy was three times higher at an interval between 50–60% and ten times higher between 60–70%. For lesion length, the cut-off value was 20 mm, and the risk of requiring a tracheostomy was two times higher at an interval between 20–30 mm and fourteen times higher between 40–50 mm. Conclusion The American Spinal Injury Association grade A, a radiological injury level of C5 and above, an MCC ≥50%, a lesion length ≥20 mm, and osteophyte formation at the level of injury were considered to be predictive values for requiring tracheostomy intervention in patients with cervical SCI.

Prospective Multicenter Surveillance Study of Surgical Site Infection after Spinal Surgery in Korea : A Preliminary Study

Objective This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following spinal surgery using data from a Korean SSI surveillance system that included diagnoses made by surgeons. Methods This was a prospective observational study of patients who underwent spinal surgeries at 42 hospitals in South Korea from January 2017 to December 2017. The procedures included spinal fusion, laminectomy, discectomy, and corpectomy. Univariate and multivariate logistic regression analyses were performed. Results Of the 3080 cases included, 30 showed infection, and the overall SSI rate was 1.0% (an incidence of 1.2% in spinal fusion and 0.6% in laminectomy). Deep incisional infections were the most common type of SSIs (46.7%). Gram-positive bacteria caused 80% of the infections, and coagulase-negative staphylococci, including Staphylococcus epidermidis, accounted for 58% of the grampositive bacteria. A longer preoperative hospital stay was significantly associated with the incidence of SSI after both spinal fusion and laminectomy (p=0.013, p<0.001). A combined operation also was associated with SSI after laminectomy (p=0.032). Conclusion An SSI surveillance system is important for the accurate analysis of SSI. The incidence of SSI after spinal surgery assessed by a national surveillance system was 1.0%. Additional data collection will be needed in future studies to analyze SSI in spinal surgery.

Prospective Multicenter Surveillance Study of Surgical Site Infection after Intracranial Procedures in Korea : A Preliminary Study

Objective This study aimed to investigate the rates, types, and risk factors of surgical site infection (SSI) following intracranial neurosurgical procedures evaluated by a Korean SSI surveillance system. Methods This was a prospective observational study of patients who underwent neurosurgical procedures at 29 hospitals in South Korea from January 2017 to June 2017. The procedures included craniectomy, craniotomy, cranioplasty, burr hole, and ventriculoperitoneal shunt. Univariate and multivariate logistic regression analyses were performed. Results Of the 1576 cases included, 30 showed infection, for an overall SSI rate of 1.9%. Organ/space infection was the most common, found in 21 out of the 30 cases (70%). Staphylococcus aureus was the most common (41%) of all bacteria, and Serratia marcescens (12%) was the most common among gram-negative bacteria. In univariate analyses, the p-values for age, preoperative hospital stay duration, and over T-hour were <0.2. In a multivariate analysis of these variables, only preoperative hospital stay was significantly associated with the incidence of SSI (p<0.001), whereas age and over T-hour showed a tendency to increase the risk of SSI (p=0.09 and 0.06). Conclusion Surveillance systems play important roles in the accurate analysis of SSI. The incidence of SSI after neurosurgical procedures assessed by a national surveillance system was 1.9%. Future studies will provide clinically useful results for SSI when data are accumulated.

Malignant melanotic schwannoma of the vertebral body in a patient with Carney complex

Melanotic schwannoma is a rare variant of schwannoma that is capable of melanogenesis. Most melanotic schwannomas are usually benign, but the malignant type tends to metastasize. Nerve roots are the most frequent sites, but melanotic schwannoma arising from the vertebral body is extremely rare. Melanotic schwannomas are frequently associated with Carney complex, which is a disease with distinguishing features such as myxomas, spotty pigmentation, and endocrine overactivity. We report a case of malignant melanotic schwannoma of the vertebral body in a 33-year-old man with Carney complex. For the vertebral bodies of C5, Th12, and L1, surgery including corpectomy and fusion was carried out, and radiotherapy and chemotherapy were performed for regrowth and lung metastasis of the tumor. However, he died 8 months after surgery because of worsening of his respiratory condition. In this report, we also discuss features and outcomes of melanotic schwannoma based on the literature review.

Malignant Transformation of Craniopharyngioma without Radiation Therapy: Case Report and Review of the Literature

Craniopharyngiomas exhibiting histologic malignancy are extremely rare. Herein, we report the case of a 26-year-old male patient who underwent suprasellar mass excision via an interhemispheric transcallosal approach. Histopathological examination indicated that the craniopharyngioma was of the adamantinomatous subtype. The patient received postoperative medical treatment for endocrine dysfunction and diabetes mellitus without radiation treatment. Two years after the operation, he presented with progressive visual disturbance and altered mentality. Magnetic resonance imaging revealed a huge mass in the suprasellar cistern and third ventricle. He underwent a second operation via the same approach. The histopathological examination showed an adamantinomatous craniopharyngioma with sheets of solid proliferation in a spindled pattern, indicating malignant transformation. Malignant transformation of craniopharyngioma in the absence of radiation therapy has been reported in only five cases, including this one. We present a case of malignant transformation of craniopharyngioma with a brief review of relevant literature.