Bacteria detected after instrumentation surgery for pyogenic vertebral osteomyelitis in a canine model

Objective

This study was designed to identify the presence, type and origin of bacteria adjacent to the metal implant in the infected region in a canine model of pyogenic vertebral osteomyelitis treated with single-stage anterior autogenous bone grafting and instrumentation.

Methods

Dogs with pyogenic spondylodiscitis underwent one-stage debridement, autogenous bone grafting and titanium plate instrumentation and perioperative antibiotic therapy. The implants and adjacent vertebral bones were removed surgically at various postoperative time points (4, 8, 12 and 24 weeks) for bacteria detection. Bacteria were detected from retrieved spinal implants as well as surrounding bones by culture and/or pyrosequencing methods in 17 (85 %) of all 20 animals. The positive rate for bacteria presence was 45 % by culture and 80 % by pyrosequencing method.

Results

Radiological or macroscopic examination showed no signs for infection recurrence in any animal regardless of bacteria presence at the surgical site. However, organism identical with the causative bacterium for spinal infection was found in only two of nine culture-positive animals.

Conclusion

Within the confines of the study, the use of metallic implants in an infected area did not lead to a clinically relevant infection although bacteria may exist at the surgical site. The use of metallic implants in an infected area of the spine is safe. The metallic implants may not be the “culprit” for the persistence or recurrence of infection.     

1对患Axenfeld-Riger综合征双胞胎病人的治疗和护理

Axenfeld-Riger综合征是以双眼发育性缺陷,伴有或不伴有全身发育异常为特点的一组发育性疾病,表现为双眼发育性缺陷,继发性青光眼,可伴有全身发育异常,多为牙骨和面骨异常,为常染色体的显性遗传,多有家族史,男女相同[1].临床特点表现为:双眼发病, 视力减退,角膜后胚胎环,前房角异常,虹膜角膜粘连,虹膜发育异常,无瞳,瞳孔异位,多瞳等.我科于2006年7月收治了1对患有Axenfeld-Riger综合征的双胞胎姐妹病人,现将治疗和护理报告如下.     

Changing name of epilepsy in Korea; cerebroelectric disorder (noi‐jeon‐jeung,뇌전증,腦電症)

Public misconception of epilepsy may lead to significant stigma to the disease itself, thereby causing impaired quality of life in people with epilepsy. Traditionally, epilepsy has been considered to be the consequence of evanescent spiritual forces, and even demonic possession (in many countries). The names of epilepsy in some East Asian countries originated from China, and include madness in their meaning. We recently changed the Korean name of epilepsy, gan‐jil (??, 癎疾: a crazy, convulsive disease having meaning similar to 癲癎), to a neutral and scientifically explainable name: noi‐jeon‐jeung (???; 腦電症; cerebroelectric disorder). We expect that changing the stigmatized name of epilepsy to a neutral and scientific term with the meaning of cerebroelectric disorder will reduce the social stigma by understanding of epilepsy as one of the neurologic disorders.     

Weekend catch-up sleep is independently associated with suicide attempts and self-injury in Korean adolescents

The current study aims to determine the associations of insufficient sleep with suicide attempts and self-injury in a large, school-based Korean adolescent sample.     

Hashimoto’s encephalopathy: South Korean experiences

Hashimoto’s encephalopathy (HE) is a rare neurological disorder. Early diagnosis and treatment are critical to prevent irreversible brain damage. In the present study, we aimed to describe and classify HE on the basis of clinical, neuroimaging, and EEG findings. We retrospectively reviewed the clinical, radiological, and electrophysiological findings in patients who showed both neurological symptoms and high titers of anti-thyroid antibodies, and who were admitted between 2006 and 2012. Our patients were classified into two groups: those presenting seizures (group 1) and those with diffuse encephalopathies (group 2). Group 1 contained two patients. Patient 1, who showed verbal memory disturbance, focal MRI lesions, and partial seizure activity on EEG, recovered with antiepileptic and steroid treatments. Five of six patients assigned to group 2 were treated with steroids and showed significant improvement. One patient treated with azathioprine showed moderate improvement. Four of these patients had accompanying metabolic disturbances. HE is a treatable neurologic disorder with different subtypes, each with its own clinical manifestations and treatment options. HE can be difficult to identify and requires careful and attentive clinical observation for diagnosis.     

Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.     

Immunohistochemical analysis of cyclooxygenase‐2 and brain fatty acid binding protein expression in grades I‐II meningiomas: Correlation with tumor grade and clinical outcome after radiotherapy

This study was done to evaluate the association of cyclooxygenase 2 (COX‐2) and brain fatty acid binding protein (BFABP) with tumor grade and outcome of grades I‐II meningiomas treated with radiotherapy. From 1996 to 2008, 40 patients with intracranial grades I‐II meningiomas were treated with radiotherapy. Immunohistochemical staining for COX‐2 and BFABP were performed on formalin‐fixed paraffin‐embedded tissues. COX‐2 expression was significantly associated with BFABP status and both COX‐2 (P < 0.01) and BFABP (P = 0.01) expression were stronger in the grade II meningiomas than in grade I tumors. Among the clinicopathologic factors, age and COX‐2 status were prognostic in progression‐free survival. Patients with moderate or strong COX‐2 expression had worse outcome than those with negative or weak COX‐2 expression (P = 0.03) after controlling for potential confounders. Our results suggest that the molecular biomarker COX‐2 has prognostic significance in intracranial grades I‐II meningiomas following radiotherapy.