Chul Hee Lee

Neurological deterioration, headache, vomiting, bradycardia, or hypertension after emergent percutaneous coronary intervention should prompt immediate brain imaging. When subarachnoid hemorrhage is detected shortly after coronary stenting, the hemorrhage onset may remain uncertain, and antiplatelet decisions require individualized multidisciplinary assessment.

Purpose: We report a rare case of deep vein thrombosis and pulmonary embolism that occurred following 2 weeks in the prone position after a trans pars plana vitrectomy with gas tamponade to treat rhegmatogenous retinal detachment. Case Summary: A 49-year-old man without a remarkable medical history visited our clinic complaining of gradual vision loss on the inferior side of the left eye. In fundus examinations, rhegmatogenous retinal detachment involving the macula with multiple tears was noted. After trans pars plana vitrectomy with gas tamponade, the patient was encouraged to maintain a prone position for retinal reattachment. However, after 2 weeks in the prone position, he complained of right calf pain and swelling. The department of cardiovascular surgery was consulted immediately and deep vein thrombosis and pulmonary embolism were diagnosed. After deep vein thrombectomy and anticoagulation therapy, the lower extremity symptoms improved and the patient was stable during follow-up with a well attached retina. Conclusions: When prolonged prone positioning after retina surgery is necessary, careful monitoring for the possibility of deep vein thrombosis and pulmonary embolism is required, especially in high-risk patients.

Roll-over protective structures (ROPS) are essential safety features for excavators, particularly when operating on slopes. The load testing of ROPS systems for certification is mandated by ISO 12117-2 requirements. However, hydraulic excavators' attachments affect the required performance capability of the ROPS, making the evaluation process complex. This study presents a methodology for evaluating the strength of hydraulic excavator ROPS using numerical analysis. Nonlinear finite element analysis using ABAQUS is performed to assess the safety of the ROPS according to ISO standards, reducing time and costs by minimising the number of physical tests required. The structural strength analysis of the ROPS involves nonlinear contact, buckling, and large deformation, solved through quasi-static analysis and penalty method. Lateral, longitudinal, and vertical loads are performed, and the results show a good correlation between finite element analysis and bench test results. The study validates the FEA methodology for hydraulic excavator ROPS and provides a framework for performing strength tests on protective structures using numerical analysis methods.

Objective: In recent years, the number of cases of unruptured intracranial aneurysms in older patients has been increasing, but the best treatment remains a matter of debate. This study aimed to compare the treatment methods for unruptured intracranial aneurysms in patients aged 65 years and older.Methods: A retrospective review was conducted of data from unruptured intracranial aneurysms treated with surgical clipping or endovascular coiling between 2004 and 2019. Clinical and imaging information was collected. The treatment methods, procedure-related complications, and imaging and clinical results were analyzed. Data were assessed through a comparative analysis of underlying diseases (diabetes mellitus, hypertension, and hypercholesterolemia), smoking and alcohol use history, the location and size of the aneurysms for patients who received each treatment, and complications that occurred after each treatment.Results: Of 211 patients over the age of 65, 71 were treated with clipping and 140 with coiling. The complications that occurred immediately after treatment included postoperative hemorrhage (subarachnoid hemorrhage, intracerebral hemorrhage, intraventricular hemorrhage), chronic subdural hemorrhage, infection, and puncture site infection. Postoperative computed tomography images of the clipping sites had four times more opacity than those of coil embolization, but the outcomes (Glasgow outcome scores) showed no significant differences between clipping and coil embolization.Conclusion: Coil embolization and clipping are safe and effective treatment methods for unruptured intracranial aneurysms in elderly patients. Thus, the active treatment of unruptured intracranial aneurysms, which are likely to be retrofitted, should be considered.

Won D, et al. Korean J Neurotrauma. 2019 Jul;15:e27. https://doi.org/10.13004/kjnt.2019.15.e27

Kim J, et al. Korean J Neurotrauma. 2019 Jul;15:e24. https://doi.org/10.13004/kjnt.2019.15.e24