OBJECTIVE: The purpose of this paper is to report our experiences in managing seventeen cases of residual intracranial aneurysms following surgical or endovascular treatment and discuss the incidence of residual aneurysms, the indications and technique of retreatment of residual aneurysms. METHODS: During a period of 42 months, we treated 391 aneurysms in 339 patients with microsurgical clipping or GDC embolization as a primary treatment. In 39 of them, follow-up angiography revealed residual aneurysms and seventeen of whom were retreated. There were eleven cases in ACoA, three cases in distal ICA, one, in each of MCA, ACA and basilar artery. We reviewed retrospectively the clinical notes, operation records and cerebral angiograms of seventeen patients who had been treated for residual aneurysms. RESULTS: Complementary treatment was performed in 8 cases by means of surgery and in 9 cases by means of GDC embolization. There were eleven females and six males with an age variation between 29 and 78 years. The mean duration of angiographic follow-up was 17.3 months. Of the seventeen cases that were treated for residual aneurysms, fourteen achieved complete occlusion. Of 17 retreated patients, fifteen patients had good recovery according to the Glasgow Outcome Scale. CONCLUSION: When occlusion after endovascular or surgical treatment is incomplete, a new multidisciplinary approach should be carried out. Given our experiences, we recommend coil embolization of the choice in cases that the residual aneurysmal neck had been narrowed by previous clipping. On the other hand, if the residual aneurysm has enough space to clip but not enough to coil, we recommend the microsurgical clipping.
Aneurysm ; Angiography ; Basilar Artery ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Glasgow Outcome Scale ; Hand ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Neck ; Retreatment ; Retrospective Studies

BACKGROUND: The aims of this study were to assess the etiologies, survival and prognositic factors of patients with chronic cor pulmonale visited Pusan National University Hospital. METHODS: This study included 103 patients with chronic cor pulmonale. There were 67 men and 36 women. The diagnosis of chronic cor pulmonale was primarily based on the presence of underlying lung disorder and echocardiographic finding of enlarged or hypertrophied right ventricle. Other clinical data including patients' symptoms and signs, findings of arterial blood gas analysis, hematologic and biochemical laboratory and pulmonary function test were assessed. RESULTS: The most common underlying lung disorder was pulmonary tuberculosis (59.2%) and chronic obstructive pulmonary disease was the next (28.2%). The survival rate was 57% in one year, 45% in two years, and 34% in three years. The prognostic factors were maximal voluntary ventilation(MVV), forced vital capacity(FVC), FEV1, serum Na, vital capacity(VC), serum albumin and peak expiratory flow(PEF) in univariate analysis. And in multivariate analysis, serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant. CONCLUSION: Pulmonary tuberculosis was the most important underlying lung disorder in chronic cor pulmonale. The survival rate was 57% in one year, 45% in two years, and 34% in three years. Serum albumin(p=0.0144) and VC(p=0.0078) were statistically significant prognostic factors.
Blood Gas Analysis ; Busan ; Diagnosis ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Lung ; Male ; Multivariate Analysis ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Heart Disease* ; Respiratory Function Tests ; Serum Albumin ; Survival Rate ; Tuberculosis, Pulmonary

BACKGROUND: The patients with mitral stenosis are generally accompanied with impaired pulmonary function. The aim of this study was to evaluate the changes of pulmonary function after percutaneous mitral balloon valvuloplasty (PMV) in that patients. METHODS: PMV was performed in 36 patients with mitral stenosis in Pusan National University Hospital and hemodynamic, echocardiographic and pulmonary function test data before and after PMV were analyzed. RESULT: After PMV, NYHA functional class was improved from 2.2+/-0.6 to 1.2+/-0.4 (p<0.001). The mean left atrial pressure and mean pulmonary arterial pressure significantly decreased from 14.5+/-6.2 mmHg to 5.7+/-4.4 mmHg(p<0.001) and from 25.3+/-10.9 mmHg to 15.5+/-7.4 mmHg (p<0.001), respectively. Cardiac output was slightly decreased from 5.34+/-1.31 L/min to 5.28+/-1.25 L/min (p=0.50). Mean mitral pressure gradient decreased from 13.5+/-5.8 mmHg to 4.4+/-2.1 mmHg (p<0.001) and mitral valvular area significantly increased from 0.86+/-0.19 cm2 to 1.71+/-0.28 cm2 (p<0.001). In pulmonary function test, only MVV and PEF was significantly improved from 77.2+/-23.8% to 88.4+/-27.9% (p<0.01) and 87.1+/-26.8% to 97.5+/-26.4% (p<0.01), respectively. But, VC, FEV1, FEF25-75% and FVC were not changed significantly. In exercise treadmil test, exercise duration was significantly improved from 482.0+/-266.2 sec to 718.0+/-287.5 sec (p<0.001). CONCLUSION: We observed the results of better hemodynamic changes and exercise capacity after PMV. But, there was no significant improvement in pulmonary function after PMV. In our opinion, irreversible pulmonary changes and hemodynamic effect on pulmonary function should be considered.
Arterial Pressure ; Atrial Pressure ; Balloon Valvuloplasty* ; Busan ; Cardiac Output ; Echocardiography ; Exercise Test ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Respiratory Function Tests