No abstract available.
Epilepsy* ; Occipital Lobe* ; Rabeprazole*

BACKGROUND: Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. METHODS: Twenty MIDCAB patients were randomly allocated into two groups, group E (n = 10) receiving esmolol 0.3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4). Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of < 0.05. RESULTS: Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. CONCLUSION: Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique.
Anesthesia* ; Blood Pressure ; Bradycardia* ; Central Venous Pressure ; Coronary Artery Bypass ; Heart Rate ; Hemodynamics ; Humans ; Hypotension* ; Myocardial Ischemia ; Neostigmine* ; Oxygen Consumption ; Pulmonary Wedge Pressure ; Transplants

Hemangiopericytomas is a rare malignant tumor of the central nervous system having an incidence of 1-3.8% of all primary intracranial meningeal tumors, and the occurrence of cystic hemangiopericytomas is even rarer. We report our recent experience of a case of cerebral hemangiopericytoma associated with a large cyst in a 38 year-old man. The patient presented with 1-month history of headache. Computerized tomography(CT) and magnetic resonance image(MRI) showed a huge-sized, cystic tumor in the left frontal region. Histopathological report of the excised tumor confirmed cystic hemangiopericytoma. Over the years, the issue of classifying hemangiopericytoma as a form of meningioma has been controversial. Since hemangiopericytoma differs from that of ordinary meningiomas because of its extremely malignant behavior and different histological and ultrastructural properties, the author suggest that hemangiopericytoma classified not with meningiomas. Regardless of classification, total surgical removal of this tumor is crucial due to its tendency for local recurrence despite aggressive resection.
Adult ; Central Nervous System ; Classification ; Headache ; Hemangiopericytoma* ; Humans ; Incidence ; Meningeal Neoplasms ; Meningioma ; Recurrence

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.
Balloon Occlusion ; Carotid Artery, Internal ; Fistula* ; Humans ; Ligation ; Veins

To provide a guideline of accurate diagnosis and proper methods of treatment of meningioma, the most common benign intracranial tumor, the author studied 57 cases of meningioma who had been diagnosed and operated at the Department of Neurosurgery, Inje Medical College, Paik Hospital, Pusan from July, 1983 to June, 1988. The results were as followings. 1) The ratio of male to female was 1 to 2.2 and 31.6% of the 57 patients were in the 5 th decade of age and 29.8% in the 6 th decade. 2) The predilection sites were parasagittal and falx(33.3%), convexity(26.3%) and sphenoid ridge (21.1%) areas. The most frequent histological type was meningotheliomatous type(47.4%) which was followed by transitional(15.8%) and fibroblastic(10.5%) type. 3) The common initial clinical features were headache(29.3%), visual disturbance(24.6%), seizure(22.8%) and motor weakness(10.5%). In radiologic diagnostic tests, there were abnormal findings in 47.4% on plain skull X-ray, the possibility of diagnosis as the meningioma was 91.2% by means of brain CT scan only, which was regarded as the most accurate and safe method. 4) The extent of operation were total(84.2%), subtotoal(12.3%) and partial(3.5%) removal, The surgical outcome were excellent(49.1%) and good(29.8%). 5) The preoperative embolization of feeding artery was effective to reduce the operative bleeding, and the CO2 laser was thought to be effective surgical tool to remove the meningioma, with its unique properties of non-mechanical bloodless evaporation of tumor and minimalizing of brain edema.
Arteries ; Brain ; Brain Edema ; Busan ; Diagnosis ; Diagnostic Tests, Routine ; Female ; Hemorrhage ; Humans ; Lasers, Gas ; Male ; Meningioma* ; Neurosurgery ; Skull ; Tomography, X-Ray Computed

The authors are reporting traumatic giant aneurysm arising from supraclinoid portion of internal carotid artery. The patients was a 22-years old man who had suffered a major head injury in a traffic accident. On admission he was comatous and there were multiple abrasion over the body and severe hemorrhage comming from the left ear with open fracture in left parietal. 4 weeks later, computed tomographic scan demonstrated large well enhanced mass in the suprasellar region. Carotid angiography showed giant aneurysm fed by supraclinoid portion of internal carotid artery. After frontotemporal craniectomy, direct approach was performed using surgical microscope.
Accidents, Traffic ; Aneurysm* ; Angiography ; Carotid Artery, Internal ; Craniocerebral Trauma ; Ear ; Fractures, Open ; Hemorrhage ; Humans ; Rabeprazole ; Young Adult

A case of Moya-Moya disease with AVM is reported. It is well known that Moya-Moya disease sometimes is accompanied by cerebral aneurysm. However, only four case of Moya-Moya disease with AVM have previously been published in the world. A 36-year-old women suffered from sudden onset of mental deterioration & left hemiparesis, Brain CT scan showed intraventricular hemorrage in both lateral & 3rd ventricle. Enhanced CT scan revealed irregular enhancing area in the right posterior parietal cortex. Cerebral angiography showed an arteriovenous malformation fed by basal Moya-Moya vessels & posterior meningeal artery. Emergeny external ventricular drainge was done. 2 weeks later, the patient had operation for excision of AVM & encephalomyosynangiosis.
Adult ; Arteriovenous Malformations* ; Brain ; Cerebral Angiography ; Female ; Humans ; Intracranial Aneurysm ; Meningeal Arteries ; Moyamoya Disease* ; Paresis ; Rabeprazole ; Tomography, X-Ray Computed

The reports of the association of cerebral aneurysm and brain tumor are rare. Recently, we experienced five cases of association of cerebral aneurysm and bain tumor and available literature were reviewed. Of five cases of brain tumor, there were two cases of meningioma, two cases of pituitary adenoma and a case of malignant glioma. Vascular clips were used for aneurysm obliteration in three cases, coating was in a case and four cases of them had favorable outcome. The association of cerebral aneurysm and brain tumor had difficult problems in treatment such as brain swelling and hemorrhage from the aneurysm after removal of tumor.
Aneurysm ; Brain Edema ; Brain Neoplasms* ; Brain* ; Glioma ; Hemorrhage ; Intracranial Aneurysm* ; Meningioma ; Pituitary Neoplasms

The incidence of intracranal aneurysm is rare in childhood and adolescence. During the period from January 1982 through December 1989, 793 aneurysms were operated on the our department. Of these 8 aneurysms occurred 8 patients under age of 18 years. The average age was 11.6 years(range 4 to 18 years). There were 6 male and 2 females. Presenting sings and symptoms included SAH in 6 aneurysms and focal neurologic deficits in 2 aneurysms. All aneurysms were surgically treated : direct clipping was performed in 6, aneurysmorraphy in 1, trapping alone in 1. The postoperative result were excellent in 5, good in 2, and fair in 1. The rarity of such lesions in childhood and adolescence and their pathogenesis are reviewed briefly.
Adolescent* ; Aneurysm ; Female ; Humans ; Incidence ; Intracranial Aneurysm* ; Male ; Neurologic Manifestations

The authors reported the cases of 23 patients with aneurysms measuring 2.5 cm or greater in diameter found during 7 years period in which we performed 596 operations for aneurysm of the 23 patients, 14 were treated by direct operation, 3 by internal carotid ligation with or without bypass surgery, 2 by trapping, 1 by wrapping and the other 3 by conservative therapy. The overall incidence of giant aneurysms was 3.9% but varied according to location; 9 cases were located on the internal carotid artery; 8 were on the anterior communicating artery; 5 were on the middle cerebral artery. 14 patients had hemorrhagic attacks, 7 had mass effects from the aneurysm, and 2 had ischemic events. Overall favorable outcome was 65% and the mortality was 13%. Based on the review of the literature, the appropriateness of surgery and surgical methods are discussed.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Humans ; Incidence ; Intracranial Aneurysm* ; Ligation ; Middle Cerebral Artery ; Mortality