Acute cerebral embolism continues to be a major cause of stroke morbidity in children and young adults. A variety of drugs including steroids, dextran, barbiturates, and anticoagulants are used in the management of cerebral ischemia, despite controversy over their benefits in clinical and experimental situations. The operative treatment includes microsurgical cerebral embolectomy and cerebral revascularization. Middle cerebral artery embolectomies which have been carried out in human with variable results, have been reported by different authors. In order to define a time limit for cerebral embolectomies before irreversible brain damage has been incurred, the canine middle cerebral artery was embolized by means of a gutta percha cylinder, 4 mm long by 1.5 mm in diameter, via the internal carotid artery. It was observed that embolectomy of the middle cerebral artery performed between 4 and 5 hours postembolism could prevent the expected cerebral infarction effectually. Middle cerebral artery embolectomy beyond 5-hour periods invariably resulted in severe hemorrhagic infarction with concomitant neurological impairment.
Anticoagulants ; Barbiturates ; Brain ; Brain Ischemia ; Carotid Artery, Internal ; Cerebral Infarction ; Cerebral Revascularization ; Child ; Dextrans ; Embolectomy* ; Gutta-Percha ; Humans ; Infarction ; Intracranial Embolism ; Middle Cerebral Artery ; Steroids ; Stroke ; Young Adult

The authors report 2 cases of pseudotumor cerebri in which ventriculoperitoneal shunting procedures have been performed to relieve intracranial hypertensions, and satisfactory results have been obtained.
Pseudotumor Cerebri* ; Ventriculoperitoneal Shunt*

This report is made to investigate clinical outcome in 144 patients with severe head injuries. The result was as follows: 18% made a good recovery, 25% were moderately disabled, 11% were left vegetative, and 44% died. The outcome from severe head injuries seemed to become worse with advancing age. It was observed that the prognosis for head injury in general worsens in the group older than 30 years and the apparent increased morbidity and mortality with a surgical hematoma relate more to age than to the presence of the hematoma.
Craniocerebral Trauma* ; Head* ; Hematoma ; Humans ; Mortality ; Prognosis

There is a current tendency to believe that malignant melanoma originate from epidermal melanocyte rather than from pigmented cell of the upper dermis. Approximately 15% of all malignant melanoma in the body occur in head and neck regions. The majority of the patients were in the sixth & seventh decade. A case of malignant melanoma in the occipital region in a 2-year-old girl is reported. Physical and X-ray studies showed a large brownish pigmented mass with ulcerated surface and small bony defect in the occipital region.
Child, Preschool ; Dermis ; Female ; Head ; Humans ; Melanocytes ; Melanoma* ; Neck ; Ulcer

In 1976 Ramanathan et al introduced a unilimb circle circuit connecting the CO2, absorber and dome valve. A coaxial breathing circuit, Mera F Type breathing circuit, is very light in weight, compact and it can be made any length. This circuit can be used as a circle system, rebreathing or non-rebreathing system and it can be applicable to both pediatric and adult anesthesia. This circuit is easily adaptable to humidification and pollution control devices. It is especially suitable for any kind of surgical procedures including head, neck and others requiring any awkward positions. A clinical study of this circuit was done in 30 cases and compaired with 18 cases using the coventional circuit. Fresh gas flow, tidal volume and respiratory rate were 4 L/min(02:2 L/min., N2O:2L/min.),10 ml/kg and 12-14/min respectively. Controlled ventilation using a volume preset ventilator was used in all cases. After induction, radial artery cannulation with a 20 G angiocatheter was done and blood gas analysis was performed at 30, 60 and 90 minutes respectively. The blood gas analysis was found satisfactory in either the conventional or the Mera F circuit system.
Adult ; Anesthesia* ; Blood Gas Analysis ; Catheterization ; Head ; Humans ; Neck ; Radial Artery ; Respiration* ; Respiratory Rate ; Tidal Volume ; Ventilation ; Ventilators, Mechanical

The authors report a case of intradural schwannoma of the cauda equina that was totally removed by microsurgical operation.
Cauda Equina ; Neurilemmoma*

The authors report a case of intradural schwannoma of the cauda equina that was totally removed by microsurgical operation.
Cauda Equina ; Neurilemmoma*

During orthotopic liver transplantation (OLT), changes of hemodynamic, electrolytes and acid-base balance are frequently occurred. These changes may influence mortality and prognosis during and after surgery. The purpose of this study was to observe and evaluate the changes of hemodynamics and electrolytes occurring in 14 cases canine OLT. After insertion of endotracheal tube, anesthesia was maintained with 1%enflurane and pancuronium bromide. Swan-Ganz catheter(7.5 Fr.) was inserted into right external jugular vein and 20 gauge angiocatheter was also inserted into left femoral artery. Complete hemodynamic variables and electrolytes were measured 30 minutes after skin incision, anhepatic stage, 5 minutes before reperfusion, 5 and 30 minutes after reperfusion. The results were as follows; On reperfusion of grafted liver, 9 cases(64%) showed postreperfusion syndrome. In 9 cases showing Postreperfusion syndrome, cardiac output, systemic vascular resistance, mean pulmonary arterial pressure were decreased and serum potassium concentration was increased on reperfusion, but there were no significant changes in central venous pressure, pulmonary capillary wedge pressure, heart rate, body temperature and serum ionized calcium concentration when comparing with before reperfusion. Decreased mean arterial pressure during reperfusion in postreperfusion syndrome might be speculated through decrease of myocardial contractility and systemic vascular resistance.
Acid-Base Equilibrium ; Anesthesia ; Animals ; Arterial Pressure ; Body Temperature ; Calcium ; Cardiac Output ; Central Venous Pressure ; Dogs ; Electrolytes ; Femoral Artery ; Heart Rate ; Hemodynamics* ; Jugular Veins ; Liver Transplantation* ; Liver* ; Mortality ; Pancuronium ; Potassium ; Prognosis ; Pulmonary Wedge Pressure ; Reperfusion ; Skin ; Transplants ; Vascular Resistance

During hemorrhagic shock, liver is susceptible to ischemia and decreased hepatic energy charge results in decreasing arterial ketone body ratio(AKBR). Reperfusion after hemorrhagic shock can greatly amplify the generation of toxic oxygen metabolites. As a result, the fluxes of these highly toxic metabolites can overwhelm the endogenous antioxident defense mechanisms and lead to tissue injury. In order to observe the effect of glutathione(GSH) on the AKBR in hemorrhagic shock, dogs(n=16) were anesthetized with 1% enflurane in 02. We pretreated glutathione (100 mg/kg) intravenously before hemorrhagic shock in glutathione (GSH) group (n=8). Shock was induced with bleeding and mean arterial pressure was maintained 50 mmHg for 30 minutes. Recovery from shock was done with transfusion of preserved blood and maintained for 30 minutes. We measured arterial ketone bodies and ketone body ratio before, during and after shock, and compared them to control group (n=8) which was not pretreated with glutathione. AKBR during and after hemorrhagic shock in GSH group (0.8 and 1.0) were higher than those in control group (0.5 and 0.8). Light microscopic examination of liver biopsy revealed less portal degeneration during and after hemorrhagic shock in GSH group than control group. Pharmacologic modulation of hepatocytic function with glutathione before hemorrhagic shock has shown some beneficial effect with protection of decreased AKBR and histological change during and after hemorrhagic shock.
Animals ; Arterial Pressure ; Biopsy ; Defense Mechanisms ; Dogs* ; Enflurane ; Glutathione* ; Hemorrhage ; Ischemia ; Ketone Bodies ; Liver ; Oxygen ; Reperfusion ; Shock ; Shock, Hemorrhagic*

BACKGROUND: Activated fibrinolysis during cardiopulmonary bypass(CPB) is one of the causes of post CPB coagulopathy. Antifibirinolytics such as tranexamic acid have been administered prophylactically before CPB to decrease postCPB bleeding. However, their routinely application has been challenged as regarding it's thrombotic complication. This study was performed to evaluate the effect of tranexamic acid administered before CPB by thromboelastography. METHODS: 50 open heart surgical patients were randomly selected and devided into two groups, control(N=25) and tranexamic acid group(N=25). In tranexamic acid group. 125mg of tranexamic acid were singly infused before vena caval and aortic cannulation. All of parameters of thromboelastography (TEG) and fibrin degradation products measured before and after CPB were compared between two groups. RESULTS: There were no significant differences in fibrinolytic indexes of TEGs between control group and tranexamic group afte CPB. And there were also no changes in fibrinolysis index between before and after CPB in both groups. The concentration of FDP did not changed after CPB in both groups. CONCLUSIONS: It may be considered that prophylactic administration of tranexamic acid before CPB to reduce post-CPB bleeding would not be recommended routinely.
Catheterization ; Fibrin Fibrinogen Degradation Products ; Fibrinolysis* ; Heart* ; Hemorrhage ; Humans ; Thoracic Surgery* ; Thrombelastography ; Tranexamic Acid*