The routine management of head injury includes hyperventilation to produce hypocapnis with arterial CO2 tension 25~30 torr. But a decrease in cerebral blood flow with hypocapnia may result in cerebral ischemia. Our study was to evaluate the change of cerebral blood flow during hyperventilation in halthane anesthesia. The jugular venous oxygen saturation(SjvO2), arterio-venous oxygen content difference(CaO2-CjvO2), and oxygen extraction ratio(O2ER) were used as criteria of cerebral ischemia with reduced cerebral blood flow. The results are as follows: 1) SjvO2 was lower in group 2(PaCO2=22.8torr) than group 1(PaCO2=30.3 torr). 2) CaO2-CjvO2 and O2ER were higher in Group 2 than group 1. 3) No more increased possibility of cerebral ischemia with reduced cerebral blood flow was observed Group 2 than group 1.
Anesthesia ; Brain Ischemia ; Craniocerebral Trauma ; Hyperventilation ; Hypocapnia ; Oxygen*

BACKGROUND AND OBJECTIVES: Pseudo-labyrinthine symptom without any other accompanying neurologic symptoms or signs occur with cerebellar infarction. The prognosis and management of cerebellar infarction differ from those of vertigo associated with unilateral vestibulopathy. The objective of study was to analyze the clinical symptoms of cerebellar infarction mimicking unilateral vestibulopathy according to the infarction territory. MATERIALS AND METHOD: Among 273 patients who showed pseudo-labyrinthine symptoms or signs, 28 patients were diagnosed cerebellar infarction on MRI between January 2003 and October 2006. Out of the 28 patients, 9 patients accompanying with focal neurologic symptoms or signs in early stage were excluded, and a retrospective analysis of total 19 patients was done through chart reviews. Using diffusion-weighted imaging, we divided 19 patients into two groups, AICA and PICA territory infarction. Clinincal features, outcome of audiologic and vestibular function test were compared between the groups. RESULTS: Among the 19 subjects, 10 were males and 9 were females, the mean age was 63.1+/-.0. On MRI, 5 (26.3%) subjects showed infarction in unilateral AICA territory, 14(73.7%) in unilateral PICA territory. In the patients with AICA territory infarction, audiological tests confirmed unilateral sensorineuronal hearing loss in all 5 subjects. On V-ENG, 4/5 (80%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 4/5 (80%) had a canal paresis to caloric stimulation. In several days of hospital stay, 3/5 (60%) showed new neurologic signs, facial numbness. In the patients with PICA infarction, there was no hearing change. On V-ENG, 12/14(85.7%) demonstrated horizontal or mixed horizontal torsional spontaneous nystagmus, and 7/14 (50%) had a canal paresis to caloric stimulation. In several days of hospital stay, 10/14 (71.4%) accompanied with cerebellar ataxia. CONCLUSION: Cerebellar infarction simulating unilateral vestibulopathy is more common than previously thought. Early recognition of the cerebellar infarction showing pseudo-vestibular symptom may allow specific management. Also taking into account that clinical features differ by infarction territory will assist in determining the patient's status of the disease.
Cerebellar Ataxia ; Cerebellum ; Female ; Hearing ; Hearing Loss ; Humans ; Hypesthesia ; Infarction* ; Length of Stay ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Paresis ; Pica ; Prognosis ; Retrospective Studies ; Vertigo ; Vestibular Function Tests

BACKGROUND: Manual ventilation in pediatric anesthesia limits the anesthesiologist's ability to manage patients suffering from unexpected problems. Although modified Mapleson D systems connected to ventilators have been used for controled ventilation of anesthetized infants and children, the complexity of factors affecting rebreathing within the Mapleson D circuit has resulted in a variety of recommendations for fresh gas flow and minute ventilation. The aim of this study was to devise a formula for ventilator settings which would provide normal tidal volume, respiratory rate, and minute ventilation without rebreathing during mechanical ventilation in pediatric anesthesia and compare this method to manual ventilation. METHODS: 56 infants and small children anesthetized with enflurane and nitrous oxide were studied. We have constructed a formula for ventilator settings which would generate a predictable normocapnia. PetCO2, PaCO2, SpO2, and SaO2 were measured during manual ventilation (control) and during mechanical ventilation. RESULTS: Mean PaCO2 with the mechanical ventilation was within normal range. PaCO2 was significantly lower (P<0.05) with the manual ventilation than with the mechanical ventilation. CONCLUSIONS: We conclude that our formula for ventilator settings can be safely and competently applied to mechanical ventilation with Jackson-Rees system in pediatric anesthesia.
Anesthesia* ; Child ; Enflurane ; Humans ; Infant ; Nitrous Oxide ; Reference Values ; Respiration, Artificial ; Respiratory Rate ; Tidal Volume ; Ventilation* ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Nasal polyp is a disease of the mucous membranes in the nose and the paranasal sinuses that develops as a reaction to a variety of stimuli including allergens and various microbes. The etiology and formation of nasal polyp are still unclear and have been debated for many years. The objective of the present study is to investigate the correlation among allergic rhinitis, asthma and recurrent nasal polyps. MATERIALS AND METHODS: We conducted a retrospective review of patients with severe nasal polyps who underwent endoscopic sinus surgery. Patients who had a minimum Lund- MacKay score of 16 and a minimum of 12 months of follow-up were included in the analysis. Data collection included demographics, presence of asthma or documented allergic rhinitis, recurrence rates, and follow up. RESULTS: Three hundred and forty one records were reviewed. Two hundred and forty-three (71.3%) patients had no underlying asthma and allergic rhinitis. Seventy-nine (32.5%) patients among them developed recurrent nasal polyps. Seventy-two (21.1%) patients had documented allergic rhinitis without asthma. Twenty-one (29.2%) patients among them developed recurrent nasal polyps. Fifteen (4.4%) patients had both asthma and allergic rhinitis. Eight (53.3%) patients among them developed recurrent nasal polyps. Eleven (3.3%) patients had asthma without allergic rhinitis. Six (54.6%) patients among them developed recurrent nasal polyps. CONCLUSION: Knowing recurrence rates after endoscopic sinus surgery for nasal polyps in regards to underlying asthma and allergic rhinitis is clinically significant. In our study, the presence of asthma significantly correlated with higher recurrence (p<0.05). But, the presence of allergy was not statistically significant.
Allergens ; Asthma* ; Data Collection ; Demography ; Follow-Up Studies ; Humans ; Hypersensitivity ; Mucous Membrane ; Nasal Polyps* ; Nose ; Paranasal Sinuses ; Recurrence* ; Retrospective Studies ; Rhinitis*

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

Petrous apicitis is an extension of infection from the mastoid air cell tract into petrous apex. Petrous apicitis, a potentially fatal complication of suppurative otitis media, presents a variety of symptoms. But the classical findings of petrous apicitis, called Gradenigo's syndrome that include abducens nerve palsy, deep facial pain and acute suppurative otitis media, rarely occur. Gradenigo's syndrome can be treated with surgery, but the advent of antibiotics and early imaging study allow conservative treatment in some uncomplicated cases. With the widespread use of antibiotics, petrous apicitis has become an uncommon disease. So most physicians have little clinical experience in their diagnosis and treatment of this disease. We present a case of Gradenigo's syndrome, which was unresponsive to conservative treatment. We provide here details of our experience of treating the patient with surgery without complication.
Abducens Nerve Diseases ; Anti-Bacterial Agents ; Diagnosis ; Facial Pain ; Humans ; Mastoid ; Otitis Media, Suppurative ; Paralysis* ; Petrositis* ; Petrous Bone