To evaluate the reproducibility of the Ambulatory Electrocardiography (AECG), we examined the consistency rates of premature beats between the baseline AECG's and the repeat AECG's in 23 patients who underwent AECG's times within 1 year. 12 patients were male and 11 patients were female. Their mean age was 48 years. (Range ; 20 years-75 years) The time interval between both AECG's was 1 month 20 days. (Range ; 1 day-9months) They did not take any antiarrhythmic druge during the observation period except 4 patients who were taking calcium channel blockers or beta receptor blockers for hypertensive heart disease or ischemic heart disease. The consistency rate of both frequency and complexity of ventricular premature beats was 52%. The consisency rate of both frequency and complexity of supraventicular premature beats was 35%. These consistency rates seemed to vary as the time interval between both AECG's differed. In the case of ventricular premature beats, the consistency rates of 1 day, 8 days and 5 months as the time interval were 100%, 38% and 14% respectively. In the case of supraventricular premature beats, the consistency rates were 50%, 25% and 29%. We concluded that the reproducility of the AECG was low and this reproducibility became lower as the time interval between both AECG's became longer and that hese facts had to be considered when the effect of the antiarrhythmic drugs was evaluated.
Anti-Arrhythmia Agents ; Calcium Channel Blockers ; Cardiac Complexes, Premature ; Electrocardiography, Ambulatory* ; Female ; Heart Diseases ; Humans ; Male ; Myocardial Ischemia

No abstract available.
Gram-Positive Bacterial Infections* ; Teicoplanin*

Intraoperative monitoring has been a valuable part in the cerebral aneurysm surgery. Insight into the nervous system and the relationship of the aneurysm to the adjacent structure during the surgery provide critical information to the surgeon allowing reversal or avoidance of neural insults and the complete clipping of the aneurysm. The goal of cerebral aneurysm surgery is to eliminate the risk of hemorrhage but not disrupt the surrounding vascular and neural structures. Several techniques including microvascular doppler ultrasonography, monitoring cerebral blood flow, evoked potentials, intraoperative angiography, endoscope assisted aneurysm surgery and neuronavigator system are used for the surveillance in the aneurysm surgery. The abnormal findings in these procedures can change surgical management during the surgery such as removal or readjustment of temporary or permanent clips and a decrease in brain retraction or manipulation. The additional feedback provided by intraoperative monitoring promises to improve the safety and efficacy of aneurysm surgery.
Aneurysm ; Angiography ; Brain ; Endoscopes ; Evoked Potentials ; Hemorrhage ; Intracranial Aneurysm* ; Monitoring, Intraoperative ; Nervous System ; Ultrasonography, Doppler

Chronic hypertension causes pathologic changes within the tunica media, termed lipohyalinosis. The most prominent changes were seen at bifurcation point within the vessels and middle and distal portion of the vessels. The role of microaneursyms in spontaneous intracerebral hemorrhage (ICH) secondary to hypertension is not well understood. A cerebral amyloid angiopathy is associated with fibrinoid necrosis and affects the small to medium sized vessels and it may account for a higher percentage of spontaneous ICH in the elderly. Neurologic dysfunction secondary to ICH is caused by initial hemorrhage with its associated mass effect, and tissue destruction with hematoma enlargement. Consequently, the further deterioration may be due to cerebral edema. The exact role of CBF changes is not unproved in the pathogenesis of neuronal injury. However, much has been learned about the mechanisms involved the brain edema formation after ICH. A number of components of blood are capable of inducing brain injury and brain edema formation. The hematoma exerts its effects not only by mechanical but also by chemical influences.
Aged ; Brain Edema ; Brain Injuries ; Cerebral Amyloid Angiopathy ; Cerebral Hemorrhage* ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Necrosis ; Neurologic Manifestations ; Neurons ; Tunica Media

The thoracic spine is rigidly stabilized by the ribs, anterior and posterior longitudinal ligaments, and a sagittal orientation of the facet joints that resists axial rotation and horizontal translation. Thus, a significant force is required to cause a fracture and dislocation in the thoracic spine. A 32-year-old man was involved in a motor-vehicle accident and presented with complete paraplegia and spondyloptosis on the 8th thoracic vertebral segment. He also suffered with hypoxia and hypovolemic shock. Posterior reduction and fixation with pedicle screw was achieved with the anatomic alignment and rigid stability. This posterior technique for thoracic spondyloptosis is believed to be sufficient to make good alignment and solid fixation.
Adult ; Anoxia ; Dislocations ; Humans ; Longitudinal Ligaments ; Paraplegia ; Ribs ; Shock ; Spine ; Zygapophyseal Joint

After bimaxillary orthognathic surgery for correction of facial deformity, the factors influencing stability of bone segment are the amount of bone segment, surgical technique, fixation technique, rotation of proximal segment. The aim of this study is to analyze the significance of the factors influencing skeletal relapse after bimaxillary orthognathic surgery. From March 1994 to march 2003, 11 patients who underwent bimaxillary procedures without genioplasty or any other orthognathic surgical procedures were included for sample. Lateral cephalograms were analyzed before surgery, 1 month and 12 months after surgery respectively. Vertical, horizontal, angular and dental measurements were obtained from each tracing using the horizontal and vertical reference lines. The mean amount of bone movement and relapse was 7.03mm, 2.44mm (35%) respectively at pogonion and 3.41mm, 0.6mm (18%) respectively at point A. After statistical analysis of collected data, the amount of skeletal movement, fixation technique were significantly related to relapse, but rotation of proximal segment, surgical procedures were not significantly related to relapse. Then we suggest that when operation is planned, 20-30% overcorrection was recommended at the time of bimaxillary surgery.
Congenital Abnormalities ; Genioplasty ; Humans ; Orthognathic Surgery* ; Orthognathic Surgical Procedures ; Recurrence

A pseudoaneurysm is a contained arterial disruption in the intimal and medial layers of an arterial wall. It may originate from a perforation caused by traumatic or iatrogenic injury or the dehiscence of a surgical anastomosis. Because of its insidious onset and delayed presentation, orthopaedic surgeons should be aware of the possibility of such a lesion after an initial trauma. We report on a case of a delayed huge pseudoaneurysm of the popliteal artery that occurred 11 months after conservative treatment of a supracondylar fracture of the femur in order to keep in mind the possibility of the delayed presentation of vascular injury after a distal femur fracture.
Anastomosis, Surgical ; Aneurysm, False* ; Femoral Fractures ; Femur* ; Popliteal Artery* ; Vascular System Injuries

It is well known that stereotaxic urokinase(UK) irrigation through a catheter is one of surgical methods in the management of hypertensive intracerebral hematoma(ICH) patients. Several authors recommended irrigation with 6000 IU UK, 4 times per a day. Based on authors' experience some patients who were managed with above protocol suffered from complications such as meningitis and/or pneumonia. It might be partially caused by prolonged duration of irrigation and immobilization of the patients. In order to reduce complications and to improve the final outcome of hypertensive ICH patients, we tried high dose UK irrigation(group II:irrigation with 50ml of normal saline mixed with 200,000 IU UK at immediate postoperative period, followed by two times of 20,000 IU UK irrigation per a day) to remove the ICH rapidly in those patients since Oct. 1991. We compared the rate of decreasing volume of hematoma, Glasgow coma scale(GCS) score change according to postoperative period, final outcome, and the rate of complications between this group(group II) and group I(4 times irrigation with 6,000 IU UK per a day). The results shows that the rate of decreasing volume of hematoma is slightly more rapid in group II than group I. The rate of poor outcome(vegetative and death) is lower in group II than I(group I vs. II:34% vs. 20% respectively). The rate of complication is lower in group II than I(group I vs. II:38.5% vs. 0.0%, respectively). One case(5%) of postoperative rebleeding was noted in group II. From this study, we concluded that, even if the beneficial effects are small, the high dose UK irrigation is one of protocols in the management of hypertensive ICH patients.
Catheters ; Coma ; Hematoma* ; Humans ; Immobilization ; Meningitis ; Pneumonia ; Postoperative Period ; Urokinase-Type Plasminogen Activator*

Total tongue resection result in severe speech problem, swallowing difficulty and life threatening aspiration. When a total glossectomy is performed, the functional recovery of swallowing, articulation, and airway protection are important for maintaining life quality of the patient. To achieve good functional results, First, the donor tissue should be bulky. Second, the tissue should be pliable and capable of movement. Third, the neotongue should be innervated by anastomosis to the hypoglossal nerve. Innervated latissimus dorsi free flap satisfies the above conditions. The authors performed two immediate total tongue reconstruction using a innervated latissimus dorsi myocutaneous free flap in which the thoracodorsal nerve was anastomosed to the hypoglossal nerve. Decanulation was performed on the 15th and 20th day respectively after the operation. The oral intake of pureed diet was possible in both patients without aspiration. After 3 months, it was confirmed in videofluoroscopic study that the neotongue was able to contact with the palate effectively. And the articulation was satisfactory. Considering speech and feeding rehabilitation, innervated latissimus dorsi flap can be more valuable method of tongue reconstruction than any other methods and we recommend it for better life quality of the patient.
Deglutition ; Diet ; Free Tissue Flaps* ; Glossectomy ; Humans ; Hypoglossal Nerve ; Palate ; Quality of Life ; Rehabilitation ; Superficial Back Muscles* ; Tissue Donors ; Tongue*

Isolated fourth(IV) ventricle in shunted patients has been reported with increasing frequency. Symptomatic isolated IV ventricular hydrocephalus in adults, however, has seldom been described. We report five such cases among total of 420 shunted cases in our institution from January 1992 to December 1995. The causes of initial hydrocephalus were postsurgical meningitis(SAH, teratoma and abscess of posterior fossa), tuberculous meningitis and neurocysticercosis of the IV ventricle. All cases were symptomatic with clinical findings related to posterior fossa lesions. Two patients developd symptoms in 2 months after V-P shunts and the others between 17 and 118 months after V-P shunts. These 5 patients required IV ventricular shunting. All patients improve postoperatively except one patient who developed 6th nerve palsy related to secondary irritation of the brainstem by the IV ventricular catheter. Inflammatory changes in the ependyma of both aqueduct of Sylvius, foramina Luschka and Magendi have been regarded as the most important factors in the development of the isolation of IV ventricle, especially in adults. It is generally recommended to shunt in cases of the adult symptomatic isolated IV ventricle. Alternative surgical techniques and prevention of such complications are discussed.
Abducens Nerve Diseases ; Abscess ; Adult* ; Brain Stem ; Catheters ; Cerebral Aqueduct ; Diagnosis* ; Ependyma ; Humans ; Hydrocephalus* ; Neurocysticercosis ; Teratoma ; Tuberculosis, Meningeal