No abstract available.
Peritoneal Dialysis, Continuous Ambulatory* ; Pharmacokinetics* ; Renal Dialysis*

The authors presented 9 cases of surgically treated CSF rhinorrhea, two of which were spontaneous and 7 were traumatic delayed. The duration of leakage was longer than 1 month in most cases and seven of the nine cases were complicated by meningitis. The leakage site was most accurately detected by metrizamide computed tomographic cisternography(MCTC) and the most frequent leakage site was the cribriform plate. Good surgical results were obtained by direct repair and/or shunt without recurrence during follow-up period from 7 months to 2 years.
Cerebrospinal Fluid Rhinorrhea ; Ethmoid Bone ; Follow-Up Studies ; Meningitis ; Metrizamide ; Recurrence

It is known that antithrombin III is a potent vasodilator and plasmin is a vasoconstrictor, and some patients with a subarachnoid hemorrhage(SAH) develop clinical vasospasm and some patients do not. Under the hypothesis that the development of clinical vasospasm might depend on the difference of the blood level of antithrombin III in each patient with SAH and that the plasmin might have a role in the development of clinical vasospasm, we repeatedly checked the levels of blood antithombin III with a single radial immunodiffusion method and CSF fibrinogen degradation products(FDP : indirect indicator of plasmin activity) with a latex-test(Thrombo-Wellcotest(R)) during the period between 1-4, 5-11 and 12-24 days after a SAH in 29 patients. 10 patients with diseases except those with a SAH were selected as a control group. First, we analyzed the difference of the average of blood antithrombin III and CSF FDP between aneurysmal SAH patients and control patients and then, between patients with clinical vasospasm(8 cases) and patients without clinical vasospasm(21 cases). Secondly, we also analyzed the difference of these data between patients with clinical vasospasm and patients without clinical vasospasm according to the sampling day after a SAH. As a result, there was no statistical difference between the average blood level of antithrombin III in control and in SAH patients(29.06+/-3.04 vs. 25.61+/-6.95, respectively), and in patients with clinical vasospasm and in patients without clinical vasospasm(26.59+/-7.65 vs. 23.67+/-7.40, respectively). The average CSF levels of FDP is higher in SAH patients than in control patients(18.16+/-14.36 vs. 1.00+/-3.16, respectively : p<0.01). It is also higher in patients with clinical vasospasm than in patients without clinical vasospasm. However, there is no statistical significance(28.75+/-9.91 vs. 21.75+/-12.07, respectively : p>0.05). In the analysis of the average CSF levels of the FDP according to the sampling day after a SAH, even though the average levels is higher in patients with clinical vasospasm than in patients without clinical vasospasm(1-4 days : 31.43+/-14.64 vs. 27.33+/-16.24, 5-11 days : 23.75+/-17.68 vs. 18.10+/-16.32, 12-24 days : 32.50+/-13.89 vs. 18.82+/-16.54, respectively), a statistical significant difference was noticed only in levels which were checked between 12 and 24 days after a SAH(p<0.05). This study concludes that the blood level of antithrombin III shows no difference between the control and SAH patients, and patients with clinical vasospasm and patients without clinical vasospasm. Although it suggests a causal relationship between the FDP itself or plasmin in CSF and the development of clinical vasospasm, it does not justify any valid conclusion.
Aneurysm* ; Antithrombin III* ; Cerebrospinal Fluid* ; Fibrinogen ; Fibrinolysin ; Humans ; Immunodiffusion ; Subarachnoid Hemorrhage* ; Vasospasm, Intracranial

In order to find out the relationship between blood viscosity and the development of an ischemic symptom(clinical vasospasm) following an aneurysmal subarachnoid hemorrhage(SAH), was checked daily the hematocrit(Hct), blood viscosity and plasma viscosity from admission day to 14 days after SAH in 33 patients. Twelve patients with diseases except those with a SAH were selected as a control group. We analyzed the difference of the average hematocrit, blood viscosity, and plasma viscosity between the control group, non-spasm group and spasm group on admission, and then the period of preoperative, postoperative with mannitolization, and postoperative without mannitolization. We also analyzed the change of those according to the SAH day, and the relationship between the blood viscosity and the level of hematocrit in each group. As a result, aneurysmal SAH patients with clinical vasospasm showed a higher plasma viscosity than the control(1.82+/-0.21 vs. 1.55+/-0.14, respectively : p<0.01) and clinical non-spasm(1.82+/-0.21 vs. 1.66+/-0.12, respectively : p<0.05) group of patients on admission statistically. In the spasm group, the blood viscosity was raised during the spasm risk period(SAH 7-10 days). The level of the hematocrit in the spasm group was lower than the non-spasm group and most of them checked below 30% after surgery. In the relationship between the level of hematocrit and the blood viscosity, the spasm group showed a relatively higher blood viscosity than the non-spasm group. These results suggest that the blood viscosity has some role in the development of ischemic symptoms after a subarachnoid hemorrhage, but major determinants such as erythrocyte aggregation, plasma fibrinogen concentration and platelet aggregation which affect the microcirculation have a more important role. Therefore, when hemodilution are used for prevention or improvement of ischemic symptoms after subarachnoid hemorrhage, the level of the hematocrit and the focus on decreasing the major determinants of the viscosity in microcirculation should be considered.
Aneurysm* ; Blood Viscosity* ; Erythrocyte Aggregation ; Fibrinogen ; Hematocrit* ; Hemodilution ; Humans ; Mannitol ; Microcirculation ; Plasma* ; Platelet Aggregation ; Spasm ; Subarachnoid Hemorrhage* ; Viscosity*

A retrospective study of 100 cervical spinal cord injury patients admitted consequtively to the Department of Neurosurgery, Dongsan Medical Center, Keimyung University between March, 1985 and June, 1989 was conducted. The average age was 42 and 84(84%) were male. The majority sustained their spinal cord injury in a motor vehicle accident(50%) or in a diving accident(36%). Thirty-three percent(33/100) of these patients had surgical intervention by anterior approach(14/33), posterior approach(17/33) and total laminectomy(2/33). The others were only immobilized by traction or neck brace. Not only neurological recovery in operated and nonoperated patients but also complete and incomplete injury was compared. The degree of the neurological injury was classified by the Frankel classification. 12 cases turned out to be more aggravated than the condition at admission, among them 9 cases were middle and low cervical incomplete injuries. At final follow-up no appreciable differences in achievement in activities of daily living and mobility were noted between patients treated with surgical stabilization of the cervical spinal column and those treated nonsurgically.
Activities of Daily Living ; Braces ; Classification ; Diving ; Follow-Up Studies ; Humans ; Immobilization ; Male ; Motor Vehicles ; Neck ; Neurosurgery ; Retrospective Studies ; Spinal Cord Injuries ; Spinal Injuries* ; Spine ; Traction

BACKGROUND AND OBJECTIVES: The purpose of this study was to figure out the correlation of hypertension and atherogenic dyslipidemia in postmenopausal women. MATERIALS AND METHODS: The study population consisted of consecutive 380 postmenopausal women (age> or =50, FSH>40IU/L and triglyceride[TG]<400 mg/dl) visiting health promotion center at Samsung Cheil Hospital from March 1997 to July 1998. We measured blood pressure by automatic sphygmomanometer (A & Dco.LTD.TM-2654) and divided them into four groups by blood pressure (Group I:systolic blood pressure[SBP]< 120 mmHg and diastolic blood pressure[DBP]<80 mmHg, n=87. Group II:SBP 120-139 mmHg or DBP 80-89 mmHg, n=109. Group III: SBP 140-159 mmHg or DBP 90-99 mmHg, n=127. Group IV: SBP> or =160 mmHg or DBP> or =100 mmHg, n=57). We measured thier body mass index (BMI) and waist-hip ratio (WHR). We also measured their levels of glucose, total cholesterol and TG by automatic biochemical analyzer (Hitachi 7150) and HDL cholesterol by direct method using AutoDAIICHI reagent. We calculated LDL cholesterol levels by Friedewald formula. RESULTS: MI, WHR and glucose level of group IV were significantly higher than those of group I. But there were no significant differences among the groups in the levels of total cholesterol, LDL cholesterol and apolipoprotein B. HDL cholesterol level of group I was statistically higher than that of group IV. TG level and LDL cholesterol/apo B ratio of group IV were significantly higher and lower than those of other groups respectively. CONCLUSION: Postmenopausal women who had moderate or severe hypertension show the trend toward abdominal obesity and atherogenic dyslipidemia. We might have to pay attention to these metabolic abnormalities in postmenopausal women with hypertension.
Apolipoproteins ; Blood Pressure ; Body Mass Index ; Cholesterol ; Cholesterol, HDL ; Cholesterol, LDL ; Dyslipidemias* ; Female ; Glucose ; Health Promotion ; Humans ; Hypertension* ; Menopause ; Obesity, Abdominal ; Sphygmomanometers ; Waist-Hip Ratio

Diuretic therapy for the treatment of edema in patients with end-stage renal disease (ESRD) is unsatisfactory, and a combination of thiazide and loop diuretics may produce better clinical effects. To evaluate the influence of thiazide on loop diuretic therapy for ESRD, we performed a crossover study of furosemide versus hydrochlorothiazide plus furosemide treatment. The diuretic effects of furosemide (160 mg i.v.) alone versus a combination of hydrochlorothiazide (100 mg p.o.) and furosemide were studied in ten ESRD patients with proteinuria greater than 1 g/day. The diuretic effects were compared for 24 h urine volume and electrolyte excretion. To detect the influence of thiazide that may have been obscured in the widely dispersed data, pharmacodynamic analysis of urine furosemide excretion rate versus fractional excretion of sodium (FeNa) was also performed using mixed-effect modeling. Combination therapy was not significantly different from furosemide monotherapy in terms of 24 h urine volume, chloride, or sodium excretion. Hydrochlorothiazide was not a significant covariate in the furosemide effect for the pharmacodynamic model. In patients with ESRD and severe proteinuria (>1,000 mg/day), the combination of hydrochlorothiazide with furosemide therapy did not increase the diuretic effect of furosemide.
Cross-Over Studies ; Diuretics ; Edema ; Furosemide ; Humans ; Hydrochlorothiazide* ; Kidney Failure, Chronic* ; Proteinuria ; Sodium ; Sodium Potassium Chloride Symporter Inhibitors