No abstract available.
Seoul*

By the expansion of stalk of laminaria inserted into the right epidural space of the rabbit head, cerebral compression and edema were produced. The studies of the occurrence and changes of experimental brain edema have been observed by weighing the wet and dry brain tissue, and by calculating the percentage of water content and that of swelling, with rate of per cent water content to that of control group. The percentage of water content and swelling of cerebral gray and white matters in the compressed site showed higher values than those in control and in non-compressed groups. As compared with normal group, the rate of per cent water content of cerebral gray matter at the site of compression showed gradually increasing tendency as time elapsed by 12 hours, while that of white matter demonstrated a increase of it by 24 hours and decreased gradually thereafter. Cerebral edema induced by laminaria compression was more evident and severe in the white matter than in the gray. Oxygen and glucose that are utilized the brain are two of the most important substances and play very important roles in the brain to form high energy bond and nucleic acid. Authors have attempted to measure oxygen consumption in normal rabbit brain and diseased brain that are produced by the expansion of stalk of laminaria in the intracranial epidural space. The value of oxygen consumption of cerebral gray and white matters in the compressed hemispheres showed higher values than those in control group, and they revealed a tendency of rather rapid increases at early experimental stages, an of gradual decrease thereafter.
Brain Edema* ; Brain* ; Edema ; Epidural Space ; Glucose ; Head ; Laminaria ; Oxygen ; Oxygen Consumption

Bleeding into the subarachnoid space is one of frequent complications in neurosurgical practice and most frequently caused by rupture of meningeal by trauma to the head. Hemorrhage into the subarachnoid space may occur in patient with blood dyscrasias, intracranial tumors, vascular anomalies, certain toxic or infectious disease of the nervous system, and intracerebral hemorrhages. In may be worthy academic interest and clinical practice to estimate the age of blood after hemorrhage into cerebrospinal fluid (CSF). The age was estimated and assessed by an immunological method with hemoagglutination activity using native Korean phytoagglutinin. The age of the red blood cells in RBC-CSF suspension of normal subjects was assessed and estimated by the hemoagglutination of phytoagglutinin in vitro. Vicia PHA and Clerodendron PHA chosen from among 18 different varieties of PHA are panhemoagglutinin and demonstrated the agglutination reaction most effectively. The agglutination activity of PHA with RBC-CSF suspension decreased gradually as time elapsed and activity subsided on 7~8th day. The age of RBC in CSF can be estimated by titration. The agglutination activity of PHA to RBC in CSF suspension continued for a longer period than that of PHA to either RBC in normal saline or anti-serum A and B in CSF. It would be well to say that the experimental results can be applied to clinical situations, especially subarachnoid hemorrhage.
Agglutination ; Cerebral Hemorrhage ; Cerebrospinal Fluid* ; Clerodendrum ; Communicable Diseases ; Erythrocytes ; Head ; Hemorrhage ; Humans ; Nervous System ; Rupture ; Subarachnoid Hemorrhage ; Subarachnoid Space ; Vicia

We found an error in this article. The author's name should be corrected as following: from "Younsuk Koh" to "Younsuck Koh".

We presented two cases of entrapment neuropathy which were confused with herniated lumbar disc syndrome. One was "meralgia paresthetica in association with lumbar disc herniation", and "the other inguinal neuritis along with obturator neuritis". Syndromes of these entrapment neuropathies were confirmed by subcidence of pain and creation of progressively longer pain-free intervals after analgesic blocks of the corresponding nerves by infiltration of Xylocaine and prednisolone.
Lidocaine ; Nerve Compression Syndromes ; Neuritis ; Prednisolone

Although there are differences in the mode of onset, symptomatology and clinical course in the various types of cerebrovascular lesions, the general picture may be quite similar and it is often difficult to determine the nature of the lesion in any individual case from the clinical data. In the vast majority of cases the symptoms of a cerebrovascular accident are of sudden onset and reach maximum intensity within few minutes or a few hours at the most. Locksley, et al. have reported autopsies on people who died from spontaneous intracerebral or subarachnoid hemorrhage, and they found that a primary or metastatic brain tumor was the cause of hemorrhage in only 2%~3% of their necropsy. We presented our experience with two such patient whose clinical pictures before the surgery were quite similar with those of cerebrovascular accident. Cases with a large chronic subdural hematoma and cerebral glioblastoma multiforme demonstrated a sudden and dramatic onset of coma and focal neurological symptoms immediately before admission to the hospital. The responsible mechanism or etiology for the mode of such sudden dramatic onset of symptoms may be derangement of intracranial pressure mechanism and sudden hemorrhage in the tumor.
Autopsy ; Brain Neoplasms ; Coma ; Glioblastoma ; Hematoma, Subdural, Chronic ; Hemorrhage ; Humans ; Intracranial Pressure ; Stroke* ; Subarachnoid Hemorrhage

Since Maisonneuve mentioned osteomyelitis by typhoid fever for the first time in 1835, numerous investigators had reported salmonella osteomyelitis. But these are very rare in its incidence ; only 0.82% of patients with typhoid infections have skeletal involvement. The authors recently experienced a case of salmonella osteomyelitis in lumbar spine respectively caused by salmonella typhi D group. A 48 year-old female was admitted to our Dept. of Neurosurgery with 4 months history of severe lumbago. On hospitalization her emperature raised upto 39 degrees C once and widal test showed salmonella typhosa OH 640x. Lumbar spine X-ray films demonstrated irregular bony destruction of L2 and L3 with mild degree of narrowing of intervertebral space of L2-3. Pus evacuation and currettage of involved vertebrae surgically were performed. Salmonella osteomyelitis involving intervertebral space was confirmed by culture of pus obtained from pathologic lesion and by biochemical test. Satisfactory result is obtained by surgical and antibiotic therapy.
Female ; Hospitalization ; Humans ; Incidence ; Low Back Pain ; Middle Aged ; Neurosurgery ; Osteomyelitis* ; Research Personnel ; Salmonella typhi ; Salmonella* ; Spine* ; Suppuration ; Typhoid Fever ; X-Ray Film

BACKGROUND: Critical care physician staffing is a crucial element of the intensive care unit (ICU) organization, and is associated with better outcomes in ICUs. Adult ICUs in Korea have been suffering from inadequate full-time intensivists and nurses because of insufficient reimbursement rates (<50% of the original critical care cost) from the National Health Insurance System. Recently, full-time intensivists have been introduced as a prerequisite for adult ICUs of tertiary hospitals in Korea. The purpose of this study was to examine the perception of intensivist staffing among critical care program directors regarding the barriers and solutions when implementing an intensivist model of critical care in Korea. METHODS: An email survey of critical care program directors in designated teaching hospitals for critical care subspecialty training by the Korean Society of Critical Care Medicine was performed. The survey domains included vision, culture, resources, barriers, and potential solutions to implementing intensivist physician staffing (IPS). RESULTS: Forty-two critical care program directors were surveyed. A total of 28 directors (66.7%) responded to email queries. Of these, 27 directors (96.4%) agreed that IPS would improve the quality of care in the ICU, although half of them reported a negative perception of relevant clinical colleagues for the role of full-time intensivists and poor resources for IPS in their hospitals. Increased financial burden due to hiring full-time intensivists and concerns regarding exclusion from the management of their critically ill patients in the ICU, together with loss of income for primary attending physicians were stated by the respondents to be major barriers to implementing IPS. Financial incentives for the required cost from the health insurance system and enhancement of medical law relevant to critical care were regarded as solutions to these issues. CONCLUSIONS: Critical care program directors believe that intensivist-led critical care can improve the outcome of ICUs. They indicated the financial burden due to IPS and underestimation of a full-time intensivist's role to be major barriers. The program directors agreed that a partnership between hospital leaders and the Ministry of Health and Welfare was needed to overcome these barriers.
Adult* ; Critical Care ; Critical Illness ; Electronic Mail ; Hospitals, Teaching ; Humans ; Insurance, Health ; Intensive Care Units ; Jurisprudence ; Korea ; Motivation ; National Health Programs ; Personnel Staffing and Scheduling ; Surveys and Questionnaires ; Tertiary Care Centers

Tuberculous meningitis, which commonly causes thick granulations over the base of the brain, is a frequent cause of post-meningitic hydrocephalus. Raised intracranial tension affects the cause of tuberculous meningitis adversely. The development of hydrocephalus may account for the raised intracranial pressure. Insertion of a V-A(V-P) shunt significally alters the course of the disease. The results in 5 cases have been detailed and discussed. Operation could be performed even in an active stage of the disease without much fear of milliary dissemination.
Brain ; Hydrocephalus* ; Intracranial Pressure ; Tuberculosis, Meningeal*

A direct intracranial operative approach that occludes the neck of the aneurysmal sac by clipping, and excludes it from the circulation without interference with the lumen of the parent vessel, is the ideal treatment of symptomatic intracranial aneurysm. With this procedure, however, there is no assurance of complete obliteration of the aneurysmal sac. Furthermore aneurysms arising from the anterior communicating artery are particularly dangerous because of the effects produced by spasm of the important neighboring perforating vessels. Since Logue published on the treatment of anterior communicating aneurysms by proximal ligation of an anterior cerebral artery in 1956, there has been by the large number of series of cases reported by other surgeons. Tindall classified three pattern of angiographic filling in patients with anterior communicating aneurysms and in type III, each anterior cerebral artery fills from its respective side, while the aneurysm fills from one side only, proximal ligation of anterior cerebral artery was performed with good effect. Five patients with anterior communicating artery aneurysm were treated by proximal occlusion of the dominant anterior cerebral artery with no mortality or morbidity. There was also instance of recurrent hemorrhage during the follow up period for 8 months to 5 years. We thought this operative procedure, therefore, can offer a highly acceptable result if the surgeon applies strict criteria to patient selection. Technically, the procedure was simple, earlier and could be performed more quickly than the direct attack.
Aneurysm ; Anterior Cerebral Artery* ; Arteries ; Follow-Up Studies ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Ligation ; Mortality ; Neck ; Parents ; Patient Selection ; Spasm ; Surgical Procedures, Operative