13 cases of intracranial Aneurysm were obliterated intracranially with Heifetz clip under Halothane /O2 Deliberate Hypotensive anesthesia. Deliberate hypotension in the surgery of intracranial aneurysm is used to diminish bleeding and render an aneurysmal sac slack to make clipping easy. Herein is presented a review of clinical experience of deliberate hypotension in conjunction with postural drainage. Clinical investigation has shown that this method offers a wider margin of safety. All factors stressed again the needs for careful, adequate and ideal clippage of the neck of aneurysm preferably with the use of Heifetz clip. Deliberate hypotension and adequate clippage of the neck of aneurysm subsequently allowed a favorable clinical result with an operative mortality by 7.7%.
Anesthesia* ; Aneurysm ; Drainage, Postural ; Halothane ; Hemorrhage ; Hypotension ; Intracranial Aneurysm* ; Mortality ; Neck

We report here on a case of sand aspiration in a 32-year-old man who had been accidentally buried in the deep pile of sand for four hours. Chest radiograph showed bilateral fluffy consolidations and nodular lesions with a typical 'sand bronchogram' in both lower lung zones, and these findings were more clearly visualized on the HRCT. The patient recovered completely with conservative treatment that included mechanical ventilation and postural drainage.
Adult ; Bronchography ; Drainage, Postural ; Humans ; Lung ; Radiography, Thoracic ; Respiration, Artificial ; Silicon Dioxide*

Two cases of Kartageneranjx syndrome were presented. They were sisters in the same family and were 15 years and 13 years old respectively. Chief complaints of the first case were chronic cough and expectoration and of the second case were chronic cough, expectoration and nasal stuffiness. Situs inversus, bronchiectasis and paranasal sinusitis were identified in both cases. EKG showed typical findings of mirror image compatible with dextrocardia in all two cases. Administration of antibiotics and postural drainage were performed with good resultin the first case but no remarkable improvement in the second case. A brief review of literatures was made.
Adolescent ; Anti-Bacterial Agents ; Bronchiectasis ; Cough ; Dextrocardia ; Drainage, Postural ; Electrocardiography ; Humans ; Siblings* ; Sinusitis ; Situs Inversus

The differentiation between lung abscess and empyema can be difficult, but has important therapeuticconsequences. Thoracostomy tube drainage is essential therapy for an empyema, whereas prolonged antibiotic therapyand postural drainage often suffice for a lung abscess. Conventional radiographic findings are usually relied onto help make correct indfferentiation between empyema and lung abscess, but overlying lung disease or unfavorablelocation of lesion often results in ambiguous findings. Although ultrasound has proved useful in differentiatingempyema from lung abscess, CT is best accurate diagnostic method. Authors reviewed chest CT of 50 cases(41empyemas, 9 lung abscesses)which were diagnosed by suegery or clinical background during the period from May 1980to June 1985 at Dongsan Medical Center, Keimyung University. The results were as follows: 1) Age and sexdistribution a) Empyema: The incidence was most common in the 6th and 7th decades. Male to female ratio was 3:1.b) Lung abscess: The incidence was most common in the 5th, 6th and 7th decades. Male to female ratio was 2:1. 2)Wall characteristics(empyema 32 cases, lung abscess 9 cases): The 9 cases of 41 empyemas had not defined theirwalls. a) Empyema had at least a part of their wall that was thin (81%), uniform width(84%), and smooth on bothmargins (more than 96%). b) The wall of lung abscess was thick (89%), and irregular margins(100%). 3) Separationof uniformly thickened visceral pleura from parietal pleura("split pleura" sign) was seen only in 68% of allempyemas. 4) Adjacent lung compression was seen only in 88% of all empyemas. 5) Chest wall angle: In 78% of allempyemas had obtuse or mixed angles, wherease in 85% of all lung abscesses had acute angle. 6) Shape oflesion:Empyema had variant shapes from round to crescent, however all lung abscesses had round or ovoid shape. 7)Size of lesion: In 85% of all empyemas had medium(41%) or large (44%) size, but the lung abscess had onlysmall(33%) or medium (67%) size. 8) Air in lesion was seen in 41% empyemas and in 89% lung abscesses. 9) Adjacentlung consolidation showed in 34% empyemas and in all lung abscesses. 10) Free pleural fluid was seen in 12%empyemas and in 89% lung abscesses. 11)Septated lesions were seen in 32% empyemas and in 56% lung abscesses. 12)Multiple lesions were seen in 44% empyemas and in 55% lung abscesses. 13) Mediastinal shifting was seen in 49%enpyemas and in 44% lung abscesses, but which all lung abscesses were coexisted with empyemas. 14) Pleuralcalcification was seen only in 5 cases(12%) of all empyemas. 15) Location of leison: Most(93%) of empyemas werelocated in posterolateral portion of hemithorax, and most (78%) of lung abscesses involved in right lower lobe.
Clothing ; Drainage ; Drainage, Postural ; Empyema ; Female ; Humans ; Incidence ; Lung Abscess ; Lung Diseases ; Lung ; Male ; Methods ; Pleura ; Rabeprazole ; Thoracic Wall ; Thoracostomy ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVE: To investigate the current status of respiratory care in community-dwelling amyotrophic lateral sclerosis (ALS) patients using non-invasive ventilatory support. METHOD: Trained investigators visited patients' homes in order to conduct the survey. Questions regarding the time since diagnosis and ventilatory support, department and type of ventilator were asked. The parameters of mechanical ventilation were noted. The presence of respiratory symptoms, frequency of oxygen saturation monitoring, maneuvers for sputum clearance and frequency of air stacking exercise were also investigated. RESULTS: Data from 169 individuals were analyzed. The mean age was 59.1+/-12.5 years, time since diagnosis was 48.0+/-42.8 months and duration of ventilatory support was 25.7+/-20.8 months. The types of ventilator used were significantly different according to the medical departments where they had been prescribed. More than 50% of the subjects had sleep awakening, shortness of breath or daytime drowsiness despite ventilatory support. Air stacking exercises were performed in 8.8%. Sputum clearing maneuvers such as manually assisted cough, mechanical in/ex-sufflation or postural drainage were used by 13.6% of the individuals. Only 16.0% of the patients checked their oxygen saturation level more than once a day. CONCLUSION: Current respiratory care is inappropriate in ALS patients using non-invasive ventilatory support at home. The current system for ventilator prescription and monitoring needs modification to improve the respiratory care status.
Amyotrophic Lateral Sclerosis ; Cough ; Drainage, Postural ; Dyspnea ; Exercise ; Humans ; Oxygen ; Positive-Pressure Respiration ; Prescriptions ; Research Personnel ; Respiration, Artificial ; Respiratory Therapy ; Sleep Stages ; Sputum ; Ventilators, Mechanical

Guillian-Barre syndrome may result in severe pulmonary insufficiency and death. Four cases disgnosed as this syndrome were treated with respirators such as Bird Mk-7, Bennett PR-Z, Bennett MA-1 and Ohio-560. All of the patients were tracheostomized and had a cuffed tracheostomy tube inserted. Volume and pressure respirators were fixed according to vital signs and arterial blood gas tensions. Mechanical and ultrasonic nebulizer and a heated humidifier were used for humidification. Lung vibration, postural drainage and breathing exercises were performed as occasion required. To prevent cross-infection aseptic techniques were used far tracheal suction and the sterilizable parts of the respirator and tracheostomy tube were changed daily. During the weaning from the respirator the vital signs, lung volumes and blood gas tensions with pH were carefully observed. Duration of respirator uses were 19 to 79 days and thereafter all were improved without complications. The results were as follows; 1. In 3 of 4 cases pseudomonas aeruginosa were cultured in sputum. 2. Narcosis, due to hypercapnea, and atelectasis were observed in case 1 and 2. 3. Electrolytes remained within normal limits in all cases. 4. The period of complete weaning from respirators required 4 to 30 days. 5. Bennett MA-1 and Ohio-560 respirators were more convinient than pressure limited respirators for humidification and regular deep breathing.
Birds ; Breathing Exercises ; Drainage, Postural ; Electrolytes ; Hot Temperature ; Humans ; Humidifiers ; Hydrogen-Ion Concentration ; Lung ; Nebulizers and Vaporizers ; Pseudomonas aeruginosa ; Pulmonary Atelectasis ; Respiration ; Sputum ; Stupor ; Suction ; Tracheostomy ; Ultrasonics ; Ventilators, Mechanical ; Vibration ; Vital Signs ; Weaning