This study was designed to determine if topical cardiac hypothermia is a necessary adjunct to intraoperative myocardial protection. In this study, 105 patients ranging in age from 22 to 74 years were included. Myocardial temperature was measured at the ventricular septum. All patients received cold blood cardioplegia without topical cooling. In most of the patients(90%) the myocardial temperature was dropped to 10-15degrees C without topical cooling. In Group A, myocardial temperature was dropped rapidly to 10-15degrees C with, 1,000ml or less cardioplegic solution. In Group B, the amount of cardioplegic solution required for lowering myocardial temperature to 10-15degrees C was 1,000-2,000ml. In Group C, myocardial temperature was not dropped below 18degrees C or cardioplegic solution over 2,000ml was required for lowering myocardial temperatur. Eight patients(8/61, 8%) in group A, 12 patients(12/35, 34%) in group B and 8 patients(8/9. 89%) in group C had Complete obstructive lesions in at least one of major branches of coronary artery(p=0.001). Myocardial perfusion score was different among the groups(8.27+/-2.27 in group A, 9.98+/-2.21 in group B, 10.30+/-2.49 in group C, p<0.002). These data suggest that routine topical hypothermia may be unnecessary if myocardial temperature of less than 15degrees C could be attained with cold blood cardioplegia, especially in case of myocardial perfusion score below 10.
Cardioplegic Solutions* ; Heart Arrest, Induced ; Humans ; Hypothermia ; Perfusion ; Ventricular Septum

Recent technological advances in ultrasound instrumentation have resulted in equipment that will image in "real-time" slices of the human brain similar in quality to computerized tomography(CT). Multiple authors have attested to its usefulness in locatin, characterizing, and facilitating in the biopsy or removal, or both, of intracerebral masses. In this study, the author has examined the efficacy of intraoperative neurosurgical ultrasound in 18 patients who were admitted to the Department of Neurosurgery, Kyung Hee University Hospital. The results were as follows : 1) It can provide critical assistance in precise localization of subcortical masses, since in many instances the overlying surface of brain provides no clue for localization. 2) This technique is very useful for the identificantion of deep lesions, provding infromation about their solid and cystic components and about the shortest route of access to tumor. 3) It provides precise information to help guide biopsy needles into deep lesions, and to confirm their presence within the lesion itself. 4) The system is highly accurate in visualizing ventricular catheters during and after their placement. 5) The system is inherently safe for the patient and the operating room personnel since there is no radiation exposure.
Biopsy ; Biopsy, Needle ; Brain ; Catheters ; Humans ; Needles ; Neurosurgery* ; Operating Rooms ; Ultrasonography*

This study was carried out to find out changes in regional cerebral blood flow(r-CBF) in relation to(i) clinical status of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysms ; (ii) the degree of subarachnoid hemorrhage as indicated by brain CT scanning ; (iii) the severity of angiographic vasospasm, and (iv) other neuropathological condition. Measurement of r-CBF were performed, using 133Xe inhalation method, on 50 patients with ruptured intracranial aneurysms. Some of the major findings were as follows : 1) The degree of abnormalities of blood flow correlated well with the clinical severity of neurological deficits. 2) A marked reduction in r-CBF was found in patients with intracerebral hematoma, ischemic lesion and hydrocephalus. 3) In angiospasm area, r-CBF was found in patients with intracerebral hematoma, ischemic lesion and hydrocephalus. 3) In angiospasm area, r-CBF decreases below 30ml/100gm/min in almost all of the patients, and severity of vasospasm correlated with the decrease of CBF. 4) The measurement of CBF on patients with subarachnoid hemorrhage was thought to the useful for foreseeing the clinical outcome of the patients.
Brain ; Hematoma ; Humans ; Hydrocephalus ; Inhalation ; Intracranial Aneurysm* ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

STUDY DESIGN: This is a retrospective study analyzing 76 patients treated by decompression, pedicle screw instrumentatin and fusion for spondylolytic spondylolisthesis with symptomatic spinal stenosis. OBJECTIVES: This is to verify the advantages of adding posterior lumbar interbody fusion (PLIF) to the usual posterolateral fusion (PLF) with pedicle screw instrumentation. SUMMARY OF BACKGROUND DATA: Stabilization after decompression of spondylolytic spondy- lolisthsis is difficult due to insufficiency of fusion base, gap between the bases and incompetent anterior disc support. PLIF offers anterior support, reduction and a broad fusion base. METHODS: Forty patients were treated with PLF and 36 were treated with additional PLIF. They were compared for union, reductin of the deformity and clinical results. RESULTS: The patients were followed up for more than 2 years (mean: 4.6 years). Nonunion was observed in 3 PLF cases (7.5%) and none in PLIF. Reduction of slippage was 28.3% in PLF and 41.6% in PLIF (p < 0.05). In PLF group, 8 patients (20%) had recurrence of deformity with loss of reduction more than 50%. Hardware failures occurred in 2 with PLF. There was no major neurologic complications in both groups. Both groups had a few difference in the satisfactory results, but some difference in the excellent result by Kirkaldy-Willis criteria. Excellent result was 45% in PLF and 75% in PLIF. CONCLUSIONS: Addition of PLIF to PLF following a complete decompression and pedicle screw flxation is a recommendable procedure for the treatment of spondylolytic spondylolisthesis with spinal stenosis.
Congenital Abnormalities ; Decompression ; Humans ; Pedicle Screws ; Recurrence ; Retrospective Studies ; Spinal Stenosis ; Spondylolisthesis

No abstract available.
Evoked Potentials*

Dural arteriovenous malformations(DAVM) or Dural Arteriovenous fistulas(DAVF) consists of multiple arteriovenous shunt between arteries and a dural venous sinuses or a meningeal vein, constitute 10% to 15% of all intracranial arteriovenous malformations Most commonly they involve the transverse, the sigmoid and the cavernous sinuses. Other locations include the tentorial incisure, the superior sagittal sinus, the torcular Herophili, anterior cranial fossa, the convexity dura mater, and the foramen magnum. In angiographic features, leptomeningeal retrograde venous drainage, variceal or aneurysmal venous structure, and galenic venous drainage are significantly associated with aggressive neurological course caused by intracranial hemorrhage(ICH or SAH). Lesion at tentorial incisura and anterior cranial fossa has a tendency to have aggressive neurological course. Dural AVM located at cavernous sinus are classified as 4 types according to arterial distribution. Treatment of Dural AVF or CCF includes conservative monitoring, manual compression, arterial embolization, transvenous occlusion, surgical excision and radiation therapy. Surgical therapy with or without preparatory embolization remains the most versatile and effective therapeutic option. It is usually aimed at resecting the dural leaflets harboring the AVM(and adjacent sinus) and at disconnecting leptmeningeal draining pathways which are typically the source of serious neurological sequelae. In Tentorial AVF or anterior cranial fossa AVF the first choice of treatment is surgery because of difficulty in accessibility through transarterial or transvenous embolization.
Aneurysm ; Arteries ; Arteriovenous Malformations* ; Cavernous Sinus ; Colon, Sigmoid ; Cranial Fossa, Anterior ; Drainage ; Dura Mater ; Fistula* ; Foramen Magnum ; Intracranial Arteriovenous Malformations ; Superior Sagittal Sinus ; Veins

No abstract available.
Writing*

OBJECTIVE: The current progress of the molecular biological study is in the situation of documentation of relation between the tumor development and the gene mutation. We report an analysis of gene expression profiling of meningioma by cDNA chip. METHODS: Meningioma, tumor attached dura and normal dura were obtained during surgery. RNA was extracted from each specimen and cDNA microarray was done. After that, we confirmed the reliability of results from the microarray technique by RT-PCR. RESULTS: We examined the expression of the tumor related gene by cDNA chip. The genes showing two fold changes in the expression were analyzed to find the difference between two groups. The analysis of the tumor and tumor attached dura indicated that the expression of twenty four genes were increased and seventeen genes were decreased in the tumor. The analysis of the gene expression of tumor and normal dura showed increase in twenty seven genes and decrease in thirty one genes. Nine genes in the tumor showed more increase than those in the tumor attached dura and the normal dura. We performed RT-PCR using cytokines to confirm the reliability of the microarray result. CONCLUSION: The cDNA chip contributes as a good laboratory method to check various gene expression of the meningioma and the dura. In the future, the relationship between the expression of IL-1beta, IL-4, IL-6, IL-8, and the function of each gene are required to investigate.
Cytokines ; DNA, Complementary* ; Gene Expression Profiling* ; Gene Expression* ; Interleukin-4 ; Interleukin-6 ; Interleukin-8 ; Meningioma* ; Oligonucleotide Array Sequence Analysis ; Reproducibility of Results ; RNA

Somatosensory evokd responses(SSERs) and auditory evoked responses(AERs) were studied in 33 patients with cerebral aneurysms and arteriovenous malformations(AVMs) to see if these tests were useful indicators of cerebral vasospasm. 7/21 had abnormal SSER and 5/28 an abnormal AER. The SSER was abnormal in 4/7 patients with severe vasospasm but in only 1/13 without spasm or with mild or moderate spasm. Abnormal SSERs in patients with severe vasospasm indicated a poor prognosis. Abnormalities on the SSER and AER correlated best with the degree of clinical deficit. These tests seemed insufficiently sensitive to reliable detect impending ischemia.
Arteriovenous Malformations* ; Humans ; Intracranial Aneurysm* ; Ischemia ; Prognosis ; Spasm ; Vasospasm, Intracranial

In 1992 the Korean Medical Association intended to make revised evaluation and rate of physical impairment based upon rate and evaluation of physical impairment according to National Compensation Law which was composed of 14 subdivisions with various rates of physical impairment. Committee of Evaluation of Physical Impairment in Korean Neurosurgical Society provided revised evaluation of nervous or mental impairment, peripheral never impairment and spinal column impairment. Because McBride Disability Evaluation and Guide to the Evaluation of Permanent Impairment by American Medical Association have been used widely in this field the author describe evaluation and rate of physical impairment in each method briefly and compare to revised evaluation by Korean Medical Association in subject of neurologic and spinal impairment.
American Medical Association* ; Compensation and Redress ; Disability Evaluation ; Jurisprudence ; Spine