In 30 patients subjected to craniotomy for cerebral aneurysm, the correlation of cerebral blood flow and cerebral metabolism were evaluated by measuring mean arterial pressure (MAP) and cerebral arterio-venous oxygen content differences(AVDO2) during isoflurane and neurolept anesthesia. 15 patients were given 1 MAC isoflurane anesthesia and 15 patients neurolept anesthesia. MAP, AVDO2 and PaCO2 were measured before skin incision, after skin incision, after opening of dura and after closing of dura. The results were as follows: 1) In both groups, significant increases in MAP was observed after skin incision(P<0.05), no significant difference between the two groups was found. 2) In both groups, significant decreases in AVDO2 was observed after skin incision (<0.05), AVDO, values showed insignificant difference. The results indicate that even moderate increases in MAP after skin incision during isoflurane and neurolept anesthesia affect AVDO2 values, suggesting increases in cerebral blood flow. Therefore measures that prevent increase in MAP during incision should be implemented. The study suggests that isoflurane anesthesia is as useful as neurolept anesthesia in terms of AVDO2 to patients undergoing aneurysmal surgery.
Anesthesia* ; Aneurysm* ; Arterial Pressure ; Craniotomy ; Humans ; Intracranial Aneurysm ; Isoflurane* ; Metabolism ; Oxygen* ; Skin

No abstract available.
Cerebral Infarction ; Diffusion Magnetic Resonance Imaging ; Polycythemia ; Polycythemia Vera

A case of successful correction of subclavian steal syndrome by percutaneous transluminal angioplasty with stenting in a male patient who found incidentally significant interarm blood pressure difference. Small difference in blood pressure (BP) between two arms is a relatively common. Significant interarm BP difference is a potential marker of peripheral vascular disease such as subclavian artery stenosis and a predictor of cardiovascular disease. The subclavian steal syndrome is a condition that results from stenosis of subclavian artery proximal to the vertebral artery. The resulting symptoms are vertebrobasilar insufficiency symptoms due to reversal of blood flow from the contralateral vertebral and basilar artery into the ipsilateral upper extremity vessels and arm ischemic symptoms. Stenotic lesion of subclavian artery has traditionally been treated surgically. However recent trends are undergoing a paradigm shift from open surgery to endovascular approach. We report a patient with subclavian steal syndrome who found incidentally 35 mmHg interarm systolic BP difference. It was successfully treated by percutaneus transradial angioplasty with stenting on stenotic lesion of the subclavian artery.
Angioplasty ; Arm ; Basilar Artery ; Blood Pressure ; Cardiovascular Diseases ; Constriction, Pathologic ; Humans ; Male ; Peripheral Vascular Diseases ; Stents ; Subclavian Artery ; Subclavian Steal Syndrome ; Upper Extremity ; Vertebral Artery ; Vertebrobasilar Insufficiency

BACKGROUND: It has traditionally been known that there is normally a difference in blood pressure (BP) between the two arms; there is at least 20 mm Hg difference in the systolic blood pressure (SBP) and 10 mm Hg difference in the diastolic blood pressure (DBP). However, recent epidemiologic studies have shown that there are between-arm differences of < 5 mm Hg in simultaneous BP measurements. The purposes of this study is to examine whether there are between-arm differences in simultaneous BP measurements obtained from ambulatory patients without cardiovascular diseases and to identify the factors associated these differences. METHODS: We examined 464 patients who visited the outpatient clinic of Gangneung Asan Hospital clinical department. For the current analysis, we excluded patients with ischemic heart disease, stroke, arrhythmia, congestive heart failure, or hyperthyroidism. Simultaneous BP measurements were obtained using the Omron MX3 BP monitor in both arms. The inter-arm difference (IAD) in BP was expressed as the relative difference (right-arm BP [R] minus left-arm BP [L]: R - L) and the absolute difference (|R - L|). RESULTS: The mean absolute IAD in SBP and DBP were 3.19 +/- 2.38 and 2.41 +/- 1.59 mm Hg, respectively, in men and 2.61 +/- 2.18 and 2.25 +/- 2.01 mm Hg, respectively, in women. In men, there were 83.8% of patients with the IAD in SBP of < or = 6 mm Hg, 98.1% with the IAD in SBP of < or = 10 mm Hg, 96.5% with the IAD in DBP of < or = 6 mm Hg and 0% with the IAD in DBP of > 10 mm Hg. In women, 89.6% of patients had IAD in SBP of < or = 6 mm Hg, 92.1% with IAD in DBP of < or = 6 mm Hg, and 0% with IAD in SBP of > 10 mm Hg or IAD in DBP of > 10 mm Hg. Gangneung Asan Hospital clinical series of patients showed that the absolute IAD in SBP had a significant correlation with cardiovascular risk factors such as the 10-year Framingham cardiac risk scores and higher BP in men and higher BP in women. However, the absolute IAD in SBP and DBP had no significant correlation with the age, obesity, smoking, drinking, hyperlipidemia, diabetes, metabolic syndrome, and renal function. CONCLUSION: Our results showed that there were no significant between-arm differences in simultaneous BP measurements. It was also shown that most of the ambulatory patients without cardiovascular diseases had an IAD in SBP of < 10 mm Hg and an IAD in DBP of < 6 mm Hg.
Adult ; Ambulatory Care Facilities ; Arm ; Arrhythmias, Cardiac ; Blood Pressure ; Blood Pressure Determination ; Cardiovascular Diseases ; Drinking ; Epidemiologic Studies ; Female ; Heart Failure ; Humans ; Hyperlipidemias ; Hyperthyroidism ; Male ; Myocardial Ischemia ; Obesity ; Organothiophosphorus Compounds ; Risk Factors ; Smoke ; Smoking ; Stroke

PURPOSE: The purpose of this study was to assess the tumor characteristics and long-term clinical outcomes of adjuvant treatments after surgery with a curative aim for patients with breast cancer who are 65 years and older. MATERIALS AND METHODS: Patients with breast cancer who underwent curative surgery from 2000 to 2009 were analyzed (n=4,388). Tumor characteristics and survival outcome were compared by dividing the patients into two age groups (< 65 and ≥ 65 years old). The Kaplan-Meier method was used for comparison of survival rates by log-rank test, and a Cox regression model was used to examine the effect of variables. RESULTS: Among 4,388 patients with invasive breast cancer, 317 patients (7.2%) were 65 years or older and the median age of all patients was 47 years (range, 18 to 91 years). Tumor characteristics were similar between the two age groups, but the older patients were treated less often with adjuvant treatments. During a median follow-up period of 122 months, recurrence-free survival (RFS) was equivalent for patients 65 years and older compared to younger patients, but significantly worse in overall survival (OS) and breast cancer–specific survival (BCSS) (5-year OS, 94.3% vs. 90.5%; p < 0.001 and 5-year BCSS, 94.7% vs. 91.8%; p=0.031). In the multivariate model, age ≥ 65 years old was identified as an independent risk factor for OS and RFS. CONCLUSION: Elderly breast cancer appeared to have worse outcomes with very low prevalence in Korea, despite similar tumor characteristics. More active adjuvant therapies would have a role for aggressive subtypes for fit, elderly patients.
Aged* ; Breast Neoplasms* ; Breast* ; Follow-Up Studies ; Humans ; Korea* ; Methods ; Population Characteristics ; Prevalence ; Risk Factors ; Survival Rate ; Treatment Outcome