We found a rare case of uncommon branching pattern with a prominent articular ramus of the inferior gluteal artery in a 39-year-old Korean male cadaver, whose cause of death was rectal carcinoma. The inferior gluteal artery branches off downwards at a time, the muscular rami ran in parallel with one another, and the articular ramus gave another muscular branch and has an anastomosis with the medial circumflex femoral artery. Knowledge of vascular variations in the gluteal region may give useful information of versatile flaps for reconstruction and the prominent articular ramus found in this case is good enough to consider the existence of the anastomosis between the medial circumflex femoral artery and the inferior gluteal artery as normal, not rudimentary
Adult ; Arteries* ; Buttocks ; Cadaver* ; Cause of Death ; Femoral Artery ; Humans ; Male

We found a rare case of uncommon branching pattern with a prominent articular ramus of the inferior gluteal artery in a 39-year-old Korean male cadaver, whose cause of death was rectal carcinoma. The inferior gluteal artery branches off downwards at a time, the muscular rami ran in parallel with one another, and the articular ramus gave another muscular branch and has an anastomosis with the medial circumflex femoral artery. Knowledge of vascular variations in the gluteal region may give useful information of versatile flaps for reconstruction and the prominent articular ramus found in this case is good enough to consider the existence of the anastomosis between the medial circumflex femoral artery and the inferior gluteal artery as normal, not rudimentary
Adult ; Arteries* ; Buttocks ; Cadaver* ; Cause of Death ; Femoral Artery ; Humans ; Male

An induced hypotension is employed as a useful technique for operations on intracranial aneurysms, brain tumors and other intracranial lesions to diminish operative bleeding and to decrease brain tension. In aneurysm surgery under induced hypotension, the sac becomes softer and thus diminishes the risk of rupture when clips are applid. In 1946 Gardner used arteriotomy to lower blood pressure by decreasing the blood volume during brain tumor surgery, then gradually improved. Pharmacologically-induced hypotension soon became the cominant method of producing hypotension. Halothane and trimethaphan are the most popular drugs for this purpose. On the other hand, the risks of hypotension are obvious. These include decreased cardiac output, decreased cerebral blood flow, and low perfusion pressure exposing brain tissue to the risk of hypoxia thereby aggravating the effects of the circulatory disturbance present in the brain lesion. In this situation the blood oxygen tension in jugular-bulb and lactate content in brain tissue have been found to be reliable indices of degrees of cerebral oxygenation. Consequently, several investigators have studied the critical level of arterial blood pressure during hypotensive anesthesia and have accepted 60 mmHg of systolic pressure(40~50 mmHg of mean arterial pressure) as a clinically applicable level free from the danger of cerebral hypoxia. Furthermore, Griffiths and Gillies(1948) postulated that systolic pressure over 30 mmHg would provide adequate tissue oxygenation. However, there are only a few reports concerning the adequacy of cerebral oxygenation under such low levels of arterial blood pressure. The purpose of this study is to investigate cereral hemodynamics and metabolism during halothane-induced hypotensive anesthesia and to find any evidence of cerebral hypoxia at the levels of 60 mmHg and 30 mmHg, of systolic blood pressure. 15 adult mongrel dogs, weighing 10~13kg, were anesthetized with intravenous pentobarbital sodium. Endotracheal intubation was performed. One femoral artery was cannulated with a polyethylene tube for arterial blood sampling. The tube was connected to a Statham pressure transducer for continuous arterial blood pressure recording. The common carotid artery was exposed and a probe of square-wave electromagnetic flowmeter was placed on the vessel to record the carotid blood flow. An electrocardiogram and above two parameters were recorded simultaneously on a 4-channel polygraph. The internal jugular vein was cannulated and a catheter threaded up to the jugular-bulb for sampling of venous blood draining from the brain. The cisterna magna was punctured with an 18 gauge spinal needle to sample the cerebrospinal fluid. The experiments were divided into control phase, induction phase, hypotensive phase I, hypotensive phase II, and recovery phase. Each phase was maintained for 30 minutes. Cerebrospinal fluid, arterial venous blood were sampled at the end of each phase for analysis of gas tension and lactate content. 100% oxygen was inhaled during the induction phase. During the hypotensive phases, halothane/O2 was administered to lower the arterial blood pressure. In the hypotensive phase I and hypotensive phase II systolic pressure was maintained at 60 mmHg and 30 mmHg, respectively. In the recovery phase, halothane was discontinued and 100% oxygen only was inhaled. The results obtained are summarized as follows; 1. The carotid artery blood flow, which represents the cerebral blood flow, decreased linearly during the decline of the arterial blood pressure. At the end of each phase there was no difference in the carotid blood flow between hypotensive phase I and phase II. Cerebral vascular resistance was markedly reduced in the hypotensive phase II, which suggests cereral vasodilation. 2. Cerebral venous pO2 decreased significantly in the hypotensive phases, but the values till remained within normal limits. A marked reduction of arterial pCO2 was noted in the hypotensive phases. The values approach the lower limits of safety. 3. The most outstanding difference between hypotensive phase I and II is in the lactate content of cerebral venous blood and cerebrospinal fluid. There was a moderate increase of lactate content, and a slight reduction of cereral venous pH in hypotensive phase II, however, a significant degree of cerebral hypoxia and metabolic acidosis could be excluded. 4. Most of the changes in the cerebral metabolism and hemodynamics including arterial blood pressure, tent to return to return to normal at the end of the recovery phase. From the result of this study, it is concluded; Halothane-induced hypotensive anesthesia at 60 mmHg of systolic blood pressure(45 mmHg of possibility of mild metabolic acidosis 30 mmHg of systolic blood pressure(23 mmHg of mean arterial pressure), adequate cerebral oxygenation is maintained without difficulty.
Acidosis ; Adult ; Anesthesia* ; Aneurysm ; Animals ; Anoxia ; Arterial Pressure ; Blood Pressure ; Blood Volume ; Brain ; Brain Neoplasms ; Cardiac Output ; Carotid Arteries ; Carotid Artery, Common ; Catheters ; Cerebrospinal Fluid ; Cisterna Magna ; Dogs ; Electrocardiography ; Femoral Artery ; Flowmeters ; Halothane ; Hand ; Hemodynamics ; Hemorrhage ; Humans ; Hydrogen-Ion Concentration ; Hypotension ; Hypoxia, Brain ; Intracranial Aneurysm ; Intubation, Intratracheal ; Jugular Veins ; Lactic Acid ; Magnets ; Metabolism ; Needles ; Oxygen ; Pentobarbital ; Perfusion ; Polyethylene ; Research Personnel ; Rupture ; Transducers, Pressure ; Trimethaphan ; Vascular Resistance ; Vasodilation

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis if confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The first case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.
Adult* ; Autopsy ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gliosis ; Headache ; Humans ; Hydrocephalus* ; Infant ; Memory ; Neurologic Examination ; Papilledema ; Seizures ; Skull ; Third Ventricle ; Ventriculostomy

Though non-tumoral stenosis of the aqueduct has long been described as a common cause of hydrocephalus in infants and young children, its occurrence in adults has been recorded infrequently. In adults, the general picture of the clinical features is of chronic hydrocephalus such as impaired memory, epilepsy, unsteady gait, headache and other features of increased intracranial tension and endocrine disorders and features indicative of hypothalamic involvement. Plain skull X-rays show the signs of increased intracranial tension. The diagnosis if confirmed by ventriculography with or without lumbar encephalography. Recently cerebral angiography is stressed in diagnosis of aqueductal stenosis. We have seen two cases of aqueductal stenosis which can be regarded as non-tumoral origin. They were females and 29 and 34 years old respectively. Their symptoms were similar. It was headache for several months' duration which were aggrevated as time progress and combined with convulsions. Bilateral papilledema was the only finding in neurological examination. In conray ventriculography, the third ventricles were markedly enlarged and involved the salla tursica, and conray was not filled the caudal part of the aqueduct in two cases. The first case, following Torkildsens ventriculocisternal shunt did well for several days, however, patient died in spite of massive antibiotic therapy and ventriculostomy after removal of shunt tube which was regarded as infective. Autopsy showed periaqueductal gliosis without neoplasmic infiltration. Second case was improved with anterior third ventriculostomy.
Adult* ; Autopsy ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis ; Epilepsy ; Female ; Gait Disorders, Neurologic ; Gliosis ; Headache ; Humans ; Hydrocephalus* ; Infant ; Memory ; Neurologic Examination ; Papilledema ; Seizures ; Skull ; Third Ventricle ; Ventriculostomy

We have done clinical analysis of 92 cases with chronic subdural hematoma, admitted to our department from August 1, 1984 to July 31, 1987. The following results were obtained; 1) The ratio of male versus female was 3.6:1, and 6 cases(71.7%) were over 50 year-old age. 2) 50 cases(75.7%) in older group(over 50) had head trauma history, and 11 cases(42.3%) in younger group(under 50). 3) The major clinical symptoms and signs in older group were mental deterioration and hemiparesis, in younger group headache and vomiting. 4) The hematoma densities in CT on admission were hyperdense 1.0%, isodense 33.7%, hypodense 39.3%, and mixed 25.9%. The shapes were biconvex 45.7%, planoconvex 35.8%, and crescenteric 18.5%. 5) The operation method was either burr hole drainage, or craniotomy with membranectomy, according to patient's physical condition and CT findings. In postoperative results there was no significant difference in both.
Craniocerebral Trauma ; Craniotomy ; Drainage ; Female ; Headache ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Male ; Middle Aged ; Paresis ; Vomiting

The radiofrequency has been used for percutaneous cordotomy in patient having intractable pain. Recently the use of this radiofrequency has been extended to include other neurosurgical procedures, which in the past were done with chemical agents or mechanical methods etc. We treated one case of trigeminal neuralgia with the radiofrequency. The gasserian ganglion was punctured through the foramen ovale using a modified Hartel technique and the radiofrequency lesion was made in the second and third branches of the right trigeminal nerve selectively. The postoperative result was satisfactory. We reviewed the literature and described the technical procedures and complications.
Cordotomy ; Foramen Ovale ; Humans ; Neurosurgical Procedures ; Pain, Intractable ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*

Visual evoked potentials were elicited by flash in 29 patients with a variety of cerebral lesions and in 10 normal controls. In 12 patients with focal brain lesions, no wave form could be recorded in one side. Of the remaining 23 sides, the average P1 latency showed no difference from that of the normal controls. In 17 patients with diffuse brain lesions no wave form could be elicited in 12 sides. Average P1 latency of remaining 22 sides showed statistlcally significant difference from that of normal controls. In this study it appears that delayed P1 latencies are associated with diffuse cerebral lesions rather than with localized lesions.
Brain ; Evoked Potentials, Visual* ; Humans

Ureaplasma urealyticum causes infection or colonization of female genital tracts associated with preterm delivery and infertility and the infection of the bloodstream, respiratory tract, and central nervous system in infants, especially in prematures. We report the first case of U. urealyticum meningitis in a premature infant in Korea. She was born with a birth weight of 1,481 gram at 32+3 weeks' gestation and hospitalized for a respiratory care in the NICU in November 2005. Endotracheal aspirates and urine cultures grew U. urealyticum at <10(4) CFU/mL of the specimens at 2-day-old, and cerebrospinal fluid (CSF) cultures grew U. urealyticum at > or = 10(4) CFU/mL of CSF. The patient had a marked CSF pleocytosis, low glucose and high protein content on the 13th hospital day. CSF cultures for ordinary bacteria, mycobacteria and fungi remained negative. U. urealyticum was resistant to erythromycin, tetracycline, ciprofloxacin and pristinamycin, but susceptible to doxycycline. Although she was treated with erythromycin for 30 days, the organism was still isolated four times from the CSF with fluctuation of C-reactive protein (CRP). After the addition of chloramphenicol, CSF cultures became negative in 3 days. However, CRP rose again with increased BUN at the 99th hospital day, and she died on the 103rd hospital day under the diagnosis of a clinical sepsis of unknown origin. In acute meningitis of prematures already colonized with U. urealyticum, ureaplasmal cultures and susceptibility test are warranted in Korea.
Anti-Bacterial Agents/*therapeutic use ; Drug Resistance, Bacterial ; Erythromycin/*therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/*diagnosis/drug therapy ; Meningitis, Bacterial/*diagnosis/drug therapy ; Ureaplasma Infections/*diagnosis/drug therapy ; *Ureaplasma urealyticum

A submucosal lymphatic cyst is a thin-walled cyst, lined by flattened lymphatic endothelium, containing thin serous fluid. It rarely causes clinical symptoms, and it is incidentally discovered during fiberoptic panendoscopy or radiologic study in most cases. It is an extremely rare benign tumor of the stomach; however, a submucosal lymphatic cyst should be considered if a pliable and benign submucosal lesion is detected during fiberoptic panendoscopy. We report a case of submucosal lymphatic cyst of the stomach which showed a typical clinical picture. This report is the first case of submucosal lymphatic cyst of the stomach in Korea to the best of our knowledge.
Age Factors ; Biopsy ; Case Report ; Gastric Mucosa/pathology ; Human ; Lymphangioma/etiology/*pathology/surgery ; Male ; Middle Age ; Stomach Neoplasms/etiology/*pathology/surgery