The authors carried out various treatment modalities in 74 consecutive patients with hypertensive basal ganglionic-thalamic intracerebral hemorrhage and were admitted to the Department of Neurosurgery. Konkuk University Hospital, from Jan. 1991 to Dec. 1993. A variety of prognostic factors that influence mortality were observed. The locaton of hematoma was at the basal ganglia in 47 cases and at the thalamus in 27 cases. The prognosis gets poorer as the hematoma extended wider and deeper. The prognosis was unfavorable when the hematoma was over 30cc(P<0.001). The mortality rate was higher in cases with IVH than in cases without IVH(P<0.005). In cases with IVH, 19 cases(26%) showed dilated 4th ventricular hemorrage and higher mortality rate(P<0.001). Cases in which the GCS were less than 9 on admission showed higher mortality rate(P<0.0001). The mortality rate was also higher if the midline shift was more than 10mm on the initial brain CT scan(P<0.005). THe group where the unilateral or bilateral pupillary light reflex was unreactive(35cases) showed poorer prognosis than the group where the bilateral pupillary light reflex was reactive(P<0.0001). The ventriculocranial ratio(VCR), hydrocephalus, surrounding edema edema around the heamtoam, and treatment modality were not related to the prognosis. The significant prognostic factors in patients with hypertensive basal ganglionic-thalamic intracerebral hemorrhage were location and type of hematoma, whether or not the volume of hematoma is more than 30cc, IVH, dilated 4th ventricular hemorrhage, Graeb's score of more than 7, GCS of less than 9, midline shift of more than 10mm, and reactivity of pupillary light reflex.
Basal Ganglia ; Brain ; Cerebral Hemorrhage* ; Edema ; Ganglion Cysts* ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Mortality ; Neurosurgery ; Prognosis ; Reflex ; Thalamus

The introduction of microdiscectomy in lumbar spine surgery has resulted in a significant decrease in postoperative pain and length of hospital stay. Intraoperative application of long-acting local anesthetic agents and corticosteroids during lumbar discectomy have been used for the management of postoperative pain. However, the efficacy of local anesthetic agents and corticosteroids has not been reported. This study evaluated 30 patients undergoing lumbar microdiscectomy. These patients were divided into three groups. Group I(10 patients) received intramuscular Depomedrol and intravenous Solumedrol at the start of the operation. A gelfoam soaked with Depomedrol was placed over the affected nerve root following discectomy. In addition, bupivacaine was infiltrated into the paraspinal musculature at the skin incision and during closure. Group II(10 patients) received intramuscular bupivacaine and used a saline-soaked gelfoam. Group III(10 patients) acted as a control group without corticosteroids and bupivacaine. Patients in Group I had a statistically significantly shorter hospital stay(8.9 days) compared to the control group(14.9 days). Patients in Group I required less postoperative narcotic analgesia than the other groups. A larger percentage of patients in Group I reported reduction of lower back pain and radicular pain until #POD 3 compared to other groups. These results indicate that the combination of long-acting local anesthetic agents and corticosteroids can reduce postoperative discomfort and hospital stay.
Adrenal Cortex Hormones* ; Analgesia ; Anesthetics ; Bupivacaine* ; Diskectomy ; Gelatin Sponge, Absorbable ; Humans ; Length of Stay ; Low Back Pain ; Methylprednisolone Hemisuccinate ; Pain Management* ; Pain, Postoperative ; Skin ; Spine

Negative pressure pulmonary edema is a recognized complication of airway obstruction, particularly after endotracheal extubation. The application of oxygen therapy and continuous positive airway pressure with the administration of diuretics under a rapid diagnosis usually clears pulmonary edema. We report a case of 61-year-old man who developed negative pressure pulmonary edema following extubation after an endoscopic submucosal dissection under general anesthesia.
Airway Extubation ; Airway Obstruction ; Anesthesia, General ; Continuous Positive Airway Pressure ; Diuretics ; Humans ; Middle Aged ; Oxygen ; Pulmonary Edema

BACKGROUND AND OBJECTIVES: Diabetes mellitus has been known as a multisystemic disorder that causes chronic complications, and diabetic peripheral and autonomic neuropathy may affect olfaction. The aim of this study was to evaluate the olfactory status of diabetic patients and the influencing factors on olfaction. Materials and Method: The olfactory status was evaluated with the recognition threshold of T and T olfactometery to diabetic group of 37 patients (19 male, 18 female) and control group of 115 healthy adults (56 male, 59 female). To the diabetic group, retrospective analysis of diabetic duration, alcohol and smoking history, and associated chronic complication such as neuropathy, retinopathy and nephropathy was done. And fasting blood sugar and HbA1c level was assessed. The statistical analysis was performed using Students t-test and Spearman methods. RESULTS: The olfactory recognition threshold of the diabetic group was significantly higher than that of the control group according to age, and there was no significant difference of the recognition threshold between male and female in both diabetic and control groups. The recognition threshold was significantly correlated with diabetic duration, associated complications and serum HbA1c level in the diabetic group. However, serum fasting sugar level and smoking history did not affect the recognition threshold in diabetic group. CONCLUSION: The diabetic patients with inappropriate sugar control have decreased olfaction than healthy normal control. We suggest that diabetic duration, associated chronic complications, and serum HbA1c level may be the influencing factors of olfactory dysfuction of diabetes.
Adult ; Blood Glucose ; Diabetes Mellitus ; Fasting ; Female ; Humans ; Male ; Retrospective Studies ; Smell ; Smoke ; Smoking