No abstract available.
Cerebral Hemorrhage* ; Mucormycosis*

No abstract available.
Humans ; Spondylolisthesis*

No abstract available.
Hematoma* ; Orbit*

BACKGROUND: The purpose of this study is to assess the ability of dipyridamole99mTc-MIBI SPECT to identify and localize coronary artery disease(CAD). METHODS: The study population consists of 60 patients(37 males, 23 females : mean age 57+/-10 years) including 30 with prior myocardial infarction who underwent both dipyridamole99mTc-MIBI SPECT and coronary angiography for the evaluation of chest pain. RESULTS: The sensitivities for detection of CAD(> or =50% and > or =70% coronary stenosis by angiography) by dipyridamole99mTc-MIBI SPECT are 96% and 98% respectively, and specifities are 71% and 73% respectively. The sensitivities for detection of individual diseased vessels(> or =50% and > or =70%) are 79% and 90% for left anterior descending artery(LAD), 53% and 59% for left circumflex artery(LCX), 45% and 53% for right coronary artery(RCA), 64% and 77% for LCX/RCA, 63% and 72% for total. The specificities for detection of individual diseased vessels(> or =50% and > or =70%) are 62% for LAD, 98% and 98% for LCX, 92% and 89% for RCA, 91% and 89% for LCX/RCA, 87% and 86% for total. The concordances for ditection of individual didseased vessels beteen coronary angiography and dipyridamole99mTc-MIBI SPECT are all fair for SAD(Kappa=0.4 in > or =50% stenosis, 0.54 in > or =70% stenosis)LCX(Kappa=0.56,0.63),RCA(Kappa=0.4,0.44) and LCX/RCA(Kappa=0.56,0.67). CONCLUSION: Dipyriddamole99mTc-MIBI SPECT appers to be an useful noninvasive test for both identification and localization of coronary artery disease.
Chest Pain ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis* ; Female ; Humans ; Male ; Myocardial Infarction ; Tomography, Emission-Computed, Single-Photon*

Atotal of 26 patients diagnosed as diffuse axonal injury(DAI) between Nov. 1993 and Dec. 1995, were evaluated retrospectively with special attention given to MRI findings. In clinical aspects, there was male predominance(1.9:1) with the mean age of 28.5 years. The clinical grades based on the Glasgow coma scale(GCS) score were classified as mild(13-15), moderate(9-12) and severe(3-8). The duration of hospitalization and loss of consciousness(LOC) at admission were well correlated with the severity of clinical status. As regards the outcome of patients, twenty patients(77%) recovered as alert, but three patients(12%) died of sepsis. Short duration of LOC less than one day and young age of less than 10 years were good prognostic factors. The MRI findings of DAI were divided into three grades; in grade 1, there was small scattered lesions in the white matter of the cerebral hemisphere, in grade 2, focal lesion in the corpus callosum, and in grade 3, there was an additional focal lesion in the brain stem. The final outcome of grade 3 was poor, but in grade 2, there was wide spectrum between initial clinical status from alertness to semicoma and relative good result.
Axons* ; Brain Stem ; Cerebrum ; Coma ; Corpus Callosum ; Diffuse Axonal Injury ; Hospitalization ; Humans ; Magnetic Resonance Imaging ; Male ; Retrospective Studies ; Sepsis

Spontaneous migration of the shunt catheter into the posterior cranial fossa is very rare complication of lumboperitoneal shunt operation. The authors report a case with communicating hydrocephalus following ruptured intracranial aneurysm for which a lumboperitoneal shunt was placed. Four years later, she was presented with low back pain after the slip-down in jury, and radiologic studies revealed compression fracture at T12 and intracranial migration of shunt catether into the posterior fossa. From our knowledge, there is only one other such case reported in the literature.
Catheters* ; Cranial Fossa, Posterior ; Fractures, Compression ; Hydrocephalus ; Intracranial Aneurysm ; Low Back Pain

Controlled mechanical ventilation with positive end-expiratory pressure(PEEP) is a widely accepted method for the treatment of acute respiratory failure. But artificial ventilation with large tidal voume, high airway pressure and an inspired oxygen concentration of l00% are necessary for adequate arterial oxygenation in severe acute pulmonary parenchymal failure. It has been suspected that such therapy may cause irreversible pulmonary damage. The extracorporeal respiratory support has been called extracorporeal membrane oxygenation (ECMO), extracorporeal CO, removal(ECCO2R) or extracorporeal lung assist(ECLA). They are prolonged venoarterial(VA) or venovenous(VV) bypass for the refractory hypoxemia which provides the diseased lung with rest. The respiratory rate can be lowered down to about 4~8 rates/min during ECLA. PEEP is known to improve the ventilation perfusion distribution with alveolar recruitment. Low frequency positive pressure ventilation is accompanied by PEEP to keep alveoli open during ECLA. The level of PEEP must be determined adequately because high PEEP may decrease the cardiac output especially during VV ECLA. The experimental model for acute respiratory failure was induced by the intravenous injection of oleic acid 0.07ml/kg on six mongrel dogs(15.8+/-0.7kg). After values of arterial oxygen saturation(SaO2) and end-tidal CO2(E(T)CO2) were stabilized on the monitor, we measured control values of hemodynamic parameters. The stepwise increase of PEEP from 5 cmH2O to 15 cmH2O via 10 cmH2O was followed by the comparison of the respective hemodynamic values at each PEEP with control. Compared with control, PEEP of 5 cmH2O did not cause any changes and PEEP of 15 cmH, decreased cardiac output. At PEEP of 10 cmHO, the cardiac output and oxygen flux was maintained with normoxia. It was concluded that PEEP of 10 cmHO can be applied to clinical VV ECLA.
Animals ; Anoxia ; Cardiac Output ; Dogs* ; Extracorporeal Membrane Oxygenation ; Hemodynamics ; Injections, Intravenous ; Lung ; Models, Theoretical ; Oleic Acid* ; Oxygen ; Perfusion ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Insufficiency* ; Respiratory Rate ; Ventilation

The authors present a case of huge atypical choroid plexus papilloma in both lateral and third ventricles. A 2-year-old girl presented with lethargy and vomiting. Magnetic resonance images disclosed a huge enhancing mass, which probably arose from the left lateral ventricle and extended to the right lateral and the third ventricles. Total removal of the mass via the interhemispheric transcallosal approach was done. Histologically, an atypical choroid plexus papilloma was identified. Second operative treatment, subduro-peritoneal shunt, was performed due to postoperative subdural effusion. The patient was discharged two weeks after the second surgical procedure without a neurological deficit.
Child, Preschool ; Choroid Plexus* ; Choroid* ; Female ; Humans ; Lateral Ventricles ; Lethargy ; Papilloma, Choroid Plexus* ; Subdural Effusion ; Third Ventricle ; Vomiting

In cervical spine disease patients, the authors performed awake intubation with a flexible fiberscope under local anesthetic preparation to avoid insult to the cervical spine during intubation, and had patients self pronate for positioning to prevent possible complications durings the turning from cart to operating table. We performed this method in 25patients(age15-68 years,19male female6). For oral anesthesia we used 15-20cc of 4% lidocaine in a divided dose. We injected 2 cc of 2% lidocaine for each superior laryngeal nerve block and injected 4-6 cc of 2 to 4% lidocaine through the cricothyroid membrane for transtracheal nerve block with a 22-gauge intravenous catheter. It took 5-10 minutes in 23 patients and over 10 minutes in 2 patients for local anesthetic preparation. It took less than 1 minute in 15 patients, 1-4 minutes in 6 patients and more than 4 minutes in 4 patients for fiberoptic awake intubation. We observed vocal cord movement in 6 patients and blood clot in the trachea in 7 patients. Seventeen patients did pronate without help, 5 patients needed some help and 3 patients needed full support. Among the 3 patients who needed full support, 2 patients were in a halo traction state and one was in deep sedation. Ten patients complained of pain or discomfort during intubation. This complaint may be related which the time taken for intubation and inadequate local anesthesia. There were no complications related to positioning. We concluded that fiberoptic awake intubation and self pronation for positioning is a safe and useful method for anesthetic mnagement in cervical spine disease patients.
Anesthesia ; Anesthesia, Local ; Catheters ; Deep Sedation ; Humans ; Intubation* ; Laryngeal Nerves ; Lidocaine ; Membranes ; Nerve Block ; Operating Tables ; Pronation* ; Spine* ; Trachea ; Traction ; Vocal Cords

OBJECTIVE: A 10-year retrospective lumboperitoneal(LP) shunt surgery was reviewed in order to verify the several prognostic factors including the etiology, the findings of brain computed tomography(CT) and/or magnetic resonance imaging(MRI), and the effect of lumbar drainage which have been implicated in the result of LP shunt. PATIENTS AND MEHTODS: A series of 32 patients who underwent LP shunt surgery between March 1988 and May 1998 for the management of communicating hydrocephalus was reviewed. RESULTS: The etiology of communicating hydrocephalus was subarachnoid hemorrhage(SAH) in 19 cases(59.4%), head trauma in 10 cases(31.2%), intracerebral hemorrhage in 2 cases(6.3%), meningitis in 1 case(3.1%), tumor in 1 case(3.1%), and idiopathic in 2 cases(6.3%). The mean follow-up period was 1.2 years(range, 2 week to 8.5 year). Among them, twenty four patients(75%) were clinically improved after shunt operation. The result of LP shunt was not related to the etiologies and many findings of brain CT/MRI such as ventricular index, Evan's index, periventricular low density, obliteration of cerebral sulci and cortical atrophy. However, the result of LP shunt was significantly related to the effect of preoperative lumbar drainage(p=0.0184). CONCLUSION: This result suggests that the effect of preoperative lumbar drainage has a significant role in predicting the result of LP shunt in patients with communicating hydrocephalus.
Atrophy ; Brain ; Cerebral Hemorrhage ; Craniocerebral Trauma ; Drainage ; Follow-Up Studies ; Humans ; Hydrocephalus* ; Meningitis ; Retrospective Studies