BACKGROUND: Vascular dementia is common cause of dementia, second to the dementia of Alzheimer desease. However in Asia and many developing countries, the incidence of vascular dementia exceeds that of Alzheimer's disease. Though many stroke-related factors related the nature of vascular injury, e.g. infarction and hemorrhage, have not assessed yet. Clarifying the difference of electroencephalograpy and clinical prognosis between infarction and hemorrhage, the aim of this study was to elucidate the role of nature of vascular injury. METHODS: to reduce confounding factors, the study population was restricted to the patients of single hemispheric striatocapsular infarction and hemorrhage saving cortex. On admission, we checked the KMMSE and FIM scores and using quantified EEG, we analyzed occipital peak frequency and the relative background alpha, theta and delta spectra power taken from 16 derivations by averaging twenty-2 -sec epoch in infarction, hemorrhage patients and elderly controls. After 6 months follow up, we compare the MMSE, FIM score between infarction and hemorrhage group. RESULTS: 1) Compared with infarction group, hemorrhage groups had a significantly bilateral lower occipital peak freqauency and background bilateral alpha spectra power. 2) In hemorrhage group, there is lower tendency in K-MMSE after 6 month follow up compared to infarction group. CONCLUSION: This study suggests that hemorrhage show more bilateral electrophysiological dysfunction than infarction group and possible grave prognosis for vascular dementia compared to infarction group.
Aged ; Alzheimer Disease ; Asia ; Dementia ; Dementia, Vascular ; Developing Countries ; Electroencephalography* ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Infarction* ; Prognosis* ; Vascular System Injuries

No abstract available.
Anxiety Disorders* ; Anxiety*

BACKGROUND: The purpose of this study was to measure and compare the optimum depth of the internal jugular venous catheterization between the right and left side. METHODS: Forty-four patients were enrolled for this study and divided into two groups (22 patients each). The optimum depth of the catheterization was calculated using the sum of two component (A and B); the advanced length of the catheter from the level of the cricoid cartilage (A) and the distance from the catheter tip to the junction of the superier vena cava and right atrium (B). RESULT: The optimum depths of the internal jugular venous catheterization were 16.0 1.0 cm (right) and 18.4 1.5 cm (left) respectively. Left side was significantly longer than right side (p<0.05). In this study, we experienced some complications; arterial punctures (5 cases) and migration of the catheter to the opposite subclavian vein (1 case). Five complications were associated with left internal jugular venous cannulation and one was associated with the right side cannulation. CONCLUSION: We concluded that the optimum depth of the internal jugular venous catheterization was longer in the left side than in the right side.
Catheterization* ; Catheters* ; Cricoid Cartilage ; Heart Atria ; Humans ; Punctures ; Subclavian Vein

Extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hepercarbia are refractory to conventional treatments. Neonatal venoarterial(VA) ECMO in the USA is recognized as a therapeutic modality to neonatal respiratory failure and extracorporeal carbon dioxide removal(ECCO2R) in Europe is used for adult respiratory distress syndrome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. ECCO2R adopts low-flow venovenous(VV) bapss. VV bypass provides gas exchange without cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer and no major artery is sacrificed in ECCO2R. Highly oxygenated blood flows into pulmonary circulation which may relieve pulmonary hypertension. To evaluate the effectiveness of ECCO2R, we developed an experimental model on 7 mongrel dogs. Under general anesthesia with i. v. pentobarbital, two thin-walled polyurethane tubes in the external jugular vein and the femoral vein were connected with the extracorporeal circuit. Without ventilating the oxygenator duting VV bypass, control hemodynamic and blood gas values under conventional mechanical ventilation(CMV) were obtained. We proceeded to oxygen insufflation(OI), and extra- corporeal CO2 removal (ECCO2R) in that order. Oxygen was delivered at 300ml/min to the animal lung for OI and ECCO2R and was added at 21/min to the oxygenator only for ECCO2R. Hemodynamic parameteres did not vary among CMV, OI and ECCO2R. Arterial PH in CMV was 7.35+/-0.07 and was decreased to 7.19+/-0.05 in OI due to the increase of PaCO (70+/-3 mmHg). PaO2 was remained constant through the experiment. Mixed venous PH in CMV was 7.31+/-0.05 and was decreased to 7.15+/-0.08 in OI, Blood gas analysis values were same between CMV and ECCO2R. Carbon dioxide removal through the lung (V(L)CO2) were 47+/-3 ml/min in CMV, 9+/-3 ml/min in OI and 8+/-2 ml/min in ECCO2R. The amount of carbon dioxide removed via the oxygenator (VoCO2) was 38+/-5 ml/min in ECCO2R. The total amount of CO2 removal (VCO2) between CMV and ECCO2R was same statistically. The bypass flowrate at the lowest E(T)CO2 (end-tidal CO2) was 60+/-9 ml/min, resulting in 35+/-4% of bypass ratio. It can be concluded that ECCO2R can alleviate hypercapnea using a low flow VV bypass and may be used as an altermative of mechanical ventilator in the setting of acute respiratory failure.
Anesthesia, General ; Animals ; Anoxia ; Arteries ; Blood Gas Analysis ; Carbon Dioxide* ; Carbon* ; Catheters ; Dogs ; Drainage ; Europe ; Extracorporeal Membrane Oxygenation ; Femoral Vein ; Heart Atria ; Hemodynamics ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Jugular Veins ; Lung ; Membranes ; Models, Theoretical ; Oxygen ; Oxygenators ; Oxygenators, Membrane ; Pentobarbital ; Perfusion ; Polyurethanes ; Pulmonary Circulation ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Ventilators, Mechanical

BACKGROUND: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. METHODS: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04~0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. RESULTS: Before anesthesia, P(LF)(spectral power of LF-unit; sec2/Hz) is 0.06(0.03, 0.34) {median(5 percentile, 95 percentile)}, P(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P(LF)/P(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P(LF) is 0.06(0.03, 0.34), P(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P(LF)/P(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P(LF)/P(HF) 0.47(0.25, 1.34). During anesthesia, P(LF). is 0.14(0.05, 0.41), P(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P(LF)/P(HF), 0.58(0.22, 1.08). CONCLUSIONS: In general anesthesia, P(LF) P(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P(LF)/P(HF) and Ps during anesthesia also decreased, but P(LF)/P(HF) did not change. There were significant differences in degree of decrease in Ps and P(HF) between general and epidural anesthesia, but no differences in and P(LF)/P(HF).
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Autonomic Nervous System ; Catheters ; Cesarean Section* ; Enflurane ; Female ; Heart Rate* ; Heart* ; Humans ; Lidocaine ; Pregnancy

BACKGROUND: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. METHODS: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04~0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. RESULTS: Before anesthesia, P(LF)(spectral power of LF-unit; sec2/Hz) is 0.06(0.03, 0.34) {median(5 percentile, 95 percentile)}, P(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P(LF)/P(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P(LF) is 0.06(0.03, 0.34), P(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P(LF)/P(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P(LF)/P(HF) 0.47(0.25, 1.34). During anesthesia, P(LF). is 0.14(0.05, 0.41), P(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P(LF)/P(HF), 0.58(0.22, 1.08). CONCLUSIONS: In general anesthesia, P(LF) P(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P(LF)/P(HF) and Ps during anesthesia also decreased, but P(LF)/P(HF) did not change. There were significant differences in degree of decrease in Ps and P(HF) between general and epidural anesthesia, but no differences in and P(LF)/P(HF).
Anesthesia ; Anesthesia, Epidural* ; Anesthesia, General ; Autonomic Nervous System ; Catheters ; Cesarean Section* ; Enflurane ; Female ; Heart Rate* ; Heart* ; Humans ; Lidocaine ; Pregnancy

BACKGROUND: Though symptomatic improvements after treatment of donepezil is well documented in Alzheimer's disease (AD), the electrophysiological change have not yet been elucidated. Among the parameters of quantitative electroen-cephalography (q-EEG), high frequency activity, especially gamma rhythm, may play a role in normal cognitive function including the integration of sensory processing, association, coupling or selective attention, which are characteristically impaired in AD. METHODS: In order to define the profile of q-EEG changes including gamma rhythm after donepezil treatment, we followed 17 AD patients for 12 weeks. We analyzed the spectra power taken from 16 derivations by averaging twenty-2-sec epoch in normal controls and AD patients. After logarithmic transformation of spectra power, statistical test was done and the effect of donepezil treatment on q-EEG profile was analyzed during follow up period. RESULTS: Before medication of donepezil, AD patients had a significantly lower alpha spectra power as well as a significant higher delta spectra power, compared with normal control. After medication of donepezil in AD patients, compared to base-line q-EEG, gamma spectra power was significantly increased, whereas delta spectra power was significantly reduced. Compared to absolute power, relative power was more sensitive in detecting change of EEG after donepezil treatment. CONCLUSIONS: This study suggests that donepezil significantly change delta and gamma spectra power in q-EEG, and the increase in gamma rhythm may be correlated with the clinical improvements after donepezil treatment. (J Korean Neurol Assoc 19(3):245~250, 2001)
Alzheimer Disease* ; Electroencephalography* ; Follow-Up Studies ; Humans

BACKGROUND: Alzhiemeranjx disease (AD) and vascular dementia (VD) are common types of dementia. As a result of the development of new specific agents for AD, and because vascular dementia is a potentially preventable dementia, differentiating these diseases is of great importance. The role of EEG spectral analysis in the differential diagnosis between Alzheimer type and vascular dementia is still controversial. Since there have been few studies concerning the differential diagnosis of dementia by EEG, the present study has focused on this aspect. Usefulness of EEG in differen-tial diagnosis of dementia will be elucidated by clarifying relationship between type of dementia and spectral profile of EEG. METHODS: We analyzed the power spectra taken from 16 derivations and spectral profile was constructed by averaging twenty 2 sec epochs in three study groups (normal controls, AD and VD). Spectral profile was divided into three groups; (I) type A, showing a dominant 6.5-12 Hz peak (ii) type B, lacking a dominant peak in the 6.5-12 Hz (iii) type C, corresponding to a flat, low voltage, spectrum. To elucidate the relationship between spectral profile and other factors including diagnosis, statistical test was done. RESULTS: (1) In AD, type C profile was statistically more prevalent than in VD and type A profile was reversed. (2) In AD, Mini-Mental State Examination (MMSE) score was statistically lower in type C profile. (3) Spectral profile was not associated with age, age of symptom onset, and symptom duration. CONCLUSIONS: This study suggested that spectral profile is a useful tool for the differential diagnosis of dementia (AD and VD) and correlated with the severity of disease in AD.
Dementia ; Dementia, Vascular* ; Diagnosis ; Diagnosis, Differential* ; Electroencephalography*

To examine the effect of isoflurane on systemic hemodynamics and renal blood flow, the author measured mean arterial pressure, cardiac output, central venous pressure, renal blood flow and plasma renin activity by administration of 1 MAC and 2 MAC isoflurane with 50% nitrous oxide to dogs. From the above results total peripheral resistance and renal vascular resistance were calculated. The results are the following: 1) With an increase in isoflurane MAC, mean arterial pressure and cardiac output were decreased. 2) Total peripheral resistance did not differ between the control and 1 MAC isoflurane but decreased with 2 MAC isoflurane. 3) With an increase in isoflurane MAC, renal blood flow and renal vascular resistance were decreased but the decrease in renal blood flow was comparatively less than the decreases in mean arterial pressure and cardiac output. 4) Plasma renin activity was increased with an increase in isoflurane MAC. It is concluded that isoflurane decreases renal blood flow by decreasing mean arterial pressure and cardiac output in dogs, but it is strongly suggested that renal blood flow does not decrease more markedly than expected from the decreases in mean arterial pressure and cardiac output by direct dilation of renal vasculature and/or autoregulation.
Animals ; Arterial Pressure ; Cardiac Output ; Central Venous Pressure ; Dogs ; Hemodynamics ; Homeostasis ; Isoflurane* ; Nitrous Oxide ; Plasma ; Renal Circulation* ; Renin ; Vascular Resistance

To ten male volunteers, 25 to 35 years old and without any known disease, physiological saline solution (placebo) 1 ml, morphine 10mg, and Remeflin 16 mg were administered intramuscularly. Effects of tbese agents upon ventilation at rest and respiratory response to carbon dioxide rebreathing were studied. The results are as follows: 1) Morphine significantly decreased respiratory rate, minute volume, and Pao2 and increased Paco2 without significantly affecting either tidal volume or arterial pH. 2) In morphine-induced respiratory depression, Remeflin improved ventilation by significantly increasing tidal volume and minute volume with resultant increase in Pao2 and decrease in Paco2, Remeflin did not significantly alter respiratory rate and arterial pH 3) Morphine displaced respiratory response curve to carbon dioxide obtained with placebo 7 torr to the right and Remeflin 6 torr to the left. No changes in slope of the curves were observed. 4) It is concluded that Remeflin stimlulatea respiration by directly acting upon the respiratory center.
Adult ; Carbon Dioxide ; Humans ; Hydrogen-Ion Concentration ; Male ; Morphine ; Respiration ; Respiratory Center ; Respiratory Insufficiency ; Respiratory Rate ; Sodium Chloride ; Tidal Volume ; Ventilation ; Volunteers