The mechanisms involved in brain neuronal damage in ischemia are related to the elevation of cytosolic calcium concentration and calcium antagonist is considered as a promising drug that may alleviate ischemic neuronal damage. Using transient global ischemia model of Mongolian gerbil, we studied the effect of nimodipine, a cerebroselective calcium antagonist, on ischemic brain edema. We treated each gerbil intraperitoneally with nimodipine (lmg/kg) or the same amount of saline 30 minutes prior to ischemia, and transient global ischemia was induced by means of clipping both common carotid arteries either for 10 minutes or for 45 minutes. Three hours after reperfusion, the animals were decapitated and the water content of the bain was determined by oven dry method. With 10 minute ischemia the brain water content in nimodipine pretreatment group (78.6 +/- 0.2%) was lower than that in saline pretreatment group (79.1 +/- 0.4%) significantly (p<0.05). But with 45 minute ischemia nimodipine pretreatment did not reduce the postischemic increase of water content compared with saline pretreatment (79.8 +/- 0.4% and 79 6 +/- 0.4%, respectively; not significant). Our results suggest that nimodipine pretreatment may suppress the development of ischemic brain edema and its effect depends largely on the extent of brain ischemia.
Animals ; Brain Edema* ; Brain Ischemia ; Brain* ; Calcium ; Carotid Artery, Common ; Cytosol ; Gerbillinae* ; Ischemia ; Neurons ; Nimodipine* ; Reperfusion

Shy-Drager syndrome is a multisystem degenerative disorder of the central nervous system in which progressive autonomic failure such as orthostatic hypotension, urinary or fecal incontinence, impotence and anhidrosis is a main feature. The nonautonomic neurological abnormalities include parkinsonia, cerebellar and pyramidal signs. In 1984 we met 3 such cases at Seoul National University Hospital and present them here with a brief review of literatures.
Central Nervous System ; Erectile Dysfunction ; Fecal Incontinence ; Hypohidrosis ; Hypotension, Orthostatic ; Male ; Seoul ; Shy-Drager Syndrome*

We analysed 20 cases of cerebellar hemorrhage which were diagnosed with the brain CT scan at Seoul National University Hospital from 1982 to 1984. The most frequent presumptive cause of the hemorrhage was hypertension (65% of our cases). Most of the ictus occurred during their normal daily activities. Common symptoms at the onset were vomiting, headache, vertigo, other cerebellar dysfunctions and subsquent alteration of consciousness. The patients who showed rapid deterioration of neurologic condition were fatal in outcome. The poorer the consciousness at arrival and the larger the size of hematoma or hydrocephalus at first brain CT scan, the graver the outcome. So we suggest that suboccipital craniotomy is inevitable in cases of rapid deterioration within several hours, hematoma larger than 4 cm in diameter and marked hydrocephalus on their first brain CT scan. And neurosurgical treatment will be considered in cases of aggravating tendency over 24 hrs with hematoma larger than 3 cm and/or moderate hydrocephalus on the brain CT scan.
Brain ; Cerebellar Diseases ; Consciousness ; Craniotomy ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Hydrocephalus ; Hypertension ; Seoul ; Tomography, X-Ray Computed ; Vertigo ; Vomiting

The authors reviewed the medical records of 94 patients who met the strict diagnostic criteria of spontaneous subarachnoid hemorrhage (SAH). They were diagnosed and treated at Seoul National University Hospital from January 1983 to June 1984. The interrelationships among the age, clinical status on admission, findings on brain computerized tomography (CT), site of the ruptured aneurysm and the intracranial complicaions (ventricular dilatation, vasospasm, rebleeding) and their outcome were studied. Conclusions obtained are as follows: 1) The local clot on CT (especially associated with ICH and /or IVH) was more frequently found in clinically poor patients than in good ones. 2) Cerebral angiography (TFCAs, 53 cases) revealed the anterior communicating artery (A-COM) to be the most common site of aneurysm in 21 cases (39.6%) and multiple aneurysms in 5 cases (9.4% : two in 4 cases, three in 1 case) and no aneurysm in 9 cases (17%). Vasospasm on angiography was found in 27 cases (50.9%). 3) Ventricular dilatation, which was measured on the first CT after SAH, was detected in 43 cases (45.7%). High incidence was found in the cases showing a local clot on CT (53.4%), especially associated with intraventricular hemorrhage (IVH; 83.3%), and in the cases of A-COM aneurysm rupture (52.4%; probably due to IVH). 4) The clinical vasospasm was edtected in 41 cases (43.6%). The interval between SAH and the development of clinical vasospasm ranged from from 3 to 35 days (mean 9.8 days). Thirty-five cases (85.4%) of them suffered from clinical vasospasm within 14 days. The incidence of clinical vasospasm steeply increased in the elderly patients (Fifties: 60%, Sixties: 66.7%) but that of findings of vasospasm on angiography (angiographic vasospasm) slowly increased with age. The local clot on CT seemed to be the most important factor of vasospasm, both clinically (51.7%) and angiographically (75%). The site of vasospasm on angiography was closely related with that of the ruptured aneurysm. 5) Rebleeding occurred in 21 cases (22.3%) with the interval ranging from 2 hours to 38 days (mean 10.1 days) after SAH and 14 cases (66.7%) of them rebled within 10 days. The shorter the interval after SAH, the higher the incidence. There were no definitely related factors affecting the rebleeding but it seemed to be affected to some extent by ICH and/or IVH on CT (31.3%). 6) Thirty-five cases (37.2%) diedof various causes. Mortality seemed to be most closely related with the clinical status on admission. Other related iactros were the aging, the local clot on CT (53.4%), especially associated with ICH and/or IVH (69.7%), and the development of various systemic or intracranial complications. Mortality seemed to be more closely related with ventricuar dilstation and rebleeding than with vasospasm. But it was suggested that vasospasm should be regrarded as a major cause of disabilities and an indirect cause of death.
Aged ; Aging ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteries ; Brain ; Cause of Death ; Cerebral Angiography ; Dilatation ; Hemorrhage ; Humans ; Incidence ; Medical Records ; Mortality ; Rupture ; Seoul ; Subarachnoid Hemorrhage*

Although a variety of agents have been introduced for the treatment of hypertension, the ideal drug has not yet been discovered. However, among the agents available, prazosin hydrochloride (Minipress(R)) appears to be accepted by the majority of physicians as it lowers blood pressure effectively with relatively low incidence of side effects. It has been considered that the hypotensive effect of prazosin is a result of peripheral vasodilation due to direct relaxation of vascular smooth muscle and blockade of alpha-adrenergic receptors in the arteriolar smooth muscle. Following the development of prazosin. many trials have been designed to potentiate its hypotensive effect by the combination with other agent, especially thiazide or beta blocker. Minizide(R), a preparation that thiazide is added to prazosin, is an example. The antihypertensive effect of Minizide(R) was evaluated in 30 hypertensive subjecs. The results were as follows; 1. The systolic and diastolic blood pressure were effectively lowered in both supine and standing position with the overall response rate of 86.7% as judged to be responsive in one that lost systolic pressure more than 15 mmHg and distolic pressure 10 mmhg. Among 30 cases 18 cases could be maintained with their diastolic pressure below 90 mmHg and 24 cases with their diastolic pressure below 100 mmHg by the end of 8th week of treatment with the daily dose of minizide(R) from a half tablet to two tablets. 2. During the period of 8 weeks, troublesome postural hypotension was not observed in any case. The pulse rate was not accelerated significantly by Minizide(R) treatment. 3. Minimal side effects were recorded in 5 cases; two of mild nausea, one of slight dizziness, one of minimal gastrointestinal irritation symptom and one of mild glucosuria. neither of them hindered the authors from finding the study.
Blood Pressure ; Dizziness ; Heart Rate ; Hypertension ; Hypotension, Orthostatic ; Incidence ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Nausea ; Prazosin ; Receptors, Adrenergic, alpha ; Relaxation ; Tablets ; Vasodilation

Although a variety of agents have been introduced for the treatment of hypertension, the ideal drug has not yet been discovered. However, among the agents available, prazosin hydrochloride (Minipress(R)) appears to be accepted by the majority of physicians as it lowers blood pressure effectively with relatively low incidence of side effects. It has been considered that the hypotensive effect of prazosin is a result of peripheral vasodilation due to direct relaxation of vascular smooth muscle and blockade of alpha-adrenergic receptors in the arteriolar smooth muscle. Following the development of prazosin. many trials have been designed to potentiate its hypotensive effect by the combination with other agent, especially thiazide or beta blocker. Minizide(R), a preparation that thiazide is added to prazosin, is an example. The antihypertensive effect of Minizide(R) was evaluated in 30 hypertensive subjecs. The results were as follows; 1. The systolic and diastolic blood pressure were effectively lowered in both supine and standing position with the overall response rate of 86.7% as judged to be responsive in one that lost systolic pressure more than 15 mmHg and distolic pressure 10 mmhg. Among 30 cases 18 cases could be maintained with their diastolic pressure below 90 mmHg and 24 cases with their diastolic pressure below 100 mmHg by the end of 8th week of treatment with the daily dose of minizide(R) from a half tablet to two tablets. 2. During the period of 8 weeks, troublesome postural hypotension was not observed in any case. The pulse rate was not accelerated significantly by Minizide(R) treatment. 3. Minimal side effects were recorded in 5 cases; two of mild nausea, one of slight dizziness, one of minimal gastrointestinal irritation symptom and one of mild glucosuria. neither of them hindered the authors from finding the study.
Blood Pressure ; Dizziness ; Heart Rate ; Hypertension ; Hypotension, Orthostatic ; Incidence ; Muscle, Smooth ; Muscle, Smooth, Vascular ; Nausea ; Prazosin ; Receptors, Adrenergic, alpha ; Relaxation ; Tablets ; Vasodilation

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects
Adult ; Anemia ; Ascites ; Blood Pressure ; Cardiac Output ; Electrocardiography ; Fibrosis ; Hemodynamics* ; Humans ; Liver Cirrhosis* ; Liver* ; Stroke Volume ; Systole ; Vascular Resistance

No abstract available.
Olivopontocerebellar Atrophies*

Takayasu's arteritis(TA) is a nonspecific areritis of unknown etiology affecting segmentally the aorta and its main branches, which result in stenosis, occlusion or aneurysm of involved arteries. The clinical manifestations present with a variety of symptoms such as headache, dyspnea on exertion, pain and weakness of extremities, pulse deficit, and hypertension according to involves arteries. Usually it can be managed by medical or surgical treatment, and recently by percutaneous transluminal balloon angioplasty. The type III classified by Lupi-Herrena and associates is the most frequent variety of TA. However the case of type III involving both subclavin arteries and both renal arteries has rarely been reported. We experienced a case of TA involving both subcalvian arteries, and both renal arteries presented with paroxysmal hypertension and right flank pain, in which the stenosis of both subclavian arteries were managed by percutaneous transluminal balloon angioplasty and the stenosis and occlusion of both renal arteries were successfully managed by aorto-renal bypass surgery with autogenous right iliac artery and synthetic vessel(Gortex). The patient was discharged uneventfully.
Aneurysm ; Angioplasty, Balloon ; Aorta ; Arteries* ; Constriction, Pathologic* ; Dyspnea ; Extremities ; Flank Pain ; Headache ; Humans ; Hypertension ; Iliac Artery ; Renal Artery* ; Subclavian Artery ; Takayasu Arteritis*