BACKGROUND: The aim of this study are to detect the radiological findings of decompression sickness that could elucidate the pathogenesis of decompression sickness and to evaluate the results of management of decompression sickness with hyperbaric oxygen therapy. METHODS: Forty nine patients(42 men and 7 women; 23-51, mean 32 years) were referred to the Hyperbaric Oxygen Therapy Center of Dong-A University Hospital for diving related injuries. All patients were studied neurologically and radiologically. Forty patients(81.6%) were type 1 decompression sickness who complained pains in various sites. Eight patients(16.3%) were type 2 decompression sickness with spinal cord involvement and underwent MR examination of the spinal cord. One patient(2.0%) was type 2 decompression sickness with chest involvement. Two patients(4.1%) among nine patients of type 2 decompression sickness were combined with type 3 decompression sickness who was suspected of cerebral embolization. All patients of type 1 were treated with therapeutic hyperbaric recompressions of US Navy treatment table 5 and auxiliary therapy. Six patients of type 2 were treated with US Navy treatment table 6 and two patients of type 3 were treated with US Navy treatment table 6A. RESULTS: Magnetic Resonance Image(MRI) demonstrated patchy areas of increased signal intensity in the spinal cord on both T2-weighted and fast SE T2-weighted images in five patients with symptoms of spinal cord injury, corresponding to an area of the cord believed to be clinically involved. Chest X-ray and spiral computed tomogrphy(CT) scan demonstrated patchy area in right middle lobe of lung in type 2 decompression sickness of chest involvement and disappeared two weeks later with hyperbaric oxygen therapy. All patients of type 1 decompression sickness were improved with hyperbaric oxygen therapy and auxiliary therapy. Motor weakness of extrimities were improved immediately during hyperbaric therapy within hyperbaric chamber in six patients among eight patients of type 2 decompression sickness with spinal cord involvementbut. Two patients who were not improved during first time of hyperbaric oxygen therapy were remained neurological deficit 6 months later. One patient of type 2 decompression sickness with chest involvement were also improved with hyperbaric oxygen therapy and auxiliary therapy. Two patients of type 3 decompression sickness combined with type 2 were also improved neurologically after hyperbaric oxygen therapy with auxiliary therapy. CONCLUSION: MRI has proved to be reliable in the detection of spinal cord involvement due to decompression sickness that were previously undetectable by other neuroradiological investigations(such as myelography, CT, angiography, isotopic tests) and its pathologic findings might be corresponded to ischemic injury of spinal cord. Patch area which was demonstrated by chest spiral CT and chest P-A of type 2 decompression sickness might be related to hemorrhage of lung parenchyme due to alveolar rupture which was resolve two weeks later. Therapeutic hyperbaric recompression is very effective in the management of decompression sickness.
Angiography ; Decompression Sickness* ; Decompression* ; Diving ; Female ; Hemorrhage ; Humans ; Hyperbaric Oxygenation ; Lung ; Magnetic Resonance Imaging ; Male ; Myelography ; Rupture ; Spinal Cord ; Spinal Cord Injuries ; Thorax ; Tomography, Spiral Computed

An intrathoracic meningocele is a saccular protrusion of the meninges through a normal or enlarged intervertebral foramen or bony defect of the thoracic vertebrae. It extends anteriorly between the ribs and into the thoracic cavity, displacing the pleura and lung and lying in the paravertebral gutter if of sufficient size. Meningocele, single or multiple, are prone to occur in cases of von Recklinghausen's neurofibromatosis, often in association with kyphoscoliosis. In this case, we found a case of intrathoracic meningocele associated with multiple lipoma of variable sizes in the back and hyperpigmentation in the anterior chest and upper back region but no evidence of neurofibromatosis. Because of rarity of this disease entity, we report a case of intrathoracic meninggocele with review of literature.
Deception ; Hyperpigmentation ; Lipoma ; Lung ; Meninges ; Meningocele* ; Neurofibromatoses ; Pleura ; Ribs ; Thoracic Cavity ; Thoracic Vertebrae ; Thorax

This study was undertaken to determine the cardiovascular response to the spinal cord trauma in cats and to determine the autonomic mechnisms involved. The electrocardiogram and arterial blood pressure were recorded in anesthetized cats after the spinal cord trauma of 500 gm-cm at T4-T6 levels. 1. Acute spinal cord trauma caused a wide variety of severe cardiac arrhythmias and acute hypertension. 2. The increase of blood pressure could be prevented by intravenous phenoxybenzamine, and alpha adrenergic blocking agent. The pressor response was mediated by the alpha adrenergic receptor sites of the peripheral nervous system. 3. Tachycardia was occurred by the administration of atropine and bilateral vagotomy before trauma without affecting pressor response. 4. The arrhythmias could be eliminated by the combined administration of propranolol and atropine, but not prevented by the administration of either propranolol or atropine without affecting pressor response. These results suggest that the arrhythmias might be a response of hyperactivity of both sympathetic and parasympathetic divisions of the autonomic nervous system.
Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Atropine ; Autonomic Nervous System ; Blood Pressure ; Cats* ; Electrocardiography ; Hypertension ; Parasympathetic Nervous System ; Peripheral Nervous System ; Phenoxybenzamine ; Propranolol ; Receptors, Adrenergic ; Spinal Cord Injuries* ; Spinal Cord* ; Sympathetic Nervous System ; Tachycardia ; Vagotomy

Authors analysed a series of 175 patients with aneurysmal subarachnoid hemorrhage(SAH) who have undergone the treatment for subarachnoid hemorrhage from July, 1990 to May, 1994 to assess the clinical factors related to clinical vasospasm. This investigation revealed following conclusions. 1) The severity of subarachnoid hemorrhage as seen on computed tomography seemed to be correlated with the appearance of clinical vasospasm. Patients with severe SAH on initial CT scan were at higher risk or clinical vasospasm. 2) Patients with history of hypertension had more significant clinical vasospasm than did normotensive patients after aneurysmal SAH. 3) Aneurysms of the anterior communicating artery were showen to have the highest incidence of clinical vasospasm. 4) Patients with moderate to severe diffuse vasospasm on cerebral angiography had more significant clinical vasospasm than patients with no or local vasospasm. These conclusions suggest that clinical vasospasm after aneurysmal SAH are related to the followi ng predictable factors;amount of blood on the initial CT scan;angiographic vasspasm;history of hypertension and location of aneurysm. Proper management of these factors may diminish the incidence and severity of clinical vasospasm and reduce the morbidity and mortality rate.
Aneurysm* ; Arteries ; Cerebral Angiography ; Humans ; Hypertension ; Incidence ; Infarction ; Mortality ; Subarachnoid Hemorrhage* ; Tomography, X-Ray Computed

The treatment of cerebral arteriovenous malformations is concerned primarily with eliminating the substantial risk of potentially lethal intracranial hemorrhage. The surgical technique chosen aims to resect the AVM without removing or damaging brain tissue and interfering with microcirculation. The selection of the technical modalities is based on the presence of preoperative neurological deficits or an intracerebral hematoma, and the relationship of the AVM to the functionally important area. There is, however, controversy regarding the inherent risk of surgery involving AVM's, especially those with large parenchymal hemorrhage, those in the functional area, those with medially located draining veins, and those with a combination of these factors. This report illustrates the need for surgical decision making on a case-by-case basis. In this report three different technical modalities were used to resect AVM's. First, in cases involving an AVM of the ventricular trigone, the author advocated the direct transcortical parieto-occipital approach using a microsurgical technique based on knowledge of the anatomic architecture and hemodynamics of AVM's. Second, a small AVM in the left frontal opecular area was stereotactically resected using the transsulcal approach, with minimal resultant brain retraction or damage. Third, resection of a medium-sized AVM in which there was a massive life-threatening parenchymal hemorrhage involved multi-stage surgery. These results suggest that a successful selection of technical modalities can help to minimize complications and improve outcome.
Arteriovenous Malformations ; Brain ; Decision Making ; Hematoma ; Hemodynamics ; Hemorrhage ; Intracranial Arteriovenous Malformations* ; Intracranial Hemorrhages ; Microcirculation ; Veins

OBJECTIVE: We present the difference of histopathologic changes of the internal elastic lamina (IEL) and collagen III in the superficial temporal artery (STA) between aneurysmal patients and non-aneurysmal patients. Also, the pathologic data with clinical features by comparative methods to validate the risk factor of the intracranial aneurysm are presented. METHODS: Samples of the STA were harvested form 38 patients including aneurysmal and non-aneurysmal patients undergoing craniotomy. Paraffin-embedded sections were examined, using hematoxylin and eosin, van Giebson and mouse anti-collagen III staining techniques. Histopathological observations were analysed and correlated with clinical features such as presence of aneurysm, hypertension, age, and sex. RESULTS: Twenty-seven patients had the intracranial aneurysm. Of these 24 patients were 50 years old or older. Nineteen patients had a history of hypertension. Twenty patients were female. Histopathological study demostrated the derangement of IEL and the deficiency of type III collagen were prominent in aneurysmal patients (p<0.05). Fifty years old or older patients did not show correlation with the deficiency of type III collagen, but with the derangement of IEL (p<0.05). The female sex was not correlated with the derangement of IEL but with the deficiency of type III collagen (p<0.05). However, Hypertension was not correlated with these pathologic data. CONCLUSION: Patients with intracranial aneurysms have severe histopathologic changes of the arterial wall showing the derangement of IEL and the deficiency of type III collagen. In the clinico-pathologic study, the advanced age and female sex were considered as risk factors of the intracranial aneurysm.
Aneurysm ; Animals ; Collagen Type III ; Collagen* ; Craniotomy ; Elastin* ; Eosine Yellowish-(YS) ; Female ; Hematoxylin ; Humans ; Hypertension ; Intracranial Aneurysm* ; Mice ; Middle Aged ; Risk Factors ; Temporal Arteries*

The omentum has been used over the years for a variety of clinical problems. Recently it has shown that placing the omemtum on the brain and spinal cord can lead to an extensive development of vascular connections at the omental/CNS interface. Success with omental transposition to the human brain has led to increasing intreast in placing the omentum onto the human spinal cord. One paraplegic patient was chosen to enter into a feasibility study to see if omental transposition to their spianl cord might result in clinical benefit. The length of time from injury was about 21 months respecively. This patient had little, if any, motor and sensory function below umbilicus level. The operation required surgical lengthening of the pedicled omentum followed by its placement into a subcutaneous tunnel created backward along the lateral chest wall up to T-10, 11 level. An extensive thoracic laminectomy was then performed followed bya wide opening of the dura. In our case the cord showed segmental shrinkage of the spinal cord consistent with previous trauma. The omentum was laid directly onto the underlying spinal cord. Our observation for five months has shown that placement of the omentum onto the chronically injured spinal cord allowed for subsequent improvement in neuroelectrical activity, as manifested by reproducible somatosensory evoked potentials, and, more importantly, in moter function. It is considered that placing the omentum directly upon the brain or spinal cord may have the effect of either improving local vascular perfusion or, possibly, exerting some biochemicals(neurotransmitter), or as yet unknown, influence. But further observation is warranted to determine whether this improvement will be continued and will be observed in another cases.
Brain ; Evoked Potentials, Somatosensory ; Feasibility Studies ; Humans* ; Laminectomy ; Neurotransmitter Agents ; Omentum ; Perfusion ; Sensation ; Spinal Cord ; Spinal Cord Injuries ; Thoracic Wall ; Umbilicus

OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
Aneurysm* ; Hemorrhage ; Humans ; Mortality ; Subarachnoid Hemorrhage*

OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
Aneurysm* ; Hemorrhage ; Humans ; Mortality ; Subarachnoid Hemorrhage*

OBJECTIVE: We report the correlation between known risk factors for cerebrovascular disease and formation of multiple intracranial aneurysms. METHODS: We reviewed the medical records and outcomes of 524 patients who had undergone aneurysmal operation at our hospital between January 1996 and May 2001. Of 524 patients who had undergone operations with intracranial aneurysm, 130 patients had multiple intracranial aneurysms. The authors examined the correlations between the risk factors(patient age, sex, menopausal state of female patients, hypertension, cigarette smoking) and the presence of multiple intracranial aneurysms by using chi-square test retrospectively. RESULTS: The male to female ratio was about 1 : 2.05(male : female=129 : 265) for patients with single intracranial aneurysm, and male to female was about 1 : 3.06(male : female=32 : 98) for patients with multiple intracranial aneurysms. Among 256 female patients with single intracranial aneurysm, 182 patients(68.9%) were postmenopausal, and, among 98 female patients with multiple intracranial aneurysms, 81 patients(82.6%) were postmenopausal. The mean age of the patients with single intracranial aneurysm was 54 years, and, with multiple intracranial aneurysms, the mean age was 57.8 years. The presence of hypertension was found in 149 patients(37.8%) with single intracranial aneurysm, and, in 55 patinets (42.3%) with multiple intracranial aneurysms. Cigarette smoking was found in 116 patients(29.4%) with single intracranial aneurysm and 47 patients(36.1%) with multiple intracranial aneurysms. CONCLUSION: There is a significant correlation between menopausal state of female patients and presence of multiple intracranial aneurysms. However, gender, hypertension and smoking are not related to multiple intracranial aneurysms.
Aneurysm ; Female ; Humans ; Hypertension ; Intracranial Aneurysm* ; Male ; Medical Records ; Postmenopause ; Retrospective Studies ; Risk Factors* ; Smoke ; Smoking ; Tobacco Products