Blood flow velocity changes induced by the focal brain activation can be assessed by using Transcranial Doppler sonography (TCD). To explore the hemispheric dominant hemodynamic effect by performing calculation, we applied TCD technique to detect cerebral blood velocity asymmetry. METHODS Twenty healthy right-handed subjects were tested. We measured mean flow velocities (MFV) in the middle and posterior cerebral arteries (MCA, PCA). Photic stimulation was given separately as a control task for calculation. RESULTS While the photic stimulation increased the blood velocity only in PCAs, performing calculation increased the velocity in MCAs. Right-left difference was noted by performing calculation with greater increase in left MCA (right: 8.8 %; left: 21.2 %). CONCLUSION Application of TCD enabled us to measure the hemodynamic changes supporting the left hemispheric dominance of calculation task. Futhermore, increase in non-dominant right hemisphere suggests the functional interaction of cerebral activity.
Blood Flow Velocity* ; Brain ; Dominance, Cerebral ; Hemodynamics ; Passive Cutaneous Anaphylaxis ; Photic Stimulation ; Posterior Cerebral Artery ; Ultrasonography, Doppler, Transcranial

PURPOSE: There have been several reports claiming benefits for the simplified method of appendectomy over the traditional method of embedding suture at the stump, without contradictory opinions ever having been published. Nevertheless, most surgeons continue to carry out purse-string sutures in daily practices of open appendectomy as long as the stump situation permits. In case where the cecum near the stump is friably swollen due to the spread of inflammation in advanced appendicitis, we have often faced uncomfortable pulling of cecal stitches during embedding procedures experiencing tearing or incomplete approximation of the pulled wall. To avoid this difficulty and shorten the procedure, we have been performing simple double ligations of the stump and observed the results. METHODS: Prospectively we assigned patients to an operative method of either simple ligations or embedding sutures, alternatively upon admission, and performed this method of stump management with two surgeons for 4 years, and postoperative complications were observed in 362 and 273 cases respectively. RESULTS: There was no advantage of one method over the other in recovery course, and in view of the complication rates associated with stump inadequacy and adhesive ileus, even in cases of perforated appendicitis also. CONCLUSION: When possible, Stump ligations simplify appendectomy procedure without increased operative sequelae, even in cases of perforated appendicitis. So this procedure could be recommended instead of purse-string sutures, especially in cases of thick and friable cecal wall due to acutely disseminated appendiceal inflammation.
Adhesives ; Appendectomy* ; Appendicitis ; Cecum ; Humans ; Ileus ; Inflammation ; Ligation* ; Postoperative Complications ; Prospective Studies ; Sutures*

PURPOSE: Until recently, the surgical treatment of perforated appendicitis in South Korea showed a relatively high incidence of postoperative infectious complications compared with centers having protocols for managements. Authors have been performing appendectomies for perforated cases under the principle of massive irrigation of the peritoneal cavity and primary closure of incision wound that leaves a suction drain from pelvic cavity, expecting reducing chance of infective complications and thus reducing the stress faced by operators. METHODS: Among 788 cases of appendicitis from September 1997 to December 2002, 172 patients showing perforation and peritonitis in the operative field were reviewed retrospectively. All the operations were performed by the principle mentioned above, and data were collected on various major complications, especially infective wound and intra-abdominal complications. RESULTS: There were 7 cases of suppurative wound infection, and 5 cases of intra-abdominal abscess, representing a total incidence of 7.0% (n=12) in 172 patients. Other major complications such as adhesive ileus (n=3), intestinal fistula (n=1), or remote organ infective event (n=1) were also recognized. CONCLUSION: Massive saline irrigation during appendectomy of perforated appendicitis-without antibiotic mixture-that leaves a negative suction drain from the pelvic cavity and the primary closure of incision wounds have yielded satisfactory results concerning various aspects, especially in lessening infective postoperative complications.
Abdominal Abscess ; Adhesives ; Appendectomy ; Appendicitis ; Humans ; Ileus ; Incidence ; Intestinal Fistula ; Korea ; Peritoneal Cavity ; Peritonitis ; Postoperative Complications ; Retrospective Studies ; Suction ; Wound Infection ; Wounds and Injuries

Central venous catheters provide long-term available vascular access. They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation. Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance. The complications of central venous catheterization are frequent, which include malposition, pneumothorax, hemothorax, chylothorax, arterial puncture, hematoma, air embolism and infection. Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade. In this case, we report a malposition of central venous catheter with 9-Fr introducer sheath which is located in the right subclavian vein via ipsilateral internal jugular vein and the correction of this misplacement assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope).
Cardiac Tamponade ; Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters* ; Central Venous Pressure ; Chylothorax ; Embolism, Air ; Hematoma ; Hemothorax ; Jugular Veins ; Pneumothorax ; Punctures ; Radiography* ; Subclavian Vein ; Thrombophlebitis

Stellate ganglion block (SGB) is a procedure that is widely used for many diseases associated with sympathetically-maintained pain in the head, neck, and upper extremities. Various hemodynamic changes may occur after SGB. Among them, we experienced two patients who developed highly increased blood pressure after SGB. We suspect that the spread of local anesthetics produced parasympathetic blockade of the vagus nerve, an imbalance between the sympathetic and parasympathetic activities and deafferentiation of the glossopharyngeal and vagus nerve, which both innervated the carotid sinus, as the mechanism of this increased blood pressure.
Anesthetics, Local ; Blood Pressure ; Carotid Sinus ; Head ; Hemodynamics ; Humans ; Neck ; Stellate Ganglion ; Upper Extremity ; Vagus Nerve