The authors report a case of postoperative supratentorial epidural hematoma as a complication of acoustic neurinoma surgery. The 43-year-old man presented with hearing difficulty on the left side and decreased facial sensation. MR imaging demonstrated a huge, cystic left acoustic neurinoma and the retromastoid suboccipital approach was used for gross-total resection of the tumor. Postoperatively, the patient was drowsy and showed right hemiparesis. Computed tomographic scanning revealed a huge epidural hematoma in the left parietooccipital convexity. The intraoperative course was uneventful. Immediate craniotomy was performed and the epidural hematoma was removed. Bleeding from the superior sagittal sinus occurred, but was completely controlled. Postoperatively, the patient was neurologically normal, except for mild left facial weakness. Remote postoperative intracranial hemorrhage is a rare complication of craniotomy with significant morbidity and mortality. Such hemo-rrhages are likely to develop at or soon after surgery and can be related to the craniotomy site, operative positioning, and nonspecific mechanical factors. In this case, mechanical displacement of the brain secondary to excessive dehydration and CSF drainage was thought to be the cause of postoperative epidural hematoma. Clinical awareness of this rare but potential complication is essential to its early diagnosis and treatment. Difficulty in awakening from anesthesia and the development of new neurological deficits not attributable to the operative site are the most important keys to early diagnosis. Computed tomography is the diagnostic method of choice.
Acoustics* ; Adult ; Anesthesia ; Brain ; Craniotomy ; Dehydration ; Drainage ; Early Diagnosis ; Hearing ; Hematoma* ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Mortality ; Neuroma, Acoustic* ; Paresis ; Sensation ; Superior Sagittal Sinus

An aneurysm arising from the intracranial portion of the internal carotid artery(ICA) is usually found at the junction of the ophthalmic, superior hypophyseal, posterior communicating or anterior choroidal artery, or at the bifurcation of the internal carotid, but very rarely at the junction of the persistent trigeminal artery. We present a case of a 49-year-old man who presented with a massive subarachnoid hemorrhage, with large intracerebral hematoma due to rupture of the aneurysm originating from the distal portion of the internal carotid artery. During surgery, we found that the aneurysm was originated at the junction of the internal carotid artery and the artery arising from the distal to anterior choroidal artery. We considered this artery to be an anatomical variant of the uncal artery(UA) arising from the internal carotid artery.
Aneurysm* ; Arteries* ; Carotid Artery, Internal* ; Choroid ; Hematoma ; Humans ; Middle Aged ; Rupture ; Subarachnoid Hemorrhage

BACKGROUND AND OBJECTIVES: Using n-aliphatic alcohols whose physical properties change gradually as their length increases, we investigated the changes of olfactory threshold and trigeminal pungency threshold with the increase of carbon chain length. MATERIALS AND METHOD: Olfactory and trigeminal pungency thresholds were measured in ethanol (C2), 1-butanol (C4), 1-hexanol (C6) and 1-octanol (C8) in 40 normal adults using a two-alternative forced-choice modified by the ascending method of limit (CCCRC) test. Plastic bottles with 30 ml of four n-aliphatic alcohols were diluted threefold successively by mineral oil. Plastic bottles containing only mineral oil were used as controls. RESULTS: The olfactory and trigeminal pungency thresholds decreased and the ratio of olfactory threshold/trigeminal pungency threshold increased with the length of carbon chain in n-aliphatic alcohols. The correlation coefficients among olfactory thresholds in each alcohol were higher than those among trigeminal pungency thresholds. CONCLUSION: Alcohol with long carbon chains showed low olfactory and trigeminal pungency thresholds, indicating that high lipid solubility is an important factor in olfaction and trigeminal chemosensitivity.
1-Butanol ; 1-Octanol ; Adult* ; Alcohols* ; Carbon* ; Ethanol ; Humans ; Mineral Oil ; Plastics ; Smell ; Solubility

Epidural abscess and vertebral osteomyelitis induced by epidural injection is rare but one of the most serious complications. A 58-year old woman complained of aggrevating radicular pain to bilteral lower legs, tenderness on coccygeal area and claudication, after epidural injection for management of intractable sciatica. MRI and ultrasound revealed epidural abscess compressing dural sac at the level of L5-S1 vertebral body, sacrococcygeal abscess, and later S5- 1stcoccyx osteomyelitis. We report epidural abscess and vertebral osteomyelitis induced by caudal epidural injection.
Abscess ; Epidural Abscess ; Female ; Humans ; Injections, Epidural ; Leg ; Osteomyelitis ; Sciatica

Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin.
Brain ; Deamino Arginine Vasopressin ; Demyelinating Diseases ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Myelinolysis, Central Pontine* ; Osmolar Concentration ; Polyuria* ; Pons ; Urination

BACKGROUND: Atrial fibrillation (AF) is thought to beget AF by shortening atrial refractoriness and reversal of rate adaptation of atrial refractoriness. This phenomenon of electrophysiologic remodeling of the atria during AF has been reported to play a major role in inducibility and stability of AF. METHODS: Thirty-one patients with induced AF lasting >1 second during electrophysiologic study for documented or suspected supraventricular or ventricular tachycardia were included in this study. All the patients had no structural heart disease and history of AF. High right atrium (HRA) burst pacing or extra-stimulation was applied to induce AF. Eleven patients with AF sustained >or=3 min was grouped into Group I and 20 patients with AF <3 min into Group II. P wave duration and amplitude, left atrial (LA) size, atrial refractory period (ARP), intraatrial conduction time (IACT) from HRA electrode catheter to His bundle electrode catheter and characteristics of atrial activities during induced AF were compared between 2 groups. RESULTS: There was no difference in the distribution of underlying cardiac arrhythmias. P wave durations and amplitudes and echocardiographic LA sizes were similar between 2 groups. ARPs and IACTs in group I and II were similar (198.0 +/- 23.9 ms vs. 200.8 +/- 23.0 ms; 38.7 +/- 8.5 ms vs. 38.6 +/- 9.5 ms, respectively). During AF, mean interval of atrial activities in group I was significantly shorter than group II (156.6 +/- 24.2 ms vs. 187.6 +/- 28.0 ms, p<0.01). The degree of irregularity of atrial activities during AF was significantly higher in group I than group II (16.9 +/- 8.7 vs. 9.8 +/- 5.0, p<0.05). The duration of the atrial activities was wider in group I than group II (81.4 +/- 17.5 ms vs. 53.9 +/- 12.4 ms, p<0.001) and the amplitude was lower in group I than group II (56.1 +/- 36.0% vs. 109.0 +/- 51.8%, p<0.05), and the degree of fractionation was greater in group I than group II (4.8 +/- 1.1 vs. 3.2 +/- 0.5, p<0.05). CONCLUSION: These results suggest that shortening of atrial refractoriness and lengthening of local conduction time at the time of or shortly after induction of AF may play a major role in the induction and stabilization of AF.
Arrhythmias, Cardiac ; Atrial Fibrillation* ; Bundle of His ; Catheters ; Echocardiography ; Electrodes ; Electrophysiology ; Heart Atria ; Heart Diseases ; Humans ; Tachycardia, Ventricular

BACKGROUND: It is known that prolonged QRS duration (QRSd) in a 12-lead ECG is associated with decreased left ventricular (LV) systolic function in patients with dilated cardiomyopathy. Development of LV systolic dysfunction and prolongation of paced QRSd are often observed in patients with permanent pacemakers (PPM). However, the significance of prolonged paced QRSd in patients with PPM is not determined. METHODS: We studied sixty-four patients (male:female=27:37, mean age=57.6+/-15.4 years) who had been on PPM (DDD: 15, VDD: 18, VVI: 31) for more than one year (mean: 68.2+/-44.0 months). LV function was normal before implantation of PPM. The 12-lead ECG and echocardiography were recorded prior to implantation, immediately after implantation and at the last follow-up. RESULTS: Paced QRSd did not significantly increase during the follow-up period. LVEF at the last follow-up (LVEF-FU) was significantly lower than that prior to implantation (59.3+/-11.5% vs. 64.9+/-10.1%, p<0.001). Eleven (17.2%) patients developed LV systolic dysfunction (LVEF<50%) during the follow-up period. Paced QRSd at the last follow-up and diabetes mellitus were correlated with LV systolic dysfunction (R2=0.302, p<0.001). There was a significant negative correlation between the paced QRSd and LVEF-FU (r=-0.451, p<0.01) and between change of paced QRSd and that of LVEF during follow-up (r=-0.419, p<0.01). LVEF-FU was reduced more in patients with paced QRSd >or=180 ms than in patients without (44.4+/-12.0% vs. 61.7+/-9.5%, p<0.001). In predicting LV systolic dysfunction with the paced QRSd (cut-off value: 180 ms), sensitivity, specificity, positive and negative predictive values were 60.0%, 88.7%, 50.0% and 99.2%, respectively. The paced QRSd at the last follow-up was significantly correlated with paced QRSd immediately after implantation (r=0.542, p<0.01). CONCLUSION: LV systolic dysfunction after long-term right ventricular apical pacing may develop. Prolongation of paced QRSd 180 ms during follow-up may suggest development of LV systolic dysfunction. New technologies to minimize prolongation of paced QRSd should be investigated to prevent LV systolic dysfunction after permanent ventricular pacing.
Cardiomyopathy, Dilated ; Diabetes Mellitus ; Echocardiography ; Electrocardiography ; Follow-Up Studies ; Humans ; Sensitivity and Specificity ; Ventricular Dysfunction, Left* ; Ventricular Function

BACKGROUND/AIMS: Essential hypertension is the most common cardiovascular disease and is involved in the development of the various cardiac arrhythmias, including atrial fibrillation. Recently, several studies have shown that statins have anti-arrhythmic effects, including the prevention of atrial fibrillation. This study investigated the effects of statins on cardiac electrophysiologic remodeling in patients with essential hypertension using the signal-averaged electrocardiogram (ECG) and standard 12-lead ECG. METHODS: This prospective multicenter study enrolled 115 patients with hypertension. Various antihypertensive drugs were administered alone or in combination according to their blood pressure. Statins were administrated in 56 patients. Laboratory tests, a standard 12-lead ECG, and signal-averaged ECG were performed at 1, 3, 6, and 12 months. Statistical analysis was performed using paired and independent t-tests and repeated measures analysis of variance (ANOVA). RESULTS: There was no significant difference in the clinical characteristics of the patients with and without statins. After antihypertensive therapy for 1 year, the P wave dispersion, high-frequency low-amplitude (HFLA) signals in the QRS complex of less than 40 micronV, and T peak-to-end dispersion were increased significantly (p<0.001, p<0.05, and p<0.01, respectively) in the patients who were not taking statins, while these changes were not seen in the statin group. CONCLUSIONS: These results demonstrate that electrophysiologic remodeling was progressive in patients with essential hypertension, despite antihypertensive therapy. However, combination therapy with a statin may inhibit the deterioration of inhomogeneity in atrial refractoriness and conduction disturbance.
Antihypertensive Agents ; Arrhythmias, Cardiac ; Atrial Fibrillation ; Blood Pressure ; Cardiovascular Diseases ; Electrocardiography ; Electrophysiology ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypertension ; Prospective Studies

BACKGROUND AND OBJECTIVES: Reactive oxygen species are known to be produced when atrial fibrillation develops. This study was performed to investigate the effects of hydrogen peroxide (H2O2) on the action potential parameters of the mouse atrium. SUBJECTS AND METHODS: Mouse (ICR) atrial fibers were excised and immersed in cold bicarbonate-containing Tyrode's solution. The preparations were then perfused with oxygenated (95% O2, 5% CO2) Tyrode's solution and driven by an electrical stimuli 1 ms in duration at a frequency of 1 Hz. The transmembrane potentials were recorded at 0, 2.5, 5, 10, 20 and 30 minute, and compared between groups I (control), II (H2O2 0.1 mM), III (H2O2 0.5 mM) and IV (H2O2 1 mM). RESULTS: In group I, the maximal diastolic potential (MDP), action potential amplitude (APA), maximal slope at phase 0 depolarization (Vmax), action potential duration until 50% and 90% of repolarization (APD50, APD90) were unchanged with increasing time. In group II, the MDP and APA were unchanged, but the Vmax was decreased, and the APD50 and APD90 prolonged. In group III, the MDP was increased and the Vmax decreased; the APD50 and APD90 were prolonged, but the APA unchanged. In group IV, the MDP was increased, the Vmax and APA decreased And the APD50 and APD90 prolonged. After-depolarization was observed in 40% (8/20) and 54.5% (12/22) of groups III and IV, respectively, and asystole occurred in 18.2% (4/22) of group IV. CONCLUSION: Hydrogen peroxide changed the action potential parameters in both time and dose dependent manner, and also elicited after-depolarization at higher concentrations. These results suggest reactive oxygen species are involved in the electrical remodeling and arrhythmogenesis in atrial myocardium.
Action Potentials* ; Animals ; Atrial Fibrillation ; Atrial Remodeling ; Free Radicals ; Heart Arrest ; Hydrogen Peroxide ; Membrane Potentials ; Mice* ; Myocardium* ; Oxygen* ; Reactive Oxygen Species