Autoregulation of cerebral blood flow is altered by volatile anesthetics and vasodilators such as nitroglycerin. Forty patients with cerebral aneurysm were anesthetized with halothane or isoflurane, and hypotension (mean arterial pressure: 55 mmHg) was induced with nitroglycerin. Blood gas analysis of radial artery and internal jugular vein during normotension and hypotension was performed. The results were as follows 1) There were no significant changes in juqular venous oxygen saturation, difference of arterial and venous oxygen content and extration rate of oxygen between normotension and hypotension. 2) There were no differences in SjvO2, CaO2, CjvO2, and O2ER between halothane and isoflurane. There is no possibility of cerebral ischemia in induced hypotension by nitroglycerin during halothane and isoflurane anesthesia.
Anesthesia* ; Anesthetics ; Arterial Pressure ; Blood Gas Analysis ; Brain Ischemia ; Halothane* ; Homeostasis ; Humans ; Hypotension* ; Intracranial Aneurysm ; Isoflurane* ; Jugular Veins ; Nitroglycerin ; Oxygen* ; Radial Artery ; Vasodilator Agents

The changes in arterial carbon dioxide tension (PaCO2) during cardiopulmonary bypass reflect changes of temperature and gas flow through an oxygenator. The changes in PaCO2 can be reduced through the frequent analysis of arterial blood gases and subsequent adjustment of total gas flow and CO2 concentration in the gas flow or both. Utilizing a capnometer (CAPNOMAC AGM-103. Datex), we compared end-tidal carbon dioxide tension (PetCO2) from the capnometer with temperature corrected PaCO2 during cardiopulmonary bypass. One end of the sampling port of the capnometer was incorporated into the prime port of the arterial reservoir in a bubbling type oxygenator (William-Harvey). When arterial reservoir temperatures of the oxygenator were 30 degrees C and 35 degrees C, PetCO2 from the capnometer was recorded and two arterial blood gas samplings were done at the same temperatures. The results were as follows: 1) The difference of PetCO2 and temperature corrected PaCO2 was below 3 mmHg in all cases. 2) The relationship between PetCO2 and temperature corrected PaCO2 was significantly linear. The results show that continuous monitoring of PetCO2, using a capnometer is useful to control the changes in PaCO2 during cardiopulmonary bypass.
Carbon Dioxide* ; Carbon* ; Cardiopulmonary Bypass* ; Gases ; Oxygen ; Oxygenators

No abstract available.
Hematoma*

BACKGROUND: It is not so reasonable international classification of disease and surgical procedure to clinicians. Authors made a more comprehensive standardization for neurological disease and neurosurgical procedures and have been used for the analysis of the inpatients. METHODS: For making the standardization of disease, we modified the mane of disease according to that used for daily report during 10 years, textbook of neurosurgery, but kept the fields of international coding system in each. Neurosurgical procedures were made and modified according to Current Procedure Terminology 96. Client-server system was used for networking and database software was applied. The neurosurgical patients admitted at Soonchunhyuna University Hospital from January o December, 1998 were analysed with this system. RESULTS: Diseases were classified as 14 large categories and 379 small categories. Neurosurgical procedures were did also 20 large and 202 small categories. Futhermore, international coding system such as ICD-10 and ICD-9CM maintained for the disease and procedures in each. The number of patients for admission and operation during 1 year were 834 and 412 patients. The accurate and rapid interpretation of the disease and surgical procedures was identified. CONCLUSIONS: It could be possibel to make database of patients management with the resonable standardization of disease and neurosurgical procedures.
Classification ; Clinical Coding ; Humans ; Inpatients* ; International Classification of Diseases ; Neurosurgery ; Neurosurgical Procedures

OBJECTIVE: We report six patients with traumatic intracerebellar hematomas between 1997 and 2003 at our hospitals. METHODS: Each data about patients' clinicoradiologic findings, management, and outcomes, which were retrospectively reviewed. RESULTS: All patients had skull fracture on occiput and five patients with large hematomas(three cm or greater) were operated on. In the results of surgery, three patients were good outcome but two patients were fatal due to compression of brain stem. One patient with small hematoma (1.5cm) was treated conservatively and recovered. CONCLUSION: In our cases, the clinical course and prognosis of traumatic intracerebellar hematoma were grave. The results of this study support that early diagnosis based on strict observation in patients with occipital fracture will lead to best results.
Brain Stem ; Craniocerebral Trauma ; Early Diagnosis ; Hematoma* ; Humans ; Prognosis ; Retrospective Studies ; Skull Fractures

PURPOSE: To compare functional MR imaging of the motor cortex during active and passive movement. MATERIALS AND METHODS: Seven healthy, right-handed volunteers (M:F=6:1; age:25-30 years) were included in this study. A 1.5-T whole body scanner and the multislice EPI BOLD method were used. The motor paradigm was flexion-extension of a thumb against rest. In the active motion task, the thumb was flexed voluntarily once a second, while in the passive task, it was tied with a thread and pulled to flex and extend passively at the same interval and with the same intensity as in the active task. For image postprocessing, an SPM 96 program was used. The sites, numbers, and signal intensity of the activated pixels were determined, and the threshold for significance was set at p<0.001 to p<0.01. RESULTS: In the active motion task, strong activation at the contralateral side of the primary sensorimotor cortex and supplementary motor cortex occurred in all 14 examples in all seven volunteers. Additionally, the ipsilateral primary sensorimotor cortex and supplementary motor area were activated in 12/14 and 11/14 such tasks, respectively. During passive motion tasks, on the other hand, weak activation occurred at the contralateral side of the primary sensorimotor cortex in all cases, but in the contralateral supplementary motor cortex in only three. In the ipsilateral primary sensorimotor cortex and supplementary motor area, there was no activation. CONCLUSION: Compared with the active motion task, activation occurring in the contralateral primary sensorimotor cortex and supplementary cortex was weaker and less frequent during the passive task, and during this latter, the ipsilateral motor cortex remained inactive. These results may be useful for the clinical application of functional MR imaging in unconscious patients or in animal studies.
Animals ; Hand ; Humans ; Magnetic Resonance Imaging* ; Motor Cortex* ; Thumb ; Volunteers

PURPOSE: This study investigated factors affecting recurrent wheezing in infants, focusing on whether or not respiratory syncytial virus (RSV) infections in children <3 years of age induce recurrent wheezing later in life. METHODS: The inclusion criteria were children <3 years of age who were hospitalized for an RSV infection from January 2006 to December 2009. We evaluated lateral flow immunochromatography (RSV Respi-Strip test). Subjects with at least three episodes of physician-verified wheezing were defined as recurrent wheezers. A group of 79 children hospitalized with RSV infections were compared with a matched control group. The following data were collected: age, gender, admission duration, gestational age, obesity, history of atopic dermatitis, parental history of allergic diseases, exposure to passive smoking, exposure to indoor animals, and daycare attendance. RESULTS: Rates of obesity and exposure to passive smoking were significantly higher in the RSV group than those in the control group. The frequency of recurrent wheezing in the RSV group (39.2%) was higher than that in the control group (10.1%). Compared to the control group, recurrent wheezing occurred 5.76 times more often in the RSV group, 2.49 times more often in males, and 2.41 times often in patients with a parental history of allergic diseases. CONCLUSION: The results demonstrated that RSV infection is significantly associated with recurrent wheezing, and that the risk is higher in male children and in children with a parental history of allergic diseases.
Animals ; Child ; Dermatitis, Atopic ; Gestational Age ; Humans ; Immunochromatography ; Infant ; Male ; Obesity ; Parents ; Respiratory Sounds ; Respiratory Syncytial Virus Infections ; Respiratory Syncytial Viruses ; Tobacco Smoke Pollution

OBJECTIVE: The lack of anatomical knowledge for the anterior cervical microforaminotomy is liable to injure the neurovascular structures. The surgical anatomy is examined with special attention to the ventral aspect exposed in anterior cervical microforaminotomy. METHODS: In 16 adult formalin fixed cadaveric cervical spine, the author measured the distances from the medical margin of the longus colli to the medical wall of the ipsilateral vertebral artery and the angle for the ipsilateral vertebral artery. The distances from the lateral margin of the posterior longitudinal ligament to the medial margin of the ipsilateral medial wall of the vertebral artery, to the ipsilateral dorsal root ganglion was measured too. RESULTS: The distance from the medial margin of the longus colli to the ipsilateral vertebral artery was 13.3~14.7mm and the angle for the ipsilateral vertebral artery was 41~42.5 degrees. The range of distance from the lateral margin of the posterior longitudinal ligament to the ipsilateral vertebral artery was 11.9~16.1mm, to the ipsilateral dorsal root ganglion was 11.6~12.9mm. CONCLUSION: These data will aid in reducing neurovascular injury during anterior cervical approaches.
Adult ; Cadaver ; Formaldehyde ; Ganglia, Spinal ; Humans ; Longitudinal Ligaments ; Spine ; Vertebral Artery

With improvements in diagnostic imaging techniques for the brain, pituitary tumors without neurological signs or symptoms have occasionally been found. To evaluate therapeutic strategy for incidentally found pituitary tumors ("pituitary incidentaloma"), we analyzed the result of magnetic resonance imaging findings and of ophthalmological and endocrinological studies in 3 cases with follow up. Incidentally found functioning tumors were excluded. All of 3 cases is greater than 10mm in tumor size("pituitary macroincidentaloma"). The follow-up period was 49 months, 16 months and 6 months(mean, 25.3 months) in each case. There was no evidence of tumor enlargement, endocrinological problems and visual field defect during follow-up period. Patients with pituitary incidentalomas usually follow a benign course and neurosurgical intervention is not initially required in the management even those greater than 10mm in diameter. Observation over time may be good approach to the patient with a pituitary macroincidentaloma to avoid the unnecessary risk for surgery in a patients with a stable mass.
Brain ; Diagnostic Imaging ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pituitary Neoplasms ; Visual Fields

PURPOSE: This study was undertaken to investigate the preoperative diagnosis, indication for operation, postoperative complication, postoperative medical treatment and recurrence rate in patients with Crohn's disease who were treated with operation. METHODS: Forty patients with Crohn's diseases had been operated on at the Department of Surgery, Yonsei University College of Medicine during the period from Jan 1986 to May 1999 and they were reviewed retrospectively. We studies symptoms, surgical indications, preoperative and postoperative treatments, involvement sites, types of operation and recurrence rate in Crohn's disease. RESULTS: The male to female ratio was 1.5: 1, and age distribution was from 8 to 69 years old with mean age of 33 years old. The duration of symptoms varies from within 1 day to above 10 years and most of them had within 1 month as 17 cases (42.5%). Symptoms are abdominal pain, hematochezia, anorexia, abdominal mass and diarrhea. The most frequent symptom was the abdominal pain as 85%. Crohn's disease was diagnosed only 45% before operation, less than what we expected. In another hand it surprised us find out that tuberculosis enteritis was diagnosed as much as 20%. The most common indication of operation was medical treatment failure as 13 cases, and fistula was 7 cases, intestinal obstruction with stenosis and tumor were 6 cases each other. The involvement of small bowel was most common as 40%, and the most common operative findings were ulceration and fistula for 17 cases and 12 cases respectively. Small bowel cases were treated with segmental resection and anastomosis in all 16 cases. Large bowel cases were performed right hemicolectomy in 10 cases and total colectomy in 1 case. Both small and large bowel involvement cases, right hemicolectomy was done in 4 cases, right hemicolectomy and segmental resection of small bowel was done in 6 cases. The recurrence rate of postoperative medical treatment was 16% and 28% for 5 years and 10 years respectively. The recurrence rate with no postoperative medical treatment was 13% and 26% for each 5 years and 10 years. There was no significantly difference in both groups. CONCLUSION: The major surgical indications for Crohn's disease were medical treatment failure, fistula and intestinal obstruction. Specially in Korea, differential diagnosis with tuberculosis enteritis was very important. Postoperative complication and recurrence rate has relatively low incidence. Our study suggest that postoperative medical treatment was controversial.
Abdominal Pain ; Adult ; Age Distribution ; Aged ; Anorexia ; Colectomy ; Constriction, Pathologic ; Crohn Disease* ; Diagnosis ; Diagnosis, Differential ; Diarrhea ; Enteritis ; Female ; Fistula ; Gastrointestinal Hemorrhage ; Hand ; Humans ; Incidence ; Intestinal Obstruction ; Korea ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Treatment Failure ; Tuberculosis ; Ulcer