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*

Pneumocephalus is exceedingly rare in the absence of trauma or recent surgery. It is most commonly seen after severe head injury, with disruption of the dura and subsequent cerebrospinal fluid leakage. Intracranial air has also been reported as a complication of shunting. This may be secondary to intermittent shunt failure or a persistent communication between the extracranial and intracranial space that permits the entrance of air. In the present case, air appeared to enter the ventricular system through the fistula that connected the frontal sinus. This air replaced the CSF being drained into the peritoneal cavity by the shunt. The decrease of intracranial pressure after a shunt might play a role in causing pneumocephalus. We report a case of tension pneumocephalus after shunting for hydrocephalus as a life-threatning complication.
Cerebrospinal Fluid ; Craniocerebral Trauma ; Fistula ; Frontal Sinus ; Hydrocephalus* ; Intracranial Pressure ; Peritoneal Cavity ; Pneumocephalus*

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

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

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

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

Angiomyolipoma arising from the liver is a rare primary benign lipomatous tumor of the lever. We experienced a case of surgically proven hepatic angiomyolipoma, which was preoperatively diagnosed by definning of its characteristic histologic components and benign radiologic nature with various imaging modalities including ultrasound, dynamic computed tomography, angiography, and magnetic resonance imaging. It was the first reported case in the world that full radiologic evaluation was taken and internal vascular proliferation was defined by using dynamic bolus CT prior to angiography.
Angiography ; Angiomyolipoma* ; Liver* ; Magnetic Resonance Imaging ; Ultrasonography