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

No abstract available.
Hematoma*

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

Traditional anterior interbody fusion with autograft has limitations such as graft collapse, graft extrusion, pseudoarthrosis, and donor site morbidity. A short hospital stay and reduced donor site complications can be achieved by using synthetic graft materials such as Biocompatible Orthopaedic Polymer(BOP). A retrospective study to evaluate bone graft was carried out in a series of 111 patients in whom interbody fusions were performed for cervical spondylosis and cervical spine injury using anterior(modified Trans-Unco-Discal) approach with autogenous ilium or BOP between January 1988 and December 1994 at our hospital. The radiological assessments were made between postoperative and follow-up x-ray findings, and the postoperative clinical results and complications were statistically analyzed. The major results were as follows: 1) Clinical results of spondylotic patients were graded excellent in 57%, good in 32% and fair in 11% in ilium group, and excellent 65%, good 25%, fair 5% and poor 5% in BOP group. Clinical results patients with cervical injury were graded excellent in 25%, good in 25%, fair in 25% and poor in 25% in ilium group, and excellent 29%, good 21%, fair 29% and poor 21% in BOP group. As to graft materials, there were no statistically significant difference in clinical results(p=0.76, p=0.75). 2) Mean height of graft bone were 13.0mm in ilium group and 10.0mm in BOP group at postoperative x-ray findings, and 11.6mm in ilium group and 6.1mm in BOP group at follow-up x-ray findings. Incidence where the height of graft bone at follow-up x-ray findings was less than 80% of immediately postoperative height were 7% in ilium group and 58% in BOP group, and there was a statistically significant difference(p<0.05). BOP sank into the adjacent end plate as compared to ilium. 3) Mean duration of period required for fusion was about 40 days in ilium group and 132 days in BOP group with a statistically significant difference (p<0.01). 4) The rate of complications related to bone graft was 16% in ilium group and 30% in BOP group. Incidence of complications was higher in BOP than ilium group, but there was no statistically significant difference(p=0.28). According to the above results, clinical results were not significantly different between both graft materials, but ilium was superior to BOP as a good spacer with maintenance of height of graft bone and good bony fusion.
Autografts ; Follow-Up Studies ; Humans ; Ilium* ; Incidence ; Length of Stay ; Pseudarthrosis ; Retrospective Studies ; Spine* ; Spondylosis ; Tissue Donors ; Transplants*

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*

A 59-year old female was admitted to Yongdong Severance Hospital due to diarrhea and lower abdominal pain lasting for 2 months. She had a previous history of admission for stomach cancer on September 1995. At that time, she underwent total gastrectomy and gastroduodenostomy. The pathology of the specimen revealed a signet ring cell carcinoma of stomach. On admission, computerized tomography revealed rectal wall thickness and no evidence of lymph node enlargement in abdomen and pelvic cavity. Barium enema study showed stricture of rectum. After sigmoidoscopic biopsy, she was diagnosed as a rectal metastasis resulted in rectal stricture and underwent sigmoid loop colostomy. Hence we present a case of gastric cancer with rectal metastasis resulted in rectal stricture.
Abdomen ; Abdominal Pain ; Barium ; Biopsy ; Carcinoma, Signet Ring Cell ; Colon, Sigmoid ; Colostomy ; Constriction, Pathologic* ; Diarrhea ; Enema ; Female ; Gastrectomy ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis* ; Pathology ; Rectum ; Stomach ; Stomach Neoplasms*

OBJECTIVE: Chronic hydrocephalus is one of the major complications following aneurysmal subarachnoid hemorrhage(SAH). However the incidence and predicting factors requiring shunting after SAH is not precisely known. The authors investigated the incidence of chronic hydrocephalus, timing of shunting procedure, and factors to predict the need for shunting in patients with aneurysmal SAH. PATIENTS AND METHODS: A series of 209 patients admitted to our institute from January 1993 to December 1997, who presented with SAH and underwent craniotomy for aneurysm clipping were studied retrospectively. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after initial hemorrhage and that required shunting. The author divided study group into shunt group(SG, n=20) and non-shunt group(NSG, n=189). Patients were evaluated based on following factors: age, sex, history of hypertension and diabetes mellitus, consciousness at admission, Hunt-Hess grade, the presence of intracranial hemorrhage, Graeb's score, bifrontal index(BFI), Fisher grade, amount of SAH, location of aneurysm, time of aneurysm clipping, rebleeding, and vasospasm. RESULTS: The incidence of chronic hydrocephalus was 9.6%(20/209). The timing of the shunting procedure ranged from 16 days to 150 days after initial hemorrhage with the average being 77(+/-37)days. In a univariate analysis with chi-square test, age, consciousness, Hunt-Hess grade, amount of SAH, BFI, Fisher grade, and Graeb's score were significantly related with the need for shunting(p<0.05). In a multivariate logistic regression analysis, odds ratio was calculated for each variables. If the odds ratio of below 60 year of age was 1.0 then that of above 61 was 5.4(p<0.001). If the odds ratio of alert/drowsy was 1.0 then that of stupor/coma was 4.4(p<0.05). If the odds ratio of 0 of Graeb's score was 1.0 then that of 1-10 was 4.3(p<0.05). If the odds ratio of amount of SAH below score 3 was 1.0 then that of above score 4 was 1.8. If the odds ratio of BFI below 30 was 1.0 then that of above 31 was 1.1. CONCLUSION: The development of chronic hydrocephalus after aneurysmal SAH is multifactorial, but should be strongly suspected in patients with older age, decreased level of consciousness or IVH at admission. The patients require a shunt from 2 weeks to 5 months from the time of their initial hemorrhage.
Aneurysm* ; Consciousness ; Craniotomy ; Diabetes Mellitus ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Hemorrhages ; Logistic Models* ; Odds Ratio ; Retrospective Studies ; Subarachnoid Hemorrhage*

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

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

Prirnary sclerosing cholangitis, a chronic progressive cholestatic hepatobiliary disorder of unknown etiology, is characterized by inflammation, scarring and obliteration of bile duct leading to biliary cirrhosis and liver failure. Because histologic finding has only a limited role in the diagnosis, the gold standard for establishing the diagnosis is cholangiographic demonstration of typical diffuse biliary stricutre or beading. The natural history is extremely variable. We report two cases of primary sclerosing cholangitis diagnosed by repeated endoscopic retrograde cholangiographies. They were followed up for 7 and 2 years, respectively.
Bile Ducts ; Cholangiography ; Cholangitis, Sclerosing* ; Cicatrix ; Diagnosis ; Inflammation ; Liver Cirrhosis, Biliary ; Liver Failure ; Natural History