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

No abstract available.
Hematoma, Epidural, Spinal* ; Meningioma*

OBJECTIVE: Earlier reports have revealed that the incidence of posttraumatic hydrocephalus (PTH) is higher among patients who underwent decompressive craniectomy (DC). The aim of this study was to determine the influencing factors for the development of PTH after DC. METHODS: A total of 693 head trauma patients admitted in our hospital between March 2004 and May 2007 were reviewed. Among thee, we analyzed 55 patients with severe traumatic brain injury who underwent DC. We excluded patients who had confounding variables. The 33 patients were finally enrolled in the study and data were collected retrospectively for these patients. The patients were divided into two groups: nonhydrocephalus group (Group I) and hydrocephalus group (Group II). Related factors assessed were individual Glasgow Coma Score (GCS), age, sex, radiological findings, type of operation, re-operation and outcome. RESULTS: Of the 693 patients with head trauma, 28 (4.0%) developed PTH. Fifty-five patients underwent DC and 13 (23.6%) developed PTH. Eleven of the 33 study patients (30.3%) who had no confounding factors were diagnosed with PTH. Significant differences in the type of craniectomy and re-operation were found between Group I and II. CONCLUSION: It is suggested that the size of DC and repeated operation may promote posttraumatic hydrocephalus in severe head trauma patients who underwent DC.
Brain Injuries ; Coma ; Confounding Factors (Epidemiology) ; Craniocerebral Trauma ; Craniotomy ; Decompressive Craniectomy ; Humans ; Hydrocephalus ; Incidence ; Retrospective Studies

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

PURPOSE: Conflicting results have been reported for western populations on associations of serum insulin-like growth factor I (IGF-I) and major IGF-binding protein-3 (IGFBP-3) with the risk of prostate cancer. However, few data have been available for oriental populations. We undertook a matched case-control study in a low-risk Korean population to extend our knowledge about potential associations. MATERIALS AND METHODS: Serum IGF-I and IGFBP-3 levels were determined for 330 men (165 cases and 165 healthy age-matched controls). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between plasma IGF levels and prostate cancer. We also investigated the potential influence of the associations according to clinical risk for advanced disease at diagnosis. RESULTS: We noted that the risks of prostate cancer were unrelated to the IGF-1 level and IGF-I/IGFBP-3 molar ratio. In contrast, a strong inverse association was observed between IGFBP-3 levels and the risk for prostate cancer. Men in the highest quartile of IGFBP-3 levels had a 71% reduced risk of prostate cancer compared with men in the lowest quartile (OR=0.29, 95% CI: 0.11-0.64, P(trend)<0.001). Subgroup analysis revealed a significant inverse association between plasma IGFBP-3 and the likelihood of a high risk prostate cancer. CONCLUSIONS: Plasma IGFBP-3 levels were inversely associated with the risk of prostate cancer and the likelihood for high-risk disease, suggesting that IGFBP-3 plays a protective role against prostate cancer in the Korean population.
Case-Control Studies ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Logistic Models ; Male ; Molar ; Odds Ratio ; Plasma ; Prostate ; Prostatic Neoplasms

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

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

Hypertensive intracerebral hemorrhage(ICH) is one of the leading causes of death in Korea. However, there are too many controversies regarding the pathogenesis and proper management of this disease. The author investigated the role of surgical treatment in improving the outcome of hypertensive ICH by analyzing the results of surgical and conservative therapy performed in 339 patients with hypertensive ICH during the past 8 years from 1986 to 1993. The peak age incidence of patients with hypertensive ICH was in the sixth decade(29.2%), and 88.5% of the cases occurred after the fifth decade. There was no sexual preponderance. Winter was the most prevalent season. Location of the hemorrhage was putamen in 9.2%, thalamus in 23.6%, lobular in 14.5%, cerebellum in 11.2%, caudate nucleus in 5.9%, and brain stem in 4.7%. The Glasgow coma scale(GCS) on admission was 3-5 in 17.7%, 6-8 in 2.4%, 9-12 in 20.1%, and 13-15 in 39.8%. Surgery was performed in 127 patients(37.5%) and the remaining patients were treated conservatively. The surgery rate was the highest(52.7%) for patients with 6-8 GCS, and the volume of hemorrhage was 0-45 cc. The outcome of all patients at discharge was graded as good recovery in 24.2%, moderate disability in 33.0%, severe disability in 11.8%, vegetative state in 8.6% and death in 22.4%. The mortality rate was 42.7% for patients with a 3-8 GCS, 23.5% for 9-12 GCS, and 1.5% for 13-15 GCS. The mortality rate was 9.2% in cases with a hemorrhage volume of less than 15cc, while in those over 60cc, the mortality rate was 75%. The results of surgical and conservative treatment were compared in each subgroups because the method of treatment differed according to the GCS and the volume of hemorrhage. When the GCS was less than 8, and when the hemorrhage volume was over 30cc, better results were obtained with surgery than with of conservative management(P<0.025, P<0.01, respectively).
Brain Stem ; Caudate Nucleus ; Cause of Death ; Cerebellum ; Coma ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhage, Hypertensive* ; Korea ; Mortality ; Persistent Vegetative State ; Putamen ; Seasons ; Thalamus