OBJECTIVES: Autonomic nerve system dysfunction has been reported in patients following traumatic brain injury (TBI). However, studies providing direct evidence of a link between the two have been scarce. The purpose of the present study was to evaluate cardiac autonomic modulation in post-acute ambulatory outpatients with TBI using an analysis of heart rate variability (HRV). METHODS: Twenty-one patients with TBI and 21 age- and gender-matched normal controls were evaluated. The HRV assessments were performed using conventional time and frequency domain analyses as well as non-linear complexity analysis. RESULTS: In the patient group, standard deviation values of the RR intervals (SDNN), the square root of the mean squared differences of successive normal sinus intervals (RMSSD), total successive RR interval difference (TSRD), and the very low frequency (VLF) power spectral parameter were significantly lower than in the control group. The patients with moderate severity of TBI exhibited a significantly lower value of VLF than those with mild severity. The severity of anxiety symptoms had a tendency to be correlated with the mean heart rate and the ratio of low-to-high frequency spectral power. CONCLUSION: The results of the present study provide evidence that TBI is associated with reduced HRV, suggesting the critical involvement of central autonomic structures in the pathogenesis of TBI. The HRV measures may serve as an index for monitoring aspects of autonomic function in patients with TBI.
Aluminum Hydroxide ; Anxiety ; Autonomic Nervous System ; Autonomic Pathways ; Brain Injuries ; Carbonates ; Heart ; Heart Rate ; Humans ; Outpatients

Dural arteriovenous fistula (DAVF) is a rare condition affecting approximately 1.5% of 1,000,000 individuals annually. It frequently occurs in the transsigmoid and cavernous sinuses. An isolated sigmoid sinus is extremely rare and is treated by performing transfemoral transvenous embolization along the opposite transverse sinus.A 69-year-old woman presented with asymptomatic Borden type III/Cognard type III DAVF involving an isolated sigmoid sinus. She underwent a staged operation in which a navigation system was used to expose the sigmoid sinus in the operating room before transferring the patient to the angio suite for transvenous embolization.Various modalities have been used to treat DAVF, including surgical disconnection, transarterial embolization, transvenous embolization, and stereotactic radiosurgery. However, treating DAVF cases where the affected sinus is isolated can be challenging because an easily accessible surgical route may not be available. In this case, direct sinus cannulation and transvenous embolization were the most effective treatments.

BACKGROUND: Extubation is recommended to he performed at minimum pressure support (PSmin) during the pressure support ventilation (PSV). In field, physicians sometimes perform additional 1 hr T-piece trial to the patient at PSmin to reduce re-intubation risk. Although it provides confirmation of patient's breathing reserve, weaning could be delayed due to increased airway resistance by endotracheal tube. METHODS: To investigate the effect of additional 1 hr T-piece trial on weaning outcome, a prospective study was done in consecutive 44 patients who had received mechanical ventiIation more than 3 days. Respiratory mechanics, hemodymic, and gas exchange measurements were done and the level of PSmin was calculated using the equation (PSmin=peak inspiratory flow rate x total ventilatory system resistance) at the 15cm H2O of pressure support. At PSmin, the patients were randomized into intervention (additional 1 hr T-piece trial) and control (extubation at Psmin). The measurements were repeated at PSmin. during weaning process (in cases of intervention), and after extubation. The weaning success was defined as spontaneous breathing more than 48hr after extuintion. In intervention group, failure to continue weaning process was also considered as weaning failure. RESULTS: Thirty-six patients with 42 times weaning trial were satisfied to the protocol Mean PSmin level was 7.6 (+/-1.9)cm H2O. There were no differences in total ventilation times (TVT), APACHE III score nutritional indices, and respiratory mechanics at PSmin between 2 groups. The weaning success rate and re-intubation rate were not different between intervention group (55% and 18% in each) and control group (70% and 20% in each) at first weaning trial. Work of breathing, pressure time product, arid tidal volume were aggravated during 1 hr T-piece trial compared to those of PSmin in intervention group (10.4+/-1.25 and 1.66+/- 1.08 J/L in work of breathing)(191+/-232 and 287+/-217cm H2Os/m in pressure time product) (0.33+/-0.09 and 0.29+/-0.09 L in tidal volume) (P<0.05 in each). As in whole, TVT, and tidal volume at PSmin were significantly different between the patients with weaning success (246+/-195 hr, 043+/-0.11 L) and the Those with weaning failure (407+/-248 hr, 0.35+/-0.10L) (P<0.05 in each). CONCLUISON: There were no advantage to weaning outcome by addition of 1 hr T-piece trial compared to prompt extubation to the patient at PSmin.
Airway Resistance ; APACHE ; Humans ; Nutrition Assessment ; Prospective Studies ; Respiration ; Respiratory Mechanics ; Tidal Volume ; Ventilation ; Weaning* ; Work of Breathing

Background: and Purpose In young patients (aged 18–60 years) with patent foramen ovale (PFO)- associated stroke, percutaneous closure has been found to be useful for preventing recurrent ischemic stroke or transient ischemic attack (TIA). However, it remains unknown whether PFO closure is also beneficial in older patients. Methods: Patients aged ≥60 years who had a cryptogenic stroke and PFO from ten hospitals in South Korea were included. The effect of PFO closure plus medical therapy over medical therapy alone was assessed by a propensity-score matching method in the overall cohort and in those with a high-risk PFO, characterized by the presence of an atrial septal aneurysm or a large shunt. Results: Out of the 437 patients (mean age, 68.1), 303 (69%) had a high-risk PFO and 161 (37%) patients underwent PFO closure. Over a median follow-up of 3.9 years, recurrent ischemic stroke or TIA developed in 64 (14.6%) patients. In the propensity score-matched cohort of the overall patients (130 pairs), PFO closure was associated with a significantly lower risk of a composite of ischemic stroke or TIA (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.24–0.84; P=0.012), but not for ischemic stroke. In a subgroup analysis of confined to the high-risk PFO patients (116 pairs), PFO closure was associated with significantly lower risks of both the composite of ischemic stroke or TIA (HR: 0.40; 95% CI: 0.21–0.77; P=0.006) and ischemic stroke (HR: 0.47; 95% CI: 0.23–0.95; P=0.035). Conclusion Elderly patients with cryptogenic stroke and PFO have a high recurrence rate of ischemic stroke or TIA, which may be significantly reduced by device closure.