No Abstract Available.

The effect of hyperbaric tetracaine spinal anesthesia was studied in 40 patients having genitourinary surgery in the horizontal lithotomy position. Patients were randomly assigned to one of two groups, after spinal injection, patients in one group were placed immediately in the supine and horizontal lithotomy position, and patients in the second group were placed immediatley in the supine and horizontal position for 10 minutes and then placed into the horizontal 1thotomy position. There were no statistically significant differences in anesthesia sensory level and heart rate of patients placed immediately in the horizontal lithotomy position compared to the patients kept in the supine position for the first 10 minutes after receiving the spinal anesthetic. The ranges of systolic blood pressure were all within normal limits, although systolic blood pressure showed a difference at 5,10 and 60 minute intervals after anesthesia. We conclude that immediate application of the horizontal lithotomy position can be safely practiced in the anesthesia of genitourinary surgery.
Anesthesia ; Anesthesia, Spinal* ; Blood Pressure ; Heart Rate ; Humans ; Injections, Spinal ; Supine Position ; Tetracaine*

The aim of this study was to evaluate the incidence and the management of hydrocephalus following ruptured intracranial aneurysms. The authors analyzed 223 patients with aneurysmal subarachnoid hemorrhage(SAH) during the last two years retrospectively. The results are summarized as follows. Eighty patients(35.9%) showed ventricular dilatation on a brain CT scan. Twenty-five patients(11.2%) required shunt surgery. Hydrocephalus was closely related to the amount of hemorrhage and the location of the ruptured aneurysm. Two of 9 patients with acute hydrocephalus, who were managed by extraventricular drainage(EVD) before definite aneurysm surgery. The shunt surgery was done before aneurysm surgery in 16 patients and rebleeding occurred in 3 patients. Radioactive isotope(RI) cisternography diagnosed communicating hydrocephalus in 11 patients and the lumboperitoneal shunt was performed in those cases. It is concluded that hydrocephalus following aneurysmal SAH is the communicating type, an indication for shunt surgery could be determined by RI cisternography, and lumboperitoneal shunting seems to be the best treatment of choice to avoid rapid decompression of the ventricles and to protect the already compromised cerebral hemisphere. Decompression of the ventricles before aneurysmal surgery should be avoided whenever possible.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Cerebrum ; Decompression ; Dilatation ; Hemorrhage ; Humans ; Hydrocephalus* ; Incidence ; Intracranial Aneurysm* ; Retrospective Studies ; Tomography, X-Ray Computed

Most trauma induced fistulas are direct communications between the intracavernous carotid artery and the cavernous sinus. Theses abnormal communications are characterized by high pressure, high blood flow and a clinically obvious constellation of symptoms and signs. We here in report a patient with traumatic carotid cavernous sinus fistula(CCSF). who developed central retinal vein occlusion(CRVO) during detachable balloon embolization. The mechanism of CRVO occurring during detachable balloon embolization. The mechanism of CRVO occurring during detachable ballon embolization for CCSF was discussed. We report this case with the review of previous reports.
Balloon Occlusion ; Carotid Arteries ; Carotid-Cavernous Sinus Fistula* ; Cavernous Sinus ; Fistula ; Humans ; Retinal Vein*

To evaluate the cerebral blood flow in feline hydrocephalic brain, this study was designed to measure the regional cerebral blood flow(rCBF;frontal and periventricular area) by the hydrogen clearance method in different stages of the kaolin-induced hydrocephalus and the postshunt status. The results were as follows: 1) A reduction of rCBF was detected in the left periventricular area at two weeks after kaolin injection. A significant reduction of rCBF was revealed in the left periventricular area at two and four weeks after kaolin injection. However, the rCBF of the left frontal cortex was significantly decreased at four weks after kaolin injection. 2) At one week after shunt operation, the significant restroration of rCBF was found in the left frontal cortex and the left periventricular area.
Brain ; Hydrocephalus* ; Hydrogen ; Kaolin

In order to compare the amount of surgically induced astigmatism among sutureless group(Group 1),10-0 nylone suture group(Group 2),and using tissue adhesive group(Group 3),we analysed a series of rabbit cataract surgery cases in these three groups. We performed cataract surgery on 30 eyes of 15 rabbits by Irrigation and aspiration technique. After cataract surgery,10 eyes by sutureless technique,10 eyes were closed by conventional 10-0 nylon suture technique, and 10 eyes by tissue adhesive(Beriplast) technique.We collected keratometric data before and after surgery(At 1,2,4,8 weeks).In postoperative astigmatic change,three groups had the distinct features in the evolution for postoperative astigmatism.The group 1 showed early against-the-rule(ATR)astigmatism,which advanced ATR and showed about 0.5D astigmatic change at 8 weeks.The group 2 showed early with-the-rule(WTR)astigmatism about 1.13D,which advanced toward ATR from 1week.The group 3 showed little ATR about 0.2D,which was minimal change in astigmatism.At 8 weeks after operation,there was no signifi-cant difference in the astigmatic change among the three groups(P>0.05), which were no complications observed. In this study,the tissue adhesive(Beriplast)seem to be a simple,effective and less induced astigmatic changing corneoscleral suture technique than other suture techniques
Astigmatism* ; Cataract* ; Nylons ; Rabbits ; Suture Techniques ; Sutures ; Tissue Adhesives*

OBJECTIVE: To establish a treatment guideline for intracranial cavernous malformation, the authors analyzed the clinical features, treatment modality, complications, and late outcomes in 76 consecutive cases (45 microsurgical resections, 30 stereotactic radiosurgeries, one microsurgery followed by radiosurgery) managed at the Yonsei University Medical Center from 1985 to 1998. RESULTS: Among 104 lesions in 76 patients, 64(61.5%) lesions were supratentorial and 40(38.5%) infratentorial. Hemorrhage was the most common presentation(31 patients, 40.8%), followed by generalized seizure(15 patients, 19.7%). Fifteen(19.7%) patients had mixed presentation with generalized seizure and hemorrhage, while 9(11.9%) patients presented focal deficits. The remaining 6(7.9%) patients had headache or incidental lesion. Almost all infratentorial lesions(92.5%) were managed with radiosurgery, and 65.6% of supratentorial lesions with microsurgery. The average follow-up period was 14.6 months for the microsurgery group and 32 months for the radiosurgery group. The overall outcome was good in 68(89.5%), fair in 6(7.9%), poor in 1(1.3%), and dead in 1(1.3%). Total microsurgical resection and symptomatic cure rate was 95.6%. Two lesion were incompletely resected. One lesion was followed by radiosurgery and the other was followed by reoperation. Only 38.5% of lesions with radiosurgery were shrunken. CONCLUSION: Microsurgical removal is effective for lesions in the non-eloquent area, or with recurrent hemorrhages and seizures. Although radiosurgery could be considered for lesions with multiplicity in the eloquent or deep-seated area, further study for the radiosurgical effect on cavernous malformations is required.
Academic Medical Centers ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Intracranial Hemorrhages ; Microsurgery ; Radiosurgery ; Reoperation ; Retrospective Studies* ; Seizures

Twenty-nine patients haboring primary or recurrent malignant gliomas were treated with direct implantation of radioactive sources into the tumor in afterlozded, removable catheters using stereotatic technique between November 1987 and October 1990. Indine-125(I-125) was implanted in 22 patients and high dose rate(HDR) Iridium-192(Ir-192) in 7 patients. All patients had been treated with external radiation and most had been treated with chemotherapeutic agents. one or more sources were placed in each tumor to deliver 5000-8000 cGy to the tumor's periphery for I-125 and 3000 cGy for HDR Ir-192. Eleven of 13 patients with glioblastoma multiforme were alive at 35 weeks whose mean survival was 74 weeks, and remained two were expired at 35 and 78 weeks, respectively. All 5 patients with anaplastic astrocytoma were alive at 39 weeks whose mean survival was 74 weeks. Five of 9 recurrent blioblastoma were alive at 22 weeks whose mean survival was 44 weeks, and remained three were expired at 13, 17 and 22 weeks respectively. All two patients with anaplastic astrocytoma were alive at 22 and 52 weeks, respectively. Four patients with deep seated analphastic astrocytoma(3 in the thalamus and 1 in the third ventricle) were treated successfully by brachytheray without any surgical morbidity and mortality and they were still alive 38, 48, 74 and 123 weeks after brachytherapy. There were few minor postoperative complications including 3 meningitis. 2 leak of cerebrospinal fluid and 3 radiation necrosis without any mortality. The authors conclude that the brachytherapy with temporary implanted I-125 or Ir-192 sources may provide long-term survial in selected patients with primary or recurrent malignant gliomas.
Astrocytoma ; Brachytherapy* ; Catheters ; Cerebrospinal Fluid ; Glioblastoma ; Glioma* ; Humans ; Meningitis ; Mortality ; Necrosis ; Postoperative Complications ; Thalamus

PURPOSE: To investigate whether hospitalization influences serum prostate-specific antigen (PSA) values. MATERIALS AND METHODS: Transrectal ultrasound-guided prostate biopsies were performed for detecting prostate cancer in 2,017 patients between February 2001 and April 2011 at Ajou University Hospital. Of those patients, 416 patients who were hospitalized for prostate biopsies, whose serum PSA values were measured at the outpatient department within 1 month of admission and also just after admission, and who had negative prostate biopsy results were included in the present study. We retrospectively reviewed the data of the 416 patients and compared the serum PSA values measured in the outpatient department with those measured during hospitalization. RESULTS: Among all 416 patients, the interval between the two PSA measurements was 22.2 days (range, 3 to 30 days) and the prostate size measured by transrectal ultrasonography was 53.63 mL (range, 12.8 to 197.9 mL). Among all patients, mean serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department (6.69 ng/mL vs. 8.01 ng/mL, p<0.001). When stratified according to age, the presence or absence of chronic prostatitis in the biopsy pathology, serum PSA levels, and prostate size, the serum PSA levels measured during hospitalization were significantly lower than those measured in the outpatient department in all subgroups, except in cases aged 20 to 39 years and those with PSA <4 ng/mL, in whom no significant differences were shown. CONCLUSIONS: Hospitalization decreases serum PSA values compared with those measured on an outpatient basis in patients with benign prostatic diseases. Therefore, serum PSA values should be checked on an outpatient basis for serial monitoring.
Aged ; Biopsy ; Hospitalization ; Humans ; Outpatient Clinics, Hospital ; Outpatients ; Prostate ; Prostate-Specific Antigen ; Prostatic Diseases ; Prostatic Neoplasms ; Prostatitis ; Retrospective Studies

BACKGROUND: Rotational atherectomy(RA) uses a high speed, rotating, diamond-tipped elliptic burr to abrade atherosclerotic plaque to increase lumen size. Differential forward cutting with RA burr results in ablation of diseased plaque, leaving the nomal, uninvolved arterial wall intact. Increased lesion length, increased lesion angulation and lesion calcification were predictive of an abrupt closure after balloon coronary angioplasty(balloon PTCA). RA facilitates the treatment of distal, tortuous and difficult-to-cross lesion. We evaluated the usefulness of RA as initial treatment modality in type B2 or C lesions, comparing with the balloon PTCA. METHOD: RA with adjunctive balloon PTCA were performed in 94 patients with 101 lesion sites(M/F:68/26, age:59.5+/-10.0 years) and balloon PTCA were performed in 245 patients with 293 lesion sites(M/F:188/57, age:58.7+/-10.3 years). Lesion analysis using a modified American College of Cardiology/American Heart Association classification system(ACC/AHA) showed that type B2 lesion was 35.6% and 64.5%, type C lesion was 64.4% and 35.5% in RA/adjunctive balloon PTCA and balloon PTCA, respectively. RESULTS: According to modified ACC/AHA lesion classification, type C lesion was higher percentage(64.4% vs 35.6%) in RA with adjunctive balloon PTCA compared with balloon PTCA and B2 lesion was higher percentage(64.5% vs 35.6%) in balloon PTCA(p<0.05). Diffuse lesion(61.4% vs 23.9%), irregular lesion(81.2% vs 65.5%), and heavily calcified lesion(40.6% vs 8.9%) were more commonly noted adverse morphologic features in RA with adjunctive balloon PTCA compared with balloon PTCA(p<0.05). However, total occlusion(25.9% vs 16.9%) was more common in balloon PTCA(p<0.05). Procedural success was achieved in 84.1% of RA with balloon adjunctive PTCA and in 82.3% of balloon PTCA. Myocardial infarction occurred in 2 patients(2.1%) and 4 patients(1.6%) in RA with adjunctive balloon PTCA and balloon PTCA, respectively. There were no procedural deaths or emergency surgeries in both groups. One case of cardiogenic shokc, 3 cases of no-reflow and 3 cases of wire embolization occurred in RA with adjunctive balloon PTCA. CONCLUSION: The overall success rate of RA appears to be similar to that of balloon PTCA despite of more complex lesion morphology(long lesion segment, irregularity and heavy calcification). RA is safe method of initial treatment modality with a high success rate in type B2 or C lesion. Longterm result after RA remains to be determined.
Angioplasty, Balloon ; Atherectomy, Coronary* ; Classification ; Emergencies ; Heart ; Humans ; Myocardial Infarction ; Plaque, Atherosclerotic