BACKGROUND: The end-tidal carbon dioxide (ETCO2) is defined as a partial pressure of carbon dioxide at the end of an exhaled breath. And it has been found to correlate with cardiac output during cardiopulmonary resuscitation (CPR) in animal model. The purpose of this study is to determine that the assessment of ETCO2 could provide a highly sensitive predictor of return of spontaneous circulation (ROSC) during CPR. METHODS: Prospective, observational study was performed from Oct 1996 to Mar 1997 at the Severance hospital. All patients were endotracheally intubated and connected immediately to mainstream capnography sensor. We measured ETCO2 with Escort II model 20100 monitor(Medical Data Electronics, Inc, USA). It works on the principle of nondispersed infrared absorption with radiometric single beam optics. RESULTS: This study included 70 patients (52 were men) with a mean age of 54+/-15 years. ROSC was obtained in 43 patients. The initial ETCO2 averaged 15.5 +/-8.2 mmHg in survivors and 6.5+/-5.3 mmHg in nonsurvivors (p<0.01), and during the first 20 minutes of CPR, the maximal ETCO2 averaged 29.7+/-10.3 mmHg in survivors and 10.2+/-8.9 mmHg in nonsurvivors (p<0.01). ETCO2 was not significantly different in relation to initial rhythm, survival time after ROSC and possible cause of arrest. There is no cutoff value of ETCO2 satisfying greater than 90% of both sensitivity and specificity in predict ROSC. When maximal ETCO2 was less than 12 mmHg, we observed sensivity of 100% in predicting ROSC. CONCLUSION: Our results demonstrate that ETCO2 measurement represents a valuable, noninvasive, and clinical tool for monitoring patients during CPR.
Absorption ; Capnography ; Carbon Dioxide* ; Carbon* ; Cardiac Output ; Cardiopulmonary Resuscitation* ; Humans ; Models, Animal ; Observational Study ; Partial Pressure ; Prospective Studies ; Sensitivity and Specificity ; Survivors

No abstract available.

No abstract available.
Cerebral Hemorrhage* ; Tuberous Sclerosis*

No abstract available.
Atrophy* ; Heat Stroke* ; Hot Temperature*

Clear cell sarcoma of the kidney (CCSK) is a highly malignant childhood tumor, distinguished from classic Wilms' tumor by its propensity to metastasize to the skeletal system. Authors described a case of CCSK from a 3-year-old boy in the right kidney, showing various histologic features, such as classic, epithelioid, trabecular, neurilemmoma-like, cystic and entrapped collecting tubular pattern. Ultrastructurally epithelial differentiation was absent. Immunohistochemically, none of the intrinsic tumor cells showed positive staining with the antibodies against the keratin, S-100 protein, carcinoembryonic antigen, vimentin, desmin and myoglobin, suggesting primitive mesenchymal cell in origin.
Child, Preschool ; Humans ; Immunohistochemistry ; Kidney Neoplasms/metabolism/*pathology ; Male ; Neoplasm Metastasis ; Sarcoma/metabolism/*pathology

We monitored motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation to predict functional recovery of motor weakness after hemorrhage. We tried to elucidate the relationaship between suppression of MEPs and degrees of recovery in 20 patients with radiologically confirmed hypertenaive intracerebral hemorrhage (ICH), who showed varying degrees of hemiparesis. Magnetic stimulation and assessment of motor weakness were carried out within 7 days after ictus and approximately 3 months after hemorrhage. We found little correlation between changes of latencies and outcome of motor function. The absence of MEPs in acute stage indicated absolutely poor recovery of muscle strength. The presence of MEPs in the same period in patients with complete hemiplegia predicted some recovery of motor function. The suppression of amplitude was more accurate than prolongation of latency in predicting the functional recovery. We concluded that the presence of MEPs in acute stage can provide early prediction of functional recovery of motor weakness. When MEPs are present, treatment should be aggressively employed to achieve maximal recovery of motor function in the extremities.
Cerebral Hemorrhage ; Evoked Potentials, Motor* ; Extremities ; Hematoma* ; Hemiplegia ; Hemorrhage ; Humans ; Muscle Strength ; Paresis ; Transcranial Magnetic Stimulation

Metamorphopsia of different types have been noted in patients with posterior cerebral artery infarction, especially when the lesion is bilateral or occipitotemporal. Micropsia (objects appearing reduced in size) is commonly due to retinal disease, which causes displacement of the receptor cells. It can be hysterical in origin, but rarely micropsia is accompanied by occipitotemporal lesion. We present here a case of micropsia due to bilateral occipital infarction after coronary angiography (CAG). A 55 year-old male had experienced cortical blindness due to cerebral infarction following CAG. Brain CT reveals poorly defined low density lesions in bilateral occipital cortices. Brain SPECT shows perfusion defect in both occipital lobes with markedly decreased perfusion in left temporal area. Two weeks later, as he regains visual acuity, he complains of micropsia, I.e., his hands and fingers look small and the people outside the window looks very small like ants. This perverted visual illusion lasts about 15 days.
Ants ; Blindness, Cortical ; Brain ; Cerebral Infarction ; Coronary Angiography* ; Fingers ; Hand ; Humans ; Illusions ; Infarction* ; Infarction, Posterior Cerebral Artery ; Male ; Middle Aged ; Occipital Lobe ; Perfusion ; Retinal Diseases ; Tomography, Emission-Computed, Single-Photon ; Vision Disorders* ; Visual Acuity

OBJECTIVES: A stratified cross-over study was conducted to evaluate the effects of familiarity with computer on the performance of computerized neurobehavioral tests. Effects of keyboard type on the relationship between familiarity with computer and performance of computerized neurobehavioral tests were also examined. METHODS: We tested 70 persons classified into three groups according to degree of familiarity with computer: Group 1 was people with no computer competency, Group 2 had slight working experience on the computer, and Group 3 were highly competent and efficient on the computer. For each group, we executed 4 tests of the Korean version of the Swedish Performance Evaluation System (Simple Reaction Time, Addition, Symbol Digit, and Finger Tapping Speed). Three types of keyboard were applied for all three groups. Type 1 keyboard was a conventional layout with 106 keys. We removed the unused keys except for the 17 which were used in the test and remodeled the normal keyboard into Type 2 keyboard with 17 keys (10 numeric keys, 4 arrow keys, space bar, and both Ctrl keys). Type 3 keyboard with 11 keys consisted of 10 numeric keys and the space bar was newly developed for the computerized neurobehavioral performance test. RESULTS: It was found that Simple Reaction Time, Addition, and Finger Tapping Speed were not affected by familiarity with computer and type of keyboard. The mean reaction time of Symbol Digit adjusted by age and educational level with Type 1 keyboard was found to have significant difference among the three groups (F=3.347, p=0.041). The performance of Symbol Digit in Group 1 was found to be significantly lower than that in Group 2. The performances of Symbol Digit measured with Types 2 and 3 keyboards were not found to have significant differences among the three groups. In Groups 1 and 3, the performances of Symbol Digit measured with Type 1 keyboard were found to be significantly lower than those of other keyboards. CONCLUSIONS: According to the above results, Simple Reaction Time, Addition, and Finger Tapping Speed have high priority over other neurobehavioral tests for the workers having varying degrees of computer familiarity. It is also suggested that familiarity with computer and keyboard type needs to be considered in interpretation of the performance of Symbol Digit. We recommended executing the computerized neurobehavioral test with keyboards 2 or 3 to reduce the effect of computer familiarity.
Cross-Over Studies ; Fingers ; Humans ; Reaction Time ; Recognition (Psychology)*

In order to examine the neurotoxic mechanism of oxygen radicals on cultured bovine oligodendrocytes, cytoxic effect of oxygen radicals was examined when cultures were treated with various concentrations of xanthine oxidase (XO) and hypoxanthine (HX) in culture medium. In addition, the neuroprotective effect of iron-chelators against the neurotoxicity induced by oxygen radicals was evaluated by MTT assay. Cell viability was remarkably decreased in a time-dependent manner after exposure of cultured bovine oligodendrocytes to 20mU/ml XO and 0.1mM HX for 4 hours. In the neuroprotective effect of iron-chelators on oxidant-induced neurotoxicity, tetrakis (2-pyridylmethyl)ethylenediamine (TPEN) blocked the neurotoxicity induced by oxygen radicals, while DFX was not effective in blocking oxidant-induced neurotoxicity in these cultures. These results suggest that oxygen radicals are toxic in cultured bovine oligodendrocytes, and also selective iron-chelators such as TPEN are effective in blocking the neurotoxicity induced by oxygen radicals.
Allopurinol* ; Cell Survival ; Hypoxanthine ; Neuroprotective Agents ; Oligodendroglia ; Reactive Oxygen Species ; Xanthine Oxidase

Delayed hypoxic encephalopathy is one of the most important neurologic sequelae in carbon monoxide (CO) poisoning. Regional cerebral blood flow (CBF) of cerebral cortices were measured in five patients with delayed CO encephalo'pathy confirmed by clinical features and magnetic resonance imaging (MRI) and five normal persons using "'Tc-HMPAO SPECT (technetium 99m hexamethylpropylene amine oxide single photon emission computed tomography). For the quantitative analysis, six pairs of region of interest in cerebral cortices and cerebellar hemispheres were determined. Among five regions to cerebellar ratios, those of superior and inferior frontal, parietal, and temporal cortices were significantly reduced (p<005). The degree of reduction in CBF was marked especially in frontal and temporal cortices and similar in both hemispheres. Early scan failed to predict delayed neurologic sequelae in one patient, but follow-up scan was well correlated with clinical improvement in another patient. Diffuse reduction of CBF in cerebral cortices was different from the anatomical MR findings. We think that reduced CBF in cerebral cortices is associated with clinical features of delayed carbon monoxide encephalopathy. Transient vascular mechan' ism or re duced cortical energy metabolism might be the cause of reduced CBF in cerebral cortices.
Carbon Monoxide* ; Carbon* ; Cerebral Cortex ; Energy Metabolism ; Follow-Up Studies ; Humans ; Hypoxia, Brain ; Magnetic Resonance Imaging ; Poisoning ; Rabeprazole ; Tomography, Emission-Computed, Single-Photon