Rapid administration of solution containing dextroae results in marked hyperglycemia and osmotic diuresis hut a balanced electrolyte solution containing maltese does not increase blood sugar. 30 patients were chosen at random and divided into 3 groups j.e, one group received 5% dextrose in water, the second group received Hartmann solution and the third group, 5% maltose in a balanced electrolyte solution. The Patient's blood was collected in the operating room prior to the start l.V. infusion, for the measurement of blood sugar, insulin, osmolarity and electrolrtes in various conditions of N.P.O. Intravenous fluid was administered at a rate of 10 m1/kg/hour while anesthesia was induced and maintained with an endotracheal tube in place. Blood samples were taken one hour. 2 hours and 3 7ours f:on the time 1,V. infusion started, In the of 5% dextrose in water groups, the value of blood sugar and insulin was 88.5+/-12.1 mg% and 14.60+/-7.67 un/ml at NPO, 257.7+/-60.8mg% and 70.75+/-37.55 un/m1 at 1 hour, 298.8+/-84.4mg%: and 143.19+/-50.32 un/ml at 2 hours and 228.6+/-75.8% and 127.71+/-56.98 un/m1 at 3 hours. Although the b1ood sugar and insulin values increased markedly. but potassium and chloride were 4.74+/-0.55 mEq/l and 101.1+/-2.9 mEq/l and 4.11+/-0.31 mEq/l, 107.4+/-2.3 mEq/l and 3.75+/-0.41 mEq/l, 176.4+/-2.7mEq/l and 3.89+/-0.50mEq/l, 106.3+/-2.2 mEq/l and shoewed mild decrease, by the way, osmolarity and serum sodium did not changed. In contrast to the 5% dextrose in water groups, there are no changes in the blood glucose. insulin levels, osmolarity or and electrolrtes in the either Hartmann or Elitol (Elitol=5% maltose contained in a balanced electrolyte solution) groups. There was a slight increase in osmolarity with maltose but it was not significant. Accordingly it is concluded that rapid infusion of harmann or 5% maltose contained ina balanced electrolyte solution affects the blood sugar and insulin levels insignificantly compared to the dextrose cont5aining solution which increase the blood sugar and indulin levels markedly.
Anesthesia ; Blood Glucose* ; Diuresis ; Electrolytes* ; Glucose ; Humans ; Hyperglycemia ; Insulin* ; Maltose ; Operating Rooms ; Osmolar Concentration* ; Potassium ; Sodium ; Water

A case of multiple hemangioendothelioma of the cauda equina nerve roots and conus medullaris is described. This case is the first report of intradural multiple hemangioendothelioma in Korea. A 74-year-old woman presented with a 4-month history of progressive bilateral leg weakness and lancinating leg pain especially at night. Magnetic resonance image revealed multiple enhancing nodular masses in the cauda equina nerve roots and pial surface of the conus medullaris. We performed total removal of conus medullaris mass and partial removal of two nerve rootlets masses. Two lesions were histologically examined and found to be hemangioendotheliomas
Aged ; Cauda Equina* ; Conus Snail ; Female ; Hemangioendothelioma* ; Humans ; Korea ; Leg ; Spinal Cord*

OBJECTIVE: The purpose of this study was to compare clinical findings and outcomes of Enterprise and Solitaire stent-assisted coiling (SAC). MATERIALS AND METHODS: Between January 2012 and March 2014, 86 patients (mean age, 60.3 years) harboring 89 aneurysms were treated with Enterprise (n = 57) or Solitaire (n = 32) SAC. The patients' demographics, angiographic results, and clinical outcomes were reviewed retrospectively. RESULTS: There were no cases of stent navigation, deployment failure, arterial dissection, or intraoperative aneurysmal rupture. Angiographic follow-up imaging was available for 86 (96.6%) aneurysms (Enterprise group, n = 55; Solitaire group, n = 31). Immediate postoperative and follow-up angiographic results showed no flow or only minimal flow into the neck in 83% (Enterprise group, 77.2%; Solitaire group, 93.8%) and 95.3% (Enterprise group, 92.7%; Solitaire group, 100%) of SAC-treated aneurysms, respectively. Both stent groups showed good immediate postoperative and follow-up clinical outcomes. Excepting 2 cases, all patients achieved modified Rankin Scale scores of 0. Coil loop or tail protrusion into the parent artery was observed in 17 (29.8%) and 7 (21.9%) cases in the Enterprise and Solitaire groups, respectively. No statistically significant difference in terms of angiographic results or clinical outcomes was observed between the groups. CONCLUSION: Excellent and comparable clinical and angiographic outcomes for wide-neck intracranial aneurysms were achieved using both stents. Because of its higher radial strength and better vessel wall apposition, we cautiously propose that the Solitaire stent may be more effective for SAC of aneurysms harboring a large or severe tortuous parent artery.
Aneurysm* ; Arteries ; Demography ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Neck ; Parents ; Retrospective Studies ; Rupture ; Stents* ; Tail

OBJECTIVE: The purpose of this study was to compare clinical findings and outcomes of Enterprise and Solitaire stent-assisted coiling (SAC). MATERIALS AND METHODS: Between January 2012 and March 2014, 86 patients (mean age, 60.3 years) harboring 89 aneurysms were treated with Enterprise (n = 57) or Solitaire (n = 32) SAC. The patients' demographics, angiographic results, and clinical outcomes were reviewed retrospectively. RESULTS: There were no cases of stent navigation, deployment failure, arterial dissection, or intraoperative aneurysmal rupture. Angiographic follow-up imaging was available for 86 (96.6%) aneurysms (Enterprise group, n = 55; Solitaire group, n = 31). Immediate postoperative and follow-up angiographic results showed no flow or only minimal flow into the neck in 83% (Enterprise group, 77.2%; Solitaire group, 93.8%) and 95.3% (Enterprise group, 92.7%; Solitaire group, 100%) of SAC-treated aneurysms, respectively. Both stent groups showed good immediate postoperative and follow-up clinical outcomes. Excepting 2 cases, all patients achieved modified Rankin Scale scores of 0. Coil loop or tail protrusion into the parent artery was observed in 17 (29.8%) and 7 (21.9%) cases in the Enterprise and Solitaire groups, respectively. No statistically significant difference in terms of angiographic results or clinical outcomes was observed between the groups. CONCLUSION: Excellent and comparable clinical and angiographic outcomes for wide-neck intracranial aneurysms were achieved using both stents. Because of its higher radial strength and better vessel wall apposition, we cautiously propose that the Solitaire stent may be more effective for SAC of aneurysms harboring a large or severe tortuous parent artery.
Aneurysm* ; Arteries ; Demography ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Neck ; Parents ; Retrospective Studies ; Rupture ; Stents* ; Tail

After acute interruption of cerebral blood flow, various hemodynamic, morphologic and metabolic changes ensue in the occluded area. Such changes and subsequent brain damage are of great concern in the course of temporary arterial occlusion during aneurysmal surgery. Many experimental studies investigating the processes of cerebral infarction have been done through selective occlusion of intracranial vessels, and it has been known that 4 to 8 minutes interruption of cerebral blood flow results in irreversible brain damage. Cerebral resistance following vascular occlusion may be influenced by collateral circulation, hypothermia and hyperventilation. Recently we experienced two patients with right middle cerebral artery aneurysms, who were operated upon under normothermia, slight hypotension, and hyperventilation using microsurgical technique. The technique of temporary occlusion of middle cerebral artery was applied as an adjunctive method.
Aneurysm ; Brain ; Cerebral Infarction ; Collateral Circulation ; Hemodynamics ; Humans ; Hyperventilation ; Hypotension ; Hypothermia ; Intracranial Aneurysm* ; Middle Cerebral Artery*

The familial occurrence of bilateral acoustic neuroma has rarely been reported in the literatures, and its inheritance is known to be an autosomal dominant trait in association with or without von Recklinghausen's disease. Recently, we experienced an unusual case of bilateral acoustic neuroma, which was familially occurred in mother and her son. A 18-year-old Korean boy was referred to us due to bilateral hearing disturbance and staggering gait of one year duration. There were no stigmata of von Recklinghausen's disease. Neurological examination, simple skull films and vertebral angiograms revealed various evidences of bilateral cerebellopontine angle tumors. At operation, a hen egg-sized firm mass was subtotally removed at the left cerebellopontine angle region and a peanut-sized mass was totally removed at the right cerebellopontine angle region via suboccipital craniectomy. The histological diagnosis was neurofibroma. In family history, 13 years ago his mother was operated on C6-7 neurofibroma at her age of 28 years, and again operated on bilateral acoustic tumors 2 years later. The histological diagnosis was also neurofibroma.
Acoustics* ; Adolescent ; Cerebellopontine Angle ; Christianity ; Diagnosis ; Gait ; Hearing ; Humans ; Male ; Mothers ; Neurofibroma ; Neurofibromatosis 1 ; Neurologic Examination ; Neuroma, Acoustic* ; Skull ; Wills

A 20-year-old male patient was admitted to this hospital because of headache and high fever on October 10, 1974. He has insidiously develope frontal headache and high fever for these 10 days, followed by vomiting, convulsions, aphasia and motor weakness on the left extremities and subsequently fell into semicomatose state. Hemogram showed marked leukocytosis, 22500/mm3, and cerebrospinal fluid cell count revealed increased leukocyte, 1210/mm3. Simple skull Roentgenograms showed no significant abnormalities except for suspicious haziness on the left frontal sinus. Carotid angiogram showed distal shift of the anterior cerebral artery, medial displacement of the middle cerebral artery and small avascular area on the left temporo-parietal area. Brain scan showed high activities on the entire left cereral hemisphere. On October 12, 1974 a large fronto-temporo-parietal osteoplastic craniotomy was done. Yellowith green, foul odored pus gushed out from the subdural space of the entire operating fields. Preteus mirabilis was isolated in pus culture. He was discharged with good recovery two months later.
Anterior Cerebral Artery ; Aphasia ; Brain ; Cell Count ; Cerebrospinal Fluid ; Craniotomy ; Empyema, Subdural* ; Extremities ; Fever ; Frontal Sinus ; Headache ; Humans ; Leukocytes ; Leukocytosis ; Male ; Middle Cerebral Artery ; Mirabilis ; Odors ; Seizures ; Skull ; Subdural Space ; Suppuration ; Vomiting ; Young Adult

Spontaneous intracerebral hemorrhage is generally very uncommon in young adult life. Moreover in infancy or childhood. The etiology of spontaneous intracerebral hemorrhage has been discussed in some detail, but the exact underlying causes, in many cases, remain in doubt. The clinical and radiological characteristics are same as ones of intracerebral hemorrhage in adulthood and the traditional methods in diagnostic approach of treatment are still available. We recently experienced a case of spontaneous intracerebral hematoma mainly located in the lateral portion of the basal ganglia in a 12 years old boy. He was admitted to our hospital through the emergency room with suddenly developed left side hemiplegia. There was no evidence of head trauma. Right side carotid angiogram revealed the hematoma. Upon surgery a large hematoma was noted in the lateral portion of the basal ganglia and its complete removal was quite possible. Recovery of the motor disturbance was discernibly rapid and he was discharged on foot on the postoperative 45th day.
Basal Ganglia ; Cerebral Hemorrhage ; Child ; Craniocerebral Trauma ; Emergency Service, Hospital ; Foot ; Hematoma* ; Hemiplegia ; Humans ; Male ; Young Adult

The traumatic middle meningeal arteriovenous fistula is a rare condition complicated from head injury and usually found incidentally by carotid angiography. A few articles reported previously showed this condition if formed due to tearing of the walls of middle meningeal vessels by skull fracture and regarded as a wonderful defence mechanism keeping from a big intracranial hematoma. We have encountered 3 cases of them, all of which were accompanied by skull fracture. On of them had a big epidural hematoma and others only small amount. We show these cases in detail with the review of literatures.
Angiography ; Arteriovenous Fistula ; Craniocerebral Trauma ; Hematoma ; Skull Fractures

Rupture of the lumbar intervertebral disc into the dural sac is very rare. Total of 11 cases have been reported in the literatures. In Korea, one case of the intradural herniated disc of L4,5 interspace was reported at Seoul National University Hospital in 1972. Patients of the intradural herniated disc have usually a long history of recurrent low back pain and sudden exacerbation of symptoms with radiating pain on both lower extremities precipitated by minor trauma. A 47 years old female was admitted to Seoul National University Hospital complaining of wevere low back pain and radiating gluteal pain on both sides. She had had intermittent lumbago of 25 years' duration. Eight months prior to admission, radiating gluteal pain on both sides developed in addition to the aggravation of the lumbago due to minor back trauma. Physical and neurological examination showed local protrusion and the tenderness of the L3, L4 spinous process area, the hyperalgesia on the right L3, L4, and L5 dermatomes, no saddle anesthesia, normal dorsiflexion of both ankles and great toes, slight decrease of the right knee jerk and bilateral absence of the ankle jerk, and no sphincter dysfunction. Myelogram showed complete block at t he L3-4 interspace level. Total laminectomy of the L3 and L4 was done. When the dura was opened, a solid round mass of a thumb-tip size was seen occupying the whole dural sac, compressing the nerve roots. The mass was a herniated disc from L3-4 interspace that had ruptured through central part of the posterior longitudinal ligament and ventral dural wall. Protruded intradural mass was removed en masse after incision of the overlying arachnoid membrance and the remaining L3-4 interspace disc material was removed in pieces extradurally. The mass was revealed as a degenerated nucleus pulposus on microscopic examination. The patient had an uneventful recovery with improvement of the neurological deficits.
Anesthesia ; Ankle ; Arachnoid ; Female ; Humans ; Hyperalgesia ; Intervertebral Disc ; Intervertebral Disc Displacement ; Knee ; Korea ; Laminectomy ; Longitudinal Ligaments ; Low Back Pain ; Lower Extremity ; Middle Aged ; Neurologic Examination ; Rupture ; Seoul ; Toes