We have analysed 144 patients with hypertensive putaminal hemorrhage, admitting from January 1992 to December 1993. Surgical treated group with Komai's stereotactic system was 71 patients and medical treated group was 73 patients. The results were as follows: 1) The patients with ventricular rupture were 36 cases(25%). According to the degree of ventricular rupture, the mortality was increased and the good outcome was decreased(P<0.01). 2) The prognosis was evaluated in favorable condition(alert and drowsy) and unfavorable condition(stuporous, semicomatose, comatose). In unfavorable condition, the mortality of surgical patients was lower than that of non-surgical patients(P<0.01). 3) Surgical patients with smaller hematoma(< or = 40ml) showed btter outcome than non-surgical patients:The statistical difference was not significant. But in larger hematoma(>40ml), the outcome in both treated group was similar. 4) According to CT classification, in class II(extending to anterior limb of internal capsule), good outcome of surgical group was better than that of non-surgical group. In class V(extending th thalamus or subthalamus), the mortality in surgical group was lower than that of non-surgical group(P<0.05) .
Classification ; Extremities ; Humans ; Mortality ; Prognosis ; Putaminal Hemorrhage* ; Rupture ; Thalamus

BACKGROUND: The nucleus tractus solitarius (NTS), the region of the brain stem in which primary baroreceptor afferents teminate, is critically important in the normal regulation of arterial pressure (AP). In the NTS, excitatory amino acids such as L-glutamate serve as the main neurotransmitter in the regulation of AP. However, the function of GABA in the NTS has not been established. To test the function of GABA, we applied GABAergic agents to the NTS. METHODS: The experiments were conducted on adult male Sprague-Dawley rats weighing 300-500g. A cannula (PE-50 tubing filled with heparinized saline) was inserted into the femoral artery for recording of AP and heart rate(HR). Another cannula was inserted into the femoral vein for administration of nitroprusside or phenylephrine. After rats were placed on a sterotaxic instrument, the dorsal surface of the medulla was exposed, and with the aid of a surgical microscope, the NTS was visualized. Drug injections were made into the NTS using single- or three-barreled grass micropipettes pulled to an outer diameter of 80-100(micro)m and connected to a 1(micro)l Hamilton syringe. RESULTS: The follwing results were obtained in this experiment. Injection into the NTS of 10 or 20 nmol nipecitic acid, a selective inhibitor of GABA untake, produced an increase in AP. The pressor responses evoked by two doses of nipecotic acid were not significantly different. Injection of GABA(A) agonist, musciml(5 pmol in 80 nl artificial CSF) and GABA(B) agonist, baclofen (20 pmol in 80 nl) into the NTS of urethane-anesthetized rats prodused an increase in AP of 16.6+/-1.3 and 27.6+/-1.5 mmHg, respectively. Thus the pressor response to GABA(B) agonist was greater than to GABA(A) agonist. On the other hand, microinjection of GABA(A) antagonist, bicuculline and GABA(B) antagonist, phaclofen into the NTS decreased AP by approximately 13.4+/-1.0 and 20.9+/- mmHg, respectively. Thus injection of nipecotic acid into the NTS was greater in control group compared with the muscimiol or baclofen groups. The AP changes caused by i.v. injection of nitroprusside or phenylephrine were smallest in control group and greatest in the baclofen group. When calculated as baroreflex sensitivity, the change was greatest in control group and smallest in the baclofen group. CONCLUSION: From these results it was concluded that GABA in the NTS plays an important role in the regulation of AP, especially through GABA(B) receptors, and have an inhibitory effect on baroreceptor reflex.
Adult ; Animals ; Arterial Pressure ; Baclofen ; Baroreflex ; Bicuculline ; Blood Pressure ; Brain Stem ; Catheters ; Excitatory Amino Acids ; Femoral Artery ; Femoral Vein ; GABA Agents ; gamma-Aminobutyric Acid* ; Glutamic Acid ; Hand ; Heart ; Heparin ; Humans ; Male ; Microinjections ; Neurotransmitter Agents ; Nitroprusside ; Phenylephrine ; Poaceae ; Pressoreceptors ; Rats ; Rats, Sprague-Dawley ; Solitary Nucleus* ; Syringes

BACKGROUND: Thyroid diseases is common in adult and frequently has significant clinical consequences. But, Prevalence have not been accurately estimated before performance of sensitive TSH and high resolution ultrasound devices on thyroid gland in practice. The objective of the study was to obstain prevalance rate of thyroid dysfunction and structural abnormality by sensitive TSH, Free T4 and high resolution ultrasound. METHODS: The subjects were 10,543(5,638 male and 4,815 female) individuals who visited a health care center of a general hospital in Kangnung city during the period of Jan. 1st, 1997 through May 31st, 2000. For thyroid dysfunction, serum TSH(Thyroid Stimulation Hormone) and Free T4 concentration of those were measured by RIA or IRMA. During the period of Dec. 1st, 1997 through May 25th, 1998, 1,316 individuals were examined by radiology specialists using high resolution ultrasonography with 7.5 MHz linear array. Consequently 21 patients who showed thyroid nodule were performed ultrasound-guided fine needle aspiration. Accordingly medical records containing results of physical examination made by 3 specialists in family medicine before thyroid ultrasonography were investigated in association with other diagnostic modalities. RESULTS: The measurements of thyroid function revealed that 10,090(96.5%) were normal, 240(2.3%) low(below 0.39 mU/L) and 123(1.2%) high(above 5.1 mU/L) in TSH. In terms of prevalence rate per 1,000 population, 15.2 cases were with subclinical hyperthyroidism, and 9.0 cases with subclinical hypothyroidism, 7.7 cases with hyperthyroidism and 3.3 cases with hypothyroidism. Among 94 individuals(7.1%) with structural abnormality on thyroid gland by ultrasonography, 60(4.6%) showed solitary solid nodule, 12(0.9%) multiple solid nodules, 18(1.4%) cystic nodules and 3(0.3%) diffuse parenchymal lesions. Physical examination found only 13.3% of 91 nodules found by high-resolution ultrasonography, and nodules as large as above 1.0 cm in size were palpable only in 22.2%. 21 Of 91 thyroid nodules was received ultrasound-guided FNA and 4(19%) were found to have malignant nodules. CONCLUSION: The study results showed the relatively high rate of thyroid diseases among general population, with the prevalence rate of thyroid dysfunction 3.6%, thyroid nodule 6.9%, malignant incidentaloma among thyroid nodules 4.4%. Physical examination was relative ineffective in detection for thyroid nodules in routine health examinations.
Adult* ; Biopsy, Fine-Needle ; Delivery of Health Care ; Gangwon-do* ; Hospitals, General ; Humans ; Hyperthyroidism ; Hypothyroidism ; Male ; Medical Records ; Physical Examination ; Prevalence* ; Specialization ; Thyroid Diseases* ; Thyroid Gland* ; Thyroid Nodule ; Ultrasonography

OBJECTIVES: The presence of chronic low oxygen delivery to the tissues (blood flow X Hb concentration X arterovenous oxygen content difference) in patients with chronic lung disease (CLD) leads to a aggravated dyspnea. Therefore, total oxygen delivery to the tissues is a reverse correlation with severity of dyspnea. So far, the treatment of patients with CLD has been limited to only the increase of ventilation and perfusion capacity. However, this study focused on the capacity of oxygen delivery to the tissues in patients with CLD. We measured blood oxygen parameters as one of the extended approaches. METHOD: Simultaneous arterial and venous blood samples from 15 patients with CLD at rest were evaluated for 2.3-DPG, CO-Hb (Carboxy-monohe-moglobin), Met-Hb (methomoglobin), ABGA (Arterial blood gas analysis), VBGA (Venous blood gas analysis) and Hb (Hemoglobin). Smokers and patients with other disease were excluded from the study in order to avoid the factors (2.3-DPG, CO-Hb etc.) which can shift the oxygen dissociation curve. There were 12 men and 3 women, ranging in age from 40 to 75 years. The disease onset varied from 3 years to more than 30 years. RESULTS: 1) As total oxygen delivery to the tissues decreased, Ao2(Arterial oxygen partial pressure) and A-VCb (Arteriovenous oxygen content difference) decreased, while 2.3-DPG increased. Total oxygen delivary to the tissues showed a significant correlation with more A-V and 2.3-DPG than AO2. 2) AO2 had a correlation with A-VO2 but AO2 did not clearly reflect A-VO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) As A-VO2 decreased, there was more significant relationship among 2.3-DPG, A-VO2 and tissue oxygen delivery. 5) A-VO2 showed a significant reverse correlation with 2.3-DPG as well as Met-Hb % + CO-Hb %. 6) ACO2 (arterial carbon dioxide partial pressure) showed a correlation with 2.3-DPG as well as A-VO2. 7) Arterial PH did not correlate with 2.3-DPG as well as A-V. CONCLUSION: 1) AO2 in patient with CLD correlated with A-VO2 but AO2 did not clearly reflect A-V. 2) Total oxygen delivery (severity of dyspnea) showed a significant correlation with more A-VO2 and 2.3-DPG than AO2. 3) 2.3-DPG activity depended on more A-VO2 than AO2. 4) 2.3-DPG activity had a reverse correlation with A-V in spite that 2.3-DPG shifts the oxygen dissociation curve to the right, because 2.3-DPG shift is secondary change associated with the low oxygen delivery to the tissues, More extensive k prospective investigations are needed to clearly define correlation among A-VO2, 2.3-DPG and prognosis of patients with CLD.
Carbon Dioxide ; Dyspnea ; Female ; Humans ; Hydrogen-Ion Concentration ; Lung Diseases* ; Lung* ; Male ; Oxygen* ; Perfusion ; Prognosis ; Ventilation