Lumbar disc surgery is a common operation with rare vascular complications. The authors report a case of iliac arteriovenous(AV) fistula and pseudoaneurysm as a complication of lumbar disc surgery. A 52-year-old man underwent lumbar disc surgery 14 months prior to the admission. His chief complaints were progressive pain and swelling on the left lower limb. Contrast medium enhanced computed tomography(CT) scan showed dilatation in both iliac veins, right iliac AV fistula, and an pseudoaneurysm. Angiogram demonstrated a pseudoaneurysm originated from the right common iliac artery, associated left iliac vein compression, and dilatation in both iliac veins. The patient was treated with an endovascular stent placement. Angiogram obtained after stent grafting demonstrated elimination of the pseudoaneurysm, occlusion of the AV fistula, and right iliac artery patency. One month after the stent placement, his leg pain and swelling were improved markedly. A high suspicion based on clinical signs, CT scan, and angiography are important in the early detection of AV fistula. An endovascular stent placement is considered a promising treatment in select patients with iliac AV fistulae and pseudoaneurysms.
Aneurysm, False* ; Angiography ; Arteriovenous Fistula* ; Blood Vessel Prosthesis ; Dilatation ; Fistula ; Humans ; Iliac Artery ; Iliac Vein ; Leg ; Lower Extremity ; Middle Aged ; Stents ; Tomography, X-Ray Computed

The tracheobronchial histopathologic findings in 7 healthy cats used with high frequency oscillation ventilation (HFOV) were compared with those in 6 cats used with conventional mechanical ventilation (CMV). 4-point, 9-variable scoring system was used to evaluate the injury in the trachea, right & left main bronchi and parenchyma. The following results were obtained; 1) The tracheobronchial tree received HFOV had no significant damage compared with CMV (P>0.05). 2) Intraepithelial mucus loss and emphysema were slightly more prominent in CMV groups. As above results; the tracheobronchial histopathologic difference was not prominent between CMV and HFOV groups received with relatively short period, however, the cellular of function and barotrauma may be more prominent in CMV groups. From now on, as causes of tracheobronchial injury in HFV, interaction between humidification and mechanical trauma considers further study.
Animals ; Barotrauma ; Bronchi ; Cats* ; Emphysema ; High-Frequency Ventilation* ; Mucus ; Respiration, Artificial* ; Trachea ; Trees

In a series of rabbits, two craniectomies were made in both side of the parietal hone. Each lesion was filled with gelfoam, lyocura, fat and dural film. Five rabbits were left empty as a control group. The animals were killed in one month after the operation. The degree of adhesion between the soft tissue of the scalp and various dural substitute was evaluated at the time of operative dissection and studied histopathologically. The results were as follows. 1) The insertion of dural substituted substances can prevent the adhesion between the scalp and dura mater. 2) The dural film was most effective in prevention of adhesion. 3) The dural film inserted group exhibited inflammatory reaction. 4) The gelfoam, lyodura and fat inserted groups were though to have had a moderate prevention effect of adhesion. With these results, we could conclude that the insertion of material between the dura and scalp can prevent adhesion. However the ideal inserted material which can pevent inflammatory reaction and adhesion has not been determined. At this point we have not found and ideal substitute. To get an ideal material for prevention of adhesion, further intensive study is required.
Animals ; Dura Mater ; Gelatin Sponge, Absorbable ; Rabbits ; Rabeprazole ; Scalp

A case of ruptured aneurysm of the distal PICA presenting with isolated intraventricular hemorrhage is presented. The diagnosis of distal PICA aneurysm should be considered if isolated intraventricular hematoma is found without obvious parenchymal hemorrhage or subarachnoid blood in the basal cisterns. Complete vertebral arteriography is a requiste for the recognition of this condition. The outcome in patients with these aneurysms should be good if surgical repair is performed before rebleeding occurs.
Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries* ; Diagnosis ; Hematoma ; Hemorrhage* ; Humans ; Pica

OBJECTIVES: There are evidences of apoptotic neuronal cell death in Alzheimer's disease (AD). Recent studies suggested AD pathogenesis in the central nervous system as well as in peripheral lymphocytes. The object of this study is to compare the cell viability and the proliferation activity in AD patients with healthy normal control by using peripheral lymphocytes. METHODS: We analyzed the cell viability and the proliferation activity of phytohemagglutinin (PHA)-activated lymphocytes from 73 AD patients and 31 normal contols. The cell viability and the proliferation activity were measured at baseline (T0), 24 hours (T24), 48 hours (T48), 72 hours (T72), 96 hours (T96), by the tryphan blue method and the BrdU proliferation activity method, respectively. RESULTS: The cell viability of PHA-activated peripheral lymphocytes in AD patients was significantly decreased at T72, T96 compared with healthy controls (F=8.034, p<0.001). In AD patients, the decline of proliferation activity appeared in earlier than healthy normal controls. CONCLUSION: This study suggests that there is a decreased cell viability and the proliferation activity of peripheral lymphocytes in AD patients. These finding may be related with the increased apoptosis in Alzheimer's disease.
Alzheimer Disease* ; Apoptosis ; Bromodeoxyuridine ; Cell Death ; Cell Survival* ; Central Nervous System ; Humans ; Lymphocytes* ; Neurons

In spite of the appropriate antibiotic treatment and the development of newer antibiotics, bacterial meningitis still has a high risk of complications. Especially, vascular involvements of meningitis, including vasospasms and infarctions, frequently result in neurologic sequelae. Here, we report a case of bacterial meningitis complicated by arterial vasospasms and multiple infarctions during a clinically improving course. This case suggests that in the management of bacterial meningitis, early evaluation and monitoring of vasculitis by TCD and its management could prevent fatal outcomes.
Anti-Bacterial Agents ; Cerebral Infarction* ; Fatal Outcome ; Infarction ; Meningitis ; Meningitis, Bacterial* ; Vasculitis

BACKGROUND: Fungus is the common pathogen of nosocomial infection, and the 4th common pathogen of nosocomial bloodstream infection. We evaluated the annual occurrence, the relation between fungemia and central venous catheter-related infection, the risk factors and survival rate of fungemia. METHODS: We reviewed medical record of 209 cases with fungemia occurred in the period of from 1992 to 1997 in Severance hospital retrospectively. RESULTS: The annual occurrence of nosocomial fungemia was 3.9, 6.7, 6.7, 7.8, 13.6, 8.0, per 10,000 patient discharges in 1992, 1993, 1994, 1995, 1996, 1997. The species of fungemia wete Candida albicans (47.79o), C. glabrata (12.1%), C. parapsilosis (11.7%), C. tropicalis (11.2/o), C. guilliermondii (1.9fo), C. krusei (1.9%), Rhodotorula species (2.3%), Trichosporon species (1.9%), molds (4.7%). The proportion of definite catheter-related bloodstream infection was 41.6%, probable catheter-related bloodstream infection 28.2%, and the fungemia that was not related with central venous catheter infection was 30.1%. Mortality rate of fungemia was 53.6%, and median survival days were 29 days. Catheter removal and antifungal therapy increased survival rate, but persistent fungemia and thrombocytopenia were poor prognostic factors. CONCLUSION: The fungal bloodstream infection is increased and high proportion of fungemia is related to central venous catheter-related infection. Since catheter removal and antifungal therapy have benefit on survival rate, early evaluation of catheter-related infection and antifungal therapy in fungemia patient is recommended.
Candida albicans ; Catheter-Related Infections ; Catheters ; Central Venous Catheters ; Cross Infection ; Fungemia* ; Fungi ; Humans ; Incidence* ; Medical Records ; Mortality ; Patient Discharge ; Retrospective Studies ; Rhodotorula ; Risk Factors ; Survival Rate ; Thrombocytopenia ; Trichosporon

In this study, high frequency oscillatory ventilator was designed and constructed. Using designed by phase-lock loop system, in order to accurately and easily treat both the outlet volume and rpm. A system has been designed and is being evaluated using CD4046A PLL IC. We use this PLL IC for the purpose of motor controls. The device consists of PLL system, pumping mechanism, piston, cylinder, and special crank shaft are required. This system characteristics were as follows: 1) Frequency: 20-1800 rpm 2) Outlet air volume: 1-50 cc
Ventilators, Mechanical*

BACKGROUND: Video-assisted thoracic surgery (VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. MATERIAL AND METHOD: Group I (n=18) underwent video-assisted thoracic surgery, and group II (n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. RESULT: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I (155.6+/-77.8cc) than in group II (572.8+/-280.1cc) (p<0.05). CONCLUSION: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.
Analgesics, Opioid ; Anesthesia ; Chest Tubes ; Drainage ; Esophageal Achalasia ; Esophageal Diseases* ; Humans ; Leiomyoma ; Length of Stay ; Pain, Postoperative ; Pleural Effusion ; Thoracic Surgery, Video-Assisted* ; Thoracotomy* ; Vocal Cord Paralysis

High frequency ventilation (HFV) is a new ventilatory technique that uses very small tidal volume (less than the anatomic dead space) and high frequency, and classified 4 distinct types according to frequency and mode of gas delivery. The mechanism of gas transport of high frequency oscillation ventilation (HFOV) is somewhat different to other types of HFV. To evaluate the determinants of PaCO² in HFOV, a study was done with a HFOV on 9 cats, and the results are: 1) PaCO² was not correlated with frequency at the constant stroke volume (6 voltage) and bias flow (6 L/minutes). 2)PaCO² was correlated with stroke volume but not with bias flow under the constant frequency (15 Hz/min) and bias flow (3 to 6 L/min). From above results, the main determinant of PaCO² on artificial ventilation with HFOV was stroke volume, but further study between flow, the site of delivery to the airway and humidification of bias flow and CO² elimination is required in future research.
Animals ; Bias (Epidemiology) ; Cats* ; High-Frequency Ventilation* ; Stroke Volume ; Tidal Volume ; Ventilation