No abstract available.
Atrial Fibrillation* ; Heart* ; Thoracic Surgery*

BACKGROUND: Pulmonary atresia (PA) with ventricular septal defect has various morphology of pulmonary arteries and pulmonary blood flow sources, so pulmonary arterial hypoplasia and arborization abnormality make this anomaly difficult to manage surgically. In cases associated with juxtaductal stenosis, we evaluated the change of the pulmonary arterial and juxtaductal stenotic site after shunt operations, and would like to find useful information in surgical planning and methodology of these patients. MATERIAL AND METHOD: Among 59 cases diagnosed as PA with ventricular septal defect associated with juxtaductal stenosis, 29 cases who had cardiac catheterization before and after shunt operation were selected from July, 1991 to July, 1996. In 10 cases of right shunt operation (Group I) and 19 cases of left shunt operation (Group II), the diameters of the descending aorta, both pulmonary arteries, and the juxtaductal stenosis site were measured before and after the shunt operation. RESULT: In both Group I and II, the pre-and postoperative ratio of diameters of the ipsilateral pulmonary artery to the descending aorta was from 0.78+/-0.31 units to 1.01+/-0.26 units and from 0.67+/-0.18 units to 0.84+/-0.27 units respectively, showing a signigicant increase. The contralateral pulmonary artery index was increased from 0.92+/-0.28 units to 1.05+/-0.15 units and from 0.94+/-0.27 units to 1.08+/-0.37 units respectively, but could not be confirmed statistically. In both groups, the change of juxtaductal stenosis showed an aggravating tendency but of no statistical significance from 0.43+/-0.27 units to 0.39+/-0.25 units and from 0.32+/-0.10 units to 0.30+/-0.16 units respectively, and we experienced 2 total obstruction in Group II. Because the increased pulmonary blood flow by shunt operation has a favorable effect to the pulmonary arterial growth, the shunt operation is a recommended treatment in patients with hypoplastic pulmonary arteries. But in PA with ventricular septal defects, the change of juxtaductal stenosis is very important. In conclusion, the growth of ipsilateral (shunt site) pulmonary artery was promoted by shunt operation, but there is a tendency for the juxtaductal stenosis to be aggravated. And we experienced 2 total obstruction in Group II. CONCLUSION: Thus, in cases operated with shunt method, much careful postoperative follow up study including angiographic evaluation is needed, and after the shunt operation on the side of pulmonary artery associated with juxtaductal stenosis, early precise planning for total correction is recommended.
Aorta, Thoracic ; Cardiac Catheterization ; Cardiac Catheters ; Constriction, Pathologic* ; Follow-Up Studies ; Heart Septal Defects, Ventricular* ; Humans ; Pulmonary Artery ; Pulmonary Atresia*

BACKGROUND: Depth and subdural electroencephalographic (EEG) recordings are often required to identify an area of the brain for epileptic surgery. We simultaneously compared bilaterally placed depth and subdural electrode EEGs to determine the site of seizure origins from the temporal lobes. METHODS: We included nine consecutive patients with medically refractory temporal lobe epilepsy, whose noninvasive evaluations such as magnetic resonance imaging, scalp and sphenoidal EEG, and other tests had not proved consistent lateralization. All patients had bilateral temporal depth electrodes, anterior and lateral temporal subdural strip electrodes. Thirty-eight clinical seizures and 3 subclinical seizures were evaluated. RESULTS: Seven out of 9 patients (78%) had unitemporal seizures, one patient had bilateral seizures, and the other had lateral temporal seizures in an invasive study. Ictal onset was localized by depth electrodes in 8 patients, and subdural strip electrodes in one. In ictal recordings, the ictal rhythms never spread to the contralateral neocortex before the ipsilateral neocortex. Most of the ictal rhythms began focally with periodic spikes or fast activities in the depth electrode, then spread to the ipsilateral strip electrode after 14 to 90 seconds (mean : 35.2 seconds). If ictal rhythms propagated to the contralateral side, it took 14 to 140 seconds (mean : 64.2 seconds). Subdural strip electrodes were less sensitive than depth electrodes in the detection of seizure onset and subclinical seizures, but were accurate when lateralized. CONCLUSIONS: We conclude that EEG recordings with depth and subdural strip electrodes correctly identify and lateralize temporal lobe seizures more often than subdural electrodes alone.
Brain ; Electrodes* ; Electroencephalography ; Epilepsies, Partial ; Epilepsy, Temporal Lobe* ; Humans ; Magnetic Resonance Imaging ; Neocortex ; Scalp ; Seizures ; Temporal Lobe*

BACKGROUND: Persistent auras after temporal lobectomy may be bothersome to the patients even though they are seizure free. But most authors specifically are concerned about the seizure outcome itself. The aim of the present study was to investigate which factors are related to persistent auras in patients with temporal lobe epilepsy(TLE) after temporal lobectomy. METHODS: We have retrospectively analysed many factors in 38 TLE patients with aura. All patients underwent anterior temporal lobectomy with amygdalo-hippocampectomy. Twenty three patients were seizure and aura free (completely seizure-free) and 15 patients had persistent auras(persistent auras) in spite of seizure-free. Characteristics of auras, past medical history, presence of secondary GTC, seizure frequency, age of surgery, age of onset, duration of habitual seizure, ictal EEG pattern, and pre- and postoperative MRI findings were compared between group with completely seizure-free and group with persistent aura. RESULTS: Characteristics of aura, past medical history, presence of secondary GTC, seizure frequency, ictal EEG pattern, age of onset, and age of surgery had no statistical differences between both groups. Seizure duration of group with persistent aura seemed to be longer than that of group with completely seizure-free(13.6 years vs 17.0 years, median test, p=0.10) and remained hippocampus in postsurgical MRI seemed to be related to persistent auras(Fisher's exact test, p=0.06). CONCLUSIONS: We found that there were suggestive differences in seizure duration and remained hippocampus between the two groups.
Age of Onset ; Anterior Temporal Lobectomy ; Electroencephalography ; Epilepsy* ; Epilepsy, Temporal Lobe ; Hippocampus ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies ; Seizures ; Temporal Lobe

PURPOSE: Usefulness of sphenoidal electrodes for detecting mesial temporal seizure foci remains controversial. Our aim is to determine whether sphenoidal electrodes are superior to surface electrodes for EEG localization in patients with mesial temporal lobe epilepsy (TLE). METHODS: We retrospectively reviewed ictal EEGs recorded simultaneously with standard International 10-20 System, subtemporal and sphenoidal electrodes in 92 patients who underwent temporal lobectomy. Patients were divided into mesial (n=67) and neocortical (n=25) TLE. Ictal EEGs were reviewed in a blinded fashion in both longitudinal bipolar and Pz referential montages. RESULTS: Thirty four (13.1%) of 259 mesial temporal seizures were exclusively isolated to sphenoidal electrode at least 3 seconds before involvement of subtemporal electrodes or were localized to temporal lobe on sphenoidal electrode when scalp electrode failed to localize seizure onset, whereas only 2 (2.6%) of 75 neocortical temporal seizures were (p<0.05). The usefulness of sphenoidal electrode was related to the distribution but not the frequency of ictal onset on scalp EEG. CONCLUSIONS: Although isolated or localized sphenoidal seizure onset in patients with mesial TLE are not frequent, sphenoidal electrodes are superior to scalp electrodes for the localization of mesial temporal seizure foci.
Electrodes* ; Electroencephalography* ; Epilepsy, Temporal Lobe ; Humans ; Retrospective Studies ; Scalp ; Seizures* ; Temporal Lobe*

Nonconvulsive status epilepticus (NCSE) of frontal origin is rare. The symptoms are unusual and different from that of temporal origin which makes it difficult to be diagnosed. We report two cases with NCSE of frontal origin. The first case was a 17-year-old girl who presented indifference and reduced word fluency, responsiveness, and facial expres-sion daylong with intermittent unresponsiveness and slight rightward eye and head deviations. Confusion was not noted. Electroencephalogram (EEG) showed the recurrent 2 Hz spike-wave ictal discharges on the left frontal area, sometimes spreading to the opposite side. The second case was a 57-year-old woman who had a medically intractable epilepsy. During long-term Video/EEG monitoring, the continuous 2 Hz spike-and-wave complexes were noted on the right hemisphere and the left frontal area. At that time, neurological examination including cognitive functions was normal except for a mild jaw tremor. No confusion was noted. However, she looked depressed, inactive, and affectively indifferent. Intravenous lorazepam injection abolished status EEG activities as well as clinical symptoms. Ictal single photon emission computed tomography (SPECT) showed an increased perfusion in the right frontal lobe. Cortical dysplasia was pathologically diagnosed after a right frontal lobectomy.
Adolescent ; Electroencephalography ; Epilepsy ; Female ; Frontal Lobe ; Head ; Humans ; Jaw ; Lorazepam ; Malformations of Cortical Development ; Middle Aged ; Neurologic Examination ; Perfusion ; Status Epilepticus* ; Tomography, Emission-Computed, Single-Photon ; Tremor

Recent researches on clinically used triazole antifungal reagents are focused on their pharmacokinetic disadvantage which increases the probability of inducing adverse effects in patients. For this point, in the present laboratory, Chemon Inc., has investigated new antifungal reactive compounds, KAF-200522 and its chloride form, KAF-200522 . HCl, which has a modified triazole structure. Pharmacokinetic data were measured with LC-MS/MS in male mice which were orally treated with the above compounds at 10 mg/kg. Tmax and t1/2 of KAF-200522 . HCl were comparable to KAF-200522, but AUC and Cmax were 1.4 and 1.6 times higher than those of KAF-200522, respectively. In beagle dogs, AUC and Cmax of KAF-200522 . HCl were 2.7 and 1.4 times higher than those of KAF-200522, and t1/2 was 3.5 times higher than that of KAF-200522. Moreover, in beagle dogs, the oral bioavailability value of KAF-200522 . HCl was revealed as 31.0% to contrast to 6.2% of KAF-200522. In 1-week repeated oral treatment toxicity study of KAF-200522 in male rats, inhibition of body weight gain was observed in 120 mg/kg treatment group, and loss of body weight was observed in 600 mg/kg treatment group. In the toxicokinetic study of KAF-200522, no accumulation after the systemic exposure was observed. In conclusion, as to the new antifungal drug development, KAF-200522 . HCl was considered to be advantageous in pharmacokinetic characteristics compared to KAF-200522.
Animals ; Area Under Curve ; Biological Availability ; Body Weight ; Dogs ; Humans ; Indicators and Reagents ; Male ; Mice ; Models, Animal ; Rats

The methods commonly used for monitoring neuromuscular transmission do not allow evaluating of an intense neuromuscular blockade. A sufficient dose of non-depolarizing relaxant used for endotracheal intubation causes disappearance of the response to single, tetanic and train of four (TOF)nerve stimulation for a variable period of time during which the magnitude of neuro-muscular blockade can not be evaluated by the traditional stimulation forms. Enhancement of posttetanic twitch tension in partially curarized patients remains constant regardless of the dose of non-depolarizing muscle relaxant or magnitude of neuromuscular blockade. If this also holds true for an intense neuromuscular blockade, the response to posttetanic twitch stimulation after the injection of a non-depolarizing muscle relaxant must appear earlier than the response to pretetanic twitch or TOF neve stimulation. The present study was designed to evaluate neuromuscular blockade during the period of no response to single or TOF stimulation by quantifying the degree of posttetanic potentiation. The possibility existed that the relatively frequent use of a tetanic stimulation (every 6 minutes) might have influenced the recovery of neuromuscular blockade. Therefore, we have studied the conventional TOF stimulation comparing with posttetanic count stimulation which may affect the recovery of intravenous pancuronium(0.08 mg/kg) induced neuromuscular block. The results were as follows; 1) The time of the T1 appearance was 815 seconds and 50% T4 ratio was 1,214.3 seconds in TOF group. 2) The time of the T1 appearance was 790 seconds and 50% T4 ratio was l,l35.5 seconds in PTC group, The recovery time appeared to be shorter in this group but statistically not signifi cant. 3) ln PTC group, TOF recovery was observed after average 2.3 times of tetanic stimulation. Above findings may suggest that intense pancuronium block in rabbit is not affeced by the TOF or PTC stimulation.
Humans ; Intubation, Intratracheal ; Neuromuscular Blockade* ; Pancuronium

The domestic product of a non-depolarizing muscle relaxant, Metuben, was studied on its effect in rabbit. Twenty four rabbits of either sex weighing 2~3kg were divided into four groups (consisting of 6 animals each) to administer Metuben in doses of 0.05 mg/kg, O.l mg/kg, 0.2 mg/ kg and 0.4 mg/kg, respectively. All animals were anesthetized with 20% urethane 5 ml/kg given intraperitoneally and 2.5% pentothal sodium 10 mg/kg intravenously. ECG was monitored by Physio-contro1(lifepak 7)model. The animal lungs were mechanically ventilated through a tracheostomy and Shinano animal respirator set to deliver a 30 ml/kg tidal volume at 30 breaths/min. This ventilatory pattern resulted in the PaCO2 values within the range of 30-40 mmHg. Twitches of the tibialis anterior muscle were elicited at 0.1 Hz, "Train of four" via the peroneal branch of the sciatic nerve, and the Myotest stimulator were applied at supramaximal voltage. Twitch recording was done via Biophysiograph. Results were as follows: 1) The effect of Metuben as a dose-dependent long lasting non-depolarizing muscle relaxant was confirmed. Their relaxant effect in rabbits were quite different from man. 2) In rabbits, Metuben showed great individual differences in its effect even with the s'ame dosage. The length of muscle relaxing activity.and the occurence of recurarization after neostigmine reverse were extremely variable suggesting its safety margin is quite narrow.
Animals ; Electrocardiography ; Individuality ; Lung ; Muscle Relaxation* ; Neostigmine ; Rabbits ; Sciatic Nerve ; Sodium ; Thiopental ; Tidal Volume ; Tracheostomy ; Urethane ; Ventilators, Mechanical

Lung cancer metastatic to the small intestine is uncommon. Despite the widespread nature of metastases that characterize this carcinoma, symptomatic intestinal metastases are extremely rare, but have been reported as a cause of intestinal obstruction, hemorrhage, malabsorption, and perforation. We have recently encountered two cases with squamous cell lung cancer who underwent endoscopic retrograde cholangiopancreatography for obstructive jaundice. Biopsies obtained from concentric ulcerative mass in the duodenum showed metastatic squamous cell carcinoma in the lymphatics. Histologically, the pulmonary and duodenal lesions were identical and this suggests a lymphatic route of dissemination. This is the report of two cases with obstructive jaundice secondary to duodenal metastasis from primary lung cancer. Metastatic squamous cell carcinoma of the lung to the duodenum should be considered in the differential diagnosis of patients harboring such a malignancy who have obstructive jaundice.
Biopsy ; Carcinoma, Squamous Cell ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis, Differential ; Duodenum ; Hemorrhage ; Humans ; Intestinal Obstruction ; Intestine, Small ; Jaundice ; Jaundice, Obstructive* ; Lung Neoplasms* ; Lung* ; Neoplasm Metastasis* ; Ulcer