Pontine hemorrhage is characterized by high mortality and morbidity. We report a case of pontine hemorrhage treated by extraventricular drainage (EVD) of cerebrospinal fluid (CSF) and control of intracranial pressure (ICP) at the neuro-intensive care unit (NICU). The patient's ICP was well controlled, but hyperthermia with tachycardia developed 8 hours after admission, and the patient expired with sudden cardiac arrest. A literature review revealed that high fever (>39degrees C) developing within 24 hours after onset of hemorrhage with tachycardia (>110 beat/min) is a clinical indicator for high probability of death. Therefore, it is important that not only ICP and neurological changes but also vital signs, especially body temperature and heart rate, be monitored in pontine hemorrhage patients.
Body Temperature ; Death, Sudden, Cardiac ; Drainage ; Fatal Outcome ; Fever ; Heart Rate ; Hemorrhage ; Humans ; Intracranial Pressure ; Tachycardia ; Vital Signs

In most intracranial surgery cases, a drain catheter is inserted to prevent the collection of the wound hematoma or seroma. A drain catheter is also inserted to drain the hematoma or the cerebrospinal fluid. The drain catheter itself does not cause complications; but many complications occur during its removal, such as hematoma, seroma, air collection and pseudomeningocele formation. To prevent these complications, neurosurgeons perform a suture on the catheter to remove the site. In this study, an additional horizontal mattress suture and an anchoring suture to the drainage catheter are proposed. This method maintains negative pressure in the catheter insertion site during the catheter removal, compresses the catheter tunnel site and attaches the external wounds strongly. The technique is easy and safe to perform, and does not require an additional suture to remove the catheter.
Catheters* ; Cerebrospinal Fluid ; Drainage* ; Hematoma ; Seroma ; Sutures* ; Wounds and Injuries

PURPOSE: We evaluated the factors that affect the improvement of the initial peak flow rate after transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) patients by using noninvasive tools. METHODS: One hundred and twenty seven BPH patients who had undergone TURP or PVP between January 2005 and May 2009 were evaluated. They were divided into 2 groups: the postoperative initial peak urinary flow rate (Qmax) was less than 10 mL/sec (Group 1; n=37, TURP=11, PVP=26) and more than 10 mL/sec (Group 2; n=90, TURP=41, PVP=49). We confirmed the patients' preoperative check lists. The check list were the international prostate symptom score (IPSS), the quality of life score, a past history of acute urinary retention (AUR), body mass index and/or pyuria, the serum prostate-specific antigen (PSA) level and the prostate volume, the prostate transitional zone volume and prostatic calcification. The initial Qmax was measured at the outpatient clinic one week after discharge. RESULTS: The improvement rate was not significant difference between the TURP group (78.8%) and the PVP group (65.3%). The efficacy parameters were the IPSS-storage symptom score, the prostate volume, the PSA level and a past history of AUR. The IPSS-storage symptom scores of Group 1 (12.3+/-3.3) was higher than those of Group 2 (10.5+/-1.7). The prostate volume of Group 2 (42.3+/-16.6 g) was bigger than that of Group 1 (36.6+/-7.8 g). The PSA level of Group 2 (3.8+/-2.6 ng/mL) was higher than that of Group 1 (2.6+/-2.6 ng/mL). A past history of AUR in Group 1 (35.1%) was more prevalent than that of Group 2 (15.6%). CONCLUSIONS: The non-invasive factors affecting the initial Qmax after TURP or PVP were the IPSS-storage symptom score, the prostate volume and a past history of AUR. Accordingly, in patients who have a higher IPSS-storage symptom score, a smaller prostate volume and a history of AUR, there might be a detrimental effect on the initial Qmax after TURP or PVP. These factors might also be used as long-term prognostic factors.
Ambulatory Care Facilities ; Body Mass Index ; Humans ; Laser Therapy ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Pyuria ; Quality of Life ; Transurethral Resection of Prostate ; Urinary Retention ; Volatilization

BACKGROUND: Pneumococcus is the most common cause of acute otitis media, community acquired pneumonia and invasive bacterial diseases in children. Ninety serotypes have been identified, and the distribution differs according to geographic area and ages. The 7 valent pneumococcal protein conjugate vaccine is used widely. To evaluate the efficacy of the vaccine, it is essential to investigate the distribution of the pneumococcal serotypes. MATERIALS AND METHODS: The serotypes and antibiotic resistance of the pneumococcus isolated from 308 patients at Shinchon Severance hospital from September of 2001 to July of 2005 were analyzed. RESULTS: The pneumococcci were isolated mostly from sputum and blood, and ear discharge in the descending order. Serotyping was possible in 265 cases, and the distribution of serotypes were 19F (16.2%), 19A (12.8%), 23F (8.7%), 6B (7.9%), and 6A (7.2%). Fifty two cases were isolated from those patients less than 16 years of age and the distribution of serotypes was 19F, 19A, 23F, 14, 6B, 6A and 4. Resistance to penicillin was 64.6% in all cases and 67.3% in children. The more common serotype showed the higher rate of penicillin resistance. Multi-drug resistance was demonstrated in 64.7%. Forty three percent of the total identified serotypes were included in the 7 valent pneumococcal conjugate vaccine. And 61.5% of the serotypes identified in children were included in the vaccine. CONCLUSION: The 7 valent vaccine may be used effetively in Korea. But, further study is needed to address serotype switching after the use of the protein conjugated vaccine, which has been reported in other countries.
Anti-Bacterial Agents ; Child ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Ear ; Humans ; Korea ; Otitis Media ; Penicillin Resistance ; Penicillins ; Pneumonia ; Serotyping ; Sputum ; Streptococcus pneumoniae* ; Streptococcus*

BACKGROUND: Pneumococcus is the most common cause of acute otitis media, community acquired pneumonia and invasive bacterial diseases in children. Ninety serotypes have been identified, and the distribution differs according to geographic area and ages. The 7 valent pneumococcal protein conjugate vaccine is used widely. To evaluate the efficacy of the vaccine, it is essential to investigate the distribution of the pneumococcal serotypes. MATERIALS AND METHODS: The serotypes and antibiotic resistance of the pneumococcus isolated from 308 patients at Shinchon Severance hospital from September of 2001 to July of 2005 were analyzed. RESULTS: The pneumococcci were isolated mostly from sputum and blood, and ear discharge in the descending order. Serotyping was possible in 265 cases, and the distribution of serotypes were 19F (16.2%), 19A (12.8%), 23F (8.7%), 6B (7.9%), and 6A (7.2%). Fifty two cases were isolated from those patients less than 16 years of age and the distribution of serotypes was 19F, 19A, 23F, 14, 6B, 6A and 4. Resistance to penicillin was 64.6% in all cases and 67.3% in children. The more common serotype showed the higher rate of penicillin resistance. Multi-drug resistance was demonstrated in 64.7%. Forty three percent of the total identified serotypes were included in the 7 valent pneumococcal conjugate vaccine. And 61.5% of the serotypes identified in children were included in the vaccine. CONCLUSION: The 7 valent vaccine may be used effetively in Korea. But, further study is needed to address serotype switching after the use of the protein conjugated vaccine, which has been reported in other countries.
Anti-Bacterial Agents ; Child ; Drug Resistance, Microbial ; Drug Resistance, Multiple ; Ear ; Humans ; Korea ; Otitis Media ; Penicillin Resistance ; Penicillins ; Pneumonia ; Serotyping ; Sputum ; Streptococcus pneumoniae* ; Streptococcus*

OBJECTIVE: The surgical clipping of paraclinoid segment internal carotid artery aneurysms is considered difficult because of the complex anatomical location and important neighboring structures. Our experiences of pterional craniotomy and extradural anterior clinoidectomy (EAC) to clip paraclinoid aneurysms are reported herein. METHODS: We present two patients with paraclinoid aneurysms who underwent surgical clipping using pterional craniotomy and EAC. The clinical results and operative techniques were reviewed from the patients' medical records. RESULTS: EAC improves the surgical field in the suprasellar and periclinoid regions. Clinically, a good outcome was obtained in both cases. No surgical complications directly resulting from the EAC were observed. CONCLUSION: Favorable surgical results can be obtained with pterional craniotomy and EAC for the clipping of paraclinoid aneurysms. EAC is advocated for the clipping of paraclinoid aneurysms.
Aminocaproic Acids ; Aneurysm ; Carotid Artery, Internal ; Craniotomy ; Humans ; Surgical Instruments

BACKGROUND: The management of postoperative pain with traditional narcotic analgesic regimen is associated with an unacceptably high failure rate and at best has represented a cautious compromise between adequate analgesia and the risk of complications, particularly that of respiratory depression. The purpose of this investigation was to compare the efficacy and safety of nalbuphine given by patient-controlled analgesia (PCA) with differential dosages after total knee replacement. METHODS: A double-blind clinical trial of 75 patients who received intravenous nalbuphine with patient- controlled analgesia during the postoperative first 48 hours after total knee replacement, was carried. Patients were assigned to three groups by the concentration of nalbuphine: Group 1 (n = 25), 2 mg/ml; Group 2, 4 mg/ml; Group 3, 6 mg/ml. The settings of PCA in three groups were same. RESULTS: Visual analog scale (VAS) scores were used to assess pain. Group 2 and 3 patients reported significant lower VAS over the postoperatively 6 hours and 12 hours at either rest or movement compared to group 1. PCA demands, delivered doses and PCA nalbuphine dosage per hours except supplemental analgesic doses in the first 48 hours were lower in group 2 and 3 compared to group 1. There were significant differences among groups at postoperatively 6 and 12 hours in nausea, vomiting and sedation of the side effects. CONCLUSIONS: IV PCA with nalbuphine is thought to be potent and safe for postoperative pain relief without the major morbidity like respiratory depression, in addition, the careful observation and treatment on the side effect like nausea, vomiting and sedation, is surely needed.
Analgesia ; Analgesia, Patient-Controlled* ; Arthroplasty, Replacement, Knee ; Humans ; Nalbuphine* ; Nausea ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Respiratory Insufficiency ; Visual Analog Scale ; Vomiting

STUDY DESIGN: Retrospective study of clinical experiences. OBJECTIVES: The correct discrimination of a compressed root is very important for proper decompression. With a foraminal disc herniation, the cephalad root is compressed. The diagnostic importance of the clinical and radiological findings was investigated. SUMMARY OF LITERATURE REVIEW: A compressed root, due to a herniated disc, is known as a caudal root (i. e. L5 root compressed by L4-5 disc herniation). In some cases, a prolapsed disc may compress the cephalad root, resulting in a difficult diagnosis. MATERIAL AND METHOD: The medical records, plain X-ray and MRI of 17 patients were reviewed, and the physical examination and MRI findings were carefully evaluated to retrospectively document the efficacy of the diagnoses. Every MRI image of each patient was graded according to the 4 point ranking system of diagnostic efficacy devised by the authors. The clinical outcomes and postoperative complications were also investigated. RESULTS: Ten, 5 and 2 of the 17 patients had L4-5, L5-S1 and L3-4 foraminal disc herniations, respectively. Eight of 10 L4-5 cases showed a positive femoral nerve stretching test. The knee jerk reflex was diminished in 7 patients, with bilateral hyporeflexia in the other 3. The body-cut axial MRI image was the most effective, and the coronal images were also very helpful, whereas the routine axial images were of least value. Most cases achieved a satisfactory clinical result. CONCLUSIONS: Foraminal disc herniations seem to be reasonably common. For the accurate discrimination of a compressed root, a thorough physical examination seems to be very important. When MRI is performed for these cases, in addition to routine studies, the body-cut axial and coronal MRI images are effective and useful, and their use is strongly recommended.
Decompression ; Diagnosis ; Discrimination (Psychology) ; Femoral Nerve ; Humans ; Intervertebral Disc Displacement ; Knee ; Magnetic Resonance Imaging ; Medical Records ; Physical Examination ; Postoperative Complications ; Reflex ; Reflex, Abnormal ; Retrospective Studies

INTRODUCTION: To prevent hemodialysis-related infections, it is important to maintain hemodialysis system without microbial contamination. In May 2003, routine surveillance showed that dialysis water from dialysis port was contaminated with bacteria. To identify the causes of the contamination, we conducted an investigation as follows. METHODS: Patients undergoing dialysis were carefully monitored to see whether evidences of pyrogenic reactions or infections were present. Factors that could have influence on bacterial contamination in hemodialysis systems were thoroughly examined. In addition, microbiologic surveillances were done 7 times in 1 month. RESULTS: Although pyrogenic reactions or bacteremia did not occur, R. pickettii was repeatedly isolated above the Association for the Advancement of Medical Instrumentation (AAMI) standards from almost all dialysis units. Bacterial counts of specimens were higher in the proximal part of the water supply tube than the other parts in all dialysis machines. The colony count of R. pickettii exceeded the maximum level of technical limit in the specimens collected from the dialysis machines in the early morning after intermission of 48 hours. The structure of the supply tube was suspected as the origin of the colonization because stagnant water is a reservoir for bacterial multiplication. After remodeling the structure of the water supply tube, neither R. pickettii nor any other bacteria were isolated. CONCLUSION: Our investigation successfully identified the source of R. pickettii contamination of reverse osmosis water. Appropriate corrective measures for water distribution systems of hemodialysis center could prevent outbreak of dialysis-associated illnesses.
Bacteremia ; Bacteria ; Bacterial Load ; Colon ; Dialysis ; Humans ; Osmosis ; Ralstonia ; Ralstonia pickettii ; Renal Dialysis ; Water ; Water Supply

Endovascular aortic repair is a new alternative to conventional surgical repair of aortic pathology. It is a less invasive technique and gives less hemodynamic stress to the patients who may have concomitant systemic diseases, compared with open aortic reconstruction. We report 2 cases of patients with thoracic aortic diseases, who underwent endovascular stent graft placement under general anesthesia. We also include a review of the literature about anesthetic management of endovascular aortic repair and present our opinions about the need to choose a suitable anesthetic technique for each patient, the method to recognize and handle the possible complications and hemodynamic changes to which we have to pay attention during procedures.
Anesthesia, General ; Aortic Diseases* ; Blood Vessel Prosthesis* ; Hemodynamics ; Humans ; Pathology ; Stents*