No abstract available.
Animals ; Evoked Potentials* ; Rats*

BACKGROUND: It is well known that a lacunar infarction has characteristic clinical features and a relatively good prognosis. However, the significance of lesions in the parent artery of patients with lacunar syndrome as regard to the prognosis remains unsettled. METHODS: Using the data of consecutive patients with their first ischemic stroke and were followed longer than 1 year, were divided the patients by their clinical features and the results of the work-up was as follows; (1) mismatching [MM] group; lacunar syndrome and the presence of parent arterial lesion, (2) large artery artherosclerosis [LAD]; non-lacunar syndrome and the presence of parent arterial lesion, (3) no determined etiology [NE]; non-lacunar syndrome without parent arterial lesion, and (4) small artery disease [SAD]; lacunar syndrome without parent arterial lesion. Patients with a potential source of embolism were excluded from this study. The prognosis and recurrence rate of patients with the MM group were compared with those of other groups. RESULTS: A total of 176 patients were included; 56 LAD, 62 SAD, 22 MM and 36 NE groups. An unstable hospital course was more frequently found in LAD than in the other groups. The recurrence rate of the MM group (23%) was significantly higher than that of SAD (2%), but was similar to that of patients with non-lacunar syndrome (LAD 16%, NE 28%). CONCLUSIONS: Among patients with lacunar syndrome, the prognosis of those with parent arterial lesions was different from those without lesions. Therefore, a systematic work up of the stroke mechanism may be important in patients with lacunar syndrome.
Arteries ; Embolism ; Humans ; Parents* ; Prognosis ; Recurrence ; Stroke ; Stroke, Lacunar*

No abstract available.
Postural Orthostatic Tachycardia Syndrome* ; Syncope

The serious complications of pulmonary arteriovenous malformation (PAVM) are hypoxia, dyspnea, hemothorax, cerebrovascular accident, and brain abscess due to an intrapulmonary right to left shunt. We report no anesthetic complications intraoperatively or postoperatively in a 40-year-old male with PAVM who underwent brain abscess removal and pulmonary lobectomy without specific invasive monitoring.
Adult ; Anoxia ; Arteriovenous Malformations* ; Brain Abscess* ; Brain* ; Dyspnea ; Hemothorax ; Humans ; Male ; Stroke

BACKGROUND: Cardiopulmonary bypass (CPB), a standard adjunct for open heart surgery, can also play an important role in treating patients with noncardiac diseases. MATERIAL AND METHOD: We report a collective analysis of noncardiac applications of cardiopulmonary bypass experienced at Seoul National University Hospital from 1969 to 1996. Out of a total of 20 patients, 8 were treated for membranous obstruction of inferior vena cava (MOVC), 5 for malignant melanoma, 3 for pulmonary embolism, 1 for double lung transplantation, 1 for intracranial giant aneurysm (GA), 1 for renal cell carcinoma (RC), and 1 for liposarcoma. CPB was used to induce profound hypothermia with circulatory arrest in 6 patients (MOVC 4, GA 1, RC 1). RESULT: CPB time was 113 mins on average for MOVC, 161 mins for GA, and 156 mins for RC, while the lowest rectal temperature was 26degree C on average in MOVC, and 19degree C in GA and RC. Postoperative recovery was good in all MOVC patients. The patient with GA, who underwent reoperation for the removal of hematoma, died 14 days postoperatively. The patient with RC recovered from the operation in a good condition but died from metastatic spread 6 months later. CPB was instituted for pulmonary embolectomy in 3 patients, in whom postoperative courses were uneventful, except in 1 patient who showed transient neurologic symptoms. CPB was used in a patient with double-lung transplantation for hemodynamic and ventilatory support. The patient was weaned successfully from CPB but died from low output and septicemia 19 days postoperatively. CPB without circulatory arrest was used to treat in 4 patients with MOVC. These patients showed good postoperative courses. CPB was used to administer high concentrations of chemotherapeutic agents to the extremities in 6 patients (malignant melanoma 5, recurrent liposarcoma 1). CPB time was 153 mins on average. No complications such as edema and neurologic disability were found. CONCLUSION: Although CPB has a limited indication in noncardiac diseases, if properly applied, it can be a very useful adjunct in a variety of surgical cases.
Aneurysm ; Carcinoma, Renal Cell ; Cardiopulmonary Bypass* ; Edema ; Embolectomy ; Extremities ; Hematoma ; Hemodynamics ; Humans ; Hypothermia ; Liposarcoma ; Lung Transplantation ; Melanoma ; Neurologic Manifestations ; Pulmonary Embolism ; Reoperation ; Seoul ; Sepsis ; Thoracic Surgery ; Vena Cava, Inferior

Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. The clinical presentation of meningeal irritation is very rare. Nonetheless, if present and associated with fever, pituitary apoplexy may be misdiagnosed as a meningitis. We experienced a case of pituitary apoplexy masquerading as a meningitis. A 42-year-old man presented with meningitis associated symptoms and initial imaging studies did not show evidence of intra-lesional hemorrhage in the pituitary mass. However, a follow-up imaging after neurological deterioration revealed pituitary apoplexy. Hereby, we report our case with a review of literatures.
Adult ; Consciousness ; Fever ; Follow-Up Studies ; Headache ; Hemorrhage ; Humans ; Meningitis* ; Paresis ; Pituitary Apoplexy*

OBJECTIVE: Post-traumatic stress disorder (PTSD) is a group of diseases that are observed in patients who had experienced a serious trauma or accident. However, some experienced it even after only a mild traumatic brain injury (TBI), and they are easily ignored due to the relatively favorable course of mild TBI. Herein, the authors investigated the incidence of PTSD in mild TBI using brief neuropsychological screening test (PTSD checklist, PCL). METHODS: This study was conducted on patients with mild TBI (Glasgow coma scale > or =13) who were admitted from January 2012 to December 2012. As for PCL, it was done on patients who showed no difficulties in communication upon admission and agreed to participate in this study. By using sum of PCL, the patients were divided into high-risk group and low-risk group. PTSD was diagnosed as the three major symptoms of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders, fourth-edifion. RESULTS: A total of 314 TBI patients were admitted and 71 of them met the criteria and were included in this study. The mean age was 52.9 years-old (range: 15-94). The mean PCL score was 28.8 (range: 17-68), and 10 patients were classified as high-risk group. During follow-up, 2 patients (2.7%) of high risk group, were confirmed as PTSD and there was no patient who was suspected of PTSD in the low-risk group (p=0.017). CONCLUSION: PTSD is observed 2.8% in mild TBI. Although PTSD after mild TBI is rare, PCL could be considered as a useful tool for screening of PTSD after mild TBI.
Brain Injuries* ; Checklist ; Coma ; Diagnostic and Statistical Manual of Mental Disorders ; Follow-Up Studies ; Humans ; Incidence* ; Mass Screening* ; Stress Disorders, Post-Traumatic*

OBJECTIVE: Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. METHODS: This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. RESULTS: Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). CONCLUSION: In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.
Air Ambulances* ; Ambulances ; Developed Countries ; Emergencies ; Humans ; Korea ; Neurosurgery ; Retrospective Studies ; Trauma Centers ; Triage

BACKGROUND: Patient satisfaction with anesthesia is an important outcome of hospital care. The aim of this study was to assess the overall level of satisfaction with anesthetic care and to identify predictive factors associated with dissatisfaction. METHODS: Our subjects were adult in-patients with ASA 1-3 who had undergone an elective operation during the previous 12 months. The major measure of subjective outcome was the overall level of satisfaction with anesthetic care on the first day after operation. Patients were asked to rate if they were 'very satisfied', 'somewhat satisfied', 'neutral', 'somewhat dissatisfied' or 'very dissatisfied'. We also measured other predetermined outcomes, such as nausea, vomiting, pain and other complications. RESULTS: At the time of analysis, our database contained information on 3376 patients. 283 (8.4%) patients were 'very satisfied', 1826 (54.1%) were 'somewhat satisfied', 1119 (33.1%) were 'neutral', 133 (3.9%) were 'somewhat dissatisfied' and 15 (0.4%) were 'very dissatisfied' with their anaesthetic care. The number of postanesthetic factors (81.7%) were greater than the number of preanesthetic factors (8.8%) and intranesthetic factors (9.5%) for dissatisfaction with anesthetic care. The causes of dissatisfaction were postoperative pain (43 patients, 29.1%), postoperative nausea and vomiting (17, 11.5%), sore throat (17, 11.5%), waiting a long time before surgery (9, 6.1%), myalgia (6, 4.1%), back pain (6, 4.1%) and other complications. Strong relations were found between patient dissatisfaction and an anesthetic duration of more than 2 hours, moderate or severe postoperative pain, moderate to severe postoperative nausea and vomiting, and other anesthesia-related adverse events. CONCLUSIONS: This study found that patient satisfaction with anesthetic care is high and identified several factors associated with dissatisfaction that may be preventable or better managed.
Adult ; Anesthesia ; Back Pain ; Humans ; Myalgia ; Nausea ; Pain, Postoperative ; Patient Satisfaction ; Pharyngitis ; Postoperative Nausea and Vomiting ; Vomiting