The authors performed prospectively the transcranial Doppler monitoring of bilateral anterior and middle cerebral arteries in 15 patients with ruptured cerebral aneurysm. The entry criteria for the study were confined to the patients who were admitted within 3 days after bleeding and had clinical grades of I, II, or III. The mean frequency shifts of bilateral anterior and middle cerebral arteries were increased immediately after ictus and showed continous further elevation between the 3rd and 8th rupture days. After that, they normalized slowly. The increase of frequency shift preceded clinical ischemic symptoms and an early steep increase of frequency shift was correlated to a high chance for suffering delayed ischemic deficits. The thick clots in subarachnoid cisterns shown on CT scans taken within the third rupture day were correlated well to the severe increase of frequency shifts. The aggressive treatment was done on asymptomatic patients who showed relatively rapid increase of frequency shifts, and they had shown no or trasient mild ischemic symptoms.
Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prospective Studies ; Rupture ; Tomography, X-Ray Computed

The effect of the calcium antagonist nimodipine on the feline cerebral cortical blood flow in experimentally induced subarachnoid hemorrhage(SAH) was studied. Cerebral cortical blood flow was measured in the middle cerebral territory at specified intervals by the hydrogen clearance method. SAH was induced in 25 cats by a slow injection of fresh autogenous arterial blood into the cisterna magna. Twenty-five cats were divided into 5 groups of 5 cats each according to the timing of the cerebral cortical blood flow measurements after SAH ; immediate(Group la, lb), 24 hours(Group 2), 48 hours(Group 3) and 7 days (Group 4). Cerebral cortical blood flow dereased by 55.5%, 39.2%, 41.4%, and 38.3% from pre-SAH levels in each group respectively. During nimodipine infusion(1 microgram/kg/min) cerebral cortical flow increased by 89.0%, 51.8%, 87.5% and 24.5% from pre-nimodipine infusion levels in each group respectively. Mean arterial blood pressure(MABP) after cisternal blood injection increased by 6.5% from pre-SAH levles, and MABP during nimodipine infusion decreased by 15.4% from pre-Nimodipine infusion levels. The calcium antagonist nimodipine increased cerebral cortical blood flow significantly in experimentally induced SAH without considerable changes of MABP. Results are considered promising for trials in the treatment and prevention of cerebral by vasospasm following SAH.
Animals ; Calcium* ; Cats ; Cisterna Magna ; Hydrogen ; Nimodipine* ; Subarachnoid Hemorrhage*

OBJECTIVE: Nitric oxide and endothelin-1 are two endothelium derived relaxing and constricting factors probably involved in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage. The aim of this study is to ascertain the effects of nitric oxide donor(nitroglycerine) to reverse endothelin-1 induced cerebral vasoconstriction in vivo, when administered to the adventitial side of the basilar artery exposed through a transclival approach and common carotid artery exposed through a transcervical approach. METHODS: The exposed arteries were subjected to pharmacological manipulations and direct observation of the changes of their sizes under surgical microscope. Measurements of blood pressure, pulse rate and cerebral blood flow using thermal diffusion flowmetry during the drug infusion were done. RESULTS: 1) Nitroglycerine rapidly and completely reversed endothelin-1-induced vasoconstriction. The average value for maximal vasoconstriction by endothelin-1/synthetic cerebrospinal fluid was 58.3% of baseline arterial diameter and occurred within 30 minutes. 2) The nitroglycerine administered via adventitial side of the blood vessel was not associated with any changes in systemic blood pressure nor other vital signs. 3) Same changes occurred in the common carotid artery, although the severity of the occurrence and reversal of vasospasm were not significant compared to those of basilar artery. CONCLUSION: Intrathecally administered nitroglycerine was effective in reversing cerebral vasoconstriction without causing systemic hypotension. These findings provides the potential for the development of targeted therapy to reverse cerebral vasospasm after subarachnoid hemorrhage using nitric oxide donors.
Arteries ; Basilar Artery ; Blood Pressure ; Blood Vessels ; Carotid Artery, Common ; Cerebrospinal Fluid ; Endothelin-1* ; Endothelium ; Heart Rate ; Hypotension ; Nitric Oxide ; Nitric Oxide Donors ; Nitroglycerin* ; Rheology ; Subarachnoid Hemorrhage ; Thermal Diffusion ; Vasoconstriction ; Vasospasm, Intracranial ; Vital Signs

Fourty-seven patients with non-aneurysmal spontaneous subarachnoid hemorrhage were reviewed retrospectively. Attention was directed to the distribution and amount of subarachnoid hemorrhage on computerized tomography scans. Though the hemorrhage could be distributed in all cisterns, the frequency and amount of hemorrhage were higher in infratentorial cisterns than in supratentorial cisterns. Among infratentorial cisterns, the hemorrhage was distributed to cisterns around the brain-stem mainly and it had a predilection for interpeduncular cistern. Also the telangiectasia of thalamoperforating artery might be one of the causes of non-aneurysmal spontaneous subarachnoid hemorrhage.
Arteries ; Hemorrhage ; Humans ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Telangiectasis

In brachytherapy of uterine cervical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. The post-treatment calculated point A dose was not much different from the pretreatment planned dose (500 cGy). The average+/-standard deviation was 500+/-18 cGy and 84 percent of 82 intracavitary radiotherapy was within the range of 500+/-25 cGy.
Brachytherapy ; Cervix Uteri* ; Female ; Radiotherapy* ; Uterine Cervical Neoplasms

The author analyzed 66 cases of intracranial arteriovenous malformations treated in the Department of Neurosurgery of Yonsei University Hospital from 1977 to 1985. The results are summarized as follows : 1) The ratio of male to female was 2:1 and 75.8% or 50 cases were distributed between the 2nd and 4th decade. 2) The common presenting symptoms were either seizure alone(14%) or various symptoms resulting from hemorrhage(75%). 3) Arteriovenous malformations were suggested in 93.3% and were diagnosed in about half of the cases with the brain CT scan. Enhanced tubular shadow was the most important finding and hyperdensity of the lesion on precontrast brain CT scan was the most common finding. 4) The most common site of involvement was the supratentorial subcortical region with 75.4%, followed by the supratentorial deep region with 14.8%, and the infratentorial and dural region with 4.8%. 5) When compared to small(< 2cm) and large(> 4cm) lesions, there was less chance of hemorrhage in medium sized lesion(> 2cm to < 4cm). When the subcortical and deep regions of the supratentorial lesion were compared, there was no difference in incidence of hemorrhage. 6) According to angiographic findings, 46.6% was grade I lesions. The anterior cerebral artery and the middle cerebral artery were most commonly involved. 7) After craniotomy, total resection was performed in 34 of 43 cases or 79.1%. Due to either size or location, 14.4% or 7 of 43 cases were inoperable. 8) Immediate postoperative neurological deficits were noted in 12.5% or 6 of 48 cases. Non-hemorrhagic patients showed postoperative deficits more frequently than hemorrhagic patient did. 9) Regardless of treatment modality, there was a significant increase in number of patients who could be classified as grade I at discharge. 10) Long-term follow-up was carried out on 19 craniotomy cases. Neurological improvement was noted in 63.2% of these 19 cases. Among this group, there was no cases of neurological deterioration.
Anterior Cerebral Artery ; Arteriovenous Malformations ; Brain ; Cerebral Hemorrhage ; Craniotomy ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Intracranial Arteriovenous Malformations* ; Male ; Middle Cerebral Artery ; Neurosurgery ; Seizures ; Tomography, X-Ray Computed

The aim of this study was to evaluate the incidence and the management of hydrocephalus following ruptured intracranial aneurysms. The authors analyzed 223 patients with aneurysmal subarachnoid hemorrhage(SAH) during the last two years retrospectively. The results are summarized as follows. Eighty patients(35.9%) showed ventricular dilatation on a brain CT scan. Twenty-five patients(11.2%) required shunt surgery. Hydrocephalus was closely related to the amount of hemorrhage and the location of the ruptured aneurysm. Two of 9 patients with acute hydrocephalus, who were managed by extraventricular drainage(EVD) before definite aneurysm surgery. The shunt surgery was done before aneurysm surgery in 16 patients and rebleeding occurred in 3 patients. Radioactive isotope(RI) cisternography diagnosed communicating hydrocephalus in 11 patients and the lumboperitoneal shunt was performed in those cases. It is concluded that hydrocephalus following aneurysmal SAH is the communicating type, an indication for shunt surgery could be determined by RI cisternography, and lumboperitoneal shunting seems to be the best treatment of choice to avoid rapid decompression of the ventricles and to protect the already compromised cerebral hemisphere. Decompression of the ventricles before aneurysmal surgery should be avoided whenever possible.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Cerebrum ; Decompression ; Dilatation ; Hemorrhage ; Humans ; Hydrocephalus* ; Incidence ; Intracranial Aneurysm* ; Retrospective Studies ; Tomography, X-Ray Computed

The authors measured flow velocity of intracranial arteries to venrify the patency of the parent arteries and branches after clip placement during aneurysm surgery. Before the clinical study, experimental sonographic recording was done with a feline aorta. The patency was evaluated by recording the flow velocity and pulse waveform using intraoperative microvascular Doppler sonography. The results of the clinical study were summarized as follows: (1) The patency of the parent artery can be proved. (2) The complete clipping of aneurysmal sac can be confirmed. (3) Vasospasm or narrowing of the arterial caliber can be detected. (4) Severe arteriosclerosis may mimic decreased flow velocity. It is suggested that the use of intraoperative microvascular Doppler sonography is an atraumatic and reliable method of testing the optimal clipping of the aneurysm and patency of the parent artery.
Aneurysm ; Aorta ; Arteries ; Arteriosclerosis ; Humans ; Intracranial Aneurysm* ; Parents ; Ultrasonography

We reported a case of recurrent arteriovenous malformation, which had been operated on before and disappeared on postoperative angiography. Though a postoperative angiogram after the first operation indicated complete excision of the lesion, the patient returned with intracerebral hemorrhage, and an angiogram indicated reappearance of the lesion. Total excision was carried out at the second operation. It is concluded that long term follow-up angiography or vascular imaging procedures are required in particular cases of cerebral arteriovenous malformation with hematoma, difficulty in hemostasis and/or deep seated lesion.
Angiography* ; Arteriovenous Malformations ; Cerebral Hemorrhage ; Follow-Up Studies ; Hematoma ; Hemostasis ; Humans ; Intracranial Arteriovenous Malformations ; Recurrence*

Congenital M llerian anomalies of uterus are so infrequently encountered and endometriosis, primary infertility, hematometra, and urinary tract anomalies are claimed to be common complaints in women with unicornuate uterus. We report one case of rudimentary horn associated with agenesis of right kidney and pelvic endometriosis which is presented with brief review of literature about anomaly of the female genital tract.
Animals ; Endometriosis* ; Female ; Hematometra ; Horns* ; Humans ; Infertility ; Kidney* ; Urinary Tract ; Uterus