Voice changes developing after endotracheal intubation during right hemicolectomy with endotracheal intubation have been found to be due to a right recurrent laryngeal nerve palsy in 43-years-old male patient. It was likely that the inflated cuffed tube rode up to the level of the cricoid cartilage during the course of surgery as traction was placed on the endotracheal tube because the condenser humidifier and breathing circuit weighed heavy. Cuff overexpansion, in addition to muscle relaxation and decreased tracheal elasticity were considered as contributing factors of vocal cord palsy. We believe that tube traction and cuff overexpansion were the mechanism of vocal cord palsy in our patient. So we recommend the routine use of tube stand so that weigh of the breathing circuit does not transmit traction to the endotracheal tube. Concurrently, filling the cuff with a sample of the inspired mixture of gases, saline and 4% lidocaine in special cases or regular deflation of the cuff must be considered.
Cricoid Cartilage ; Elasticity ; Gases ; Humans ; Intubation, Intratracheal* ; Lidocaine ; Male ; Muscle Relaxation ; Respiration ; Traction ; Vocal Cord Paralysis* ; Vocal Cords* ; Voice

Adequate relaxation of the laryngeal adductor muscle is required to obtain good tracheal intubating condition. But we couldnt check rountinely laryngeal adductor muscle response, so we quantify the effects of succinylcholine and vecuronium at the laryngeal adductor muscles and the adductor pollicis. Twenty adult patients of ASA physical status 1-2 were studied during propofol-fentanyl anesthesia. The trachea was intubated without the use of muscle relaxants and the tube cuff placed between the vocal cords. Succinylcholine 1.5 mg/kg or vecuronium 0.1 mg/kg was given as a single bolus by random allocation. Muscular activity was evoked with supramaximal stimuli in a train-of-four sequence every 12 sec to the ulnar nerve and the anterior branch of the recurrent laryngeal nerve at the notch of the thyroid cartilage and forehead. Neuromuscular transmission was monitored at wrist by mechano-myography and laryngeal response was measured as pressure changes in the cuff of the tracheal tube positioned between the vocal cords. Pressure inside the cuff was measured with an air-filled transducer. TOF responses of both sites were continuously recorded on strip chart. Lag time and onset time were no statistically significant differences at the laryngeal adductor and adductor pollicis after succinylcholine or vecuronium bolus injection. Clinical durations were significantly shorter at the laryngeal adductor than at the adductor pollicis after succinylcholine and vecuronium injection. In one patient, onset of neuromuscular blocking effect with vecuronium was 125 sec slower at the laryngeal adductor than at the adductor pollicis. We recommand that if vecuronium is selected for gentle and smooth tracheal intubation, intubation will be delayed sufficient time after adductor pollicis relaxation.
Adult ; Anesthesia ; Forehead ; Humans ; Intubation ; Muscles* ; Neuromuscular Blockade* ; Random Allocation ; Recurrent Laryngeal Nerve ; Relaxation ; Succinylcholine* ; Thyroid Cartilage ; Trachea ; Transducers ; Ulnar Nerve ; Vecuronium Bromide* ; Vocal Cords ; Wrist

We treated 8 patients with large pituitary adenomas(4 females, 4 males) with bromocriptine. In all patients the level of prolactin was decreased to within the normal range and in most patients the size of tumor was decreased remarkably, high cure rate of large pituitary tumor fallowing operation after pretreated bromocriptine was obtained.
Bromocriptine* ; Female ; Humans ; Pituitary Neoplasms* ; Prolactin ; Reference Values

Moyamoya disease is characterized by progressive occlusion of major cerebral arteries and development of an abnormal vascular network. We performed EDAS(encephalo-duro-arterio-synangiosis) on 2 patients with moyamoya disease and obtained preoperative and follow-up brain SPECT to evaluate the effect of EDAS. In this study, moyamoya disease was confirmed by angiogram and the relation between the patient's clinical status and postoperative findings of SPECT was presented. In all cases, a marked increasing of blood perfusion was noticed on the implanted area together with improvement of clinical status.
Brain* ; Cerebral Arteries ; Follow-Up Studies ; Humans ; Moyamoya Disease* ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p<0.05). 5) Risk factors for coronary arterial disease including diabetes mellitus, hypertension, hypercholesterolemia (serum cholesterol<0A65B>240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Catheters ; Constriction ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Membranes ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Risk Factors ; Smoke ; Stents ; Ultrasonics* ; Ultrasonography

We analysed the results of 34 herniated lumbar disc patients who were treated with chemonucleolysis and took CT/discography from Jan. 1991 to Jun. 1992 at the Department of Neurosurgery, Presbytrian Medical Center, Chonju, Korea. The overall success rate of chemonucleolysis was 82.4%. The CT/discographic findings were divided according to whether fluorescing or not, and degeneration or not. The success rates in fluorescing and non-fluorescing group were 95.2% & 61.5%, respectively, and those in degeneration and non-degeneration group were 66.7% & 100%, respectively. So, the results showed that the outcome of chemonucleolysis was better when the herniated disc fragment demonstrated a large uptake of contrast material visible, or there was no annular appearance to describe degeneration on CT/discography.
Humans ; Intervertebral Disc Chemolysis* ; Intervertebral Disc Displacement ; Jeollabuk-do ; Korea ; Neurosurgery ; Prognosis*

To get effective access to the floor of the frontal fossa and the superior orbit, the resection of supraorbital rim has been done. We performed the supraorbital approach as combined technique with uni- or bifrontal craniotomy in order to minimize frontal lobe retraction and achieve excellent exposure for safe manipulation in seven patients of anterior skull base and intraorbital lesions. Of seven patients, two patients of olfactory groove meningioma underwent the operation with supraorbital bifrontal craniotomy;one patient of tuberculum sellar meningioma, bifrontal supraorbital-pterional approach;four patients of intraorbital benign lesions(one patient of meningioma, one patient of neurilemmoma, two patients of benign lesions in lacrimal gland), supraorbital unifrontal craniotomy. There was little or no functional, anatomical, or cosmetic deficit associated with this approach technique. We believe the supraorbital approach to be a helpful technique as combined procedure of the uni- or bifrontal approach and the approach of choice for the intraorbital tumors except those in the inferior portion.
Craniotomy ; Frontal Lobe ; Humans ; Meningioma ; Neurilemmoma ; Orbit ; Skull Base* ; Skull*

The optimum timing of surgery for ruptured intracranial aneurysms still remains controversial. In order to compare the total management outcome between early and late surgery a retrospective analysis was carried out. Of 159 patients, 97 patients were selected according to the entry criteria and were divided into two groups ; group I(46pts.) was early surgery planned patients and group II(51 pts.) was late surgery planned patients. The results obtained are as follows ; 1) The incidence of a good recovery for the early surgery planned group was 74%, and that of the late surgery planned group was 67%, but there was no statistically significant difference between two groups. 2) The incidence of a delayed ischemic deficit was 24% for the early surgery planned group, and 29% for the late surgery planned group, with no statistically significant difference. But, the incidence of rebleeding was 2% for the early surgery group, and 14% for the late surgery planned group, so there was a statistically significant difference here. 3) The total management outcome of the early and late surgery planned group was similar, but early surgery was advantageous for the prevention of rebleeding.
Aneurysm, Ruptured ; Humans ; Incidence ; Intracranial Aneurysm* ; Retrospective Studies ; Subarachnoid Hemorrhage

OBJECTIVE: The precise intra- vs. extradural localization of aneurysms involving the paraclinoid internal carotid artery is critical for the evaluation of patients being considered for aneurysm surgery. The purpose of this study was to investigate the clinical usefulness of T2-weighted three-dimensional (3-D) fast spin-echo (FSE) magnetic resonance (MR) imaging in the evaluation of unruptured paraclinoid aneurysms. METHODS: Twenty-eight patients with unruptured cerebral aneurysms in their paraclinoid regions were prospectively evaluated using a T2-weighted 3-D FSE MR imaging technique with oblique coronal sections. The MR images were assessed for the location of the cerebral aneurysm in relation to the dural ring and other surrounding anatomic compartments, and were also compared with the surgical or angiographic findings. RESULTS: All 28 aneurysms were identified by T2-weighted 3D FSE MR imaging, which showed the precise anatomic relationships in regards to the subarachnoid space and the surrounding anatomic structures. Consequently, 13 aneurysms were determined to be intradural and the other 15 were deemed extradural as they were confined to the cavernous sinus. Of the 13 aneurysms with intradural locations, three superior hypophyseal artery aneurysms were found to be situated intradurally upon operation. CONCLUSION: High-resolution T2-weighted 3-D FSE MR imaging is capable of confirming whether a cerebral aneurysm at the paraclinoid region is intradural or extradural, because of the MR imaging's high spatial resolution. The images may help in identifying patients with intradural aneurysms who require treatment, and they also can provide valuable information in the treatment plan for paraclinoid aneurysms.
Aneurysm ; Arteries ; Carotid Artery, Internal ; Cavernous Sinus ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Prospective Studies ; Subarachnoid Space

We analyzed the overall surgical results in 100 patients with intracranial aneurysms operated in Presbyterian Medical Center during the period from June 1990 to December 1993. Preoperatively, all patients were in Hunt and Hess grades I-III. Overall outcomes revealed 83 patients(83%) of good outcome, 10 patients(0%) of fair outcome. 3 patients(3%) of poor outcome, and 4 patients(4%) of dead outcome. The outcome was worse if surgery was performed in the 4 to 10 day post- bleed interval(P<0.05) and there was no statistical difference of the rate of good outcome between the parients operated at 0 to 3 days, and 11 day more after subarachnoid hemorrhage. In good grade patients, surgical trauma rather than delayed ischemic deficit was considered as the major cause of unfavorable outcome of aneurysm surgery. Intermedia to period operation increased the chance of postoperative delayed ischemic deficit. Systemic complications and vasospasm were the major causes of dead outcome in the oldaged patients.
Aneurysm ; Humans ; Intracranial Aneurysm* ; Protestantism ; Subarachnoid Hemorrhage