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

No abstract available.
Tibial Fractures*

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

The authors performed prospectively the transcranial Doppler monitoring of middle cerebral arteries in 37 patients with ruptured cerebral aneurysm. The entry criteria for the study were confined to the patients who had clinical Grades of 1, 2, or 3, and were operated within 4 days after bleeding. There were several sonographic risk factors of developing delayed ischemic deficits; 1) An early steep increase of flow velocity exceeding 120 cm/sec. 2) An increase of maximum flow velocity more than 140 cm/sec. 3) The flow velocity increasing simultaneously with the onset of delayed ischemic deficit in which case preventive treatment was impossible. 4) Prolonged elevation of flow velocity for more than 7 days despite of aggressive treatment. It seemed to be mandatory to start preventive and aggressive treatment for the asymptomatic patients who showed higher flow velocity than 140 cm/sec. Transcranial Doppler sonography has another potential on deciding the timing of surgery.
Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prospective Studies ; Risk Factors ; Ultrasonography ; Ultrasonography, Doppler, Transcranial

Nausea and vomiting are common problems after strabismus surgery in pediatric patients. We compared the effects of droperidol and ephedrine with conventional regimen consisting of halothane-N2O to the effects of conventional regimen itself, 69 children. ASA physical status l, ages 1-12yrs, were studied. Each child was randomly assigned to receive droperidol 0.04mg/kg., ephedrine 0.5mg/kg or normal saline 2ml intramuscularly, 10 minutes before the end of surgery. The incidence of postanesthetic nausea and vomiting was 17% in the droperidol group(p<0.05)., 13% in the ephedrine group(p<0.05), which were significantly less than the control group(43%). But there was no significant difference between droperidol group and ephedrine group. We concluded that droperidol and ephedrine have significant postoperative antiemetic effect in patients undergoing strabismus surgery.
Antiemetics ; Child* ; Droperidol ; Ephedrine ; Humans ; Incidence ; Nausea ; Postoperative Nausea and Vomiting* ; Strabismus* ; Vomiting

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*

The purpose of this study was to set the guidelines for selection of patients to do early surgery in ruptured intracranial aneurysm. We assessed 706 patients with single rupture and without large hematoma, who underwent aneurysm surgery from 1985 to 1995. The male and female ratio was 1:1.5. Among the 706 patients, early surgery was performed in 214 cases. The results of early surgery were good in 193 cases(90.2%), fair in 13 cases(6.0%), poor in 1 case(0.5%) and dead in 7 cases(3.3%). The rate of dead outcome in the early surgery group was higher compared to other timing groups. The Fisher group 1, 2 and 3 reveale good outcome in early surgery group;92.6%, 96.3%, 88.8% respectively. The incidence of delayed ischemic deficits(DID) of early surgery group was same as other groups. However, in Fisher group 3, the incidence of DID was significantly low, 32.5%, in early surgery group. It is suggested that the criteria of selection of early surgery in patients with ruptured intracranial aneurysm would include as follows:1) patients with good clinical grade, 2) poor grade patients with marked irritability, acute hydrocephalus, and poorly controlled hypertension, 3) none-complex aneurysm requiring less brain retraction, dissection and brief temporary clipping, 4) age under 60 or over 60 with good physical status, and 5) Fisher group 3 requiring cisternal larvage and anticipated triple-H therapy.
Aneurysm ; Brain ; Female ; Hematoma ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Intracranial Aneurysm* ; Male ; Patient Selection* ; Rupture

The effects of phenytoin on the neuromuscular blockades(NMBs) appear to be different according to the time intervals between their administration. In general, single injection of phenytoin immediately prior to NMB may produce the augmentation of NMBs, while long-term phenytoin therapy on the neuromuscular blocking actions of vecuronium were investigated in rats using the sciatic nerve-anterior tibialis muscle preparation. Eighteen male rats were divided randomly into three groups; Group I(without phenytoin), II (single phenytoin 40 mg/kg I.V. just prior to vecuronium administration), III(phenytoin 40 mg/ kg administered intraperitoneally twice daily for 14 days). In all the groups, vecuronium with the cumulative dose-response technique of ED was administered intravenously. The results are as follows; 1) The ED of vecuronium was significantly higher in Group III(162.3+/-12.4 ug/kg) than in Group I or II(135.7+/-11.0 or 126.77 +/-16.66 u/kg, respectively), and also the ED did so(218.1 +/-28.3 or respectively). 2) In the cumulative dose-response curves with vecuronium, the slope of Group III was significantly lower than that of Group I or IL 3) The plasma concentrations of phenytoin in Group II and III were 60.9+/-15.1 ug/ml and 9.0+/-2.3 ug/ml, respectively. 4) The duration of vecuronium was significantly shorter in Group III(22.3+/-5.2 sec) than in Group I or II(34.7+/-5.7, 44.3+/-8.7 sec, respectively), and also the recovery index did so(36.8+/-4.4, 43.8+/-5.6 and 27.7+/-5.7 sec in Group I, II and III, respectively). 5) There was no statistically significant difference of mean arterial pressure, heart rate, body temperature, acid-base status and electrolytes among groups. In conclusion, pheytoin with long-term therapy may induce the resistance to vecuronium and shorten its recovery. However, there is no effect in the single injection of phenytoin on the vecuronium-induced neuromuscular block.
Animals ; Arterial Pressure ; Body Temperature ; Electrolytes ; Heart Rate ; Humans ; Male ; Neuromuscular Blockade* ; Phenytoin* ; Plasma ; Rats* ; Vecuronium Bromide*

PURPOSE: To evaluate the efficacy and stability of the wrap-clipping methods as a reconstructive strategy in the treatment of unclippable cerebral aneurysms. MATERIALS AND METHODS: Twenty four patients who had undergone wrap-clipping microsurgery were retrospectively reviewed. Type and morphology of the treated aneurysm, utilized technique for wrap-clip procedure, and clinical outcome with angiographic results at their last follow-up were evaluated. RESULTS: Of 24 patients, eleven patients had internal carotid artery (ICA) blister-like aneurysms, three had dissecting type aneurysms, and ten had fusiform aneurysms. The follow-up period for the late clinical and angiographic results ranged from 10 to 75 months (mean 35 months). Wrap-clipping was performed in eleven, wrap-holding clipping was in ten, and combination of wrap-clip and wrap-holding clip was in three cases. At the last angiographic follow-up study, twelve aneurysms (50%) were found to have completely healed, and nine aneurysms (38%) were at least stable. However, wrap-holding clip for the elongated blister type of ICA aneurysm was found failed, leading to fatal rebleeding in one case, and two cases of combination of wrap-clip-wrap-holding clip revealed delayed branch occlusion and marked regrowing, respectively. CONCLUSION: Wrap-clipping strategy could be an easy and safe alternative for unclippable aneurysms. The wrapped aneurysm mostly disappeared, or at least remained stationary, after a long-term period. However, surgeons should be aware of that the wrapped aneurysm might become worse. Therefore, follow-up surveillance for an extended period should be mandatory.
Aneurysm ; Blister ; Carotid Artery, Internal ; Follow-Up Studies ; Humans ; Intracranial Aneurysm* ; Methods ; Microsurgery ; Retrospective Studies

The clinical review was done on 15 cases with the foreign body in the upper gastrointestinal tract who visited and underwent endoscopic removal of foreign body at department of lnternal Medicine of Chonnam University Hospital and Namkwang Hospital from June 1982 to August 1987. The results are as follows: 1) The age distribution varied from 32 yeara to 83 years of age, being most prevalent at 6th decade, The ratio between male and femaie was 4:1, more prevelant in male. 2} Among 15 eases, 8 cases were lodged in the esophagus and 7 cases in the stomach. The foreign bodies in the esophagus were meat, pressure-through package, food materials and bone in order of frequency and those in the stomach were bezoar, persimmon seed, brown seaweed, tooth brush and suture materials. 3) Cambined diseases of upper gastrointetinal passage disturbance were 1 case of esophageal cancer and 3 cases of gastric outlet obstruction caueed by duodenal ulcers and gastric malignancy. Other combined diseases were schizophrenia, chronic alcoholism, diabetes mellitus and gastrie polyp. 4) Complications by foreign body were retropharyngeal abscess and phlegmonous esophagitis with esophageal ulcer.
Age Distribution ; Alcoholism ; Bezoars ; Cellulitis ; Diabetes Mellitus ; Diospyros ; Duodenal Ulcer ; Esophageal Neoplasms ; Esophagitis ; Esophagus ; Foreign Bodies* ; Gastric Outlet Obstruction ; Humans ; Jeollanam-do ; Male ; Meat ; Polyps ; Retropharyngeal Abscess ; Schizophrenia ; Seaweed ; Stomach ; Sutures ; Tooth ; Ulcer ; Upper Gastrointestinal Tract*