To elucidate the early sequential morphogenetic progress of exencephaly and myeloschisis, rat embryos whose mothers had been treated with hypervitaminosis A were studied at 1-day interval from gestation day 10.5 to 15.5. In exposed animals sequential change was found in both exencephaly and myeloschisis as the embryos grew up. The 10.5-day old exencephalic embryos had still widely open cephalic neural tubes. Exencephalic embryos older than 13.5 days of gestation showed strikingly severe eversion and overgrowth of the cephalic neuroepithelium, thus failed in forming normal primitive brain. The convex dorsal surface of the exencephaly was covered with ependyma, which was connected directly with surrounding surface eqithelium at the periphery. The earliest morphologically recognized myeloschisis was in the 13.5-day old embryos. In myeloschisis, divergence at the roof plate and eversion of the spinal neural tube, disorganized overgrowth of the neuroepithelium, malformed and misplaced spinal ganglia and nerve roots, and absence of the neural arch and dermal covering were characteristic. It is suggested that exencephaly results from failure of the cephalic neural tube closure which is followed by eversion and overgrowth of the neuroepithelium. And failure in closure of the posterior neuropore and disturbance in the development of the tail bud probably play major role in the morphogenesis of myeloschisis.
Animals ; *Embryonic and Fetal Development ; Female ; Hypervitaminosis A ; Neural Tube Defects/chemically induced/*pathology ; Pregnancy ; Rats ; Rats, Inbred Strains ; Spinal Cord/*abnormalities/embryology

CT has becom increasingly important diagnostic method as the inital examination in the diagnosis of subarachnoid hemorrhage with direct detection of extravasated blood inbasal cistern and cortical sulci. Furthermore, CT provides better and exact visualization of the presence, localization, extent and degree of intracerebral, intraventricular and subdural hemorrhage, infarction, hydrocephalus and rebleeding which may be associated wtih subarachnoid hemorrhage, and also could detect the causative lesions with contrast enhancement inmany cases. The purpose of the paper is to describe the CT findings of subarachonid hemorrhage due to various causes and to evalute the diagnostic accuracy of CT in subarachonoid hemorrhage. Authors analysed a total of 153 cases with subarachnoid hemorrhage confirmed by lumbar puncture at Seoul National University Hospital from March 1979 to April 1981, with special emphasis on CT findings.All of the cases took CT scan and 125 cases of the mangiography. The results are as follows; 1. Most prevalent age group was 4th to 6th decades (78%). The ratio ofmale to female was 1.1:1. 2. Of all 125 with angiography, aneurysm was a major cause (68%). Others were arterio-venous malformation (9.6%), Moya-moya disease(4%) and unknown (18.4%). 3. Of all 153 cases with CT scan,hemorrhage was demonstrated in 98 cases (64.1%); SAH in 72 cases (47.1%), ICH in 65 cases (42.5%), IVH in 34 cases(22.2%) and SDH in 1 case(0.7%). SAH combined with ICH was a major group (34.7%) in SAH. Detecton rate of SAH was68.3% within the first 7 days and 5.8% after 7 days. 4. In aneurysms, SAH was detected in 60 of 85 cases (70.6%);88.1% within the first 7 days and 5.6% after 7 days. Anterior communicating artery was the most common site of theaneurysms(40%), in which detection rate of SAH was 100% within the first 7 days. SAH was combined with ICH in38.3%. 5. On CT, SAH of unilateral Sylvian fissure was pathognomonic for ruptured MCA aneurysm and ICH of corpuscallosum for ACA aneurysm. 6. The detection rate of aneurysm itself on CT was 20%(17/85) and its size was variablefrom 5 to 25mm. 7. Infarction was demonstrated in 9 cases (6%) and there was no significant correlation between infarction and angiospasm, 8. Hydrocephalus was detected in 65% cases(42.5%), and 21 cases (32.3%) were demonstrated within the first 3 days.
Aneurysm ; Angiography ; Arteries ; Diagnosis ; Female ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hydrocephalus ; Infarction ; Methods ; Seoul ; Spinal Puncture ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

BACKGROUND: Endotoxin is a complex lipopolysaccharide molecule situated within the outer membrane of Gram-negative bacteria. Sepsis and acute respiratory failure (ARDS) can be induced by endotoxin. In order to introduce and develop the experimental model of ARDS in sepsis, we induced sepsis with the endotoxin and investigated the change of respiratory pathophysiology during sepsis using a multiple inert gas elimination technique (MIGET). METHODS: Ten New Zealand white rabbits were anesthetized and ventilated with a Harvard apparatus. In 5 rabbits, 2 mg/kg of lipopolysaccaride from E. coli was infused intravenously for 30 min (Toxin group). At 1, 2, 3, and 4 hours after endotoxin infusion, arterial blood gas, and hemodynamic profiles were checked. To perform the MIGET, six inert gases (SF6, krypton, desflurane, enflurane, diethyl ether, acetone) of widely varying solubility were infused peripherally and the excretion and retention data was determined from measurements of inert gas tensions in pulmonary arterial, systemic arterial blood samples and mixd expiratory gas sampling of pre and post septicemia using gas chromatography. We transformed and analysed the data into a V/Q distribution curve to find out the change of V/Q distribution curve. After the experiments, the animals were dissected and the lungs were extracted for wet/dry weight ratio (WW/DW) and microscopic examination. RESULTS: In the Toxin group, the pulmonary arterial pressures were increased and arterial oxygen tensions were decreased after the endotoxin infusion. The lung WW/DW were increased and inflammatory findings were seen in microscopic examination. In the MIGET, shunt, deadspace and log SDQ were increased in the toxin group, though there were wide V/Q distributions in the control group. CONCLUSIONS: We developed a successful endotoxin induced septic animal model, V/Q distribution curve and data using MIGET. The accomplishment of the experiment will not only allow us to better understand pulmonary pathophysiology of endotoxin induced sepsis using MIGET, but it will also contribute to other pulmonary physiology experiments associated with sepsis.
Animals ; Arterial Pressure ; Chromatography, Gas ; Enflurane ; Ether ; Gram-Negative Bacteria ; Hemodynamics ; Krypton ; Lung ; Membranes ; Models, Animal ; Models, Theoretical ; Noble Gases ; Oxygen ; Physiology ; Rabbits ; Respiratory Insufficiency ; Sepsis ; Solubility ; Ventilation-Perfusion Ratio*

BACKGROUND: At present, there are many instruments to diagnose anxiety and depression. However, most of the instruments have a number of questions. Therefore, we have many difficulties in applying them to the primary care. The purpose of this study was to measure the reliability and the validity of a Korean-translated Goldberg s short screening scale for anxiety and depression, which were developed for screening of anxiety and depression in primary care. METHODS: 178 asymtomatic subjects and 58 patients(anxiety 15, depression 43) aged from 18 to 64 years old were selected. The patients were diagnosed by psychiatrist according to DSM-IV criteria. This study was performed for 3 months, from May to August 1996. The reliability of this instrument was measured by internal consistency reliability. The validity of this instrument was measured by three methods. The first method was the comparison of the score between the patients and the control group. The second method was to measure the relationships of this instrument with the other instruments such as Self-rating Depression Scale and State-Trait Anxiety Inventory. The last method was to measure the relationship of this instrument with Comprehensive Global Assessment. In addition, we calculated the sensituvity and specificity at the cut off values. RESULTS: The Cronbach's a value was 0.736 for the anxiety and 0.749 for the depression. Goldberg anxiety scale was significantly associated with state in STAI(r=0.279, P<0.001), and trait in STAI(r=0.125, P=0.041). However, Goldberg depression scale was not sigficantly associated with SDS. Goldberg anxiety scale as well as Goldberg depression scale were significantly associated with CGA(r=0.433, P=0.001; r=0.695, P=0.001). The seore of Goldberg anxiety scale was significantly higher in the anxious patients than in the control group(P=0.047). The score of Goldberg depression scale was significantly higher in the depressive patients than in the control group(P<0.001). For anxiety scale of Goldberg scale, the sensitivity and the specificity was 60% and 68% at score 3. For depression scale of Goldberg scale, the sensitivity and the specificity was 80% and 68% at score 2. CONCLUSIONS: We concluded that the value of Cronbach's a in Goldberg scale was 0.736 for anxiety and 0.749 for depression. For the validity, the scores of Goldberg scale were higher in patient group than in asymptomatic group. However, the relationships of Goldberg scale with other screening instruments were variable. So further study for the validity of Goldberg scale is requested.
Anxiety* ; Depression* ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mass Screening* ; Middle Aged ; Primary Health Care ; Psychiatry ; Sensitivity and Specificity

The authors reviewed twenty four patients with internal carotid-posterior communicating artery aneurysms with oculomotor palsy from 1976 to 1984. The incidence of third nerve palsy in the posterior communicating artery aneurysms was 37.5%(24 out of 64). The occurrence of the third nerve palsy without subarachnoid hemorrhage was 20.8%(5 out of 24). The initial degree of third nerve involvement seems to parallel the degree of recovery. Direct clipping of the aneurysm showed far better results than those of carotid ligation. The average duration of neurological recovery was 4.9 month after treatment. The order of third nerve function recovery was as follows:ptosis, pupil, medial gaze, and upward and downward gaze.
Aneurysm ; Arteries ; Humans ; Incidence ; Intracranial Aneurysm* ; Ligation ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Paralysis ; Pupil ; Recovery of Function ; Subarachnoid Hemorrhage

Guanine aminohydrolase(GAH;EC 3. 5. 4. 3.) was partially purified 122-fold from rat cerebrum to a specific activity of 7.22 in its per mg protein with a recovery of 7.47% by fractionation with ammonium sulfate, chromatography on DEAE-cellulose and hydroxyapatite, gel filtration on Sephadex G-200, and isoelectric focusing(pH4-6). The molecular weight of partially purified rat cerebral guanine aminohydrolase was estimated to be 110,000. But, in the cerebral cytosol, a rather higher molecular weight form of the enzyme was identified. The activity of the higher molecular weight form of guanine aminohydrolase was increased by dialyzing the cytosol, and it was converted into the lower molecular weight form(M.W.110,000) by addition of 2-mercaptoethanol. The reaction velocity of partially purified guanine aminohydrolase of rat cerebrum disclosed a hyperbolic curve, with its KM being 6.0uM at pH 8.0. The preparation showed high substrate specificity:among the purine nucleotides, nucleosides and bases with amino group, only guanosine and guanine were deaminated by the enzyme, and the reaction rate of the enzyme displayed by guanosine was less than 10% of that by guanine. When observed under the equimolar concentration of the substrate, hypoxanthine as well as inosine inhibited the activity of the rat cerebral guanine aminohydrolase by 9.4 and 7.8%, respectively, while 5-aminoimidazole-4-carboxamide inhibited the activity of it by 38%. The activity was inhibited by p-hydroxymercuric benzoate as well. Complete loss of its activity was observed after 30 minutes incubation at 60 degrees C, suggesting the preparation was heat labile.
Ammonium Sulfate ; Animals ; Benzoates ; Cerebrum* ; Chromatography ; Chromatography, Gel ; Cytosol ; DEAE-Cellulose ; Durapatite ; Filtration ; Guanine Deaminase* ; Guanine* ; Guanosine ; Hot Temperature ; Hydrogen-Ion Concentration ; Hypoxanthine ; Inosine ; Mercaptoethanol ; Molecular Weight ; Nucleosides ; Purine Nucleotides ; Rats* ; Xanthine Oxidase

Cerebral cysticercosis presents a quite variable clinical picture in its manifestation and course. This clinical polymorphism produces principal difficulties in its diagnosis and in planning therapeutic strategies as well as in evaluating therapeutic results. The author reviewed his experience with 52 cases of cerebral cysticercosis, surgically treated from 1977 to 1987 in Department of Neurosurgery, Seoul National University Hospital. The age of patients at time of diagnosis varied between 7 and 66 years(mean 43.4 years), with 75% from the fourth to the seventh decade. There was a 1.6:1 male to female ratio. The two most common residency of the patients, next to the Seoul area, were Cheju Provience(21%) and Chollanam Province(15%). The chief symptoms and signs were those of increased ICP(94%), focal neurological deficits(69%), seizure(40%), mental change(33%) and meningismus(21%). We classified 52 cases into the following groups based on the location of lesion in the brain CT scans:a) Parenchymatous(34%), b) Intraventricular(25%), c) Meningocisternal(18%), and d) Mixed type(33%). ELISA was highly reliable in making the diagnosis, this test, however, should not be regarded as a quantitative clue to evaluate the degree of curability. In cases no improvenent was achived clinically after praziquantel therapy and/or surgical treatment disappeared cysts in follow-up brain CT, a further diagnostic work-up to search for a intraventricular or mixed type is recommended. In 2 cases with a single, superficially located parenchymatous cyst, one burr hole trephination followed by aspiration using a brain needle was proved to be very effective. Surgical treatment in combination with a praziquantel therapy produced a marked improvement in 47 cases(90.4%) out of 52 cases. In the mixed type, the surgical outcome was unfavorable compared with other types.
Brain ; Cysticercosis* ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Internship and Residency ; Jeju-do ; Male ; Needles ; Neurosurgery ; Praziquantel ; Seoul ; Trephining

The formation of intracranial arterial aneurysm is associated with vascular anomaly and accompanied hemodynamic abnormality. The authors report three cases of anterior communicating artery aneurysms associated with multiplicated anterior communicating artery, two duplicated, and one triplicated. It is not certain that multiplication of anterior communicating artery is responsible for development of anterior communicating artery aneurysm, but it would be interesting to remind the two factors affecting the formatin of arterial aneurysm, vascular anomaly and hemodynamic abnormality. Careful dissection is mandatory to avoid undue traction of aneurysm, to preserve small out important vessels, and to increase the room in which to operate within the subarachnoid space, espically if the anterior communicating artery is multipliated.
Aneurysm ; Arteries* ; Hemodynamics ; Intracranial Aneurysm* ; Subarachnoid Space ; Traction

Retrospective analysis of reoperation and complication was made for 186 patients with lumbar herniated disc. The results showed complication rate of 7%(13 cases) and reoperation rate of 10.2%(19 cases). The primary complications were infections(9 cases), technical errors(2 cases), and scores(2 cases). Rate of discitis was 1.6%(3 cases). The outcomes of reoperation resulted in excellent recovery of 16%(3 cases) and good recovery of 58%(11 cases). The most common intraoperative findings of reoperation were inadequate disectomy or missed disc fragments 31.6% or 6 cases;epidural fibrosis 26.3% or 5 cases;and new herniation at other level 15.8% or 3 cases. Excellent and good results could be achieved in patients operated within 1 month or more than 6 months after while the patients who underwent reoperation between 1 month and 6 months showed poor results. The delicate perioperative menagement and complete discectomy, adequate bleeding control and laminectomy were considered to be essential in reducing the chance of complication and reoperation.
Discitis ; Diskectomy ; Fibrosis ; Hemorrhage ; Humans ; Intervertebral Disc Displacement ; Laminectomy ; Reoperation* ; Retrospective Studies

One case of craniopharyngioma confined to the third ventricle is reported. His symptom was only headache without visual disturbance or endocrine dysfunction. The CT scan showed isodense round mass in the anterior portion of the third ventricle with strong homogeneous enhancement. There was no calcification.
Craniopharyngioma* ; Headache ; Third Ventricle ; Tomography, X-Ray Computed