Excitatory amino acids have been implicated as one of the important putative cellular toxins in ischemic brain. Ketamine antagonizes the excitotoxic action of excitatory amino acids in the central nervous system. The present study was undertaken to determine whether ketamine anesthesia protect the formation of brain edema in the model of focal cerebral ischemia in rats. Forty adult male Sprague-Dawley rats weighing between 300gm and 400gm were used in this study. The animals were anesthetized with either halothane or ketamine, and then right middle cerebral artery occlusion were performed. After 4 hours of ischemia, the brain water and ion contents(Na+ and K+) were determined in the central, intermediate, and outer zones of each cortical mantle. In both halothane and ketamine anesthetized groups, there were significant brain edema in the ischemic central and intermediate zones. Ionic shifts were also observed in the ischemic central and intermediate zones to approximately same extent as the brain water content in both groups. However, there were no significant differences of brain edema between the two groups in the corresponding ischemic zones. These results suggest that ketamine anesthesia does not have significant protective effect on the formation of brain edema during the early stages of permanent incomplete cerebral ischemia.
Adult ; Anesthesia* ; Animals ; Brain Edema* ; Brain Ischemia ; Brain* ; Central Nervous System ; Excitatory Amino Acids ; Halothane ; Humans ; Infarction, Middle Cerebral Artery ; Ischemia* ; Ketamine* ; Male ; Rats* ; Rats, Sprague-Dawley

OBJECTIVE: The purpose of study was to assess the status of posterior communicating artery in patient with aneurysms arising from the internal carotid-posterior communicating artery and the angiographic blood flow pattern of anterior-posterior circulation through the posterior communicating artery especially to the posterior cerebral artery. The clinical outcomes according to the pattern of posterior communicating artery and the blood flow to the posterior cerebral artery were analysed. PATIENTS AND METHODS: The data includes 41 cases of internal carotid-posterior communicating artery aneurysm among 248 cases of aneurysms which were operated from September 1993 to August 1998. The clinical informations were obtained by review of the records and radiologic films retrospectively. The statistical analysis were performed using Chi-square tests. RESULTS: The female was predominant and peak age was fifties. The operative result was in close relation with initial Hunt-Hess grades(p=0.039), Fisher grade(p=0.001) but showed no statistical differences with age(p=0.106). The flow pattern of posterior cerebral artery was mainly from both anterior and posterior circulation(28cases, 68%), and the size of posterior communicating artery was smaller than P1 segment of posterior cerebral artery in 28cases(68%) but each of them showed no statistical differences with outcome. CONCLUSIONS: Even though there were no statistical differences of outcome according to the size of posterior communicating artery and the pattern of blood flow to the posterior cerebral artery, it is mandatory to save the posterior communicating artery for the preservation of otherwise normal blood flow to the perforators and main branches of posterior circulation.
Aneurysm ; Arteries ; Female ; Humans ; Intracranial Aneurysm* ; Posterior Cerebral Artery ; Retrospective Studies

This study has been examined different morphologic measurements in the evaluation of patients with lumbar spinal stenosis. Preoperative CT-Myelography from 30 patients who underwent surgery for central lumbar stenosis were analyzed. Based on this, we concluded as follows : 1) Bony measurement alone did not reliably identify patients with spinal stenosis. 2) Measurement of the transverse area of the dural sac on CT-Myelography was the most accurate method for identifying stenosis. 3) Lumbar myelography was still considered to have an important role in the valuation of a patient with stenosis because of correlation between the cross-sectional area of the dural sac and the anteroposterior diameter of the dural sac was excellent. 4) We identified soft-tissue problems as the main cause of stenosis. 5) The most common level of maximum stenosis was L4-5.
Constriction, Pathologic ; Humans ; Myelography* ; Spinal Stenosis*

Two cases in which postoperative hepatic necrosis followed by halothane(fulthane) anesthesia are presented. Case 1 was 3 dar-old neonate who was performed corrective surgery for jejunal atresia under the halothane anesthesia. He was placed with hyperalimentation just after operation, and was relatively well. He died on postoperative 11 days. Necropsy matrial was obtained from liver. Histologic finding of liver disclosed massive cental hemorrhagic necrosis. Case 2 was a 17 year-old boy who was performed corrective open heart surgery for TOF under the halothane anesthesia, He developed oliguria just after operation. On postoperative 1 day, hepatocellular and renal dysfunction were found, and peritoneal diaysis performed. He died on postoperative 3 day. Necropsy matrials were obtained from liver and kidney-Liver disclosed massive central hemorrhagic necrosis. Kidney showed intact glomeruli and proximal and distal convoluted tubular cells were degenerated. The configuration of tubular basement membrane was not clear. These considered to be acute tubular necrosis, ischemic type.
Adolescent ; Anesthesia* ; Basement Membrane ; Halothane* ; Humans ; Infant, Newborn ; Intestinal Atresia ; Kidney ; Liver ; Male ; Massive Hepatic Necrosis* ; Necrosis ; Oliguria ; Thoracic Surgery

PURPOSE: MR findings of the spinal metastasis and the tuberculosis are well known, but sometimes it might be difficult to differentiate these lesions. Therefore we reviewed and analyzed the MR findings which would be useful for the differentiation. MATERIALS AND METHODS: T1- and T2-weighted spin echo images and gadolinium-enhanced Tl-weighted images were obtained with 1. 5T and 1. 0T superconductive MR imager. We reviewed MR findings in 16 cases of spinal metastases and 24 cases of spinal tuberculosis in terms of signal intensity, contrast enhancement pattern, disc space involvement, spinal canal compressing feature and paraspinal soft tissue mass. RESULTS: The signal intensities of both lesions were hypointense on T1WI and hyperintense on T2WI except those of the metastatic lesions from the prostatic carcinoma. Heterogeneous enhancement was noted in 63% of metastasis, whereas peripheral rim enhancement was noted in 83% of spinal tuberculosis(p (.001). Spinal canal compression by collapsed vertebra was only noted in spinal metastasis, and that by paraspinal soft tissue was noted in both spinal metastasis and tuberculosis(p (.001). Disc space invasion was noted in 19% of spinal metastasis and 88% of spinal tuberculosis. Spinal tuberculosis was common at lower thoracic spine(T10) and typically involved two or more adjacent vertebral bodies(96%). CONCLUSION: The important differential point between spinal metastasis and tuberculosis was the enhancement pattern, involvement of two or more contiguous vertebral bodies and the feature of spinal canal compressing. The secondary importance was the disc space involvement pattern.
Neoplasm Metastasis* ; Spinal Canal ; Spine ; Tuberculosis ; Tuberculosis, Spinal*

One case of far lateral lumbar disc herniation(FLLDH) at left L5-S1 intervertebral space is reported. The herniation of disc material was localized mainly beyond the intervertebral foramen. Metrizamide myelogram was normal and only spine CT scan revealed the protruded disc material compressing the upper root inside and outside of the intervertebral foramen. Accordingly, the presenting symptoms and signs were due to left L5 root compression. Facetectomy was followed by removal of the herniated disc material. The patient was improved well.
Humans ; Intervertebral Disc Displacement ; Metrizamide ; Spine ; Tomography, X-Ray Computed

No abstract available.
Humans ; Pituitary Neoplasms*

No abstract available.
Epidural Abscess* ; Spondylitis*

Forty-four patients were operated on functioning pituitary adenomas during 5 years since Jun. 1977 at the Department of Neurosurgery, Seoul National University Hospital. Clinical and laboratory findings were analyzed and the following results were obtained. 1) The peak incidence was in the 3rd and 4th decade 21 cases were male and 23 cases were female. 2) Endocrinologic study revealed prolactinoma in 28 cases(37%), somatotropic adenoma in 13 cases(17%), corticotropic adenoma in 3 cases(4%), endocrine-inactive adenoma in 32 cases(42%). 3) MAin symptoms were endocrine symptoms(86%), headache(75%) and visual field defect(59%). 4) Seven(16%) were in the stage I(micro-adenoma), 27(61%) in the stage II, 6(14%) in the stage III, 4(9%) in the stage IV. 5) The rate of endocrinologic cure or improvement was 65% in prolactinoma and 75% in somatotropic adenoma. This result was less favorable less favorable than the result of other recent studies, but it seemed to be due to large proportion of large or invasive adenoma instead of micro-adenoma in this series. 6) In prolactinoma, 7 out of 12 patients with amenorrhea resumed menstrual cycle and 2 patients had pregnancies postoperatively. 7) The visual field defect was improved in 16 of 21 cases(76%) postoperatively.
Acromegaly ; Adenoma ; Amenorrhea ; Female ; Humans ; Incidence ; Male ; Menstrual Cycle ; Neurosurgery ; Pituitary Neoplasms* ; Pregnancy ; Prolactinoma ; Seoul ; Visual Fields

Forty-two cases of brain abscess operated at the Department of Neurosurgery, Seoul National University Hospital during the past 10 years from Jan. 1971 to June 1981 were studied clinically. The incidence of this disease did not decline throughout the period and preponderance of males under the age of 20 was found. The abscesses of ear and nose origin constituted the largest group(35.7%) and cyanotic heart disease was followed(19.0%). In 33%, the primary site of infection could not be established. Headache was by far the most common symptom and frequent locations were temporal, frontal, parietal and cerebellum in order of frequency. On bacteriological study, G(-) rods, streptococcus, staphylococcus and anaerobic bacteroides were cultured and about 30% was sterile. Mixed infection was about 20%. CT scan made it possible to detect the brain abscess easily and accurately, especially in cerebellar abscess and multiple abscess. Factors influencing the surgical outcome were preoperative status and surgical procedure. Excision was superior to simple aspiration in respect of recurrence and surgical outcome.
Abscess ; Bacteroides ; Brain Abscess* ; Brain* ; Cerebellum ; Coinfection ; Ear ; Headache ; Heart Diseases ; Humans ; Incidence ; Male ; Neurosurgery ; Nose ; Rabeprazole ; Recurrence ; Seoul ; Staphylococcus ; Streptococcus ; Tomography, X-Ray Computed