We have experienced an anesthetic management of 56-year-old male patient with carotid stenosis. Carotid endarterectomy was performed with processed electroencephalography (compressed spectral array, CSA) monitoring. Carotid endarterectomy has significant risk of perioperative stroke and myocardial infarction. For brain protection during carotid cross clamp, body temperature of patient was maintained at 33.5oC and thiopental was infused continuously to induce burst suppression. To maintain blood pressure during cross clamp, dopamine was infused continuously and phenylephrine was injected intermittently. CSA was performed to monitor thiopental-induced burst suppression and ischemic brain insult. After releasing carotid cross clamp, body temperature was raised to 35oC.
Blood Pressure ; Body Temperature ; Brain ; Carotid Stenosis ; Dopamine ; Electroencephalography ; Endarterectomy, Carotid* ; Humans ; Hypothermia ; Male ; Middle Aged ; Myocardial Infarction ; Phenylephrine ; Stroke ; Thiopental

BACKGROUND:Acute vestibular neuronitis is the disease of which the etiology and pathophysiology are largely unknown . But the viral infection and ischemia of the labyrinth and the vestibular nerve are considered as general etiology. This study was performed to support the viral infection rather than the ischemic theory. MATERIALS & METHODS:We studied seventy years old female patient who showed painful vesicles on left auricle and vertigo with spontaneous nystagmus to the right side. We performed physical examination, serologic test, ENG test, pure tone audiogram, brain magnetic resonance imaging and polymerase chain reaction. RESULTS:We found small vesicles and vascular injection in left EAC, herpes zoster IgG positive, spontaneous right beating in electronystagmograpy, 54% left canal paresis in Caloric test , decreasing left side Tc in velocity step rotatory test, decresed gain, deviation to left in symmetry and phase lead in sinusoidal harmonic acceleration test, normal range hearing in pure tone audiogram, microangiopathy on cortex in brain MRI and negative PCR. CONCLUSION:This case supports viral infection etiology rather than ischemia in vestibular neuritis. But more studies to find the etiology of vestibular neuronitis are required.
Acceleration ; Brain ; Caloric Tests ; Ear, Inner ; Female ; Hearing ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Immunoglobulin G ; Ischemia ; Magnetic Resonance Imaging ; Paresis ; Physical Examination ; Polymerase Chain Reaction ; Reference Values ; Serologic Tests ; Vertigo ; Vestibular Nerve ; Vestibular Neuronitis

In the clinical practice of neurosurgery, there are frequent needs which require urgent communication between housestaff and attending physician due to the emergency situation. But, the traditional methods such as telephone communication were not sufficient and sometimes, result in misjudgement of patient's status. So, our research team develop the computer software which can be used for emergency surgical and medical decision making. This software can transmitted the high quality images of CT, MRI and other X-ray with the conventional telephone line and personal computer system.
Data Compression ; Decision Making ; Emergencies* ; Humans ; Magnetic Resonance Imaging ; Microcomputers* ; Neurosurgery ; Telephone ; Teleradiology

OBJECTIVES: In this paper, we proposed an algorithm for recognizing a rotator cuff supraspinatus tendon tear using a texture analysis based on a histogram, gray level co-occurrence matrix (GLCM), and gray level run length matrix (GLRLM). METHODS: First, we applied a total of 57 features (5 first order descriptors, 40 GLCM features, and 12 GLRLM features) to each rotator cuff region of interest. Our results show that first order statistics (mean, skewness, entropy, energy, smoothness), GLCM (correlation, contrast, energy, entropy, difference entropy, homogeneity, maximum probability, sum average, sum entropy), and GLRLM features are helpful to distinguish a normal supraspinatus tendon and an abnormal supraspinatus tendon. The statistical significance of these features is verified using a t-test. The support vector machine classification showed accuracy using feature combinations. Support Vector Machine offers good performance with a small amount of training data. Sensitivity, specificity, and accuracy are used to evaluate performance of a classification test. RESULTS: From the results, first order statics features and GLCM and GLRLM features afford 95%, 85%, and 100% accuracy, respectively. First order statistics and GLCM and GLRLM features in combination provided 100% accuracy. Combinations that include GLRLM features had high accuracy. GLRLM features were confirmed as highly accurate features for classified normal and abnormal. CONCLUSIONS: This algorithm will be helpful to diagnose supraspinatus tendon tear on ultrasound images.
Classification ; Data Interpretation, Statistical ; Entropy ; Image Processing, Computer-Assisted ; Rotator Cuff ; Sensitivity and Specificity ; Subject Headings ; Support Vector Machine ; Tears ; Tendons ; Ultrasonography*

The gross tissue specimens are a valuable aid to the teaching of pathology and anatomy. However, traditional methods for storage and handling of them are discouragingly difficult and, recently, minimal surgical resections as well as preoperative interventions make it more difficult to have instructive gross specimens. Plastination is a process of tissue preservation by impregnation with silicone polymers or epoxy resins. The process in our study involves dehydration by cryosubstitution in aceton, defatting, forced impregnation of silicon polymer in a vacuum, curing and finishing. We submitted 40 surgically resected specimens to plastination. The resulting specimens are odorless, relatively dry, durable, life-like, non-hazardous, maintenance-free, and do not deteriorate with time. Plastinated specimens are a useful adjunct to the teaching of pathology, particularly suited for use in small groups, and appropriate method of tissue preservation. They are much preferred to wet preparation and conventional pots by both students and teachers owing to their accessibility, superior illustrative powers, and comparative ease of interpretation.
Dehydration ; Epoxy Resins ; Humans ; Pathology* ; Polymers ; Silicones ; Tissue Preservation ; Vacuum

OBJECTIVE: In the mobile computing environments, doctors or patients with mobile devices can access services at any time, any place. It makes chronic diseases, such as asthma care successively and in long-term. This paper presents a new multiagent system using data mining technique for the management of asthma in mobile computing environments. METHODS: In mobile computing environments, mobile communication is prone to disconnection. To use the services when disconnected, we locally store the recommendation information in mobile devices. Then, when user reconnects network, the new information is delivered in mobile devices. Because mobile devices have a limitation of resource, we store only patterns and recent data. We adopted data mining technique from the large pool of accumulated patients data can be utilized to summarize observed correlations and trends. RESULTS: We propose multiagent system composed of a Pattern Agent, a Selection Agent and a Recommendation Agent. They make asthmatic-caring system access effectively in mobile computing environments. We describe the underlying architecture and the process. Then we make a prototype with asthmatic patients data in the Severance Hospital in Korea. CONCLUSION: The results of our study can be contributed to aid management of asthma in mobile computing environments.
Asthma* ; Chronic Disease ; Data Mining* ; Humans ; Korea ; Telemedicine

OBJECTIVES: Soft-computing techniques are commonly used to detect medical phenomena and to help with clinical diagnoses and treatment. The purpose of this paper is to analyze the single electroencephalography (EEG) signal with the chaotic methods in order to identify the sleep stages. METHODS: Data acquisition (polysomnography) was performed on four healthy young adults (all males with a mean age of 27.5 years). The evaluated algorithm was designed with a correlation dimension and Lyapunov's exponent using a single EEG signal that detects differences in chaotic characteristics. RESULTS: The change of the correlation dimension and the largest Lyapunov exponent over the whole night sleep EEG was performed. The results show that the correlation dimension and largest Lyapunov exponent decreased from light sleep to deep sleep and they increased during the rapid eye movement stage. CONCLUSIONS: These results suggest that chaotic analysis may be a useful adjunct to linear (spectral) analysis for identifying sleep stages. The single EEG based nonlinear analysis is suitable for u-healthcare applications for monitoring sleep.
Delivery of Health Care ; Electroencephalography ; Humans ; Light ; Male ; Regression Analysis ; Sleep Stages ; Sleep, REM ; Young Adult

In this paper, waveform preserving coding technique is proposed for the bio-signals based on wavelet transform local maxima representation. In order to efficiently encode the bio-signal, it utilize the inherent property of bio-signals that sharp waves corresponding to the local maxima in wavelet domain contain the most of the clinically significant information in general. The testing sets of ECG and EEG are experimented to select the appropriate wavelet basis and to demonstrate the usefulness regarding to coding efficiency. The spline basis is more suitable in designing the coder than the Harr basis since the spline basis produces less number of local maxima than the Harr basis. The proposed wavelet method based on spline basis outperforms the conventional subband coding technique in terms of wave form degradation and coding efficiency. The actual transmission experiment using external communication network and the general personal computer demonstrates the applicability to telemedicine system handling the bio-signals.
Clinical Coding ; Electrocardiography ; Electroencephalography ; Microcomputers ; Telemedicine* ; Wavelet Analysis

According to the rapid development of computer technology, 3-dimensional reconstruction of CT scan data is becoming one of most up-to-dated diagnostic imaging techniques. This technique is helpful for determining the morphology of complex human structures, surgical plannings and for training aids. The authors developed the 3-dimensional reconstruction software which can be running at the personal computer. The various phases in the generation of 3-D reconstruction are described and clinical application is demonstrated by examples.
Diagnostic Imaging ; Humans ; Microcomputers ; Running ; Tomography, X-Ray Computed

In clinical surgery, there are frequent needs for communication between the house staff and the attending physician in an emergency situation. It's often insufficient for the house staff to make a decision through the information which is delivered in the form of only voice through the telephone line. To overcome the limitation of voice communication, we have designed an emergency teleradiology system which can be used for emergency surgical and medical decision making. The system can transmit the high quality images of CT, MRI, and other X-ray data using a PC attached to a modem through the conventional telephone line. Progressive transmission adopted in the system enables us to efficiently utilize the band-width of telephone line which is typically very low. The iterative residual coding/decoding algorithm compresses various medical images effectively, and thus fast-transmission of images date helps the house staff to perceive the status of emergent patient and make a fast and correct decision about the patient. The system also satisfies design requirements such as low-cost, ease of operation and interactive image communication including voice. 'Teleradiology system' proposed in this paper has been installed and operated in the emergency care unit of Severance Hospital, and as a result, it is effective in the emergency situations.
Decision Making ; Emergencies ; Emergency Medical Services ; Humans ; Internship and Residency ; Magnetic Resonance Imaging ; Modems ; Telephone ; Teleradiology* ; Voice