We present a case of severe intracranial hypotension syndrome following lumbar drainage. A 60-year-old woman developed recurrent attacks of vertigo, nausea and vomiting a week prior to admission. Brain MRI revealed a homogeneously well-enhanced mass in the right frontal lobe ; this was found to be a meningioma, and was totally removed. Dural defect was covered with fat and fascia, and postoperative cerebrospinal fluid(CSF) leakage through the frontal sinus was noted. Lumbar drainage was initiated, and about 36 hours later, the patient complained of bouts of headache, nausea and vomiting. Her mental state then gradually deteriorated, and she became stuporous. Brain CT was performed immediately and revealed bifrontal subdural fluid collection and signs of severe brain edema including obliteration of ventricles and basal cisterns. The lumbar drain was then clamped and she regained consciousness 12 hours later. This case clearly demonstrates that to avoid complications such as severe intracranial hypotension syndrome in a patient who has undergone lumbar drainage, the rate and amount of CSF drainage should be closely monitored.
Brain ; Brain Edema ; Consciousness ; Drainage* ; Fascia ; Female ; Frontal Lobe ; Frontal Sinus ; Headache ; Humans ; Intracranial Hypotension* ; Magnetic Resonance Imaging ; Meningioma ; Middle Aged ; Nausea ; Stupor ; Vertigo ; Vomiting

BACKGROUND: Portable glucometers are often utilized at the patient's bedside in the ICU or operating room for frequent measurements of the blood glucose concentration. Many of these devices are based on a glucose oxidase method that may be influenced by PO2. The aim of this study was to evaluate the influence of a high PO2 of arterial blood on measured glucose values compared with venous blood. METHODS: Forty adult patients who underwent surgery with general anesthesia were included in this study. Each patient had a cannula inserted into the radial artery and a central venous catheter through the right internal jugular vein. Two hours after the induction of anesthesia, we drew arterial and venous blood and measured the blood glucose concentration using both a bedside glucometer based on a glucose oxidase method and a laboratory glucometer based on a hexokinase method. We also measured blood gas, electrolyte, and hematocrit values. Statistical analyses were performed with repeated measure ANOVA, multiple linear regression, and Bland-Altman's analysis. Data is expressed as mean +/- SD. RESULTS: The arterial blood glucose concentration measured by the glucose oxidase method (119.5 +/- 25.0 mg/dl) was significantly lower than the venous blood (133.5 +/- 24.8 mg/dl) and hexokinase method (134.2 +/- 27.1 mg/dl). There was no significant difference between the venous blood glucose concentration by the glucose oxidase method and hexokinase method. When we used the correction formula: corrected glucose value = arterial glucose value by glucose oxidase method + 0.1053 X PaO2 - 5.414, the bias improved from - 14.6 mg/dl to 1.0 mg/dl. CONCLUSIONS: The blood glucose concentration measured by the glucose oxidase method is more accurate in venous blood than oxygenated arterial blood. When we measure the blood glucose level using the glucose oxidase method, we should consider the influence of high oxygen tension.
Adult ; Anesthesia ; Anesthesia, General ; Bias (Epidemiology) ; Blood Glucose* ; Catheters ; Central Venous Catheters ; Glucose Oxidase* ; Glucose* ; Hematocrit ; Hexokinase ; Humans ; Jugular Veins ; Linear Models ; Operating Rooms ; Oxygen* ; Radial Artery

In order to determine the current infection status of pond smelts, Hypomesus olidus, and other freshwater fishes with trematode metacercariae, a total of 4,861 pond smelts and 18 other freshwater fishes, collected from the Soyang and Uiam Lakes in Gangwon-do, the Unam Lake in Jeollabuk-do, the Jangseong Lake in Jeollanam-do, the Uirim-ji (lake) in Chungcheongbuk-do, and the Andong Lake in Gyeongsangbuk-do, were individually digested with 1% pepsin-HCl and examined under a dissecting microscope. In all pond smelts caught from the 6 lakes, we were unable to detect any known human infectious trematode metacercariae in Korea. However, in other freshwater fishes, such as, Squalidus japonicus coreanus (Unam Lake), and Zacco platypus (Jangseong Lake) and Opsariichthys uncirostris amurensis (Jangseong Lake), metacercariae of human-infecting trematodes, i.e., Clonorchis sinensis and Metagonimus sp. were detected, respectively.
Trematode Infections/*veterinary ; Osmeriformes/*parasitology ; Korea ; Humans ; Fresh Water ; Fish Diseases/*parasitology ; Animals

PURPOSE: The purpose of this study is to understand student recognition of CBT as well as its strengths and weaknesses, and to explore the improvement methodologies for the effective development and implementation of CBT. METHODS: A questionnaire survey was conducted twice (before and after implementation of CBT) with a total of 17 multiple-choice and 2 essay-type questions. The multiple-choice questions were analyzed by frequency analysis and the essay-type questions were coded by content analysis. RESULTS: The results are as follows. First, the overall satisfaction with CBT was shown to be high. Second, students listed the merits of CBT as follows: simple correction of answers (before: 89.4%; after: 80.8%), presentation of realistic materials (before: 72.9%; after: 84.7%), prompt feedback on grades (before: 60.3%; after: 71.1%), shortened exam time and effective time scheduling (before: 86.5%; after: 66.4%), accurate estimation of abilities (before: 70.2%; after: 36.6%), and assistance in academic improvement (before: 70.9%; after: 22.1%). Drawbacks of CBT were: inconvenience of review (before: 70.9%; after: 22.1%), inconvenient screen organizations (before: 0%; after: 48.1%), possibility of cheating (before: 73.9%; after: 31.8%), and equality issue of test (before: 47.3%; after: 17.3%). CONCLUSION: Assessment paradigms are currently shifting from summative evaluation to formative evaluation, from one-off assessment to continuous assessment, and from output assessment to process assessment. Therefore, CBT must be expanded to move from result-oriented summative evaluation to formative evaluation continuously monitoring the student learning process.
Education, Medical ; Humans ; Learning ; Process Assessment (Health Care) ; Surveys and Questionnaires