No abstract available.
Bilirubin* ; Infant, Newborn ; Jaundice, Neonatal*

A 64-year-old man was admitted to our hospital in semicomatous consciousness. Brain computed tomography scans demonstrated 2.6 x 2.5 cm sized hyperdense mass in the pineal region with multiple punctate calcifications and hydrocephalus. Brain magnetic resonance imaging demonstrated a pineal mass which was heterogeneously enhanced with gadolinium. After external ventricular drainage, the patient regained consciousness. The mass was totally removed via occipital transtentorial approach. No consequent ventricular shunt was needed and the patient recovered without any neurological deficit. Final pathologic report of the tumor was ependymoma.
Brain ; Consciousness ; Drainage ; Ependymoma* ; Gadolinium ; Humans ; Hydrocephalus ; Magnetic Resonance Imaging ; Middle Aged ; Pinealoma

The purpose of this study is to obtain information of simple and effective methods for the pos-tlaminectomy pain control, and to reduce the consumption of supplemental analgesic drugs and side effects. In a double blind study, 75 patients scheduled for lumbar laminectomy were randomly divided into five groups according to the epidurally instilled drugs, such as, morphine 2mg,Group M2; morphine 3mg,Group M3; methylprednisolone 80 mg, Group D; morphine 2mg plus methylprednisolone 80mg, Group M2D; normal saline as a control Group C. All of the drugs were prepared in 2ml normal saline solution. The following items were recorded in the postoperative period: Pain score using visual analogue scale(VAS) at 6, 12, 24, 48 hours after the operation; the episode of supplemental systemic analgesic; the need for postoperative urethral catheterization; any evidence of respiratory depression; pruritus; nausea and vomiting. The results were as follows. I) VAS score were not significantly different between control group and group M2(p>0.05), but usually less in the group M2 and supplemental analgesic consumption was significantly less in the group M2 than in the control group. 2) VAS score were less in the group M3 than in the group M2 and significantly less than in the control group at 6 hour after operation and also supplemental analgesic consumption was significantly less in the group M3. 3) Group D revealed similar VAS score with group M2 at 6 and 12 hour but significantly lower VAS score at 24 and 48 hour after operation than group M2. 4) VAS score were the most significantly less in the group M2D at 6,12,24,48 hour after operation than in the control group and supplemental analgesic consumption was significantly less in the group M2D. 5) Side effects were not significantly different among all groups. These findings suggest that epidurally instilled morphine 3mg, or methylprednisolone 80mg or both before the closure of the laminectomy wound is effective, simple and safe method for the post-laminectomy pain control and reducing supplemental intramuscular analgesics without specific complication.
Analgesics ; Double-Blind Method ; Humans ; Laminectomy* ; Methylprednisolone* ; Morphine* ; Nausea ; Pain, Postoperative* ; Postoperative Period ; Pruritus ; Respiratory Insufficiency ; Sodium Chloride ; Urinary Catheterization ; Urinary Catheters ; Vomiting ; Wounds and Injuries

BACKGROUND: Oxygen free radicals are likely to be involved in decreases of the tracheal epithelial barrier function, increases of permeability, and inhibitions of ciliary activity. The present study was undertaken to determine the interaction between isoflurane, propofol and oxidative injury with respect to the contractile force of tracheal smooth muscle in guinea-pig. METHODS: Strips of guinea-pig trachea were suspended in organ chambers, and their isometric tension was recorded by a MacLab. Tissues were allocated to 7 groups (each: n = 10) of control, 2%, 3%, and 4% isoflurane, 25 micrometer, 50 micrometer, and 100 micrometer propofol. All strips were challenged with 10 5 M acetylcholine (ACh) to get maximal contractions and followed washout. All strips were exposed to 10 4 M H2O2 contained modified Krebs solution for 30 minutes after the strips were perfused with each concentration of anesthetics for 20 minutes. After washout of organ chambers and 30 minutes of rest, all strips were contracted with ACh. Several strips were prepared for microscopic evaluation. RESULTS: The contractile heights to H2O2 showed 36.7+/-20.2% of control value in the control group, and there were significant differences between the control and the propofol 100 micrometer group as shown by Tukey test. There were no significant differences in contractile heights to the second ACh in any of the 6 groups except the 100 micrometer propofol group. Microscopic morphological changes were not detected by 1,000 light microscopic evaluation. CONCLUSIONS: We suggest that the contractile heights of strips to H2O2 which were lower in four anesthetic groups than in the control group indicated a counteracting relaxation of smooth muscle caused by anesthetics. We suggest that there might be some functional effects of H2O2 on smooth muscle cells other than epithelial injury and that 100 micrometer propofol might have some protective effects against smooth muscle cell injury from 10- 4 H2O2.
Acetylcholine ; Anesthetics ; Free Radicals ; Hydrogen* ; Isoflurane* ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Oxygen ; Permeability ; Propofol* ; Relaxation ; Trachea*

BACKGROUND: Oxygen free radicals are likely to be involved in decreases of the tracheal epithelial barrier function, increases of permeability, and inhibitions of ciliary activity. The present study was undertaken to determine the interaction between isoflurane, propofol and oxidative injury with respect to the contractile force of tracheal smooth muscle in guinea-pig. METHODS: Strips of guinea-pig trachea were suspended in organ chambers, and their isometric tension was recorded by a MacLab. Tissues were allocated to 7 groups (each: n = 10) of control, 2%, 3%, and 4% isoflurane, 25 micrometer, 50 micrometer, and 100 micrometer propofol. All strips were challenged with 10 5 M acetylcholine (ACh) to get maximal contractions and followed washout. All strips were exposed to 10 4 M H2O2 contained modified Krebs solution for 30 minutes after the strips were perfused with each concentration of anesthetics for 20 minutes. After washout of organ chambers and 30 minutes of rest, all strips were contracted with ACh. Several strips were prepared for microscopic evaluation. RESULTS: The contractile heights to H2O2 showed 36.7+/-20.2% of control value in the control group, and there were significant differences between the control and the propofol 100 micrometer group as shown by Tukey test. There were no significant differences in contractile heights to the second ACh in any of the 6 groups except the 100 micrometer propofol group. Microscopic morphological changes were not detected by 1,000 light microscopic evaluation. CONCLUSIONS: We suggest that the contractile heights of strips to H2O2 which were lower in four anesthetic groups than in the control group indicated a counteracting relaxation of smooth muscle caused by anesthetics. We suggest that there might be some functional effects of H2O2 on smooth muscle cells other than epithelial injury and that 100 micrometer propofol might have some protective effects against smooth muscle cell injury from 10- 4 H2O2.
Acetylcholine ; Anesthetics ; Free Radicals ; Hydrogen* ; Isoflurane* ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Oxygen ; Permeability ; Propofol* ; Relaxation ; Trachea*

To evaluate the antihypertensive effects of serotonin antagonist, ketanserin, a daily dosage of 10~40mg (18.9+/-6.8 mean+/-SE) was administered to 22 patients with essential hypertension and aged 55??1 years (64+/-7.7 mean+/-SE) for 12 weeks. After 12 weeks of ketanserin treatment mean blood pressure decreased from 177.9+/-11.9 to 15.7+/-15.3mmHg in systole and from 104.2+/-7.4 to 88.4+/-7.9mmHg in diastole (P<0.001). There was no significant change in heart rates with ketanserin treatment. The antihypertensive treatment with ketanserin was effective in 18 patients(81.8%) and ineffective in 4 patients (18.2%). Adverse reactions such as drowsiness (8.7%), edama (4.3%) and weakness (4.3%) were noted, but all were mild and transient. This results suggest that ketanserin is an effective and safe antihypersive agent in the treatment of essential hyperension.
Aging* ; Blood Pressure ; Diastole ; Heart Rate ; Humans ; Hypertension* ; Ketanserin* ; Serotonin ; Sleep Stages ; Systole

OBJECTIVE: So called "lumbar dorsal ramus syndrome(LDRS)" is known to have low back pain(LBP) with buttock and/or leg pain, and considered one of the causes of chronic LBP. The radiofrequency facet rhizotomy (RFFR) is known to be effective treatment for the selected patients with chronic LBP. The goal of this study is to evaluate the therapeutic effectiveness of RFFR in patients with LDRS. METHODS: LDRS is mainly diagnosed by way of blocking the lumbar dorsal ramus with local anesthetics. Their accompanied spinal conditions are sprain, stenosis, HNP, and fracture. These patients underwent unilateral or bilateral RFFR at L4, L5, and S1 levels, from August, 1999 to May, 2000. Results were graded at the end of follow up as excellent, good, fair, and poor. Successful result was considered when excellent or good grades were obtained. RESULTS: Total number of patients received RFFR was 75. The number of LDRS with sprain was 46(8.5% of patients with sprain). Mean age and male to female ratio were 51.8+/-16.7 and 1:1.4, respectively. Mean follow up period was 340.0+/-232.2 days(1month - 2years). Characteristic tender points were posterior superior iliac crest, anterolateral aspect of inferior thigh, posterior aspect of femoral head, and medial side of heel. The success rate at the last follow-up in total patients and patients with sprain were 73.3% and 87.0%, respectively. Other combined spinal conditions except sprain seemed to have undesirable influence on the result of RFFR(p<0.05). CONCLUSION: RFFR is fairly effective treatment for LDRS, especially for the patient with sprain. Combined spinal conditions other than sprain are poor prognostic factors.
Anesthetics, Local ; Buttocks ; Constriction, Pathologic ; Female ; Follow-Up Studies ; Head ; Heel ; Humans ; Leg ; Male ; Rhizotomy* ; Sprains and Strains ; Thigh

Vascular injury during lumbar disc surgery is a rare but potentially life-threatening complication. It has been managed by open vascular surgical repair. With recent technologic advance, endovascular treatment became one of effective treatment modalities. We present a case of a 32-year-old woman who suffered with common iliac artery injury during lumbar disc surgery that was treated successfully by endovascular repair with temporary balloon occlusion and subsequent insertion of a covered stent. Temporary balloon occlusion for 1.5 hours could stop bleeding, but growing pseudoaneurysm was identified at the injury site during the following 13 days. It seems that the temporary balloon occlusion can stall bleeding from arterial injury for considerable time duration, but cannot be a single treatment modality and requires subsequent insertion of a covered stent.
Adult ; Aneurysm, False ; Balloon Occlusion ; Female ; Hemorrhage ; Humans ; Iliac Artery ; Stents ; Vascular System Injuries

We report the case of a 64-year-old man with dural arteriovenous fistula (DAVF) at right jugular foramen, presented as subarachnoid and intraventricular hemorrhage. The malformation was fed by only the neuromeningeal trunk of the right ascending pharyngeal artery and drained into the right lateral medullary veins craniopetally. Complete embolization was attained by selective transarterial glue injection, but patient showed lower cranial neuropathies. A 3-month follow-up angiogram still showed persistent fistula occlusion. Transarterial glue embolization is a feasible method, only if a transvenous access is not possible in case of single channel fistula.
Adhesives ; Arteries ; Central Nervous System Vascular Malformations ; Cranial Nerve Diseases ; Fistula ; Follow-Up Studies ; Hemorrhage ; Humans ; Middle Aged ; Subarachnoid Hemorrhage ; Veins

Remote cerebellar hemorrhage (RCH) is rare but potentially lethal as a complication of spinal surgery. We recently experienced a case of RCH in a 61-year-old man who showed mental deterioration after lumbar spinal surgery. There was dural tearing with subsequent cerebrospinal fluid (CSF) loss during the surgery. Brain computed tomography scan revealed cerebellar hemorrhage, 3rd and 4th ventricular hemorrhage and pneumocephalus. He underwent suboccipital craniectomy and hematoma removal. The most important pathomechanism leading to RCH after spinal surgery has been known to be venous bleeding due to caudal sagging of cerebellum by rapid leak of large amount of CSF which seems to be related with this case. Dural repair and minimizing CSF loss after intraoperative dural tearing would be helpful to prevent postoperative RCH.
Brain ; Cerebellum ; Hematoma ; Hemorrhage ; Humans ; Middle Aged ; Pneumocephalus