BACKGROUND: External ventricular drainage (EVD) is an important procedure for draining excessive cerebrospinal fluid (CSF) and monitoring intracranial pressure. Generally, EVD is performed in the operating room (OR) under aseptic conditions. However, in emergency circumstances, the operation may be performed in the intensive care unit (ICU) to save neuro-critical time and to avoid the unnecessary transfer of patients. In this study, we retrospectively analyzed the risk of EVD-induced CNS infections and their outcomes according to the operating place (ICU versus OR). In addition, we compared mortalities as well as hospital and ICU days between the CNS infection and non-CNS infection groups. METHODS: We reviewed medical records, laboratory data and radiographic images of patients who had received EVD operations between January, 2013 and March, 2015. RESULTS: A total of 75 patients (45 men and 30 women, mean age: 58.7 +/- 15.6 years) were enrolled in this study. An average of 1.4 catheters were used for each patient and the mean period of the indwelling catheter was 7.5 +/- 5.0 days. Twenty-six patients were included in the ICU group, and EVD-induced CNS infection had occurred in 3 (11.5%) patients. For the OR group, forty-nine patients were included and EVD-induced CNS infection had occurred in 7 (14.3%) patients. The EVD-induced CNS infection of the ICU group did not increase above that of the OR group. The ICU days and mortality rate were higher in the CNS infection group compared to the non-CNS infection group. The period of the indwelling EVD catheter and the number of inserted EVD catheters were both higher in the CNS infection group. CONCLUSIONS: If the aseptic protocols and barrier precautions are strictly kept, EVD in the ICU does not have a higher risk of CNS infections compared to the OR. In addition, EVD in the ICU can decrease the hospital and ICU days by saving neuro-critical time and avoiding the unnecessary transfer of patients. Therefore, when neurosurgeons decide upon the operating place for EVD, they should consider the benefits of ICU operation and be cautious of EVD-induced CNS infection.
Catheter-Related Infections ; Catheters ; Catheters, Indwelling ; Cerebrospinal Fluid ; Drainage* ; Emergencies ; Female ; Humans ; Intensive Care Units* ; Critical Care* ; Intracranial Pressure ; Male ; Medical Records ; Mortality ; Operating Rooms* ; Retrospective Studies ; Ventriculostomy

No abstract available.

It is well known that most anesthectis and drugs are metabolized and excreted in the liver. There are many controversies regarding postoperative halothane hepatotoxicitr and often reported postoperative hepatic dysfunction following enflurane anesthesia. It appears that the development of hepatic necrosis after anesthesia depends on a chance combination of events but not anesthetics itself. Common causes of postoperative hepatic damages ia possibly due to viral heatitis, since in oar country viral hepatitis B are increasing in frequency recently. This study was performed to evaluate the effect of enflurane on liver function in 25 asy-mptomatic patients hepatitis B surface antigen positive. The results seems favorable for anesthesia and sureery. on asymptomatic viral hepatitis B patients.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Enflurane ; Halothane ; Hepatitis B ; Hepatitis B Surface Antigens* ; Humans ; Liver* ; Necrosis

PURPOSE: The solid variety of cerebella r tumors in adult is relatively uncommon. This study is to describe the characteristic MR findings of various solid cerebellar tumors in adult. METHODS: Twenty three cerebellar solid tumors from 22 consecutive patients over age of 15 with surgical confirmations were retrospectively evaluated with MR imaging. H istologic diagnosis included hemangioblastoma (n=6), metastasis (n=6), high-grade astrocytoma (n=3), and medulloblastoma (n=8). The MR findings were reviewed with attention to the size, the signal intensity of the tumors, pattern of enhancement, tumoral margin, degree of peritumoral edema, signal void vascular structures within and/or around the tumor, and location in relation to attachment to the pial surface of the tumor. RESULTS: Solid hemangioblastomas consistently showed slightly low or iso signal intensity on T1 -weighted images and high intensity on T2-weighted images, dense homogeneous enhancement, and signal void vessels within and/or around the mass. Metastatic tumors showed various find ings with predominantly low or iso signal intensity on T2-weighted images. Medulloblastomas was midline and/or paramidline in location, and had larger mass formation. High-grade astrocytomas revealed nonspecific MR findings with no signal void vessels. CONCLUSION: Hemangioblastoma, metastasis, malignant astrocytoma, and medulloblastoma should be included in differential diagnosis of solid cerebellar tumors in adult. Dense homogeneous enhancement and signal void vessels are characteristic of hemangioblastoma. The signal intensity of the tumor, and presence of signal void vessels, location and enhancement pattern can be some value in differential diagnosis of solid cerebellar tumors in adult.
Adult* ; Astrocytoma ; Cerebellar Neoplasms* ; Diagnosis ; Diagnosis, Differential ; Edema ; Hemangioblastoma ; Humans ; Magnetic Resonance Imaging ; Medulloblastoma ; Neoplasm Metastasis ; Retrospective Studies

PURPOSE: A consecutive series of 710 patients who underwent curative gastrectomy for carcinoma was studied with a special reference to the number or frequency of lymph node metastasis and the patient's prognosis. MATERIAL AND METHODS: Survival rates were calculated by the Kaplan-Meier method, and the difference between each group was evaluated statistically by the log-rank method. Follow-up was obtained for 709 patients (99.9%). RESULTS: According to the number of lymph nodal metastases, the five year survival rate for group 1 (1~3 positive nodes) was 50.9%; for group 2 (4~6 positive nodes), 56.7%; and for group 3 (more than 6 positive nodes), 12.0% (p<0.0001). According to the frequency of lymph node metastases, the five year survival rate for those with up to 25 per cent frequency of metastases was 47.5%; for those with up to 50 per cent frequency of metastases, 15.6%; and for those with greater than 50 per cent metastases, 6.3% (p<0.0001). According to the frequency of the regional lymph nodes (which include perigastric nodes along the lesser and greater curvatures, nodes located along the left gastric, common hepatic, splenic, and celiac arteries) metastasis, we categorized them as group 0 (N0: no metastasis), 1 (N1: metastasis in up to 25%), and 2 (N2: metastasis in greater than 25%). CONCLUSION: This subdivision could be successfully applied to the clinical evaluation of gastric carcinoma (five year survival rate for N0, 86.9%; for N1, 49.0%; and for N2, 10.7% (p<0.0001)) without difficulty in dividing certain lymph nodes into the correct location.
Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes* ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms* ; Survival Rate

It was attempted to clarify the participation of K+ channels in the post-receptor mechanisms of the muscarinic and A1-adenosine receptor-mediated control of acetylcholine (ACh) release in the present study. Slices from the rat hippocampus were equilibrated with (3H)choline and the release of the labelled products was evoked by electrical stimulation (3 Hz, 5 V/cm, 2 ms, rectangular pulses), and the influence of various agents on the evoked tritium-outflow was investigated. Oxotremorine (Oxo, 0.1~10 micrometer), a muscarinic agonist, and N6-cyclopentyladenosine (CPA, 1~30 micrometer), a specific A1-adenosine agonist, decreased the ACh release in a dose-dependent manner, without affecting the basal rate of release. 4-aminopyridine (4AP), a specific A-type K+-channel blocker (1~100 micrometer), increased the evoked ACh release in a dose-related fashion, and the basal rate of release is increased by 3 and 100 micrometer. Tetraethylammonium (TEA), a non-specific K+-channel blocker (0.1~10 mM), increased the evoked ACh release in a dose-dependent manner without affecting the basal release. The effects of Oxo and CPA were not affected by 3 micrometer 4AP co-treatment, but 10 mM TEA significantly inhibited the effects of Oxo and CPA. 4AP (10 micrometer- and TEA (10 mM)-induced increments of evoked ACh release were completely abolished in Ca2+-free medium, but these were recovered in low Ca2+ medium. And the effects of K+-channel blockers in low Ca2+ medium were inhibited by Mg2+ (4 mM) and abolished by 0.3 micrometer tetrodotoxin (TTX). These results suggest that the changes in TEA-sensitive potassium channel permeability and the consequent limitation of Ca2+ influx are partly involved in the presynaptic modulation of the evoked ACh-release by muscarinic and A1-adenosine receptors of the rat hippocampus.
4-Aminopyridine ; Acetylcholine* ; Animals ; Electric Stimulation ; Hippocampus* ; Muscarinic Agonists ; Oxotremorine ; Permeability ; Potassium Channels ; Rats* ; Receptors, Muscarinic ; Tea ; Tetraethylammonium ; Tetrodotoxin

Purpose: This study examined the effects of ankle control training using neuromuscular electrical stimulation (NMES), leg muscle activation, and balance in stroke patients. Methods: Thirty-one stroke patients diagnosed with cerebral infarction and cerebral hemorrhage were selected for the study. The experimental group underwent ankle control training using NMES, while the control group applied NMES to the paretic tibialis anterior muscle for 30 minutes per session, five times a week for four weeks. The muscle activity changes were measured using surface electromyography, and balance parameters were evaluated using a functional reach test (FRT). Results: The intra-group comparison of the concentric muscle activity revealed improvements in the experimental group, including paretic tibialis anterior (TA) muscle (p<0.05), medial gastrocnemius muscle (MG) (p<0.01), and lateral gastrocnemius muscle (LG) (p<0.05), as well as MG (p<0.05), LG (p<0.05), soleus muscle (p<0.05) of the non-paretic side, and soleus muscle symmetry index (p<0.05). The intra-group comparison of the eccentric muscle activity showed improvements in the experimental group, including MG (p<0.01) and LG (p<0.01) of the paretic side, as well as MG (p<0.01), LG (p<0.01) of the non-paretic side, and LG symmetry index (p<0.01). The intra-group comparison of the functional reach test revealed significant differences in the test results in the experimental and control groups (p<0.05). Conclusion Ankle control training using NMES had a positive effect on the changes in muscle activation and improved balance in patients with stroke.

Traumatic thyroid hematoma is a rare problem in cases of blunt trauma, but it can be a life-threatening condition. We report here on a case of thyroid hematoma that was complicated with unexpected airway obstruction due to blunt trauma on the anterior neck. A 23-year-old man who developed neck painful swelling and dyspnea was admitted to the emergency room with a blunt neck injury after motor-bicycle accident, and he hit his anterior neck against the handle-bar. He had no previous thyroid pathology and other medical problems. On the initial examination, his vital signs were stable and the oxygen saturation was 97.8%. A computed tomography (CT) scan of the neck showed fragmentation and extensive hematoma within the right thyroid gland and dislocation of the trachea. No definite bleeding focus was identified on the angiography that was done through the carotid artery. Two hours later, the patient experienced sudden respiratory distress and the oxygen saturation dropped rapidly. The patient needed emerg encyendotracheal intubation and surgical intervention. He successfully underwent right lobectomy of the thyroid gland, and was discharged on the 6th hospital day without any complications. The thyroid function was normal after 3 months.
Airway Obstruction* ; Angiography ; Carotid Arteries ; Dislocations ; Dyspnea ; Emergency Service, Hospital ; Hematoma* ; Hemorrhage ; Humans ; Intubation ; Neck ; Neck Injuries ; Neck Pain ; Oxygen ; Pathology ; Thyroid Gland* ; Trachea ; Vital Signs ; Young Adult

Gastrocelic fistula of malignant origin is a rare complication, usually due to gastric or colon cancer. Possible other etiologic factors resulting in gastrocolic fistula are peptic ulcer, trauma, carcinoid tumor, intestinal tuberculosis, Crohn's disease, lymphoma, intraabdominal abscess, diverticulitis and etc. At the present, earlier diagnosis and treatment of gastric and colon cancer may explain the low frequency of malignant gastrocolic fistula than the past but the review of Korean literatures revealed only two reports of gastrocolic fistula secondary to gastric cancer and another from benign gastric ulcer. Yet, there has been no report of fistula due to colon cancer. We experienced a case of colon cancer with postural dizziness, fecal eructation who was diagnosed as gastrocolic fistula by endoscopy, barium enema, UGI series and finally underwent operation. Therefore, we report this case with the review of literatures.
Abscess ; Barium ; Carcinoid Tumor ; Colon* ; Colonic Neoplasms* ; Crohn Disease ; Diagnosis ; Diverticulitis ; Dizziness ; Endoscopy ; Enema ; Eructation ; Fistula* ; Lymphoma ; Peptic Ulcer ; Stomach Neoplasms ; Stomach Ulcer ; Tuberculosis

OBJECTIVE: Chronic subdural hematoma (CSDH) is one of the most common types of intra-cranial hemorrhages usually associated with trauma. Surgical treatment is the treatment of choice and burr hole trephination (BHT) is widely performed. The recurrence rate in the patients with CSDH is 3.7-30%. This study investigated the risk factors associated with the recurrence of patients with CSDH who underwent BHT. METHODS: One hundred twenty-five patients with CSDH underwent BHT. Eight of 125 patients (6.4%) underwent reoperation for recurrent CSDH. We retrospectively analyzed demographic, clinical and radiological findings, catheter tip location and drainage duration as the risk factors for the recurrence of CSDH. RESULTS: Recurrence of CSDH in the high- or mixed-density groups was significantly higher than those in the low- or iso-density groups (p<0.001). Placement of catheter tip at the temporoparietal area was associated with a significantly higher recurrence rate of CSDH than placement at the frontal area (p=0.006) and the brain re-expansion rate (BRR) was much lower than placement at the frontal area (p<0.001). CONCLUSION: The operation may be delayed in high- and mixed-density groups, unless severe symptoms or signs are present. In addition, placing the catheter tip at the frontal area helps to reduce the incidence of postoperative recurrence of CSDH and to increase the BRR.
Brain ; Butylated Hydroxytoluene ; Catheters ; Drainage ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Incidence ; Recurrence* ; Reoperation ; Retrospective Studies ; Risk Factors* ; Trephining*