A Ruptured lenticulostriate artery aneurysm in moyamoya disease treated with Onyx embolization

Lenticulostriate artery (LSA) aneurysms are uncommon. Here, we report one case of ruptured LSA aneurysm which is related to Moyamoya disease (MMD). Surgical treatment of this aneurysm is challenging because of its deep location and complex neural structures around the LSA. We report one case treated with endovascular Onyx embolization, successfully and review LSA aneurysm associated with MMD.

Postoperative Non-Pathological Fever Following Posterior Cervical Fusion Surgery : Is Laminoplasty a Better Preventive Method than Laminectomy?

Objective@#: To analyze the incidence and characteristics of delayed postoperative fever in posterior cervical fusion using cervical pedicle screws (CPS). @*Methods@#: This study analyzed 119 patients who underwent posterior cervical fusion surgery using CPS. Delayed fever was defined as no fever for the first 3 postoperative days, followed by an ear temperature ≥38°C on postoperative day 4 and subsequent days. Patient age, sex, diagnosis, laminectomy, surgical level, revision status, body mass index, underlying medical disease, surgical duration, and transfusion status were retrospectively reviewed. @*Results@#: Of 119 patients, seven were excluded due to surgical site infection, spondylitis, pneumonia, or surgical level that included the thoracic spine. Of the 112 included patients, 28 (25%) were febrile and 84 (75%) were afebrile. Multivariate logistic regression analysis showed that laminectomy was a statistically significant risk factor for postoperative non-pathological fever (odds ratio, 10.251; p=0.000). In contrast, trauma or tumor surgery and underlying medical disease were not significant risk factors for fever. @*Conclusion@#: Patients who develop delayed fever 4 days after posterior cervical fusion surgery using CPS are more likely to have non-pathologic fever than surgical site infection. Laminectomy is a significant risk factor for non-pathologic fever.

Validity, Reproducibility of Visual Analogue Scales in Assessment of Appetite Sensations

BACKGROUND: Appetite control and weight reduction is important for the treatment of chronic disease such as obesity, hypertension, and diabetes mellitus. Visual analogue scales (VAS) is widely used to assess appetite. We investigated the reproducibility and the validity of the Korean version of VAS for appetite which will be helpful for clinical use. METHODS: The subjects received the same test meal and 8 VAS questionnaires between 6 weeks. They started to fill out the questionnaire before lunch, continued after lunch every hour, and ended after dinner. The questionnaire was asked about hunger, satiety, fullness, prospective consumption, sweet, salty, savoury, and fatty. During the test meal, the subjects could eat ad libitum until 'comfortable satisfaction'; and after the test meal we calculated energy intake. We assessed the correlation between test-retest VAS for each appetite and evaluated the validity of VAS for hunger with energy intake as "gold-standard". RESULTS: The VAS curves of each appetite were similar between the test and the retest. The VAS of each appetite on the test day was strongly correlated with that on the retest day. The CRs of 4.5 hour mean VAS (20~34 mm) was smaller than the CRs of fasting VAS (35~54 mm). The correlation coefficient of Hunger VAS before dinner and the energy intake was 0.436 on the test day and 0.400 on the retest day. The VAS of the sweet was correlated to the total glucose intake (P<0.05), and the VAS of salty to the salt intake. CONCLUSION: The validity of the VAS score for appetite, especially hunger, sweet and salty taste was good. Indeed, the reliability of VAS for appetite was good to use this scale in a clinical setting.

Effects of Clonidine on the Requirements of Dopamine Used as a Concomitant Drug of Amrinone in Coronary Artery Bypass Surgery (CABG) / 대한마취과학회지

BACKGROUND: Clonidine premedication has many beneficial effects in patients undergoing CABG surgery. Amrinone, having the ability to increase cardiac performance without increasing myocardial O2 consumption, is a valuable drug in postoperative management after cardiopulmonary bypass (CPB). The use of amrinone with a catecholamine is also important clinically because the cathecholamines support perfusion pressure and the combined use exerts synergistic or additive effects. We performed this study to examine whether clonidine premedication could change the amount of dopamine used concomitantly with amrinone for management after CPB. METHODS: Nineteen patients for elective CABG were allocated to two groups according to their premedication; a placebo (Group 1, n = 13) or clonidine 4 microgram/kg p.o. (Group 2, n = 6). All patients arrived in the operating room with infusion of isosorbide dinitrate (ID). Anesthesia was performed with standard techniques. Before initiation of CPB, significant lowering of BP or HR was treated with phenylephrine or atropine respectively. Amrinone was given bolus (0.75 mg/kg) and infusion (10 microgram/ kg/min) was begun instead of ID at the release of aortic cross-clamp. Dopamine infusion (3 microgram/kg/min) was started at 35degree C (rectal) and its rate was adjusted for maintaining acceptable hemodynamics. We compared the amount of infused dopamine within 90 mins after CPB between the two groups. We also compared systolic BP, HR and CVP before induction, 10 mins after induction and 60 mins after CPB. RESULTS: Systolic BP and HR before induction and HR 10 mins after induction were significantly lower in Group 2 (P < 0.05), but they were all within normal range. The proportion of patients who needed phenylephrine or atropine before CPB was not significantly different in the two groups. The amount of infused dopamine was significantly larger in Group 2 (P < 0.05). Hemodynamics were acceptable after CPB although HR 60 min after CPB was significantly lower within the normal range in Group 2 (P < 0.05). Weaning time from CPB was not significantly different in the two groups. No significant adverse effect was observed throughout this study. CONCLUSIONS: Clonidine, used as premedication, increases the need of catecholamine which is concomitantly administered with amrinone for weaning from CPB. But this method provides clinically effective result without jeopardizing hemodynamics in CABG.

Anesthetic Management of Ovarian Bleeding with Eisenmenger's Syndrome: A case report / 대한마취과학회지

Eisenmenger's syndrome is defined as a high pulmonary vascular resistance associated with pulmonary hypertension or high pulmonary pressure close to systemic values with a reverse or bidirectional shunt at aortopulmonary, interventricular or interatrial levels. We report the case of a 42-year-old woman with an emergency operation for ovarian bleeding with Eisenmenger's syndrome secondary to large VSD. She had abdominal pain and vaginal spotting which developed one month earlier. In a preoperative abdominal ultrasonography, there was a fluid collection on the Cul-de-sac. There was no significant cardiorespiratory symptom except peripheral cyanosis. Anesthesia was performed with fentanyl, midazolam and vecuronium in standard monitorings including pulmonary artery pressure monitoring. Bolus and continuous infusions of amrinone were given to decrease right to left shunt. After the administration of amrinone, PaO2, PaO2/FiO2, P(A-a)O2 and P(a/A)O2 were improved and pulmonary arterial pressure was preferentially decreased compared with systemic arterial pressure. There was no significant problem throughout the operation, a right ovarian wedge resection. She was transferred to the intensive care unit in an intubated state postoperatively and discharged one week later without any complications.

Comparisons of Vascular Pain during Intravenous Administration: Thiopental and Propofol / 대한마취과학회지

BACKGROUND: Even though propofol having many clinical merits, a vascular pain during intravenous administration of it could maKe us choose other induction agents. One of many METHODS to decrease vascular pain, the use of propofol preserved in a cold temperature (1 4degeesC) was introduced and Known to be effective. The purpose of this study was to compare vascular pain of cold propofol with that of thiopental as induction agents. METHODS: Sixty adult patients for elective surgery were randomly assigned to the two groups according to receiving thiopental (Group I, n = 30) or propofol (Group II, n = 30), then they were divided randomly into two subgroups according to the selection of vascular size; vein on the dorsum of hand or antecubital fossa. As an induction agent, 2.5% thiopental (5 mg/Kg) or cold 1% propofol (2 mg/Kg) were given intravenously during 40 sec. The severity of vascular pain (classified by 4 points verbal category system) and the incidences of pain were compared according to the induction agents and the selection of vascular size. The incidences of moderate to severe pain according to the selection of induction agents were compared. RESULTS: There was no significant difference in the severity, incidence of pain or incidence of moderate to severe pain in both groups, There was no significant difference in the incidence of pain according to the vascular size. CONCLUSIONS: As cold propofol was given slowly (during 40 sec), the vascular pain was not significant to hinder the selection of propofol as an induction agent compared with that of thiopental.

The Analgesic Effects of Intrathecal Clonidine on the Rat Postincisional Model / 대한마취과학회지

BACKGROUND: Clonidine is an alpha2-adrenergic drug used for analgesic effect, reducing sympathetic stimulation and anesthetic requirement. We examined the analgesic effect of clonidine on incisional pain after its intrathecal administration using a rat postincisional model. METHODS: After an intrathecal (IT) catheter insertion in 20 Spraw Dawley rats, they were divided into two groups; one group (Group S, n = 10) received a saline 20microl injection through an IT catheter, and another (Group C, n = 10) received clonidine 20microgram in 10microl volume followed by another 10microl of saline for washing the catheter. The measurements of the threshold of tactile allodynia (TTA) were performed at 20, 40, 60, 80, 120, 180 and 240 mins after the IT injection. Additionally, 1, 2 and 3 days after the first IT injection, IT injection and the measurements of TTA of pre- and post-injection were repeated. The measurements of TTA were performed in both areas, 5 mm (N-area) and 10 mm (R-area) away from incision by using von Frey hair and up-down method. RESULTS: TTA (N-area) and TTA (R-area) during 4 hours after IT injection in Group C were greater than those in Group S (P< 0.05). TTA (N-area) of post-injection 2 and 3 days after the first IT injection were greater than those of pre-injection in Group C (P< 0.05), and TTA (R-area) after the IT injection 1, 2 and 3 days after the first IT injection were greater than those of pre-injection in Group C (P< 0.05). CONCLUSIONS: A single IT injection of clonidine 20microgram had analgesic effects lasting more than 4 hours in the rat postincisional model. Additional IT clonidine could show antiallodynic effects during three days after the first IT clonidine.

Transient Swelling of both Parotid Glands Following General Anesthesia / 대한마취과학회지

Parotid gland swelling in association with general anesthesia is an unusual complication. Benign postoperative parotid swelling should be recognized as a noninfectious, self-limiting process occurring immediately after surgery. This enlargement is non-tender, rubbery in consistency, without crepitus, and may be accompanied by variable salivation. The mechanism of the occurrence remains unknown, but two factors most frequently associated with this phenomenon appear to be physical stimulation or manipulation of the airway or coughing and/or straining. We report bilateral parotid gland swelling in a middle-aged man after surgery under general anesthesia.

Lumbar Intradural Lipomatosis: A case Report / 대한정형외과학회잡지

Intradural lipomatosis is a rare clinical entity characterized by excessive fat deposition in the intradural space. And they occur slightly more frequently in males. It may lead compression of the spinl cord or lumbargo, radiating pain, paresthesia, intermittent claudication and if they involve the cervical and thoracic region, the patients with tumours in these regions most frequently present with a slow ascending monoparesis or paraparesis, cutaneous sensory loss and defective deep sensation. Only 3% of tumours have been reported in the thoraco-lumbar region. The diagnosis should be based on a combination of clinical, imaging, surgical, and histological findings, and especially the diagnostic procedure of choice in patients with progressive myelopathy is MRI scan as it produces accurate imaging without exposure to ionizing radiation. He was treated surgically-removal of excessive fat tissue and decompressive laminectomy. We report a case of intradural lipomatosis that we had removed by surgically.

Comparison between Planar View and SPECT View on the Dipyridamole Thallium 201 Myocardial Perfusion Scintigraphy

Exercise testing with Thallium imaging is widely used for the noninvasive evaluation of patients suspected of having coronary artery disease. However, many patients referred for stress testing connot exercise adequately for either physical or psychological reasons, and as a result may have nondiagnostic or suboptimal test results. Intravenous dipyridamole in conjunction with Thallium imaging is as effective alternative method without exercise. But, myocardial imaging using the standard scintillation camera technique(planner view) is hampered by superposition of proximal & distal cardial walls and by the segmental nature of myocardial ischemia. For this reason, Single Photon Emission Computed Tomography(SPECT) reslut in high specificity & sensitivity rates for the detection of coronar artery disease compared with conventional technique. So we performed dipyridamole Th-201 myocardial scintigraphy on 25 subjects who have suspicious angina or myocardial infarction instead of exercise Th-201 myocardial scintigraphy, and compared SPECT view with conventional plannar view. The results obtained are as follows : 1) T1-201 scintigraphic findings in 17 patients with suspicious angina were as follows ; redistribution defect was seen in 4 cases in plannar view and 13 cases in SPECT view. 2) T1-201 scintigraphic findings in 8 patients with myocardial infarction were as follows ; in planner view, perfusion defect was seen in all cases and 1 cases of them, redistribution defect was accompained, and in SPECT view, perfusion defect was seen in all cases and 6 cases of them, redistribution defect was accompained. 3) During dipyridamole infusion, the mean systolic & diatolic pressure decreased from 133+/-22.7/86+/-13.5 to 121+/-23.9/78+/-13.1mmHg and the heart rate increased from 68+/-12.4 to 84+/-12.4beats/min. 4) Adverse effects of dipyridamole were noted in 14(56%) of the subjects, but in 12 of these, the symptoms were mild in severity and subsided spontanously. To summarize, Dipyridamole-201 myocardial imaging is a useful and test for coronary artery disease, and the new tomographic technique, SPECT view, is more useful than the conventional plannar view.

A Case of Congenital Isolated Unilateral Absence of It. Pulmonary Artery

Unilateral adsence of a pulmonary artery is frequently undiagnosed. Unless this entity is recognized, a patient with a potentially curable lesion may become inoperable. The importance of considering unilateral absence of a pulmonary artery in the diffirential diagnosis of cyanotic congenital heart disease and pulmonary hypertension has become clear. We exeperienced a case of congenital isolated unilateral absence of it. pulmonary artery confirmed by clinical features, lung scan, echocardiogram and angiogram.

Clinical Observation on Effect of Diltiazem(Herben(R)) in Angina Pectoris

We evaluate the effects of diltiazem in 19 patients with ischemic heart disease (15 patients) of classical anginal pectoris & 4 patients of variant angina) by means of clinical status & electrocardiographic changes and obtain the results as follows: 1. The pulse rate & blood pressure were decreased by diltiazem slightly but these decreases were not significant in statistical meaning. 2. Diltiazem administration of 4 weeks duration normalized EKG completely in 4 patients & partially in 3 patients among the 13 patients who showed abnormal resting EKG initially. 3. All 19 patients who received diltiazem showed clinical improvement; 9 patients had excellent responses, 7 patients good responses & 3 patients fair responses. 4. Diltiazem had side effects in 3 patients, drowsiness, mild euphoria & possibly tolerance respectively in each patients.

A Clinical Observation of the Duodenitis / 대한소화기내시경학회지

A clinieal Observation was done on the 110 cases (male; 52 cases, female; 58 cases) of duodenitis under the gastroduodenoscopic examination among the patients who were performed endoscopic examination because of seeking for the cause of dyspepsia period from Aug. 1981 to Sep. 1981 at Department of lnteral Medicine of BNUH. The results were summerized as follow 1) Normal finding(Grade 0) was highest as 40% in the incidence according to grade of duodenits. Next was moderate (Grade II & II) as 24. 5%, the 3rd was mild(Grade I) as 20% and lowest in severe(Grade IV) duadenitis as 15.5%, 2) Sex distribution of duodenitis showed 37 cases in male and 29 cases in female. And male was slightly higher in incidence than female. 3) Age distribution of duodenitis revealeii 3rd decade and 4th decade were highest in incidence, 30 cases and 28 cases respectively. The order of frequency was 5th decade, 6th decade, 1st decade and 7th decade. 4) Duodenitis was slightly higher in after 4th decade than before 4th decade. 5) The 56 cases of duodenitis except for 1 case were aasociated with gastroduodenal diseases such as gastritis, peptic ulcer or gastric carcinoma. Association of gastritis is highest as 79. 4%. 6) Acurracy of diagnosis in duodenitis on X-ray study was 3 cases in 20 cases. Generally X-ray study was little value in diagnosis of duodenitis.