Risk Factors of Postoperative Hematomas after Surgery for Intracranial Meningiomas

OBJECTIVE: Meningioma is a benign tumor which has a high occurrence rate of postoperative hematomas. The purpose of this study is to analyze risk factors for postoperative hemorrhages after meningioma surgery. METHODS: One hundred and fifty three patients with intracranial meningiomas, operated at the Department of Neurosurgery, National Medical Center, between January 1995 and December 2003 were included in this retrospective study. Risk factors considered to be related with postoperative hematomas were age, sex, preoperative pharmacological anticoagulants for medical co-morbidity, tumor location, histological type of the meningioma, infiltration of dural sinus and arachnoid, removal range of tumors, and the perioperative coagulation status including prothrombin time, partial thromboplastin time, and platelet count. RESULTS: Patients' aged more than 70 years with a platelet count of less than 150 x 10(9) l(-1) after surgery had statistically significant relations to the occurrence rate of postoperative hematomas. The other factors had no statistical significance. CONCLUSION: Various and intensive preoperative examinations for coagulation factors of patients, especially of older age, and proper transfusion before meningioma surgery are necessary for preventing postoperative hematoma.

Cranioplasty Using Frozen Autologous Bone

OBJECTIVE: Variable materials have been used in cranioplasty of skull defects, of which autologous bone is the most ideal. The authors explore methods and clinical results of cranioplasty with frozen autologous bone. METHODS: Cranioplasty was performed using frozen autologous bone in 16 patients with skull defects between August 1997 and April 1999. Primary diseases were severe head injury in 14 patients and cerebral infarction in two patients, and all of them received decompressive craniectomy. Cranioplasty were done from 25 to 225 days after primary operation. The mean follow-up period was 34 months. RESULTS: There was no infection or epidural hematoma. During the follow-up period, autologous bone flap were fused firmly to the skull without absorptive evidences and delayed complications. It was satisfactory in all cases when considered aesthetic aspects. CONCLUSION: Cranioplasty using frozen autologous bone is safe and satisfactory method for repair of surgically induced skull defects.

Effects of DMSO on the Active Sodium Transport Across Frog Skin / 대한피부과학회지

As an attempt to evaluate any possible effects of dimethylsulfoxide (DMSO) on the phenomena of membrane transport, effects on the short-circuit current (SCC) and potential difference (PD) across the isolated frog skin were studied under the conditions of various bathing medium, Changes of SCC and PD were measured by the method described by Ussing and Zerahn. Addition of DMSO to the inside bathing medium resulted in an initial increase in SCC followed by a secondary decline to pre-DMSO level, while DMSO at outside medium was without effect. Dose-responses(SCC) relationship revealed a linear one from 30 to 60 mM. Substitution of chloride by sulfate ion from bathing medium caused no alteration in the basic pattern and magnitude of response, thus indicating the specificity of DMSO action on the Na transport. Hypertonic solutions of DMSO added to either outer or inner bathing medium evoked a prompt fall in SCC and PD consistently. By isotopic measurement of sodium fluxes with Na24, it was evident that increased sodium influx was entirely responsible for the initial increase in SCC induced by DMSO. Of various parameters concerned with transepithelial Na transport, outer membrane permeability to Na (PoNa) was shown to be the onIy parameter which was significantly elevated by DMSO administration. From these findings, it was postulated that DMSO-induced increment in sodium influx was mediated by its stimulating action on the sodium penctration through the outer permeability barricr after binding to a receptor site different from that for the antidiuretic hormone (ADH.)

Further Analysis of Various Renal Functions in the Korean III. Urinary Excretion of Phosphate, Ammonia and Titratable Acid

In an attempt to investigate the pattern of the urinary acidification process in the Korean, the urinary excretion of phosphate, ammonia, and the titratable acid were measured in 20 medical students (A group) and in 15 psychiatric patients (B group) under regular Korean diets, while the effects of high protein diets on them were studied in 4 subjects. In addition, TmPO4 was also determined in 11 subjects. The urinary excretions of phosphate, titratable acid, and ammonia under regular Korean diets were markedly lower as compared to those of the Europeans. However, there was no difference in the plasma concentration of phosphate between the Korean and the European. Upon administration of high protein diets, the urinary excretions of phosphate and titratable acid increased while the urine pH and the ammonia excretion were little affected. Thus, the correlations between urinary nitrogen and titratable acidity were 0.50 and 0.65, respective1y, showing a linear relationship. However, the correlation between urinary nitrogen and ammonia excretion was slight. The value of TmPO4 ranged from 74 to 355 muM/min with the mean of 193 muM/min, which is considerably higher than that of the European. On the basis of these findings, the overall pattern of the urinary acidification processes in the Korean is discussed.

Studies on Electrolytes and Nitrogen Metabolism of the Korean

In order to further characterize the basic pattern of electrolyte and nitrogen metabolism of the Korean, 24-hour urines were collected from 1,260 male subjects who were randomly selected from three different geographical areas (city, rural and island) in age from 6 to 25. For the city subjects, studies were conducted in both summer and winter for a seasonal comparison, while the other subjects were studied in the autumn only. Of these subjects, blood samples were also obtained from 225. In all groups, the serum composition of electrolytes including proteins was within normal range. The daily urine output which increased as a function of age was somewhat greater in summer than in winter. The daily urine output per unit surface is decreased inversely according to age. On the other hand, the urine osmolality which increased with age was higher in winter than in summer. The daily salt excretion which was greater in summer than in winter increased according to age, although the daily salt excretion per unit surface area was constant regardless of age. The daily potassium excretion was such that the urinary K/Na ratio decreased according to age while it was higher in winter than in summer. Likewise, the daily nitrogen excretion was much greater in winter than in summer while it increased with age. However, the daily nitrogen excretion per unit surface area decreased in older subjects age. In contrast to these seasonal differences in respect to certain electrolytes and nitrogen excretion, there was no distinct geographic difference in these variables. Moreover, many of the above variables changed according to age, but tended to stabilize at the age of approximately 15 years. A comparison of the present data with others indicates that the daily urine output and the daily salt excretion are greater while the urine osmolality, the daily nitrogen excretion and the urinary K/Na ratio are lower in the Korean than in the occidental. Moreover, these results strongly suggest that Korean people acquired a habit of ingesting low-protein and high-salt diets at the age of 6 years or perhaps before.

Work Performance After Thoracic Surgery

Cardio-pulmonary responses to a given step-up exercise test were studied in 43 patients who previously received various thoracic operations such as pleural decortication, one or two segmental resections, right or left upper lobectomy, plombage or pneumonectomy. Fourteen control subjects were also studied for comparison. Following a 30 minute rest, the step-up exercise was performed to heights of 20, 30 and 40cm, in that order, for 8 to 10 min. at each height. During the rest and the steady-state exercise period, the expired gas was collected for a period of 5 minutes for the determinations of the minute volume, the O2 consumption and the CO2 Output. Alveolar gas samples were a1so taken following the expired gas collection. The heart rate and blood pressure were also checked during the rest and immediately after each exercise. Various cardio-pulmonary functions of the patient at rest were little different from those of the control, except the heart rate which tended to be higher in the patient than in the control. Although the work capacity of the patient was lower than in the control, most patients were able to complete the required exercise test. However, in carrying out a given exercise load, the patient groups had a greater minute volume, the respiratory rate, the O2 consumption and the CO2 output as compared to the control, indicating that the mechanical efficiency is considerably lowered in the patient. Of various patient groups, the work performance was most limited in the pneumonectomy group while the group with one or two segmental resections was little affected. It is suggested that the patient with one or two segmental resections may be allowed to engage in physical activity up to 700 kg-m/min or more while those with pneumonectomy should not exert themselves above 500 k-gm/min.

Further Analysis of Various Renal Functions in the Korean I. Studies on Water Metabolism of the Korean

A typical pattern of daily water exchange was determined in 10 medical students during three different seasons: summer, autumn and winter. The daily water intake was averaged to 3,810ml of which 1,256ml was from liquids, 2,055ml from the water contained in food and 500ml from the water of oxidation. On the other hand, the daily water output was 1,844ml by urinary loss, 144ml by fecal loss and 1,819ml by evaporative loss. The above quantitative pattern of daily water exchange in the Korean remained unchanged throughout the year. The daily urinary output of NaCl and urea-nitrogen was in the order of 20gm and 10gm, respectively. Furthermore, the magnitude of daily water intake was well correlated to the daily urinary output of NaCl but little correlated to that of urea-nitrogen. A comparison of these data with the corresponding figures obtained from the occidental indicates that the daily water intake and the daily urinary output of NaCl were significant1y greater in the Korean than those in the occidental. On the basis of these results, the greater water intake in the Korean was attributed to their high salt intake.

Further Analysis of Various Renal Functions in the Korean II. Effect of High Protein Diet on Water Metabo1ism and Renal Functions

Effects of high protein diet on water metabolism and on various renal functions were studied in 4 medical students. The daily water intake during the high protein intake was averaged to 3,000ml of which 39% was from liquids, 49% from the water contained in food and 12% from the water of oxidation. Of the daily water output, 53% was by urine, 3% by feces and 44% by the evaporation. As compared to the occidental, this average daily water intake of 3,000ml on high protein diet was greater in the Korean. Moreover, the daily water intake for a given caloric intake or body weight was still significantly greater in the Korean. Moreover, the quantitative pattern of daily water exchange was not modified by the protein content in the diet. On the other hand, the urine osmolarity as well as the urea concentration increased when the protein intake was augmented. However, the urinary concentrations of Na+, Cl- and K+ were not affected by the amount of protein intake. When high protein diet was given, the values of CIN and CPAH showed only a slight increase but renal concentrating ability as judged by the magnitude of maximal negative free water clearance (T H20) showed a significant increase. From these results, it is evident that the lower renal concetrating ability of the normal Korean is most likely due to low protein intake. However, greater water intake in the Korean is independent of the changes in the renal concentrating ability. On the basis of these facts, it is again suggested that greater water intake in the Korean is attributable to greater salt intake.

Analysis of Various Renal Functions in the Korean

Various renal functions were studied in 45 young Koreans, 41 males and 4 females. The glomerular filtration rate, the renal plasma and blood flows and the filtration fraction were comparable to those in the occidental. The renal diluting capacity, as judged by the value of positive free water clearance (CH2O), was also comparable to that in the occidental. However, the renal concentrating ability, as judged by values of both the maximum urine osmolality induced by pitressin injection or during dehydration and the maximum negative free water clearance (TcmH2O) during mannitol diuresis, was somewhat low in the Korean. The tubular reabsorptive capacity of glucose (TmG) Was significantly low in the Korean while the tubular secretory capacity of PAH (TmPAH) was not altered. The urea clearance and its ratio with the inulin clearance were generally low. Moreover, the normal osmolar composition of urine indicated that urea is responsible for only 20 to 30%, while salt accounts for nearly 2/3 of the total urine osmolality. In view of the fact that the Korean is chronically maintained on a low or poor protein diet, these results are discussed in the light of this peculiar dietary habit of the Korean. Although the reduction of both the renal concentrating ability and the urea clearance could be reasonably attributed to a low protein intake, the observed low value of Tmc could not be explained thus at present.

The Relation of Urine Specific Gravity to Its Composition and Osmolality in the Normal Korean

A random urine sample was obtained from each of 155 normal Koreans and its specific gravity (S.G.), the total osmolality (Uosm) and the concentration of chloride (UCl) and urea (Uurea) were determined. The Uosm, 2 X UCl and Uurea were then plotted as a function of the S. G., and the following regression equations were obtaind: Uosm (in mOsm/kg) = 34,500 (S.G.-1,000), 2xUCl (in mOsm/kg) = 20,000 (S.G. 1,000), and Uurea (in mOsm/kg) = 10,000 (S.G.-1,000). the analysis of these data indicated that 58.5% of the Uosm could be accounted for by NaCl and 28.8% by urea while 41.0% of the S. G. of urine could be accounted for by NaCl and only 14.5% by urea. A comparison of these data with corresponding figures obtained from occidentals suggests that, in the Korean, the contribution of NaCl to both the Uosm and S.G. of urine is considerably higher, while that of urea is significantly lower than that in the occidental. This peculiarity of the urinary composition in Koreans is attributed to their ingestion of a lowprotein, high-salt diet.

Binding of Some Sulfonphthalein Dyes to Plasma Protein of Various Species

No abstract available.

Kinetic Studies on the Competition Between Para-aminohippuric Acid(PAH) and Diodrast for Renal Trnsport in the Dog

No abstract available.