Gauze Packing for the Massive Venous Sinus Bleeding in a Patient with Acute Subdural Hematoma of Posterior Fossa / 대한신경손상학회지

A 57-year-old male had cardiac arrest during an operation of traumatic acute subdural haematoma (ASDH) and intraparenchymal haemorrhage in the infratentorium due to a great amount of bleeding from the pre-injured venous sinus. After effective bleeding control using a gauze, the patient recovered without additional neurological sequelae. The operation of traumatic ASDH in the infratentorium always poses a risk of excessive bleeding from the injured venous sinus that could be life-threatening to the patient. This risk could be avoided with the effective first method that can immediately control the bleeding.

Spontaneous Absorption of Cerebral Air Embolus Developed Accidentally during an Intra-arterial Procedure

Cerebral arterial air embolism (CAAE), although infrequent, is a complication that can occur at any time during an invasive medical procedure. We experienced two cases of CAAE during cerebral angiography accidentally. The author reports the two cases of CAAE wherein air emboli dissolved spontaneously and immediately under normal atmospheric pressure, not under therapeutic hyperbaric environment. One of the cases shows entire dissolution of the air embolus on the moving image. This report shows that arterial air embolus can be absorbed spontaneously, and air embolus size is one of the factors that influence air embolus dissolution besides hyperbaric oxygen condition.

Intracranial Vasospasm without Intracranial Hemorrhage due to Acute Spontaneous Spinal Subdural Hematoma

Spontaneous spinal subdural hematoma (SDH) is very rare. Furthermore, intracranial vasospasm (ICVS) associated with spinal hemorrhage has been very rarely reported. We present an ICVS case without intracranial hemorrhage following SDH. A 41-year-old woman was admitted to our hospital with a complaint of severe headache. Multiple intracranial vasospasms were noted on a brain CT angiogram and transfemoral cerebral angiography. However, intracranial hemorrhage was not revealed by brain MRI or CT. On day 3 after admission, weakness of both legs and urinary incontinence developed. Spine MRI showed C7~T6 spinal cord compression due to hyperacute stage of SDH. After hematoma evacuation, her symptoms gradually improved. We suggest that spinal cord evaluation should be considered in patients with headache who have ICVS, although intracranial hemorrhage would not be visible in brain images.

Pseudoaneurysm of the Petrosal Internal Carotid Artery in the Middle Ear as a Complication of Middle Ear Cholesteatoma

We report the case of a 66-year-old man who had significant otorrhagia caused by a ruptured pseudoaneurysm in the petrous internal carotid artery (ICA). The patient had middle ear cholesteatoma, and computed tomography (CT) showed bony erosion and exposure of the ICA into the middle ear cavity. Further angiography of the right carotid artery revealed a pseudoaneurysm protruding from the petrosal ICA into the middle ear cavity. The pseudoaneurysm was promptly treated with coil embolization and stenting. The patient continues to be monitored regularly with clinical follow-up, and carotid angiography and temporal bone CT revealed no interval changes at the embolized site 3 years after the procedure.

An ideal model of informed consent communication / 한국의학교육

Informed consent (IC) should be a form of communication between a physician and patient in which information regarding all options of a medical procedure and the patient's preference is shared. The aim of this study was to create a standard for communication by IC for physicians. The IC standard was developed based on an analysis of a dialogue in our previous experience with a medical communication program and a review of the literature. The dialogue pattern of the IC standard had the following six elements: opening; orientation; disclosure of information; conforming and complementing; shared decision making; and closing. Factors that influenced effective IC-based communication included preparation, attitude, empathy, listening, a psychosocial factor, nonverbal communication, explanation, and understanding. The IC communication standard will be useful in improving the quality of communication between a physician and patient in obtaining IC. It will also be used as a guideline for communication educators and medical students. Innovative strategies and rigorous studies are needed to improve IC counseling to establish effective patient-centered interviews.

Effectiveness of Mechanical Embolectomy for Septic Embolus in the Cerebral Artery Complicated with Infective Endocarditis

There has been a controversy over data of thrombolytic and endovascular surgical treatment about cerebral infarction secondary to infective endocarditis. We report a woman who received early mechanical embolectomy as a treatment of acute stroke with infective endocarditis. A 35-yr-old woman was hospitalized due to right hemiparesis. Brain image showed cerebral infarction at the middle cerebral artery and echocardiography demonstrated vegetation at the mitral valve. She was successfully treated with embolectomy and parenteral antibiotics without any neurologic sequelae. This report shows that the early retrieve of septic cerebral emboli can be a helpful treatment of acute stroke associated with endocarditis.

Multiple Liver Abscesses Associated with Ventriculoperitoneal Shunt Infection: Case Report and Review of the Literature

Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy.

A Ruptured Aneurysm in the Branch of the Anterior Spinal Artery

Incidence of aneurysm of the anterior spinal artery is known to be very low and the standard treatment strategy has not yet been established. The author experienced a case of subarachnoid hemorrhage (SAH) caused by the rupture of an aneurysm in the branch of the cervical anterior spinal artery, which was managed conservatively. The patient had end-stage common bile duct cancer and survived for 103 days after onset of the SAH without a re-rupture of the aneurysm.

An Experience of Blood Transfusion by Difference of the Count of Fusion Segments in Lumbosacral Spinal Fusion / 대한수혈학회지

BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.

An Experience of Blood Transfusion by Difference of the Count of Fusion Segments in Lumbosacral Spinal Fusion / 대한수혈학회지

BACKGROUND: A large amount of blood is lost during spinal fusion surgery; therefore, a blood transfusion is required. In this study, we analyzed the amount of transfusion and hemodynamic changes in relation to the count of fusion segments in lumbosacral spinal surgeries. METHODS: We analyzed 67 patients who had undergone lumbosacral fusion. They were divided into five groups according to the levels of fusion segments (one level: Group 1, two levels: Group 2, three levels: Group 3, four levels: Group 4 and above three levels: Groups 3+4). Total amounts of transfusion and perioperative hemodynamic changes were compared among each group. RESULTS: Of the total 67 cases, 40 cases were Group 1, 19 cases were Group 2, five cases were Group 3, three cases were Group 4, and eight cases were Groups 3+4. Average volume of Red Blood Cell (RBC) transfusion per operation was 703+/-463 mL (Group 1), 934+/-372 mL (Group 2), 1,677+/-847 mL (Group 3), 1,231+/-412 mL (Group 4), and 1,509+/-669 mL (Group 3+4); and average volume of fresh frozen plasma (FFP) per operation was 55+/-141 mL (Group 1), 108+/-181 mL (Group 2), 306+/-368 mL (Group 3), 567+/-260 mL (Group 4), and 404+/-317 mL (Groups 3+4). Eight patients received transfusion of Platelet Concentrate (PC); each patient received 10 units (400 mL). The preoperative mean level of hemoglobin and platelet was 13.62+/-1.47 g/dL and 245+/-60x10(3)/microliter, postoperatively, 10.26+/-1.14 g/dL and 150+/-46x10(3)/microliter. CONCLUSION: As the fusion segments increase, the need for transfusion of RBC, FFP, and PC increases. Application of the Maximum Surgical Blood Order Schedule (MSBOS) system is required in the planning of spinal fusion, especially in multiple segments.

Recurrent Subarachnoid Hemorrhage after Complete Obliteration of Intracranial Aneurysm

The authors report a case of recurrent subarachnoid hemorrhage (SAH) after complete occlusion of an intracranial aneurysm. It is known that regrowth of an aneurysm after the complete clipping is a rare event. For detection of recurrence, however, it may be necessary to follow up with the patient regularly after the initial operation for intracranial aneurysms, because re-rupture of an aneurysm can cause a fatal result, and the cumulative risk of a recurrent SAH is thought to be not low over time.

The Effect of Tyrosine Kinase Inhibitors on the L-type Calcium Current in Rat Basilar Smooth Muscle Cells

OBJECTIVE: Tyrosine kinase inhibitors may be useful in the management of cerebral vasospasm. It has not yet been reported whether L-type Ca2+ channels play a role in tyrosine kinase inhibitors-induced vascular relaxation of cerebral artery. This study was undertaken to clarify the role of L-type Ca2+ channels in tyrosine kinase inhibitors-induced vascular relaxation, and to investigate the effect of tyrosine kinase inhibitors on L-type Ca2+ channels currents in freshly isolated smooth muscle cells from rat basilar artery. METHODS: The isolation of rat basilar smooth muscle cells was performed by special techniques. The whole cell currents were recorded by whole cell patch clamp technique in freshly isolated smooth muscle cells from rat basilar artery. RESULTS: Patch clamp studies revealed a whole-cell current which resembles the L-type Ca2+ current reported by others. The amplitude of this current was decreased by nimodipine and increased by Bay K 8644. Genistein(n=5), tyrphostin A-23(n=3), A-25(n=6) 30micrometer reduced the amplitude of the L-type Ca2+ channel current in whole cell mode. In contrast, diadzein 30 micrometer (n=3), inactive analogue of genistein, did not decrease the amplitude of the L-type Ca2+ channels current. CONCLUSION: These results suggest that tyrosine kinase inhibitors such as genistein, tyrphostin A-23, A-25 may relax cerebral vessel through decreasing level of intracellular calcium, [Ca2+]i, by inhibition of L-type Ca2+ channel.

The Effect of Papaverine on the Calcium-dependent K+ Current in Rat Basilar Smooth Muscle Cells

OBJECTIVE: Papaverine has been used in treating vasospasm following subarachnoid hemorrhage(SAH). However, its action mechanism for cerebral vascular relaxation is not clear. Potassium channels are closely related to the contraction and relaxation of cerebral smooth muscle. Therefore, to identify the role of potassium and calcium channels in papaverine-induced vascular relaxation, we examine the effect of papaverine on potassium channels in freshly isolated smooth muscle cells from rat basilar artery. METHODS: The isolation of rat basilar smooth muscle cells was performed by special techniques. The whole cell currents were recorded by whole cell patch clamp technique in freshly isolated smooth muscle cells from rat basilar artery. Papaverine was added to the bath solution. RESULTS: Papaverine of 100 microM into bath solution increased the amplitude of the outward K+ current which was completely blocked by BKCa(large conductance calcium dependent potassium channels)blocker, IBX(iberiotoxin), and calcium chealator, BAPTA(1, 2-bis(o-aminophenoxy)ethane-N, N, N', N'-tetraacetic acid), in whole cell mode. CONCLUSION: These results strongly suggest that potassium channels may play roles in papaverine-induced vascular relaxation in rat basilar artery.