Ocular Complications after Injection of Intra-arterial Carboplatin in Gliomas

Carboplatin intra-arterial chemotherapy(IAC) has an advantage of increased uptake during the first passage of the drugs through tumor capillaries. Although not common, this type of therapy is known to cause neurological complications, myelosuppression, and ototoxicity. However, the incidence of ocular toxicity is reported to be rare. Eleven of our patients with glioma(Grade II Astrocytoma: 3, Grade III Astrocytoma: 1, Grade IV Astrocytoma: 5, Gliofibroma: 1, Oligodendroglioma: 1) underwent IAC regimen with carboplatin(300mg/m2) which were administrated after blood-brain barrier disruption. Of there, 3 patients had ocular complications after supra-ophthalmic IAC injection of carboplatin but fully recovered following steroid therapy. Although our results from IAC seem to be favorable for these patients, we suggest that its complications, such as ocular toxicity, need to be carefully considered prior to treatment.

Influence of Hypoglycemia and Hypothermia on Direct Current Potential During Cortical Spreading Depression in Rats

The object of this study was to investigate the influences of hypoglycemia and hypothermia on the direct current(DC) pontetial changes during cortical spreading depression(CSD) in rats. The induction of CSD was achieved by the application of KCI solution on the cortex of the frontal lobe. Hypoglycemia and hypothermia were induced respectively by insulin injection and the application of an ice pack. The DC potential changes during progressive hypoglycemia and hypothermia were measured with microelectrodes from the cortex of the parietal lobe of rats. Under contril condition, the rate of CSD was one per 5-10 min and the negative shift of DC potential was about 30 mV. The recovery time from negative shift to base line of DC potential was about 40 sec. In rats treated with insulin, the amplitude of DC potential shift was unaffected by hypoglycemia. The recovery time of DC shift was 40+/-2.26 sec at normoglycemia and it was delayed progressively as the blood glucose level lowered. The mean of it was 63+/-8.02 sec at 30 mg/dl and 77.1+/-22.0 sec with the blood glucose falling below 20 mg/dl. The same delay in the recovery time as seen in the hypogylcemia group was observed in rats treated with hypothermia. The recovery time of DC shift was 39.4+/-3.02 sec in normothermia(36.5degrees C), but it was delayed to 61.15+/-4.15 sec at 30degrees C and 96.67+/-14.92 sec at 26degrees C body temperature. This study suggested that each condition of profound hypoglycemia below 30 mg/dl and hypothermia below 30degrees C was to be harmful to the ion homeostasis and the integrity of the cell membrane and it may lead neurons to death.

The Effects of Acetazolamide and Fluphenazin on CSF Formation

The purpose of this study was to invstigate the effect of acetazolamide and fluphenazine on the formation of CSF. Studis were performed in 12 cats those were divided into 2 groups;A-F group included animals received initial acetazolamide infusion and additional infusion of fluphenazine to the initial infusion and the F-A group for vice versa. The rate of CSF formation was measured at 3cm above zero outflow pressure by force transducer which connected to personal computer. After obtaining steady value of CSF formation rate, the drugs were infused intravenously according to the protocol. Base line CSF formation rate, 18.87+/-6.52 microliter/min. is reduced to 6.67+/-2.45 microliter/min after acetazolamide infusion and further reduced to 3.48+/-4.06 microliter/min after additional fluphenazine. In fluphenazine group, the base line CSF formation rate, 16.34+/-4.58 microliter/min is reduced to 9.63+/-4.58 microliter/min after initial infusion of fluphenazine and further to 6.45+/-3.64 microliter/min. after additional infusion of acetazolamide. Mean reduction of CSF formation after initial intravenous infusion of acetazolamide and fluphenazine were 59% and 37% respectively. Although statistically insignificant, the CSF formation reduction in A-F group revealed more even and profound value comparing with that of F-A group. These date suggest that in addition to the effect of acetazolamide to reduce the formation of CSF, some other mechanism may exist in CSF formation that major tranquilizer exert the effect on CSF formation.

Clinical Analysis of Ruptured Intracranial Aneurysms

The author analyzed 177 consecutive cases of saccular, ruptured intracranial aneurysms admitted to the Department of Neurosurgery in Korea University Hospital during the period from August 1983 to July 1987. the results of analysis were summarized as follows. 1) Mean age of the patients was 50.4 years. 2) Incidence of clinical vasospasm was 27.2%(46/177) and of rebleeding was 10.7%(19/177). 3) Surgery was done for patients which accounts for 57.6% of all patients. Functional recovery was noted in 84 of the these surgically treated patients(84.6%). 4) The prognostic factors are age, hypertension, size of aneurysm, site of aneurysm, preoperative neurological state, vasospasm, hydrocephalus, rebleeding, timing of operation, multiplicity. 5) The mean size of aneurysms was 6.9mm. The direction of aneurysms was variable, but most of them pointed in the direction of blood flow in afferent arteries.

Clinical Analysis of Ruptured Intracranial Aneurysms

The author analyzed 177 consecutive cases of saccular, ruptured intracranial aneurysms admitted to the Department of Neurosurgery in Korea University Hospital during the period from August 1983 to July 1987. the results of analysis were summarized as follows. 1) Mean age of the patients was 50.4 years. 2) Incidence of clinical vasospasm was 27.2%(46/177) and of rebleeding was 10.7%(19/177). 3) Surgery was done for patients which accounts for 57.6% of all patients. Functional recovery was noted in 84 of the these surgically treated patients(84.6%). 4) The prognostic factors are age, hypertension, size of aneurysm, site of aneurysm, preoperative neurological state, vasospasm, hydrocephalus, rebleeding, timing of operation, multiplicity. 5) The mean size of aneurysms was 6.9mm. The direction of aneurysms was variable, but most of them pointed in the direction of blood flow in afferent arteries.

Raeder's Paratrigeminal Syndrome

The authors report two cases of paratrigeminal syndrome. They were male and involved in the left side, and had no known hypertension. The syndrome was produced and encountered in patients who had undergone a percutaneous carotid angiography and surgery with ligation of common carotid artery for the treatment of carotidcavernous sinus fistula. The clinical manifestations were unilateral, intense, throbbing supraorbital and periorbital pain recurring regularly, accompanied by drooping of the eye lid and miosis with normal sweating on the same side as the pain. The cases were treated conservatively with diphenylhydantion and antimigraine preparations with apparent success. It is probable that the underlying pathology of the syndrome in these cases may be compression of the internal carotid sympathetic fibers due to swelling of the interal carotid arterial wall. The clinical features and courses were compatible with those of group 2 of Raeder's syndrome.