Kim, So Hyun;Jung, Hyun Ho;Whang, Kum;Kim, Jong Yun;Pyen, Jin Su;Oh, Ji Woong
Journal of Korean Neurosurgical Society
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v.56
no.2
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pp.86-90
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2014
Objective : The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. Methods : We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. Results : Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were $2.42{\pm}1.24$ hours and $3.69{\pm}2.57$ hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were $192.12{\pm}45.97$ and $151.10{\pm}25.14$ for expansion and no expansion, respectively (p=0.001). Conclusions : The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.
Kim, Dae-in;Kim, Jae-hoon;Kang, Hee-in;Moon, Byung-gwan;Kim, Joo-seung;Kim, Deok-ryeong
Journal of Korean Neurosurgical Society
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v.59
no.5
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pp.498-504
/
2016
Objective : Although subdural hematoma (SDH) is commonly treatable by burr hole surgery in the late subacute or chronic stage, there is no clear consensus regarding appropriate management and exact predictive factors for postoperative recurrence also remain unclear. The aim of this study was to evaluate risk factors associated with recurrence of SDH that requires burr hole surgery in the late subacute or chronic stage. We also identified the appropriate timing of surgery for reducing the recurrence. Methods : We retrospectively reviewed 274 patients with SDH in the late subacute or chronic stage treated with burr hole surgery in our hospital between January 2007 and December 2014. Excluding patients with acute intracranial complications or unknown time of trauma onset left 216 patients included in the study. Results : Of 216 patients with SDH in the late subacute or chronic stage, recurrence was observed in 36 patients (16.7%). The timing of the operation in patients with late subacute stage (15-28 days) resulted in a significant decrease in recurrence (RR, 0.33; 95% CI, 0.17-0.65; p=0.001) compared to chronic stage (>28 days). Otherwise, no significant risk factors were associated with recurrences including comorbidities and surgical details. Conclusion : The results indicated that time from trauma onset to burr hole surgery may be important for decreasing the risk of recurrence. Therefore, unless patients can be treated conservatively without surgery, prompt surgical management is recommended in patients diagnosed as having late subacute or chronic subdural hematoma treatable by burr hole surgery, even when neurological deficits are unclear.
The purpose of this study was to evaluate the factors influencing the ambulatory status in hemiplegia with intracerebral hemorrhage after rehabilitation. Thirty patients with stroke who was admitted in the Chosun University Hospital, between from January 1st' 1998 and December 31st' 1998, were included in this study. The following variables as a potential predictors for ambulation were evaluated at treatment of the stroke onset; 1) general characteristics including age and sex, and 2) clinical characteristics including frequency and onset time of the stroke, affected side, duration of the treatment, time interval between onset and rehabilitation, manual muscle test of paretic limb, sitting and standing balance, proprioception, perception, cognitive function. We compared and analyzed the these variables to the two type of ambulatory status at the time of the discharge by Modified Barthel Index, independent, dependent. The data were analyzed by student t-test, Fisher-exact test, Mann Whitney-U test, $X^{2}$-test, correlation analysis(spearman's). The results were as follows; 1. Were no significantly inflenced independent ambulatory status among general characteristics. 2. Frequency of the stroke and proprioception (p<0.05), muscle strength of the lower limb, cognitive function and standing balance (p<0.01), perception and sitting balance (p<0.001) were significantly inflenced independent ambulatory status among clinical characteristics. 3. Independent Variable correlated with the ambulatory status were muscle strength of the lower limb, proprioception and sitting balance (p<0.05), standing balance, frequency of the stroke, perception and cognitive function (p<0.01). Therefore the muscle strength of the lower limb, proprioception, sitting balance, standing balance, frequency of the stroke, perception, cognitive function were the most significant influencing factors of ambulatory status after rehabilitation.
Introduction: This systematic review evaluated the use of buffered versus non-buffered lidocaine to increase the efficacy of inferior alveolar nerve block (IANB). Materials and Methods: Randomized, double-blinded studies from PubMed, Web of Science, Cochrane Library, Embase, and ProQuest were identified. Two of the authors assessed the studies for risk of bias. Outcomes included onset time, injection pain on a visual analog scale (VAS), percentage of painless injections, and anesthetic success rate of IANB. Results: The search strategy yielded 19 references. Eleven could be included in meta-analyses. Risk of bias was unclear in ten and high in one study. Buffered lidocaine showed 48 seconds faster onset time (95% confidence interval [CI], -42.06 to -54.40; P < 0.001) and 5.0 units lower (on a scale 0-100) VAS injection pain (95% CI, -9.13 to -0.77; P=0.02) than non-buffered. No significant difference was found on percentage of people with painless injection (P = 0.059), nor success rate (P = 0.290). Conclusion: Buffered lidocaine significantly decreased onset time and injection pain (VAS) compared with non-buffered lidocaine in IANB. However due to statistical heterogeneity and low sample size, quality of the evidence was low to moderate, additional studies with larger numbers of participants and low risk of bias are needed to confirm these results.
Background: Pain is an unpleasant sensation ranging from mild localized discomfort to agony and is one of the most commonly experienced symptoms in oral surgery. Usually, local anesthetic agents and analgesics are used for pain control in oral surgical procedures. Local anesthetic agents including lignocaine and bupivacaine are routinely used in varying concentrations. The present study was designed to evaluate and compare the efficacy of 0.25% and 0.5% bupivacaine for postoperative analgesia in infraorbital nerve block. Methods: Forty-one patients undergoing bilateral maxillary orthodontic extraction received 0.5% bupivacaine (n = 41) on one side and 0.25% bupivacaine (n = 41) on the other side at an interval of 7 d. The parameters evaluated for both the bupivacaine concentrations were onset of action, pain during procedure (visual analog scale score [VAS]), and duration of action. The results were noted, tabulated, and analyzed using the Wilcoxon signed rank test. Results: The onset of action of 0.5% bupivacaine was quicker than that of 0.25% bupivacaine, but the difference was not statistically significant (P = 0.306). No significant difference was found between the solutions for VAS scores (P = 0.221) scores and duration of action (P = 0.662). Conclusion: There was no significant difference between 0.25% bupivacaine and 0.5% bupivacaine in terms of onset of action, pain during procedure, and duration of action. The use of 0.25% bupivacaine is recommended.
Kim, Se Jin;Kim, Ga Eun;Park, Jae Hyun;Lee, Sang Lak;Kim, Chun Soo
Clinical and Experimental Pediatrics
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v.62
no.1
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pp.36-41
/
2019
Purpose: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. Results: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4-1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3-1,628.7) and decreased activity (OR, 34; 95% CI, 1.8-633.4), were found to be associated with fatality. Conclusion: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.
This study was carried out to investigate the fertility and farrowing date in post-weaning sows using PG600 and inseminated with frozen semen. A total of 48 sows of Landrace, Large White and Duroc after 7-week lactation were used at the Chungnam Provincial Animal Breeding Station. The results obtained were summarized as follows: 1. Motility had no significant differences between the breeds, but NAR acrosome was highest in Landrace, followed by Duroc and Large White(p<.01). 2. Interval from weaning to estrus and length of estrus were, respectively, 3.7 days and 52.6hours of sows treated with PG600, and 6.5 days and 53.8 hours for control sows. The average interval from weaning to onset of estrus was significantly(p<.01) shorter by 2.8 days in PG600 treated sows compared to control sows. 3. In Landrace, Duroc and Large White, farrowing rate and number of pigs born alive per litter were 55.0%, 10.0; 43.8%, 8.1; and 16.7%, 3.5, respectively. Average pig weight at birth and survival rate at 56 days had no significant differences between the breeds. 4. Farrowing rate, number of pigs born alive per litter, average pig weight at birth and survival rate at 56 days were, respectivey, 45.8%, 101, 1.56kg and 94.5% for sows treated with PG600, and 37.5%, 7.0, 1.66kg and 93.8% for control sows. Sows treated with PG 600 had an average of 3.1 more pigs at farrowing compared to control sows.
Objective : The aim of this study is to analyze the clinical symptoms, radiological changes, interval from first operation to symptom recurrence and to propose the proper treatment method for re-operated patients following chronic subdural hematoma surgery. Methods : Between January 1992 and April 2003, 18 of 138patients of chronic subdural hematoma repeatedly underwent surgical treatment. The symptoms, mental status by Bender grade, radiological hematoma size and midline shifting, interval from symptom onset to diagnosis, surgical method and prognosis by Glasgow outcome scale[GOS] between the first attack and the recurrence were compared. Results : The symptoms at the time of recurrence were nearly the same as with the first attack, but two patients[2/18, 11.1%] showed a more declined mentality. In addition, the recurred hematoma sizes were the same or large than those previously found. Many patients were recurred within two weeks[13/18, 72.2%]. Most patients were operated on using the previous burr hole, with the exception of one patient who recurred at a different site. All patients had a good prognosis more than GOS 4 [GOS 4:4, GOS 5:12], but two died due to extracranial complication and infection. Conclusion : These results suggest that the early diagnosis and treatment are important, mostly recurred same symptoms within two weeks. Re-operation using the previous burr hole site is a good method.
Since opening of the Yeungnam University Hospital in June 1983 till end of 1984, total 30 cases of cerebral thrombosis were analysed clinically. Among the 30, 17 cases were given Urokinase from 60,000 to 240,000 units daily for 2-46 days. The interval from the onset to the inititiation of therapy varied from 1 hour to 17 days. Ten cases showed marked recovery and 6 cases moderate improvement. One case, in which only 120,000 units daily were administered, showed stationary course. The interval of the Urokinase untreated 13 cases was from 3 days to 18 months. Six cases were stationary, whereas 7 cases showed mild improvement. Age, sex, past history, associated diseases, and the laboratory findings are shown in the tables. Conclusion is that the earlier the therapy started, the higher the dosage used, the better of the results is obtained.
Fifth one Nili-Ravi dairy buffaloes were studied in North-west Frontier Province of Pakistan. Rectal examination of reproductive organs was carried out on days 14 and 21 and then fortnightly. Milk samples were collected and analyzed for progesterone levels (MPL). Feed samples were collected fortnightly and analyzed. The buffaloes calving during the normal breeding season (NBS, August to January) (p<0.01) postpartum estrus interval of 55.95 days versus 91.15 days in those calving during the low breeding season (LBS, February to July). MPL in the LBS remained lower than the NBS (p<0.01). Shortest postpartum ovulation interval was noted during autumn(August to October), followed by winter (November to January), summer (May to July) and spring (February to April). The incidence of silent ovulations was during LBS than NBS (70.6% versus 29.4%). In autumn there was minimum intake of crude protein (CPI) and maximum intake of metabolizable energy (MEI, p<0.01). Calcium intake was higher in NBS than LBS calving buffaloes (p<0.01). Phosphorus, copper and magnesium intake was lower (p<0.05) and zinc intake was higher (p<0.01) in autumn, It was (p<0.05) and zinc intake was higher (p<0.01) in autumn, It was concluded that onset of breeding season was associated with increasing MEI and decreasing CPI and minerals intake.
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