• Science of Emotion and Sensibility
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• v.27 no.3
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• pp.61-70
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• 2024

This study aimed to investigate the effects of voluntary intrathoracic pressure adjustment during the Valsalva maneuver (VM) on changes in prefrontal brain function and cerebral blood flow dynamics using diagnostic ultrasound and near-infrared spectroscopy (NIRS). Sixteen healthy adults performed VM by adjusting their expiratory pressure. Their regional oxygen saturation (rSO2) and oxidized hemoglobin (HbO) levels were measured to confirm changes in prefrontal lobe function. To confirm hemodynamic changes in cerebral blood vessels, this study measured peak systolic velocity (PSV), heart rate (HR), vascular stiffness (STIFF), and pulse wave velocity (PWV) in the common carotid artery before and after the VM. Results showed significant cerebrovascular physiological changes after 30mmHg VM. In particular, PSV increased significantly following VM, whereas PWV and STIFF significantly decreased. A similar trend was observed in 40mmHg VM to 30mmHg, but no significant change was observed except for HR, which showed a significant decrease. Furthermore, rSO2 tended to increase in the prefrontal region after preforming 30 and 40mmHg VM, but it did not show a significant difference. In contrast, HbO significantly decreased after performing 30 and 40mmHg VM. This trend did not show any difference depending on intrathoracic pressure. In conclusion, VM performance at both intrathoracic pressure levels has the same effect on brain function, but induces difference changes in cerebrovascular vessels' physiological function. Thus, at 40mmHg VM, it interferes with effective vascular relaxation due to high intrathoracic pressure. However, 30mmHg VM has an effective effect on cerebrovascular function by causing a significant increase in the elasticity of arterial blood vessels. Such VM performance can effectively improve cerebrovascular function.

• Journal of Korean Neurosurgical Society
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• v.45 no.6
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• pp.386-389
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• 2009

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

• Journal of Korean Neurosurgical Society
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• v.29 no.12
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• pp.1570-1576
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• 2000

Objective : To evaluate objectively the sites of injury in patients with posttraumatic olfactory deficits and to suggest the diagnostic procedure for evaluation of posttraumatic anosmia. Methods : Ten patients with posttraumatic olfactory dysfunction were examined by means of olfactory testing, sinoscopy, contrast filled paranasal sinus computed tomography(contrast filled PNS CT) and magnetic resonance imaging(MRI). Five normal persons without olfactory dysfunction were also evauluated. The aerodynamic patency of olfactory cleft was examined by contrast filled PNS CT. The olfactory system(oflactory bulbs, olfactory tracts, inferior frontal region, hippocampi, or temporal lobes) was investigated in detail with MRI. The difference in the size of the olfactory bulb between normal volunteers and anosmic patients was evaluated by Student's t test. Results : Contrast filled dynamic CT scan was useful method for the evaluation of dynamic patency of the olfactory cleft. Paranasal CT scan of the all anosmic patients showed dynamic reflux of contrast media in olfactory cleft on valsalva maneuver. For the largest cross-sectional area and great height, the difference in olfactory bulb size between normal volunteers and patients was statistically significant(p<0.001) in MRI study. Conclusion : Posttraumatic anosmia was completely evaluated by olfactory testing, sinoscopy, and contrast filled CT scan for differentiation between conductive type and neurogenic type. Neurogenic anosmia was confirmed by perfect localization with MRI study.

• Archives of Plastic Surgery
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• v.37 no.4
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• pp.489-491
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• 2010

Purpose: Retrobulbar hemorrhage is a rare complication followed by blepharoplasty, trauma, orbital reconstruction, and so on. Most of the cases occur within 24 hours, half of them in the first 6 hours. Some authors have reported delayed retrobulbar hemorrhage after blepharoplasty and trauma within 1 day to 9 days. However, there have been few reports of delayed retrobulbar hemorrhage resulting from the complication of orbital reconstruction. Methods: A 22-year-old male underwent orbital floor reconstruction due to the orbital floor fracture. In 84 hours after the surgery, he complained sudden onset orbital pain and decreased visual acuity immediately after defecation. Intraocular pressure was unmeasurable due to the swelling at that time. Emergency computed tomography was performed. Results: Computed tomography revealed subperiosteal hematoma on inferior orbital wall extended to the apex. Emergency decompressive surgery was performed within 1 hour. After evacuation of hematoma, orbital symptom was improved and visual acuity was restored. Conclusion: Delayed retrobulbar hemorrhage is rare but vision-threatening. Therefore early diagnosis and treatment of delayed retrobulbar hemorrhage is thought to be crucial. The cause of delayed hemorrhage was not clear, however, valsalva maneuver might be the cause of hemorrhage.

• Tuberculosis and Respiratory Diseases
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• v.45 no.2
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• pp.404-415
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• 1998

Background: Sleep apnea syndrome, which occurs in 1~4 % of the adult population, frequently has different cardiovascular complications such as hypertension, ischemic heart disease, cardiac arrythmia as well as sleep-wake disorder such as excessive daytime hypersomnolence or insomnia. Mortality and vascular morbidity are reported to be significantly higher in sleep apnea syndrome patients than in normal population. According to the recent studies, autonomic dysfunction as well as hypoxemia, hypercapneic acidosis, and increased respiratory effort, may playa role in the high prevalence of cardiovascular complications in patients with sleep apnea syndrome. However the cause and mechanism of autonomic neuropathy in patients with sleep apnea syndrome are not well understood. We studied the existence of autonomic neuropathy in patients with sleep apnea syndrome and factors which influence the pathogenesis of autonomic neuropathy. Method: We used the cardiovascular autonomic neuropathy(CAN) test as a method for evaluation of autonomic neuropathy. The subjects of this study were 20 patients who diagnosed sleep apnea syndrome by polysomnography and 15 persons who were normal by polysomnography. Results: Body mass index and resting systolic blood pressure were higher in sleep apnea group than control group. Apnea index(Al), respiratory disturbance index(RDI) and snoring time percentage were significantly higher in sleep apnea group compared with control group. But there were no significant differences in saturation of oxygen and sleep efficiency in two groups. In the cardiac autonomic neuropathy test, the valsalva ratio was significantly low in sleep apnea group compared with control group but other tests had no differences between two groups. The CAN scores and corrected QT(QTc) interval were calculated significantly higher in sleep apnea group, but there were no significant correlations between CAN scores and QTc interval. There were no significant data of polysomnography to correlate to the CAN score. It meant that the autonomic neuropathy in patients with sleep apnea was affected by other multiple factors. Conclusion: The cardiovascular autonomic neuropathy test was a useful method for the evaluation of autonomic neuropathy in patients with sleep apnea syndrome and abnormalities of cardiovascular autonomic neuropathy were observed in patients with sleep apnea syndrome. However, we failed to define the factors that influence the pathogenesis of autonomic neuropathy of sleep apnea syndrome. This study warrants futher investigations in order to define the pathogenesis of autonomic neuropathy in patients with sleep apnea syndrome.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.