Clinical Significance of Rebleeding and Risk Factors Affecting Rebleeding in Patients with Spontaneous Subarachnoid Hemorrhages

To investigate the clinical significance of and risk factors for rebleeding in patients with spontaneous subarachnoid hemorrhages(SAH), the authors reviewed the consecutive cases of 527 patients admitted in the 7-year period from 1988 to 1995. Of these patients, 75(14.2%) rebled. Rebleeding occurred within 24 hours in 45 patients, among whom 32 cases rebled within 12-24 hours after initial SAH, within 1-3 days in 19, within 4-7 days in 9, and after 1 week in 2. These patients had an overall mortality of 82.9% compared to 28.4% for patients without rebleeding. The patients with rebleeding within 24 hours after the initial attack had an operative rate of 34.9% and a postoperative mortality of 53.3% compared to 26.8%, 37.5%, respectively, for patients with rebleeding after 24 hours. The significant factors affecting rebleeding were as follows;Over 70 years in age, association with intracerebral hematoma(10-20cc), sizure before operation, aneurysms on the vertebrobasilar system, poor neurological condition on admission, and angiography within 6 hours of initial SAH. Ultra-early operation within 24 hours following intentional delay in angiography of at least 6 hours from the initial rupture is recommended if the associated hematoma is not large enough to show mass effect.

Hypertensive Intracerebral Hemorrhage Associated with Unruptured Intracranial Saccular Aneurysms:Report of Three Cases

No abstract available.

Outcome form Diffuse Brain Injury Related to Patient's Age

The present study compares the outcome of adult and pediatric patients with severe diffuse brain injury, and analyzes factors affecting the prognosis related to age difference. Of 912 patients admitted with head injury during the past three years, 223(1.7%) patients were identified as severe diffuse brain injury. Among the 223 patients. 100 patients were 15 years of age or less as the pediatric group. The mortality rate for pediatric and adult group was 39.0% and 48.8%, respectively. The common factors affecting poor prognosis for both groups were Glasgow Coma Scale(GCS) of 5 or less, papillary abnormality, hypoxia(PaO2<60 mmHg), the presence of skull fracture(basilar skull fracture in children, and basilar or vault skull fracture in adult group), diffuse brain swelling, subarachnoid hemorrhage, intraventricular hemorrhage, and thin subdural hematoma. The factors affecting prognostic difference between the adult and pediatric group with diffuse brain injury were the presence of vault skull fracture(p<0.01) and diffuse brain swelling(p<0.05). In patients associated with vault skull fracture or diffuse brain swelling, adult group had a significantly poorer outcome than child group.

Agglutination activities of human sera to cat red blood cells / 대한법의학회지

No abstract available.

Outcome Following Diffuse Brain Injury in Children

No abstract available.

Two Cases of Primary Intracranial Melanoma

Primary malignant melanoma arising from the leptomeninges is a rare entity. We report two cases of primary intracranial melanoma developed in one aged 65 years female and the other 70 years male. One case died 2 years after the operation, and the other case is still living more than 1 year after operation. Both cases seems to have a relatively long survival. The literature on this subject is briefly reviewed.

Traumatic Intracerebral Hematoma

During a 36-month period, clinical outcome in 170 patients with traumatic intracerebral hematoma(TICH) was analysed. These patients represented 5.1% of 3328 consecutive patients with head injuries admitted to the Soonchunhyang University Chunan Hospital. The overall mortality was 33.5%. A significant number of patients(52.6%), who were not comators at the time of admission(GCS0.005) ; 2) the presence of associated lesions(p>0.01) ; 3) time delay of two hours or more from admission to operation(p>0.05) ; 4) actual midline shift of 4.5mm or above on initial CT scan(p>0.005) ; 5) obliteration of suprasellar cistern(p>0.005) ; 6) the presence of delayed traumatic intracerebral hematoma(DTICH) in non-surgical patients with GCS score of 8 or above(p>0.01). Age and location of hematoma did not affect outcome, but the patients with multiple located hematoma showed higher mortality than the others. Time delay in the treatment of TICH and DTICH contribute significantly to poor outocme. Rapidly progressive DTICH within 48 hours after trauma is high in mortality. Follow-up CT scan might as well be performed till 48 hours after injury and 8 hours after initial operation, even though neurological status did not alter for the worse.

Ganglioglioma of Conus Medullaris: Case Report

Gangiogliomas are rare tumors, primarily seen in patients under the age of 30 years. They occure least commonly in the spinal cord. We present a 17-year-old girl who harbored an intramedullary conus ganglioglioma.

Experiences of Neurosurgical Care Unit

We made use of a neurosurgical care unit (NCN) from May 1986. The NCU differs from the intensive care unit (ICU) in several points. The NCU has 16 beds for neurosurgical patients who require continuous observation while the intensive therapy is not likely to be required. Wall units for oxygen and suction are equipped for each bed. One of the patient's family or relatives could attend the patient in the NCU. Neurosurgical nurse education has been offered monthly according to a scheduled curriculum to enhance an ability of neurosurgical close observation. The NCU has several unique advantages. The NCU can solve the bed availability problem caused by not only increased requirement for beds but also patients who were stabilized but still dependant or had some risk of sudden deterioration. Patients in the NCU require more observation than therapy. Thus, the NCU requires less equipments than the ICU, so it is cheap to set up. Regular neurosurgical nurse education fills up the efficiency of the NCU. Attendance of the family not only adds man-power but also provides a skinship and more intimate therapeutic environment. It also potentiates ability to care at home by their family. Our model of NCU has brought so significant advantages that we may advocate the efficacy of such an intermediate care facility, and present here our model of NCU.

Investigation with a Questionnaire for Diagnosis and Duration of Treatment of Head Injury

Recent advances in diagnosis and therapy for head injury have brought some changes in concepts, definition of the terms, therapeutic methods and the duration of treatment. In medical certificates, the diagnosis and duration of treatment also need to be changed according to the new concepts. Mixed use of the terms according to the classic and the new concepts may cause confusion. We investigated with a questionnaire to assess the acceptability of the new concepts of head injury, and seeked for a plan to avoid possible confusion in medical certificates. We sent questionnaires for diagnosis and duration of treatment of 10 given examples of head injury to 367 neurosurgeons whose addresses could be identified. Questionnaires were answered by 52 neurosurgeons. The diagnosis described in the questionnaires showed wide variability with a range of 10 to 32 different descriptions, on average 16.8 different descriptions for each case. Duration of treatment also revealed great discrepancy. Coefficients of variation for duration of treatment varied from 33.44% to 54.37%. Cerebral contusion was the most commonly used term. It was described in every 10 given examples, and to take an average, 32.3 neurosurgeons used cerebral contusion or each case. To avoid possible confusion in medical certificates, it is necessary to make a guide for medical certificates for head injuries according to the new concepts, and a chance of training of this guide should be provided.

CO2 Laser Effect on blood Vessel Repair and Coagulative Ability

Lasers have used safely to and in the resection of highly vascular tumors or arteriovenous malformation. As far as blood vessel coagulation, arteries up to 2mm in diameter and veins up to 3mm in diameter can be reliably sealed with the Nd-YAG laser, and lesser size of vessels can be coagulated with the CO2 laser. Another advantage of laser is to be a useful tool for small vessel repair or anastomosis without microsuture technique. The aim of this experiment was to investigate intensity and duration of exposure with the CO2 laser for vessel coagulation and repair. 36 rats weighing 200 to 250 gm, were used in this study. For vessel coagulation of extracranial arteries and veins, power density between 10 and 50 watts/cm2(W) was applied with handpiece, and for vessel repair or anastomosis 2 W was applied with micromanipulator. The results obtained were as follows : 1) The artery was perforated immediately over 10 W with 0.5 seconds of exposure of smaller focal beam. 2) The artery was constricted in its diameter in defocused beam with 30-40 W, and perforated with 50 W. 3) The lower limit of venous coagulation was 15 W, 0.5 sec. of exposure and 2 mm of focal beam diameter. 4) The lower limit or arterial coagulation was 10 W, 5 sec. of exposure, 4 mm of focal beam diameter, and exposure time was reduced to 3 sec. at 20 W. 5) The repair or anastomosis of artery was accomplished with 2 W, 0.05 sec. of exposure of 0.2 mm of focused beam by 6 times of delivery, and the delivery times could be successfully reduced to half under the overlying thin blood clot film on the anastomosis site of the artery. 6) In the histological examination, the entire layer of coagulated vessel wall on the laser delivered side disclosed marked constriction and destruction. On the anastomosis site, re-endothelialization began from 3 days, and completed by 2 weeks after operation.

A Case of Multicentric Glioblastoma Multiforme

A 46 year-old male with drowsy mentality and left hemiparesis had been treated. Right carotid angiogram showed a mass effect on the posterior temporal region. Preoperative CT brain scan revealed two separated hypodense masses with ring enhancement on the each hemisphere. The right-sided mass was totally removed and there was no invasion into the ventricle and meninges. The histological diagnosis was a glioblastoma multiforme. The left-sided mass was followed with the repeated CT scan, which showed the similar CT findings of a glioblastoma multiforme, and there was no evidence of commiccural extension. The above findings were consistent with the criteria of multicentric tumor.

A Case of Benign Chondroblastoma of the Temporal Bone

A 39 year-old male with swelling of the left temporal region, the left facial numbness, visual disturbance and slurred speech had been treated. Pain skull film showed an osteolytic bony defect in the left temporal squama with sclerotic margin. Left carotid angiogram showed a mass effect on the subtemporal region. CT scan revealed a well demarcated homogenous increased density of a snowman appearance in the left temporoparietal region. On operation, the temporal extradural highly vascularized mass was totally removed piecemeal, and another 6x5x5 cm of grayish brown rubbery-hard mass which located in the temporal lobe parenchyme was removed en bloc. The mass seemed to be extended from the extradural region. The histological diagnosis was a benign chondroblastoma. The patient was discharged without any evidence of neurological deficit.