Experimental Study on Local Hypothermia in the Spinal Cord

A study of effect of local hypothermia upon the spinal cord was performed in cats. With a cuff, a cooler, to which was attached connecting tubes to a refrigerator, the experimental technique was deviced to cool the spinal cord locally at midthoracic level. Cold liquid, saline at a temperature of +/-1.1 degrees C, was circulated in closed system through the tubing into the cuff which was snugly rested on the dorsal surface of the spinal cord as a heat exchanger. The temperatures were measured with thermocouples at various sites in the spinal cord before, during, and after the cooling every two minutes upto twenty minutes. In the cord underneath the cuff, the mean precooling temperature of 35.4 degrees C in normal control group was lowered to 11.0 degrees C during the first two minutes of cooling. After this in initial rapid drop in temperature, there was a further gradual reduction of 4.5 degrees C upto 20 minutes cooling to be 6.5 degrees C. The lowest mean temperatures recorded throughout cooling were 4.3 degrees C at dorsal surface and 6.9 degrees C at center of the cord. And the temperature lowering was nearly not noted beyond the cord 1 cm apart from an edge of cuff in rostral and caudal directions. For comparison, the temperature in the cord that had not been injured was also measured. The rate of cooling in the cord underneath the cuff seemed to be faster than in the control group of animal in which the cord was not injured. Another design of this experiment was an evaluation of the protective effect of local hypothermia with respect to cord edema and injury associated cord hemorrhage. Immediately after intravenous administrations of fluorescin the spinal cords were contused with impaction injury. These injured cords were removed ar different time intervals after trauma, and spread or distribution of fluorescin in frozen sectioned specimens was observed under ultraviolet illumination with fluorescence microscope. In all cooling groups, pathological pictures were reduced in its degree and extent more than those in the control group, and that, earlier the cooling after the injury to the cord, better the result was outcome. It would be well to say that local hypothermia might be within the margin of safety and beneficial in the management of spinal cord injury in this experiment.

Hematoma as a Consequence of Ruptured Intracranial Aneurysms

The importance of hematoma associated with ruptured aneurysm has been discribed frequently. Hematomas may be intracisternal, intracerbral or subdural and intracerebral hematomas frequently rupture into the adjacent ventricle. The authors have analysed in clinically 33 cases of intracranial hematomas which developed as a consequence of 100 cases of ruptured intracranial aneurysms. Of 100 cases of ruptured intracranial aneurysms, the incidence of hematoma was 33%(33 cases). The most common site of aneurysm associated with hematoma was middle cerebral artery(50%) and anterior cerebral-anterior communicating artery in turn. Intracerebral hematomas are most common(20%), followed by intracerebral and intraventricular hematomas(5%). The incidence of subdural hematomas and intraventricular hematomas is 3% in each. There was no significant difference according to sex. The incidence of hematoma was considerably increased in 30-40 age group. The operative result in 33 cases who have hematomas was favorable(excellent good result) in 36.5%, and was unfavorable(fair - poor result) in 27.4%. The operative mortality was 36.4% and 7.5% in non-hematoma group. Cases of internal carotid artery aneurysms with hematoma carried the highest mortality and the next is cerebral-anterior communicating artery aneurysms. There showed poor result in cases of preoperative grade IV & V, either hematoma or non-hematoma group. We also analysed the correlations between the frequency of hematoma and the vasospasm, hydrocephalus. Of 33 cases of ruptured aneurysm with hematoma, vasospasm was detected in 8 cases, hydrocephalus was in 6 cases and vasospasm, combined with hydrocephalus was 8 cases. It revealed a tendency of increased mortality in cases of hematoma with vasospasms.

Experimental Study on Cerebrospinal Fluid: Bloody Cerebrospinal Fluid

Bleeding into the subarachnoid space is one of frequent complications in neurosurgical practice and most frequently caused by rupture of meningeal vessels by trauma to the head. Hemorrhage into the subarachnoid space may occur in patient with blood dyscrasias, intracranial tumors, vascular anomalies, certain toxic or infectious diseases of the nervous system, and infracerebral hemorrhages. It may be worthy for academic interest and clinical practice to estimate the age of blood after hemorrhage into the cerebrospinal fluid. To simulate a bloody cerebrospinal fluid encountered with subarachnoid hemorrhages in clinical practice, 10% RBC-CSF suspension in vitro was made for the experiment. The age of the red blood cells in the RBC-CSF suspension of normal subject was assessed and estimated chemically by quantitative analysis of oxygen, methemoglobin, potassium and billrubin. Oxygen started to be detected chemically in the 24 hour experimental group, and the amount of it was rapidly decreased as time elapsed by 72 hours and not detected thereafter. Methemoglobin was chemically detected on 3rd day and value of it was increased gradually throughout the entire period of experiment. An increase of amount of potassium above a normal value began to be detected in the 72 hour experimental group and the increase of it continued gradually throughout the entire period of experiment. Rate of the increase of methemoglobin showed higher than that of potassium. Bilirubin was detected on 5th day of experiment and increase of the clinical reaction was continued by the end of experimental period. It would be well to say that the experimental results could be applied in some aspect to clinical situation, espically subarachnoid hemorrhage.

Ventriculoperitoneal Shunt Complicated by Ascitis and Hydrothorax

The majority of current shunting procedures involve either a ventriculoperitoneal or a ventriculoatrial placement. The ventriculoperitoneal placement have less serious associated morbidity than the atrial placement but revision of the placement is occasionally requested by complications associated with the shunting procedure. A case of ventriculoperitoneal shunt complicated by ascites and hydrothorax was reported, in which the shunting procedure was indicated for relief of hydrocephalus in an infant.

Ventriculoperitoneal Shunt Complicated by Ascitis and Hydrothorax

The majority of current shunting procedures involve either a ventriculoperitoneal or a ventriculoatrial placement. The ventriculoperitoneal placement have less serious associated morbidity than the atrial placement but revision of the placement is occasionally requested by complications associated with the shunting procedure. A case of ventriculoperitoneal shunt complicated by ascites and hydrothorax was reported, in which the shunting procedure was indicated for relief of hydrocephalus in an infant.