Analysis of the Risk Factors of Hematoma Enlargement in Patients with Spontaneous Intracerebral Hemorrhage

OBJECTIVE: The purpose of this study was to evaluate the risk factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage(ICH). METHODS: A series of 214 ICH patients diagnosed by brain CT scan in our neurosurgery department from June 1995 to July 1998 were reviewed with clinical status, past medical histories, laboratory findings, CT findings and prognosis. RESULTS: In 27 patients(12.6%), the second CT scan showed an enlarged hematoma. Age, sex, and site of hematoma were not related to hematoma enlargement. A long interval(>6 hours) between the onset and the 1st CT scan strongly reduced the incidence of hematoma enlargement. The incidence of hematoma enlargement significantly increased in patients with previous history of hypertension, cerebral infarction and ICH. This analysis also demonstrated the following independent factors predisposed to hematoma enlargement: initial high systolic blood pressure, high serum total protein, low serum albumin, low serum sodium, prolonged prothrombin time(>14 sec) and activated partial thromboplastin time(>29.5 sec), irregular hematoma shape, and combined intraventricular hemorrhage. Prognosis in the group of hematoma enlargement showed high mortality(48.1%) and poor outcome. CONCLUSION: Patients with previous history of hypertension, cerebral infarction and ICH, and with high systolic blood pressure, prolonged coagulation time, irregular hematoma shape and intraventricular hemorrhage in CT scan should be observed carefully. And, early surgical therapy of large hematoma and meticulous control of blood pressure may decrease the mortality and morbidity in patients with spontaneous ICH.

Inhalation effect of 1,1-dichloro-1-fluoroethane (HCFC-141b) on the respiratory system / 천식및알레르기

BACKGROUND: 1,1-dichloro-1-fluoroethane (HCFC-141b) has been known to be relatively safe except irritation of the skin and upper airway, and pulmonary disease directly associated with HCFC-141b exposure has not been reported yet. OBJECTIVE: We report a highly suspicious case of HCFC-141b-related occupational asthma, which was assessed by workplace challenge, but not confirmed by specific inhalation test. We also performed animal experiment to evaluate whether long-term exposure to HCFC-141b could cause inflammation of the airway and parenchymal lung tissue. METHOD: Forty Sprague-Dawley rats were divided into 4 groups. HCFC-141b exposure for each group was carried out under the condition of 6 hours a day, 5 days a week for 13 weeks by inhalation with different concentration of HCFC-141b; Group A-control: Group B-low concentration, 1500 ppm: Group C-moderate concentration, 3000 ppm: and Group D-high concentration, 6000 ppm. Bronchoalveolar lavage (BAL) and histopathological examination of lung tissue was undertaken after HCFC-141b exposure. RESULTS: HCFC-141b did not induce any abnormal change in the clinical and behavioral signs during and at the termination of the inhalation exposure. Compared with control rat, significantly abnormal findings in the microscopic examination of BAL and tissue preparations was not noted in HCFC-141b exposed rats. CONCLUSION: We report a suspicious case of occupational asthma due to HCFC-141b exposure. Animal experiment, however, revealed that HCFC-141b has no toxic or side effect on the respiratory system regardless of its concentration.

Capillary Telangiectasia of the Posterior Fossa Presenting with Repeated Cerebellar Hemorrhage

Hemorrhage due to capillary telangiectasia is rare. We report a case of capillary telangiectasia presenting with repeated cerebellar hemorrhage in a 38-year-old male. To our knowledge this is the first case of repeated cerebellar hemorrhage from the capillary telangiectasia. At the first operation, we removed hematoma only, but rebleeding occurred repeatedly in the same area. Finally, we evacuated the recurrent hematoma and vascular mass of capillary telangiectasia at the second operation under surgical microscope. Based on the findings of this case and a review of the literature, we conclude that capillary telangiectasia can be the cause of the massive repeated hemorrhage.