ABSTRACT
Aneurysmal subarachnoid hemorrhage (SAH) treatment has progressed, and patients are rapidly aging in Japan. Consequently, dynamic changes must have emerged in the clinical practice of SAH. This study aimed to elucidate chronological changes of aneurysmal SAH and the prognostic factors in the previous quarter century in Japan. We conducted a retrospective survey regarding aneurysmal SAH in eight institutions in Japan. The study included 848, 863, and 781 patients in the first (1989-1993), second (1999-2003), and third (2009-2013) periods, respectively. The chronological changes of factors that influenced the poor outcomes and differences between the nonelderly (<75 years) and elderly patients were investigated. Mean age was significantly higher in patients in the third period (61.4 years) than in those in the other two periods (first, 57.8 years; second, 59.5 years). During these periods, the proportion of good outcomes did not change; however, the mortality rate significantly decreased from 19% in the first period to 11% and 9.2% in the second and third periods, respectively. The poor outcome was mainly caused by the significantly higher incidence of systemic complication and procedural complication in the first period and the significantly lower incidence of delayed ischemic neurological deficit in the third period. The elderly patients had significantly poorer clinical outcomes than the nonelderly ones. During the last 25 years, the age of patients with aneurysmal SAH has rapidly increased. The study results may contribute to the improvement of the treatment strategy of SAH in advanced countries with a rapidly aging population.
Subject(s)
Intracranial Aneurysm , Subarachnoid Hemorrhage , Humans , Aged , Middle Aged , Subarachnoid Hemorrhage/therapy , Subarachnoid Hemorrhage/complications , Retrospective Studies , Intracranial Aneurysm/complications , Japan/epidemiology , Treatment OutcomeABSTRACT
We aimed to study tracer kinetics in radioisotope (RI) cisternography. For this purpose, we analyzed the RI images of 36 individuals in whom absence of cerebrospinal fluid (CSF) leakage was confirmed. For the semiquantitative assessment of tracer clearance, the geometric mean of the RI count in the anterior and posterior images was obtained for the entire head as well as for the whole spinal axis. After correcting for the radioactive decay of the tracer, tracer clearance was expressed as a ratio of the count in the range of the whole CSF space at different time points to that at the time of tracer delivery. Tracer clearance from the CSF space was not related to the degree of cranial transport of the tracer in 1 hour, but was significantly related with the age of the patients. At 24 hours after the injection, tracer clearance was significantly faster in the younger patients (Group I: age < 40 years) than in the older patients (Group II: age > or = 40 years). The cranial transport of the tracer appeared to be rapid in group I; however, the difference between these 2 groups was not significant. These results indicate that age should be taken in account while establishing the reference values for tracer kinetics in normal individuals.
Subject(s)
Cerebrospinal Fluid/diagnostic imaging , Adolescent , Adult , Age Factors , Aged , Female , Humans , Male , Middle Aged , Radionuclide Imaging , Time FactorsABSTRACT
Patients demonstrating critical limb ischemia with a long-distance occlusion of the major arteries are sometimes poor candidates for bypass surgery, because tandem occlusion complicates distal anastomoses and poor run-off causes early occlusion of bypass grafts. In order to resolve these problems, angiogenesis therapy was attempted by subcutaneous injection of granulocyte colony-stimulating factor either before or after peripheral bypass surgery in 2 cases.
Subject(s)
Angiogenesis Inducing Agents/therapeutic use , Arterial Occlusive Diseases/drug therapy , Blood Vessel Prosthesis Implantation , Granulocyte Colony-Stimulating Factor/therapeutic use , Ischemia/drug therapy , Lower Extremity/blood supply , Neovascularization, Physiologic/drug effects , Wound Healing/drug effects , Aged, 80 and over , Angiogenesis Inducing Agents/administration & dosage , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/physiopathology , Arterial Occlusive Diseases/surgery , Collateral Circulation/drug effects , Combined Modality Therapy , Female , Granulocyte Colony-Stimulating Factor/administration & dosage , Humans , Injections, Subcutaneous , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/surgery , Lenograstim , Male , Radiography , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use , Treatment OutcomeABSTRACT
Since cerebrospinal fluid (CSF) leakage is highlighted as a cause of persistent headache, radionuclide cisternography has been increasingly performed in Japan to confirm the disorder, although the limited ability of the examination should be recognized. We present 3 cases in which failure of a tracer injection was strongly suspected. In 2 cases with chronic symptoms, the tracer appeared to be injected into the epidural space, because of irregular initial accumulation of the tracer and lack of diffusion along the CSF cavity. Another is a case with spontaneous CSF leakage confirmed by MRI, and the tracer was thought to be injected into the leaked fluid accumulated in the spinal epidural space. Tracer in the CSF space rapidly disappeared within several hours in all cases. As such cisternographic images may be misdiagnosed as severe CSF leakage, careful interpretation of images in patients especially with no typical MR findings of CSF leakage is necessary. Excessive tracer clearance from the body suggests such technical failure.
