No shinkei geka. Neurological surgery
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Review Case Reports
[Shotgun pellet embolus in the cerebral circulation via the internal carotid artery in the neck; a case report].
A 57-year-old hunter was shot accidentally and admitted to our hospital without any neurological deficits. Plain X-ray films of the neck revealed the presence of several shotgun pellets, one of which was thought to be in the vicinity of the right internal carotid artery at the C1 level. One week later, while surgical removal of pellets was being performed under fluoroscopic control, the pellet entered into the lumen of the artery and migrated to the intracranial vessels. ⋯ In the literature, 20 similar cases have been hitherto reported and briefly reviewed. Of these 20, 6 cases died of cerebral infarction. We believe that embolectomy is warranted as soon as possible when patients show a condition building up to a stroke.
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Transorbital penetrating brain injury is rare during this time of peace. In our paper, we reported seven cases of these injuries and discussed the mechanism and treatment of intracranial complications. Transorbital penetrating brain injuries were caused by thin, long and relative hard objects such as chop-stick (case 3), pencil (case 6), bamboo stick (case 1, 2, 7) and a piece of metal (case 4, 5). ⋯ The one exception was a case in which a large intracerebral hematoma was over-looked in an ophthalmological clinic. This patient died. Nowadays, CT scan and MRI give clear information about the anatomical location of injuring objects and intracranial complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical characteristics and therapeutic problems of neurogenic pulmonary edema (NPE) occurring in the acute stage of severe subarachnoid hemorrhage (SAH) were examined. The relationship between SAH and NPE was studied in 208 patients who arrived at the hospital in the acute stage (within 24 hours after the onset) of severe SAH in the past nine years. NPE was observed in four (6%) of 64 Grade III patients, nine (18%) of 49 Grade IV patients and 20 (21%) of 95 Grade V patients. ⋯ In comparison of the age, blood pressure, PaO2, serum electrolyte, WBC, and blood sugar level on admission between the two groups, significantly higher values of diastolic pressure and blood sugar levels were shown in the NPE group than non-NPE group. The mean interval between the onset of SAH and the diagnosis of NPE on chest film was 2.5 hours, while the NPE findings disappeared within three days after the onset of SAH (mean 1.2 days). In all cases, the NPE findings disappeared after a variety of respiratory managements had been carried out.(ABSTRACT TRUNCATED AT 250 WORDS)