No shinkei geka. Neurological surgery
-
Knockout in boxing entails deliberate production of the state of unconsciousness. Acute subdural hematoma which is the most common acute brain injury in boxing, accounts for 75% of all acute brain injuries and is the leading cause of boxing fatalities. The aim of this study is to evaluate acute subdural hematoma caused by professional boxing by analyzing the content of bouts, the level of consciousness on admission, CT scan, therapy and outcome 3 months after admission. ⋯ Overall outcome was better than that published in previous reports and also than that observed in other head injuries, for example, traffic accident and fall. The reasons for this could be that the patients were younger, that there was immediate surgical treatment, and that brain injury without cerebral contusion had contributed to better outcome. Finally, the best medical management intervention seems to be to diagnose and treat the lesions as early as possible after occurrence of subdural hematoma.
-
Obliteration procedures for large high-flow arteriovenous malformations (AVM) were simulated using a compartmental flow model to investigate the role of altered autoregulatory conditions in the development of hyperperfusion and normal perfusion pressure breakthrough (NPPB). Since the arterioles are primarily responsible for autoregulatory function, the role of these structural changes on the development of hyperperfusion was also studied by evaluating the wall thickness (T), internal radius (Ri) and tangential wall stress (sigma). As the AVM flow was decreased during the obliteration procedures, the perfusion pressure (delta P) of the brain tissue surrounding the AVM increased. ⋯ If the upper limit of the autoregulatory pressure range was assumed to decrease and become the yield point in the brain surrounding high flow AVMs, hyperfusion or NPPB could be considered to develop in the conditions with the autoregulatory pressure range being narrowed and/or shifted to the lower pressure level. Induced systemic hypotension was found to be effective in reducing the magnitude of Fb, delta P, and Pf when induction was appropriately performed in stepwise fashion. T/Ri and sigma were kept in narrow ranges compared to those before induction of hypotension.