No shinkei geka. Neurological surgery
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The clinical course of ten cases of head injury complicated with multiple systemic injuries were studied by comparing two groups divided according to the presence or absence of associated coagulative-fibrinolytic abnormality. All these cases had intracranial hemorrhagic lesions proven by the high density area in the initial CT scan. Five cases showed signs of disseminated intravascular coagulation (DIC) as evidenced by decreased counts of platelet, and/or elevated value of FDP at the time of admission. ⋯ S., died of acute renal failure and multiple organ failure. In contrast with these cases, five cases without signs of DIC intracranial hematomas did not enlarge in spite of the similar neurological conditions to the former group. In head injured patients with systemic injury, DIC frequently causes secondary hemorrhage in the intracranial lesions of minor severity.
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The authors previously reported the effect of preoperative factors affecting the reduction of chronic subdural hematoma. In this report, we evaluated some operative factors, including operative methods, duration of drainage, and residual air volume, with newly developed CT volumetry technique. As described before, the hematoma volume reduces exponentially. ⋯ These results suggest that the residual air in the hematoma cavity may delay the reduction rate of the hematoma. Based on these results, the authors pay attention to the following points; 1) Less invasive burr hole method should be selected. 2) Patient's head position should be controlled to make the burr hole at the highest level in the operative field. 3) Hematoma cavity should be filled with saline as much as possible. 4) The inner membrane should never be injured, as it may cause tension pneumocephalus. Moreover, the drainage of cerebrospinal fluid may reduce the counter pressure and it leads to the delay of the hematoma reduction.
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Case Reports
[Two cases of acute idiopathic subdural hematoma with delayed intracranial hypertension].
Two cases of acute idiopathic subdural hematoma with delayed intracranial hypertension were presented. The first case was a 68-year-old man admitted for vomiting following headache for eight days. There was no history of head trauma. ⋯ The delayed intracranial hypertension appeared in these two cases about 10 days after the initial symptom. Two kinds of mechanisms are suspected: 1) swelling of the hematoma because of the adsorption of cerebrospinal fluid, 2) the occurrence of secondary brain edema. From our experience, a repeated CT scan is necessary for 2 to 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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The presence of cysts within the sacral spinal canal, so-called sacral cysts, is described in literature. These include 'sacral perineural cyst', 'sacral extradural cyst', 'occult intrasacral meningocele' and 'anterior sacral meningocele'. Sacral perineural cyst in these cystic disorders was first described as an incidental autopsy finding by Tarlov in 1938. ⋯ Communication of the cyst with subarachnoid cerebrospinal fluid may be poor, but myelogram and CT myelogram demonstrate the cysts filling with contrast media. With the advent of magnetic resonance imaging (MRI), imaging of the sacral perineural cysts has improved. Recently we had the opportunity to evaluate a patient in whom perineural cysts had caused considerable erosion of the sacrum.(ABSTRACT TRUNCATED AT 250 WORDS)
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Prostaglandin (PG) E1 is a potent vasodilator on the peripheral vessels and also has an inhibitory action of platelet aggregation. Lipo PGE1, the lipid emulsified PGE1 has much longer half life time in the circulation than PGE1 which is rapidly inactivated in the lung. The purpose of this investigation was to study the clinical and hemodynamic effect of Lipo PGE1 on the 15 patients with acute or subacute focal cerebral ischemia. ⋯ Immediately after the Lipo PGE1 treatment, rCBF of the MCA region was increased by 6% on the affected side and by 11% on the non-affected side. rCBF of the affected MCA territory was increased more than 15% in five cases (Group 1) and was changed less than +/- 15% in seven cases (Group 2) by the first Lipo PGE1 treatment. Lipo PGE1 was administered every 8 hours for 10 to 14 days in these 12 cases. By the continuous Lipo PGE1 treatment, rCBF of the affected MCA territory increased by 18% in the Group 1 and by 3% in the Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)