No shinkei geka. Neurological surgery
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High dose ACNU and radiation therapy with autologous bone marrow rescue was performed in a 3-year-old boy suffering from cerebellar medulloblastoma, whose main mass had been removed at operation when widespread subarachnoid tumor dissemination was already present. The myelosuppression, which is a major side effect of high dose chemotherapy, was successfully prevented by the autologous bone marrow grafting and the serial CT scans showed complete disappearance of the tumor. ⋯ Although the autologous bone marrow rescue therapy is a technical advance to cope with myelosuppression secondary to chemotherapy, side effects of the other organs, particularly of the respiratory system, remain to be solved. The optimal treatment schedule should be established as soon as possible.
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One hundred fourteen patients with ruptured cerebral aneurysms were reviewed in regard to the incidence and etiological factors of preoperative disturbances of water and electrolyte metabolism. Patients with inadequate salt intake, evidence of renal disease, cardiac failure or excessive diuretic therapy were excluded. Twenty-five (21.9%) patients developed water and electrolyte disturbances. ⋯ The patients in grade III, IV according to Hunt & Hess. The patients with high density in the basal subarachnoid space on the CT scan. The patients with a small hematoma in the region of the basal frontal interhemispheric fissure in cases with aneurysms of the anterior communicating or anterior cerebral artery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
[Marked effect of furosemide and hypertonic saline in the treatment of SIAD after head injury].
A case of SIADH after head injury was encountered and treated successfully with furosemide and hypertonic saline. 250 mg of furosemide was given twice at two hours' interval. The dose of 2.5% saline for the infusion was calculated according to the excretion of sodium in the urine collected during this period. ⋯ The consciousness of the patient returned to normal. The problems of quick correction of hyponatremia including the central pontine neurolysis were discussed.
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When cerebral infarct extends over a wide area and severe cerebral edema follows, there may be some cases where external decompression is necessarily indicated. Decompression is generally performed when signs of tentorial herniation appear and brainstem damage seems to be still reversible. We have been performing operations in such indication, but result of operations were poor. ⋯ A prophylactic external decompression being carried out just when a tentorial herniation is certainly imminent, could be an option. Analysis of serial CT scannings on infarction cases definitely revealed that before cerebral edema became manifest and tentorial herniation developed, there was a period when there were such findings as uniform: low density appears over the whole middle cerebral artery territory. this low density is homogeneous. lateral ventricle is slightly compressed and cortical sulci disappear suggesting slight cerebral edema. We have tried external decompression on three cases as soon as we found these CT findings, before there were signs of tentorial herniation and the outcome were satisfactory.