Nō to shinkei = Brain and nerve
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We report a 62-year-old man who developed coma and died in a fulminant course. The patient was well until May 1, 1996 when he noted chillness, tenderness in his shoulders, and he went to bed without having his lunch and dinner. In the early morning of May 2, his families found him unresponsive and snoring; he was brought into the ER of our hospital. ⋯ Cardiac rupture appeared to be the cause of terminal sudden hypotension and cardiopulmonary arrest. It appears likely that a vegetation which had been attached to the aortic valve induced thromboembolic occlusion of the left internal carotid artery which had already been markedly sclerotic by atherosclerosis. It is also possible that the vegetations in the aortic valve came from mural thrombi at the site of acute myocardial infarction, as no bacteria were found in those vegetations.
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Clinical Trial
[Clinical evaluation on etiology and surgical outcome in syringomyelia associated with Chiari type I malformation].
Etiology of syringomyelia associated with Chiari type I malformation has been unknown. Moreover, the surgical procedure of foramen magnum decompression for this type of syringomyelia has not been standardized yet. No one procedure has been always successful, leading to many alternative procedures. ⋯ There was no significant difference among 4 groups on the degree of reduction of syrinx in the sagittal plane as evaluated on MRI, whereas with regards to improvement of the clinical symptoms, dural group was significantly worse than the other three groups. The surgical procedure of dural plasty was clearly less invasive than those of tonsillectomy and lysis of subarachnoidal trabecula. These results suggest that we should select dural plasty as a primary surgical procedure for syringomyelia associated with Chiari type I malformation.