Nihon geka hokan. Archiv für japanische Chirurgie
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We investigated serum complements (CH50, C3, C4) after aneurysmal subarachnoid hemorrhage in 21 patients over a 2 to 3-week period. For a control, we performed the same examination on patients with non-subarachnoid hemorrhage such as hypertensive intracerebral hemorrhage. There were no remarkable changes of serum complements in the control patients. ⋯ They decreased severely, however, in patients with severe vasospasm and major neurological deficits. The patients with mild symptomatic vasospasm and no major neurological deficits showed transient decreases of C4 levels 5 to 10 days after subarachnoid hemorrhage. Our data showed that sequential measurements of serum complements C4 after subarachnoid hemorrhage was useful for choosing the method of therapy and for predicting the prognosis of aneurysmal patients after subarachnoid hemorrhage.
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Case Reports
[Pneumothorax, subcutaneous emphysema and mediastinal emphysema in transnasally intubated patients].
A 41-year-old woman was admitted to our clinic because of an acute subdural hematoma. After an emergency operation her neurological status improved with an increase in the Glasgow Coma Scale score from 6 to 11. On the second postoperative day she developed frequent episodes of clonic convulsive seizures localized in the face and the left upper extremity, and her level of consciousness deteriorated. ⋯ When she was undergoing the CT scanning 3 days after intubation, she developed subcutaneous and mediastinal emphysema similarly to case 1. Although it is reported to be not a rare complication in patients on a mechanical ventilator, subcutaneous emphysema or pneumothorax is extremely rare in those intubated patients with spontaneous respiration. The mechanism of these complications in these cases is briefly discussed.
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Occlusion of the middle cerebral artery (MCA) in rats is being used increasingly widely as an experimental model of focal brain ischemia. However, the incidence of infarction or the size of infarction is variable. As a preliminary study we examined the anatomical variations of branching of the middle cerebral artery (MCA) and the incidence and extent of infarction and the time course of neurologic deficits following occlusion of the MCA at various sites in Sprague-Dawley (SD) rats and spontaneously hypertensive rats (SHR). ⋯ In the tandem occlusion group, neurologic deficit was more severe, but it was still transient. The branch occlusion group and the ICV group caused large infarction of the pallium with moderate neurologic deficits in 5 of 8, and 6 of 8 rats, respectively. The medial occlusion group caused infarction in the pallium and/or basal ganglia in 5 of 6 rats, and neurologic deficits were severe and persistent.(ABSTRACT TRUNCATED AT 250 WORDS)
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Three cases of brainstem contusion in whom the lesion could not be found by x-ray computed tomography (CT) but was identified clearly by magnetic resonance imaging (MRI) were reported. CT is apparently very useful in detecting the hemorrhagic components in patients with acute head injury, and it will definitely retain its important role in the management of emergency patients with possible life-threatening intracranial hemorrhage. MRI has been also known to be very useful in the diagnosis of patients with head injuries, especially in the detection of contusion in the frontal base, tip and the base of the temporal lobe, and the brainstem. T2-weighted images are the best for demonstrating such traumatic contusion of the brain.