Sixty-two cases of acute subdural hematoma were clinically analyzed with special reference to such prognostic factors as age, Glasgow Coma Scale (GCS) score on admission, pupillary signs, decerebration, and initial computed tomography (CT) findings. Intraparenchymal lesions demonstrated by CT were evaluated according to Yamaura's classification. In 19 cases, serum fibrin and fibrinogen degradation products (FDP) were measured at the time of admission. Emergency surgery was performed in 46 cases, and the remaining 16 patients were treated conservatively. The final outcome was judged according to the Glasgow Outcome Scale, and patients were divided into a “good outcome” group (good recovery or moderate disability) and a “poor outcome” group (severe disability, vegetative state, or death). In general, the outcomes proved to be unsatisfactory. Forty-four patients (71%) had a poor outcome, with 32/62 (52%) mortality, and only 18 (29%) had a good outcome. The clinical factors associated with a poor outcome were age over 64 years, a GCS score on admission of less than 7, decerebration, and absence of pupillary reaction to light. Initial CT scans showed brain damage in 46 patients (74%), 39 (85%) of whom had a poor outcome. This indicates that the outcome was significantly related to brain injury complicating the acute subdural hematoma. A high serum FDP level was similarly related to a poor outcome, which suggests that the serum FDP level reflects the degree of both primary and secondary brain injury. Thus, measurement of serum FDP may be valuable both in assessing clinical status and in evaluating the extent of brain injury in acute subdural hematoma.
Abstract An operative technique called the extensive transbasal approach is reported with the operative results of 11 cases. This is an operative mode in which en bloc osteotomy of the orbital roofs and frontal sinus is performed after ordinary bifrontal craniotomy. Through this approach, a far wider operative space than that afforded by conventional operative techniques is possible, and reconstruction of the frontal base can be made securely. We consider this approach of major clinical value.
Presented are an operative technique and clinical indications for split rib cranioplasty, and the results of its practical application. This technique was applied to 6 patients, in five of whom infection after previous cranioplasty had been noted before split rib cranioplasty. Two patients out of the 5 had been suffering from inveterate and repetitive postoperative infections; one patient had been operated on twice and the other three times, respectively. Operative results were excellent without serious and/or infectious complications, except initially in one patient who presented hemothorax after rib harvest. This method can be applied for those who have extensive defect of the skull or who need additional reconstruction using split rib graft because of infectious complications after previously performed cranioplasty. This technique also has the following advantage; cranial contour is easy to reconstruct and good cosmetic results can be expected.
A case of the subtotal removal of a large recurrent acoustic neuroma by translabyrinthine approach is reported. The operation has enabled the patient to return to her normal routine.The translabyrinthine approach is usually indicated only for small tumors below 2cm in size and localized in the inner ear meatus. This report suggests that in the case of a patient of advanced age or poor general condition, the translabyrinthine approach can be used effectively, even when the tumor is large or recurrent, for the purpose of tumor decompression.
✓ A case of multiple aneurysms is reported in which rupture of the internal carotid aneurysm occurred during carotid angiography, opacifying the subdural space. The patient recovered and was successfully treated by clipping of the aneurysm neck.
In this paper, a case of ruptured newly-developed right internal carotid posterior communicating artery bifurcation aneurysm, which occurred 11 years after contralateral common carotid artery ligation for a ruptured left side aneurysm, is reported.Common carotid artery ligation for the left internal carotid posterior communicating artery bifurcation aneurysm seemed to be effective to some extent from the following view points: rebleeding from the ipsilateral aneurysm was prevented and a decrease in size of that aneurysm was obtained.The new aneurysm might have developed due to the long-term hemodynamic stress exerted on the pre-existing fragility of the arterial wall. Such stress may have resulted from increased blood volume in the ipsilateral internal carotid artery after the contralateral common carotid artery ligation.
To clarify the effect of 200ml whole blood donation on peripheral blood and iron stores in young female, blood samples were examined before and 4 days after blood donation. Fourty seven donors of age 18 to 20 were divided into 4 groups according to hemoglobin and serum ferritin level; normal subjects without iron deficiency (N), iron deficiency without anemia (ID), iron deficiency anemia (IDA), and anemia without iron deficiency (A).The exsanguination from the donors with a prevalence of iron deficiency resulted in the increase of iron deficiency groups (ID and IDA) from 14 (30%) to 23 (49%) in contrast to the decrease of group N from 33 (70%) to 21 (45%). Considering the difficulty of oral iron supply, the author would like to propose a measure to protect young female donors from falling in iron deficiency as follows.1. Recommend component blood donation excluding RBC.2. Assay storage iron level.3. Inject a sufficient amount of iron intravenously for the donors with iron deficiency.
As compared to the diameter frequency distribution of myelinated fibers of L3, L4 and L5 ventral spinal roots (VSRs) which have two well developed peaks [large-diameter axons (AL) and intermediate-diameter axons (AI)] and a poorly developed or non-existent peak of small-diameter axons (AS), D11 VSRs contain small AL and AI peaks and a prominent AS peak. Because the ratio of AL to AI myelinated fibers of D11 VSRs is similar to that in L3, L4 and L5 VSRs and it is known that D11 VSRs contain many pre-ganglionic autonomic fibers it seems likely that AS is composed predominantly of preganglionic autonomic fibers. The mean diameter of the AS peak in D11 VSRs is ∼2.4 µm. Average numbers of AS, AI and AL myelinated fibers for D11 VSRs are 3835, 738 and 1545 per root. These values should be useful as controls for morphometric studies of various neuropathies. The average diameter positions of the peak of AL, AI and AS of D11 VSRs as compared to those of L3, L4 and L5 are displaced to smaller diameter categories which may reflect the smaller axon diameters of neurons which are shorter.
