[Show abstract][Hide abstract] ABSTRACT: Unusually broad areas of cerebral infarction were demonstrated by CT scan in three head injured infants with acute intracranial hematoma. They revealed very characteristic CT findings including contralateral hemispheric ischemic zone. Case 1 is a 5-month-old boy who had hit his head 4 days before. On admission he was semicomatose and his respiration had suffered from generalized seizures with arterial PO2 value of 43 mmHg. CT scan revealed right subdural hematoma, and bihemispheric ischemic low density was also demonstrable. Hematoma clot weighing 10 grams was removed through emergency craniotomy, followed by external decompression. There was a marked atrophic change in the right cerebral hemisphere and contralateral frontal base during the following few months, but the basal ganglionic region, brainstem and cerebellum were hardly affected. The patient developed comparatively well mentally for the next one and a half years. Case 2 was a 2-year-old boy who had a previous history of moderate head trauma 8 hours before admission. After a lucid interval, sudden epileptic attacks hospitalized him in a condition of cardiopulmonary arrest. CT scan revealed severe epidural hematoma on the patient's right cerebrum. Emergency craniotomy was performed and hematoma 95 g in weight was removed followed by decompression. Postoperative CT showed broad ipsilateral ischemic edema including the contralateral cerebral hemisphere and brainstem. One and a half years later, the patient shows decorticated posture with ataxic respiration and negative light reflexes. Case 3 was an 8-month-old boy who had fallen down and hit his head on the floor. Status epilepticus had attacked him, causing him to be admitted in a dyspneic state.(ABSTRACT TRUNCATED AT 250 WORDS)
No preview · Article · Jan 1989 · No shinkei geka. Neurological surgery
[Show abstract][Hide abstract] ABSTRACT: We have studied serial changes of FPA and FPB β15-42 which are thought to be direct index of action of thrombin and plasmin, in 8 patients during surgery with cardiopulmonary bypass. A statistically significant elevation of FPA was observed before cardiopulmonary bypass which did not return to normal during bypass despite conventional heparin anticoagulation, suggesting inadequate heparin dosage and continued thrombin activity during bypass. A statistically significant elevation of FPB β15-42 was also observed during cardiopulmonary bypass. Judging from FPA/FPB β15-42 ratio, fibrinolytic activity exceeded coagulation, suggesting primary fibrino (geno)-lysis during bypass. It seems likely that activation of fibrinolytic system may occur in the oxygenation mechanism or pump may activate the plasminogen-plasmin system or it may alter the activity of endothelial plasminogen activator.
No preview · Article · Jun 1988 · Masui. The Japanese journal of anesthesiology
[Show abstract][Hide abstract] ABSTRACT: We studied serial changes of FPA and FPB β 15-42 which are thought to be direct indices of action of thrombin and plasmin in 27 patients during anesthesia and operation. Statistically significant elevations of FPA, FPBβ15-42, and FPA/FPBβ15-42 ratio were observed after anesthesia and operation. These changes suggest that intravascular coagulation and fibrinolytic activity (thrombin and plasmin formation) increased due to anesthesia, physiological hemostasis and wound healing. Judging from FPA/FPBβ15-42 ratio, coagulation exceeded fibrinolysis. Comparing nitrous oxide-oxygen-enflurane group with nitrous oxide-oxygen-enflurane plus 1.5% mepivacaine epidural anesthesia group, there were no significant changes in FPA, PFBβ15-42, FPA/FPBβ15-42 ratio. Namely epidural anesthesia did not suppress coagulation and fibrinolytic activities during operation. The uterus and thyroid gland are rich in plasminogen activator. Statistically significant bleeding was observed during operations of these organs with no significant changes in FPA, FPBβ15-42. This result suggests that coagulation and fibrinolytic activities in the operation of these organs are equal to those in other operations.
No preview · Article · May 1988 · Masui. The Japanese journal of anesthesiology
[Show abstract][Hide abstract] ABSTRACT: A 46 year old female was admitted to our emergency room because of cardiopulmonary arrest by hanging. After ten minutes cardiopulmonary resuscitation, she was resuscitated but her consciousness did'nt recover. CT-scans on the day of admission showed no abnormalities but on the second hospital day it showed symmetrical low density areas within the basal ganglia, the thalamus, the hippocampus, and the occipital lobe. There were marked enhanced effect in cerebral sulci due to cytotoxic edema of hypoxic encephalopathy. She was comatose for a week, her pupils were dilated, light reflex and other brain stem reflex were absent. CT-scans on the sixth hospital day showed marked brain swelling with disappearance of the ventricular systems (so called brain tamponade). Brain death was confirmed on the basis of Japanese Criteria on the seventh and tenth day of admission. She had been suffering from pneumonia and urinary tract infection with an elevation of temperature since the fourth hospital day. We detected Enterobacter Cloacae (E. Cloacae), Klebsiella Oxytoca from the cultures of sputum and urine. On the tenth hospital day her temperature was running up to 39.4 degrees C and blood count revealed a peripheral blood leucocytosis of 40,300/mm3 with a shift to the left. E. Cloacae was also detected from the cultures of blood. Skull roentgenogram showed multiple gas collections in the ventricular systems. CT-scans on the fourteenth hospital day showed multiple gas-containing brain abscess. The etiology of this infection was considered due to septicemia of E. Cloacae. She died from acute renal failure on the fifteenth hospital day. Consent for autopsy was not accepted.(ABSTRACT TRUNCATED AT 250 WORDS)
No preview · Article · Apr 1988 · Nō to shinkei = Brain and nerve
[Show abstract][Hide abstract] ABSTRACT: Arterial blood gas analysis of 69 patients with acute myocardial infarction were evaluated to provide a basis for respiratory care. Patients were divided into two groups: group A which received oxygen therapy only (n = 38) and group B which received oxygen therapy with mechanical ventilation (n = 31). The patients in group B were further divided into surviving cases (n = 14) and fatal cases (n = 17). On admission patients assigned to group B had lower PaO2 values than those placed in group A. In group B, there was no difference in the P/F value before mechanical ventilation of the surviving and the fatal cases, but the survivors demonstrated an improvement of the P/F value and an increase in cardiac index after mechanical ventilation. It may be reasonable to assume that a P/F value of less than 250 serves as an indicator for the initiation of mechanical ventilation. An increase in the P/F value after mechanical ventilation seems to be a valuable index to estimate prognosis in respiratory failure.
No preview · Article · Feb 1988 · Advances in Experimental Medicine and Biology