To evaluate the risk of definitive intracranial microsurgical aneurysm obliteration as a function of the timing of the operative intervention, we retrospectively reviewed 167 consecutive patients in the department of Neurosurgery of Busan Paik's Hospital, Inje medical college, from January 1980 to December 1983. The patients who were operated upon within the first 3 days of their most recent subarachnoid hemorrhage formed the early group;the patients operated upon after the 3 days were considered to have undergone the late surgery. On the base of their clinical outcome the patients were allocated to one of five outcome categories(excellent, good, fair, poor, death) both at the time of their hospital discharge and at their most recent clinical revaluation. The 83% favorable outcome estimated from early operation and 72% from late operation. The mortality was estimated 5% from early operation and estimated 11% from late operation. The optimal timing of surgery for ruptured intracranial aneurysms is currently unknown, but early operation is an effective and reliable method to reduce the occurrence of rebleeding, vasospasm, ischemic complication and medical complication etc. Recently, there has been a resurgence of interest in early operation and increasing numbers of surgeons have been adopting this modality, but prompt, accuate diagnosis and early referral to specialized centers is the only way in which significant advances in reducing the overall morbidity and mortality for majority of patients can be achieved.
Aneurysm ; Aneurysm, Ruptured ; Busan ; Diagnosis ; Humans ; Intracranial Aneurysm* ; Microsurgery ; Mortality ; Neurosurgery ; Postoperative Complications ; Referral and Consultation ; Retrospective Studies ; Subarachnoid Hemorrhage

The rupture of a popliteal artery aneurysm is very rare, and can lead to serious complications if untreated. Any reports of a huge pseudoaneurysm, following rupture of the popliteal artery aneurysm could not be found in a review of the literature. A pulsatile huge mass leading to a deep venous thrombosis, was observed in a 74 years old male patient who for 2 months had had a progressively swollen and painful left leg. On angiographic evaluation, the mass was found to be a pseudoaneurysm originating from a ruptured true aneurysm of the popliteal artery. There was also a small true aneurysm in the contralateral extremity at the same localization. Both the false, and true aneurysms were resected surgically and arterial continuity was established with a synthetic polytetrafluoroethylene graft.
Aged ; Aneurysm/*complications/surgery ; Aneurysm, False/*complications/surgery ; Aneurysm, Ruptured/*complications/surgery ; Blood Vessel Prosthesis ; Human ; Male ; Polytetrafluoroethylene ; *Popliteal Artery/surgery

Abnormalities, Multiple ; Adult ; Aneurysm, Ruptured ; complications ; Aortic Aneurysm ; complications ; Aortic Rupture ; complications ; Endocarditis, Bacterial ; etiology ; Heart Septal Defects, Ventricular ; complications ; Humans ; Male ; Sinus of Valsalva

Hemobilia, in patients with the diagnosis of polyarteritis nodosa, is rare at clinical presentation and has a grave prognosis. We describe a case of massive hemobilia, due to aneurysmal rupture, in a patient with polyarteritis nodosa. A 39-year-old man was admitted to the hospital with upper abdominal pain. The patient had a history of partial small bowel resection, for intestinal infarction, about 5 years prior to this presentation. Abdominal computed tomography demonstrated multiple high attenuation areas in the bile duct and gallbladder. Hemobilia with blood seepage was visualized on endoscopic retrograde cholangiopancreatography; this bleeding stopped spontaneously. The following day, the patient developed a massive gastrointestinal bleed with resultant hypovolemic shock. Emergent hepatic angiogram revealed multiple microaneurysms; a communication was identified between a branch of the left hepatic artery and the bile duct. Hepatic arterial embolization was successfully performed. The underlying disease, polyarteritis nodosa, was managed with prednisolone and cyclophosphamide.
Rupture/*complications ; Polyarteritis Nodosa/*physiopathology ; Male ; Humans ; Hepatic Artery/*pathology ; Hemobilia/diagnosis/*etiology ; *Embolization, Therapeutic ; Aneurysm, Ruptured/*complications/therapy ; Adult

BACKGROUND: The principal surgical technique for treating an abdominal aortic aneurysm since the 1960s has been the transperitoneal approach, yet there have been some recent studies that have reported improved surgical results with using the retroperitoneal approach. However, there are only limited clinical Korean studies that have, compared between the transperitoneal and retroperitoneal approaches. MATERIAL AND METHOD: This study included 36 patients who had been diagnosed as having an aneurysm of the abdominal aorta and they were surgically treated between January 2001 and July 2007. The patients were subdivided into the retroperitoneal approach group (n=17) and the transperitoneal approach group (n=19), and they were compared in terms of the preoperative risk factors, the postoperative complications and the operative mortality. The risk factors of operative mortality risk and long-term survival for the 36 patients were assessed by the Kaplan-Meier method. RESULT: There were no significant differences between the groups in terms of gender, age, the underlying disease, a history of smoking, rupture of aneurysm, the preoperative symptoms, the operation time and the incidence of postoperative complications. However, the duration of postoperative fasting, the number of days of having an indwelling nasogastric tube and the length of the stay in the intensive care unit were significantly short for the retroperitoneal approach group (p<0.05). There was a 16.7% rate of operative mortality (6/36) and five of the deaths were attributed to preoperative ruptured aneurysm. On univariate analysis, a higher preoperative serum creatinine level (SCr > or =1.8 mg/dL, p=0.016) and ruptured aneurysm (p<0.001) were the significant risk factors of operative mortality. As assessed by the Kaplan-Meier method, the long-term survival was comparable between the groups and the five-year survival rate of all the patients was 57.5%. CONCLUSION: In the present study, a retroperitoneal approach has several advantages such as a shorter intensive care unit stay, a shorter duration of postoperative fasting and a shorter duration of an indwelling nasogastric tube. Therefore, unless there is any contraindication for a retroperitoneal approach, it could be considered as a primary surgical access for repairing an abdominal aortic aneurysm.
Aneurysm ; Aneurysm, Ruptured ; Aorta ; Aorta, Abdominal ; Aortic Aneurysm, Abdominal ; Creatinine ; Fasting ; Humans ; Incidence ; Intensive Care Units ; Postoperative Complications ; Risk Factors ; Rupture ; Smoke ; Smoking ; Survival Rate

Subarachnoid hemorrhage (SAH) can be classified as traumatic SAH or spontaneous SAH based on etiology. The traumatic SAH is the common manifestation of head injury and difficult to make a diagnosis in forensic investigation. Based on practical experiences of forensic investigation and relevant references, the main points (SAH identification, examination, death mechanism) were summarized in this article. For the understanding, we try to classify the traumatic SAH into three subtypes: brain injury associated SAH, traumatic rupture of basal cerebral vessels SAH and traumatic focal SAH.
Aneurysm, Ruptured/complications* ; Cause of Death ; Craniocerebral Trauma/complications* ; Diagnosis, Differential ; Forensic Pathology ; Hematoma, Epidural, Cranial/complications* ; Humans ; Intracranial Aneurysm/complications* ; Intracranial Arteriovenous Malformations/complications* ; Rupture/complications* ; Subarachnoid Hemorrhage/pathology* ; Subarachnoid Hemorrhage, Traumatic/pathology*

BACKGROUND: Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS: Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS: Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS: We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.
Anesthesia ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteriovenous Malformations ; Defibrillators, Implantable ; Female ; Fistula ; Humans ; Hydrocephalus ; Intracranial Arteriovenous Malformations ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Radiology, Interventional ; Retrospective Studies ; Water-Electrolyte Balance

A recurrent aneurysm at the anastomosis site or the remaining artery frequently occurs after the operative treatment of an aneurysm in Behcet's disease despite anti-inflammatory medication. Herein, a ruptured left renal artery stump aneurysm in a patient with Behcet's disease, who received a left nephrectomy, aorto-biiliac bypass and heterotopic autotransplantation of the right kidney for the treatment of an abdominal aortic aneurysm and renal hypertension one year prior to this admission, is reported. An aneurysm and rupture occurred despite the administration of anti-inflammatory medications while monitoring of the clinical findings, such as skin manifestations, erythrocyte segmentation rate (ESR) and C-reactive protein (CRP). Although there is no definite proven treatment modality to prevent recurrent aneurysms at the anastomosis site or a remote artery, close follow-up with anti-inflammatory medications, and surveillance with regular intervals are the only current methods for the prevention and/or to treatment of an arterial complication in patients with Behcet's disease.
Adult ; Anastomosis, Surgical/*adverse effects ; Aneurysm, Ruptured/*etiology ; Aortic Aneurysm, Abdominal/*surgery ; Behcet Syndrome/*complications/surgery ; Human ; Hypertension, Renal/surgery ; *Kidney Transplantation ; Male ; Recurrence ; *Renal Artery ; Transplantation, Autologous

OBJECTIVETo investigate the relationship between cerebral vasospasm and occurrence of delayed ischemic neurological deficit (DIND).

METHODSThe clinical records and radiographic images of 118 patients with subarachnoid hemorrhage admitted during last 5 years were reviewed. The incidence,degree and localization of cerebral vasospasm were evaluated, and morbidity of related DIND was analyzed. Patients with cerebral vasospasm were divided into three groups: Group MCA (middle cerebral artery), Group ACA (anterior cerebral artery) and Group ICA (intracranial carotid artery) according to the location of cerebral vasospasm. The consistency of DIND and image of cerebral infarction were examined.

RESULTThere was a weak correlation between cerebral vasospasm and incidence of DIND (r=0.22; P=0.016). The incidence of DIND was increased with severity of cerebral vasospasm (U=2.589, P<0.05). The group MCA had a significantly higher incidence of DIND than that of ACA and ICA groups (68.0% compared with 36.7% and 25.0%, respectively, chi(2)=8.195, P=0.004), the difference between later two groups was not statistically significant (chi(2)=0.646, P=0.421).

CONCLUSIONCerebral vasospasm may be an important factor leading to DIND occurrence; the severity and location of cerebral vasospasm is related to the incidence of DIND.

Adult ; Aged ; Aneurysm, Ruptured ; complications ; Carotid Artery, Internal ; Female ; Humans ; Intracranial Aneurysm ; complications ; Ischemic Attack, Transient ; etiology ; Male ; Middle Aged ; Rupture, Spontaneous ; Subarachnoid Hemorrhage ; complications ; Time Factors ; Vasospasm, Intracranial ; etiology

OBJECTIVETo evaluate clinical strategy and effect of early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm.

METHODSSeventy-five patients presenting with anterior circulating aneurysmal subarachnoid hemorrhage (SAH) underwent early-mid-phase (within 3 days or 3-10 days) microsurgical clipping at Huashan Hospital between January 2001 and August 2004. Glasgow outcome scale (GOS) was conducted to evaluate patients' outcomes.

RESULTSOf 81 intracranial aneurysms, 77 lesions were clipped successfully, and 4 were wrapped. Good outcome was achieved in 53 cases, mild disability in 9 cases, severe disability in 7 cases, persistent vegetative state in 3 cases, and 3 patients (4%) died after surgery. The difference of GOS was statistically significant between patients in Hunt and Hess Grade I-III and Grade IV-V. However, there was no significant difference between early surgery and metaphase surgery.

CONCLUSIONSEarly-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm is considered the feasible opinion.

Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aneurysm, Ruptured ; complications ; surgery ; Female ; Humans ; Intracranial Aneurysm ; complications ; surgery ; Male ; Microsurgery ; methods ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Rupture, Spontaneous ; complications ; surgery ; Subarachnoid Hemorrhage ; etiology ; surgery ; Treatment Outcome