Hypertensive intracerebral hematoma is a serious and potentially lethal condition. The indication of surgery in this hematoma is still controversial. Authors have treated 335 cases of hypertensive intracerebral hematomas which were confirmed by computerized tomography between July 1, 1982 and June 30, 1986. The hematomas have been classified according to their modes of extension on computerized tomography. The outcome was assessed on their basis of activity daily living. According to our study, moderate and severe types of putaminal hematoma cases have shown better results with surgery than conservative management. Mortality was 23.7 percent in surgery and 35.3 percent in conservative management.
Hematoma* ; Mortality ; Putaminal Hemorrhage

Gastrointestinal bleeding is a common medical emergency with significant morbidity and mortality. Although endoscopic treatment was recommended as the first-line approach, it is often limited in real clinical practice. Over the past few decades, transcatheter arterial embolization has become a major treatment modality for the management of gastrointestinal bleeding that is refractory to endoscopic management. This review aims to describe the outcomes and complications of transcatheter arterial embolization for gastrointestinal bleeding.
Emergencies ; Hemorrhage ; Mortality

OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
Aneurysm* ; Hemorrhage ; Humans ; Mortality ; Subarachnoid Hemorrhage*

OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
Aneurysm* ; Hemorrhage ; Humans ; Mortality ; Subarachnoid Hemorrhage*

BACKGROUND AND OBJECTIVE

A growing body of evidence supports that inflammatory mechanisms are involved in secondary brain injury after intracerebral hemorrhage (ICH) which has implications on the morbidity and mortality of stroke patients. Neutrophil-to-lymphocyte ratio (NLR) is a comprehensive index marker of inflammation and immune status of a patient. The prognostic value of NLR in predicting in-hospital mortality and functional outcome of patients with spontaneous intracerebral hemorrhage will be assessed in this study.

We retrospectively selected 151 hemorrhagic stroke patients, and demographic and clinical characteristics were collected and computed for NLR. Receiver operating characteristic analysis using Youden’s index was utilized to determine the NLR cut-off value with the best sensitivity and specificity. The association of NLR with the inhospital mortality and functional outcome was assessed using Logistic regression analysis. Pearson Product Model Correlation was employed to evaluate the correlation of NLR with ICH volume.

Admission NLR >7 showed a significant association (p = <0.001 OR 7.99) with in-hospital mortality with a sensitivity of 70.83% and specificity of 72.82%. Furthermore, computed NLR of more than 6.4 showed significant association (p = 0.040 OR 2.92) with poor functional outcome. However, our study revealed that admission NLR showed a low level of correlation (r=0.2968, p=0.002) with the volume of ICH.

This study demonstrated that ICH patients with an elevated NLR is associated with increased inhospital mortality and poor functional outcome and that NLR can be used to predict clinical outcome among patients with spontaneous ICH.

Bleeding from anastomotic site in operation for aorta has been troublesome, because it has influence on postoperative morbidity and mortality. Therefore, hemostasis is very important. We describe a simple and effective method for achieving hemostasis of the anastomotic site in aortic surgery. By wrapping around anastomotic site with remnant artificial vascular graft, we have acquired good results.
Aorta ; Hemorrhage ; Hemostasis* ; Mortality ; Transplants*

We administered new imidazole dervative, nizofenone, to 15 cases in the acute stage following subarachnoid hemorrhage between December, 1990 and March, 1991 to determine its therapeutic value of ischemic protection. The appearance of delayed ischemic deficit was not prevented, but its prognostic adverse effect was ameliorated. The ability to perform the normal activity was 67% in the group which did not show the delayed ischemi deficit. And the ability to perform the normal activity was also 67% in the group whih showed the delayed ischemic deficit. No significant side effect was seen in the end of its administration. But in 6 cases, the administration was stopped because of deterioration of patient' consciousness level despite its administration. No therapeutic value was observed in the poor grade(Hunt and Hess grade III-IV) patients. The ability to perform the normal activity was still 29% in the poor grade group. The mortality was 13% despite nizofenone. In this clinical trial, we concluded that nizofenone had the ameliorating effect to the adverse effect of the delayed ischemic deficit in the good grade(Hunt and Hess grade I-II) patients. But the effect to the poor grade patients was not observed. So large scaled controlld study would be necessary to verify its good therapeutic effect to the whole population of subarachnoid hemorrhage patients.
Consciousness ; Humans ; Mortality ; Subarachnoid Hemorrhage*

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is one of the most common medical emergencies treated by gastroenterologists. Despite recent development of endoscopic techniques and acid-suppressive therapies, NVUGIB is still associated with high mortality rates. Risk assessment in NVUGIB is important for building therapeutic plans and discriminating patients with low risks. Previously developed scoring systems were rarely used by clinicians due to their complexity. Recently, new scoring systems have been introduced to overcome these disadvantages. Herein, we review the articles describing the various scoring systems. Recent data regarding the comparison of each scoring system are also discussed.
Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Mortality ; Risk Assessment

Intracerebral hemorrhage is a lethal stroke type with a high morbidity and mortality. Hematoma growth is one of the independent determinants of neurological and functional outcomes after intracerebral hemorrhage. Attenuation of growth is an important therapeutic strategy. Hemostatic therapeutic intervention, given ultra-early in the course of intracerebral hemorrhage, may thus improve clinical outcomes by arresting ongoing bleeding and limiting in turn the size of the hematoma. Recombinant factor VIIa is a hemostatic drug approved to treat bleeding in hemophilia or other coagulopathy; it has also been reported to arrest bleeding in nonhemophilic cases. We reviewed of the published articles specifically addressing clinical trials of recombinant factor VIIa treatment for acute intracerebral hemorrhage and evaluate the safety and feasibility of it.
Cerebral Hemorrhage* ; Factor VIIa* ; Hematoma ; Hemophilia A ; Hemorrhage ; Mortality ; Stroke

The purpose of this study is to characterize the recurrence and to investigate the risk factors for the recurrence in the 989 patients who had hypertensive intracerebral hemorrhage between 1989-1995. Fifty-three patients(5.4%) had two episodes of hemorrhage with median interval of 22.3+16.3 months(range, 1.7-71.9 months). The probable risk of recurrent hemorrhage was the highest within two years of the first hemorrhage, being 3.6 % in the first year and 3.5 % in the second year. The sites of the recurrent hemorrhage were different from the initial site in all patients. The common patterns of recurrence were "ganglionic(putamen/caudate nucleus)-thalamic" in 26.8% and "ganglionic-ganglionic in 21.4%. The "lobar-lobar" pattern was noted in only 2 patients, The overall mortality was 28.3%. In patients who had ganglionic-ganglionic pattern, the mortality was significantly inc reased (p<0.005). No recurrent hemorrhage occurred during the regular treatment for hypertension. The only significant tactor for recurrent hemorrhage was the antihypertensive therapy of less than 3 months after the initial attack(p<0.005). Considering lifelong treatment for hypertension, long-term regular control for hypertension will be required to prevent the recurrent hemorrhage.
Hemorrhage ; Humans ; Hypertension ; Intracranial Hemorrhage, Hypertensive ; Mortality ; Recurrence ; Risk Factors