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*

OBJECTIVE: Despite recent technical advances in neurological surgery and medical management, patients with aneurysmal subarachnoid hemorrhage(SAH) who underwent surgery have been still at high risk of morbidity and mortality. For early prediction of postoperative outcome and proper management, we analyzed brain computed tomography(CT) findings taken at three days after cerebral aneurysm surgery. METHODS: Focusing on the relationship between the surgical outcomes and postoperative brain CT findings, the authors studied 153 consecutive patients with aneurysmal subarachnoid hemorrhage who had been treated surgically between January 1993 and December 1996. RESULTS: Brain CT findings were classified into following categories; non-specific(49 cases, 32.0%), hematoma at operation site(14 cases, 9.2%), ventricular dilatation(10 cases, 6.5%), subdural hygroma(27 cases, 17.6%), low density (28 cases, 18.3%), hemorrhage at remote site(0 cases, 0%) and combined lesions(25 cases, 16.3%). The poor surgical outcomes were 6% in normal CT finding group and 36% in abnormal CT finding group(p=0. 00011, Chi-square test). CONCLUSION: These findings suggest that postoperative third day brain CT findings could be used for an early predictor of outcomes and proper active managements could improve the poor outcome.
Aneurysm ; Brain* ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Mortality ; Subarachnoid Hemorrhage

Upper gastrointestinal (UGI) hemorrhage remains one of the more common cause of emergency hospital admissions. The majority of patients with ulcer bleeding will not have recurrent bleeding, but 25% of patients will have recurrent or continuous bleeding and require further therapy. Endoscopy is the preferred investigative procedure for UGI bleeding because of its accuracy and low complication rate. Although no study has clearly demonstrated improved mortality rates attributable specifically to the use of endoscopy, it is likely that improved therapeutic outcome lags behind diagnostic advances. All of these 4 patients died eventually due to the massive UGI bleeding in hospital and autopsy was done between September, 1997. and May, 1998. in National Institute of Scientific Investigation (NISI). Despite major advances in diagnostic and therapeutic capabilities, mortality from this often devastating condition remains unacceptably high. The optimal balance between operative and non-operative therapy has yet to be determined. So the close cooperation between internist and surgeon is required.
Autopsy* ; Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage* ; Hemorrhage ; Humans ; Mortality ; Ulcer*

In order to define the hospital course and the best surgical timing for the poor grade subarachnoid hemorrhage(SAH) patients, 131 patients(from 1989 to 1991) whose clinical grade on admission were Hunt and Hess grade III to V were analyzed. Their admission grades was III(90 patients), IV(30 patients), and V(11 patients). Patients were grouped into the early surgery group(within 3 days of the last hemorrhage), the intermediate group(4 to 14 days), the late surgery group(14 days after the last hemorrhage), and non-surgical group. Early surgery was performed on 17 patients, intermediate on 31 patients, and late on 54 paients. Twenty-nine patients did not undergo surgery. This non-surgical group had a high mortality rate(72.4%). During the waiting period for a delayed surgery(later than 3 days), 21% improved their clinical state, 53.5% were stationary and 25.5% became worse. Morbidity and mortality were compated among these three surgical groups and the non-surgical group, with sratistical analysis using chi square test and Fisher's exact test. No statistical differences were noted between the management groups in terms of associated disease, location of aneurysms, Fisher's grade, occurrence of hydrocephalus or symptomatic vasospasm. The mortality rate was significantly lower in the combined surgical groups than in the non-surgical group(p<0.05). Mortality was related to the timing of surgery. It was higher after early surgery than in the other two gorups, but it was not different between the intermediate and late surgery groups. Morbidity was not different among the three surgery groups. The major cause of morbidity and mortality in the early surgery group was brain swelling, while rebleeding, hydrocephalus, and vasospasm, were the main causes in the intermediate and delayed surgery groups. It is concluded that it is not recommended that early surgery must be done in all the poor grade SAH patients. However three days after the last hemorrhage, it is better to perform surgery as soon as possible, because there were no statistically significant differences between the intermediate group and the late surgery groups in the mortality and the morbidity rates.
Aneurysm ; Brain Edema ; Hemorrhage ; Humans ; Hydrocephalus ; Mortality ; Subarachnoid Hemorrhage*