In a series of 91 patients underwent stereotaxic evacuation of spontaneous intraparenchymal hematoma during last 2 years; 15 had simple aspiration and 76 had urokinase irrigation gradually through the indwelling silastic catheter. Dosage of used urokinase was average 26,000u and duration was average 2.8 days. The average removed volume percent of the hematoma was 80.1+/-15.2%, eight out of 76 cases were performed urokinase irrigation revealed rebleeding; causes were overpressure during aspiration in 4 cases, blood dyscrasia in 3 cases, and fibrinolytic effect of urokinase in one case. High incidence of rebleeding were; thalamus(4 out of 16 cases; 25%) in location, before 6 hours(4 out of 19 cases; 21.1%) in operation time interval from ictus, below 10ml(4 out of 13 cases; 30.8%) in volume of the hematoma, but not correlated with amount of used urokinase. Causes of unsatisfactory removed cases were small hematoma, brain stem and thalamic hemorrhage and malposition of the catheter. Even in cases of combined ventricular hemorrhage, we didn't experienced hydrocephalus with urokinase irrigation. In 20 cases sampled randomly, osmolality of serum and aspirated liquefied hematoma were compared; the serum osmolality was 297.6+/-12mEq and osmolality of liquefied hematoma induced by urokinase was 304.7+/-11.3mEq. These findings strongly suggest that the surrounding interstitial fluid of the hematoma was shifted into the liquefied hematoma because of 7mEq difference of osmotic pressure. Over all good result(daily living activity) on discharge was 64.5% and mortality rate was 7.9%.
Brain Stem ; Catheters ; Extracellular Fluid ; Hematoma* ; Hemorrhage ; Humans ; Hydrocephalus ; Incidence ; Mortality ; Osmolar Concentration ; Osmotic Pressure ; Urokinase-Type Plasminogen Activator

The objective of this study was to investigate clinical and radiographic features and gender differences in Korean patients with adult-onset ankylosing spondylitis. Multicenter cross-sectional studies were conducted in the rheumatology clinics of 13 Korean tertiary referral hospitals. All patients had a confirmed diagnosis of ankylosing spondylitis according to the modified New York criteria. Clinical, laboratory, and radiographic features were evaluated and disease activities were assessed using the Bath ankylosing spondylitis disease activity index. Five hundred and five patients were recruited. The male to female ratio was 6.1:1. Average age at symptom onset was 25.4+/-8.9 yr and average disease duration was 9.6+/-6.8 yr. Males manifested symptoms at a significantly earlier age. HLA-B27 was more frequently positive in males. Hips were more commonly affected in males, and knees in females. When spinal mobility was measured using tragus-to-wall distance and the modified Schober's test, females had significantly better results. Radiographic spinal changes, including bamboo spine and syndesmophytes, were more common in males after adjustment of confounding factors. In conclusion, we observed significant gender differences in radiographic spinal involvement as well as other clinical manifestations among Korea patients with adult-onset ankylosing spondylitis. These findings may influence the timing of the diagnosis and the choice of treatment.
Adult ; Age of Onset ; *Asian Continental Ancestry Group ; Female ; HLA-B27 Antigen/diagnostic use ; Humans ; Joints/pathology ; Male ; Severity of Illness Index ; Spondylitis, Ankylosing/diagnosis/*pathology/*physiopathology/*radiography