The authors performed prospectively the transcranial Doppler monitoring of bilateral anterior and middle cerebral arteries in 15 patients with ruptured cerebral aneurysm. The entry criteria for the study were confined to the patients who were admitted within 3 days after bleeding and had clinical grades of I, II, or III. The mean frequency shifts of bilateral anterior and middle cerebral arteries were increased immediately after ictus and showed continous further elevation between the 3rd and 8th rupture days. After that, they normalized slowly. The increase of frequency shift preceded clinical ischemic symptoms and an early steep increase of frequency shift was correlated to a high chance for suffering delayed ischemic deficits. The thick clots in subarachnoid cisterns shown on CT scans taken within the third rupture day were correlated well to the severe increase of frequency shifts. The aggressive treatment was done on asymptomatic patients who showed relatively rapid increase of frequency shifts, and they had shown no or trasient mild ischemic symptoms.
Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Prospective Studies ; Rupture ; Tomography, X-Ray Computed

The effect of the calcium antagonist nimodipine on the feline cerebral cortical blood flow in experimentally induced subarachnoid hemorrhage(SAH) was studied. Cerebral cortical blood flow was measured in the middle cerebral territory at specified intervals by the hydrogen clearance method. SAH was induced in 25 cats by a slow injection of fresh autogenous arterial blood into the cisterna magna. Twenty-five cats were divided into 5 groups of 5 cats each according to the timing of the cerebral cortical blood flow measurements after SAH ; immediate(Group la, lb), 24 hours(Group 2), 48 hours(Group 3) and 7 days (Group 4). Cerebral cortical blood flow dereased by 55.5%, 39.2%, 41.4%, and 38.3% from pre-SAH levels in each group respectively. During nimodipine infusion(1 microgram/kg/min) cerebral cortical flow increased by 89.0%, 51.8%, 87.5% and 24.5% from pre-nimodipine infusion levels in each group respectively. Mean arterial blood pressure(MABP) after cisternal blood injection increased by 6.5% from pre-SAH levles, and MABP during nimodipine infusion decreased by 15.4% from pre-Nimodipine infusion levels. The calcium antagonist nimodipine increased cerebral cortical blood flow significantly in experimentally induced SAH without considerable changes of MABP. Results are considered promising for trials in the treatment and prevention of cerebral by vasospasm following SAH.
Animals ; Calcium* ; Cats ; Cisterna Magna ; Hydrogen ; Nimodipine* ; Subarachnoid Hemorrhage*

OBJECTIVE: Nitric oxide and endothelin-1 are two endothelium derived relaxing and constricting factors probably involved in the pathogenesis of cerebral vasospasm after subarachnoid hemorrhage. The aim of this study is to ascertain the effects of nitric oxide donor(nitroglycerine) to reverse endothelin-1 induced cerebral vasoconstriction in vivo, when administered to the adventitial side of the basilar artery exposed through a transclival approach and common carotid artery exposed through a transcervical approach. METHODS: The exposed arteries were subjected to pharmacological manipulations and direct observation of the changes of their sizes under surgical microscope. Measurements of blood pressure, pulse rate and cerebral blood flow using thermal diffusion flowmetry during the drug infusion were done. RESULTS: 1) Nitroglycerine rapidly and completely reversed endothelin-1-induced vasoconstriction. The average value for maximal vasoconstriction by endothelin-1/synthetic cerebrospinal fluid was 58.3% of baseline arterial diameter and occurred within 30 minutes. 2) The nitroglycerine administered via adventitial side of the blood vessel was not associated with any changes in systemic blood pressure nor other vital signs. 3) Same changes occurred in the common carotid artery, although the severity of the occurrence and reversal of vasospasm were not significant compared to those of basilar artery. CONCLUSION: Intrathecally administered nitroglycerine was effective in reversing cerebral vasoconstriction without causing systemic hypotension. These findings provides the potential for the development of targeted therapy to reverse cerebral vasospasm after subarachnoid hemorrhage using nitric oxide donors.
Arteries ; Basilar Artery ; Blood Pressure ; Blood Vessels ; Carotid Artery, Common ; Cerebrospinal Fluid ; Endothelin-1* ; Endothelium ; Heart Rate ; Hypotension ; Nitric Oxide ; Nitric Oxide Donors ; Nitroglycerin* ; Rheology ; Subarachnoid Hemorrhage ; Thermal Diffusion ; Vasoconstriction ; Vasospasm, Intracranial ; Vital Signs

Fourty-seven patients with non-aneurysmal spontaneous subarachnoid hemorrhage were reviewed retrospectively. Attention was directed to the distribution and amount of subarachnoid hemorrhage on computerized tomography scans. Though the hemorrhage could be distributed in all cisterns, the frequency and amount of hemorrhage were higher in infratentorial cisterns than in supratentorial cisterns. Among infratentorial cisterns, the hemorrhage was distributed to cisterns around the brain-stem mainly and it had a predilection for interpeduncular cistern. Also the telangiectasia of thalamoperforating artery might be one of the causes of non-aneurysmal spontaneous subarachnoid hemorrhage.
Arteries ; Hemorrhage ; Humans ; Retrospective Studies ; Subarachnoid Hemorrhage* ; Telangiectasis

We reported a case of recurrent arteriovenous malformation, which had been operated on before and disappeared on postoperative angiography. Though a postoperative angiogram after the first operation indicated complete excision of the lesion, the patient returned with intracerebral hemorrhage, and an angiogram indicated reappearance of the lesion. Total excision was carried out at the second operation. It is concluded that long term follow-up angiography or vascular imaging procedures are required in particular cases of cerebral arteriovenous malformation with hematoma, difficulty in hemostasis and/or deep seated lesion.
Angiography* ; Arteriovenous Malformations ; Cerebral Hemorrhage ; Follow-Up Studies ; Hematoma ; Hemostasis ; Humans ; Intracranial Arteriovenous Malformations ; Recurrence*

Congenital M llerian anomalies of uterus are so infrequently encountered and endometriosis, primary infertility, hematometra, and urinary tract anomalies are claimed to be common complaints in women with unicornuate uterus. We report one case of rudimentary horn associated with agenesis of right kidney and pelvic endometriosis which is presented with brief review of literature about anomaly of the female genital tract.
Animals ; Endometriosis* ; Female ; Hematometra ; Horns* ; Humans ; Infertility ; Kidney* ; Urinary Tract ; Uterus

The aim of this study was to evaluate the incidence and the management of hydrocephalus following ruptured intracranial aneurysms. The authors analyzed 223 patients with aneurysmal subarachnoid hemorrhage(SAH) during the last two years retrospectively. The results are summarized as follows. Eighty patients(35.9%) showed ventricular dilatation on a brain CT scan. Twenty-five patients(11.2%) required shunt surgery. Hydrocephalus was closely related to the amount of hemorrhage and the location of the ruptured aneurysm. Two of 9 patients with acute hydrocephalus, who were managed by extraventricular drainage(EVD) before definite aneurysm surgery. The shunt surgery was done before aneurysm surgery in 16 patients and rebleeding occurred in 3 patients. Radioactive isotope(RI) cisternography diagnosed communicating hydrocephalus in 11 patients and the lumboperitoneal shunt was performed in those cases. It is concluded that hydrocephalus following aneurysmal SAH is the communicating type, an indication for shunt surgery could be determined by RI cisternography, and lumboperitoneal shunting seems to be the best treatment of choice to avoid rapid decompression of the ventricles and to protect the already compromised cerebral hemisphere. Decompression of the ventricles before aneurysmal surgery should be avoided whenever possible.
Aneurysm ; Aneurysm, Ruptured ; Brain ; Cerebrum ; Decompression ; Dilatation ; Hemorrhage ; Humans ; Hydrocephalus* ; Incidence ; Intracranial Aneurysm* ; Retrospective Studies ; Tomography, X-Ray Computed

In brachytherapy of uterine cervical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. The post-treatment calculated point A dose was not much different from the pretreatment planned dose (500 cGy). The average+/-standard deviation was 500+/-18 cGy and 84 percent of 82 intracavitary radiotherapy was within the range of 500+/-25 cGy.
Brachytherapy ; Cervix Uteri* ; Female ; Radiotherapy* ; Uterine Cervical Neoplasms

To formulate treatment strategies for poor-grade patients after aneurysmal subarachnoid hemorrhage(SAH), medical records were analyzed for 166 patients who were in Hunt and Hess grade IV or V among 588 consecutive aneurysmal SAH patients admitted during the past 5 years. Causes for unfavorable outcome(poor or dead) in these 166 patients were carefully evaluated to improve the management outcome. Overall management results were favorable(good or fair) in 71(42.8%), and unfavorable in 95(78 dead, 17 poor). Direct clipping was performed in 90 patients, and the surgical results were favorable in 69(76.7%) and unfavorable in 21(23.3%). Surgery was not performed in 76 patients because of moribund state on arrival in 41, neurological deterioration due to rebleeding in 15, massive brain swelling in seven, serious medical illness in five, severe delayed ischemic deficit in one, and massive cerebral infarction following angiography in one, and refused surgery in six. Seven patients survived from non-surgery group(2 fair, 5 poor). Direct effects of aneurysm rupture(34.8%) and early rebleeding(34.8%) were the causes of unfavorable outcome in grade IV patients, while it was direct effect of aneurysm rupture(91.8%) in grade V patients. It is suggested that since rebleeding is the only preventable factor of unfavorable outcome, urgent management seems necessary to prevent rebleeding, especially for grade IV patients. Grade IV patients should be treated aggressively with direct clipping for non-complex aneurysms or for patients with hematoma, and with coil embolization for complex aneurysms without hematoma.
Aneurysm ; Angiography ; Brain Edema ; Cerebral Infarction ; Embolization, Therapeutic ; Hematoma ; Humans ; Intracranial Aneurysm* ; Medical Records

OBJECTIVE: The purpose of this study was to provide management strategy and to improve management outcome of patients with unruptured intracranial aneurysms (UIA). PATIENTS AND METHODS: The authors reviewed the database as sources for identifying and analyzing patients, and analyzed the management outcome of patients with UIA. From June 1979 to June 1999, among total of 1,801 patients treated for intracranial aneurysms, 372 patients with 437 unruptured aneurysms were treated by surgery (335 patients) or neurointervention (37 patients). One hundred and forty - three patients with 158 UIA had no history of SAH from a different aneurysm (group 1), and 229 patients with 279 UIA had a ruptured aneurysm that have been repaired simultaneously or before treatment of UIA (group 2). We reviewed the rate of favorable (good, fair) and unfavorable (poor or dead) outcome one year after the treatment. RESULTS: The rate of favorable and unfavorable outcome in group 1 was 96.5% and 3.5% respectively. In Group 2, the rate was 93.5% and 6.5%. However, the most of the unfavorable outcome in group 2 came from treatment of the ruptured aneurysm, or SAH. The only significant factor contributed to unfavorable outcome in group 1 was size of UIA. Those of group 2 were age, Fisher grade, Hunt - Hess grade, and aneurysm number. Complications attributable to surgical or endovascular treatment of UIA that occurred in 38 of 372 patients (10.2%) were cerebral infarction (17), intracerebral hemorrhage (10), epidural hematoma (4), cranial nerve injury (3), infection (2), venous infarction (1), and subarachnoid hemorrhage (1). CONCLUSION: Rupture of an intracranial aneurysm is a devastating event. The safe size below which rupture is unlikely is unclear. There appears to be increased risk from unruptured aneurysms discovered in SAH patients. All unruptured aneurysms in healthy patients as well as in patients with history of SAH should be repaired.
Aneurysm ; Aneurysm, Ruptured ; Cerebral Hemorrhage ; Cerebral Infarction ; Cranial Nerve Injuries ; Hematoma ; Humans ; Infarction ; Intracranial Aneurysm* ; Rupture ; Subarachnoid Hemorrhage