OBJECTIVETo compare the efficacy of 3% hypertonic saline solution with 20% mannitol in treatment of intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage.

METHODSAn alternating treatment protocol was used to compare the efficacy of 160 mL 3% hypertonic saline solution (HSS) with 150 mL 20% mannitol for episodes of increased intracranial pressure (ICP) in patients with aneurysmal subarachnoid hemorrhage. The dependent variables were the extent and duration of reduction of increased ICP after each event.

RESULTSBoth 3% HSS and 20% mannitol rapidly decreased the ICP in patients with aneurysmal subarachnoid hemorrhage (P <0.01). No difference between two medications in the extent of duration of ICP and reduction of action (P >0.05).

CONCLUSION3% HSS should be considered as the first-line osmotic drug in treatment of intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage.

Humans ; Intracranial Hypertension ; drug therapy ; Mannitol ; therapeutic use ; Saline Solution, Hypertonic ; therapeutic use ; Subarachnoid Hemorrhage ; drug therapy ; Treatment Outcome

Intracranial infections are one of the most common neurological diseases in children and are associated with high mortality and morbidity. Intracranial hypertension and hydrocephalus are the common, fatal complications of intracranial infections, so early diagnosis and timely treatment are the keys to saving patients' lives and reducing neurological sequelae. This paper introduces the progress in the etiology, diagnosis, and treatment of intracranial hypertension and hydrocephalus in children with intracranial infections.
Central Nervous System Infections ; complications ; Child ; Humans ; Hydrocephalus ; diagnosis ; etiology ; therapy ; Intracranial Hypertension ; diagnosis ; etiology ; therapy

OBJECTIVETo compare the effects of 15% hypertonic saline and 20% mannitol in doses of similar osmotic burden for treatment of intracranial hypertension in patients with severe traumatic brain injury.

METHODSWe used an alternating treatment protocol to compare the effects of hypertonic saline with that of mannitol given for episodes of increased intracranial pressure (ICP) in patients with severe brain injury. Standard guidelines for the management of severe traumatic brain injury were followed. For episodes of increased ICP, 20% mannitol (2 ml/kg, infused for over 20 min) and 15% saline (0.42 ml/kg, administered as a bolus via a central venous catheter) of similar osmotic burden were given alternately, with the choice of agent for the initial hypertensive event determined on a randomized basis. Reduction of ICP and duration of the action were recorded after each event.

RESULTSThe data were collected from 33 patients with 237 hypertensive events. The mean decrease in ICP was 8.7 mm Hg at 28.7∓9.3 min after mannitol treatment as compared with 9.3 mm Hg at 23.6∓7.1 min after treatment with hypertonic saline (P>0.05). The mean duration of the effect was 270 min for mannitol and 318 min for hypertonic saline (P>0.05).

CONCLUSIONSTreatment with 15% hypertonic saline and 20% mannitol in doses of similar osmotic burden produces similar effects in management of increased ICP in patients with severe traumatic brain injury in terms of the time of action onset, maximum ICP reduction, and duration of action.

Brain Injuries ; therapy ; Humans ; Intracranial Hypertension ; therapy ; Mannitol ; therapeutic use ; Saline Solution, Hypertonic ; therapeutic use

BACKGROUND AND PURPOSE: Cerebral venous flow obstruction (CVFO) is a fatal complication of traumatic brain injury. To compare the outcomes of patients with CVFO secondary to traumatic-brain-injury-induced transsinus fracture who were diagnosed early versus those diagnosed late in the therapeutic course. METHODS: In total, 403 patients with transsinus fracture were reviewed retrospectively. The patients were divided into an early-diagnosis group (n=338) and a delayed-diagnosis group (n=65). The patients submitted to 2D time-of-flight magnetic resonance venography (2D-TOF MRV) and/or CT venography (CTV), depending upon the findings of intracranial pressure monitoring, in order to identify potentially complicated CVFO. These examinations took place within 3 days of the onset of malignant intracranial hypertension symptoms in the early-diagnosis group, and after an average of 7 days in the delayed-diagnosis group. Once diagnosed, patients received intravenous thrombolytic therapy with low-dose urokinase. Patients with massive transsinus epidural hematoma, depressed fracture, or cerebral hernia were treated surgically to relieve the compression and repair any damage to the venous sinuses. RESULTS: Cerebral venous flow obstruction was much more severe in the delayed-diagnosis group than in the early-diagnosis group (p<0.001), and hence patients in the former group were given a higher dose of urokinase (p<0.001) for thrombolytic therapy. They were also significantly more likely to need surgery (48.1% vs. 20.6%, p=0.003) and had a higher mortality rate (37.0% vs. 4.1%, p<0.001). However, patients in both groups experienced a similarly favorable prognosis, not only with regard to functional outcome but also with respect to neuroradiological improvement, as evaluated by 2D-TOF MRV/CTV at the final follow-up (p=0.218). CONCLUSIONS: Delayed diagnosis can result in increased risk of surgery and death in the acute phase. Thrombolytic therapy with low-dose urokinase resulted in promising improvements in both functional and neuroradiological outcomes in all of the patients in this study, regardless of the time to diagnosis.
Brain Injuries* ; Delayed Diagnosis ; Early Diagnosis* ; Encephalocele ; Follow-Up Studies ; Hematoma ; Humans ; Intracranial Hypertension ; Intracranial Pressure ; Magnetics ; Magnets ; Phlebography ; Prognosis ; Retrospective Studies ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator

OBJECTIVETo compare the effects of mannitol and hypertonic saline (HS) in treatment of intracranial hypertension (ICH) of rabbits.

METHODSThe animal mode of ICH was established by perfusing artificial cerebrospinal fluids (aCSF) with controlled pressure into the cerebral ventricles of rabbits. The mean arterial pressure, respiratory rate, tidal volume, perfusion rate of aCSF and water content of cerebrum were investigated in rabbits with ICH after a single bolus of 20% mannitol (5 ml/kg), 7.5% HS (2.2 ml/kg) or 23.4% HS (2.2 ml/kg).

RESULTSAfter the intracranial pressure was elevated from 15 cmH₂O to 75 cmH₂O, the mean arterial pressure was increased and the tidal volume was decreased. After treatment by 20% mannitol, 7.5% HS or 23.4% HS, the increased percentage of mean arterial pressure and the decreased percentage of tidal volume were similar to the changes in control group. However, the perfusion rate of CSF was increased and water content of cerebrum was decreased after treatment by either 20% mannitol or 23.4% HS, but not by 7.5% HS. No different effects were found between 20% mannitol and 23.4% HS.

CONCLUSIONWith the similar osmotic burden, 20% mannitol is more effective in treating ICH than 7.5% HS. With higher osmotic load, the efficacy of HS is enhanced, and 23.4% HS may be used as an alternative to mannitol in treatment of ICH.

Animals ; Disease Models, Animal ; Female ; Intracranial Hypertension ; drug therapy ; Male ; Mannitol ; administration & dosage ; therapeutic use ; Rabbits ; Saline Solution, Hypertonic ; administration & dosage ; therapeutic use

Acute Disease ; Bacterial Infections ; prevention & control ; Brain Edema ; drug therapy ; etiology ; Critical Care ; Hepatic Encephalopathy ; etiology ; therapy ; Humans ; Intracranial Hypertension ; etiology ; therapy ; Liver Failure, Acute ; etiology ; nursing ; therapy ; Liver Transplantation ; nursing ; standards

Brain Injuries ; metabolism ; therapy ; Craniotomy ; Genomics ; Humans ; Intracranial Hypertension ; therapy ; Practice Guidelines as Topic ; Proteomics ; Stem Cell Transplantation

OBJECTIVETo observe the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection (HSH) in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs, and explore the mechanism of the effects of HSH.

METHODSTwenty dogs were randomized into 4 equal groups, namely the 7.5% NaCl (HS) group, Ringer-Lactates solution (RL) group, hydroxyethyl strarch (HES) group, and HSH group. Canine models of acute intracranial hypertension complicated by hemorrhagic shock were established by epidural balloon inflation with saline and rapid discharge of the arterial blood. One hour after the induced shock, the dogs were given HS (6 ml/kg), RL of 3-fold volume of blood loss, HES of equivalent volume of blood loss, and HSH 8 ml/kg in the 4 groups, respectively. During the shock and resuscitationperiod, the intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) of the dogs were monitored, and the serum sodium level and plasma osmolality were measured at 30 min, 1 h and 4 h after the resuscitation.

RESULTSAll dogs had similar MAP, CPP, and ICP before resuscitation (P>0.05). After resuscitation, the MAP was significantly improved (P<0.01), but the dogs in HSH group exhibited the fastest response; with the exception of the dogs in HS group to have significantly decreased MAP 2 h after resuscitation (P<0.01), all the other dogs maintained the MAP for 4 h. The CPP was also significantly increased after resuscitation (P<0.01), and in HS group, CPP decreased significantly after 2 h (P<0.01), and HSH group maintained the high CPP after 4 h. The ICP was increased significantly in RL and HES groups after resuscitation (P<0.01), reaching the peak level at 1 and 3 h, respectively, but in HS and HSH groups, the ICP decreased significantly to the lowest level at 1 h (P<0.01) which was maintained for 4 h. After resuscitation, the plasma sodium and plasma osmolality were significantly increased in HSH and HS groups.

CONCLUSIONIn dogs with acute intracranial hypertension and hemorrhagic shock, HSH can effectively resuscitate hemorrhagic shock and decrease ICP, and the effect is longer-lasting than that of HS.

Acute Disease ; Animals ; Dogs ; Female ; Hydroxyethyl Starch Derivatives ; administration & dosage ; therapeutic use ; Intracranial Hypertension ; drug therapy ; etiology ; Male ; Plasma Substitutes ; administration & dosage ; therapeutic use ; Random Allocation ; Saline Solution, Hypertonic ; administration & dosage ; therapeutic use ; Shock, Hemorrhagic ; complications ; drug therapy ; Treatment Outcome

Amphotericin B ; administration & dosage ; Antifungal Agents ; administration & dosage ; Child ; Cryptococcus neoformans ; drug effects ; pathogenicity ; Diagnosis, Differential ; Drug Delivery Systems ; instrumentation ; methods ; Humans ; Injections, Intraventricular ; Injections, Spinal ; Intracranial Hypertension ; complications ; drug therapy ; etiology ; Male ; Meningitis, Cryptococcal ; diagnosis ; drug therapy ; physiopathology ; Treatment Outcome

BACKGROUND: Long-term survival rate of chronic renal failure patients has been increasing gradually since the development of renal replacement therapy. At present, death cause of patients under the renal replacement therapy is well known, however, there is few clinical research on that of patients before starting the therapy and the referral time to a nephrologist. We have analyzed the death cause of patients before starting the renal replacement therapy and to investigate if the death has associated with the referral time to a nephrologist. METHODS: We investigated chronic renal failure patients who had been admitted Sanggye Paik Hospital from January 1997 to December 2000. Specific target was the deceased among the chronic renal failure patients who had not undergone renal replacement therapy. Our research was done in a retrograde study. We divided the target group into diabetic group and non-diabetic group. RESULTS: Among 29 expired patients, male patients were 17 and female were 12, and their average age was 61+/-12.3 years. As the cause of chronic renal failure, diabetes was 15, hypertension was 8, glomerular disease was 4, and unidentified was 2. Diabetic group were 15(51.7%) and non-diabetic group were 14(48.3%). Average age was 57.3+/-9.5 years in the diabetic group and 58.9+/-10.2 years in the non-diabetic group. The rate of male and female was 9:6 in the diabetic group and 8:6 in the non-diabetic group, so the rate seems similar in both of groups. BUN and creatinine in blood was compared at the hospital admission, the diabetic group had an average BUN of 54.3+/-12.4 mg/dL and average creatinine of 7.1+/- 2.5 mg/dL and the non-diabetic group had an average BUN 98.9+/-10.6 mg/dL and average creatinine of 9.3+/-3.0 mg/dL. Albumin in blood was 3.4+/-0.6g/dL in the diabetic and 3.6+/-0.8g/dL in the non-diabetic. As the death cause, sepsis was 17(58.6%), cardiovascular disease 5(17.5%), intracranial hemorrhage 4(13.8%), and liver disease was 3(10.1%). As the cause of sepsis, pneumonia was 9(52.9%), catheter infection 5(29.4%), peritoneum 2(11.7%) and urinary track infection was 1(6.0%). The initial meeting with a nephrologist prior to dialysis occurred as follow; in the diabetic group, early refer was 4(26.6%) and delay refer was 11(73.4%), and in the non-diabetic early refer was 2(14.2%) and delay refer was 12(85.8%). CONCLUSION: As for chronic renal failure patients before starting the renal replacement therapy, a physician should give an continual attention to the patients and refer them to a nephrologist promptly for the renal replacement therapy. In addition, a nephrologist should not lose the time for dialysis by analyzing the patient's condition thoroughly and starting the renal replacement therapy at the opportune moment, which could be helpful to reduce patients' medical expense and death rate.
Cardiovascular Diseases ; Catheters ; Cause of Death* ; Creatinine ; Dialysis ; Female ; Humans ; Hypertension ; Intracranial Hemorrhages ; Kidney Failure, Chronic* ; Liver Diseases ; Male ; Mortality ; Peritoneum ; Pneumonia ; Referral and Consultation ; Renal Replacement Therapy* ; Sepsis ; Survival Rate