RESUMEN
OBJECTIVE: We analyzed acute ischemic stroke by thromboembolism in the early period after lung cancer surgery. METHODS: A retrospective review of the clinical records of patients who underwent lung resection for primary lung cancer was performed. Patients who underwent lobectomy, bilobectomy, and pneumonectomy were included. The clinical characteristics of the patients, the incidence of atrial fibrillation (Af) after surgery, and the incidence of acute ischemic stroke were analyzed. The clinical courses of patients having acute ischemic stroke were also reviewed. RESULTS: In 4 (0.6%) of 696 patients, acute ischemic stroke occurred in the early period during hospitalization after lung cancer surgery. Acute ischemic stroke occurred within 4 days in three cases and after 4 days in one case. The resection site of the lung was the left side in all cases, and there were three cases of left upper lobectomy and one case of left lower lobectomy. As for the two recent patients, thrombus removal was performed by a neurosurgeon, and both cases achieved successful recanalization. The time between symptom detection and recanalization was 205 and 170 min, respectively. One patient was cured without any residual effect of disease, and the other patient's hemiplegia resolved and aphasia improved. CONCLUSION: Since cerebral infarction impairs the patient's quality of life, thrombus removal should be considered if possible.
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Neoplasias Pulmonares/cirugía , Neumonectomía/efectos adversos , Accidente Cerebrovascular/epidemiología , Tromboembolia/epidemiología , Anciano , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Accidente Cerebrovascular/prevención & control , Tromboembolia/prevención & controlRESUMEN
BACKGROUND: The symptoms of sudden severe headache and/or diminished consciousness characterize the onset of aneurysmal subarachnoid hemorrhage (SAH). However, several studies have suggested that some patients show an atypical presentation at the onset: symptoms lacking sudden headache and diminished consciousness. The aim of this study was to investigate the incidence and clinical features of cases with atypical onset. METHODS: Retrospective observational study based on the data collected prospectively from all patients with SAH admitted to our hospital was performed. Cases with a sudden headache at the onset were classified as the headache onset group, and cases with onset symptoms other than headache were classified as the atypical onset group. The clinical parameters were compared between the two groups. RESULTS: Of the 368 patients with SAH, 75 (20.4%) showed diminished consciousness from onset, 279 (75.8%) comprised the headache onset group, and 14 (3.8%) comprised the atypical onset group. The main symptoms in the atypical onset group were nausea or vomiting, vertigo or dizziness, and neck pain or back pain. The rate of misdiagnosis of SAH and the rate of rebleeding after misdiagnosis were higher in the atypical onset group (P = .045 and P = .043, respectively). The interval from onset to diagnosis was longer in the atypical onset group (P = .033). The atypical onset group demonstrated a more severe clinical grade on admission (P = .009), a lower rate of ruptured aneurysm repair (P < .001), and a poorer outcome (P = .003). CONCLUSIONS: Atypical onset is rare but has a great impact on the clinical course through rebleeding exacerbated by misdiagnosis or delayed diagnosis, resulting in poor outcomes.
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Hemorragia Subaracnoidea/epidemiología , Anciano , Dolor de Espalda/epidemiología , Trastornos de la Conciencia/epidemiología , Diagnóstico Tardío , Diagnóstico Diferencial , Errores Diagnósticos , Mareo/epidemiología , Femenino , Cefalea/epidemiología , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Náusea/epidemiología , Dolor de Cuello/epidemiología , Procedimientos Neuroquirúrgicos , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/terapia , Vértigo/epidemiología , Vómitos/epidemiologíaRESUMEN
The actual number and condition of Japanese patients in persistent vegetative states have not yet been fully understood. The aim of this study is to investigate the epidemiology of patients in persistent vegetative states in the Aomori prefecture. We sent questionnaires regarding gender, age, cause of persistent vegetative state, and residence of patient to all medical institutions in the Aomori prefecture (n=682). Two hundreds and seventeen institutions (31.8%) replied to the questionnaire, and eleven hundred ninety-eight patients(Male/Female=381/817) were included. Patients over 80 years-old were the most common (63.4%), and cerebrovascular stroke was the major cause (64.4%) of persistent vegetative state. Nursing homes (48.1%) and hospitals (34.6%) were the main care institutions. Population based analysis revealed that 869 persistent vegetative state patients per million were cared for in the Aomori prefecture. This result was twice as many as was previously reported in Miyagi prefecture. The number of patients in persistent vegetative states will increase in the future, due to an increasing elderly population and a high incidence of stroke in this demographic. We therefore predict that increased medical and administrative support will be required in the future.
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Estado Vegetativo Persistente/epidemiología , Encuestas y Cuestionarios , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Recolección de Datos/métodos , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
An 18-year-old male suffered a penetrating skull base injury caused by a metal rod. We made translucent three-dimensional (3D) computed tomography (CT) for clearing the injury site. This method has revealed that right carotid artery was compressed directly by the foreign body, and internal carotid artery trapping was carried out based on hemodynamics as revealed by angiography. This patient achieved modified Rankin scale score of 1 at discharge. Cases of trauma involve a variety of circumstances and therefore require a case-by-case evaluation that depends on the patient's condition. Translucent 3D CT was useful in considering the treatment strategy of the penetrating skull base injury.
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Traumatismos Penetrantes de la Cabeza/diagnóstico por imagen , Traumatismos Penetrantes de la Cabeza/terapia , Imagenología Tridimensional , Tomografía Computarizada por Rayos X/métodos , Accidentes por Caídas , Adolescente , Traumatismos Penetrantes de la Cabeza/etiología , Humanos , MasculinoRESUMEN
BACKGROUND AND IMPORTANCE: Different types of tumor have been reported in the pineal gland, but pleomorphic xanthoastrocytoma (PXA) in this region is extremely rare. CLINICAL PRESENTATIONS: A 61-year-old man had gait disturbance and dementia for 1 month. Radiological examination revealed a 22 × 26 × 22-mm-diameter mass in the pineal gland and remarkable hydrocephalus. Biopsy of the tumor was performed and histological examination confirmed diagnosis of PXA with anaplastic features. Radiation therapy with concomitant temozolomide was performed, and tumor reduction was achieved. CONCLUSION: We report the first case of PXA with anaplastic features in the pineal gland. This case indicates that temozolomide and radiation therapy are effective for treating PXA with anaplastic features.
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Astrocitoma/terapia , Pinealoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Astrocitoma/diagnóstico , Astrocitoma/patología , Quimioradioterapia , Dacarbazina/administración & dosificación , Dacarbazina/análogos & derivados , Imagen de Difusión por Resonancia Magnética , Humanos , Interferón beta/administración & dosificación , Masculino , Persona de Mediana Edad , Pinealoma/diagnóstico , Pinealoma/patología , Dosificación Radioterapéutica , Temozolomida , Resultado del Tratamiento , Vincristina/administración & dosificaciónRESUMEN
Abstract Chronic subdural hematoma (CSH) is a disease frequently seen in the neurosurgical department. CSH also has a high rate of recurrence. Our hypothesis is that thrombin solution irrigation reduces recurrence in high-risk CSH patients. We define high risk as follows: use of anti-platelets, use of anticoagulants, recurrent CSH, renal failure, liver cirrhosis, and hematological disease. From January 1, 1998, to March 31, 2008, we compared a saline solution irrigation group (43 patients) and a thrombin solution (100 unit/ml) irrigation group (36 patients) prospectively and randomly. Surgical procedures were the same: one burr hole craniostomy, drainage of hematoma, irrigation of cavity, frontal insertion of silicon tube, replacement of air with solution, and removal of tube at 24 h after surgery. We define recurrence as an additional drainage operation due to neurological deficit within six months of surgery. Recurrences of CSH arose in two patients (5.5%) with thrombin irrigation and in 11 patients (25.6%) with saline irrigation (p < 0.05). Saline irrigation patients with anti-platelet medication experienced recurrence in five of 19 patients, although no thrombin-irrigated side recurred with the same drug. No complication occurred in relation to thrombin irrigation. Irrigation of CSH with thrombin solution is an effective treatment option for high-risk cases of CSH without complication.
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Hematoma Subdural Crónico/tratamiento farmacológico , Hematoma Subdural Crónico/cirugía , Hemostáticos/uso terapéutico , Trombina/uso terapéutico , Anciano , Femenino , Humanos , Masculino , Factores de Riesgo , Prevención Secundaria , Irrigación TerapéuticaRESUMEN
With the recent advanced aging seen in society, the number of elderly patients with aneurismal subarachnoid hemorrhage (SAH) is increasing. We focused on current management of SAH in patients who were over 75 years old. From January 1st, 2004 to the end of June, 2007, we had treated 170 SAH patients including 39 who were over 75 years old. We divided the patients into three groups : Coiling Group, Clipping Group, and conservative treatment group (Conservative Group). We analyzed the Hunt-Kosnik grade (H-K), the rate of symptomatic vasospasm, the rate of shunting operation, the Glasgow Outcome Scale (GOS) at 30 days after the onset of SAH, bed rest periods and rate of shunt operation retrospectively. The Conservative Group included many H-K poor grade cases. Symptomatic vasospasm occurred significantly less in the Coiling Group. Rates of shunting operation did not have any significant change. GOS of the Coiling Group and Clipping Group had no significant change, due to the effectiveness of arterial injection for vasospasm. Patients in the Coiling Group started walking significantly earlier than members of other groups. Twenty-five percent of the Clipping Group needed a shunt operation but no patients of the Coiling Group needed a shunt. For elderly SAH patients, we recommend doing coil embolization or clipping and maintaining the patients' activity in daily life. Interventional treatment is necessary to improve results for elderly SAH patients.