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1

Delirium in Acute Subarachnoid Haemorrhage  

Microsoft Academic Search

Background: Delirium may be a presenting feature in acute subarachnoid haemorrhage (SAH). The aim of this study was to investigate the risk factors for delirium in acute SAH and to analyse the relation between delirium and location and amount of haematic densities and hydrocephalus. Methods: We assessed delirium in a sample of 68 consecutive patients with acute (?4 days) SAH

Lara Caeiro; Coraline Menger; José M. Ferro; Rodolfo Albuquerque; M. Luísa Figueira

2005-01-01

2

Takotsubo cardiomyopathy following subarachnoid haemorrhage.  

PubMed

A 67-year-old woman was admitted with aneurysmal subarachnoid haemorrhage and a 12-lead ECG showed ST segment elevation. Transthoracic echocardiography confirmed akinesis of the left ventricular mid-apical segment, with an ejection fraction of 26%, features characteristic of takotsubo cardiomyopathy. Five days later, we identified thrombus in the apex of the left ventricle. Sixteen days after onset, the thrombus had disappeared and wall motion improved (ejection fraction 58%) without evidence of cardioembolism. Takotsubo cardiomyopathy is a cause of cardiac dysfunction after stroke, including SAH. It is characterised by transiently depressed contractile function of the left mid and apical ventricle, without obstructive coronary artery disease. Clinicians should suspect takotsubo cardiomyopathy in patients with subarachnoid haemorrhage who have an ECG abnormality. Echocardiography is needed to detect the distinctive regional wall motion abnormality. Despite its severity in the acute phase, takotsubo cardiomyopathy is self-limiting and its management is conservative. PMID:24101552

Maekawa, Hidetsugu; Hadeishi, Hiromu

2014-08-01

3

[Meningitis can resemble subarachnoid haemorrhage].  

PubMed

A 70 year-old man was admitted under the diagnosis of subarachnoid haemorrhage and presented with a history of ear pain, followed by acute onset of severe headache, nausea, vomiting, impaired consciousness, and fever. However, a computed tomography (CT) showed an acute mastoiditis and pneumocephalus, and a lumbar puncture confirmed the diagnosis meningitis. The increased middle ear pressure relative to the intracranial pressure had caused air and bacteria to penetrate intracerebrally. This case illustrates the importance of a rapid diagnostic workup in acute onset headache including a careful anamnesis, CT and lumbar puncture. PMID:22579098

Elghoura, Nour Foad Diab

2012-05-14

4

Effects of subarachnoid haemorrhage on intracranial prostaglandins.  

PubMed Central

Prostaglandins E2, F2 alpha, 6 oxo F1 alpha and thromboxane B2 increased in cisternal CSF following mock subarachnoid haemorrhage in dogs, particularly PGE2 (X25.5). Concentrations were increased also in lumbar CSF of five patients some 8 days after subarachnoid haemorrhage. Subarachnoid haemorrhage did not alter the production of prostaglandins by dog whole cortex or choroid plexuses in vitro, but production by pooled dissected cerebral arteries of PGE2 was increased and of 6 oxo F1 alpha was decreased. Intravenous indomethacin decreased prostaglandin production by cerebral tissues, and caused a marked decrease in the prostacyclin metabolite in CSF. The implications of our findings for the aetiology of cerebral vasospasm are discussed. PMID:6573437

Walker, V; Pickard, J D; Smythe, P; Eastwood, S; Perry, S

1983-01-01

5

The rabbit shunt model of subarachnoid haemorrhage.  

PubMed

Aneurysmal subarachnoid haemorrhage (SAH) is a disease with devastating complications that leads to stroke, permanent neurological deficits and death. Clinical and ex-perimental work has demonstrated the importance of the contribution of delayed cerebral vasospasm (DCVS) indepen-dent early events to mortality, morbidity and functional out-come after SAH. In order to elucidate processes involved in early brain injury (EBI), animal models that reflect acute events of aneurysmal bleeding, such as increase in intracranial pressure (ICP) and decrease in cerebral perfusion pressure, are needed. In the presented arterial shunt model, bleeding is initially driven by the pressure gradient between mean arterial blood pressure and ICP. SAH dynamics (flow rate, volume and duration) depend on physiological reactions and local anatomical intrathecal (cistern) conditions. During SAH, ICP reaches a plateau close to diastolic arterial blood pressure and the blood flow stops. Historical background, anaesthesia, perioperative care and monitoring, SAH induction, technical considerations and advantages and limitations of the rabbit blood shunt SAH model are discussed in detail. Awareness of technical details, physiological characteristics and appropriate monitoring methods guarantees successful implementation of the rabbit blood shunt model and allows the study of both EBI and DCVS after SAH. PMID:25326333

Marbacher, Serge; Nevzati, Edin; Croci, Davide; Erhardt, Salome; Muroi, Carl; Jakob, Stephan M; Fandino, Javier

2014-12-01

6

Unusual case of subarachnoid haemorrhage in patient with Fabry's disease: case report and literature review  

PubMed Central

Fabry’s disease is a rare, X linked recessive disease affecting 1 in 40 000 persons. The symptoms result from a lack of or a non-functioning enzyme ? galactosidase, which leads to globotriaosylceramide accumulation in the walls of blood vessels. Mortality is generally from cardiac or renal complications and death from subarachnoid haemorrhage is distinctly rare. The authors report a man with Fabry’s disease who died after subarachnoid haemorrhage from a progressively enlarging fusiform basilar aneurysm. PMID:22761201

Cormican, Michael T; Paschalis, Thanasis; Viers, Angela; Alleyne, Cargill H

2012-01-01

7

Acute neck pain, an atypical presentation of subarachnoid haemorrhage  

PubMed Central

Subarachnoid haemorrhage can be a massively debilitating condition with long?term repercussions. The “classic” presentation of sudden?onset severe headache normally raises suspicions. However, if the presentation is atypical, the diagnosis may be missed. We report on a 52?year?old man who presented with a 1?day history of progressively worsening right?sided neck pain spreading to the chest with associated symptoms of autonomic dysfunction. After initial stabilisation, the patient's Glasgow Coma Scale (GCS) score declined, with subsequent CT scan showing an extensive subarachnoid haemorrhage. PMID:17384369

Ahmed, Julian; Blakeley, Chris; Sakar, Ramy; Aktar, Khalida; Hashemi, Kambiz

2007-01-01

8

Acute neck pain, an atypical presentation of subarachnoid haemorrhage.  

PubMed

Subarachnoid haemorrhage can be a massively debilitating condition with long-term repercussions. The "classic" presentation of sudden-onset severe headache normally raises suspicions. However, if the presentation is atypical, the diagnosis may be missed. We report on a 52-year-old man who presented with a 1-day history of progressively worsening right-sided neck pain spreading to the chest with associated symptoms of autonomic dysfunction. After initial stabilisation, the patient's Glasgow Coma Scale (GCS) score declined, with subsequent CT scan showing an extensive subarachnoid haemorrhage. PMID:17384369

Ahmed, Julian; Blakeley, Chris; Sakar, Ramy; Aktar, Khalida; Hashemi, Kambiz

2007-04-01

9

[Carotid dissection during angioplasty for vasospasm induced by subarachnoid haemorrhage. The use of multimodal cerebral monitoring].  

PubMed

We report the case of a 54-year-old woman presenting subarachnoid haemorrhage. She experienced multiple vasospasms and treatment included triple-H (hypervolaemia, hypertension, and haemodilution) and endovascular therapies. Right internal carotid dissection complicated angioplasty of the right middle cerebral artery. Combined brain tissue partial pressure of oxygen monitoring and transcranial echo-Doppler could have facilitated early diagnosis. Despite successful revascularization of right internal carotid by stenting, this complication caused acute stroke with refractory intracranial hypertension. PMID:19945247

Bordes, J; Boret, H; Prunet, B; Montcriol, A; Goutorbe, P

2009-12-01

10

Sporadic Lateral Ventricular Hemangioblastoma presenting with Intraventricular and Subarachnoid Haemorrhage.  

PubMed

Intraventricular hemangioblastoma (HB) is very rare; few cases of intraventricular HB have been reported in the literature, either sporadically or in association with von Hippel-Lindau disease. Furthermore, the incidence of ventricular haemorrhage from HB seems to be uncommon. We report a unique case of sporadic HB of the right lateral ventricle presenting with intratumoural and intraventricular haemorrhage in addition to multifocal intracranial superficial siderosis, indicating the presence of a subarachnoid haemorrhage (SAH) as well. Such a combination has not been reported before. In the future, the detection of an intraventricular mass in association with ventricular haemorrhage, with or without SAH, should include HB as a differential diagnosis, particularly when the imaging appearances are not typical of the more common intraventricular tumours. PMID:24273675

Al-Najar, Mahasen; Al-Hadidy, Azmy; Saleh, Alaa; Al-Tamimi, Ahmad; Al-Darawish, Asaad; Obeidat, Fatima

2013-11-01

11

Ventriculostomy associated haemorrhage: A complication of anti-platelet therapy during coiling.  

PubMed

Abstract A young man with Fisher grade IV subarachnoid haemorrhage (SAH) underwent aneurysm coiling following external ventriculostomy. Coiling was complicated by thrombus formation and parent vessel occlusion necessitating anti-platelet therapy. Several hours after anti-platelet therapy, catastrophic haemorrhage associated with the ventriculostomy tract occurred. Timing and location of haemorrhage suggest combined anti-platelet therapy and ventriculostomy may have been causal. The literature on ventriculostomy haemorrhage rates and risks with concomitant anti-platelet therapy are reviewed. Where endovascular coiling is being considered, the possibility of ventriculostomy-related haemorrhage should be considered and should influence subsequent treatment decisions. PMID:24810986

Sims-Williams, Hugh P; Weinberg, Daniel; Jadun, Changez K; Brydon, Howard L

2014-12-01

12

Aneurysmal subarachnoid haemorrhage in Parry-Rhomberg syndrome  

PubMed Central

Parry–Romberg syndrome (PRS) or progressive hemi facial atrophy syndrome is a rare condition of unknown aetiology that is characterised by progressive unilateral facial and cranial atrophic changes of skin, subcutaneous tissues and bone. The authors describe a 37-year-old female with a history of PRS, who presented with a subarachnoid haemorrhage secondary to rupture of a 9 mm fusiform aneurysm of the posterior cerebral artery. There was an associated external carotid arterio-venous fistula noted with this aneurysm. The aneurysm was treated by endovascular route and was successfully coiled. Follow-up angiogram revealed spontaneous resolution of the fistula with good occlusion of the aneurysm. The aetio-pathogenesis of this rare occurrence, literature review and its management is discussed. PMID:22674607

Kuechler, Derek; Kaliaperumal, Chandrasekaran; Hassan, Alfrazdaq; Fanning, Noel; Wyse, Gerry; O'Sullivan, Michael

2011-01-01

13

Magnesium protection against in vitro cerebral vasospasm after subarachnoid haemorrhage.  

PubMed

Mg2+ has recently been proposed for the treatment of cerebral vasospasm and is known to dilate vessels. In this study, we examine the effects of Mg2+ on in vitro vasospasm using CSF from vasospastic subarachnoid haemorrhage patients with vasospasm (CSFv). Oxygen consumption and isometric force measurements in the porcine carotid artery were used to assess the contractile and metabolic status of the vessels' responses to CSFv and the effect of Mg2+. Mg2+ caused a dose dependant decrease in tension following contraction by CSFv. Mg2+ (12 mM) caused a normalization of relaxation rate in tissue exposed to CSFv, caused a significant decrease in basal oxygen consumption, as well as significantly decreasing the rate of oxygen consumption of the porcine carotid artery when stimulated by CSF (0.70 +/- 0.12 versus. 0.46 +/- 0.1 micromol O2 min(-1) g(-1)). Acute Mg2+ addition demonstrated the most effective protection using an assay based on CSFv contraction. These results suggest that Mg2+ can protect vascular smooth muscle exposed to CSFv by benefiting contractile behaviour and metabolism of the arteries. PMID:11708544

Pyne, G J; Cadoux-Hudson, T A; Clark, J F

2001-10-01

14

Myocardial dysfunction after subarachnoid haemorrhage and tako-tsubo cardiomyopathy: a differential diagnosis?  

PubMed

The frequent occurrence of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage raises a number of issues about the clinical and pathophysiological similarities with the transient left ventricular apical ballooning syndrome (TLVABS) or tako-tsubo cardiomyopathy (TTC). Given the latest clinical and pathophysiological evidence about neurogenic cardiomyopathies, the diagnosis of TTC should not be ruled out in patients experiencing acute brain injury and cerebrovascular events. Each type of reversible left ventricular dysfunction mediated by the central nervous system and initiated by acute brain injury, both physical, such as intracranial bleeding or head traumas, and psychological, such as sudden emotional stress, could be encompassed in a single definition with larger inclusion criteria, such as 'acute ballooning cardiomyopathy' (ABC), that is likely to be more representative of the real needs in the clinical setting. PMID:20124311

Trio, Olimpia; de Gregorio, Cesare; Andò, Giuseppe

2010-04-01

15

Effects of apolipoprotein E genotype on outcome after ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage  

PubMed Central

Background Rodent models of acute ischaemic stroke and head injury suggest that apolipoprotein E (APOE) genotype influences neuronal repair, regeneration and survival after brain injury. Possession of an APOE ?4 allele is associated with poor outcome after head injury in clinical studies. APOE might therefore influence outcome after acute stroke in humans. Objective and methods To comprehensively search, identify, assess and carry out meta?analyses of studies reporting on the association between APOE and the combined outcome of death or dependency, or death alone, several months after ischaemic stroke, intracerebral haemorrhage (ICH) or subarachnoid haemorrhage (SAH). Results Main analyses included data from nine studies on 2262 patients (1453 with ischaemic stroke, 199 with ICH and 610 with SAH). Overall, ?4+ genotypes were not significantly associated with risk of death or dependency several months after stroke. However, there was significant heterogeneity between studies, and between the three pathological types of stroke. ?4+ genotypes were associated with increased death or dependency after SAH (relative risk (RR) 1.40, 95% confidence interval (CI) 1.06 to 1.84), with a trend towards a similar association with ICH (RR 1.38, 95% CI 0.99 to 1.92), but not with ischaemic stroke (RR 0.98, 95% CI 0.85 to 1.12). Results were similar for death alone. Conclusions APOE may differentially affect outcome after the three main pathological types of stroke. Further, large studies are needed to confirm or refute these findings, and to assess the possibility of an interaction between the effects of APOE and age. PMID:16926234

Martinez-Gonzalez, N A; Sudlow, C L M

2006-01-01

16

Magnesium for aneurysmal subarachnoid haemorrhage (MASH-2): a randomised placebo-controlled trial  

PubMed Central

Summary Background Magnesium sulphate is a neuroprotective agent that might improve outcome after aneurysmal subarachnoid haemorrhage by reducing the occurrence or improving the outcome of delayed cerebral ischaemia. We did a trial to test whether magnesium therapy improves outcome after aneurysmal subarachnoid haemorrhage. Methods We did this phase 3 randomised, placebo-controlled trial in eight centres in Europe and South America. We randomly assigned (with computer-generated random numbers, with permuted blocks of four, stratified by centre) patients aged 18 years or older with an aneurysmal pattern of subarachnoid haemorrhage on brain imaging who were admitted to hospital within 4 days of haemorrhage, to receive intravenous magnesium sulphate, 64 mmol/day, or placebo. We excluded patients with renal failure or bodyweight lower than 50 kg. Patients, treating physicians, and investigators assessing outcomes and analysing data were masked to the allocation. The primary outcome was poor outcome—defined as a score of 4–5 on the modified Rankin Scale—3 months after subarachnoid haemorrhage, or death. We analysed results by intention to treat. We also updated a previous meta-analysis of trials of magnesium treatment for aneurysmal subarachnoid haemorrhage. This study is registered with controlled-trials.com (ISRCTN 68742385) and the EU Clinical Trials Register (EudraCT 2006-003523-36). Findings 1204 patients were enrolled, one of whom had his treatment allocation lost. 606 patients were assigned to the magnesium group (two lost to follow-up), 597 to the placebo (one lost to follow-up). 158 patients (26·2%) had poor outcome in the magnesium group compared with 151 (25·3%) in the placebo group (risk ratio [RR] 1·03, 95% CI 0·85–1·25). Our updated meta-analysis of seven randomised trials involving 2047 patients shows that magnesium is not superior to placebo for reduction of poor outcome after aneurysmal subarachnoid haemorrhage (RR 0·96, 95% CI 0·86–1·08). Interpretation Intravenous magnesium sulphate does not improve clinical outcome after aneurysmal subarachnoid haemorrhage, therefore routine administration of magnesium cannot be recommended. Funding Netherlands Heart Foundation, UK Medical Research Council. PMID:22633825

Mees, Sanne M Dorhout; Algra, Ale; Vandertop, W Peter; van Kooten, Fop; Kuijsten, Hans AJM; Boiten, Jelis; van Oostenbrugge, Robert J; Salman, Rustam Al-Shahi; Lavados, Pablo M; Rinkel, Gabriel JE; van den Bergh, Walter M

2012-01-01

17

Sudden headache, third nerve palsy and visual deficit: thinking outside the subarachnoid haemorrhage box.  

PubMed

A 75-year-old lady presented with sudden severe headache and vomiting. Examination was normal, and CT and lumbar puncture not convincing for subarachnoid haemorrhage. Shortly thereafter, she developed painless diplopia. Examination confirmed right third cranial nerve palsy plus homonymous left inferior quadrantanopia. Urgent cerebral MRI with angiography was requested to assess for a possible posterior communicating artery aneurysm, but revealed an unsuspected pituitary mass. Pituitary adenoma with pituitary apoplexy was diagnosed. Pituitary apopolexy is a syndrome comprising sudden headache, meningism, visual and/or oculomotor deficits, with an intrasellar mass. It is commonly due to haemorrhage or infarction within a pituitary adenoma. Treatment includes prompt steroid administration, and potentially surgical decompression. While subarachnoid haemorrhage is an important, well-recognised cause of sudden severe headache, other aetiologies, including pituitary apoplexy, should be considered and sought. PMID:23913476

Ní Chróinín, Danielle; Lambert, John

2013-11-01

18

Subarachnoid haemorrhage and cerebral vasculopathy in a child with sickle cell anaemia.  

PubMed

Stroke in sickle cell anaemia (SCA) is either infarctive or haemorrhagic in nature. In childhood, over 75% of strokes in SCA are infarctive. We present an adolescent with SCA who developed hypertension at the age of 13, and was treated with lisinopril. Sixteen months later she was found in cardiorespiratory arrest and died on arrival in hospital. The last transcranial Doppler scan performed 6?months before her death and a brain MRI were reported normal. The autopsy discovered massive subarachnoid haemorrhage in association with vascular damage in the circle of Willis arteries. The case highlights a cause of haemorrhagic stroke, the first reported association between hypertension, SCA and a histopathologically proven cerebral vasculopathy. The difficulties in the management of haemorrhagic stroke and the poor outcome in SCA are discussed. PMID:25336550

Inusa, Baba; Casale, Maddalena; Booth, Caroline; Lucas, Sebastian

2014-01-01

19

Classification of Non-Aneurysmal Subarachnoid Haemorrhage: CT Correlation to the Clinical Outcome.  

PubMed

To propose a new computed tomography (CT)-based classification system for nonaneurysmal subarachnoid haemorrhage (SAH), which predicts patients' discharge clinical outcome and helps to prioritize appropriate patient management. A 5-year, retrospective, two-centre study was carried out involving 1486 patients presenting with SAH. One hundred and ninety patients with nonaneurysmal SAH were included in the study. Initial cranial CT findings at admission were correlated with the patients' discharge outcomes measured using the Modified Rankin Scale (MRS). A CT-based classification system (type 1 e 4) was devised based on the topography of the initial haemorrhage pattern. Seventy-five percent of the patients had type 1 haemorrhage and all these patients had a good clinical outcome with a discharge MRS of 1. Eight percent of the patients presented with type 2 haemorrhage, 62% of which were discharged with MRS of 1 and 12% of patients had MRS 3 or 4. Type 3 haemorrhage was found in 10%, of which 16% had good clinical outcome, but 53% had moderate to severe disability (MRS 3 and 4) and 5% were discharged with severe disability (MRS 5). Six percent of patients presented with type 4 haemorrhage of which 42% of the patients had moderate to severe disability (MRS 3 and 4), 42% had severe disability and one-sixth of the patients died. Highly significant differences were found between type 1 (1a and 1b) and type 2 (p¼ 0.003); type 2 and type 3 (p ¼ 0.002); type 3 and type 4 (p ¼ 0.001). Haemorrhages of the type 1 category are usually benign and do not warrant an extensive battery of clinical and radiological investigations. Type 2 haemorrhages have a varying prognosis and need to be investigated and managed along similar lines as that of an aneurysmal haemorrhage with emphasis towards radiological investigation. Type 3 and type 4 haemorrhages need to be extensively investigated to find an underlying cause. PMID:24059766

Nayak, S; Kunz, A B; Kieslinger, K; Ladurner, G; Killer, M

2011-10-31

20

Osteogenesis imperfecta presenting as aneurysmal subarachnoid haemorrhage in a 53-year-old man  

PubMed Central

The authors describe a case of aneurysmal subarachnoid haemorrhage in a 53-year-old man with background of osteogenesis imperfecta (OI). CT brain revealed diffuse subarachnoid haemorrhage (SAH) and cerebral angiogram subsequently confirmed vertebral artery aneurysm rupture leading to SAH. To the authors knowledge this is the first case of vertebral artery aneurysmal SAH described in OI. A previously undiagnosed OI was confirmed by genetic analysis (COL1A1 gene mutation). This aneurysm was successfully treated by endovascular route. Post interventional treatment patient developed stroke secondary to vasospasm. Communicating hydrocephalus, which developed in the process of management, was successfully treated with ventriculo-peritoneal shunt. The aetio-pathogenesis and management of this condition is described. The authors have reviewed the literature and genetic basis of this disease. PMID:22674700

Kaliaperumal, Chandrasekaran; Walsh, Tom; Balasubramanian, Chandramouli; Wyse, Gerry; Fanning, Noel; Kaar, George

2011-01-01

21

Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial  

Microsoft Academic Search

OBJECTIVE--To determine the efficacy of oral nimodipine in reducing cerebral infarction and poor outcomes (death and severe disability) after subarachnoid haemorrhage. DESIGN--Double blind, placebo controlled, randomised trial with three months of follow up and intention to treat analysis. To have an 80% chance with a significance level of 0.05 of detecting a 50% reduction in an incidence of cerebral infarction

J. D. Pickard; G. D. Murray; R. Illingworth; M. D. Shaw; G. M. Teasdale; P. M. Foy; P. R. Humphrey; D. A. Lang; R. Nelson; P. Richards

1989-01-01

22

[Acute headache: limitations of cerebral computed tomography and analysis of cerebrospinal fluid in the diagnosis of subarachnoid haemorrhage].  

PubMed

Subarachnoid haemorrhage constitutes a neurological emergency. In most cases the diagnosis is easy to establish by cerebral computed tomography or cerebrospinal fluid tap. However, in rare cases verification of the diagnosis is more difficult and a residual uncertainty remains. We describe three patients supposed to have a subarachnoid haemorrhage without pathological findings in both cerebral computed tomography and cerebrospinal fluid. In these cases vasospasm or cerebral aneurysm were detected by means of transcranial Doppler sonography and/or conventional angiography. We comment on the special features of this rare presentation of a severe acute neurological emergency, and we discuss diagnostic work-up and differential diagnoses. PMID:21128197

Burghaus, L; Liu, W; Fink, G R; Eggers, C

2011-01-01

23

A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage  

Microsoft Academic Search

The age and sex specific incidence rates for cerebral infarction, primary intracerebral haemorrhage and subarachnoid haemorrhage in a population of approximately 105,000 are presented. Over four years 675 patients with a first-ever stroke were registered with the Oxfordshire Community Stroke Project. The pathological diagnosis was confirmed by computerised tomography (CT) scan, necropsy or lumbar puncture (cases of subarachnoid haemorrhage only)

J Bamford; P Sandercock; M Dennis; J Burn; C Warlow

1990-01-01

24

An asymmetrical fenestration of the basilar artery coexisting with two aneurysms in a patient with subarachnoid haemorrhage: case report and review of the literature.  

PubMed

The vertebrobasilar system is a part of the cerebral arterial circle (circle of Willis), which forms the collateral circulation of the brain. A 75-year-old Caucasian female was admitted to hospital because of a strong headache radiating to the neck. On the basis of a neurological examination, the patient was classified into group III of the Hunt and Hess scale. Subarachnoid haemorrhage and 2 aneurysms of the cerebral arteries were diagnosed during multidetector 64-row computed tomography and angiography. An asymmetrical fenestration of the proximal part of the basilar artery was also observed. The bleeding aneurysm locating at anterior communicating artery was diagnosed and clipped surgically by right fronto-parietal craniotomy. The second aneurysm was located just after the junction of the vertebral arteries on the wall of the basilar artery. The presented case firstly illustrates the asymmetric fenestration of the proximal part of the basilar artery coexisting with subarachnoid haemorrhage and 2 aneurysms of brain arteries. Such observation should increase diagnostic attention in the detection of possible associated aneurysms and can help in preventing complications during all endovascular treatment procedures. PMID:24902104

Polguj, M; Majos, M; Topol, M; Majos, A

2014-05-01

25

Leukocyte count and incidence of subarachnoid haemorrhage: a prospective cohort study  

PubMed Central

Background Subarachnoid haemorrhage (SAH) is a devastating disease, in the majority of cases caused by a rupture of an arterial intracranial aneurysm. The effect of systemic low-grade inflammation on incidence of SAH is not known. The purpose of this study was to evaluate the relationship between leukocyte count, a marker of systemic inflammation, and incidence of SAH in a large cohort study. Methods Leukocyte count and other cardiovascular risk factors were measured in 19,794 individuals (17,083 men and 2,711 women, mean age 44 years) participating in a health screening program between 1974 and 1981. Incidence of SAH in relation to baseline leukocyte concentration was studied during a mean follow-up of 27 years in participants free from previous stroke. Results Ninety-five participants had a SAH, corresponding to an incidence of 22 per 100,000 in women and 17 per 100,000 in men. The hazard ratio for SAH per one standard deviation (2.01?×?109 cells/L) increase of leukocyte concentration was 1.26 (95% CI 1.05-1.53, p?=?0.014) after adjustment for several potential confounding factors including smoking. In sensitivity analysis, there was a significant association in smokers but not in non-smokers. Conclusions High leukocyte count at baseline was associated with increased incidence of SAH, although this relationship might be restricted to smokers. The results support the view that low-grade systemic inflammation could be involved in the pathogenesis of SAH, or constitute an early risk marker for the disease. PMID:24708536

2014-01-01

26

Self-perceived health status following aneurysmal subarachnoid haemorrhage: a cohort study  

PubMed Central

Objective The objective of the study was to assess the long-term self-reported health status and quality of life (QoL) of patients following an aneurysmal subarachnoid haemorrhage (ASAH) using a self-completed questionnaire booklet. Design A two-cohort study. Setting A regional tertiary neurosurgical centre. Participants 2 cohorts of patients with ASAH treated between 1998 and 2008 and followed up at approximately 1?year. Interventions Routine care. Primary and secondary outcomes A range of standardised scales included: AKC Short Sentences Test, the Barthel Index, the Self-Report Dysexecutive Questionnaire, the Everyday Memory Questionnaire, Stroke Symptom Checklist, Wimbledon Self-Report Scale, Modified Rankin Score (MRS) and a new Stroke-QoL. The data from summated scales were fit to the Rasch measurement model to validate the summed score. Results 214 patients (48%) returned the questionnaires; the majority (76%) had a World Federation of Neurosurgeons grade of 1 or 2. The most frequent aneurysm type was that of the anterior communicating artery (28%) with approximately 90% of aneurysms of the anterior circulation. Of those previously in full or part-time employment, 48.9% were unemployed at follow-up. All summated scales satisfied the Rasch measurement model requirements, such that their summed scores were a sufficient statistic. Given this, one-third of patients were noted to have a significant mood disorder and 25% had significant dysexecutive function. Patients with an MRS of 3, 4 or 5 had significantly worse scores on most outcome measures, but a significant minority of those with a score of zero had failed to return to work and displayed significant mood disorder. Conclusions A range of self-reported cognitive and physical deficits have been highlighted in a cohort of patients with ASAH. While the MRS has been shown to provide a reasonable indication of outcome, in routine clinical follow-up it requires supplementation by instruments assessing dysexecutive function, memory and mood. PMID:24699459

Quinn, Audrey C; Bhargava, Deepti; Al-Tamimi, Yahia Z; Clark, Matthew J; Ross, Stuart A; Tennant, Alan

2014-01-01

27

Idiopathic pulmonary calcification and ossification in an elderly woman with a missed diagnosis of subarachnoid haemorrhage.  

PubMed

This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient's management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis. PMID:24391231

Odubanjo, M O; Abdulkareem, F B; Banjo, A; Ekwere, T E; Awelimobor, D I

2013-09-01

28

Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients  

Microsoft Academic Search

Purpose.  The leading cause of a nontraumatic subarachnoid haemorrhage is rupture of an intracranial aneurysm. The aim of this study\\u000a was to assess the usefulness of multislice computed tomography angiography (CTA) in identifying and evaluating cerebral aneurysms\\u000a by comparing it with intra-arterial digital subtraction angiography (DSA) and intraoperative findings.\\u000a \\u000a \\u000a \\u000a Materials and methods.  During a 20-month period (June 2004 and February 2006), 130

M. El Khaldi; P. Pernter; F. Ferro; A. Alfieri; N. Decaminada; L. Naibo; G. Bonatti

2007-01-01

29

Serum procalcitonin and C-reactive protein as markers of sepsis and outcome in patients with neurotrauma and subarachnoid haemorrhage.  

PubMed

This prospective study evaluated serum procalcitonin (PCT) and C-reactive protein (CRP) as markers for systemic inflammatory response syndrome (SIRS)/sepsis and mortality in patients with traumatic brain injury and subarachnoid haemorrhage. Sixty-two patients were followed for 7 days. Serum PCT and CRP were measured on days 0, 1, 4, 5, 6 and 7. Seventy-seven per cent of patients with traumatic brain injury and 83% with subarachnoid haemorrhage developed SIRS or sepsis (P=0.75). Baseline PCT and CRP were elevated in 35% and 55% of patients respectively (P=0.03). There was a statistically non-significant step-wise increase in serum PCT levels from no SIRS (0.4+/-0.6 ng/ml) to SIRS (3.05+/-9.3 ng/ml) to sepsis (5.5+/-12.5 ng/ml). A similar trend was noted in baseline PCT in patients with mild (0.06+/-0.9 ng/ml), moderate (0.8+/-0.7 ng/ml) and severe head injury (1.2+/-1.9 ng/ml). Such a gradation was not observed with serum CRP There was a non-significant trend towards baseline PCT being a better marker of hospital mortality compared with baseline CRP (ROC-AUC 0.56 vs 0.31 respectively). This is the first prospective study to document the high incidence of SIRS in neurosurgical patients. In our study, serum PCT appeared to correlate with severity of traumatic brain injury and mortality. However, it could not reliably distinguish between SIRS and sepsis in this cohort. This is in part because baseline PCT elevation seemed to correlate with severity of injury. Only a small proportion of patients developed sepsis, thus necessitating a larger sample size to demonstrate the diagnostic usefulness of serum PCT as a marker of sepsis. Further clinical trials with larger sample sizes are required to confirm any potential role of PCT as a sepsis and outcome indicator in patients with head injuries or subarachnoid haemorrhage. PMID:15675205

Oconnor, E; Venkatesh, B; Mashongonyika, C; Lipman, J; Hall, J; Thomas, P

2004-08-01

30

Spontaneous iliopsoas haemorrhage--an unusual complication of streptokinase therapy.  

PubMed Central

We report a case of spontaneous iliopsoas haemorrhage following intravenous streptokinase which serves to remind physicians of the potential dangers of this form of therapy. Images Figure 1 PMID:2099433

Gillanders, I. A.; Nakielny, R.; Channer, K. S.

1990-01-01

31

Protein kinase C inhibition prevents upregulation of vascular ETB and 5HT1B receptors and reverses cerebral blood flow reduction after subarachnoid haemorrhage in rats  

Microsoft Academic Search

The pathogenesis of cerebral ischaemia after subarachnoid haemorrhage (SAH) still remains elusive. The purpose of the present study was to examine whether specific protein kinas C (PKC) inhibition in rats could alter the transcriptional SAH induced Endothelin (ET) type B and 5-hydroxytryptamine type 1B (5-HT1B) receptor upregulation and prevent the associated cerebral blood flow (CBF) reduction. The PKC inhibitor RO-31-7549

Saema S Beg; Jacob A Hansen-Schwartz; Petter J Vikman; Cang-Bao Xu; Lars I Edvinsson

2007-01-01

32

Prediction of two month modified Rankin Scale with an ordinal prediction model in patients with aneurysmal subarachnoid haemorrhage  

PubMed Central

Background Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating event with a frequently disabling outcome. Our aim was to develop a prognostic model to predict an ordinal clinical outcome at two months in patients with aSAH. Methods We studied patients enrolled in the International Subarachnoid Aneurysm Trial (ISAT), a randomized multicentre trial to compare coiling and clipping in aSAH patients. Several models were explored to estimate a patient's outcome according to the modified Rankin Scale (mRS) at two months after aSAH. Our final model was validated internally with bootstrapping techniques. Results The study population comprised of 2,128 patients of whom 159 patients died within 2 months (8%). Multivariable proportional odds analysis identified World Federation of Neurosurgical Societies (WFNS) grade as the most important predictor, followed by age, sex, lumen size of the aneurysm, Fisher grade, vasospasm on angiography, and treatment modality. The model discriminated moderately between those with poor and good mRS scores (c statistic = 0.65), with minor optimism according to bootstrap re-sampling (optimism corrected c statistic = 0.64). Conclusion We presented a calibrated and internally validated ordinal prognostic model to predict two month mRS in aSAH patients who survived the early stage up till a treatment decision. Although generalizability of the model is limited due to the selected population in which it was developed, this model could eventually be used to support clinical decision making after external validation. Trial Registration International Standard Randomised Controlled Trial, Number ISRCTN49866681 PMID:20920243

2010-01-01

33

Comparative clinical trial of epsilon amino-caproic acid and tranexamic acid in the prevention of early recurrence of subarachnoid haemorrhage.  

PubMed Central

A comparative controlled clinical trial of epsilon aminocaproic acid (EACA), 36 g/day and tranexamic acid (TEA), 6 g/day, was undertaken to assess their effectiveness in reducing early recurrence of subarachnoid haemorrhage (SAH). Of 90 patients treated with EACA recurrent haemorrhage was seen in 8% of these patients and 7% of the patients developed delayed ischaemic deficit. The total pre-operative mortality in EACA-group was 11%. Of 61 patients treated with TEA, 10% had recurrent haemorrhage and delayed ischaemic deficit occurred in 5% of the patients. The total pre-operative mortality in TEA-group was 11%. No difference was found between the effectiveness and side-effects of these drugs. PMID:7031186

Chowdhary, U M; Sayed, K

1981-01-01

34

Comparison of Montreal Cognitive Assessment and Mini-Mental State Examination in Evaluating Cognitive Domain Deficit Following Aneurysmal Subarachnoid Haemorrhage  

PubMed Central

Objective Cognitive deficits are common after aneurysmal subarachnoid haemorrhage (aSAH), and clinical evaluation is important for their management. Our hypothesis was that the Montreal Cognitive Assessment (MoCa) is superior to the Mini-Mental State Examination (MMSE) in screening for cognitive domain deficit in aSAH patients. Methods We carried out a prospective observational and diagnostic accuracy study on Hong Kong aSAH patients aged 21 to 75 years who had been admitted within 96 hours of ictus. The domain-specific neuropsychological assessment battery, the MoCA and MMSE were administered 2–4 weeks and 1 year after ictus. A cognitive domain deficit was defined as a cognitive domain z score

Wong, George Kwok Chu; Lam, Sandy Wai; Wong, Adrian; Ngai, Karine; Poon, Wai Sang; Mok, Vincent

2013-01-01

35

Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis  

PubMed Central

Objectives: To investigate (1) the prevalence of various aspects of cognitive and psychosocial dysfunction, including post-traumatic stress symptoms, over nine months after subarachnoid haemorrhage (SAH); (2) whether SAH is preceded by increased life stress; (3) to what extent adverse outcomes may be predicted from preillness life stress, early neurological impairment, age, and sex; and (4) relations between emotional and functional outcomes. Methods: 52 patients with good neurological recovery after surgery for SAH were each matched for age, sex, and occupation with a healthy control participant. SAH patients were assessed three and nine months postdischarge on measures of cognitive functioning, mood, and social functioning. Objective stressors and subjective life change during the preceding year were rated retrospectively. Controls completed measures of mood and social functioning once only. Results: Compared with controls, SAH patients showed increased mood disturbance, subtle cognitive impairment, and abnormally low independence and participation on measures of social functioning. 60% showed clinically significant post-traumatic stress symptomatology (intrusive thoughts or avoidance of reminders) at three months and 30% at nine months. Independence in activities of daily living was greatly reduced in half to a third of the sample at both three and nine months. Productive employment was below the 10th percentile of the control group for 75% of patients at three months and for 56% at nine months; this outcome could not be predicted from selected demographic, premorbid, or clinical variables but dependence on others for organisational activities was predicted by impaired prose recall. Mood at nine months was strongly predicted by prior mental health problems, poor physical health, dysphasia, and impaired prose recall at three months. There was no evidence of an abnormally high level of stressful life events in the year before SAH, although patients rated their subjective level of stress in this period slightly more highly than did the control participants. Conclusions: These findings highlight the need for structured support and treatment after surgery for SAH to reduce persisting mood disturbance and increase independence and participation. PMID:12023423

Powell, J; Kitchen, N; Heslin, J; Greenwood, R

2002-01-01

36

A Late Haemorrhagic Complication in an ArterioVenous Malformation Cured with Radiosurgery  

PubMed Central

Summary Radiosurgery is a recognized safe form of treating and usually curing arteriovenous malformations (AVMs). Complications related to radiosurgery, especially late sequelae, are rare. Such sequelae may be secondary to incomplete treatment of the original lesion such as haemorrhage, or secondary to the radiation damage to the tissue, or both. Sometimes treatment may induce new lesions. We report a patient who had an AVM cured with radiosurgery, but developed hemisensory loss acutely and had changes on MRI in keeping with a haematoma. We discuss the possible differential diagnosis that should be considered. PMID:22681728

Le Feuvre, D.E.J.; Parkes, J.D.; Mukheiber, P.; James, R.; Taylor, A.G.

2012-01-01

37

Risk of subarachnoid haemorrhage in people admitted to hospital with selected immune-mediated diseases: record-linkage studies  

PubMed Central

Background Subarachnoid hemorrhage (SAH) is a devastating cause of stroke, occurring in relatively young people. It has been suggested that some immune-mediated diseases may be associated with an increased risk of SAH. Methods We analysed a database of linked statistical records of hospital admissions and death certificates for the whole of England (1999–2011). Rate ratios for SAH were determined, comparing immune-mediated disease cohorts with comparison cohorts. Results There were significantly elevated risks of SAH after hospital admission for the following individual immune-mediated diseases: Addison’s disease, ankylosing spondylitis, autoimmune haemolytic anaemia, Crohn’s disease, diabetes mellitus, idiopathic thrombocytopenia purpura, myxoedema, pernicious anaemia, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, scleroderma, Sjogren’s syndrome, SLE and thyrotoxicosis. Elevated risks that were greater than 2-fold were found for Addison’s disease (rate ratio (RR)?=?2.01, 95% confidence interval 1.3-2.97), idiopathic thrombocytopenia purpura (RR?=?2.42, 1.86-3.11), primary biliary cirrhosis (RR?=?2.21, 1.43-3.16) and SLE (RR?=?3.76, 3.08-4.55). Conclusions Our findings strongly support the suggestion that patients with some immune-mediated diseases have an increased risk of SAH. Further studies of the mechanisms behind this association are warranted. PMID:24229049

2013-01-01

38

Delayed onset pulmonary glue emboli in a ventilated patient: a rare complication following endoscopic cyanoacrylate injection for gastric variceal haemorrhage.  

PubMed

Cyanoacrylate injection is a recognised endoscopic treatment option for variceal haemorrhage. We describe a 34-year old man with hepatitis B cirrhosis who presented to the hospital with upper gastrointestinal haemorrhage from gastric and oesophageal varices. Haemostasis was achieved via cyanoacrylate injection sclerotherapy and banding. Ten days later, the patient developed acute hypoxia and fever. His chest radiograph showed wide-spread pulmonary shadowing. A non-contrast CT scan confirmed multiple emboli of injected glue material from the varix with parenchymal changes either suggesting acute lung injury or pulmonary oedema. He gradually recovered with supportive treatment and was discharged home. On follow-up, he remained asymptomatic from a chest perspective. This case report discusses the rare complication of pulmonary embolisation of cyanoacrylate glue from variceal injection sites and the diagnostic dilemmas involved. Emphasis is placed on the importance of maintaining high index of clinical suspicion when assessing patients with possible procedure related complications. PMID:25320260

Chew, Joyce Ruo Yi; Balan, Anu; Griffiths, William; Herre, Jurgen

2014-01-01

39

Retinal haemorrhage as a complication of gas encephalography and gas myelography. Prospective study using oxgen gas with a discussion of pathogenetic mechanisms.  

PubMed Central

Seventy patients, submitted to oxygen encephalography and oxygen myelography, were examined by retinal funduscopy to establish the incidence of intraocular haemorrhages, a complication reported to be frequent by other investigators. We did not discover any retinal haemorrhages. Pathogenetic factors influencing intracranial or intraocular venous pressure or both are discussed, particularly the effect due to different technical procedures during the examination, and the type of anaesthesia used. PMID:599352

Slagsvold, J E; Larsen, J L

1977-01-01

40

Genetic elimination of Nrf2 aggravates secondary complications except for vasospasm after experimental subarachnoid hemorrhage in mice.  

PubMed

Nuclear factor erythroid 2-related factor 2 (Nrf2) is a key endogenous protective regulator in the body. This study aimed to explore the role of Nrf2 in subarachnoid hemorrhage (SAH)-induced secondary complications. Wild type (WT) and Nrf2 knockout (KO) mice were subjected to experimental SAH by injecting fresh autologous blood into pre-chiasmatic cistern. The absence of Nrf2 function in mice resulted in exacerbated brain injury with increased brain edema, blood-brain barrier (BBB) disruption, neural apoptosis, and severe neurological deficits at 24h after SAH. Moreover, cerebral vasospasm was severe at 24h after SAH, but not significantly different between WT and Nrf2 KO mice after SAH. Meanwhile, Molondialdehyde (MDA) was increased and GSH/GSSG ratio was decreased in Nrf2 KO mice after SAH. Furthermore, higher expression of TNF-? and IL-1? was also found after SAH in Nrf2 KO mice. In conclusion, our results revealed that Nrf2 plays an important role in attenuating SAH-induced secondary complications by regulating excessive oxidative stress and inflammatory response. PMID:24576487

Li, Tao; Wang, Handong; Ding, Yu; Zhou, Mengliang; Zhou, Xiaoming; Zhang, Xiangshen; Ding, Ke; He, Jin; Lu, Xinyu; Xu, Jianguo; Wei, Wuting

2014-04-16

41

Complications of Uterine Fibroids and Their Management, Surgical Management of Fibroids, Laparoscopy and Hysteroscopy versus Hysterectomy, Haemorrhage, Adhesions, and Complications  

PubMed Central

A critical analysis of the surgical treatment of fibroids compares all available techniques of myomectomy. Different statistical analyses reveal the advantages of the laparoscopic and hysteroscopic approach. Complications can arise from the location of the fibroids. They range from intermittent bleedings to continuous bleedings over several weeks, from single pain episodes to severe pain, from dysuria and constipation to chronic bladder and bowel spasms. Very seldom does peritonitis occur. Infertility may result from continuous metro and menorrhagia. The difficulty of the laparoscopic and hysteroscopic myomectomy lies in achieving satisfactory haemostasis using the appropriate sutures. The hysteroscopic myomectomy requires an operative hysteroscope and a well-experienced gynaecologic surgeon. PMID:22619681

Mettler, Liselotte; Schollmeyer, Thoralf; Tinelli, Andrea; Malvasi, Antonio; Alkatout, Ibrahim

2012-01-01

42

Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up  

PubMed Central

Summary Background Our aim was to assess the long-term risks of death, disability, and rebleeding in patients randomly assigned to clipping or endovascular coiling after rupture of an intracranial aneurysm in the follow-up of the International Subarachnoid Aneurysm Trial (ISAT). Methods 2143 patients with ruptured intracranial aneurysms were enrolled between 1994 and 2002 at 43 neurosurgical centres and randomly assigned to clipping or coiling. Clinical outcomes at 1 year have been previously reported. All UK and some non-UK centres continued long-term follow-up of 2004 patients enrolled in the original cohort. Annual follow-up has been done for a minimum of 6 years and a maximum of 14 years (mean follow-up 9 years). All deaths and rebleeding events were recorded. Analysis of rebleeding was by allocation and by treatment received. ISAT is registered, number ISRCTN49866681. Findings 24 rebleeds had occurred more than 1 year after treatment. Of these, 13 were from the treated aneurysm (ten in the coiling group and three in the clipping group; log rank p=0·06 by intention-to-treat analysis). There were 8447 person-years of follow-up in the coiling group and 8177 person-years of follow-up in the clipping group. Four rebleeds occurred from a pre-existing aneurysm and six from new aneurysms. At 5 years, 11% (112 of 1046) of the patients in the endovascular group and 14% (144 of 1041) of the patients in the neurosurgical group had died (log-rank p=0·03). The risk of death at 5 years was significantly lower in the coiling group than in the clipping group (relative risk 0·77, 95% CI 0·61–0·98; p=0·03), but the proportion of survivors at 5 years who were independent did not differ between the two groups: endovascular 83% (626 of 755) and neurosurgical 82% (584 of 713). The standardised mortality rate, conditional on survival at 1 year, was increased for patients treated for ruptured aneurysms compared with the general population (1·57, 95% CI 1·32–1·82; p<0·0001). Interpretation There was an increased risk of recurrent bleeding from a coiled aneurysm compared with a clipped aneurysm, but the risks were small. The risk of death at 5 years was significantly lower in the coiled group than it was in the clipped group. The standardised mortality rate for patients treated for ruptured aneurysms was increased compared with the general population. Funding UK Medical Research Council. PMID:19329361

Molyneux, Andrew J; Kerr, Richard SC; Birks, Jacqueline; Ramzi, Najib; Yarnold, Julia; Sneade, Mary; Rischmiller, Joan

2009-01-01

43

Dissecting Aneurysms of Bilateral Anterior Cerebral Artery Complicated by Subarachnoid Hemorrhage After Cerebral Infarction: A Case Report  

PubMed Central

Introduction Intracranial dissecting aneurysms have been increased due to recent advancements in diagnostic imaging. However there have been little article with subarachnoid hemorrhage and cerebral infarction occurring almost at the same time. We performed the surgical treatment and obtained good result. Case presentation A 47-year-old male presented to our hospital with chief complaints of sudden headache and mild paralysis of the left lower extremity. Brain imaging at admission revealed cerebral infarction in the right frontal lobe and subarachnoid hemorrhage in the frontal convexy and anterior interhemispheric fissure. The left and right internal carotid angiography showed a bulging cerebral aneurysm at the left A1–A2 junction and stenosis and arterial dissections in the peripheral of the bilateral anterior cerebral artery. Wrapping was performed for the dissecting aneurysm of the left anterior cerebral artery. For the right anterior cerebral artery, trapping was performed at the A2 segment without vascular anastomosis. The patient’s postoperative course was uneventful. Conclusion A consensus has not been reached on the treatment for intracranial dissecting aneurysms. Proximal trapping without vascular reconstruction was performed for the right anterior cerebral artery without vascular anastomosis to prevent rebleeding. However no symptoms of neurological deficiency were observed. Proximal trapping of dissecting aneurysm seems to be a good option when patient’s functional and life prognosis are taken into account in case that vascular reconstruction will be anticipated difficulty. PMID:24179355

Kurosu, Akihiro; Hatashita, Shizuo; Ueno, Hideo

2008-01-01

44

Subarachnoid hemorrhage  

MedlinePLUS

... signs of decreased nerve and brain function (focal neurologic deficit ) An eye exam may show decreased eye ... and efficacy. Radiology . 2010;256:887-897. Reinhardt MR. Subarachnoid hemorrhoid. J Emerg Nurs . 2010;36:327- ...

45

Dexamethasone in the treatment of subarachnoid hemorrhage revisited: a comparative analysis of the effect of the total dose on complications and outcome.  

PubMed

The benefit of dexamethasone in aneurysmal subarachnoid hemorrhage (SAH) is unproven. This actual study re-examined the impact on complications and outcome. Two hundred and forty-two patient records were analyzed. Dexamethasone had been prescribed individually. Group A consisted of patients in WFNS-grade I to III that were given at least 12mg/day dexamethasone for at least five days. All other patients in WFNS-grade I to III were assigned to group B. Groups C and D resulted from WFNS-grades IV and V, subdivided according to dexamethasone medication as groups A and B. Hydrocephalus and re-hemorrhage were significantly less frequent in group A than B (19% vs. 37%, P=0.011, and 3% vs. 13%, P=0.037, respectively). Favorable outcomes (Glasgow Outcome Scale, GOS 4 and 5) were more frequent in group A than B (99% vs. 85%; P=0.003). Frequencies of vasospasm and infections did not differ. In groups C and D significant differences were demonstrated for frequencies of hydrocephalus (C: 16%, D: 57%; P=0.006) and complications other than infection (C: 33%, D: 79%; P=0.002). Favorable outcomes were more frequent in group C than D (79% vs. 47%; P=0.046). Frequencies of vasospasm and infections did not differ. PMID:14642360

Schürkämper, Manuel; Medele, Ralph; Zausinger, Stefan; Schmid-Elsaesser, Robert; Steiger, Hans Jakob

2004-01-01

46

Omsk haemorrhagic fever.  

PubMed

Omsk haemorrhagic fever is an acute viral disease prevalent in some regions of western Siberia in Russia. The symptoms of this disease include fever, headache, nausea, severe muscle pain, cough, and moderately severe haemorrhagic manifestations. A third of patients develop pneumonia, nephrosis, meningitis, or a combination of these complications. The only treatments available are for control of symptoms. No specific vaccine has been developed, although the vaccine against tick-borne encephalitis might provide a degree of protection against Omsk haemorrhagic fever virus. The virus is transmitted mainly by Dermacentor reticulatus ticks, but people are mainly infected after contact with infected muskrats (Ondatra zibethicus). Muskrats are very sensitive to Omsk haemorrhagic fever virus. The introduction of this species to Siberia in the 1930s probably led to viral emergence in this area, which had previously seemed free from the disease. Omsk haemorrhagic fever is, therefore, an example of a human disease that emerged owing to human-mediated disturbance of an ecological niche. We review the biological properties of the virus, and the epidemiological and clinical characteristics of Omsk haemorrhagic fever. PMID:20850178

R?žek, Daniel; Yakimenko, Valeriy V; Karan, Lyudmila S; Tkachev, Sergey E

2010-12-18

47

Anticoagulation-related intracranial extracerebral haemorrhage.  

PubMed Central

From January 1981 to June 1986 116 patients with anticoagulation-related intracranial haemorrhage were referred to hospital. Seventy six of these haemorrhages were extracerebral, 69 were in the subdural and seven in the subarachnoid space. No epidural haemorrhages were identified. Compared with non-anticoagulation-related haematomas, the risk of haemorrhage was calculated to be increased fourfold in men and thirteenfold in women. An acute subdural haematoma, mostly due to contusion, was more frequently accompanied by an additional intracerebral haematoma than a chronic subdural haematoma. Trauma was a more important factor in acute subdural haematomas than in chronic. Almost half of the patients (48%) had a history of hypertension, more than a third (35%) had heart disease and about one fifth (18%) were diabetic. Headache was the most frequent initial symptom. Later decreased level of consciousness and focal neurological signs exceeded the frequency of headache. Three patients with subarachnoid haemorrhage and nine patients with acute subdural haematomas died, while those with chronic subdural haematomas all survived and had at the most mild, non-disabling sequelae. Myocardial infarction (22%), pulmonary embolism (20%), and arterial disease (20%) were the most frequent reasons for anticoagulant treatment. Critical review based on established criteria for anticoagulation treatment suggests there was no medical reason to treat a third of these patients. The single most useful measure that could be taken to reduce the risk of anticoagulation-induced intracranial haemorrhage would be to identify patients who are being unnecessarily treated and to discontinue anticoagulants. PMID:2769275

Mattle, H; Kohler, S; Huber, P; Rohner, M; Steinsiepe, K F

1989-01-01

48

Secondary Haemorrhagic Disease of the Newborn  

PubMed Central

Clinical, laboratory, and necropsy findings are presented in 5 newborn infants who died with a haemorrhagic diathesis developing within 24 hours after birth. 4 babies were born prematurely; 3 suffered birth asphyxia; and 3 became hypothermic. Laboratory studies showed fibrin degradation products, low platelet counts, and deficient coagulation factors. At necropsy extensive subarachnoid haemorrhages of a characteristic type were seen in all cases, and intravascular fibrin deposits in all but one. Haemorrhage in these babies is considered to be due to consumption of platelets and coagulation factors as a consequence of disseminated intravascular coagulation. Predisposing conditions and possible pathogenic mechanisms are discussed. Platelet counts aid early diagnosis of this form of haemorrhagic disease. Treatment by exchange transfusion using fresh heparinized blood is suggested. ImagesFIG. 1.FIG. 2. PMID:5506940

Chessells, Judith M.; Wigglesworth, J. S.

1970-01-01

49

[Haemorrhagic shock after severe blunt shoulder trauma].  

PubMed

The management of severe injured patients requires life-threatening lesions research, especially potential haemorrhagic lesions. The haemorrhagic shock is a rare but serious complication of shoulder girdle traumas. We report in this study the clinical and paraclinical signs that lead us to take care from such evolution. PMID:15904739

Da Costa-Silva, S; Bessereau, J; Ricard-Hibon, A; Juvin, Ph; Marty, J

2005-05-01

50

Viral haemorrhagic fevers  

Microsoft Academic Search

Viral haemorrhagic fevers are viral infections that can cause shock, haemorrhage and multi-organ dysfunction. Their geographical distribution is limited by the ecology of their vectors, and many of them exist in tropical zones. The most common viral haemorrhagic fevers are not transmissible from person to person, and no viral haemorrhagic fevers are a threat to casual contacts. However, four viruses

Barbara Bannister

2005-01-01

51

Thalamic haemorrhage.  

PubMed

Thalamic haemorrhage is usually considered a single entity although the thalamus is composed of anatomically as well as functionally discrete subregions receiving blood from different arteries. The clinical features vary according to the intrathalamic location of the haematomas and the bleeding artery. We investigated the impact of haematoma location and vascular territory on the clinical symptoms and signs, neuro-imaging findings and clinical courses of patients with thalamic haemorrhages by a retrospective analysis of 175 consecutive patients with thalamic haemorrhage. Based on the neuro-imaging findings we classified thalamic haematomas into four regional types and one global type according to the primary bleeding sites: (i) anterior type occurring in the territory of the tuberothalamic arteries, (ii) posteromedial type occurring in the territory of the thalamic-subthalamic paramedian arteries, (iii) posterolateral type occurring in the territory of the thalamogeniculate arteries. (iv) dorsal type occurring in the territory of the posterior choroidal arteries and (v) global type occupying the entire area of the thalamus. We studied the clinical and neuroimaging characteristics of each type. Eleven patients (7%) had the anterior type: these were the smallest haematomas and often ruptured into the anterior horn of the lateral ventricle. The major clinical signs were acute behavioural abnormalities: the clinical course was usually benign. Twenty-four patients (14%) had the posteromedial type in which haematomas often ruptured into the third ventricle, causing marked hydrocephalus, and often extended mediocaudally, involving the mesencephalon. The prognoses of this type depended on the presence of mesencephalic involvement which was associated with the worst outcome among the types even if the size of the haematoma itself was not large. The posterolateral type was most frequent (77 patients, 44%) and was characterized by large haematomas, rupture into the posterior horn of the lateral ventricle and frequent extension into the posterior limb of the internal capsule. Clinical signs included marked sensory and motor signs, hemineglect in right-side haematomas and language abnormalities with left-side haematomas. The case fatality with this type was relatively high (35%) and permanent neurologic sequelae frequently resulted. In the dorsal type (32 patients, 18%) haematomas were best visualized at the level of the body of the lateral ventricle on CT scans. The size was moderate and haematomas often extended posterolaterally into the adjacent subcortical white matter. Sensory and motor signs were common and about one third of the patients were first misdiagnosed as having lacunar infarcts. The prognoses were excellent. The global type (31 patients, 18%) of thalamic haemorrhage was clinically and radiologically very similar to the posterolateral type except that the haematomas were too large to define the bleeding focus. Severe sensory and motor signs were almost always present. In this type 25 patients died (the case fatality was 81%). PMID:9009994

Chung, C S; Caplan, L R; Han, W; Pessin, M S; Lee, K H; Kim, J M

1996-12-01

52

[Viral haemorrhagic fever].  

PubMed

Viral haemorrhagic fever denotes various kinds of febrile illness caused by certain viruses which often presents with bleeding tendency and occasionally shock. Out of these, the four maladies, Lassa fever, Ebola haemorrhagic fever, Marburg haemorrhagic fever and Crimean-Congo haemorrhagic fever which are endemically present in Africa or eastern Europe, are known to be such diseases with high man-to-man communicability. These four haemorrhagic fevers are, therefore, designated as special conditions requiring isolation during the period when the infected patients are shedding the viruses, not only in Japan but also in many other countries. We have so far only one such case of Lassa fever who returned to Japan from Sierra Leone in 1987. Some haemorrhagic fevers including dengue (haemorrhagic) fever and hantavirus infections (e.g. haemorrhagic fever with renal syndrome) are not known to be man-to-man transmissible and requiring no isolation. We have a number of dengue and dengue haemorrhagic fevers here in Japan today among imported febrile cases from tropical or subtropical countries. Every physician should take viral haemorrhagic fevers into consideration as one of the possibilities in diagnosing patients returning from overseas travel. PMID:9283226

Masuda, G

1997-08-01

53

Postoperative intracranial haemorrhage: a review.  

PubMed

Postoperative haemorrhage (POH) is one of the most serious complications of any cranial neurosurgical procedure and is associated with significant morbidity and mortality. The relative paucity of work investigating this postoperative complication prompted us to undertake a review of the literature, focussing on demographic, clinical, and surgical risk factors. A literature search was undertaken using Ovid MEDLINE (1950-2009) using keywords including craniectomy, craniotomy, neurosurgery, intracranial, reoperation, repeat craniotomy, postoperative, haemorrhage, haematoma, and bleeding. The rates of POH following intracranial procedures reported in the literature vary greatly, and meaningful comparison is difficult. We defined postoperative haemorrhage as that following craniotomy, which is clinically significant and requires surgical evacuation. Risk factors include pre-existing medical comorbidities including hypertension, coagulopathies and haematological abnormalities, intraoperative hypertension and blood loss, certain lesion pathologies including tumours, chronic subdural haematomas, and deficiencies in haemostasis. We conclude by providing recommendations for clinical practice based on the literature reviewed to aid clinicians in the detection and avoidance of POH. PMID:21246389

Seifman, Marc A; Lewis, Phillip M; Rosenfeld, Jeffrey V; Hwang, Peter Y K

2011-10-01

54

Haemorrhagic Fevers, Viral  

MedlinePLUS

... fever, dengue, Omsk haemorrhagic fever, Kyasanur forest disease). Ebola virus diseases All information on Ebola virus disease Technical information, publications, situation assessments, feature ...

55

Spontaneous Intratesticular Haemorrhage  

Microsoft Academic Search

Spontaneous intratesticular haemorrhage is a rare disease. Four cases have been described, all diagnosed after orchidectomy. We present an additional patient with a spontaneously arisen intratesticular haematoma in whom orchidectomy could be avoided.

Per Ovesen; Søren Mommsen

1991-01-01

56

Contemporary management of subarachnoid hemorrhage and vasospasm: the UIC experience  

Microsoft Academic Search

BACKGROUNDCerebral vasospasm is a well-known and serious complication of aneurysmal subarachnoid hemorrhage. The means of monitoring and treatment of vasospasm have been widely studied. Each neurosurgical center develops a protocol based on their experience, availability of equipment and personnel, and cost, so as to keep morbidity and mortality rates as low as possible for their patients with vasospasm.METHODSAt the University

Luke Corsten; Ali Raja; Kern Guppy; Ben Roitberg; Mukesh Misra; M. Serdar Alp; Fady Charbel; Gerard Debrun; James Ausman

2001-01-01

57

Managing Major Postpartum Haemorrhage following Acute Uterine Inversion with Rusch Balloon Catheter  

PubMed Central

Acute postpartum uterine inversion is a relatively rare complication. The uterus inverts and the uterine fundus prolapses to or through the dilated cervix. It is associated with major postpartum haemorrhage with or without shock. Shock is sometimes out of proportion to the haemorrhage. Minimal maternal morbidity and mortality can be achieved when uterine inversion is promptly and aggressively managed. We present this report of three cases of acute uterine inversion complicated with major postpartum haemorrhage and managed with Rusch balloon. The paper highlights the importance of early recognition and the safety of the use of intrauterine balloon to manage major postpartum haemorrhage in these cases. PMID:24826322

Keriakos, Remon; Chaudhuri, Smriti Ray

2011-01-01

58

Neuroprotection in Subarachnoid Hemorrhage  

PubMed Central

Despite advances in aneurysm ablation and the initial management of patients presenting with aneurysmal subarachnoid hemorrhage (aSAH), delayed cerebral ischemia remains a significant source of morbidity. Traditionally, delayed cerebral ischemia was felt to be a result of vasospasm of the proximal intracranial vessels, and clinical trials have relied largely on radiographic evidence of vasospasm as a surrogate for functional outcome. However, a number of trials have demonstrated a dissociation between angiographic vasospasm and outcome, and more recent data suggests that other mechanisms of injury, such as microvascular dysfunction and complex neuronal-glial interactions may influence the development of delayed ischemic deficit following aSAH. Our evolving understanding of the pathophysiology of delayed cerebral ischemia may offer the opportunity to test new therapeutic strategies in this area and improve clinical trial design. PMID:20876512

Laskowitz, Daniel T.; Kolls, Brad J.

2010-01-01

59

Ebola haemorrhagic fever.  

PubMed

This article focuses on the management of a patient who was admitted to The Aga Khan Hospital in Dar es Salaam, Tanzania, with suspected Ebola haemorrhagic fever (Ebola HF). It defines the disease, symptoms and how it is spread, diagnosed, treated and prevented. Recommendations are made for management of Ebola HF in a hospital setting. PMID:12216182

Walker, L

60

Ebola haemorrhagic fever  

PubMed Central

Ebola viruses are the causative agents of a severe form of viral haemorrhagic fever in man, designated Ebola haemorrhagic fever, and are endemic in regions of central Africa. The exception is the species Reston Ebola virus, which has not been associated with human disease and is found in the Philippines. Ebola virus constitutes an important local public health threat in Africa, with a worldwide effect through imported infections and through the fear of misuse for biological terrorism. Ebola virus is thought to also have a detrimental effect on the great ape population in Africa. Case-fatality rates of the African species in man are as high as 90%, with no prophylaxis or treatment available. Ebola virus infections are characterised by immune suppression and a systemic inflammatory response that causes impairment of the vascular, coagulation, and immune systems, leading to multiorgan failure and shock, and thus, in some ways, resembling septic shock. PMID:21084112

Feldmann, Heinz; Geisbert, Thomas W

2012-01-01

61

Hereditary Haemorrhagic Telangiectasia  

Microsoft Academic Search

\\u000a Hereditary Haemorrhagic Telangiectasia (HHT, Osler–Weber–Rendu syndrome) exemplifies diseases which have catalysed advances\\u000a in the understanding of fundamental pathophysiological mechanisms. The hallmark of HHT is the development of abnormal blood\\u000a vessels, involving the lung in approximately 50% of cases. This chapter will focus on the molecular mechanisms that underlie\\u000a their generation. While not all clinical problems in HHT can be directly

Claire Shovlin; S. Paul Oh

62

Hereditary haemorrhagic telangiectasia  

Microsoft Academic Search

Summary. Hereditary haemorrhagic telangiectasia (also known as Osler-Weber-Rendu syndrome) is a relatively common, under-recognized autosomal- dominant disorder that results from multisystem vascular dysplasia. It is characterized by telangiecta- ses and arteriovenous malformations of skin, mucosa and viscera. This article summarizes the clinical manifestations and the management of this disorder and its management. This review underscores an urgent need to conduct

A. S HAPIRO

2008-01-01

63

Subarachnoid-subarachnoid bypass for spinal adhesive arachnoiditis.  

PubMed

The authors report a case of adhesive arachnoiditis (AA) and arachnoid cyst successfully treated by subarachnoid to subarachnoid bypass (S-S bypass). Arachnoid cysts or syringes sometimes compress the spinal cord and cause compressive myelopathy that requires surgical treatment. However, surgical treatment for AA is challenging. A 57-year-old woman developed leg pain and gait disturbance. A dorsal arachnoid cyst compressed the spinal cord at T7-9, the spinal cord was swollen, and a small syrinx was present at T9-10. An S-S bypass was performed from T6-7 to T11-12. The patient's gait disturbance resolved immediately after surgery. Two years later, a small arachnoid cyst developed. However, there was no neurological deterioration. The myelopathy associated with thoracic spinal AA, subarachnoid cyst, and syrinx improved after S-S bypass. PMID:25170651

Tachibana, Toshiya; Moriyama, Tokuhide; Maruo, Keishi; Inoue, Shinichi; Arizumi, Fumihiro; Yoshiya, Shinichi

2014-11-01

64

The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs  

PubMed Central

Subarachnoid hemorrhage (SAH) is a devastating neurological disorder. Patients with aneurysmal SAH develop secondary complications that are important causes of morbidity and mortality. Aside from secondary neurological injuries, SAH has been associated with nonneurologic medical complications, such as neurocardiogenic injury, neurogenic pulmonary edema, hyperglycemia, and electrolyte imbalance, of which cardiac and pulmonary complications are most common. The related mechanisms include activation of the sympathetic nervous system, release of catecholamines and other hormones, and inflammatory responses. Extracerebral complications are directly related to the severity of SAH-induced brain injury and indicate the clinical outcome in patients. This review provides an overview of the extracerebral complications after SAH. We also aim to describe the manifestations, underlying mechanisms, and the effects of those extracerebral complications on outcome following SAH. PMID:25110700

Chen, Sheng; Li, Qian; Wu, Haijian; Krafft, Paul R.; Wang, Zhen; Zhang, John H.

2014-01-01

65

Haemorrhagic Enteropathies in Red Deer (Cervus Elaphus)  

Microsoft Academic Search

Sir, — I would like to draw your readers’ attention to the occurrence of post-stress haemorrhagic enteropathies in red deer (Cervus elaphus). Haemorrhagic enteropathy has been observed in approximately 75 percent of red deer necropsied at the Invermay Animal Health Laboratory and has also been seen in wapiti (Cervus canadensis). Deer dying with post-stress haemorrhagic enteropathy commonly have splash haemorrhages

H. J. F. McAllum

1982-01-01

66

[Fatal alveolar haemorrhage following a "bang" of cannabis].  

PubMed

The new methods of cannabis consumption (home made water pipe or "bang") may be responsible for fatal respiratory complications. We present a case, with fatal outcome, of a man of 19 years with no previous history other than an addiction to cannabis using "bang". He was admitted to intensive care with acute dyspnoea. A CT scan showed bilateral, diffuse alveolar shadowing. He was anaemic with an Hb of 9.3g/l. Bronchoalveolar lavage revealed massive alveolar haemorrhage. Investigations for infection and immunological disorder were negative and toxicology was negative except for cannabis. Antibiotic treatment was given and favourable progress allowed early discharge. Death occurred 15 days later due to alveolar haemorrhage following a further "bang" of cannabis. Autopsy showed toxic alveolar haemorrhage. The probable mechanism is pulmonary damage due to acid anhydrides released by the incomplete combustion of cannabis in contact with plastic. These acids have a double effect on the lungs: a direct toxicity with severe inflammation of the mucosa leading to alveolar haemorrhage and subsequently the acid anhydrides may lead to the syndrome of intra-alveolar haemorrhage and anaemia described in occupational lung diseases by Herbert in Oxford in 1979. It manifests itself by haemoptysis and intravascular haemolysis. We draw attention to the extremely serious potential consequences of new methods of using cannabis, particularly the use of "bang" in homemade plastic materials. PMID:21943539

Grassin, F; André, M; Rallec, B; Combes, E; Vinsonneau, U; Paleiron, N

2011-09-01

67

Symptomatic Tarlov Cyst Following Spontaneous Subarachnoid Hemorrhage  

PubMed Central

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage. PMID:22053232

Kong, Woo Keun; Hong, Seung-Koan

2011-01-01

68

Symptomatic tarlov cyst following spontaneous subarachnoid hemorrhage.  

PubMed

Most of Tarlov or perineurial cysts remain asymptomatic throughout the patient's life. The pathogenesis is still unclear. Hemorrhage has been suggested as one of the possible causes and trauma with resultant hemorrhage into subarachnoid space has been suggested as an origin of these cysts. However, Tarlov cysts related to spontaneous subarachnoid hemorrhage has not been reported. The authors report a case of Tarlov cyst which was symptomatic following spontaneous subarachnoid hemorrhage. PMID:22053232

Kong, Woo Keun; Cho, Keun-Tae; Hong, Seung-Koan

2011-08-01

69

Bilateral adrenal gland haemorrhage: an unusual cause  

PubMed Central

Summary Our patient had drainage of a large amoebic liver abscess. This got complicated by a severe degree of hypotension, which required aggressive fluid resuscitation and hydrocortisone support. Computerised tomography (CT) of the abdomen revealed bilateral adrenal gland haemorrhage (BAH) resulting in primary adrenal gland failure, which was the cause for hypotension. Patient was on long-term warfarin for provoked deep vein thrombosis of lower limb, which was discontinued before the procedure. Thrombophilia profile indicated the presence of lupus anticoagulant factor with prolonged activated partial thromboplastin time (aPTT). Patient was discharged on lifelong warfarin. This case emphasises the need for strong clinical suspicion for diagnosing BAH, rare but life-threatening condition, and its association with amoebic liver abscess and anti-phospholipid antibody syndrome (APLS). Learning points Recognition of BAH as a rare complication of sepsis.APLS can rarely cause BAH. PMID:25276353

Shenoy, Vasant; Malabu, Usman; Cameron, Donald; Sangla, Kunwarjit

2014-01-01

70

Risk of Cerebral Angiography in Patients With Subarachnoid Hemorrhage, Cerebral Aneurysm, and Arteriovenous Malformation  

Microsoft Academic Search

Background and Purpose—A well-defined complication rate of cerebral angiography in patients with subarachnoid hemorrhage (SAH), cerebral aneurysm, and arteriovenous malformation (AVM) would be useful to physicians making decisions regarding the imaging of these patients. We sought to define a statistically significant complication rate through meta-analysis of prospective studies in the literature. Methods—Meta-analysis of 3 published prospective studies of complications in

Harry J. Cloft; Gregory J. Joseph; Jacques E. Dion

71

[Complications of experimental lung transplantations].  

PubMed

Experimental lung transplantations are burdened with a very high rate of complications even is there is a strict consideration of sterile precautions. These complications occur predominantly directly in connection with organ rejection. Extrathoracic complications are rare and predominantly attributed to arterial embolism. All untreated receivers of lung had thoracic complications in autopsy. Only 5% of immune suppressively treated receivers were free of complications. Most frequent complications are pleuropulmonary infections. Weighty complications are haemorrhagic infarcts of the transplant and insufficiency of the bronchus. Only without complications can survived about years the chronic rejection. PMID:7025481

Engelmann, C; Kaltwasser, K; Danzmann, E; Riesner, R; Schimmack, L; Reutgen, H; Voigt, H

1981-01-01

72

Dengue/dengue haemorrhagic fever  

NSDL National Science Digital Library

A World Health Organization page devoted to the control of dengue. Many excellent informative PDF files are available from this page dealing with vector control, as well as recognition of symptoms, and treatment of dengue haemorrhagic fever. Estimated numbers of at risk people are staggering. A powerful resource for teaching the importance of vector borne diseases.

0002-11-30

73

Intracranial hypotension caused by cisternal irrigation for vasospasm after subarachnoid hemorrhage: a case report  

PubMed Central

Introduction Vasospasm is the most common cause of complication after a subarachnoid hemorrhage and tremendous efforts have been made to prevent it. A subarachnoid clot is the cause of the vasospasm and dissolving and washing it out is considered to be the best practice. Cisternal irrigation with urokinase and ascorbic acid has been widely used due to its proven effect. Case presentation A 60-year-old Japanese male presented with a severe headache was diagnosed with a subarachnoid hemorrhage and an immediate surgical obliteration was successfully performed. After clipping the aneurysm, a cisternal drainage tube was placed in the chiasmatic cistern. In order to clear the thick subarachnoid hemorrhage, a cisternal irrigation was performed. However, his consciousness deteriorated and his left pupil became dilated on the next day. A T1 sagittal magnetic resonance imaging scan showed an evidence of marked brain sagging with mild tonsillar descent. We continued intensive hydration and head-down positioning and the brain sagging was shown to have improved in the follow-up magnetic resonance imaging scan. Conclusions We present a case in which our patient experienced brain sagging after a cisternal irrigation of a subarachnoid hemorrhage. A subdural hematoma and low intracranial pressure suggested intracranial hypotension. Sagittal magnetic resonance imaging images are useful to evaluate brain sagging and are shown sequentially here in our case report. PMID:25223331

2014-01-01

74

Cerebral Energy Metabolism after Subarachnoid Hemorrhage.  

National Technical Information Service (NTIS)

The purpose of this study was to determine the effects of subarachnoid hemorrhage (SAH) on cerebral blood flow and cerebral oxidative metabolism. Average total hemispheric flow was measured utilizing a polarographic technique and the metabolic consumption...

J. M. Fein

1975-01-01

75

Anaesthesia in a patient with subarachanoidal haemorrhage and high oxygen affinity haemoglobinopathy (HB york): case report  

PubMed Central

Background Approximately 90 haemoglobinopathies have been identified that result in abnormally high oxygen affinity. One of these is haemoglobinopathy York (HbY), first described in 1976. HbY causes an extreme leftward shift of the oxygen dissociation curve with the P50 value changing to 12.5 - 15.5 mmHg (normal value 26.7 mmHg), indicating that approximately half of the haemoglobin is not available as oxygen carrier. Patients with haemoglobinopathies with increased oxygen affinity could suffer from the risk developing ischaemic complications due to a lack of functional oxygen carriers. This is, to best of our knowledge, the first case report on a patient with HbY published in connection with anesthesia. Case Presentation A 42-year-old female with a severe headache and Glasgow coma scale (GCS) of 15 was admitted to the neurosurgical intensive care unit with a ruptured, right sided ICA aneurysm with consecutive subarachnoid haemorrhage [Fisher III, World Federation of Neurosurgical Societies (WFNS) I)]. The medical history of the patient included an erythrocytosis (Hb 17.5?g/dl) on the base of a high-oxygen-affinity haemoglobinopathy, called Hb York (HbY). With no time available to take special preoperative precautions, rapid blood loss occurred during the first attempt to clip the aneurysm. General transfusion procedures, according to the guidelines based on haemoglobin and haematocrit values, could not be applied due to the uncertainty in the oxygen carrier reduction. To maintain tissue oxygen supply, clinical indicators of ischaemia were instead utilized to gauge the appropriate required blood products, crystalloids and colloids replacements. Despite this, the patient survived the neurosurgical intervention without any neurological deficit. Conclusions Family members of patients with HbY (and other haemoglobinopathies with increased oxygen affinity) should undergo clinical assessment, particularly if they are polycythaemic. If the diagnosis of HbY is confirmed, they should carry an "emergency anaesthesiology card" in order to avert perioperative risks arising from their "hidden" anemia. PMID:22870883

2012-01-01

76

Assessment and management of gastrointestinal (GI) haemorrhage  

Microsoft Academic Search

Acute gastrointestinal (GI) bleeding is both a common reason for hospital attendance and a common occurrence in hospitalized patients. Acute upper gastrointestinal haemorrhage (AUGH) is much more likely to be responsible for profuse or life-threatening bleeding than is lower GI haemorrhage. Despite advances in endoscopic and pharmacological treatments, AUGH still carries an overall mortality of around 10%. Prompt assessment and

Andrew R. Moore; Anthony I. Morris

2008-01-01

77

Predicting deterioration in patients with lobar haemorrhages  

Microsoft Academic Search

OBJECTIVETo study the clinical course and determine predictors of deterioration in patients with lobar haemorrhages).METHODSA comprehensive review of 61 consecutive patients with lobar haemorrhages was performed. Neurological deterioration was defined as (1) decrease in Glasgow coma sum score by 2 points, (2) new neurological deficit, or (3) clinical signs of brain herniation. A univariate logistic regression was performed and expressed

Kelly D Flemming; Eelco F M Wijdicks; Erik K St Louis; Hongzhi Li

1999-01-01

78

Screening for Systemic Manifestations of Vascular Malformations in Patients With Hereditary Haemorrhagic Telangiectasia (Osler Disease)  

Microsoft Academic Search

Hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome) is a disease characterized by systemic vascular malformations. Typical clinical manifestations are recurrent epistaxis and telangiectases of the skin and the mucous membranes. The syndrome is furthermore characterized by its hereditary aspect. The disease seems to be much more complicated than previously thought, mainly because of the accompanying vascular malformations in vital organs, like the

Ana Cerra Pohl; Jochen Alfred Werner; Benedikt Josef Folz

79

Intracranial haemorrhage in idiopathic thrombocytopenic purpura. Paediatric Haematology Forum of the British Society for Haematology  

Microsoft Academic Search

A UK survey was carried out to discover the frequency, circumstances, and outcome of intracranial haemorrhage (ICH) complicating idiopathic thrombocytopenic purpura (ITP) of childhood. A questionnaire was circulated through the membership of the UK Paediatric Haematology Forum, and thence to local paediatricians and haematologists. It sought information on any child with ITP who had had an ICH during the 20

J S Lilleyman

1994-01-01

80

Severe aortic stenosis and subarachnoid hemorrhage: Anesthetic management of lethal combination  

PubMed Central

Despite advances in various modalities of management, subarachnoid hemorrhage (SAH) continues to be associated with high mortality, which is further increased by associated comorbidities. Aortic stenosis (AS) is one such disease which can further complicate the course of SAH. We recently managed a known patient of severe AS, who presented with aneurysmal SAH. Patient was planned for eurovascular intervention. With proper assessment and planning, patient was managed with favorable outcome despite the restrictions faced in the neurovascular intervention laboratory. PMID:23878455

Sharma, Rakesh; Mehta, Yatin; Sapra, Harsh

2013-01-01

81

Intensive care of aneurysmal subarachnoid hemorrhage: an international survey  

Microsoft Academic Search

Background  Patients with aneurysmal subarachnoid hemorrhage (SAH) are routinely admitted to the intensive care unit for the management\\u000a of neurological and systemic complications.\\u000a \\u000a \\u000a \\u000a Objective  To determine the clinical practices of intensive care physicians treating SAH, and to evaluate the relationship between these\\u000a practices and published evidence.\\u000a \\u000a \\u000a \\u000a Design  Survey.\\u000a \\u000a \\u000a \\u000a Participants  Physicians identified through the Society of Critical Care Medicine (SCCM), the European Society of Intensive

Robert D. Stevens; Neeraj S. Naval; Marek A. Mirski; Giuseppe Citerio; Peter J. Andrews

2009-01-01

82

Haemorrhagic infarction after autologous cranioplasty in a patient with sinking flap syndrome  

Microsoft Academic Search

Summary  Sinking flap syndrome is a potential complication of large decompressive craniectomies that usually resolves completely after\\u000a cranioplasty. We report a 77 year-old female who underwent an autologous cranioplasty to treat a sinking flap syndrome. In\\u000a the first post-operative day she developed a large hemispheric haemorrhagic infarction. In this report we discuss the possible\\u000a pathogenic mechanism of such a complication.

P. C. Cecchi; P. Rizzo; M. Campello; A. Schwarz

2008-01-01

83

Effect of recombinant human erythropoietin on cerebral ischemia following experimental subarachnoid hemorrhage  

Microsoft Academic Search

Erythropoietin exerts a neuroprotective effect during cerebral ischemia. We investigated the effect of systemic administration of recombinant human erythropoietin in a rabbit model of subarachnoid hemorrhage-induced acute cerebral ischemia. The animals were divided into three groups: group 1, subarachnoid hemorrhage; group 2, subarachnoid hemorrhage plus placebo; group 3, subarachnoid hemorrhage plus recombinant human erythropoietin (each group, n=8). Experimental subarachnoid hemorrhage

Concetta Alafaci; Francesco Salpietro; Giovanni Grasso; Alessandra Sfacteria; Marcello Passalacqua; Antonio Morabito; Eliana Tripodo; Gioacchino Calapai; Michele Buemi; Francesco Tomasello

2000-01-01

84

How to manage peroperative haemorrhage when vaginally treating genital prolapse.  

PubMed

Surgery of genital prolapse causes haemorrhagic complications in about 1% of cases. The pelvis is highly vascular and accessing the usual landmarks of vaginal surgery, in particular the sciatic spine, is delicate work. Meticulous dissection of closed spaces is often difficult, and exposure and haemostatic procedures will be challenging in the event of any bleeding complication. When fixing prosthesis to the sacrospinous ligament, the inferior gluteal artery and its coccygeal branch are at risk. Fixation to the sacrospinous ligament must be performed more than 25mm away from the sciatic spine and, if possible, must not transfixiate it. Safe insertion of prosthesis requires sufficient experience, and an adequate learning curve. Being aware of vascular anatomy allows one to understand and treat haemorrhagic incidents. Packing or selective embolization seem to be the two methods to adopt, depending on the severity of bleeding and the conditions of exposure on the one hand, and on the technical resources available for embolization, on the other. Hypogastric ligature appears to be ineffective in this context. PMID:24813082

Azaïs, H; Bassil, A; Giraudet, G; Rubod, C; Lucot, J-P; Cosson, M

2014-07-01

85

Safety of withholding anticoagulation in patients with mechanical prosthetic valves and intracranial haemorrhage.  

PubMed

Patients with prosthetic heart valves require lifelong anticoagulation to prevent thromboembolism. When they have intracranial haemorrhage, anticoagulation has to be withheld. This study was aimed to identify safety duration and complications of anticoagulation withholding in patients with prosthetic heart valves and intracranial haemorrhage. This was a retrospective descriptive study in 26 prosthetic heart valve patients hospitalised in Srinagarind Hospital, Khon Kaen University because of intracranial haemorrhage from 2003 to 2008. Range of anticoagulation withholding was 1 to 26 days with mean 8.5 ± 7.7 days. Most patients (84.6%) were withheld anticoagulation for less than 14 days. There were five in-hospital deaths mostly within 3 days of admission from severe intracranial haemorrhage. No data of reintroduction of anticoagulation was found in three patients because they were lost to follow up. One patient had right basal ganglia infarction after 7 days of anticoagulation withholding. Prosthetic heart valve dysfunction was suspected in one patient who withheld anticoagulant for 76 days. Discontinuation of anticoagulation in patients with prosthetic heart valves and intracranial haemorrhage for less than 7 days was associated with low thromboembolic risk and there was no clinical evidence of prosthetic heart valve dysfunction when anticoagulation was withheld for less than 14 days. PMID:22435901

Krittalak, K; Sawanyawisuth, K; Tiamkao, S

2011-10-01

86

An unusual cause of lower gastrointestinal haemorrhage.  

PubMed

A previously unreported cause of lower gastrointestinal haemorrhage in a 63-year-old female patient on clopidogrel for cardiac comorbidities is presented. Endoscopy suggested a small bowel or colonic aetiology but failed to accurately localise the source. The patient became haemodynamically unstable despite conservative management and temporary cessation of clopidogrel. CT angiography demonstrated a pseudoaneurysm arising from the superior rectal artery. Percutaneous embolisation using coils was performed to successfully occlude the pseudoaneurysm, prevent further haemorrhage and avoid emergency colonic resection. PMID:22669967

Janmohamed, Azara; Noronha, Lizanne; Saini, Ashish; Elton, Colin

2011-01-01

87

COMMENTARY Magnesium sulfate for aneurysmal subarachnoid hemorrhage: the end of the road or more trials?  

E-print Network

Delayed cerebral ischemia (DCI) is a feared complication and an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). In the current study, Wong and colleagues performed a systematic review and meta-analysis of randomized controlled trials that investigated the efficacy of magnesium sulfate in patients with aneurysmal SAH. Outcome measures were DCI, cerebral infarction, and functional outcome 3 and 6 months after SAH. Magnesium sulfate decreased the rate of cerebral infarction, but not of DCI or poor functional outcome. Regarding outcome, a beneficial effect of magnesium sulfate on outcome can not be ruled out because of sample size limitations. Even if this meta-analysis had shown an effect on outcome, the question remains which treatment protocol should be applied in daily practice, since the administration of magnesium sulfate differed between most included studies. The present meta-analysis also underlines the importance of defining clinically relevant endpoints in SAH trials. Clinical deterioration due to DCI is more subject to inter-observer bias compared to cerebral infarction, which represents the ultimate outcome of the ischemic event. The Magnesium in Aneurysmal Subarachnoid Hemorrhage-II (MASH-II: ISRCTN68742385) phase III clinical trial nears completion. It aims to include 1,200 patients, and its results are urgently awaited. Delayed cerebral ischemia (DCI) is a feared complication and an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Only limited progress has been made in the prevention of DCI. More than 20 years ago, the calcium antagonist nimodipine

Mervyn Di Vergouwen

88

[Haemorrhagic fever viruses, possible bioterrorist use].  

PubMed

The majority of haemorrhagic fever viruses are responsible for various clinical manifestations, the mutual characteristics of which are fever and haemorrhage in 5 to 70% of cases. All degrees of severity can be observed, ranging from isolated fever to multi-organ failure and death. These viruses belong to one of the following families: filoviridae, arenaviridae, bunyaviridae, and flaviviridae. They must be considered as dangerous biological weapons that could potentially be used. Most of the viruses responsible for haemorrhagic fever can be transmitted to humans through the air in spray form, except the dengue virus and the agents of haemorrhagic fever from the Congo Crimea and the haemorrhagic fever with renal syndrome that are difficult to handle in cell culture. In the event of a bioterrorist act, the management of persons infected or suspected of being so will be made by the referent departments of infectious diseases, defined by the French Biotox plan. Management includes isolation, confirmation or invalidation of the diagnosis and rapid initiation of treatment with ribavirin. Ribavirin is recommended for the treatment and prophylaxis of arenavirus and bunyavirus infections; it is not effective for the other families of virus. Except for yellow fever, there is no vaccination for the other forms of viral haemorrhagic fever. PMID:15687968

Rigaudeau, Sophie; Bricaire, François; Bossi, Philippe

2005-01-29

89

Complications of hemorrhagic and ischemic stroke : a CT perfusion evaluation  

Microsoft Academic Search

In this thesis the use of CT-perfusion (CTP) imaging in the evaluation of the most severe complications of subarachnoid hemorrhage (SAH)) and ischemic stroke was explored. These complications are delayed cerebral ischemia (DCI) after SAH and damage to the blood-brain barrier (BBB) after ischemic stroke causing hemorrhagic transformation (HT) and malignant edema (ME). In part 1 of this thesis we

J. W. Dankbaar

2010-01-01

90

Spinal cord blood flow following subarachnoid tetracaine  

Microsoft Academic Search

Spinal cord and spinal durai blood flow in the cervical, thoracic and lumbosacral regions were measured in dogs using the\\u000a radioactive microsphere technique. Measurements were taken before and 20 and 40 minutes after lumbar subarachnoid injection\\u000a of one of the following: (I) physiologic saline; (2) tetracaine 20 mg or (3) tetracaine 20 mg with epinephrine 200 ?g. No\\u000a significant change

Raymond Kozody; Richard J. Palahniuk; Maureen O. Cumming

1985-01-01

91

Pituitary deficiency after aneurysmal subarachnoid hemorrhage  

PubMed Central

OBJECTIVE: Aneurysmal subarachnoid hemorrhage puts patients at high risk for the development of pituitary insufficiency. We evaluated the incidence of pituitary dysfunction in these patients and its correlation with clinical outcome. METHODS: Pituitary function was tested in 66 consecutive patients in the first 15 days after aneurysmal subarachnoid hemorrhage. The following were measured in all patients: thyroid-stimulating hormone, free thyroxine, triiodothyronine, luteinizing hormone, follicle-stimulating hormone, total testosterone (in males), estradiol (in females), prolactin, serum cortisol, plasma adrenocorticotropic hormone, growth hormone and insulin growth factor. RESULTS: The endocrine assessment was made at a mean of 7.4 days (standard deviation ±6.6) after subarachnoid hemorrhage. Forty-four (66.7%) female and 22 (33.3%) male patients were evaluated. Thirty-nine patients (59.1%) had some type of pituitary dysfunction. Follicle-stimulating hormone/luteinizing hormone deficiency was the most frequent disorder (34.8%), followed by growth hormone/insulin growth factor (28.7%), adrenocorticotropic hormone (18.1%) and thyroid-stimulating hormone (9%). Seventeen (25.7%) patients showed deficiencies in more than one axis. A greater incidence of hormone deficiency was observed in patients with a Glasgow Coma Scale score ?13 (t test, p?=?0.008), Hunt-Hess grade ?4 (t test, p<0.001), or Fisher grade 4 (t test, p?=?0.039). Hormone deficiency was not significantly associated (p>0.05) with increased hospitalization or clinical outcome. CONCLUSION: Pituitary dysfunction was identified in a substantial portion of patients with previous aneurysmal subarachnoid hemorrhage, but no association was found between this dysfunction and poor clinical outcome. PMID:23778478

Pereira, Julio Leonardo Barbosa; de Albuquerque, Lucas Alverne Freitas; Dellaretti, Marcos; de Carvalho, Gervasio Teles Cardoso; Jr, Gerival Vieira; Brochado, Vitor Michelstaedter; Drummond, Austen Venancio; de Morais, Joyce Espeschit; Ferreira, Leticia Maia; Miranda, Paulo Augusto Carvalho; de Sousa, Atos Alves

2013-01-01

92

Life threatening intracerebral haemorrhage following saw- scaled viper (Echis carinatus) envenoming-authenticated case report from Sri Lanka  

PubMed Central

Background Echis carinatus (Saw scaled viper {SSV}) is a venomous snake found in the parts of Middle East and Central Asia. SSV envenoming is characterized by local swelling and coagulopathy. Various bleeding manifestations are commonly seen with SSV envenoming. In contrast to other part of Asia, saw scale viper envenoming has not been reported to cause life threatening haemorrhagic manifestations in Sri Lanka. Case presentation We report a 19 years old healthy boy who developed massive left temporo-parietal intra cerebral haemorrhage following Echis carinatus (Saw scaled viper) bite in Sri Lanka. Conclusion Although subspecies of SSV in Sri Lanka is regarded as a ‘non lethal venomous snake’, the occurrence of rare potentially fatal complications such as intracerebral haemorrhage should be considered in their management. This case report is intended to bring the awareness of this fatal complication of SSV envenoming in Sri Lanka. PMID:23565979

2013-01-01

93

Skull fracture and haemorrhage pattern among fatal and nonfatal head injury assault victims – a critical analysis  

PubMed Central

Abstract: Background: The global incidence of fatal head injuries as the result of assault is greater than the number of non-fatal cases. The important factors that determine the outcome in terms of survival of such head injury cases include the type of weapon used, type and site of skull fracture, intra cranial haemorrhage and the brain injury. The present study aims to highlight the role of skull fractures as an indirect indicator of force of impact and the intra cranial haemorrhage by a comparative study of assault victims with fatal and nonfatal head injuries. Methods: 91 head injury cases resulting from assault were studied in the Department of Forensic Medicine, IMS, BHU Varanasi over a period of 2 years from which 18 patients survived and 73 cases had a lethal outcome. Details of the fatal cases were obtained from the police inquest and an autopsy while examination of the surviving patients was done after obtaining an informed consent. The data so obtained were analyzed and presented in the study. Results: Assault with firearms often led to fatality whereas with assault involving blunt weapons the survival rate was higher. Multiple cranial bones were involved in 69.3% cases while comminuted fracture of the skull was common among the fatal cases. Fracture of the base of the skull was noted only in the fatal cases and a combination of subdural and subarachnoid haemorrhage was found in the majority of the fatal cases. Conclusions: The present study shows skull fractures to be an important indicator of severity of trauma in attacks to the head. Multiple bone fracture, comminuted fracture and base fractures may be considered as high risk factors in attempted homicide cases. PMID:21483205

Chattopadhyay, Saurabh; Tripathi, Chandrabhal

2010-01-01

94

Combined subarachnoideal-extradural anesthesia for high-risk patients during surgery on the musculo-skeletal system.  

PubMed

Background. Patients in advanced age undergoing surgery for musculo-skeletal disorders are at risk for failure of vital systems under anesthesia. Thus the choice of anesthetic technique for high-risk patients can have a vital impact on treatment outcome. Material and method. Our research involved 344 patients ranging in age from 69 to 93 (mean 76.4 +/- 7.8) at high risk during extensive orthopedic surgery on the lower limbs. The patients were divided into three groups depending on the anesthetic technique used: Group I - general anesthesia with esophageal intubation or laryngeal mask; Group II - subarachnoid anesthesia; and Group III - combined subarachnoid-extradural anesthesia. The Goldman heart risk and ASA anesthesia risk were determined for each patient. The frequency and type of post-operative complications were also specified. Results. Altogether complications occurred in 15.6% of the patients: 6.1% in Group I, 6.8% in Group II, and 2.9% in Group III. Acute myocardial ischemia and infarct occurred only in patients with high Goldman indices. Pulmonary complications were seen in groups I and II, but not in Group III. Conclusions. Combined subarachnoid-extradural anesthesia enables deeper anesthesia during a prolonged operation, and thus makes it possible to avoid general anesthesia. The post-surgical application of continuous extradural analgesia using bupivacaine with phentanyl enables the introduction of respiratory rehabilitation and rapid mobilization, reducing the number of cardiac and pulmonary complications, and by the same token shortening the duration of hospitalization. PMID:17675997

Grabowska-Gawe?, Anna

2004-06-30

95

The subarachnoid spaces in children: normal variations in size  

Microsoft Academic Search

Intra- and extraventricular subarachnoid spaces in children were studied by high-resolution computed tomography. Scans were reviewed of 34 patients who were selected as highly likely to have normal scans. Sizes of the ventricular system and the seven extraventricular subarachnoid compartments were analyzed and graded on a subjective scale from 0 (not visible) to 4 (markedly enlarged). Data were also analyzed

P. K. Kleinman; J. L. Zito; R. I. Davidson; V. Raptopoulos

1983-01-01

96

Maternal and neonatal complications of macrosomia.  

PubMed

This case control study, aimed at identifying complications of macrosomia, was conducted in two major hospitals of Yaoundé, Cameroon over a 6-month period from 1 October 2012. Maternity records were compared of births weighing ?4000?g with those weighing between 3000?g and 3500?g. The main outcome variables were mode of delivery, low genital lacerations, Apgar score, birth injuries, postpartum haemorrhage and early neonatal death. Data were analysed using SPSS 18.0. Chi-square test or Fisher's exact test and t-test were used for comparison. P?complications observed were poor uterine contractions during labour, second-degree perineal tears, Caesarean section, instrumental delivery and postpartum haemorrhage. Neonatal complications were birth injuries, poor 5-minute Apgar score and early neonatal death. In our setting, macrosomia is associated with increased maternal and neonatal complications. PMID:24958734

Elie, Nkwabong

2014-10-01

97

A new locus for hereditary haemorrhagic telangiectasia (HHT3) maps to chromosome 5  

Microsoft Academic Search

Patients with hereditary haemorrhagic telangiectasia (HHT, or Osler-Weber-Rendu syndrome) have variable presentation patterns and a high risk of preventable complications. Diagnostic tests for mutations in endoglin (HHT type 1) and ALK-1 (HHT type 2) are available. Some HHT patients are now known to have HHT-juvenile polyposis overlap syndrome due to Smad4 mutations. Families were ascertained following the presentation of probands

S G Cole; M E Begbie; G M F Wallace; C L Shovlin

2005-01-01

98

Crimean-Congo Haemorrhagic Fever in Kosova : a fatal case report  

Microsoft Academic Search

Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries around the world. The authors report a fatal case of Crimean-Congo hemorrhagic fever (CCHF) observed in a patient from Kosova. The diagnosis of CCHF was confirmed by reverse transcription-PCR. Late diagnosis decreased the efficacy of treatment and patient died due to severe complications of infection.

Salih Ahmeti; Lul Raka

2006-01-01

99

Treatment of Intracranial Vasospasm Following Subarachnoid Hemorrhage  

PubMed Central

Vasospasm has been a long known source of delayed morbidity and mortality in aneurysmal subarachnoid hemorrhage patients. Delayed ischemic neurologic deficits associated with vasospasm may account for as high as 50% of the deaths in patients who survive the initial period after aneurysm rupture and its treatment. The diagnosis and treatment of vasospasm has still been met with some controversy. It is clear that subarachnoid hemorrhage is best cared for in tertiary care centers with modern resources and access to cerebral angiography. Ultimately, a high degree of suspicion for vasospasm must be kept during ICU care, and any signs or symptoms must be investigated and treated immediately to avoid permanent stroke and neurologic deficit. Treatment for vasospasm can occur through both ICU intervention and endovascular administration of intra-arterial vasodilators and balloon angioplasty. The best outcomes are often attained when these methods are used in conjunction. The following article reviews the literature on cerebral vasospasm and its treatment and provides the authors’ approach to treatment of these patients. PMID:24904517

Bauer, Andrew M.; Rasmussen, Peter A.

2014-01-01

100

Septicaemia and adrenal haemorrhage in congenital asplenia  

Microsoft Academic Search

Five patients developed overwhelming infection as a result of congenital asplenia, which was previously unsuspected in all cases. Each illness followed a fulminant course resulting in death within 24 hours. They illustrate the respective roles of Haemophilus influenzae infection (n = 4) and adrenal haemorrhage (n = 4) in this condition. We suggest a management protocol for screening infants with

M P Dyke; R P Martin; P J Berry

1991-01-01

101

Aneurysmal Subarachnoid Hemorrhage Models: Do They Need a Fix?  

PubMed Central

The discovery of tissue plasminogen activator to treat acute stroke is a success story of research on preventing brain injury following transient cerebral ischemia (TGI). That this discovery depended upon development of embolic animal model reiterates that proper stroke modeling is the key to develop new treatments. In contrast to TGI, despite extensive research, prevention or treatment of brain injury following aneurysmal subarachnoid hemorrhage (aSAH) has not been achieved. A lack of adequate aSAH disease model may have contributed to this failure. TGI is an important component of aSAH and shares mechanism of injury with it. We hypothesized that modifying aSAH model using experience acquired from TGI modeling may facilitate development of treatment for aSAH and its complications. This review focuses on similarities and dissimilarities between TGI and aSAH, discusses the existing TGI and aSAH animal models, and presents a modified aSAH model which effectively mimics the disease and has a potential of becoming a better resource for studying the brain injury mechanisms and developing a treatment. PMID:23878760

Sehba, Fatima A.; Pluta, Ryszard M.

2013-01-01

102

Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage.  

PubMed

Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm. PMID:25190938

Kundra, Sandeep; Mahendru, Vidhi; Gupta, Vishnu; Choudhary, Ashwani Kumar

2014-07-01

103

[Massive natriuresis and polyuria after triple craniocervical subarachnoid hemorrhage: cerebral salt wasting syndrome?].  

PubMed

A thirty-year-old male patient suffered subarachnoidal haemorrhage from an angioma positioned in the cranio-cervical transition. After rebleeding twice the patient developed a hydrocephalus internus malresorptivus and excessive natriuresis and polyuria, accompanied by depressed renin activity and extremely low aldosterone plasma levels. Neither fluid restriction and sodium substitution, nor administration of hydro-chlorothiazide/indomethacin affected natriuresis and polyuria. It was only after treatment with fludrocortisone-acetate/hydrocortisone that hyponatraemia and polyuria were resolved. At the same time a ventriculo-peritoneal shunt was applied. Differential diagnosis excluded the syndromes of inadequate antidiuretic hormone secretion, renal and cerebral diabetes insipidus, osmotic receptor hypofunction, chronic renal dysfunction and tubular necrosis. Natriuresis and polyuria developed under dexamethasone therapy. Since patient history, physical examination and laboratory criteria could not explain the electrolyte and fluid imbalance, this might be attributed to the hydrocephalus. Similar disturbances have been reported from other patients with intracranial disorders. Mechanical pressure exercised on the hypothalamus might cause the disturbance of fluid and sodium balance. Assuming a cerebral salt wasting syndrome, a putative natriuretic factor coming from the brain or an imbalance in the cerebral renin-angiotensin-system, as described in rats and dogs, must be discussed. PMID:1482743

Berendes, E; Scherer, R; Schuricht, G; Rol, R; Hengst, K

1992-11-01

104

Hypocapnia as a poor prognostic factor in aneurysmal subarachnoid hemorrhage  

PubMed Central

In this editorial, the issues of hypocapnia and its relation to symptomatic vasospasm, prognosis, and outcome among patients with aneurysmal subarachnoid hemorrhage is discussed. Potential directions for future studies are provided. PMID:24274339

2013-01-01

105

[Actiopathogenic study of per and postoperative haemorrhage in adenotonsillectomy in the child (author's transl)].  

PubMed

This study involved 4 201 records between July 1st 1969 and February 28th 1979. Various parameters represented by specific patient data (age, sex, ENT infections), laboratory examinations, operative findings and weather conditions were studied. Adenoidectomy was found to be more haemorrhagic than adenotonsillectomy, in particular in the presence of a large clump of adenoids and in autumn or winter. Use of a halothane-nitrous oxide-oxygen mixture decreased the number of haemorrhages which by contrast were increased by an operative position in a dorsal horizontal position. Finally, any deviation from standard meterological conditions would appear to be a pejorative factor. The authors conclude by stating that no serious complications were seen and that it is important to undertake a precise and complete preoperative laboratory assessment. Finally, mutual confidence between surgeon and anaesthetist is an additional factor in decreasing risk. PMID:7103335

Moreau, M C; Morelle-Lafon, E; Bonhomme, F

1982-01-01

106

Haemorrhage control in extremity stab injury  

PubMed Central

The Foley catheter is described in the emergency treatment of penetrating cardiac injuries, and its intra-operative use to control bleeding while definitive measures for intravascular embolization are being made. We present the first reported case of the use of a urinary catheter to control haemorrhage in an extremity stab injury to obtain haemodynamic stability while awaiting definitive surgical treatment. This quick, easy and useful technique can be used for junctional vascular injuries and wounds with a narrow neck, and can be easily removed once in the operating theatre. This life-saving, simple and cost-effective technique ‘internalises’ the externally applied pressure to control massive haemorrhage while awaiting definitive operative intervention. The catheter can be sutured in place if the patient is to be transferred to another department or hospital. PMID:24968429

Singh, R. A.; Asprou, F.; Patel, Amit; Trickett, R. W.

2013-01-01

107

Lessons from nosocomial viral haemorrhagic fever outbreaks.  

PubMed

The outbreak of Marburg haemorrhagic fever in Angola in 2004-2005 shows once again the devastating and rapid spread of viral haemorrhagic fevers in medical settings where hygiene practices are poorly applied or ignored. The legacy of years of war and poverty in Angola has resulted in very poor medical education and services. The initial high rate of infection among infants in Angola may have been related to poor hospital practices, possibly administration of vaccines. Though the outbreak in Angola was in a part of Africa not previously known to have filovirus infection, prior ecological modelling had predicted this location and many others. Prevention of future outbreaks will not be easy. The urgent need is dissemination of knowledge and the training, discipline and resources for good clinical practice. Educating the public to demand higher standards could be a powerful tool. Good practices are difficult to establish and maintain on the scale needed. PMID:16373655

Fisher-Hoch, Susan P

2005-01-01

108

Fatal jejunal haemorrhage syndrome in cows.  

PubMed

Jejunal haemorrhage syndrome in a four-year-old Holstein Friesian cow Umbilical cord accident in a stillborn calf Cerebellar abiotrophy/dysgenesis in a three-day-old calf Congenital swayback in a three-week-old lamb Louping ill in a two-week-old lamb These are among matters discussed in the disease surveillance report for June from SAC Consulting: Veterinary Services (SAC C VS). PMID:25344042

2014-10-25

109

Uterine artery embolization: an effective treatment for intractable obstetric haemorrhage  

Microsoft Academic Search

AIM: To present the findings of uterine artery embolization (UAE) in the management of obstetric haemorrhage.MATERIALS AND METHODS: From October 1999 to February 2003, 10 women with postpartum haemorrhage (n=7) and post-abortion haemorrhage with placenta accreta (n=3), were referred to our department for pelvic angiography and possible arterial embolization.RESULTS: Angiography revealed engorged and tortuous uterine arteries in all patients; and

T.-M Hong; H.-S Tseng; R.-C Lee; J.-H Wang; C.-Y Chang

2004-01-01

110

Angiotensin II receptor content within the subfornical organ and organum vasculosum lamina terminalis increases after experimental subarachnoid haemorrhage in rats  

Microsoft Academic Search

Summary Nests of cells within the central nervous system, namely the circumventricular organs (CVOs) which include the subfornical organ (SFO), organum vasculosum lamina terminalis (OVLT), area postrema (AP) and the median eminence (ME) are known to contain not only receptors for angiotensin II (ANG II) but also ANG II itself. Though the significance of this central ANG II network in

B. Açikgöz; T. Özgen; F. Özdo?an; A. Sungur; ?. Hakki Tekkök

1996-01-01

111

Neuropsychiatric disturbance after aneurysmal subarachnoid hemorrhage.  

PubMed

Although aneurysmal subarachnoid hemorrhage (aSAH) accounts for only 3-5% of all strokes, a high degree of morbidity has been reported in this relatively young subset of patients. Neuropsychiatric disturbance has often been neglected in these reports. We aimed to investigate the pattern and pathological factors of chronic neuropsychiatric disturbance in aSAH patients. This cross-sectional observational four-center study was carried out in Hong Kong. Neuropsychiatric outcome (Neuropsychiatric Inventory Chinese Version [CNPI]) assessments were conducted cross-sectionally 1-4 years after ictus. Pathological factors considered were early brain injury as assessed by admission World Federation of Neurosurgical Societies grade, aneurysm treatment (clipping versus coiling), delayed cerebral infarction, and chronic hydrocephalus. One hundred and three aSAH patients' spouses or caregivers completed the CNPI. Forty-two (41%) patients were reported to have one or more domain(s) of neuropsychiatric disturbance. Common neuropsychiatric disturbance domains included agitation/aggression, depression, apathy/indifference, irritability/lability, and appetite/eating disturbance. Chronic neuropsychiatric disturbance was associated with presence of chronic hydrocephalus. A subscore consisting of the five commonly affected domains seems to be a suitable tool for aSAH patients and should be further validated and replicated in future studies. PMID:24929862

Wong, George Kwok Chu; Lam, Sandy Wai; Chan, Sandra S M; Lai, Mary; Tse, Patty P P; Mok, Vincent; Poon, Wai Sang; Wong, Adrian

2014-10-01

112

Outcome following subdural haemorrhages in infancy  

PubMed Central

Subdural haemorrhages (SDH) are associated with significant neurodisability in affected individuals. The incidence of SDH in infants is between 12 and 25 cases per 100?000 children and most detected SDH are due to physical abuse. In the infant brain, SDH are caused by tearing of the bridging veins in the subdural space and may result in significant brain injury. The challenge of assessing outcome in infants with SDH is evaluating whether SDH or other accompanying brain insults are instrumental in the neurodevelopmental outcome. PMID:17376941

Jayawant, Sandeep; Parr, Jeremy

2007-01-01

113

AN AUDIT OF PRIMARY POST PARTUM HAEMORRHAGE  

Microsoft Academic Search

(20.9%), prolonged labour 21 (21.9%), retained placental tissues, 11 (12.5%), retained placenta, 11 (11.4%) Couvelliar uterus, 10 (10.4%), placenta preavia, 8 (8.3%), placenta increta, 7 (7.3%), chorioamnionitis 5 (5.2%), and multiple pregnancy, 2 (2.1%). Risk factors, grand multiparity 70 (51.5%), antepartum haemorrhage 12 (8.9%), instrumental delivery 10(7.3%), previous PPH, 6 (4.5%), choreoamnionitis, 5 (3.6%), multiple pregnancy, 2 (1.5%), no risk

Shamshad Bibi; Nargis Danish; Anisa Fawad; Muhammad Jamil

114

Targeted obstetric haemorrhage programme improves incoming resident confidence and knowledge.  

PubMed

Postpartum haemorrhage is an infrequent but potentially life-threatening obstetrical emergency amenable to simulation. An educational programme consisting of a lecture and high-fidelity simulation exercise was given to incoming obstetrics and gynaecology (OB) and family medicine (FM) residents. Residents reported pre- and post-intervention confidence scores on a 1-5 Likert scale and a subset completed a postpartum haemorrhage knowledge assessment. Residents reported significant improvements in confidence in parameters involved in diagnosis and management of postpartum haemorrhage. The postpartum haemorrhage test mean scores significantly increased (57.4 ± 9.6% vs 77.1 ± 7.9%, p < 0.01) and were significantly correlated to confidence scores (Spearman's coefficient of 0.651, p < 0.001). In conclusion, an education programme that incorporates high-fidelity simulation of postpartum haemorrhage improves the confidence and knowledge of incoming residents and appears to be an effective educational approach. PMID:24219716

Straub, H L; Morgan, G; Ochoa, P; Grable, I; Wang, E; Kharasch, M; Plunkett, B A

2013-11-01

115

Reversible cerebral vasoconstriction syndrome and nonaneurysmal subarachnoid hemorrhage  

PubMed Central

Background Reversible cerebral vasoconstriction syndrome was first described by Call, Fleming, and colleagues. Clinically this entity presents acutely, with severe waxing and waning headaches (“thunderclap”), and occasional fluctuating neurological signs. Case presentation We present four subsequent cases of patients with severe thunderclap headache and brain tomography with evidence of subarachnoid hemorrhage. The brain angiogram showed no aneurysm but intracranial vasculopathy consistent with multiple areas of stenosis and dilatation (angiographic beading) in different territories. Conclusion Neurologists should be aware of Call Fleming syndrome presenting with severe headache and associated convexity subarachnoid hemorrhage. After other diagnoses are excluded, patients can be reassured about favorable prognosis with symptomatic management. Abbreviations RCVS Reversible cerebral vasoconstriction syndrome CT Computed tomography SAH Subarachnoid hemorrhage MR Magnetic resonance CTA Computed tomography angiography MRA Magnetic resonance angiography PMID:25132905

Barboza, Miguel A; Maud, Alberto; Rodriguez, Gustavo J

2014-01-01

116

Spontaneous acute subdural haemorrhage, cerebral and pulmonary metastases in a complete mole.  

PubMed

Complete and partial moles remit spontaneously in most cases, following evacuation of the uterine cavity. However, either persistent trophoblastic disease or a frank trophoblastic tumour can follow a complete hydatidiform mole. To our knowledge, acute subdural haematoma, as a complication of cerebral metastases, following treatment for hydatidiform mole has not been reported. We describe a 29-year-old woman who presented with spontaneous acute subdural haemorrhage and pulmonary metastases, eight months after evacuation of a complete hydatidiform mole, with a fatal outcome. PMID:17609811

Agrawal, A; Agrawal, C S; Kumar, A; Kumar, M; Yadav, R

2007-07-01

117

Deep vein thrombosis induced by thalidomide to control epistaxis secondary to hereditary haemorrhagic telangiectasia.  

PubMed

Thalidomide was recently reported to reduce the severity and frequency of epistaxes in patients with hereditary haemorrhagic telangiectasia (HHT). We here describe the case of a patient with HHT and severe epistaxes refractory to medical and local surgical treatments who developed an extensive deep vein thrombosis shortly after initiation of treatment with thalidomide. This is the first report of venous thromboembolic complication induced by thalidomide prescribed in this setting. Although thalidomide was recently found to provide an alternative therapeutic strategy in patients with HHT and refractory epistaxes, this agent should be used with great caution in this indication, given its thrombogenicity and difficulties to manage systemic anticoagulation in patients with HHT. PMID:21885956

Penaloza, Andrea; Vekemans, Marie-Christiane; Lambert, Catherine; Hermans, Cedric

2011-10-01

118

Endoscopic resection of giant lipoma mimicking colonic neoplasm initially presenting with massive haemorrhage: a case report  

PubMed Central

Lipomas of the colon are benign tumors that rarely occur. Their size ranges from 2 mm to several cm. They are usually asymptomatic but occasionally they present with clinical manifestations depending on tumor size, localization and complications, which often lead to diagnostic difficulty. A 40-year-old man presented with massive rectal haemorrhage. During colonoscopy a giant polyp of over 50 mm in its bigger diameter, with a thick stalk of 2 cm, located in the transverse colon, was revealed. Endoscopic resection was performed with success. Histologic examination demonstrated a giant lipoma. In this report discussion over endoscopic resection of colonic lipomas mimicking neoplasms is also performed. PMID:20181161

2009-01-01

119

Bichat guidelines for the clinical management of haemorrhagic fever viruses and bioterrorism-related haemorrhagic fever viruses.  

PubMed

Haemorrhagic fever viruses (HFVs) are a diverse group of viruses that cause a clinical disease associated with fever and bleeding disorder. HFVs that are associated with a potential biological threat are Ebola and Marburg viruses (Filoviridae), Lassa fever and New World arenaviruses (Machupo, Junin, Guanarito and Sabia viruses) (Arenaviridae), Rift Valley fever (Bunyaviridae) and yellow fever, Omsk haemorrhagic fever, and Kyanasur Forest disease (Flaviviridae). In terms of biological warfare concerning dengue, Crimean-Congo haemorrhagic fever and Hantaviruses, there is not sufficient knowledge to include them as a major biological threat. Dengue virus is the only one of these that cannot be transmitted via aerosol. Crimean-Congo haemorrhagic fever and the agents of haemorrhagic fever with renal syndrome appear difficult to weaponise. Ribavirin is recommended for the treatment and the prophylaxis of the arenaviruses and the bunyaviruses, but is not effective for the other families. All patients must be isolated and receive intensive supportive therapy. PMID:15677844

Bossi, Philippe; Tegnell, Anders; Baka, Agoritsa; Van Loock, Frank; Hendriks, Jan; Werner, Albrecht; Maidhof, Heinrich; Gouvras, Georgios

2004-12-01

120

Pregnancy Complications  

MedlinePLUS

... Emergency Preparedness and Response Pregnant Women and Flu Pregnancy Complications On this Page Before Pregnancy During Pregnancy ... to decrease the risk of pregnancy complications. Before Pregnancy Make sure to talk to your doctor about ...

121

Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage  

Microsoft Academic Search

BACKGROUNDWith the aging of the population, surgery for ruptured intracranial aneurysms is increasing among the elderly. We sought to clarify the characteristics of chronic hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH) in elderly patients.METHODSOf the 576 surgically treated patients, 289 were aged 59 years or younger, 169 were 60 to 69, and 118 were 70 years or older. The relationship between

Hiroyuki Yoshioka; Tetsuji Inagawa; Yoshio Tokuda; Futoshi Inokuchi

2000-01-01

122

From intracranial aneurysm to subarachnoid hemorrhage : unraveling the genetics  

Microsoft Academic Search

The principle aim of this thesis was to identify genes involved in intracranial aneurysms and subsequent aneurysmal subarachnoid hemorrhage (SAH) especially those implicated in the maintenance of the integrity of the extracellular matrix (ECM) of the arterial wall. These genes were identified using a study population with a familial preponderance of the disease. In part 1 of the thesis this

Ynte Marije Ruigrok

2006-01-01

123

Cerebral aneurysm thrombosis, shrinkage, then disappearance after subarachnoid hemorrhage  

Microsoft Academic Search

The case is presented of a 37-year-old man with spontaneous thrombosis of a 10-mm left posterior communicating artery aneurysm, following presumed subarachnoid hemorrhage with negative angiography. Sequential magnetic resonance angiography and magnetic resonance source imaging (at 2 weeks, 3 months, 2 years, and 2 years, 5 months) showed progressive shrinkage and disappearance of the aneurysm.

David F. Sobel; Donald Dalessio; Brian Copeland; Barry Schwartz

1996-01-01

124

Viral haemorrhagic fever and vascular alterations.  

PubMed

Pathogenesis of viral haemorrhagic fever (VHF) is closely associated with alterations of the vascular system. Among the virus families causing VHF, filoviruses (Marburg and Ebola) are the most fatal, and will be focused on here. After entering the body, Ebola primarily targets monocytes/macrophages and dendritic cells. Infected dendritic cells are largely impaired in their activation potency, likely contributing to the immune suppression that occurs during filovirus infection. Monocytes/macrophages, however, immediately activate after viral contact and release reasonable amounts of cytokines that target the vascular system, particularly the endothelial cells. Some underlying molecular mechanisms such as alteration of the vascular endothelial cadherin/catenin complex, tyrosine phosphorylation, expression of cell adhesion molecules, tissue factor and the effect of soluble viral proteins released from infected cells to the blood stream will be discussed. PMID:18278167

Aleksandrowicz, P; Wolf, K; Falzarano, D; Feldmann, H; Seebach, J; Schnittler, H

2008-02-01

125

LASIK Complications  

Microsoft Academic Search

Laser in situ keratomileusis (LASIK) is a rapidly evolving ophthalmic surgical procedure. Several anatomic and refractive complications have been identified. Anatomic complications include corneal flap abnormalities, epithelial ingrowth, and corneal ectasia. Refractive complications include unexpected refractive outcomes, irregular astigmatism, decentration, visual aberrations, and loss of vision. Infectious keratitis, dry eyes, and diffuse lamellar keratitis may also occur following LASIK. By

Samir A Melki; Dimitri T Azar

2001-01-01

126

Maternal Mortality Review: A Case of Pulmonary Haemorrhage Due to Ruptured Lung Haemangioma Secondary to Ghon's Focus Invasion.  

PubMed

Haemangioma can be present in the lung but rarely causes complications unless there is a bleed. Ghon's focus is a result of post primary tuberculosis. It is a caseating granuloma which invades the surrounding tissue. It is usually benign and may resolve spontaneously without causing complications or active tuberculosis. This case illustrates an unfortunate patient who had a pre-existing haemangioma in the lung which was in close proximity of a Ghon's focus that had invaded on to the haemangioma leading to haemorrhage causing death. This study seeks to highlight the importance of conducting a full post mortem in cases of maternal mortality. PMID:24814628

Paranthaman, V; Subashini, A

2014-02-01

127

[Retinal haemorrhages in non-accidental head injury in childhood].  

PubMed

Retinal haemorrhages are one of the three cardinal manifestations of the "shaken baby syndrome" or "non-accidental head injury" in childhood. The role of an ophthalmologist in suspected non-accidental head injury has not only medical but also legal aspects and has been discussed controversially in the literature. The differential diagnosis and the specificity of retinal haemorrhages in childhood for an abusive head trauma will be pointed out in this paper. PMID:25181505

Oberacher-Velten, I M; Helbig, H

2014-09-01

128

An Unusual Case of Bilateral Vitreous Haemorrhage following Snake Bite  

PubMed Central

A-45-year-old man presented to us with diminution of vision in both eye following snake bite. On examination vision in the right eye (RE) was 6/36 and vision in left eye (LE) was hand movement positive and fundus examination revealed a subhyloid haemorrhage, left eye showed vitreous haemorrhage. Patient was advised bed rest, vitamin C tablets and oral steroids. PMID:24454404

Bhandari, Vipul; Lohia, Meenal

2013-01-01

129

[A new viral infectious disease: Ebola haemorrhagic fever (author's transl)].  

PubMed

All references about a new viral infection, which was seen in Sudan and Zaire at 1976 called "Ebola Haemorrhagic Fever" with high fever, diarrhoea, vomiting and great systemic haemorrhagic manifestations were reviewed. We discussed the history, etiology, epidemiology, source of infections, mode of transmission, period of communicability, clinical and laboratory findings and control measures of the disease. Some comments were made about what could be done, if a new disease of unknown etiology is seen in any part of our country. PMID:7453587

Tuncer, A

1980-01-01

130

Haemorrhage from a radiosurgically treated arteriovenous malformation after its angiographically proven obliteration: a case report.  

PubMed

Small lower-grade Spetzler-Martin arteriovenous malformations (AVMs) are mainly treated by microsurgical resection or stereotactic radiosurgery. The choice of treatment largely depends on the referring centre's preference and the patient's decision. We present here a patient with an AVM repeatedly treated at our Leksell Gamma Knife unit with radiographically confirmed obliteration of the AVM which subsequently began bleeding. This case demonstrates the possibility of late complications in radiosurgically treated AVMs even after their demonstrable obliteration. Meticulous histological examination was performed, proving patency of the AVM nidus. The risk of haemorrhagic complications of radiosurgically removed AVMs despite angiographic proof of their obliteration is, in our view, a cogent argument for preferring surgical resection if the AVM is accessible and for prolonged follow-up after radiosurgical treatment of an AVM. PMID:20464791

Bradác, O; Mayeroá, K; Hrabal, P; Benes, V

2010-05-01

131

Rabbit haemorrhagic disease (RHD) and rabbit haemorrhagic disease virus (RHDV): a review  

PubMed Central

Rabbit haemorrhagic disease virus (RHDV) is a calicivirus of the genus Lagovirus that causes rabbit haemorrhagic disease (RHD) in adult European rabbits (Oryctolagus cuniculus). First described in China in 1984, the virus rapidly spread worldwide and is nowadays considered as endemic in several countries. In Australia and New Zealand where rabbits are pests, RHDV was purposely introduced for rabbit biocontrol. Factors that may have precipitated RHD emergence remain unclear, but non-pathogenic strains seem to pre-date the appearance of the pathogenic strains suggesting a key role for the comprehension of the virus origins. All pathogenic strains are classified within one single serotype, but two subtypes are recognised, RHDV and RHDVa. RHD causes high mortality in both domestic and wild adult animals, with individuals succumbing between 48-72 h post-infection. No other species has been reported to be fatally susceptible to RHD. The disease is characterised by acute necrotising hepatitis, but haemorrhages may also be found in other organs, in particular the lungs, heart, and kidneys due to disseminated intravascular coagulation. Resistance to the disease might be explained in part by genetically determined absence or weak expression of attachment factors, but humoral immunity is also important. Disease control in rabbitries relies mainly on vaccination and biosecurity measures. Such measures are difficult to be implemented in wild populations. More recent research has indicated that RHDV might be used as a molecular tool for therapeutic applications. Although the study of RHDV and RHD has been hampered by the lack of an appropriate cell culture system for the virus, several aspects of the replication, epizootology, epidemiology and evolution have been disclosed. This review provides a broad coverage and description of the current knowledge on the disease and the virus. PMID:22325049

2012-01-01

132

Symptomatic bilateral isolated perforator infarction following aneurysmal subarachnoid hemorrhage  

PubMed Central

Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) occurs in the extraparenchymal vessels in the subarachnoid space at the base of the brain. Ischemia/ Infarction affecting primarily the perforator vessels in isolation, following aneurysmal SAH is uncommon. A 28-year-old man with a ruptured middle cerebral artery aneurysm underwent clipping of the aneurysm. He developed delayed bilateral deep seated infarcts involving both internal capsular regions, the thalamus and basal ganglia without any major vessel infarct. The patient was managed with triple H (hypertensive hypervolemic hemodilutional) therapy and calcium channel antagonists but did not show any improvement and remained in poor neurological status. Perforator vasospasm occurring secondary to aneurysmal SAH, though documented in experimental animal studies, has rarely been reported in humans in a clinical setting. The present case provides evidence, albeit indirect, of isolated perforator vasospasm, which possibly should be the target of future therapeutic strategies. PMID:23546349

Salunke, Pravin; Gupta, Sunil K

2013-01-01

133

Use of oral tramadol to prevent perianesthetic shivering in patients undergoing transurethral resection of prostate under subarachnoid blockade  

PubMed Central

Context: Under regional anesthesia, geriatric patients are prone to shivering induced perioperative complications that Anesthesiologists should prevent rather than treat. Aim: We investigated the prophylactic efficacy of oral tramadol 50 mg to prevent the perioperative shivering after transurethral resection of prostate (TURP) surgery under subarachnoid blockade (SAB). Shivering is usually overlooked in patients undergoing urological surgery under spinal anesthesia and may result in morbidity, prolonged hospital stay and increased financial burden. Use of prophylactic measures to reduce shivering in geriatric patients who undergo urological procedures could circumvent this. Oral formulation of tramadol is a universally available cost-effective drug with the minimal side-effects. Settings and Design: Prospective, randomized, double-blinded, placebo-controlled study. Patients and Methods: A total of 80 patients who were scheduled for TURP surgery under subarachnoid block were randomly selected. Group I and II (n = 40 each) received oral tramadol 50 mg and placebo tablet respectively. After achieving subarachnoid block, the shivering, body temperature (tympanic membrane, axillary and forehead), hemodynamic parameters and arterial saturation were recorded at regular intervals. Statistical Analysis Used: T-test, analysis of variance test, Z-test and Fisher exact test were utilized while Statistical Product and Service Solutions, IBM, Chicago (SPSS statistics (version 16.0)), software was used for analysis. Results: Incidence of shivering was significantly less in patients who received tramadol (7.5% vs. 40%; P < 0.01). The use of tramadol was associated with clinically inconsequential side-effects. Conclusion: We conclude that the use of oral tramadol 50 mg is effective as a prophylactic agent to reduce the incidence, severity and duration of perioperative shivering in patients undergoing TURP surgery under SAB. PMID:24665233

Tewari, Anurag; Dhawan, Ira; Mahendru, Vidhi; Katyal, Sunil; Singh, Avtar; Garg, Shuchita

2014-01-01

134

EARLYDRAIN- outcome after early lumbar CSF-drainage in aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial  

PubMed Central

Background Aneurysmal subarachnoid hemorrhage (SAH) may be complicated by delayed cerebral ischemia, which is a major cause of unfavorable clinical outcome and death in SAH-patients. Delayed cerebral ischemia is presumably related to the development of vasospasm triggered by the presence of blood in the basal cisterns. To date, oral application of the calcium antagonist nimodipine is the only prophylactic treatment for vasospasm recognized under international guidelines. In retrospective trials lumbar drainage of cerebrospinal fluid has been shown to be a safe and feasible measure to remove the blood from the basal cisterns and decrease the incidence of delayed cerebral ischemia and vasospasm in the respective study populations. However, the efficacy of lumbar drainage has not been evaluated prospectively in a randomized controlled trial yet. Methods/Design This is a protocol for a 2-arm randomized controlled trial to compare an intervention group receiving early continuous lumbar CSF-drainage and standard neurointensive care to a control group receiving standard neurointensive care only. Adults suffering from a first aneurysmal subarachnoid hemorrhage whose aneurysm has been secured by means of coiling or clipping are eligible for trial participation. The effect of early CSF drainage (starting < 72 h after securing the aneurysm) will be measured in the following ways: the primary endpoint will be disability after 6 months, assessed by a blinded investigator during a personal visit or standardized telephone interview using the modified Rankin Scale. Secondary endpoints include mortality after 6 months, angiographic vasospasm, transcranial Doppler sonography (TCD) mean flow velocity in both middle cerebral arteries and rate of shunt insertion at 6 months after hospital discharge. Discussion Here, we present the study design of a multicenter prospective randomized controlled trial to investigate whether early application of a lumbar drainage improves clinical outcome after aneurysmal subarachnoid hemorrhage. Trial registration www.clinicaltrials.gov Identifier: NCT01258257 PMID:21917146

2011-01-01

135

Ebola haemorrhagic fever in Zaire, 1976.  

PubMed

Between 1 September and 24 October 1976, 318 cases of acute viral haemorrhagic fever occurred in northern Zaire. The outbreak was centred in the Bumba Zone of the Equateur Region and most of the cases were recorded within a radius of 70 km of Yambuku, although a few patients sought medical attention in Bumba, Abumombazi, and the capital city of Kinshasa, where individual secondary and tertiary cases occurred. There were 280 deaths, and only 38 serologically confirmed survivors.The index case in this outbreak had onset of symptoms on 1 September 1976, five days after receiving an injection of chloroquine for presumptive malaria at the outpatient clinic at Yambuku Mission Hospital (YMH). He had a clinical remission of his malaria symptoms. Within one week several other persons who had received injections at YMH also suffered from Ebola haemorrhagic fever, and almost all subsequent cases had either received injections at the hospital or had had close contact with another case. Most of these occurred during the first four weeks of the epidemic, after which time the hospital was closed, 11 of the 17 staff members having died of the disease. All ages and both sexes were affected, but women 15-29 years of age had the highest incidence of disease, a phenomenon strongly related to attendance at prenatal and outpatient clinics at the hospital where they received injections. The overall secondary attack rate was about 5%, although it ranged to 20% among close relatives such as spouses, parent or child, and brother or sister.Active surveillance disclosed that cases occurred in 55 of some 550 villages which were examined house-by-house. The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of north-eastern Zaire between the Bumba Zone and the Sudan frontier near Nzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless it was established that people can and do make the trip between Nzara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an injection at the outpatient clinic.Both the incubation period, and the duration of the clinical disease averaged about one week. After 3-4 days of non-specific symptoms and signs, patients typically experienced progressively severe sore throat, developed a maculopapular rash, had intractable abdominal pain, and began to bleed from multiple sites, principally the gastrointestinal tract. Although laboratory determinations were limited and not conclusive, it was concluded that pathogenesis of the disease included non-icteric hepatitis and possibly acute pancreatitis as well as disseminated intravascular coagulation.This syndrome was caused by a virus morphologically similar to Marburg virus, but immunologically distinct. It was named Ebola virus. The agent was isolated from the blood of 8 of 10 suspected cases using Vero cell cultures. Titrations of serial specimens obtained from one patient disclosed persistent viraemia of 10(6.5)-10(4.5) infectious units from the third day of illness until death on the eighth day. Ebola virus particles were found in formalin- PMID:307456

1978-01-01

136

Ebola haemorrhagic fever in Zaire, 1976  

PubMed Central

Between 1 September and 24 October 1976, 318 cases of acute viral haemorrhagic fever occurred in northern Zaire. The outbreak was centred in the Bumba Zone of the Equateur Region and most of the cases were recorded within a radius of 70 km of Yambuku, although a few patients sought medical attention in Bumba, Abumombazi, and the capital city of Kinshasa, where individual secondary and tertiary cases occurred. There were 280 deaths, and only 38 serologically confirmed survivors. The index case in this outbreak had onset of symptoms on 1 September 1976, five days after receiving an injection of chloroquine for presumptive malaria at the outpatient clinic at Yambuku Mission Hospital (YMH). He had a clinical remission of his malaria symptoms. Within one week several other persons who had received injections at YMH also suffered from Ebola haemorrhagic fever, and almost all subsequent cases had either received injections at the hospital or had had close contact with another case. Most of these occurred during the first four weeks of the epidemic, after which time the hospital was closed, 11 of the 17 staff members having died of the disease. All ages and both sexes were affected, but women 15-29 years of age had the highest incidence of disease, a phenomenon strongly related to attendance at prenatal and outpatient clinics at the hospital where they received injections. The overall secondary attack rate was about 5%, although it ranged to 20% among close relatives such as spouses, parent or child, and brother or sister. Active surveillance disclosed that cases occurred in 55 of some 550 villages which were examined house-by-house. The disease was hitherto unknown to the people of the affected region. Intensive search for cases in the area of north-eastern Zaire between the Bumba Zone and the Sudan frontier near Nzara and Maridi failed to detect definite evidence of a link between an epidemic of the disease in that country and the outbreak near Bumba. Nevertheless it was established that people can and do make the trip between Nzara and Bumba in not more than four days: thus it was regarded as quite possible that an infected person had travelled from Sudan to Yambuku and transferred the virus to a needle of the hospital while receiving an injection at the outpatient clinic. Both the incubation period, and the duration of the clinical disease averaged about one week. After 3-4 days of non-specific symptoms and signs, patients typically experienced progressively severe sore throat, developed a maculopapular rash, had intractable abdominal pain, and began to bleed from multiple sites, principally the gastrointestinal tract. Although laboratory determinations were limited and not conclusive, it was concluded that pathogenesis of the disease included non-icteric hepatitis and possibly acute pancreatitis as well as disseminated intravascular coagulation. This syndrome was caused by a virus morphologically similar to Marburg virus, but immunologically distinct. It was named Ebola virus. The agent was isolated from the blood of 8 of 10 suspected cases using Vero cell cultures. Titrations of serial specimens obtained from one patient disclosed persistent viraemia of 106.5-104.5 infectious units from the third day of illness until death on the eighth day. Ebola virus particles were found in formalin- PMID:307456

1978-01-01

137

Are Complications Less Common in Deep Brain Stimulation than in Ablative Procedures for Movement Disorders?  

Microsoft Academic Search

The side effects and complications of deep brain stimulation (DBS) and ablative lesions for tremor and Parkinson’s disease were recorded in 256 procedures (129 DBS and 127 lesions). Perioperative complications (seizures, haemorrhage, confusion) were rare and did not differ between the two groups. The rate of hardware-related complications was 17.8%. In ventral intermediate (Vim) thalamotomies, the rate of side effects

Patric Blomstedt; Marwan I. Hariz

2006-01-01

138

Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature.  

PubMed

Spontaneous subarachnoid hemorrhage (SAH) is most commonly caused by rupture of a saccular aneurysm or other structural pathologies. Occasionally, no structural cause for the hemorrhage can be identified by radiographic imaging. These hemorrhages, termed angiogram-negative SAH, are generally considered to have a better prognosis than aneurysmal SAH. Angiogram-negative SAH subgroups include benign perimesencephalic SAH (PMH) and aneurysmal-type SAH. Outcome data for these subgroups differ from those for the group as a whole. We report data for 31 patients who presented to our institution from 2006 to the present. We performed a retrospective chart review, and report outcome data that include rates of rehemorrhage, hydrocephalus, vasospasm, permanent ischemic deficits, headaches, and outcomes based on modified Rankin Scale scores. We also performed a review of the literature and meta-analysis of the data therein. We compared rates of complications in the PMH subgroup and the diffuse-type hemorrhage subgroup. The chart review revealed no poor outcomes and no rehemorrhages in the patients with PMH. In the diffuse hemorrhage subgroup, 1 patient had a rehemorrhage and 2 patients had a poor outcome. Our literature review found an OR of 6.23 for a good outcome for PMH versus diffuse-type hemorrhage, and an OR of 2.78 for rehemorrhage in PMH versus diffuse-type hemorrhage. Angiogram-negative SAH is not a benign entity. Complications are present but are significantly reduced, and outcomes are improved, compared with aneurysmal SAH. PMID:22465208

Boswell, Scott; Thorell, William; Gogela, Steve; Lyden, Elizabeth; Surdell, Dan

2013-08-01

139

Antibodies to haemorrhagic fever viruses in Madagascar populations.  

PubMed

Sera of 381 adult people from 5 areas in Madagascar were tested by the indirect immunofluorescence method for antibodies against Congo-Crimean haemorrhagic fever and Rift Valley fever viruses (Bunyaviridae), Ebola (strains Zaire and Sudan) and Marburg viruses (Filoviridae), and Lassa virus (Arenaviridae). The highest prevalence rate was that of Ebola virus (4.5%). As no haemorrhagic syndrome has been found associated with this virus, the possible presence of a less pathogenic, antigenically related, strain is discussed. The prevalences of Congo-Crimean haemorrhagic fever and Rift Valley viruses were very low, despite previous viral isolations from potential vectors. No serum reacted against Lassa or Marburg antigens. The results are analysed in the light of the geographical and bioecological characteristics of Madagascar, which is a true 'microcontinent' very different from the African mainland. PMID:2515626

Mathiot, C C; Fontenille, D; Georges, A J; Coulanges, P

1989-01-01

140

Risk factors associated with optic disc haemorrhage in patients with normal tension glaucoma  

Microsoft Academic Search

PurposeTo evaluate the risk factors associated with optic disc haemorrhage in patients with normal tension glaucoma (NTG).Patients and methodsTwo hundred and eighty-one eyes of 281 patients with NTG (113 eyes with optic disc haemorrhage and 168 eyes without haemorrhage) were included in this study. Associations between optic disc haemorrhage and various patient-related variables (diabetes; hypertension; hypotension; cardiac disease; stroke; cold

Y-d Kim; S B Han; K H Park; S H Kim; S J Kim; M Seong; T W Kim; D M Kim

2010-01-01

141

Selection of rainbow trout resistant to viral haemorrhagic septicaemia virus and transmission  

E-print Network

Selection of rainbow trout resistant to viral haemorrhagic septicaemia virus and transmission a programme of selection for resistance to viral haemorrhagic septicaemia virus (VHSV) in rainbow trout poorly as compared with the fins of susceptible fish. rainbow trout / selection / viral haemorrhagic

Paris-Sud XI, Université de

142

Cerebral aneurysm exclusion by CT angiography based on subarachnoid hemorrhage pattern: a retrospective study  

Microsoft Academic Search

BACKGROUND: To identify patients with spontaneous subarachnoid hemorrhage for whom CT angiography alone can exclude ruptured aneurysms. METHODS: An observational retrospective review was carried out of all consecutive patients with non-traumatic subarachnoid hemorrhage who underwent both CT angiography and catheter angiography to exclude an aneurysm. CT angiography negative cases (no aneurysm) were classified according to their CT hemorrhage pattern as

Marc Kelliny; Philippe Maeder; Stefano Binaghi; Marc Levivier; Luca Regli; Reto Meuli

2011-01-01

143

MR-guided catheter navigation of the intracranial subarachnoid space.  

PubMed

Percutaneous intraspinal navigation (PIN) is a new minimally invasive approach to the CNS. The authors studied the utility of MR-guided intracranial navigation following access to the subarachnoid compartment via PIN. The passive tracking technique was employed to visualize devices during intracranial navigation. Under steady-state free precession (SSFP) MR-guidance a microcatheter-microguidewire was successfully navigated to multiple brain foci in two cadavers. SSFP MR fluoroscopy possesses adequate contrast and temporal resolution to allow MR-guided intracranial navigation. PMID:12695192

Rappard, George; Metzger, Gregory J; Fleckenstein, James L; Babcock, Evelyn E; Weatherall, Paul T; Replogle, Robert E; Pride, G Lee; Miller, Susan L; Adams, Christina E; Purdy, Phillip D

2003-04-01

144

Diffuse alveolar haemorrhage associated with aerosol propellant use.  

PubMed

Diffuse alveolar haemorrhage (DAH) is a clinical syndrome resulting from injury to the alveolar microcirculation, most commonly associated with not only autoimmune disorders or connective tissue disease, but also a variety of infections, neoplasms and toxins. We report here a case of an otherwise healthy young man with DAH attributable to an inhalation injury resulting from use of aerosol spray paint. PMID:23955981

Kelchen, Phillip; Jamous, Fady; Huntington, Mark K

2013-01-01

145

Haemorrhages in head tissues during the asphyxiation process  

Microsoft Academic Search

Two rates of carbon dioxide flow into the termination chamber were applied for the euthanasia of rats. The classical phases of asphyxia were observed in both groups of animals although their course was prolonged in rats exposed to the lower gas flow. The haemorrhages were assessed histologically in the following structures: the pericranium, compact bone and diploë of the skull,

Roman Hauser; Zbigniew Jankowski; Tomasz Gos; Maciej Krzy?anowski

2001-01-01

146

Subdural haemorrhage in infants: when are they non-accidental?  

Microsoft Academic Search

Subdural haemorrhage is relatively common in children under the age of 2 years. The most common cause is shaken baby syndrome. Paediatricians are often challenged to make this diagnosis with confidence. A clinician must approach this problem from a thorough understanding of the epidemiological, clinical, pathological features of the condition. He\\/she must work with a team of specialists in the

A. Kemp

2001-01-01

147

Rare retinal haemorrhages in translational accidental head trauma in children  

Microsoft Academic Search

Purpose The characteristic findings in accidental head injury consist of linear skull fracture, epidural haematoma, localized subdural haematoma, or cortical contusion because of a linear or translational impact force. Retinal haemorrhages have been found, although uncommon, in accidental head trauma.Methods We performed a retrospective study of 24 consecutive cases of children with severe head injuries caused by falls. Inclusion criteria

V Sturm; P B Knecht; K Landau; M N Menke

2009-01-01

148

Medical Complications Drive Length of Stay After Brain Hemorrhage: A Cohort Study  

Microsoft Academic Search

Introduction  Longer length of stay (LOS) is associated with higher complications and costs in ICU patients, while hospital protocols may\\u000a decrease complications and LOS. We hypothesized that medical complications would increase LOS after spontaneous subarachnoid\\u000a (SAH) and intracerebral (ICH) hemorrhage after accounting for severity of neurologic injury in a cohort of consecutively admitted\\u000a patients.\\u000a \\u000a \\u000a \\u000a Methods  We prospectively recorded admission characteristics, hospital complications,

Andrew M. Naidech; Bernard R. Bendok; Paul Tamul; Sarice L. Bassin; Charles M. Watts; H. Hunt Batjer; Thomas P. Bleck

2009-01-01

149

Towards safer colonoscopy: a report on the complications of 5000 diagnostic or therapeutic colonoscopies  

Microsoft Academic Search

The diagnostic and therapeutic benefits of colonoscopy are well known but most large-scale surveys, especially those involving multiple centres, may underestimate the range and incidence of complications. The detailed records of 5000 colonoscopies in a specialist unit have been analysed and conclusions drawn which may help to make the procedure safer. The incidence of haemorrhage was 1% and bowel perforation

F A Macrae; K G Tan; C B Williams

1983-01-01

150

Correlation of Transcranial Color Doppler to N20 Somatosensory Evoked Potential Detects Ischemic Penumbra in Subarachnoid Hemorrhage  

PubMed Central

Background: Normal subjects present interhemispheric symmetry of middle cerebral artery (MCA) mean flow velocity and N20 cortical somatosensory evoked potential (SSEP). Subarachnoid haemorrhage (SAH) can modify this pattern, since high regional brain vascular resistances increase blood flow velocity, and impaired regional brain perfusion reduces N20 amplitude. The aim of the study is to investigate the variability of MCA resistances and N20 amplitude between hemispheres in SAH. Methods: Measurements of MCA blood flow velocity (vMCA) by transcranial color-Doppler and median nerve SSEP were bilaterally performed in sixteen patients. MCA vascular changes on the compromised hemisphere were calculated as a ratio of the reciprocal of mean flow velocity (1/vMCA) to contralateral value and correlated to the simultaneous variations of interhemispheric ratio of N20 amplitude, within each subject. Data were analysed with respect to neuroimaging of MCA supplied areas. Results: Both interhemispheric ratios of 1/vMCA and N20 amplitude were detected >0.65 (p <0,01) in patients without neuroimages of injury. Both ratios became <0.65 (p <0.01) when patients showed unilateral images of ischemic penumbra and returned >0.65 if penumbra disappeared. The two ratios no longer correlated after structural lesion developed, as N20 detected in the damaged side remained pathological (ratio <0.65), whereas 1/vMCA reverted to symmetric interhemispheric state (ratio >0.65), suggesting a luxury perfusion. Conclusion: Variations of interhemispheric ratios of MCA resistance and cortical N20 amplitude correlate closely in SAH and allow identification of the reversible ischemic penumbra threshold, when both ratios become <0.65. The correlation is lost when structural damage develops. PMID:21660110

Di Pasquale, Piero; Zanatta, Paolo; Morghen, Ilaria; Bosco, Enrico; Forini, Elena

2011-01-01

151

Evidence that a Panel of Neurodegeneration Biomarkers Predicts Vasospasm, Infarction, and Outcome in Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Biomarkers for neurodegeneration could be early prognostic measures of brain damage and dysfunction in aneurysmal subarachnoid hemorrhage (aSAH) with clinical and medical applications. Recently, we developed a new panel of neurodegeneration biomarkers, and report here on their relationships with pathophysiological complications and outcomes following severe aSAH. Fourteen patients provided serial cerebrospinal fluid samples for up to 10 days and were evaluated by ultrasonography, angiography, magnetic resonance imaging, and clinical examination. Functional outcomes were assessed at hospital discharge and 6–9 months thereafter. Eight biomarkers for acute brain damage were quantified: calpain-derived ?-spectrin N- and C-terminal fragments (CCSntf and CCSctf), hypophosphorylated neurofilament H, 14-3-3 ? and ?, ubiquitin C-terminal hydrolase L1, neuron-specific enolase, and S100?. All 8 biomarkers rose up to 100-fold in a subset of patients. Better than any single biomarker, a set of 6 correlated significantly with cerebral vasospasm, brain infarction, and poor outcome. Furthermore, CSF levels of 14-3-3?, CCSntf, and NSE were early predictors of subsequent moderate-to-severe vasospasm. These data provide evidence that a panel of neurodegeneration biomarkers may predict lasting brain dysfunction and the pathophysiological processes that lead to it following aSAH. The panel may be valuable as surrogate endpoints for controlled clinical evaluation of treatment interventions and for guiding aSAH patient care. PMID:22174930

Siman, Robert; Giovannone, Nicholas; Toraskar, Nikhil; Frangos, Suzanne; Stein, Sherman C.; Levine, Joshua M.; Kumar, Monisha A.

2011-01-01

152

Tarlov cysts: endoscope-assisted obliteration of the communication with the spinal subarachnoid space.  

PubMed

Background and Objective?The physiopathology of Tarlov or perineural cyst (PC) symptoms is unknown, but probably its filling and distention with spinal cerebrospinal fluid makes them symptomatic. The objective of this study is to describe the endoscope-assisted obliteration of the communication between PCs and the spinal subarachnoid space (SSS). Patients and Methods?From 2007 to 2011, four male and two female patients (median age: 45 years) with PCs were treated. They complained of lumbar, sciatic, and/or perineal pain. Physical examination was normal. The diagnosis was made by magnetic resonance imaging (MRI). All the cysts were located in the midline between S1 and S3. An endoscope-assisted obliteration between PC and SSS was performed. The outcome was evaluated clinically with the Odom scale and radiologically with an MRI. Results?After a median follow-up of 25.83 months, the outcome was excellent (four cases), good (one case), and poor (one case). There were no complications. The postoperative MRI showed size and signal intensity changes in all PCs reflecting their exclusion from the SSS. Conclusions?The endoscope-assisted obliteration of the communication between PCs and the SSS is a simple technique that rendered excellent to good results in 83% of the cases. PMID:24682929

Mezzadri, Juan; Abbati, Santiago Gonzalez; Jalon, Pablo

2014-11-01

153

Traumatic enucleation with avulsion of the ophthalmic artery resulting in aneurysm-like subarachnoid hemorrhage.  

PubMed

Traumatic, nonaneurysmal subarachnoid hemorrhage (SAH) is common after closed head injury and most often results from ruptured cortical microvessels. Here, the authors present the case of a 60-year-old woman who fell and struck her head, causing traumatic enucleation and avulsion of both the optic nerve and ophthalmic artery. The arterial avulsion caused a Fisher Grade 3 SAH. During her stay in the intensive care unit, hydrocephalus and vasospasm developed, clinical conditions commonly observed after aneurysmal SAH. Epileptiform activity also developed, although this may have been related to concurrent Pantoea agglomerans ventriculitis. It is reasonable to suggest that intracerebral arterial avulsion with profuse arterial bleeding may be more likely than traditional traumatic SAH to result in clinical events similar to that of aneurysmal SAH. Special consideration should be given to the acute care of patients with intracranial arterial avulsions (conservative management vs surgical exploration or endovascular treatment), as well as long-term follow-up for vascular or other neurosurgical complications. PMID:19374504

Limbrick, David D; Behdad, Amir; Derdeyn, Colin P; Custer, Phillip L; Zipfel, Gregory J; Santiago, Paul

2009-10-01

154

[Haemocholecyst: a rare complication of anticoagulant treatment].  

PubMed

We report a case of a 50-year-old woman, taking antivitamin K for double mitro-aortic valvular replacement, having presented a clinical picture of acute cholecystitis with marked hypotension. The radiological and biologic exams showed a deep hypocoagulability, vesicular gallstones, a haemoperitoneum and retroperitoneal haematoma. After correction of biological anomalies, the patient was operated. The gallbladder was distended containing large clots and four stones without any evidence of perforation. One of the gallstones led to cystic duct obstruction. Haemocholecyst is a rare complication of anticoagulant therapy, which may occur in the setting of gallbladder stones. The usual complication was the vesicular perforation. In spite of its rarity, haemocholecyst should be suspected when an anticoagulant treated patient presents symptoms of acute cholecystis with or without haemorrhagic shock. PMID:15324963

Mikou, M M; Mouaffak, Y; Benyacob, A; Mosaddek, A; Faroudy, M; Ababou, A; Lazreq, C; Sbihi, A

2004-07-01

155

Optimal treatment determination on the basis of haematoma volume and intra-cerebral haemorrhage score in patients with hypertensive putaminal haemorrhages: a retrospective analysis of 310 patients  

PubMed Central

Background Hypertensive putaminal haemorrhage comprises major part of intra-cerebral haemorrhages, with particularly high morbidity and mortality. However, the optimal treatments for these individuals remain controversial. Methods From June 2010 to August 2013, patients with hypertensive putaminal haemorrhages were treated in the Department of Neurosurgery, West China Hospital. Information regarding the age, signs of cerebral herniation, haematoma volume, intra-ventricular haemorrhage, intra-cerebral haemorrhage score and the treatments of each patient were analyzed retrospectively. The outcome was evaluated by the 30-day mortality rate. Results The 30-day mortality rate of the patients with haematomas volume greater than or equal to 30 ml and intra-cerebral haemorrhage scores of 1 or 2 was decreased in the surgical group compared with those in the conservative group (1.92% VS. 21.40%, OR?=?0.072, p?=?0.028; 15.40% VS. 33.3%, OR?=?0.365, p?=?0.248, respectively). The mortality rate of the patients with signs of cerebral herniation was not significantly different between the surgical and conservative groups (83.30% VS. 100%; p?=?0.529). The intra-cerebral haemorrhage score was significantly associated with the 30-day mortality rate of patients with intra-cerebral haemorrhages (r?=?-0.798, p?haemorrhage scores of 1 or 2 could benefit from the surgical removal of haematomas. The intra-cerebral haemorrhage score can accurately predict the 30-day mortality rate of patients with hypertensive putaminal haemorrhages. PMID:24996971

2014-01-01

156

Non-infectious pulmonary complications after bone marrow transplantation  

PubMed Central

Bone marrow transplantation (BMT) is a successful and recognised treatment option for patients with a number of haematological and non-haematological malignant and non-malignant conditions. Pulmonary complications both infectious and non-infectious are common after BMT. Multiple factors are thought to contribute to pulmonary complications, including the type and duration of immunological defects produced by the underlying disease and treatment, the development of graft-versus-host disease (GVHD), and the conditioning regimens employed. These complications are classified as early or late, depending on whether they occur before or after 100 days from transplantation. Early non-infectious pulmonary complications typically include pulmonary oedema, upper airway complications, diffuse alveolar haemorrhage, cytolytic thrombi, and pleural effusion. Bronchiolitis obliterans, veno-occlusive disease, and secondary malignancies occur late after BMT. Idiopathic pneumonia syndrome, GVHD, and radiation induced lung injury can occur in early or late period after BMT. PMID:12151565

Khurshid, I; Anderson, L

2002-01-01

157

Desbaric air embolism during diving: an unusual complication of Osler-Weber-Rendu disease.  

PubMed

Cerebral manifestations of Osler-Weber-Rendu disease (OWRD, hereditary haemorrhagic telangiectasia) including telangiectases, venous malformations, and arteriovenous malformations, are usually under-recognised. The highest complication rate is observed in high flow cerebral arteriovenous malformations, which may present with headache, epilepsy, ischaemia, or haemorrhage. Cerebral air embolism during self-contained underwater breathing apparatus (scuba) diving as the first manifestation of pulmonary arteriovenous malformation (PAVM) in OWRD patients has never been reported before. Here we report a 31 year old male who presented desbaric air embolism as the first manifestation of PAVM. As far as we know, this is the first such case published in English medical literature. PMID:15273199

Hsu, Y-L; Wang, H-C; Yang, P-C

2004-08-01

158

Interference of apoptosis in the pathophysiology of subarachnoid hemorrhage  

PubMed Central

Programmed cell death is crucial for the correct development of the organism and the clearance of harmful cells like tumor cells or autoreactive immune cells. Apoptosis is initiated by the activation of cell death receptors and in most cases it is associated with the activation of the cysteine proteases, which lead to apoptotic cell death. Cells shrink, chromatin clumps and forms a large, sharply demarcated, crescent-shaped or round mass; the nucleus condenses, apoptotic bodies are formed and eventually dead cells are engulfed by a neighboring cell or cleared by phagocytosis. The authors have summarized the most important data concerning apoptosis in subarachnoid hemorrhage that have been issued in the medical literature in the last 20 years. PMID:24049554

Palade, C.; Ciurea, Alexandru V.; Nica, D. A.; Savu, R.; Moisa, Horatiu Alexandru

2013-01-01

159

Microalbuminuria is a prognostic predictor in aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

Objective  To determine the prevalence and the prognostic significance of microalbuminuria in patients after aneurysmal subarachnoid\\u000a hemorrhage (SAH).\\u000a \\u000a \\u000a \\u000a Design  Prospective and observational clinical study.\\u000a \\u000a \\u000a \\u000a Setting  Multidisciplinary intensive care unit.\\u000a \\u000a \\u000a \\u000a Patients  Fifty-one consecutive patients who underwent aneurysm clipping or endovascular surgery after SAH; 8 patients who underwent\\u000a surgical clipping for unruptured intracerebral aneurysm served as control.\\u000a \\u000a \\u000a \\u000a Intervention  None.\\u000a \\u000a \\u000a \\u000a Measurements and Results  General clinical and neurological data were

Yoshiaki Terao; Masafumi Takada; Takahiro Tanabe; Yuko Ando; Makoto Fukusaki; Koji Sumikawa

2007-01-01

160

Bilateral adrenal haemorrhagic infarction in a patient with antiphospholipid syndrome.  

PubMed

A 68-year-old woman with antiphospholipid syndrome presented with a 3-day history of bilateral loin pain, vomiting, fever and confusion. On examination she was febrile, hypotensive and tachycardic. Investigations revealed raised inflammatory markers, renal impairment and hyponatraemia. Abdominal ultrasound revealed two well-defined heterogeneous areas bilaterally in the region of the adrenal glands. This prompted serum cortisol measurement and a CT of the abdomen. Cortisol was low in the context of sepsis at 48?nmol/L, and CT confirmed bilateral heterogeneous adrenal pathology. The patient was managed for septic shock and adrenal insufficiency. She was recognised to have several risk factors for haemorrhagic infarction of the adrenals: antiphospholipid syndrome, sepsis, postoperative state and anticoagulant therapy. She was discharged well on glucocorticoid and mineralocorticoid therapy and a repeat CT at 4?weeks confirmed the diagnosis of bilateral adrenal infarct and haemorrhage. PMID:25410037

Godfrey, Rebecca Louise; Clark, James; Field, Benjamin

2014-01-01

161

Endometriosis: a rare and interesting cause of recurrent haemorrhagic ascites.  

PubMed

Recurrent haemorrhagic ascites as a cause of endometriosis is rare. We report the case of a 36-year-old woman presenting acutely with abdominal distension, ascites and an elevated CA-125 raising the suspicion of ovarian malignancy. Tissue biopsies retrieved during laparoscopy confirmed the diagnosis of endometriosis associated with haemorrhagic ascites. Gonadotropin-releasing hormone (GnRH) analogues were started to manage symptoms, with good effect. Subsequently, in vitro fertilisation resulted in a successful singleton pregnancy and by the second trimester, there was full resolution in symptoms. During the early puerperal period, the development of massive ascites recurred, requiring symptomatic relief through repeated ascitic drainage and GnRH analogues. Long-term follow-up is planned with the hope of continuing with medical management at least until the patient's family is complete when the surgical option of bilateral salpingo-oophorectomy with or without hysterectomy will be discussed. PMID:25355738

Bignall, Jenine; Arambage, Kirana; Vimplis, Sotirios

2014-01-01

162

Detection and localization of internal haemorrhaging using electrical bioimpedance  

NASA Astrophysics Data System (ADS)

Electrical bioimpedance is an effective measuring tool to provide quick, non-invasive, real-time results which will be applied to the detection of internal haemorrhaging. Experiments were performed on female Fancy Rats weighing 333±44g, and 10mL of porcine blood was injected abdominally over 3 minutes. Data was collected using an 8×8 needle electrode array at 5 kHz, and 95 kHz and sent to the BioParHom Z-Flow. A strong correlation was found between the electrode paths crossing directly through the blood injection site, showing a decrease of about -0.17±0.1?/mL for the 5 kHz frequency. This correlation allows us to quickly detect internal haemorrhaging and also localize it with the current path set-up in the electrode array.

Morse, J.; Fenech, M.

2013-04-01

163

Do retinal haemorrhages occur in infants with convulsions?  

Microsoft Academic Search

Aim:To determine the prevalence of retinal haemorrhages in infants presenting with convulsions and admitted to hospital, and to consider whether this finding indicates shaken baby syndrome.Methods:Prospective study of children aged 15 days to 2 years admitted with a diagnosis of first convulsion over a 2-year period (May 2004–May 2006). All infants were examined by an experienced ophthalmologist using indirect ophthalmoscopy

A I Curcoy; V Trenchs; M Morales; A Serra; M Pineda; J Pou

2009-01-01

164

Neurovascular phenotypes in hereditary haemorrhagic telangiectasia patients according to age  

Microsoft Academic Search

Hereditary haemorrhagic telangiectasia (HHT) is inherited as an autosomal dominant trait with varying penetrance and expressivity. Some of the most devastating consequences of this disease result from cerebral vascular malformations that manifest themselves in either arteriovenous fistulae (AVF), small nidus-type arteriovenous malformations (AVM) or micro-AVMs with a nidus less than 1 cm in size. The purpose of this study was to

T. Krings; A. Ozanne; S. M. Chng; H. Alvarez; G. Rodesch; P. L. Lasjaunias

2005-01-01

165

Haemorrhage into juxta-facet cysts causing bilateral foot drop  

PubMed Central

An 89 year old gentleman awaiting surgery for carcinoma of caecum presented with sudden back pain and developed foot drop two weeks later. MRI revealed multiple spinal metastases with a cyst in the canal at L4/5 causing spinal canal stenosis. Surgery revealed a juxta articular synovial cyst with haemorrhage in it. We discuss the presentation and management of juxtarticular cysts with a review of the literature. PMID:24960793

George, KJ; Roy, D; Shad, A

2012-01-01

166

Auditory laterality and attentional deficits after thalamic haemorrhage  

Microsoft Academic Search

Thalamic lesions have been shown to produce severe cognitive deficits involving language and memory. A majority of the studies\\u000a have reported cognitive deficits after lesions in the anterior and dorsomedial thalamic nuclei. We report five case studies\\u000a of effects on language processing after postero-dorsal thalamic haemorrhages. Four of the patients had lesions on the right\\u000a side, and one patient had

Knut Wester; Dexter R. F. Irvine; Kenneth Hugdahl

2001-01-01

167

Prevention of upper gastrointestinal haemorrhage: current controversies and clinical guidance  

PubMed Central

Acute upper gastrointestinal (GI) bleeding is a common medical emergency and associated with significant morbidly and mortality. The risk of bleeding from peptic ulceration and oesophagogastric varices can be reduced by appropriate primary and secondary preventative strategies. Helicobacter pylori eradication and risk stratification with appropriate gastroprotection strategies when used with antiplatelet drugs and nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in preventing peptic ulcer bleeding, whilst endoscopic screening and either nonselective beta blockade or endoscopic variceal ligation are effective at reducing the risk of variceal haemorrhage. For secondary prevention of variceal haemorrhage, the combination of beta blockade and endoscopic variceal ligation is more effective. Recent data on the possible interactions of aspirin and NSAIDs, clopidogrel and proton pump inhibitors (PPIs), and the increased risk of cardiovascular adverse events associated with all nonaspirin cyclo-oxygenase (COX) inhibitors have increased the complexity of choices for preventing peptic ulcer bleeding. Such choices should consider both the GI and cardiovascular risk profiles. In patients with a moderately increased risk of GI bleeding, a NSAID plus a PPI or a COX-2 selective agent alone appear equivalent but for those at highest risk of bleeding (especially those with previous ulcer or haemorrhage) the COX-2 inhibitor plus PPI combination is superior. However naproxen seems the safest NSAID for those at increased cardiovascular risk. Clopidogrel is associated with a significant risk of GI haemorrhage and the most recent data concerning the potential clinical interaction of clopidogrel and PPIs are reassuring. In clopidogrel-treated patients at highest risk of GI bleeding, some form of GI prevention is indicated. PMID:23997925

Brooks, Johanne; Warburton, Richard

2013-01-01

168

Spontaneous subdural haemorrhage in a patient with scleroderma renal crisis.  

PubMed

A 52-year-old woman with a history of systemic sclerosis presented with new onset seizures and renal failure. The patient's history, laboratory data and pathology supported the diagnosis of scleroderma renal crisis. The patient was also noted to have a subdural haemorrhage (SDH) in the absence of trauma. This is the first report of scleroderma renal crisis associated with a spontaneous SDH. PMID:25193814

Bhangoo, Munveer Singh; Hein, Paul; Nicholson, Laura; Carter, Caitlin

2014-01-01

169

Liver Enzymes and Ultrastructure in Rabbit Haemorrhagic Disease (RHD)  

Microsoft Academic Search

Rabbit haemorrhagic disease (RHD) is caused by a calicivirus infection that kills most adult rabbits 24–72 h after viral inoculation.\\u000a Two liver enzymes (AST, aspartate aminotransferase, and ALT, alanine aminotransferase) were monitored in blood samples of\\u000a calicivirus-infected rabbits during the short course of RHD. Values of AST were used to differentiate three stages of hepatocellular\\u000a degeneration in RHD: mild (up

P. G. Ferreira; A. Costa-e-Silva; E. Monteiro; M. J. R. Oliveira; A. P. Águas

2006-01-01

170

Postoperative abdominal complications after cardiopulmonary bypass  

PubMed Central

Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB). Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4%) developed abdominal complications postoperatively, including 11(33.3%) cases of paralytic ileus, 9(27.3%) of gastrointestinal haemorrhage, 2(6.1%) of gastroduodenal ulcer perforation, 2(6.1%) of acute calculus cholecystitis, 3(9.1%) of acute acalculus cholecystitis, 4(12.1%) of hepatic dysfunction and 2(6.1%) of ischemia bowel diseases. Of the 33 patients, 26 (78.8%) accepted medical treatment and 7 (21.2%) underwent subsequent surgical intervention. There were 5(15.2%) deaths in this series, which was significantly higher than the overall mortality (2.7%). Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients. PMID:23046511

2012-01-01

171

Damage control resuscitation from major haemorrhage in polytrauma.  

PubMed

Trauma is a global disease that affects patients across the socio-economic spectrum. Uncontrolled major haemorrhage occurs from both blunt and penetrating trauma which may lead to hypovolaemic shock and ultimately death. In polytrauma patients that require urgent resuscitation secondary to major haemorrhage, high volume fluid infusions followed by definitive surgical care have been superseded by damage control resuscitation. DCR is a systematic approach to major trauma that integrates the principles of haemostatic resuscitation, permissive hypotension and damage control surgery (DCS). The aim of DCR is to aggressively minimise hypovolaemic shock and limit the development of coagulopathy, hypothermia and acidosis known as the lethal triad. Besides increased volumes of scientific knowledge to underpin modern trauma resuscitation techniques upon, patient survival is also dependent upon effective teamwork and leadership. In conclusion, successful resuscitation from major haemorrhage depends upon a variety of factors distilled into a trauma team with effective leadership, excellent technical and non-technical team skills as well as the early initiation of DCR. PMID:23412314

Carlino, William

2014-02-01

172

Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhage  

PubMed Central

Intracranial hypertension is commonly encountered in poor-grade aneurysmal subarachnoid hemorrhage patients. Refractory raised intracranial pressure is associated with poor prognosis. The management of raised intracranial pressure is commonly referenced to experiences in traumatic brain injury. However, pathophysiologically, aneurysmal subarachnoid hemorrhage is different from traumatic brain injury. Currently, there is a paucity of consensus on the management of refractory raised intracranial pressure in spontaneous subarachnoid hemorrhage. We discuss in this paper the role of hyperosmolar agents, hypothermia, barbiturates, and decompressive craniectomy in managing raised intracranial pressure refractory to first-line treatment, in which preliminary data supported the use of hypertonic saline and secondary decompressive craniectomy. Future clinical trials should be carried out to delineate better their roles in management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage patients. PMID:23874101

Mak, Calvin Hoi Kwan; Lu, Yeow Yuen; Wong, George Kwok Chu

2013-01-01

173

Recurrent subarachnoid bleeding and superficial siderosis in a patient with histopathologically proven cerebral amyloid angiopathy.  

PubMed

A 68-year-old man with a history of hypertension presented with recurrent subarachnoid bleeding. Brain MRI showed superficial siderosis, and diagnostic cerebral angiograms did not show any intracranial vascular malformation or arterial aneurism. Post mortem neuropathological examination of the brain was consistent with a diagnosis of cerebral amyloid angiopathy. Clinicians should be aware that cerebral amyloid angiopathy should be considered in patients with unexplained recurrent subarachnoid bleeding, even in cases without familial clustering or transthyretin variant. PMID:21720529

Profice, P; Pilato, F; Della Marca, G; Colosimo, C; Gaudino, S; Arena, V; Pavone, A; Di Lazzaro, V

2011-05-01

174

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link  

Microsoft Academic Search

We describe two previously unreported associations in four cases. The first two cases demonstrate an association between segmental\\u000a mediolytic arteriopathy and vascular Ehlers-Danlos syndrome. The second two cases illustrate an association between vascular\\u000a Ehlers-Danlos syndrome and traumatic subarachnoid hemorrhage. In case 1, there was acute subarachnoid hemorrhage and mesenteric\\u000a artery dissection. In case 2, there was an acute mesenteric artery

Michael J. Pickup; Michael S. Pollanen

2011-01-01

175

Addition of intrathecal fentanyl to bupivacaine clonidine mixture effect on quality of subarachnoid block and postoperative analgesia  

PubMed Central

Context: This study was undertaken in 100 patients scheduled for lower limb orthopaedic surgeries. Aim: The objective of this study was to study the effect of addition of intrathecal fentanyl to bupivacaine clonidine mixture on the quality of subarachnoid block and compare it with intrathecal bupivacaine clonidine mixture without fentanyl. Settings and Design: In this prospective and double blind randomized controlled study, one hundred patients, between 20-40 years of age, of either sex, weighing between 40-65 Kg, measuring more than 150 cm in height, of ASA Grade I and II who were undergoing orthopaedic lower limb surgeries were selected in order to study the quality of subarachnoid block and post-operative analgesia produced by a combination of bupivacaine clonidine and fentanyl in comparison with bupivacaine clonidine. Materials and Methods: The patients were randomly divided in two groups of 50 each: Group BC: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 ?g) clonidine + 0.4 ml of 0.9% NaCl. Group BCF: 2.4 ml of 0.5% hyperbaric bupivacaine (12 mg) + 0.2 ml (30 ?g) clonidine + 0.4 ml (20 ?g) of fentanyl. The total volume of solution in both the groups was 3.0 ml. The quality of subarachnoid block and post-operative analgesia were studied. Statistical Analysis Used: The data thus obtained was statistically analysed using the following tests: Unpaired student's t-test. Average % change in data over baseline values to detect trends. A ‘P’ value of <0.05 was considered to be statistically significant. Results: There was no significant difference in duration of sensory and motor blockade in group BCF compared to BC. The duration of analgesia as assessed by, either VAS score of >5 or demand of additional analgesia was > 524.6 ± 32.21 mins in group BC and > 774.4 ± 59.59 mins in group BCF. This prolongation of duration of analgesia in group BCF compared to group BC has statistical significance. Blood pressure and heart rate changes were not significantly different among groups, whereas sedation and pruritus were significantly more frequent in Group BCF. Conclusions: In conclusion, this study has demonstrated that addition of 20 ?g fentanyl to intrathecal 30 ?g clonidine and 12 mg bupivacaine enhanced the duration of post-operative analgesia with moderately increased sedation and was not associated with hemodynamic instability or other complications.

Nazareth, Marilyn; Ghoshal, Pabitra; Namshikar, Viraj; Gaude, Yogesh

2013-01-01

176

[The role of nitric oxide and NO-synthase in the pathogenesis of cerebral damage after subarachnoid hemorrhage; laboratory models of subarachnoid hemorrhage].  

PubMed

Subarachnoid hemorrhage (SAH) of CNS is acute life-threating condition. In addition to its well understood sequential increase in intracranial pressure and decreased cerebral perfusion pressure, there is also early and late vasoconstriction. Mechanism of vasoconstriction is complex and one of important roles play changes in the amount of nitric oxide (NO). Present work overviews known pathogenesis of non-traumatic SAH, with stress on NO regulation of cerebral blood flow and its changes during SAH. It also describes mechanisms of early and late brain damage following subarachnoid hemorrhage. We discuss possible pharmacological prevention of the damage and laboratory models of nontraumatic SAH. PMID:24968538

Kolár, M; Nohejlová, K

2014-01-01

177

[Diagnosis of stroke due to cocaine and its complications].  

PubMed

INTRODUCTION. Cocaine is an independent cerebrovascular risk factor both for ischaemic and haemorrhagic events, above all among persons under 55 years of age. CASE REPORT. A case report of stroke due to the consumption of cocaine is used to review its pathophysiology and the complexity involved in the management and diagnosis of the associated complications. One of these complications reported in relation to the consumption of cocaine is vasospasm. This condition shares findings observed in ultrasound imaging studies with other conditions, such as early-onset post ischaemic hyperperfusion. Yet, there are important differences between the two as regards their treatment and prognosis. CONCLUSIONS. The consumption of cocaine is associated with cerebrovascular disease through a number of different mechanisms, which each give rise to different complications. By identifying these complications, correct management can be implemented. PMID:23884871

Larrosa-Campo, D; Ramon-Carbajo, C; Benavente-Fernandez, L; Alvarez-Escudero, R; Zeidan-Ramon, N; Calleja-Puerta, S; Pascual, J

2013-08-16

178

Subarachnoid block with Taylor's approach for surgery of lower half of the body and lower limbs: A clinical teaching study  

PubMed Central

Background: Subarachnoid anesthesia is used as the sole anesthetic technique for below umbilical surgeries, but patients with deformed spine represent technical difficulty for its establishment. This study was aimed to find out whether training of Taylor's approach to residents on normal spine is beneficial for establishing subarachnoid block in patients with deformed spine. Materials and Methods: The total of 174 patients of ASA I-III with normal and deformed spine of both genders scheduled for below umbilical surgeries under the subarachnoid block and met the inclusion criteria, were enrolled for this two-phased clinical teaching study. All participating residents have performed more than 100 subarachnoid block with the median and paramedian approach. Residents were randomized into two equal groups. During the first phase program, Group I was taught Taylor's approach by hands on method for the subarachnoid block while Group II kept on observation for the technique. During the second phase of program, Group II was also taught Taylor's approach for establishing the subarachnoid block. Block success was defined according to clinical efficacy. Results: The results of teaching of Taylor's approach were encouraging. Initially, the residents faced difficulty for establishing the subarachnoid block in deformed spine but after learning by observation and practical hands on, both groups had successfully performed the subarachnoid block by Taylor's approach in one or more attempts in patient with deformed spine with the acceptable failure rate of 15%. Conclusion: Taylor's approach for establishing subarachnoid block in deformed spine should be taught to residents on normal spine.

Gupta, Kumkum; Rastogi, Bhawna; Gupta, Prashant K.; Rastogi, Avinash; Jain, Manish; Singh, V. P.

2012-01-01

179

A Multicenter prospective study of poor-grade aneurysmal subarachnoid hemorrhage (AMPAS): observational registry study  

PubMed Central

Background Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with very high mortality and morbidity. Our limited knowledge on predictors of long-term outcome in poor-grade patients with aSAH definitively managed comes from retrospective and prospective studies of small case series of patients in single center. The purpose of the AMPAS is to determine the long-term outcomes in poor-grade patients with different managements within different time after aSAH, and identify the independent predictors of the outcome that help guide the decision on definitive management. Methods/design The AMPAS study is a prospective, multicenter, observational registry of consecutive hospitalized patients with poor grade aSAH (WFNS grade IV and V). The aim is to enroll at least 226 poor-grade patients in 11 high-volume medical centers (eg, >150 aSAH cases per year) affiliated to different universities in China. This study will describe poor grade patients and aneurysm characteristics, treatment strategies (modality and time of definitive management), hospitalization complications and outcomes evolve over time. The definitive management is ruptured aneurysm treatment. Outcomes at 3, 6, 12 months after the management were measured using the Glasgow Outcome Scale and the Modified Rankin Scale. Discussion The AMPAS is the first prospective, multicenter, observational registry of poor grade aSAH with any management. This study will contribute to a better understanding of significant predictors of outcome in poor grade patients and help guide future treatment of the worst patients after aSAH. Trial registration Chinese Clinical Trial Registry: ChiCTR-TNRC-10001041. PMID:24742248

2014-01-01

180

Impairment of cardiac metabolism and sympathetic innervation after aneurysmal subarachnoid hemorrhage: a nuclear medicine imaging study  

PubMed Central

Introduction Although aneurysmal subarachnoid hemorrhage (SAH) is often complicated by myocardial injury, whether this neurogenic cardiomyopathy is associated with the modification of cardiac metabolism is unknown. This study sought to explore, by positron emission tomography/computed tomography, the presence of altered cardiac glucose metabolism after SAH. Methods During a 16-month period, 30 SAH acute phase patients underwent myocardial 18?F- fluorodesoxyglucose positron emission tomography (18F-FDGPET), 99mTc-tetrofosmin and 123I-meta-iodobenzylguanidine (123I-mIBG) scintigraphy, respectively, assessing glucose metabolism, cardiac perfusion, and sympathetic innervation. Patients with initial abnormalities were followed monthly for two months for 18F-FDG, and six months later for 123I-mIBG. Results In this SAH population, acute cardiac metabolic disturbance was observed in 83% of patients (n?=?25), and sympathetic innervation disturbance affected 90% (n?=?27). Myocardial perfusion was normal for all patients. The topography and extent of metabolic defects and innervation abnormalities largely overlapped. Follow-up showed rapid improvement of glucose metabolism in one or two months. Normalization of sympathetic innervation was slower; only 27% of patients (n?=?8) exhibited normal 123I-mIBG scintigraphy after six months. Presence of initial altered cardiac metabolism was not associated with more unfavorable cardiac or neurological outcomes. Conclusions These findings support the hypothesis of neurogenic myocardial stunning after SAH. In hemodynamically stable acute phase SAH patients, cardiomyopathy is characterized by diffuse and heterogeneous 18F-FDG and 123I-mIBG uptake defect. Trial registration Clinicaltrials.gov NCT01218191. Registered 6 October 2010. PMID:24964817

2014-01-01

181

A prospective observational study of skin to subarachnoid space depth in the Indian population  

PubMed Central

Background and Aims: A pre-puncture estimate of skin to subarachnoid space depth (SSD) may guide spinal needle placement and reduce complications associated with lumbar puncture. Our aim was to determine (1) The SSD in Indian males, females, parturients and the overall population; (2) To derive formulae for predicting SSD and (3) To determine which previously suggested formula best suited our population. Methods: In this prospective, observational study, 800 adult Indian patients undergoing surgery under spinal anaesthesia were divided into three groups: Males (Group M), females (Group F) and parturients (Group PF). SSD was measured after lumbar puncture. The relationship between SSD and patient characteristics was studied and statistical models were used to derive formula for predicting SSD. Statistical analysis included One-way ANOVA with post hoc analysis, forward stepwise multivariate regression analysis and paired t-tests. Results: Mean SSD was 4.71 ± 0.70 cm in the overall population. SSD in adult males (4.81 ± 0.68 cm) was significantly longer than that observed in females (4.55 ± 0.66 cm) but was comparable with SSD in parturients (4.73 ± 0.73 cm). Formula for predicting SSD in the overall population was 2.71 + 0.09 × Body Mass Index (BMI). Stocker's formula when applied correlated best with the observed SSD. Formulae were derived for the three groups. Conclusions: We found gender-based differences in SSD, with SSD in males being significantly greater than that observed in the female population. SSD correlated with BMI in the parturient and the overall population. Amongst the previously proposed formulae, Stocker's formula was most accurate in predicting SSD in our population. PMID:24963181

Prakash, Smita; Mullick, Parul; Chopra, Pooja; Kumar, Santosh; Singh, Rajvir; Gogia, Anoop R

2014-01-01

182

Predictors and Outcomes of Suspected Heparin-Induced Thrombocytopenia in Subarachnoid Hemorrhage Patients  

PubMed Central

Background Heparin-induced thrombocytopenia (HIT) is a dreaded complication of heparin-related products and correlates with a worse outcome in aneurysmal subarachnoid hemorrhage (SAH) patients. Objective To study the risk factors and outcomes of SAH patients suspected of having HIT, confirmed as present or absent by the platelet factor 4 (PF4) antibody test. Methods All patients with presumed aneurysmal, nontraumatic SAH and having undergone a PF4 test were identified through our research patient database. Charts, laboratory values and images were analyzed retrospectively. Results We identified 166 patients with SAH who were tested for HIT; 42 patients (25%) had a positive antibody test. There was no difference in platelet profiles or mean platelet nadirs of HIT+ and HIT- patients (147 ± 93 vs. 153 ± 86 ×109/l, respectively). Univariate analysis identified gender, magnesium prophylaxis, Fisher group 3, clipping versus coiling, presence of angiographic vasospasm, number of vasospasm treatments, and day of HIT testing as potential risk factors associated with HIT. A multivariate analysis indicated that female gender (OR 8.2, 95% CI 2.0-33.2), greater number of vasospasm treatments (OR 1.5, 95% CI 1.2-2.0), later day of HIT testing (OR 1.2, 95% CI 1.1-1.3), and clipping (OR 5.0, 95% CI 1.42-10.0) were independently associated with HIT positivity. HIT+ patients showed more infarcts on CT, longer ICU and hospital stays and worse modified Rankin Scale scores on discharge. Conclusion The presence of HIT in SAH has adverse consequences and is more likely in female patients who have undergone aneurysm clipping and require multiple endovascular vasospasm treatments.

Mehta, Brijesh P.; Sims, John R.; Baccin, Carlos E.; Leslie-Mazwi, Thabele M.; Ogilvy, Christopher S.; Nogueira, Raul G.

2014-01-01

183

Pregnancy Complications: Gonorrhea  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Gonorrhea Pregnancy complications Pregnancy complications may need special medical care. ... the United States. Can gonorrhea cause complications during pregnancy and for your baby? Yes. Gonorrhea can lead ...

184

Pregnancy Complications: Preeclampsia  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Preeclampsia Pregnancy complications Pregnancy complications may need special medical care. ... health care provider right away. What health and pregnancy complications can preeclampsia cause? Without treatment, preeclampsia can ...

185

Quantification of exercise-induced pulmonary haemorrhage with bronchoalveolar lavage.  

PubMed

Exercise-induced pulmonary haemorrhage (EIPH) causes serious economic losses in the horse racing industry. Endoscopic examination indicates that 40-90% of horses exhibit EIPH following sprint exercise, but the limitations of the endoscope prevent diagnosis in many horses. Bronchoalveolar lavage (BAL) was utilised to detect red blood cells (RBCs) in the terminal airways in 6 horses. Two lavages were performed at weekly intervals prior to exercise, one within 90 min after exercise, and 5 at weekly intervals after exercise. The horses were exercised strenuously at 12.5-14.6 m/s on a treadmill (3 degree incline). Heart rates ranged from 192-207 beats/min, and mean pulmonary arterial pressures (mPAP) ranged from 80-102 mmHg. Neither epistaxis nor endoscopic evidence of EIPH was seen in any of the 6 horses following exercise. However, the number of RBCs in the lavage fluid increased significantly over control values immediately after exercise in all horses but returned to control values by one week after exercise. Haemosiderophages in the BAL fluid did not increase until one week after exercise and remained elevated for 3 weeks after exercise. Twenty per cent of the total population of alveolar macrophages contained haemosiderin. A positive relationship occurred between the number of RBCs in the lavage fluid and mPAP; the amount of haemorrhage increased as the mPAP exceeded 80 to 90 mmHg. The results with BAL used as the diagnostic tool, suggest that all strenuously exercised horses may exhibit EIPH; the amount of haemorrhage appears to be associated with the magnitude of the high pulmonary arterial pressure. PMID:9705109

Meyer, T S; Fedde, M R; Gaughan, E M; Langsetmo, I; Erickson, H H

1998-07-01

186

The effect of chronic subarachnoid bupivacaine infusion in dogs.  

PubMed

A functional and histologic examination of the effect of the continuous intrathecal administration of bupivacaine was made in five dogs. After a partial laminectomy at L5, a silicone rubber catheter was inserted into the subarachnoid space and advanced 10 cm cranially. A model 400 Infusaid pump, used for drug delivery, was placed in a subcutaneous pocket between the 13th rib and iliac crest. Drug infusions were individually adjusted and maintained at a concentration such that the animal just exhibited slight gait impairment. Daily bupivacaine doses ranged from 5.7-11.1 mg. Infusions were maintained for a period of 3-16 weeks. Light microscopic examination of spinal cord and roots revealed no abnormalities. A focal mononuclear cell infiltration of the leptomeninges was seen in two drug animals, as well as one catheter control animal. One of the 16-week animals had a residual limp upon drug removal. While we were not able to quantitatively assess the degree of sensory motor dissociation, the results of this study suggest that chronic intrathecal bupivacaine infusion through an implantable pump system may be a short-term alternative to intrathecal morphine in the control of cancer pain. PMID:3592272

Kroin, J S; McCarthy, R J; Penn, R D; Kerns, J M; Ivankovich, A D

1987-06-01

187

Upregulation of Relaxin after Experimental Subarachnoid Hemorrhage in Rabbits  

PubMed Central

Background. Although relaxin causes vasodilatation in systemic arteries, little is known about its role in cerebral arteries. We investigated the expression and role of relaxin in basilar arteries after subarachnoid hemorrhage (SAH) in rabbits. Methods. Microarray analysis with rabbit basilar artery RNA was performed. Messenger RNA expression of relaxin-1 and relaxin/insulin-like family peptide receptor 1 (RXFP1) was investigated with quantitative RT-PCR. RXFP1 expression in the basilar artery was investigated with immunohistochemistry. Relaxin concentrations in cerebrospinal fluid (CSF) and serum were investigated with an enzyme-linked immunosorbent assay. Using human brain vascular smooth muscle cells (HBVSMC) preincubated with relaxin, myosin light chain phosphorylation (MLC) was investigated with immunoblotting after endothelin-1 stimulation. Results. After SAH, RXFP1 mRNA and protein were significantly downregulated on day 3, whereas relaxin-1 mRNA was significantly upregulated on day 7. The relaxin concentration in CSF was significantly elevated on days 5 and 7. Pretreatment with relaxin reduced sustained MLC phosphorylation induced by endothelin-1 in HBVSMC. Conclusion. Upregulation of relaxin and downregulation of RXFP1 after SAH may participate in development of cerebral vasospasm. Downregulation of RXFP1 may induce a functional decrease in relaxin activity during vasospasm. Understanding the role of relaxin may provide further insight into the mechanisms of cerebral vasospasm. PMID:25133183

Kikkawa, Yuichiro; Matsuo, Satoshi; Kurogi, Ryota; Nakamizo, Akira; Mizoguchi, Masahiro; Sasaki, Tomio

2014-01-01

188

APOE Genotype and Functional Outcome Following Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

Apolipoprotein E (apoE), the major apolipoprotein in the central nervous system, has been shown to influence neurologic disease progression and response to neurologic injury in a gene-specific manner. Presence of the APOE4 allele is associated with poorer response to traumatic brain injury and ischemic stroke, but the association between APOE genotype and outcome following aneurysmal subarachnoid hemorrhage (SAH) remains unclear. The purpose of this project was to investigate the association between APOE genotype and outcome after SAH. We also explored the association of APOE4 genotype and cerebral vasospasm (CV) presence in a subsample of our population with available angiographic data. A sample of 206 aneurysmal SAH participants had APOE genotyping performed, Glasgow outcome scores (GOS) and modified Rankin scores (MRS) collected at 3 and 6 months after aneurysm rupture. No significant association was found between the presence of the APOE4 genotype and functional outcomes controlling for age, race, size of hemorrhage (Fisher grade), and severity of injury (Hunt & Hess grade). However when controlling for CV and the covariates listed above, individuals with the APOE4 allele had worse functional outcomes at both time points. The presence of the APOE2 allele was not associated with functional outcomes even when considering presence of CV. There was no difference in mortality associated with APOE4 presence, APOE2 presence, or presence of CV. These findings suggest APOE4 allele is associated with poor outcome after aneurysmal SAH. PMID:19017669

Gallek, Matthew J.; Conley, Yvette P.; Sherwood, Paula R.; Horowitz, Michael B.; Kassam, Amin; Alexander, Sheila A.

2009-01-01

189

A review of the pathophysiology of exercise-induced pulmonary haemorrhage in the equine athlete  

Microsoft Academic Search

In the United States, more than 75% of equine athletes are reported to suffer from exercise-related haemorrhage of the respiratory tract (Voynick and Sweeney, 1986; Sweeney et al., 1990). Fiberoptic endoscopy has traced the source of blood to beyond the bifurcation of the trachea. In 1981, the term exercise-induced pulmonary haemorrhage (EIPH) was introduced (Pascoe et al., 1981). Racehorses of

L. L. Donaldson

1991-01-01

190

Aetiological examination of an outbreak of haemorrhagic syndrome in a broiler flock in Japan  

Microsoft Academic Search

The aetiology of an outbreak of haemorrhagic syndrome (HS) in a commercial broiler flock was examined. At a rearing farm, 596 of 6376 chicks (9.3%) in a flock were culled with depression and increased mortality from 12 to 26 days of age, with a peak at 16 to 19 days of age. Most of the affected chicks examined had haemorrhagic

N. Yuasa; K. Imai; K. Watanabe; F. Saito; M. Abe; K. Komi

1987-01-01

191

Original surgical treatment of thoracolumbar subarachnoid cysts in six chondrodystrophic dogs  

PubMed Central

Background Subarachnoid cysts are rare conditions in veterinary medicine, associated with spinal cord dysfunction. Most of the 100 cases of subarachnoid cysts described since the first report in 1968 were apparently not true cysts. Reported cysts are usually situated in the cervical area and occur in predisposed breeds such as the Rottweiler. The purpose of this retrospective study, from May 2003 to April 2012, was to describe the distinctive features of thoracolumbar spinal subarachnoid cysts, together with their surgical treatment and outcome in 6 chondrodystrophic dogs. Results Five Pugs and 1 French Bulldog were examined. Images suggestive of a subarachnoid cyst were obtained by myelography (2/6) and computed tomography myelography (4/6), and associated disc herniation was observed in 3/6 dogs. A hemilaminectomy was performed. The protruding disc eventually found in 5/6 dogs was treated by lateral corpectomy. The ventral leptomeningeal adhesions observed in all dogs after durotomy were dissected. No or only mild post-operative neurological degradation was observed. Follow-up studies (7 months to 4 years) indicated good outcome and no recurrence. Conclusions All the thoracolumbar subarachnoid cysts described in these 6 chondrodystrophic dogs were associated with leptomeningeal adhesions. Good results seemed to be obtained by dissecting and removing these adhesions. A protruding disc, found here in 5/6 dogs, needs to be ruled out and can be treated by lateral corpectomy. PMID:24884635

2014-01-01

192

Subarachnoid-pleural fistula in a child: the cause and treatment.  

PubMed

Hydrothorax of the cerebrospinal fluid after a subarachnoid-pleural fistula is a rare condition. Subarachnoid-pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid-pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccurred after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid-pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid-pleural fistulae. PMID:23279024

Karabayir, Nalan; Demirkol, Demet; Al, Isik Odaman; Dolas, Ilyas; Sencer, Altay

2012-12-01

193

Diffuse alveolar haemorrhage due to 5-nitroimidazole treatment.  

PubMed

Diffuse alveolar haemorrhage (DAH) is indicated by the presence of red blood cells, fibrin and haemosiderin deposits in the lung parenchyma. We present a case of DAH in a 25-year-old male following 5-nitroimidazole treatment. The first episode of haemoptysis occurred following metronidazole treatment 10 months previously. The second episode of haemoptysis occurred following ornidazole treatment 10 days before admission. During his first admission, the patients haemoglobin concentration decreased to 40 g/L. The CXR was normal, whereas high resolution CT of the lungs revealed a diffuse acinonodular pattern. Serological tests for connective tissue diseases were negative. The haemorrhagic appearance of the BAL fluid obtained during fibreoptic bronchoscopy was consistent with DAH. Microbiological analysis of the BAL fluid showed no evidence for bacterial or mycobacterial infection. Haemosiderin laden macrophages were detected in BAL fluid and lung biopsy specimens. DAH due to use of 5-nitroimidazole was diagnosed on the basis of the patient's previous history and complete recovery following treatment with corticosteroid. This is the first reported case of DAH due to use of 5-nitroimidazole. Physicians should be aware of this side-effect when prescribing this group of drugs to patients. PMID:19645871

Uyar, Meral; Elbek, Osman; Bayram, Nazan; Ekiz, Sule; Bakir, Kemal; Dikensoy, Oner

2009-05-01

194

Octreotide infusion or emergency sclerotherapy for variceal haemorrhage.  

PubMed

To compare octreotide with injection sclerotherapy in the treatment of acute variceal haemorrhage, patients admitted with gastrointestinal bleeding and oesophageal varices confirmed by endoscopy were randomised to receive either emergency sclerotherapy with 3% sodium tetradecyl sulphate or octreotide (50 micrograms intravenous bolus plus 50 micrograms per h intravenous infusion for 48 h). At the end of the study period (48 h), the octreotide group also had sclerotherapy to obliterate the varices. 100 patients were recruited. Demographic features including the aetiology of portal hypertension and the Child-Pugh's grading of the two groups were similar. Bleeding was initially controlled in 90% of patients by emergency sclerotherapy and in 84% by octreotide infusion (95% confidence interval 0-19.5, p = 0.55). There were no significant differences between the two groups in early (within 48 h of randomisation) rebleeding (16% vs 14%), blood transfusion (3 units vs 3.5), hospital stay (5 days vs 6 days), or hospital mortality (27% vs 20%). No notable side-effects were associated with octreotide. We conclude that octreotide infusion and emergency sclerotherapy are equally effective in controlling variceal haemorrhage. PMID:8103145

Sung, J J; Chung, S C; Lai, C W; Chan, F K; Leung, J W; Yung, M Y; Kassianides, C; Li, A K

1993-09-11

195

Bioinformatics analysis of rabbit haemorrhagic disease virus genome  

PubMed Central

Background Rabbit haemorrhagic disease virus (RHDV), as the pathogeny of Rabbit haemorrhagic disease, can cause a highly infectious and often fatal disease only affecting wild and domestic rabbits. Recent researches revealed that it, as one number of the Caliciviridae, has some specialties in its genome, its reproduction and so on. Results In this report, we firstly analyzed its genome and two open reading frameworks (ORFs) from this aspect of codon usage bias. Our researches indicated that mutation pressure rather than natural is the most important determinant in RHDV with high codon bias, and the codon usage bias is nearly contrary between ORF1 and ORF2, which is maybe one of factors regulating the expression of VP60 (encoding by ORF1) and VP10 (encoding by ORF2). Furthermore, negative selective constraints on the RHDV whole genome implied that VP10 played an important role in RHDV lifecycle. Conclusions We conjectured that VP10 might be beneficial for the replication, release or both of virus by inducing infected cell apoptosis initiate by RHDV. According to the results of the principal component analysis for ORF2 of RSCU, we firstly separated 30 RHDV into two genotypes, and the ENC values indicated ORF1 and ORF2 were independent among the evolution of RHDV. PMID:22044910

2011-01-01

196

w RAPID RISK ASSESSMENT Outbreak of Ebola haemorrhagic  

E-print Network

Main conclusions and recommendations An outbreak of Ebola haemorrhagic fever is currently ongoing in Uganda with 38 cases reported, including 16 deaths. Two similar outbreaks have been seen in the past in Uganda. Through these, Uganda has developed a solid experience in dealing with such outbreaks, with the support currently of the World Health Organization, the US Centers for Disease Control and Prevention, and specialised non-governmental organisations. As the incubation period can be up to three weeks, it is likely that additional cases will be identified in the coming weeks. However, control measures currently implemented in Uganda with the support of international partners, such as isolation of cases and active monitoring of contacts, should prevent further spread of the disease. It is unlikely, but not impossible, that travellers infected in Uganda could arrive in the EU while incubating the disease and develop symptoms while in the EU. However, such cases should seek medical attention and be isolated, therefore preventing further transmission. EU citizens in Uganda are not at risk of becoming infected unless they are in direct contact with bodily fluids of dead or living infected persons or animals. Avoiding such contact would effectively mitigate this risk. Public health issue To assess the risk at EU level associated with the current Ebola haemorrhagic fever outbreak in Uganda. Source and date of request ECDC internal decision on 1 August 2012. Consulted experts ECDC experts.

unknown authors

2012-01-01

197

[Diverticulosis of the small intestine. Observations on a complicated case].  

PubMed

Small bowel diverticula, particularly the jejunal ones, are a rare disease with a poor and vague symptomatology. Sometimes detected by change under X-ray examinations or at surgery, they do not need any surgical treatment: only clinical and X-ray controls are required. Prophylactic resection of symptomatic low jejunal diverticula is controversial: patient's age and status will affect the indication to surgical treatment. Jejunal diverticulosis may generate serious, though not dramatic, symptoms: intestinal obstruction, inflammatory complications, haemorrhage, perforation of the diverticula are the most frequent emergencies which require an immediate surgical procedure. A clinical case is here reported. PMID:1907842

Mazzocconi, G; Campli, M; Adami, E A; Volpe, M; Costi, U; Stasio, A; Sbaffi, E

1991-01-01

198

Arterial embolisation for persistent primary postpartum haemorrhage: before or after hysterectomy?  

PubMed

Arterial embolisation is a recognised treatment for postpartum haemorrhage (PPH). In this retrospective study, we evaluate its use in the management of persistent PPH. Records of all births during a 54 month period at a university hospital were analysed. Two sub-groups were identified. Group I (n= 5), underwent embolisation after hysterectomy and Group II (n= 4), had embolisation as a first-line theraphy without hysterectomy. Of 20,215 births, there were 636 cases of PPH (3.1%). Nine required embolisation to control bleeding (1.4%). Group I needed multiple surgical procedures, had a larger pre- and post-operative blood requirement (12-100, median 22 units, vs. 6-12, median 8.5 units), longer embolisation (33-93, median 54 minutes, vs 20-66, 47 minutes) with a larger radiation exposure (5194-9067, median 6301 dGy, vs. 269-3862, median 950 dGy), a longer intensive care stay (3-7, median four days vs. 0-1.5, median one day), and more complications, when compared with Group II. Three of four women from Group II resumed menstrual function. Embolisation prior to hysterectomy may be preferable to embolisation after hysterectomy for the control of PPH. PMID:15270943

Bloom, Allan I; Verstandig, Anthony; Gielchinsky, Yuval; Nadiari, Michel; Elchalal, Uri

2004-08-01

199

Complications of nephropathia epidemica: three cases.  

PubMed

Haemorrhagic fever with renal syndrome (HFRS) in Scandinavia is called nephropathia epidemica (NE), and is caused by the Puumala-virus, which belongs to the Hanta-virus genus. The clinical course of NE is mostly benign, complications are uncommon, and deaths are rarely observed. We report the cases of three patients who developed serious complications in the course of NE caused by the Puumala-virus. One patient died within 24 h after admission, another developed progressive neuromuscular dysfunction (Guillain-Barré syndrome) which required auxiliary ventilation for several weeks before a slow recovery, and a third patient developed empty sella syndrome with pituitary gland insufficiency. In the first two cases the diagnosis of NE was confirmed by a rapid avidity assay for IgG antibody against Puumala-virus. In the third case the clinical course, and demonstration of NE immunity 16 years later, suggested that NE might have caused the hypopituitarism. Some patients with NE caused by the Puumala-virus may require intensive-care treatment, and the development of late complications such as empty sella syndrome and hypopituitarism should be taken into consideration. PMID:1353521

Forslund, T; Saltevo, J; Anttinen, J; Auvinen, S; Brummer-Korvenkontio, M; Korhonen, A; Poutiainen, M

1992-07-01

200

Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes  

PubMed Central

Background: Hyponatremia is the most common electrolyte abnormality seen in patients with aneurysmal SAH. Clinically significant hyponatremia (Serum Sodium <131 mEq/L) which needs treatment, has been redefined recently and there is a paucity of outcome studies based on this. This study aims to identify the mean Serum Sodium (S.Na+) level and its duration among inpatients with SAH and to identify the relationship between hyponatremia and the outcome status of patients undergoing surgery for SAH. Materials and Methods: This outcome study is undertaken in the department of neurosurgery, The Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala. Medical records of all patients with SAH from 1st January to 31st July 2010 were reviewed. Preoperative status was assessed using World Federation of Neurosurgical Societies (WFNS) grading system. Discharge status was calculated using the Glasgow outcome score scale. Results: Fifty nine patients were included in the study and 53 (89.8%) of them have undergone surgical treatment. Hyponatremia was observed in 22 of 59 patients (37%). The mean Sodium level of hyponatremic patients was 126.97 mEq/L for a median duration of two days. Glasgow outcome score was good in 89.8% of patients. We lost two patients, one of whom had hyponatremia and vasospasm. Conclusion: Hyponatremia is significantly associated with poor outcome in patients with SAH. Anticipate hyponatremia in patients with aneurysmal subarachnoid hemorrhage, timely detect and appropriately treat it to improve outcome. It is more common in patients who are more than 50 years old and whose aneurysm is in the anterior communicating artery. Our comprehensive monitoring ensured early detection and efficient surgical and nursing management reduced morbidity and mortality. PMID:23546343

Saramma, PP; Menon, R Girish; Srivastava, Adesh; Sarma, P Sankara

2013-01-01

201

Free fatty acids and delayed cerebral ischemia after subarachnoid hemorrhage  

PubMed Central

Background and purpose To understand factors related to increases in serum free fatty acid levels (FFA) and association with delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). Methods Serial measurement of systemic oxygen consumption (VO2) by indirect calorimetry (IDC) and FFA levels by liquid chromatography/mass spectrometry in the first 14 days after ictus in 50 consecutive SAH patients. Multivariable GEE models identified associations with FFA levels in the first 14 days after SAH and Cox proportional hazards model utilized to identified associations with time to DCI. Results There were 187 measurements in 50 SAH patients (mean age: 56+/?14 years old, 66% women) with a median Hunt Hess Score 3. Adjusting for Hunt Hess grade and daily caloric intake, n-6 and n-3 FFA levels were both associated with VO2 and the modified Fisher score. Fourteen (28%) patients developed DCI on median post bleed day 7. The modified Fisher score (P = 0.01), mean n-6: n-3 FFA ratio (P = 0.02), and mean VO2 level (P = 0.04) were higher in patients that developed DCI. In a Cox proportional hazards model the mean n-6:n-3 FFA ratio (P<0.001), younger age (P = 0.05) and modified Fisher scale (P = 0.004) were associated with time to DCI. Conclusions Injury severity and VO2 hypermetabolism are associated with higher n - FFA levels, and an increased n-6:n-3 FFA ratio is associated with DCI. This may indicate a role for interventions that modulate both VO2 and FFA levels to reduce the occurrence of DCI. PMID:22282893

Badjatia, Neeraj; Seres, David; Carpenter, Amanda; Schmidt, J. Michael; Lee, Kiwon; Mayer, Stephan A.; Claassen, Jan; Connolly, E. Sander; Elkind, Mitchell S.

2014-01-01

202

Subarachnoid Space: New Tricks by an Old Dog  

PubMed Central

Purpose The purpose of the study was to: (1) evaluate the subarachnoid space (SAS) width and pial artery pulsation in both hemispheres, and (2) directly compare magnetic resonance imaging (MRI) to near-infrared transillumination/backscattering sounding (NIR-T/BSS) measurements of SAS width changes in healthy volunteers. Methods The study was performed on three separate groups of volunteers, consisting in total of 62 subjects (33 women and 29 men) aged from 16 to 39 years. SAS width was assessed by MRI and NIR-T/BSS, and pial artery pulsation by NIR-T/BSS. Results In NIR-T/BSS, the right frontal SAS was 9.1% wider than the left (p<0.01). The SAS was wider in men (p<0.01), while the pial artery pulsation was higher in women (p<0.01). Correlation and regression analysis of SAS width changes between the back- and abdominal-lying positions measured with MRI and NIRT-B/SS demonstrated high interdependence between both methods (r?=?0.81, p<0.001). Conclusions NIR-T/BSS and MRI were comparable and gave equivalent modalities for the SAS width change measurements. The SAS width and pial artery pulsation results obtained with NIR-T/BSS are consistent with the MRI data in the literature related to sexual dimorphism and morphological asymmetries between the hemispheres. NIR-T/BSS is a potentially cheap and easy-to-use method for early screening in patients with brain tumours, increased intracranial pressures and other abnormalities. Further studies in patients with intracranial pathologies are warranted. PMID:22701518

Frydrychowski, Andrzej F.; Szarmach, Arkadiusz; Czaplewski, Bartosz; Winklewski, Pawel J.

2012-01-01

203

Disproportionate subarachnoid space hydrocephalus--outcome and perivascular space  

PubMed Central

Objective We sought to identify the prevalence of MRI features of disproportionately enlarged subarachnoid space hydrocephalus in possible idiopathic normal pressure hydrocephalus (DESH-iNPH) and to describe the clinico-radiological features and outcomes of a community-based investigation (The Vienna Trans-Danube Aging study). Methods Of the 697 inhabitants (all 75 years old), 503 completed extensive neurological examinations at baseline and were followed up every 30 months thereafter with MRIs, mini-mental state examination (MMSE), and the Unified Parkinson Disease Rating Scale-Motor Section (UPDRSM). The DESH-iNPH participant data were compared with the data from participants with Evans index ratios >0.3 (ex vacuo hydrocephalus), cerebral small-vessel diseases, and normal MRIs. The widening of perivascular space was also evaluated by MRI in these groups. Results Eight participants with DESH-iNPH (1.6%) and 76 with ex vacuo hydrocephalus (16.1%) at baseline were identified. The mean MMSE in DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs was 26.4, 27.9, and 28.3, respectively, and the mean UPDRSM was 9.75, 2.96, and 1.87, respectively. After a 90-month follow-up, the mortality rates for DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs were 25.0%, 21.3%, and 10.9%, respectively. The perivascular-space widening scores were significantly smaller in the DESH-iNPH cases, particularly at the centrum semiovale, compared to cerebral small-vessel disease and ex vacuo hydrocephalus cases. Interpretation The prevalence of DESH-iNPH was 1.6% for participants aged 75 years and revealed significantly lower MMSE and higher UPDRSM scores compared to the ex vacuo hydrocephalus and controls. Moreover, it is suggested that perivascular-space narrowing is a morphological and pathophysiological marker of DESH-iNPH. PMID:25356428

Akiguchi, Ichiro; Shirakashi, Yoshitomo; Budka, Herbert; Watanabe, Yuko; Watanabe, Toshiyuki; Shiino, Akihiko; Ogita, Mihoko; Kawamoto, Yasuhiro; Jungwirth, Susanne; Krampla, Wolfgang; Fischer, Peter

2014-01-01

204

Pregnancy Complications: Genital Herpes  

MedlinePLUS

... Home > Pregnancy > Pregnancy Complications > Genital herpes and pregnancy Pregnancy complications Pregnancy complications may need special medical care. ... been added to your dashboard . Genital herpes and pregnancy Genital herpes is a sexually transmitted disease (also ...

205

Pregnancy Complications: Chlamydia  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Chlamydia Pregnancy complications Pregnancy complications may need special medical care. ... younger than 25. Can chlamydia cause problems during pregnancy? Yes. If you get it before or during ...

206

Pregnancy Complications: Syphilis  

MedlinePLUS

... in the community. Home > Pregnancy > Pregnancy Complications > Syphilis Pregnancy complications Pregnancy complications may need special medical care. ... syphilis each year. Can syphilis cause problems during pregnancy and for your baby? Yes. You can pass ...

207

Use of portal pressure studies in the management of variceal haemorrhage.  

PubMed

Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources. PMID:22816007

Addley, Jennifer; Tham, Tony Ck; Cash, William Jonathan

2012-07-16

208

Intrapulmonary administration of recombinant activated factor VII in diffuse alveolar haemorrhage: a report of two case stories  

PubMed Central

Background Diffuse alveolar haemorrhage (DAH) is a serious pulmonary complication characterised by a high mortality rate and the absence of specific treatment. The intrapulmonary administration of activated recombinant factor VII (rFVIIa) in DAH was recently published in six patients by Heslet et al with an efficient hemostatic effect. We describe two cases of DAH treated with intrapulmonary rFVIIa. Methods Two cases of DAH were admitted to the ICU after presenting abrupt desaturation, tachypnea, cough and haemoptysis, requiring orotracheal intubation and mechanical ventilation. The diagnosis was achieved by the bloody return during the bronchoalveolar lavage, during the procedure rFVIIa (50 ?g/Kg in 50 ml of isotonic saline) was administered via the bronchoscope. Results Immediate cessation of bleeding was observed. Prior to intrapulmonary administration of rFVIIa, the FiO2 was 1, which was reduced to 0.4 24 hours later. Following the procedure, the haemostatic effect made blood transfusion superfluous. No thrombotic complications associated with administration of the drug were observed. After the intervention both cases progressed fast and was discharged from the ICU with no further episodes of bleeding. Conclusion 1. Local intrabronchial deposition of DAH with rFVIIa has been shown to be effective in controlling life-threatening DAH. 2. In the case described above, no thrombotic complications were observed following the intrapulmonary administration of rFVIIa. PMID:18789132

Estella, Ángel; Jareño, Antonio; Perez-Bello Fontaiña, Luis

2008-01-01

209

A huge cystic hygroma of the neck associated with intraventricular haemorrhage in a term neonate.  

PubMed

We report on a female term neonate who presented with a huge cystic hygroma of the right neck associated with intraventricular haemorrhage as demonstrated by computerized tomography and magnetic resonance imaging studies. She underwent extraventricular drainage and excision of the neck mass with stable postoperative condition. Psychomotor retardation was found thereafter. To our knowledge, the association of a large cystic hygroma of the neck with intracranial haemorrhage has not been reported previously. The possible mechanism of the occurrence of the haemorrhage is discussed. PMID:10229051

Yang, A D; Chang, Y L; Chaou, W T

1999-03-01

210

Critical care in emergency department: massive haemorrhage in trauma.  

PubMed

Inadequate resuscitation of major haemorrhage is an important cause of avoidable death in severely injured patients. Early recognition of blood loss, control of bleeding and restoration of circulating volume are critical to the management of trauma shock, and transfusion of blood components is a key intervention. Vital signs may be inadequate to determine the need for transfusion, and resuscitation regimens targeting vital signs may be harmful in the context of uncontrolled bleeding. This article addresses current concepts in haemostatic resuscitation. Recent guidelines on the diagnosis and treatment of coagulopathy in major trauma, and the role of component and adjuvant therapies, are considered. Finally, the potential role of thromboelastography and rotational thromboelastometry are discussed. PMID:22328635

Mahambrey, Tushar; Pendry, Katherine; Nee, Alexandra; Bonney, Samantha; Nee, Patrick A

2013-01-01

211

Haemorrhage after home birth: audit of decision making and referral.  

PubMed

In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care. PMID:24371910

Smit, Marrit; Dijkman, Anneke; Rijnders, Marlies; Bustraan, Jacqueline; van Dillen, Jeroen; Middeldorp, Johanna; Havenith, Barbara; van Roosmalen, Jos

2013-11-01

212

A rare case of Weil's disease with alveolar haemorrhage  

PubMed Central

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics. PMID:25183149

Chakrabarti, Abhiram; Nandy, Manab; Pal, Dipankar; Mallik, Sudesna

2014-01-01

213

Umbilical cord ulceration causing foetal haemorrhage and stillbirth.  

PubMed

We report a case of umbilical cord ulceration associated with obstruction of the duodeno-jejunal junction by a peritoneal band. Umbilical cord ulceration is a rare condition; a literature review identified a total of 17 cases only. In all cases, the ulceration was associated with congenital intestinal obstruction. Cord ulceration usually presents as sudden foetal deterioration due to foetal haemorrhage. This condition is associated with high perinatal mortality and morbidity. The causes of this condition are still unknown, and prenatal diagnosis is difficult. Awareness of the possible association between umbilical cord ulceration and intestinal obstruction, and of the need to deliver such pregnancies immediately when an abnormal foetal heart rate pattern develops might be the only means of preventing intrauterine death and improving neonatal outcomes. PMID:18382024

Chan, Symphorosa S C; Lau, Amy P K; To, K F; Leung, T Y; Lau, T K; Leung, T N

2008-04-01

214

Viewpoint: filovirus haemorrhagic fever outbreaks: much ado about nothing?  

PubMed

The recent outbreak of Marburg haemorrhagic fever in the Democratic Republic of Congo has put the filovirus threat back on the international health agenda. This paper gives an overview of Marburg and Ebola outbreaks so far observed and puts them in a public health perspective. Damage on the local level has been devastating at times, but was marginal on the international level despite the considerable media attention these outbreaks received. The potential hazard of outbreaks, however, after export of filovirus from its natural environment into metropolitan areas, is argued to be considerable. Some avenues for future research and intervention are explored. Beyond the obvious need to find the reservoir and study the natural history, public health strategies for a more timely and efficient response are urgently needed. PMID:10886793

Borchert, M; Boelaert, M; Sleurs, H; Muyembe-Tamfum, J J; Pirard, P; Colebunders, R; Van der Stuyft, P; van der Groen, G

2000-05-01

215

Threat of Marburg and Ebola viral haemorrhagic fevers in Africa.  

PubMed

Marburg and Ebola viruses are members of the filovirus family that can be regarded as recently emerged. These viruses have caused sporadic outbreaks of fatal haemorrhagic disease in Africa, Europe and recently in the USA. The case fatality rates rank among the highest ranging from 33-80%. The mode of transmission of these viruses are clearly through close contact with blood and body fluids. Disease outbreaks have been amplified in hospital situations with poor blood precautions. In villages disease has been amplified through contamination with blood and fluids during nursing the sick and burial rituals. The source of the viruses has eluded discovery and new theories regarding the nature of these viruses are being entertained. The threat of new outbreaks in Africa is real since serological evidence of the presence of the virus has been documented in Kenya, Sudan, Zaire, Zimbabwe, Gabon, Cote-d'Ivoire and Gabon. PMID:8625857

Tukei, P M

1996-01-01

216

[Fruit of the emergence of an enterovirus: acute haemorrhagic conjunctivitis].  

PubMed

First seen in Ghana and Indonesia in the early 70's, acute haemorrhagic conjunctivitis or "Apollo 11" disease is an eye infection caused by Enterovirus type 70 (EV70). The disease appeared to be a highly contagious conjunctivitis which spread rapidly all over the world. EV70 has been considered as an emerging virus and was classified as a new Enterovirus. No human or animal virus genetically similar to EV70 was known before the sudden outcome of the disease in Ghana, West Africa. EV70 appeared as a pretty demonstrative example of virus emergence and virus spreading. Studies of virus genetic mutations emphasized the variations of RNA virus within a short time period. The current review presents the EV70 infection and the genetic profile of the virus from its emergence to nowadays. PMID:18957336

Sane, F; Sauter, P; Fronval, S; Goffard, A; Dewilde, A; Hober, D

2008-01-01

217

Simultaneous occurrence of subarachnoid hemorrhage and epistaxis due to ruptured petrous internal carotid artery aneurysm: association with transsphenoidal surgery and radiation therapy: case report.  

PubMed

A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm. PMID:21441741

Endo, Hidenori; Fujimura, Miki; Inoue, Takashi; Matsumoto, Yasushi; Ogawa, Yoshikazu; Kawagishi, Jun; Jokura, Hidefumi; Shimizu, Hiroaki; Tominaga, Teiji

2011-01-01

218

A modified double injection model of cisterna magna for the study of delayed cerebral vasospasm following subarachnoid hemorrhage in rats  

PubMed Central

Delayed cerebral vasospasm following subarachnoid hemorrhage (SAH) is a serious medical complication, characterized by constriction of cerebral arteries leading to varying degrees of cerebral ischemia. Numerous clinical and experimental studies have been performed in the last decades; however, the pathophysiologic mechanism of cerebral vasospasm after SAH still remains unclear. Among a variety of experimental SAH models, the double hemorrhage rat model involving direct injection of autologous arterial blood into the cisterna magna has been used most frequently for the study of delayed cerebral vasospasm following SAH in last years. Despite the simplicity of the technique, the second blood injection into the cisterna magna may result in brainstem injury leading to high mortality. Therefore, a modified double hemorrhage model of cisterna magna has been developed in rat recently. We describe here step by step the surgical technique to induce double SAH and compare the degree of vasospasm with other cisterna magna rat models using histological assessment of the diameter and cross-sectional area of the basilar artery. PMID:23194464

2012-01-01

219

Transcranial Doppler Ultrasound in the Acute Phase of Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Background: Angiographic studies suggest that acute vasospasm within 48 h of aneurysmal subarachnoid hemorrhage (SAH) predicts symptomatic vasospasm. However, the value of transcranial Doppler within 48 h of SAH is unknown. Methods: We analyzed 199 patients who had at least 1 middle cerebral artery (MCA) transcranial Doppler examination within 48 h of SAH onset. Abnormal MCA mean blood flow velocity

Emmanuel Carrera; J. Michael Schmidt; Mauro Oddo; Noeleen Ostapkovich; Jan Claassen; Fred Rincon; David Seder; Errol Gordon; Pedro Kurtz; Kiwon Lee; E. Sander Connolly; Neeraj Badjatia; Stephan A. Mayer

2009-01-01

220

MR Imaging After Aneurysmal Subarachnoid Hemorrhage and Surgery: A Long-term Follow-up Study  

Microsoft Academic Search

BACKGROUND AND PURPOSE: We assumed that patients with surgically treated aneu- rysmal subarachnoid hemorrhage (SAH) might have more lesions than those revealed by CT that could be visible on MR images. METHODS: We conducted a retrospective study of a series of 147 patients with aneurysmal SAH who were treated surgically within 3 days of the onset of SAH. One hundred

Riku P. Kivisaari; Oili Salonen; Antti Servo; Taina Autti; Juha Hernesniemi; Juha Ohman

221

SPARSITY-BASED DECONVOLUTION OF LOW-DOSE BRAIN PERFUSION CT IN SUBARACHNOID HEMORRHAGE PATIENTS  

E-print Network

years, especially in perfusion CT (CTP) imaging, which has higher radiation dose due to its cine is at risk of infarction and irreversible recovery. However, several recent reports of radiation overSPARSITY-BASED DECONVOLUTION OF LOW-DOSE BRAIN PERFUSION CT IN SUBARACHNOID HEMORRHAGE PATIENTS

Chen, Tsuhan

222

Prophylactic Magnesium Sulfate for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis.  

PubMed

Delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage is a cause of considerable morbidity and mortality. Magnesium sulfate has been proposed as a prophylactic intervention for angiographic vasospasm and to improve clinical outcomes. A systematic review was conducted to determine the evidence for the prophylactic use of magnesium sulfate in aneurysmal subarachnoid hemorrhage. Medline, Embase, Cochrane library, clinicaltrials.gov, and controlled-trials.com were searched with a comprehensive search strategy. 2,035 records were identified in the initial search and 1,574 remained after removal of duplicates. Randomized, parallel group, controlled trials of magnesium sulfate in patients with aneurysmal subarachnoid hemorrhage were included. A total of ten studies were included. Review Manager and GRADE software were used to synthesize the results. The summary effect for Glasgow outcome scale and the modified Rankin scale is a risk ratio (RR) of 0.93 [95 % confidence interval (CI) 0.82-1.06]. The RR for mortality is 0.95 [95 % CI 0.76-1.17]. Delayed cerebral ischemia has a RR of 0.54 [95 % CI 0.38-0.75], which is the only outcome with a statistically significant summary effect measure favoring magnesium treatment. Delayed ischemic neurological deficit has a RR of 0.93 [95 % CI 0.62-1.39]. Transcranial doppler vasospasm has a RR of 0.72 [95 % CI 0.51-1.03]. Current evidence does not support the prophylactic use of magnesium sulfate in aneurysmal subarachnoid hemorrhage. PMID:24619389

Reddy, Deven; Fallah, Aria; Petropoulos, Jo-Anne; Farrokhyar, Forough; Macdonald, R Loch; Jichici, Draga

2014-10-01

223

Effect of Hypervolemic Therapy on Cerebral Blood Flow After Subarachnoid Hemorrhage A Randomized Controlled Trial  

Microsoft Academic Search

Background and Purpose—Cerebral blood flow (CBF) is reduced after subarachnoid hemorrhage (SAH), and symptomatic vasospasm is a major cause of morbidity and mortality. Volume expansion has been reported to increase CBF after SAH, but CBF values in hypervolemic (HV) and normovolemic (NV) subjects have never been directly compared. Methods—On the day after aneurysm clipping, we randomly assigned 82 patients to

Laura Lennihan; Stephan A. Mayer; Matthew E. Fink; Avis Beckford; Myunghee C. Paik; Haiying Zhang; Ya-Chi Wu; Louise M. Klebanoff; Eric C. Raps; Robert A. Solomon

224

Rare anatomical variations of persistent trigeminal artery in two patients with non-aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

Carotid–basilar anastomoses are remnants of the fetal circulation and although rare, they may become symptomatic and should be recognized during cerebral angiography. Two patients are described with non-aneurysmal subarachnoid hemorrhage and persistent trigeminal arteries (PTA) found on cerebral angiography. In the first patient, the PTA ended in the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery. The second

Edgar A Samaniego; Guilherme Dabus; Vincenzo Andreone; Italo Linfante

2010-01-01

225

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link.  

PubMed

We describe two previously unreported associations in four cases. The first two cases demonstrate an association between segmental mediolytic arteriopathy and vascular Ehlers-Danlos syndrome. The second two cases illustrate an association between vascular Ehlers-Danlos syndrome and traumatic subarachnoid hemorrhage. In case 1, there was acute subarachnoid hemorrhage and mesenteric artery dissection. In case 2, there was an acute mesenteric artery dissection with intestinal infarction. In both cases 1 and 2, segmental mediolytic arteriopathy was found in the vertebral arteries. Cases 3 and 4 were sudden deaths from traumatic subarachnoid hemorrhage with intracranial vertebral artery rupture. Genetic testing in all four cases revealed point mutations in the type 3 procollagen gene (COL3A1), as observed in vascular Ehlers-Danlos syndrome. Based on the first two cases, we propose that segmental mediolytic arteriopathy may be a marker for this disease. We further suggest that vascular Ehlers-Danlos syndrome may be related to the pathogenesis of traumatic vertebral artery injury, in some cases. We recommend that cases of segmental mediolytic arteriopathy and traumatic subarachnoid hemorrhage undergo genetic testing for COL3A1 mutations. PMID:21086191

Pickup, Michael J; Pollanen, Michael S

2011-06-01

226

Brain parenchymal, subarachnoid racemose, and intraventricular cysticercosis in an Indian man  

PubMed Central

The coexistence of brain parenchymal cysts at various stages of evolution, both intraventricular and subarachnoid racemose, is reported in a patient with neurocysticercosis. The condition has a variety of presentations, depending on the location of the cyst. This case is of particular interest because of the rarity of this condition in India.???Keywords: brain parenchymal cyst; cysticercosis; albendazole PMID:10448497

Ghosh, D; Dubey, T; Prabhakar, S

1999-01-01

227

Fluid-Attenuated Inversion Recovery MR Imaging and Subarachnoid Hemorrhage: Not a Panacea  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) constitutes an important neurologic emergency. Some authors have suggested that fluid-attenuated inversion recovery (FLAIR) MR imaging can detect SAH that may not be apparent on CT scans but may be revealed by lumbar puncture. We sought to determine how often FLAIR MR imaging findings are positive for SAH in cases with negative CT findings

Mona Mohamed; D. Cressler Heasely; Banu Yagmurlu; David M. Yousem

228

Association of Platelet and Leukocyte Counts with Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage  

Microsoft Academic Search

Background and Purpose: A proinflammatory prothrombotic state may increase the risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). We studied the relationship of levels of leukocytes, platelets, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) with the development of DCI and with clinical outcome in patients with aneurysmal SAH. Methods: In 125 patients admitted within 72 h

K. M. Kasius; C. J. M. Frijns; A. Algra; G. J. E. Rinkel

2010-01-01

229

[Hypertensive putaminal hemorrhage with extensive subarachnoid hemorrhage presenting extravasation of contrast material during angiography: case report].  

PubMed

The authors describe a case of hypertensive putaminal hemorrhage with extensive subarachnoid hemorrhage. On admission, the patient aged 71 presented right-sided motor weakness. CT scan on admission revealed left putaminal hemorrhage with extension into the ipsilateral thalamus and lateral ventricle as well as into the subarachnoid space of the suprasellar, ambient, interhemispheric and contralateral sylvian cisterns. To exclude vascular lesions, left carotid angiography was performed just after admission. The lateral view was unremarkable, but the anterior-posterior view demonstrated extravasation of contrast material from the left lateral lenticulostriate artery. The angiographic sylvian point was shifted to the lateral side. No abnormal vessels were revealed. CT scan after angiography showed exacerbation of both intracerebral and subarachnoid hemorrhages, but the consciousness level was unchanged. CT-guided stereotactic aspiration of the hematoma was performed 4 days after the onset, but failed to remove much hemtoma. The patient died of aspiration pneumonia 9 days after onset. The authors emphasize that extensive subarachnoid hemorrhage in cases with hypertensive putaminal hemorrhage may be an important finding which indicates high risk of rebleeding. PMID:10806632

Kanai, H; Niwa, Y; Koide, K

2000-05-01

230

Ventricular assist devices as rescue therapy in cardiogenic shock after subarachnoid hemorrhage.  

PubMed

We review the journey to myocardial and neurologic recovery of a 42-year-old mother with severe acute cardiogenic shock and multiorgan failure after extensive subarachnoid hemorrhage, who was salvaged successfully using a CentriMag short-term biventricular assist device. PMID:24694427

Al-Adhami, Ahmed; Macfie, Alistair; Mathieson, Calan; Quasim, Isma; Smith, Robyn; Craig, Stewart; Gardner, Roy; Payne, John; Petrie, Mark; Haj-Yahia, Saleem

2014-04-01

231

Timing of operation for poor-grade aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial  

PubMed Central

Background Subarachnoid hemorrhage is a common and dangerous disease with an unfavorable prognosis. Patients with poor-grade subarachnoid hemorrhage (Hunt & Hess Grades 4–5) are unconscious on admission. Because of the high mortality and disability rate associated with poor-grade subarachnoid hemorrhage, it is often treated conservatively. Timing of surgery for poor-grade aneurysmal subarachnoid hemorrhage is still controversial, therefore this study aims to identify the optimal time to operate on patients admitted in poor clinical condition. Methods/design Ninety-nine patients meeting the inclusion criteria were randomly assigned into three treatment groups. The early surgery group received operation within 3 days after onset of subarachnoid hemorrhage (day of SAH?=?day 1); the intermediate surgery group received operation from days 4 to 7, and surgery was performed on the late surgery group after day 7. Follow-up was performed 1, 3, and 6 months after aneurysm clipping. Primary indicators of outcome included the Extended Glasgow Outcome Scale and the Modified Rankin Scale, while secondary indicators of outcome were assessed using the Barthel Index and mortality. Discussion This is the first prospective, single-center, observer-blinded, randomized controlled trial to elucidate optimal timing for surgery in poor-grade subarachnoid hemorrhage patients. The results of this study will be used to direct decisions of surgical intervention in poor-grade subarachnoid hemorrhage, thus improving clinical outcomes for patients. Trial registration Chinese Clinical Trial Registry: ChiCTR-TRC-12002917 PMID:23957458

2013-01-01

232

Recurrent vitreous haemorrhage and epidural haematoma in a child with hypofibrinogenaemia.  

PubMed

A 14-month-old male infant was brought by parents for redness of the right eye of 18 days duration. Exam and B-scan ultrasonography revealed total hyphema, dense vitreous haemorrhage and lens subluxation in the right eye while CT disclosed right small epidural haematoma. The left eye had neither retinal haemorrhage nor disc oedema. There was no sign of shaken baby syndrome. Fibrinogen level in the blood was very low. The parents are first-degree cousins with two family members having hypofibrinogenaemia. Vitreous haemorrhage recurred after surgical intervention resulting in phthisis and loss of vision. Hypofibrinogenaemia needs to be included in the differential diagnosis of ocular haemorrhage and vision loss. PMID:22778479

Mansour, Ahmad M; Jaroudi, Mahmoud O

2012-01-01

233

Fatal haemorrhage from varicose veins: is the correct advice being given?  

PubMed Central

Summary A case report is presented illustrating the occasional sinister nature of varicose veins, revealing the need for assessment of haemorrhage risk of the patient and appropriate advice. PMID:18840868

Cocker, DM; Nyamekye, IK

2008-01-01

234

Contralateral haemorrhagic pulmonary metastases (“choriocarcinoma syndrome”) after pneumonectomy for primary pulmonary choriocarcinoma  

PubMed Central

The case history is presented of a patient which illustrates both the diagnostic difficulties of an extremely rare tumour (choriocarcinoma of the lung) and its associated haemorrhagic metastases (“choriocarcinoma syndrome”). Images PMID:7517072

Durieu, I; Berger, N; Loire, R; Gamondes, J P; Guillaud, P H; Cordier, J F

1994-01-01

235

Genetic heterogeneity in hereditary haemorrhagic telangiectasia: possible correlation with clinical phenotype  

Microsoft Academic Search

Hereditary haemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is an autosomal dominant vascular dysplasia characterised by recurrent haemorrhage. Our initial linkage studies found an HHT gene to be localised to 9q3 in two large kindreds. In the present study, we examine an additional five unrelated HHT families. Linkage analysis in this region resulted in a peak multipoint location score of 13.03,

K A McAllister; F. Lennon; B Bowles-Biesecker; W C McKinnon; E A Helmbold; D S Markel; C E Jackson; A E Guttmacher; M A Pericak-Vance; D A Marchuk

1994-01-01

236

Contrecoup haemorrhage in a patient with left pubic fracture but right obturator artery bleeding.  

PubMed

Contrecoup injury following head trauma is well known. It is caused by the acceleration-deceleration mechanism that can be fully explained by Newton's first law of motion. We report on a victim of a motor vehicle accident with non-displacement left pubis fracture but haemorrhage from the right obturator artery. Contrecoup haemorrhage should be excluded first in unstable patients without evidence of significant trauma but with a minor pelvic fracture. PMID:17652697

Huang, Ying C; Liu, Peter; Su, Jenn-Shyan; Lin, Yi-Lii

2007-08-01

237

Paediatric pulmonary haemorrhage: Independent lung ventilation as effective strategy in management  

PubMed Central

Pulmonary haemorrhage is an uncommon symptom in paediatrics with the etiology varying among the series by age, location, and the diagnostic tests employed. Once airway protection and volume resuscitation are ensured, localization of the anatomic site of bleeding, isolation of the involved airway, control of haemorrhage and treatment of the underlying cause of becomes essential. In localized persistent bleeding, airway control may be achieved by lung isolation with double lumen endotracheal tube and synchronous independent lung ventilation PMID:25316981

Murkute, Amol; Angadi, Ullas; Jain, Pawan; Sharique, Tanzila; Hegde, Rajesh

2014-01-01

238

Pregnancy Complications/Health Problems Complication Explanation  

E-print Network

1 Pregnancy Complications/Health Problems Complication Explanation Preterm Labor Labor that starts Premature Rupture of Membranes (PROM) Amniotic fluid bag surrounding baby ruptures or leaks before labor in pregnancy and goes away after delivery. Preeclampsia (hypertension) Pregnancy induced high blood pressure

Stromswold, Karin

239

Heart rate variability assessment to stratify risk of autonomic imbalance during subarachnoid block: A prospective study  

PubMed Central

Background: Hypotension after subarachnoid block is a common adverse event which can be predicted by simple, safe and indirect measure of autonomic activity. Context: Heart rate variability has been accepted as an indirect measure of autonomic activity. Aim: It was to evaluate preoperatively risk of hypotension after subarachnoid block. Setting and Design: This is controlled, randomized blind prospective study. Materials and Methods: One hundred adult patients of either sex in the age group of 25 to 60 years belonging to ASA physical status of I to III, scheduled for elective infra-umbilical surgery, were enrolled for this randomized prospective study. During preanesthetic check their HRV was analyzed for time domain and frequency domain parameters. They were classified into two groups of 50 patients each depending on their low to high frequency ratios (LF/HF). Group I included patients with LF/HF <2.5 and Group II included patients with LF/HF >2.5. Sensitivity of LF/HF for prediction of hypotension greater than 20% of baseline was tested. Result: The present study showed significant differences of systolic blood pressure (SBP) after subarachnoid block, depending on baseline LF/HF. Patients with low LF/HF showed lowest SBP of 106.08 ± 3.19 (15.22% fall of base line SBP) as compared to high LF/HF which showed 87.62 ± 8.71 (30.26% fall of base line SBP). Baseline LF/HF parameter correlated significantly with proportionate decrease in SBP after subarachnoid blocks. Statistical Analysis: Hemodynamic parameter was analyzed by using student t test on statgraphic version 5.1. Conclusion: Analysis of low and high frequency ratio, reflect autonomic control and may be used as an indirect measure for risk stratification of hypotension after subarachnoid block with high sensitivity.

Sharma, Deepak; Gupta, Kumkum; Gupta, Prashant; Tyagi, S. K.

2011-01-01

240

Historical overview and review of current day treatment in the management of acute variceal haemorrhage  

PubMed Central

Variceal haemorrhage is one of the most devastating consequences of portal hypertension, with a 1-year mortality of 40%. With the passage of time, acute management strategies have developed with improved survival. The major historical treatment landmarks in the management of variceal haemorrhage can be divided into surgical, medical, endoscopic and radiological breakthroughs. We sought to provide a historical overview of the management of variceal haemorrhage and how treatment modalities over time have impacted on clinical outcomes. A PubMed search of the following terms: portal hypertension, variceal haemorrhage, gastric varices, oesophageal varices, transjugular intrahepatic portosystemic shunt was performed. To complement this, Google™ was searched with the aforementioned terms. Other relevant references were identified after review of the reference lists of articles. The review of therapeutic advances was conducted divided into pre-1970s, 1970/80s, 1990s, 2000-2010 and post-2010. Also, a summary and review on the pathophysiology of portal hypertension and clinical outcomes in variceal haemorrhage was performed. Aided by the development of endoscopic therapies, medication and improved radiological interventions; the management of variceal haemorrhage has changed over recent decades with improved survival from an often-terminating event in recent past. PMID:24914369

Rajoriya, Neil; Tripathi, Dhiraj

2014-01-01

241

Pancreaticoduodenectomy: expected post-operative anatomy and complications.  

PubMed

Pancreaticoduodenectomy is a complex, high-risk surgical procedure performed for tumours of the pancreatic head and other periampullary structures. The rate of perioperative mortality has decreased in the past number of years but perioperative morbidity remains high. This pictorial review illustrates expected findings in early and late post-operative periods, including mimickers of pathology. It aims to familiarize radiologists with the imaging appearances of common and unusual post-operative complications. These are classified into early non-vascular complications such as delayed gastric emptying, post-operative collections, pancreatic fistulae and bilomas; late non-vascular complications, for example, biliary strictures and hepatic abscesses; and vascular complications including haemorrhage and ischaemia. Options for minimally invasive image-guided management of vascular and non-vascular complications are discussed. Familiarity with normal anatomic findings is essential in order to distinguish expected post-operative change from surgical complications or recurrent disease. This review summarizes the normal and abnormal radiological findings following pancreaticoduodenectomy. PMID:25026968

McEvoy, S H; Lavelle, L P; Hoare, S M; O'Neill, A C; Awan, F N; Malone, D E; Ryan, E R; McCann, J W; Heffernan, E J

2014-09-01

242

Chemical- and radiation-induced haemorrhagic cystitis: current treatments and challenges  

PubMed Central

To review the published data on predisposing risk factors for cancer treatment-induced haemorrhagic cystitis (HC) and the evidence for the different preventive and therapeutic measures that have been used in order to help clinicians optimally define and manage this potentially serious condition. Despite recognition that HC can be a significant complication of cancer treatment, there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. A systematic literature review was undertaken to evaluate the evidence for preventative measures and treatment options in the management of cancer treatment-induced HC. There is a wide range of reported incidence due to several factors including variability in study design and quality, the type of causal agent, the grading of bleeding, and discrepancies in definition criteria. The most frequently reported causal factors are radiotherapy to the pelvic area, where HC has been reported in up to 20% of patients, and treatment with cyclophosphamide and bacillus Calmette-Guérin, where the incidence has been reported as up to 30%. Mesna (2-mercaptoethane sodium sulphonate), hyperhydration and bladder irrigation have been the most frequently used prophylactic measures to prevent treatment-related cystitis, but are not always effective. Cranberry juice is widely cited as a preventative measure and sodium pentosanpolysulphate as a treatment, although the evidence for both is very limited. The best evidence exists for intravesical hyaluronic acid as an effective preventative and active treatment, and for hyperbaric oxygen as an equally effective treatment option. The lack of robust data and variability in treatment strategies used highlights the need for further research, as well as best practice guidance and consensus on the management of HC. PMID:24000900

Payne, Heather; Adamson, Andrew; Bahl, Amit; Borwell, Jonathan; Dodds, David; Heath, Catherine; Huddart, Robert; McMenemin, Rhona; Patel, Prashant; Peters, John L; Thompson, Andrew

2013-01-01

243

Brain abscess developing in a non-operated spontaneous intracerebral haemorrhage: a case report and literature review.  

PubMed

Brain abscesses are a rare but potentially lethal neurological lesions, generally occurring after septic episodes in immunodeficient patients or complicating neurosurgical procedures. Even though they are known complications of surgically treated intracerebral haemorrhages (ICH), the presence of a brain abscess at the site of an untreated ICH is a rare event. Such cases may result from haematogenous spread from distant foci or contiguous sites and are often preceded by episodes of sepsis and local infection. Immunodeficiency, AIDS, age, diabetes mellitus and vitamin-K deficiency are predisposing factors. Abscess formation should be considered in case of clinical deterioration, headache, and any neurological deficit after febrile episodes. Early diagnosis with neuroradiological imaging, infection blood markers and microbiological identification of the causative pathogen is crucial for treatment with surgical drainage or excision and specific antibiotic therapy, which guarantee good outcome and long-term survival. In fact, while prompt diagnosis and treatment guarantee good outcome and long-term survival, morbidity and mortality are very high in case of misdiagnosis. We report a case of a 49-year old man presenting with a brain abscess 13 weeks after a spontaneous ICH, without previous episodes of sepsis and with a suspected septic arthritis 2 weeks after abscess drainage. PMID:24310475

Rigante, Luigi; Tufo, Tommaso; Scoppettuolo, Giancarlo; Donato, Concetta; Mangiola, Annunziato

2013-01-01

244

Global spread and evolution of viral haemorrhagic septicaemia virus.  

PubMed

Viral haemorrhagic septicaemia virus (VHSV) is a rhabdovirus that infects over 48 species of teleosts and is lethal in many. VHSV threatens marine and aquatic fisheries. VHSV was first discovered outside Europe in 1988 in fish from the Pacific coast of North America. In 1994, VHSV was discovered in Newfoundland. In 2003, VHSV was isolated from fish in Lake St. Clair (Michigan and Ontario). In this study, we used 46 nucleotide sequences for the glycoprotein gene from 12 studies and 150 nucleotide sequences for the nucleoprotein gene from nine studies. We combined phylogenetics and a geographic information system to visualize the transmission paths of VHSV lineages. We also reconstructed the spread of VHSV lineages through optimization of geographic data for viral isolates on phylogenetic trees. We demonstrate that VHSV was transmitted from the North Atlantic Ocean and/or Baltic Sea to the Atlantic coast of North America and Japan in independent events. From the Atlantic coast, the virus was transmitted independently to the Laurentian Great Lakes and the Pacific coast of Canada and the contiguous United States. From the Pacific Northwest, the virus was transmitted to Asia and Alaska in independent events. These results clarify the debate ongoing in the literature on the geographic spread of VHSV. PMID:21916899

Studer, J; Janies, D A

2011-10-01

245

Quality of care in the management of major obstetric haemorrhage.  

PubMed

Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM). 31 cases were identified yielding an incidence of 3.5/1000 deliveries. The predominant causes were uterine atony 11 (35.4%), retained products of conception 6 (19.3%) and placenta praevia/accreta 6 (19.3%). Excellent initial resuscitation and monitoring was noted with a high level of senior staff input. Indicators of QOC compared favourably with the SAMM. Areas for improvement were identified. This pilot study demonstrates the feasibility of detailed prospective data collection in MOH in a busy Dublin obstetric unit with a view to developing a national audit. Standardization of definitions allows for international comparisons. PMID:21675096

Johnson, S N; Khalid, S; Varadkar, S; Fleming, J; Fanning, R; Flynn, C M; Byrne, B

2011-04-01

246

[Ebola and Marburg fever--outbreaks of viral haemorrhagic fever].  

PubMed

With an increasing frequency of traveling and tourism to exotic countries, a new threat-import of rare, very dangerous infections-emerges in humane medicine. Ebola fever and Marburg fever, whose agents come from the same group of Filoviridae family, belong among these diseases. The natural reservoir of these viruses has not yet been precisely determined. The pathogenesis of the diseases is not absolutely clear, there is neither a possibility of vaccination, nor an effective treatment. Fever and haemorrhagic diathesis belong to the basic symptoms of the diseases. Most of the infected persons die, the death rate is 70-88 %. The history of Ebola fever is relatively short-30 years, Marburg fever is known almost 40 years. Hundreds of people have died of these diseases so far. The study involves epidemics recorded in the world and their epidemiological relations. Not a single case has been recorded in the Czech Republic, nevertheless a sick traveler or infected animals are the highest risk of import these diseases. In our conditions, the medical staff belong to a highly endangered group of people because of stringent isolation of patients, strict rules of barrier treatment regime and high infectivity of the diseases. For this reason, the public should be prepared for possible contact with these highly virulent infections. PMID:17230375

Chlíbek, R; Smetana, J; Vacková, M

2006-12-01

247

Clinical and epidemiological patterns of Argentine haemorrhagic fever  

PubMed Central

The epidemiology of Argentine haemorrhagic fever (AHF) is closely related to cricetine rodents acting as natural hosts of Junin virus. The endemo-epidemic area, which has increased 5 times since the disease was first recognized 15-20 years ago, is located in a densely populated region of Argentina. It has been shown that the virus of LCM is active in humans and rodents of the AHF endemic area; this demonstrates the simultaneous presence of two arenaviruses pathogenic for man in a given geographic location. The disease is characterized by haematological, renal, neurological and cardiovascular changes. Electron microscopy and immunohistochemical studies have shown cytopathic changes, characteristic intracellular virus-like particles, and antigenic determinants of Junin virus in different organs from 9 cases of AHF. No deposits of immunoglobulins or C3 were found in the kidneys; in addition, an absence of fibrinogen and C3 in the hepatocytes and of immunoglobulins in the spleen was observed. These findings suggest a direct viral pathogenic action in the human disease. Ultrastructural and immunofluorescence studies in tissues of guinea-pigs inoculated with two strains of Junin virus revealed the presence of the same types of virus-like particles and antigenic determinants of Junin virus as were encountered in the human subjects with AHF. ImagesFig. 2Fig. 3 PMID:1085212

Maiztegui, J. I.

1975-01-01

248

The role of transcranial Doppler ultrasonography in the diagnosis and management of vasospasm after aneurysmal subarachnoid hemorrhage.  

PubMed

Transcranial Doppler ultrasonography (TCD) is a tool employed by the neurosurgeon and neurointensivist in the management of vasospasm in the intensive care unit after aneurysmal subarachnoid hemorrhage. A review of the current indications, monitoring parameters, indices, and relevance of modern TCD technology is provided, as well as algorithms for the use of TCD ultrasonography in the management of patients with subarachnoid hemorrhage. Other current uses of TCD ultrasonography are also discussed in the setting of neurocritical care. PMID:20380971

Marshall, Scott A; Nyquist, Paul; Ziai, Wendy C

2010-04-01

249

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?  

PubMed Central

BACKGROUND: The "Back to Sleep" campaign in 1991 resulted in a dramatic decrease in the incidence of sudden infant death syndrome (SIDS). The proportion of presumed SIDS deaths being actually suspicious deaths from airway obstruction is likely to have become relatively greater. There is usually little pathological evidence to suggest smothering, but intra-alveolar haemorrhage appears to be more prominent in cases where interference with the airway is suspected. AIM: To attempt to quantify intra-alveolar haemorrhage to see whether it could be used as a marker to distinguish between smothering/overlaying and SIDS. METHODS: Intra-alveolar haemorrhage was quantified using digital image analysis on haematoxylin/eosin stained sections taken from the lungs of 62 consecutive infants who had died suddenly and unexpectedly. Cases were initially classified according to the original cause of death. After quantitation, the case histories were critically reviewed. Three pathologists independently made microscopic assessments of the degree of intra-alveolar haemorrhage in the first 24 cases to see whether these accurately reflected the quantitative results. RESULTS: 73% of those infants with a history suggesting possible involuntary overlaying and 45% of those with a history suspicious of smothering had significant intra-alveolar haemorrhage (> 5% of total lung surface area assessed). From the history, the cause of death in 11 cases initially classified as SIDS would better have been given as "Unascertained." Simple microscopic assessments underestimated the true extent of the haemorrhage in 33% (8/24). CONCLUSIONS: If a moderate degree (at least 5%) of pulmonary parenchymal haemorrhage is observed, this may be an indicator of airway obstruction for a significant period, either from overlaying or possibly smothering. The diagnosis of SIDS may be being used inappropriately in such cases. Images PMID:10645227

Yukawa, N; Carter, N; Rutty, G; Green, M A

1999-01-01

250

Comparison effect of intravenous tranexamic acid and misoprostol for postpartum haemorrhage  

PubMed Central

Background: Postpartum haemorrhage (PPH) is the third-most common cause of maternal death in the United States and it is still the first prevalent cause of maternal death in developing countries. Active prevention of haemorrhage with an uterotonic or other new drugs leads to a decrease in postpartum vaginal haemorrhage. The aim of this study was to compare anti-haemorrhagic effect of Tranexamic acid (TXA) and Misoprostol for PPH. Patients and Methods: In a double-blinded randomised control clinical trial, 200 women were included after Caesarean or natural vaginal delivery with abnormal PPH. They were divided into two equal intervention and control groups. Effect of intravenous TXA and Misoprostol for postpartum haemorrhage was examined. Results: The mean age of patients was 26.7 ± 6.5 years which ranged from 14 to 43 years. The sonographic gestational age in the group treated with TXA was 37.7 ± 3.4 weeks and it was 37.4 ± 3.3 weeks for the other group (P = 0.44). The haemorrhage in the TXA and Misoprostol groups was 1.2 ± 0.33 litres and 1.18 ± 0.47 litres, respectively (P = 0.79). The haemoglobin levels after 6-12 hours of labour, in TXA group was more than that of the Misoprostol group, but this difference was not statistically significant (P = 0.22 and P = 0.21, respectively). Conclusion: Regarding to the superior results in Misoprostol group in one hand and lack of significant differences between two groups in haemorrhage during labour, post-partum haemoglobin level and discharge haemoglobin level, we can state that Misoprostol has no specific preferences to TXA, but more studies with greater population are needed. PMID:25114373

Sahhaf, Farnaz; Abbasalizadeh, Shamsi; Ghojazadeh, Morteza; Velayati, Atefeh; Khandanloo, Roya; Saleh, Parviz; Piri, Reza; Naghavi-Behzad, Mohammad

2014-01-01

251

Thermal probes alone or with epinephrine for the endoscopic haemostasis of ulcer haemorrhage.  

PubMed

In the last two decades, significant progress has been made in the diagnosis, prognostication and treatment of patients with severe peptic ulcer haemorrhage. Patients can now be risk stratified by clinical presentation and endoscopic stigmata of ulcer haemorrhage. The purposes of this chapter are to discuss: (1) the techniques of thermal probe with or without epinephrine for haemostasis of ulcers with major stigmata of haemorrhage and (2) the outcomes of treatment of patients with ulcer haemorrhage treated with endoscopic thermal probes or other therapies, medical therapy and/or surgery. Compared to medical therapy alone, patients with major stigmata actively bleeding ulcers, non-bleeding visible vessels and non-bleeding adherent clots have been shown to benefit from endoscopic haemostasis with bipolar probe, heater probe, lasers or epinephrine injection. Outcomes showing significant improvement include blood transfusions, emergency surgery rates and length of hospital stay. Meta-analyses have also reported improvements in mortality for endoscopic compared with medical therapy of patients with severe ulcer haemorrhage and major stigmata. Patients with minor stigmata of ulcer haemorrhage (such as flat spots) or no stigmata (clean-based ulcers) do not benefit from endoscopic haemostasis. Thermal probes have the advantages of good coaptive coagulation, target irrigation, portability and relative inexpense. Recently, patients with active arterial bleeding, non-bleeding adherent clots or non-bleeding visible vessels have been reported to have better results with combination epinephrine injection and thermal probe compared to monotherapy alone (such as injection, bipolar or heater probe). In addition, repeat endoscopic combination therapy has been reported to be as effective but safer than emergency surgery for management of recurrent ulcer haemorrhage. PMID:10952807

Machicado, G A; Jensen, D M

2000-06-01

252

Pulmonary complications after esophagectomy  

Microsoft Academic Search

Background. Pulmonary complications are common in patients who have undergone esophagectomy. There are no good predictive variables for these complications. In addition, the role that preoperative treatment with chemotherapy and radiation may play in postoperative complications remains unclear.Methods. We performed a retrospective review of all patients who underwent esophagectomy by a single surgeon at our institution over a 6-year period.

Christopher E Avendano; Patrick A Flume; Gerard A Silvestri; Lydia B King; Carolyn E Reed

2002-01-01

253

A novel intravital method to evaluate cerebral vasospasm in rat models of subarachnoid hemorrhage: a study with synchrotron radiation angiography.  

PubMed

Precise in vivo evaluation of cerebral vasospasm caused by subarachnoid hemorrhage has remained a critical but unsolved issue in experimental small animal models. In this study, we used synchrotron radiation angiography to study the vasospasm of anterior circulation arteries in two subarachnoid hemorrhage models in rats. Synchrotron radiation angiography, laser Doppler flowmetry-cerebral blood flow measurement, [(125)I]N-isopropyl-p-iodoamphetamine cerebral blood flow measurement and terminal examinations were applied to evaluate the changes of anterior circulation arteries in two subarachnoid hemorrhage models made by blood injection into cisterna magna and prechiasmatic cistern. Using synchrotron radiation angiography technique, we detected cerebral vasospasm in subarachnoid hemorrhage rats compared to the controls (p<0.05). We also identified two interesting findings: 1) both middle cerebral artery and anterior cerebral artery shrunk the most at day 3 after subarachnoid hemorrhage; 2) the diameter of anterior cerebral artery in the prechiasmatic cistern injection group was smaller than that in the cisterna magna injection group (p<0.05), but not for middle cerebral artery. We concluded that synchrotron radiation angiography provided a novel technique, which could directly evaluate cerebral vasospasm in small animal experimental subarachnoid hemorrhage models. The courses of vasospasm in these two injection models are similar; however, the model produced by prechiasmatic cistern injection is more suitable for study of anterior circulation vasospasm. PMID:22428033

Cai, Jun; Sun, Yuhao; Yuan, Falei; Chen, Lujia; He, Chuan; Bao, Yuhai; Chen, Zuoquan; Lou, Meiqing; Xia, Weiliang; Yang, Guo-Yuan; Ling, Feng

2012-01-01

254

A Novel Intravital Method to Evaluate Cerebral Vasospasm in Rat Models of Subarachnoid Hemorrhage: A Study with Synchrotron Radiation Angiography  

PubMed Central

Precise in vivo evaluation of cerebral vasospasm caused by subarachnoid hemorrhage has remained a critical but unsolved issue in experimental small animal models. In this study, we used synchrotron radiation angiography to study the vasospasm of anterior circulation arteries in two subarachnoid hemorrhage models in rats. Synchrotron radiation angiography, laser Doppler flowmetry-cerebral blood flow measurement, [125I]N-isopropyl-p-iodoamphetamine cerebral blood flow measurement and terminal examinations were applied to evaluate the changes of anterior circulation arteries in two subarachnoid hemorrhage models made by blood injection into cisterna magna and prechiasmatic cistern. Using synchrotron radiation angiography technique, we detected cerebral vasospasm in subarachnoid hemorrhage rats compared to the controls (p<0.05). We also identified two interesting findings: 1) both middle cerebral artery and anterior cerebral artery shrunk the most at day 3 after subarachnoid hemorrhage; 2) the diameter of anterior cerebral artery in the prechiasmatic cistern injection group was smaller than that in the cisterna magna injection group (p<0.05), but not for middle cerebral artery. We concluded that synchrotron radiation angiography provided a novel technique, which could directly evaluate cerebral vasospasm in small animal experimental subarachnoid hemorrhage models. The courses of vasospasm in these two injection models are similar; however, the model produced by prechiasmatic cistern injection is more suitable for study of anterior circulation vasospasm. PMID:22428033

Yuan, Falei; Chen, Lujia; He, Chuan; Bao, Yuhai; Chen, Zuoquan; Lou, Meiqing; Xia, Weiliang; Yang, Guo-Yuan; Ling, Feng

2012-01-01

255

Orbital cerebrospinal fluid accumulation after complicated pterional-orbitozygomatic craniotomy.  

PubMed

: We describe 2 patients who developed postoperative orbital cerebrospinal fluid (CSF) collection after orbitozygomatic pterional craniotomy. An 18-year-old woman underwent exploratory pterional-orbitozygomatic craniotomy. Five days postoperatively, after removal of a lumbar drain, proptosis and a compressive optic neuropathy developed. Computed tomography demonstrated a CSF collection contiguous with the craniotomy site. Resolution followed percutaneous aspiration and replacement of the lumbar drain. A 57-year-old woman underwent a pterional-orbitozygomatic craniotomy for removal of a left anterior clinoid meningioma, complicated by a large left hemorrhagic stroke requiring decompressive hemicraniectomy. Extracranial CSF collections accumulated in both the orbit and subgaleal spaces. Resolution followed placement of an external ventricular drain. Based on these cases, the mechanism seems to be the combination of iatrogenic formation of a communication with the subarachnoid space and elevated intracranial pressure. Resolution was achieved by normalizing intracranial pressure. PMID:24699141

Yoon, Michael K; Piluek, Wachirapon Jordan; Ruggiero, Jason P; McDermott, Michael W; McCulley, Timothy J

2014-12-01

256

[Complications in the evolution of haemangiomas and vascular malformations].  

PubMed

The differentiation of haemangiomas and vascular malformations is histological, clinical and prognostic. Although the majority of haemangiomas evolve towards spontaneous resolution, as many as 10% of cases can develop complications with ulceration, pain and haemorrhaging. Besides, the localisation of haemangiomas in the head and neck, next to vital structures, can compromise their functions. Hence, compression of the airway might be a vital emergency. Periorbital haemangiomas can give rise to amblyopia due to sensory deprivation or due to a restrictive strabismus. Lumbosacral haemangiomas must be studied with Nuclear Magnetic Resonance because of their frequent association with alterations in the midline at the level of the spine, anus, genitals or kidneys. Amongst visceral haemangiomas, hepatic haemangiomas are the most serious due to their association with congestive cardiac insufficiency. The association of extensive facial haemangiomas with anomalies of the central nervous system, vascular, cardiac, ocular and sternal anomalies, is denominated PHACE syndrome and is frequently complicated by mental deficiency, convulsions or ictus. Vascular malformations of trigeminal localisation are associated in up to 15% of cases with glaucoma or choroidal or leptomeningeal haemangiomas (Sturge-Weber syndrome). Combined vascular malformations localised in the extremities can become complicated with thrombophlebitis, regional osteolysis and even distant thromboembolisms (Klippel-Treneaunay Syndrome). On the other hand, there is a coagulopathy due to consumption (Kassabach-Merrit Syndrome) that can complicate some vascular tumours such as the Kaposiform haemangioendothelioma and the tufted angioma. Finally, the complications of the treatments employed are reviewed. PMID:15148512

Belzunce, A; Casellas, M

2004-01-01

257

Transoesophageal Echocardiography Related Complications  

PubMed Central

Summary The application of transesophageal echocardiography (TEE) has been continuously increasing over past several decades. It is usually considered a very safe diagnostic and monitoring device. Though the complications are rare, but these complications must be known to the operators performing TEE. The goal of this article is to encapsulate the potential complications associated with TEE. The complications are primarily related to gastrointestinal, cardiovascular and respiratory systems along with some miscellaneous problems related to probe insertion, drugs and inexperience of the operator. Strategies for the prevention of these complications are also analyzed in order to avoid the risk. PMID:20640107

Mathur, S K; Singh, Pooja

2009-01-01

258

A new experimental model in rats for study of the pathophysiology of subarachnoid hemorrhage.  

PubMed

A new experimental model of subarachnoid hemorrhage (SAH) in rats is described. A needle was stereotaxically placed in the prechiasmatic cistern and 300, 250 or 200 microl of blood was injected manually, keeping the intracranial pressure (ICP) at the mean arterial blood pressure (MABP) level. An acceptable mortality was observed only after injection of 200 microl of blood. In this group, MABP and ICP increased immediately after SAH, but soon approached baseline levels. The subarachnoid blood was mainly distributed in the basal cisternal system and its estimated volume was about 95% of the amount injected. This new model resembles clinical SAH, is very reproducible, easy to use and seems to be a suitable model for studies of the pathophysiology of SAH. PMID:12499866

Prunell, Giselle F; Mathiesen, Tiit; Svendgaard, Niels-Aage

2002-12-20

259

Multimodal endovascular treatment of a vertebrovertebral fistula presenting with subarachnoid hemorrhage and hydrocephalus  

PubMed Central

Vertebrovertebral fistulae are rare vascular malformations that uncommonly can rupture to present clinically as intracranial subarachnoid hemorrhage. We present a 69-year-old man presenting following spontaneous apoplectic collapse. Initial workup revealed diffuse, intracranial subarachnoid hemorrhage, intraventricular hemorrhage, and hydrocephalus. However, the etiology was not apparent on CT angiography of the head. Catheter-based angiography was performed, demonstrating a single-hole, high-flow vertebrovertebral fistula, arising from the V2 segment and decompressing into both cervical and skull base venous structures. Definitive treatment consisted of endovascular fistula obliteration with a combination of coil and liquid embolic material. The patient made a full neurological recovery. High cervical and skull base fistulae are rare causes of intracranial hemorrhage; endovascular treatment is effective at disconnection of the arteriovenous shunt. PMID:23830589

Walcott, Brian P.; Berkhemer, Olvert A.; Leslie-Mazwi, Thabele M.; Chandra, Ronil V.; Ogilvy, Christopher S.; Yoo, Albert J.

2013-01-01

260

[Factors affecting the development of chronic hydrocephalus following subarachnoid hemorrhage, with special emphasis on the role of ventricular and lumbar drainage].  

PubMed

Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage. Numerous studies have dealt so far with the triggering cause of the chronic cerebrospinal fluid (CSF) absorptional and circulatory disorders. Despite the fact that these studies gave several different explanations, most of them agreed on the fact that the obstruction of CSF pathway has a crucial role in the development of the clinical feature. By examining three years' clinical cases, the authors were trying to find out which are the factors that influence the development of the late hydrocephalus which follows the subarachnoid hemorrhage; moreover to find out if the incidence of the latter may be decreased by a continuous drainage of CSF which advances its purification. One hundred and seventy-one patients (one hundred and twenty-seven females) were treated by aneurysmal SAH at Department of Neurosurgery, University of Szeged between 2002 and 2005. The following parameters were recorded: gender, clinical state, risk factors (smoking, consuming alcohol and hypertension), the method and the time of surgical treatment as well as CSF drainage. The studies have shown that the risk of incidence of chronic hydrocephalus were higher in men and in case of severe clinical state with severe SAH. The disturbed CSF circulation and/or absorption were positively correlated with consuming alcohol and hypertension, while smoking did not affect it. The rate of the incidence of chronic hydrocephalus among our patients was lower (5.8%) compared to the results of other studies (7-40%) suggests that disturbance of CSF circulation and/or absorption may be avoided in the majority of cases by continuous external ventricular or lumbar CSF drainage, which is applied routinly. PMID:19685703

Fülöp, Béla; Deak, Gábor; Mencser, Zoltán; Kuncz, Adám; Barzó, Pál

2009-07-30

261

The effect of subarachnoid epinephrine and phenylephrine on spinal cord blood flow  

Microsoft Academic Search

Eighteen mongrel dogs were divided into three equal groups. Spinal cord and spinal durat blood flow in the cervical, thoracic\\u000a and lumbosacral regions were measured using the radioactive microsphere technique. Measurements were taken before and 10 and\\u000a 40 minutes after lumbar subarachnoid injection of one of the following: (I) physiologic saline; (2) epinephrine200 ?g or (3)\\u000a phenylephrine 5 mg. No

Raymond Kozody; Richard J. Palahniuk; John G. Wade; Maureen O. Cumming; Wayne R. Pucci

1984-01-01

262

Preserved BK Channel Function in Vasospastic Myocytes from a Dog Model of Subarachnoid Hemorrhage  

Microsoft Academic Search

Cerebral vasospasm after subarachnoid hemorrhage (SAH) is due to contraction of smooth muscle cells in the cerebral arteries. The mechanism of this contraction, however, is not well understood. Smooth muscle contraction is regulated in part by membrane potential, which is determined by K+ conductance in smooth muscle. Voltage-gated (Kv) and large-conductance, Ca2+-activated K+ (BK) channels dominate arterial smooth muscle K+

Babak S. Jahromi; Yasuo Aihara; Jinglu Ai; Zhen-Du Zhang; George Weyer; Elena Nikitina; Reza Yassari; Khaled M. Houamed; R. Loch Macdonald

2008-01-01

263

Impaired Calcium Regulation of Smooth Muscle During Chronic Vasospasm Following Subarachnoid Hemorrhage  

Microsoft Academic Search

The intracellular calcium level was determined in the canine basilar artery to investigate whether Ca2+ regulation of its smooth muscle is altered during chronic vasospasm following subarachnoid hemorrhage. A double-hemorrhage model was used. The occurrence of vasospasm was confirmed angiographically 7 days after initial hemorrhage. The intracellular calcium concentration ([Ca2+]i) of smooth muscle was measured using Fura-2. Fluorescence to excitation

Phyo Kim; Yuhei Yoshimoto; Masamitsu Iino; Sasaki Tomio; Takaaki Kirino; Yoshiaki Nonomura

1996-01-01

264

Gender Influences the Initial Impact of Subarachnoid Hemorrhage: An Experimental Investigation  

PubMed Central

Aneurysmal subarachnoid hemorrhage (SAH) carries high early patient mortality. More women than men suffer from SAH and the average age of female SAH survivors is greater than that of male survivors; however, the overall mortality and neurological outcomes are not better in males despite their younger age. This pattern suggests the possibility of gender differences in the severity of initial impact and/or in subsequent pathophysiology. We explored gender differences in survival and pathophysiology following subarachnoid hemorrhage induced in age-matched male and female rats by endovascular puncture. Intracranial pressure (ICP), cerebral blood flow (CBF), blood pressure (BP) and cerebral perfusion pressure (CPP) were recorded at and after induction of SAH. Animals were sacrificed 3 hours after lesion and studied for subarachnoid hematoma size, vascular pathology (collagen and endothelium immunostaining), inflammation (platelet and neutrophil immunostaining), and cell death (TUNEL assay). In a second cohort, 24-hour survival was determined. Subarachnoid hematoma, post-hemorrhage ICP peak, BP elevation, reduction in CPP, intraluminal platelet aggregation and neutrophil accumulation, loss of vascular collagen, and neuronal and non-neuronal cell death were greater in male than in female rats. Hematoma size did not correlate with the number of apoptotic cells, platelet aggregates or neutrophil. The ICP peak correlated with hematoma size and with number of apoptotic cells but not with platelet aggregates and neutrophil number. This suggests that the intensity of ICP rise at SAH influences the severity of apoptosis but not of inflammation. Mortality was markedly greater in males than females. Our data demonstrate that in rats gender influences the initial impact of SAH causing greater bleed and early injury in males as compared to females. PMID:24250830

Friedrich, Victor; Bederson, Joshua B.; Sehba, Fatima A.

2013-01-01

265

Impact of medical treatment on the outcome of patients after aneurysmal subarachnoid hemorrhage  

Microsoft Academic Search

BACKGROUND AND PURPOSE: The rationale behind early aneurysm surgery in\\u000a patients with subarachnoid hemorrhage (SAH) is the prevention of\\u000a rebleeding as early as possible after SAH. In addition, by clipping the\\u000a aneurysm as early as possible, one can apply treatment for cerebral\\u000a ischemia more vigorously (induced hypertension) without the risk of\\u000a rebleeding. Hypervolemic hemodilution is now a well-accepted treatment for

Frederique H Vermeij; Djo Hasan; Henk W. C. Bijvoet; Cees J. J. Avezaat

1998-01-01

266

Enhanced antinociception by nicotinic receptor agonist epibatidine and adrenal medullary transplants in the spinal subarachnoid space  

Microsoft Academic Search

Adrenal medullary transplants in the spinal subarachnoid space can reduce nociception, via the release of catecholamines and other analgesic substances, and this may be enhanced by stimulation of transplanted chromaffin cell surface nicotinic acetylcholine receptors (nAChRs). In addition, spinal nAChRs have been implicated in modulating nociception and can interact synergistically with ?-adrenergic agents. Thus, enhanced antinociception by potent nAChR agonists

Alberto J Caban; Aldric T Hama; Jeung Woon Lee; Jacqueline Sagen

2004-01-01

267

Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation  

Microsoft Academic Search

Study design: Review and analysis of seven cases of syringomyelia treated surgically.Objective: To demonstrate the beneficial role of decompressive surgery for the altered cerebrospinal fluid (CSF) flow dynamics in syringomyelia not associated with Chiari I malformation. A comparison between the pre- and post-operative syrinx size and CSF flow in the subarachnoid space was made using cine-mode magnetic resonance imaging (cine-MRI)

J-H Lee; C-K Chung; HJ Kim

2002-01-01

268

Spontaneous intradural disc herniation with focal distension of the subarachnoid space in a dog  

PubMed Central

Myelo-computed tomography of a paraparetic 14-year-old dog revealed subarachnoid distension with an intradural filling defect above the T13–L1 disc space. T12–L1 hemilaminectomy followed by durotomy allowed removal of a large piece of degenerated disc material that compressed the spinal parenchyma. Full return to function was achieved 10 days post-surgery. The distension was likely secondary to the intradural herniation, and is a rare and distinct finding. PMID:23633713

Barnoon, Itai; Chai, Orit; Srugo, Itai; Peeri, Dana; Konstantin, Lilach; Brenner, Ori; Shamir, Merav H.

2012-01-01

269

Risk Factors for Fatal Subarachnoid Hemorrhage The Japan Collaborative Cohort Study  

Microsoft Academic Search

Background and Purpose—The present study aimed to identify risk factors for mortality due to subarachnoid hemorrhage (SAH) using a comprehensive questionnaire from the Japan Collaborative Cohort (JACC) Study, a Japan-wide population-based prospective study. Methods—A total of 109 293 individuals (45 551 men and 63 742 women, aged 40 to 79 years) free of stroke at entry participated in the JACC

Shigeki Yamada; Akio Koizumi; Hiroyasu Iso; Yasuhiko Wada; Yoshiyuki Watanabe; Chigusa Date; Akio Yamamoto; Shogo Kikuchi; Yutaka Inaba; Hideaki Toyoshima; Takaaki Kondo; Akiko Tamakoshi

2010-01-01

270

Gene Transfer of Calcitonin Gene-Related Peptide Prevents Vasoconstriction After Subarachnoid Hemorrhage  

Microsoft Academic Search

We sought to determine whether adenovirus-mediated gene transfer in vivo of calcitonin gene-related peptide (CGRP), a potent vasodilator, ameliorates cerebral vasoconstriction after experimental subarachnoid hemorrhage (SAH). Arterial blood was injected into the cisterna magna of rabbits to mimic SAH 5 days after injection of AdRSVCGRP (83108 pfu), AdRSVbgal (control virus), or vehicle. After injection of AdRSVCGRP, there was a 400-fold

Kazunori Toyoda; Frank M. Faraci; Yoshimasa Watanabe; Toshihiro Ueda; Jon J. Andresen; Yi Chu; Shoichiro Otake; Donald D. Heistad

271

Effect of an antioxidant, ebselen, on development of chronic cerebral vasospasm after subarachnoid hemorrhage in primates  

Microsoft Academic Search

BACKGROUNDOxidation and\\/or free radical reactions after subarachnoid hemorrhage (SAH) may be involved in the development of chronic cerebral vasospasm. The inhibition of these reactions is thought to be one of the therapeutic strategies for prevention of cerebral vasospasm. We investigated the effect of Ebselen, a synthetic seleno-organic compound, which exhibits anti-oxidation by glutathione peroxidaselike activity to inhibit free radical reactions

Yuji Handa; Masanori Kaneko; Hiroaki Takeuchi; Akira Tsuchida; Hidenori Kobayashi; Toshihiko Kubota

2000-01-01

272

The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath  

Microsoft Academic Search

Summary The presence of enlarged optic nerve sheaths (ONS) suggests that raised intracranial pressure is transmitted to the perineural subarachnoid space (SAS). This phenomenon has gained interest because ultrasound methods are able to quantify the optic nerve sheath diameter (ONSD)in-vivo non-invasively with a resolution below 0.5 mm. In order to study the normal variation and distensibility of the human ONS.

HC Hansen; K Helmke

1996-01-01

273

[Perforation and haemorrhage duodenal bulbar ulcers in a child: a case report].  

PubMed

A perforation rarely reveals a primary duodenal ulcer. The occurring of digestive haemorrhage in post operative followings evokes spontaneously a stress ulcer. We report an observation of a child who presented on fourth day delay after operation an ulcer of the anterior duodenal bulbar face and a haemorrhage of the posterior bulbar face. A 7-year-old girl with no particular pathological antecedent was admitted for abdominal pain, bile vomiting and constipation evolving since 6 days. Clinical examination revealed a general state thickening, an infectious syndrome, a meteoric and general abdominal sensitivity. The abdominal radiography without preparation showed a pneumoperitoneum. The surgical exploration discovered a perforated ulcer on the bulbar anterior face. A simple closure associated with omental patch was performed. Four days after operation, she presented an abundant digestive haemorrhage with shock. The resuscitation did not improve the patient's general state. The upper digestive endoscopy revealed a haemorrhage of the posterior bulbar face. An adrenalin injection stopped the bleeding. The treatment by neutron pump inhibitors and an eradicating treatment of Helicobacter pylori permitted the healing of the ulcers. The occurring of digestive haemorrhage in the followings of surgical intervention for perforated ulcer involves an upper digestive endoscopy. This examination can reveal misdiagnosed ulcer during the surgical exploration and permits to perform a haemostatic act. PMID:19102114

Ngom, G; Diouf, M L; Fall, M; Konaté, I; Sankalé, A A; Diop, M; Fall, I; Ndoye, M

2008-01-01

274

Intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage.  

PubMed

Although most patients with intracranial hypotension typically present with headaches, the rest of the clinical spectrum is characteristically non-specific and often quite variable. In a patient with concurrent pathologies that can produce a similar clinical picture, a high index of suspicion must be maintained to achieve the correct diagnosis. The authors report a patient with intracranial hypotension in the setting of concurrent perineural cyst rupture and subarachnoid hemorrhage. A 63-year-old woman with a family history of ruptured intracranial aneurysms presented after a sudden thunderclap headache and was found to have diffuse subarachnoid hemorrhage. Imaging revealed anterior communicating and superior hypophyseal artery aneurysms. Following the uneventful clipping of both aneurysms, the patient experienced a delayed return to her neurological baseline. After it was noted that the patient had an improved neurological examination when she was placed supine, further investigation confirmed intracranial hypotension from perineural cyst rupture. The patient improved and returned to her neurological baseline after undergoing a high-volume blood patch and remained neurologically intact at postoperative follow-up. Although intracranial hypotension is known to be commonly associated with cerebrospinal fluid leak, its causal and temporal relationship with subarachnoid hemorrhage has yet to be elucidated. PMID:24314847

Sivakumar, Walavan; Ravindra, Vijay M; Cutler, Aaron; Couldwell, William T

2014-06-01

275

Theoretical foundations for non-invasive measurement of variations in the width of the subarachnoid space  

NASA Astrophysics Data System (ADS)

Numerical modeling was used for the theoretical analysis of the propagation of optical radiation in the tissues of the human head, generated by a single source placed on the surface of the scalp. Of special interest and importance is the propagation of radiation within the layer of cerebrospinal fluid contained in the subarachnoid space (SAS), which is the only low absorption/high transmittance medium whose width can vary rapidly. Qualitative and quantitative assessment of changes in propagation of radiation within the SAS could become a source of information on changes in the geometry of this anatomical compartment playing a crucial role in cranio-spinal physiology and pathology. Essential for the idea of the possible noninvasive assessment of changes in width of the SAS by an optical method is the dependence of intensity of radiation reaching a photodetector located at a certain distance from the source on changes in the width of this fluid layer, which acts like a biological optical waveguide. Monte Carlo modeling and numerical analysis confirmed the feasibility of assessing changes in the width of the subarachnoid space optically. Presented here are details of the Monte Carlo simulation of light propagation in the tissues of human head and the results of such simulation as a function of the width of the subarachnoid space, calculated for different distances between the source and detector and for a few selected values of bone thickness. Results of numerical modeling were then compared with those of experiments on a mechanical-optical model.

Plucinski, Jerzy; Frydrychowski, Andrzej F.; Kaczmarek, Jacek; Juzwa, Witold

2000-07-01

276

Possible role of Eptifibatide drip in-patient with aneurysmal subarachnoid hemorrhage in vasospasm prevention  

PubMed Central

Objective Approximately 18,000 patients suffer from a subarachnoid hemorrhage (SAH) in the United States annually. SAH is a form of stroke and comprises 1%–5% of all strokes. Nearly 50% of all SAH cases end in fatality within 30 days of presentation; one of eight patients die before reaching a hospital. Those who survive often have neurological or cognitive impairment. Methods This case report describes the course of two patients who presented to the emergency department with aneurismal subarachnoid hemorrhage and received external ventricular drainage and endovascular treatment of their aneurysm. Results Both patients required treatment with Eptifibatide drip after endovascular approach and their SAH in the basal cisterns resolved by day 5. Neither patient developed signs of clinical or subclinical vasospasm. Comments Eptifibatide drip facilitated resolution of the thick clot in the subarachnoid space early enough to eliminate the direct toxicity of oxyhemoglobin on the cerebral arteries and arachnoid granulations, thus preventing vasospasm and eliminating the necessity for a long-term shunt. PMID:25298852

Dababneh, Haitham; Guerrero, Waldo; Mehta, Siddhart; Moussavi, Mohammad; Kirmani, Jawad F

2014-01-01

277

Detection of Gnathostoma spinigerum antibodies in sera of non-traumatic subarachnoid hemorrhage patients in Thailand.  

PubMed

Gnathostoma spinigerum can cause subarachnoid hemorrhage (SAH). The detection of specific antibodies in serum against G. spinigerum antigen is helpful for diagnosis of neurognathostomiasis. There is limited data on the frequency of G. spinigerum infection in non-traumatic SAH. A series of patients diagnosed as non-traumatic SAH at the Srinagarind Hospital, Khon Kaen University, Thailand between January 2011 and January 2013 were studied. CT or MR imaging of the brain was used for diagnosis of SAH. Patients were categorized as aneurysmal subarachnoid hemorrhage (A-SAH) or non-aneurysmal subarachnoid hemorrhage (NA-SAH) according to the results of cerebral angiograms. The presence of specific antibodies in serum against 21- or 24-kDa G. spinigerum antigen was determined using the immunoblot technique. The detection rate of antibodies was compared between the 2 groups. Of the 118 non-traumatic SAH patients for whom cerebral angiogram and immunoblot data were available, 80 (67.8%) patients had A-SAH, whereas 38 (32.2%) had NA-SAH. Overall, 23.7% were positive for specific antibodies against 21- and/or 24-kDa G. spinigerum antigen. No significant differences were found in the positive rate of specific antibodies against G. spinigerum in both groups (P-value=0.350). PMID:24516286

Kitkhuandee, Amnat; Munkong, Waranon; Sawanyawisuth, Kittisak; Janwan, Penchom; Maleewong, Wanchai; Intapan, Pewpan M

2013-12-01

278

Eighteen years of vaccination against viral haemorrhagic septicaemia in France.  

PubMed

Viral haemorrhagic septicaemia (VHS) has been considered for many years to be a major cause of loss in the French trout industry. The high prevalence of VHS in certain geographic areas made a control strategy based on control policy unfeasible. This provided the impetus for immunoprophylaxis development that resulted in 3 successive types of vaccines: inactivated, live attenuated and recombinant vaccines. When delivered by intraperitoneal injection, the 2 propiolactone-inactivated VHS virus was immunogenic and/or protective for trout all of sizes, but it was not suitable for the practical immunization of alevin, the trout life stage that is the most sensitive to VHS. A carp cell-passed, attenuated variant of the VHS virus was effective after both immersion or injection delivery and met the practical requirements of juvenile vaccination. However, this vaccine was discarded because it retained some virulence that discouraged the launching of its commercialization. Then came the era of genetically engineered vaccines. The recombinant glycoprotein of VHSV produced in Escherichia coli or in Saccharomyces cerevisiae failed to protect fish whatever the route of delivery. A recombinant baculovirus vaccine was found to be immunogenic and protective against VHS, but only when delivered by injection. Due to its cost and route of delivery, the latter vaccine was not licensed. Simultaneously, the sudden occurrence of another rhabdovirosis, infectious haematopoietic necrosis (IHN), in France, rendered vaccination against VHS questionable. Indeed, no cross-protection between these 2 rhabdoviroses exists. If vaccination is still believed to be an effective control method for VHS, it should be based in the future upon an autoreplicative vaccine.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8581010

de Kinkelin, P; Béarzotti, M; Castric, J; Nougayrède, P; Lecocq-Xhonneux, F; Thiry, M

1995-01-01

279

Acute intracerebral haemorrhage: grounds for optimism in management.  

PubMed

Spontaneous intracerebral haemorrhage (ICH) is one of the most devastating types of stroke, which has considerable disease burden in "non-white" ethnic groups where the population-attributable risks of elevated blood pressure are very high. Since the treatment of ICH remains largely supportive and expectant, nihilism and the early withdrawal of active therapy influence management decisions in clinical practice. However, approaches to management are now better defined on the basis of evidence that both survival and speed (and degree) of recovery are critically dependent on the location, size, and degree of expansion and extension into the intraventricular system of the haematoma of the ICH. Although no medical treatment has been shown to improve outcome in ICH, several promising avenues have emerged that include haemostatic therapy and intensive control of elevated blood pressure. Conversely, there is continued controversy over the role of evacuation of the haematoma of ICH via open craniotomy. Despite being an established practice for several decades, and having undergone evaluation in multiple randomised trials, there is uncertainty over which patients have the most to gain from an intervention with clear procedural risk. Minimally invasive surgery via local anaesthetic applied drill-puncture of the cranium and infusion of a thrombolytic agent is an attractive option for patients requiring critical management of the haematoma, not just in low resource settings but arguably also in specialist centres of western countries. With several ongoing clinical trials nearing completion, these treatments could enter routine practice within the next few years, further justifying the urgency of "time is brain" and that active management within well-organized, comprehensive acute stroke care units includes patients with ICH. PMID:23088860

Delcourt, Candice; Anderson, Craig

2012-12-01

280

[Continuous intrathecal administration of nicardipine using a portable infusion pump system for management of vasospasm after subarachnoid hemorrhage].  

PubMed

We studied the feasibility of intrathecal nicardipine administration using a portable infusion pump system in five cases (two males and three females) of subarachnoid hemorrhage (SAH). All of the five cases manifested severe SAH of Hunt & Kosnic grade 3 or 4, and Fisher CT group 3. Aneurysmal sites of five cases were as follows: three internal carotid-posterior communicating artery (IC-PC) aneurysms and two anterior communicating artery (Acom) aneurysms. The container of the infusion pump system was filled with 105 ml of nicardipine-saline solution (2:1), and this system was connected to the cisternal tube. The solution was continuously injected at a daily dose of 12 ml (8 mg of nicardipine). This therapy was continued for 14 days, and new nicardipine solution was supplied only once at 8 days after the operation during this therapy. No postural restraint of patients was necessary, even during physical movement for rehabilitation. Postoperative angiography was performed in three of five cases at one week after the operation. No angiographic vasospasm was observed in any of the three cases. Symptomatic vasospasm was observed in one case of right IC-PC aneurysm as a transient total aphasia and right hemiplegia, which recovered within several hours due to induced hypervolemia and hypertension therapy. Mild meningitis at 14 days after the operation complicated this treatment in one case, but it improved in a few days after the cisternal tube was removed. It was speculated that meningitis was caused by cerebrospinal fluid leakage from the scalp exit site of the cisternal tube. All of the five cases had obtained good recovery at three months after the operation. These results show that, although this method involves a risk of infection, it has the advantage of easiness and convenience over conventional methods. Though further improvement of this method is required, this preliminary stage is potentially useful for delivering not only nicardipine, but also for other drugs which may be used in intrathecal administration therapy. PMID:11218763

Fujiwara, K; Mikawa, S; Ebina, T

2001-01-01

281

Protective effect of stellate ganglion block on delayed cerebral vasospasm in an experimental rat model of subarachnoid hemorrhage.  

PubMed

Stellate ganglion block (SGB) is a blockade of sympathetic ganglia innervating the head and neck, and is known to function through vasodilation of the target region. However, the effectiveness of SGB in relieving cerebral vasospasm (CVS) through dilation of intracerebral vessels has not been evaluated. The aim of the present study is to investigate the therapeutic effects of SGB in a rat model of subarachnoid hemorrhage (SAH) complicated by delayed CVS, and explore the underlying mechanisms. The SAH model was established by double injection of autologous arterial blood into the cisterna magna. We simulated SGB by transection of the cervical sympathetic trunk (TCST), and measured changes in the diameter, perimeter and cross-sectional area of the basilar artery (BA) and middle cerebral artery (MCA) to evaluate its vasodilatory effect. To investigate the underlying mechanisms, we determined the expression level of vasoactive molecules endothelin-1 (ET-1) and calcitonin gene-related peptide (CGRP) in the plasma, and apoptotic modulators Bcl-2 and Bax in the hippocampus. We found a significant increase in the diameter, perimeter and cross-sectional area of the BA and right MCA in SAH rats subjected to TCST. Application of SGB significantly reduced the expression of ET-1 while increasing that of CGRP in SAH rats. We also found a significant increase in the expression of Bcl-2 and decrease in the expression of Bax in the hippocampus of SAH rats subjected to TCST, when compared to untreated SAH rats. The mechanism of action of SGB is likely mediated through alterations in the ratio of ET-1 and CGRP, and Bax and Bcl-2. These results suggest that SGB can alleviate the severity of delayed CVS by inducing dilation of intracerebral blood vessels, and promoting anti-apoptotic signaling. Our findings provide evidence supporting the use of SGB as an effective and well-tolerated approach to the treatment of CVS in various clinical settings. PMID:25128600

Hu, Na; Wu, Yun; Chen, Bai-Zhao; Han, Jin-Feng; Zhou, Mai-Tao

2014-10-17

282

Skeletal muscle PO2: indicator of peripheral tissue perfusion in haemorrhagic shock.  

PubMed

The following conclusions can be made on the basis of this work: 1) Measurements of skeletal muscle oxygen tension provide an excellent index of tissue perfusion in haemorrhagic shock. 2) Correction of cardiac output and arterial blood oxygen tension in haemorrhagic shock does not necessarily ensure normal tissue oxygenation. 3) In haemorrhagic shock adequate replacement of blood loss using a balanced salt solution in addition to blood replacement is an integral part of the fluid management. 4) Correction of hypovolemia with an equivalent volume of a plasma expander and subsequent reinfusion of shed blood also returns tissue perfusion to normal. However, this treatment results in marked haemodilution and correction of extracellular fluid loss remains inadequate. PMID:26185

Niinikoski, J; Halkola, L

283

Mosquito-borne haemorrhagic fevers of South and South-East Asia*  

PubMed Central

During the past decade outbreaks of a severe haemorrhagic disease caused by dengue viruses of multiple types have been reported in the Philippines, Thailand, Malaysia, Viet-Nam and eastern India. In many of these outbreaks chikungunya virus, a group A arbovirus, was simultaneously the cause of similar but probably milder disease. Both these viruses appear to be able to be able to produce classical dengue fever in some individuals and disease with haemorrhagic manifestations in others. Because of the growing public health importance and the progressive spread of this disease a unified review of its clinical and epidemiological features has been needed. This paper presents the history and salient clinical features of mosquito-borne haemorrhagic fever and summarizes recent epidemiological studies and current diagnostic and control methods. ImagesFIG. 4 PMID:5297536

Halstead, Scott B.

1966-01-01

284

Superselective Embolisation in Acute Lower Gastrointestinal Haemorrhage: A Single Institution Experience  

PubMed Central

Background: Superselective embolisation has been recognised as integral in the management of lower gastrointestinal haemorrhage. It has also reduced the need for emergency surgery. The objective of this case series was to describe the lower gastrointestinal haemorrhage cases seen in our centre, its diagnosis and the role of superselective embolisation in patient management. Methods: All patients who underwent superselective embolisation from January 2008 until April 2009 in our centre were analysed. Data were collected from the hospital electronic medical records. Results: Four patients (three males) with a mean age of 81 years were analysed. Multidetector computerised tomography and digital subtraction angiography were positive in all patients. Superselective embolisation with platinum microcoils was performed in all patients (n = 4). Technical success was achieved in all patients (100%). Conclusion: Superselective embolisation in the treatment of lower gastrointestinal haemorrhage is safe and effective with a very high technical success rate. PMID:22135510

Md Ralib, Ahmad Razali; Zakaria, Rozman; Mohamad, Zahiah; Muda, Ahmad Sobri

2009-01-01

285

Tattoo-associated complications.  

PubMed

Tattoo rates in the United States have been rising in recent years, with an expected concomitant rise in tattoo-associated complications. Tattoo complications range from cutaneous localized and generalized inflammatory eruptions, to local bacterial or viral infections, and finally to infectious endocarditis and hepatitis. Many complications may be avoided with proper counseling prior to tattoo placement, especially in high risk individuals. It is important for physicians to be able to recognize and diagnose complications from tattoos to avoid morbidity and possible mortality. PMID:23287600

Juhas, Elizabeth; English, Joseph C

2013-04-01

286

Association between circulating angiotensin-converting enzyme and exercise-induced pulmonary haemorrhage in Thoroughbred racehorses.  

PubMed

Exercise-induced pulmonary haemorrhage has an impact on racehorse performance. Although endoscopic diagnosis (with or without the aid of bronchoalveolar lavage) is considered to be the standard diagnostic method for this condition, the use of biomarkers that could aid in quantifying risk and severity of the condition would represent an advance in equine sport medicine. This preliminary research investigated the use of angiotensin-converting enzyme (ACE) activity in plasma of racehorses and demonstrated that ACE activity is increased in horses with higher degrees of haemorrhage and is a promising biomarker for EIPH in racehorses. PMID:22196974

Costa, M F M; Ronchi, F A; Ivanow, A; Carmona, A K; Casarini, D; Slocombe, R F

2012-10-01

287

Vascular complications of osteochondromas  

Microsoft Academic Search

Purpose: Osteochondromas are the most common benign tumor of the bone. They are sometimes responsible for vascular complications involving either veins or arteries, principally around the knee.Methods: We report six cases of such complications. An extensive review of literature through a computerized research was performed.Results: We found 97 cases that were previously reported in the English literature giving sufficient details

Marc-Antoine Vasseur; Oliver Fabre

2000-01-01

288

Severe rectal haemorrhage after treatment for faecal incontinence  

PubMed Central

Bulking agent injected submucosally is an alternative effective treatment for faecal incontinence in elderly patients who fail conservative measures. Since most elderly patients are on antiplatelet therapy and are sometimes unaware of their medication, this can lead to serious complications. PMID:25180215

Taggarshe, Deepa; Visco, Jeffrey J.

2014-01-01

289

Scientific foundation and possible implications for practice of the Minimizing Adverse Haemorrhagic Events by Transradial Access Site andSystemic Implementation of AngioX (MATRIX) trial.  

PubMed

Early invasive management and the use of combined antithrombotic therapies have decreased the risk of recurrent ischaemia in patients with acute coronary syndrome (ACS) but have also increased the bleeding risk. Transradial intervention (TRI) and bivalirudin infusion compared to transfemoral intervention (TFI) or unfractionated heparin (UFH) plus glycoprotein IIb/IIIa inhibitors (GPI) decrease bleeding complications in patients with ACS. To what extent, a bleeding preventive strategy incorporating at least one of these two treatment options translates into improved outcomes is a matter of debate. The Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX study is a large-scale, multicenter, prospective, open-label trial, conducted at approximately 100 sites in Europe aiming to primarily assess whether TRI and bivalirudin infusion, as compared to TFI and UFH plus provisional GPI, decrease the 30-day incidence of death, myocardial infarction or stroke across the whole spectrum of ACS patients. PMID:24395497

Valgimigli, Marco; Calabrò, Paolo; Cortese, Bernardo; Frigoli, Enrico; Garducci, Stefano; Rubartelli, Paolo; Andò, Giuseppe; Santarelli, Andrea; Galli, Mario; Garbo, Roberto; Repetto, Alessandra; Ierna, Salvatore; Briguori, Carlo; Limbruno, Ugo; Violini, Roberto; Gagnor, Andrea

2014-02-01

290

Neurologic complications of carcinoid.  

PubMed

We reviewed the records of all patients treated for carcinoid tumors at Memorial Sloan-Kettering Cancer Center from 1974 through 1984. Of 219 patients, 90 developed metastatic complications, and of these, 36 developed neurologic complications. Metastases, the most common neurologic complication, included epidural spinal cord compression (14 patients), intracranial metastases (13 patients), leptomeningeal metastases (1 patient), and peripheral nerve lesions (5 patients). Nonmetastatic complications were hepatic encephalopathy (six patients), herpes zoster infection (two patients), cerebral infarction due to septic emboli (one patient), superior sagittal sinus thrombosis (one patient), and carcinoid myopathy (one patient). The carcinoid syndrome was seen in eight patients (4%). Response of neurologic metastases to conventional radiation therapy was usually favorable. We conclude that (1) the frequency and type of neurologic complications associated with carcinoid tumors are similar to those seen with other systemic cancers; (2) CNS metastases are relatively common in patients with metastatic carcinoid (29%); and (3) the carcinoid syndrome is less common than CNS metastasis. PMID:3703281

Patchell, R A; Posner, J B

1986-06-01

291

Modelling impact-initiated wave transmission through lung parenchyma in relation to the aetiology of exercise-induced pulmonary haemorrhage.  

PubMed

Recently we proposed that exercise-induced pulmonary haemorrhage (EIPH) results from locomotory-impact-induced trauma by impact of the scapula on the chest wall during footfall and the consequent transmission of waves through the lung. A computational model has been developed to demonstrate that wave amplification and focusing occur in the dorsocaudal tip of the lung for waves originating on the anterior subscapular surface. The propagation of an acoustic wave was investigated in a simplified 2-dimensional representation of a vertical anterio-dorsal section of horse lung. It was demonstrated that a complicated pattern of waves is transmitted from the scapula to the dorsal region. Wave motion was characterised using the instantaneous rate of change of pressure with time (dp/dt) which is associated with lung injury. Due to wave reflection and focusing, dp/dt is transiently very high on the spinal and diaphragmatic lung walls, particularly in the vicinity of the dorsal tip. The model therefore predicts that lung injury may occur in the region in which EIPH is reported to originate. PMID:10659218

Schroter, R C; Leeming, A; Denny, E; Bharath, A; Marlin, D J

1999-07-01

292

Specific cancer rates may differ in patients with hereditary haemorrhagic telangiectasia compared to controls  

PubMed Central

Background Hereditary haemorrhagic telangiectasia (HHT) is inherited as an autosomal dominant trait, affects ~1 in 5,000, and causes multi-systemic vascular lesions and life-limiting complications. Life expectancy is surprisingly good, particularly for patients over 60ys. We hypothesised that individuals with HHT may be protected against life-limiting cancers. Methods To compare specific cancer rates in HHT patients and controls, we developed a questionnaire capturing data on multiple relatives per respondent, powered to detect differences in the four most common solid non skin cancers (breast, colorectal, lung and prostate), each associated with significant mortality. Blinded to cancer responses, reports of HHT-specific features allowed assignment of participants and relatives as HHT-subjects, unknowns, or controls. Logistic and quadratic regressions were used to compare rates of specific cancer types between HHT subjects and controls. Results 1,307 participants completed the questionnaire including 1,007 HHT-subjects and 142 controls. The rigorous HHT diagnostic algorithm meant that 158 (12%) completed datasets were not assignable either to HHT or control status. For cancers predominantly recognised as primary cancers, the rates in the controls generally matched age-standardised rates for the general population. HHT subjects recruited through the survey had similar demographics to controls, although the HHT group reported a significantly greater smoking habit. Combining data of participants and uniquely-reported relatives resulted in an HHT-arm of 2,161 (58% female), and control-arm of 2,817 (52% female), with median ages of 66ys [IQR 53–77] and 77ys [IQR 65–82] respectively. In both crude and age-adjusted regression, lung cancers were significantly less frequent in the HHT arm than controls (age-adjusted odds ratio 0.48 [0.30, 0.70], p?=?0.0012). Breast cancer prevalence was higher in HHT than controls (age-adjusted OR 1.52 [1.07, 2.14], p?=?0.018). Overall, prostate and colorectal cancer rates were equivalent, but the pattern of colorectal cancer was modified, with a higher prevalence in younger HHT patients than controls. Conclusions These preliminary survey data suggest clinically significant differences in the rates of lung, breast and colorectal cancer in HHT patients compared to controls. For rare diseases in which longitudinal studies take decades to recruit equivalent datasets, this type of methodology provides a good first-step method for data collection. PMID:24354965

2013-01-01

293

Impact of rabbit haemorrhagic disease on introduced predators in the Flinders Ranges, South Australia  

Microsoft Academic Search

The impact of rabbit haemorrhagic disease (RHD) on the population dynamics and diet of foxes and feral cats was studied in the Flinders Ranges, South Australia. Populations of both foxes and cats decreased substantially some 6-10 months after the advent of RHD, when rabbit numbers were reduced by 85%. The diet of foxes changed as a result of reduced rabbit

C. HoldenA; G. MutzeB

294

Feasibility of electrical impedance tomography in haemorrhagic stroke treatment using adaptive mesh  

NASA Astrophysics Data System (ADS)

EIT has been proposed for acute stroke differentiation, specifically to determine the type of stroke, either ischaemia (clot) or haemorrhage (bleed) to allow the rapid use of clot-busting drugs in the former (Romsauerova et al 2006) . This addresses an important medical need, although there is little treatment offered in the case of haemorrhage. Also the demands on EIT are high with usually no availability to take a 'before' measurement, ruling out time difference imaging. Recently a new treatment option for haemorrhage has been proposed and is being studied in international randomised controlled trial: the early reduction of elevated blood pressure to attenuate the haematoma. This has been shown via CT to reduce bleeds by up to 1mL by Anderson et al 2008. The use of EIT as a continuous measure is desirable here to monitor the effect of blood pressure reduction. A 1mL increase of haemorrhagic lesion located near scalp on the right side of head caused a boundary voltage change of less than 0.05% at 50 kHz. This could be visually observed in a time difference 3D reconstruction with no change in electrode positions, mesh, background conductivity or drift when baseline noise was less than 0.005% but not when noise was increased to 0.01%. This useful result informs us that the EIT system must have noise of less than 0.005% at 50 kHz including instrumentation, physiological and other biases.

Nasehi Tehrani, J.; Anderson, C.; Jin, C.; van Schaik, A.; Holder, D.; McEwan, A.

2010-04-01

295

Computational Intelligence Method for Early Diagnosis Dengue Haemorrhagic Fever Using Fuzzy on Mobile Device  

NASA Astrophysics Data System (ADS)

Mortality from Dengue Haemorrhagic Fever (DHF) is still increasing in Indonesia particularly in Jakarta. Diagnosis of the dengue shall be made as early as possible so that first aid can be given in expectation of decreasing death risk. The Study will be conducted by developing expert system based on Computational Intelligence Method. On the first year, study will use the Fuzzy Inference System (FIS) Method to diagnose Dengue Haemorrhagic Fever particularly in Mobile Device consist of smart phone. Expert system application which particularly using fuzzy system can be applied in mobile device and it is useful to make early diagnosis of Dengue Haemorrhagic Fever that produce outcome faster than laboratory test. The evaluation of this application is conducted by performing accuracy test before and after validation using data of patient who has the Dengue Haemorrhagic Fever. This expert system application is easy, convenient, and practical to use, also capable of making the early diagnosis of Dengue Haemorraghic to avoid mortality in the first stage.

Salman, Afan; Lina, Yen; Simon, Christian

2014-03-01

296

PATHOGENESIS OF THE GRAFT-VERSUS-HOST REACTION IN CHICKEN EMBRYOS. THE DEVELOPMENT OF HAEMORRHAGIC LESIONS  

Microsoft Academic Search

Adult, allogeneic lymphoid tissue was introduced into chicken embryos on day 4 or clay 6 by inoculation on the chorio-allantoic membrane, intravenous injection or intracoelomic grafting. Severe haemorrhagic lesions appeared on the body surface and in the chorio-allantoic membrane within 6 days after the inoculation of donor cells. However, there was no spleen enlargement in these embryos. The development of

Karen Z Walker; Gutta I Schoefl; KJ Lafferty; EP Adams

1973-01-01

297

A limited outbreak of Ebola haemorrhagic fever in Etoumbi, Republic of Congo, 2005  

Microsoft Academic Search

Ebolavirus has caused highly lethal outbreaks of haemorrhagic fever in the Congo basin. The 2005 outbreak in the Republic of Congo occurred in the Etoumbi district of Cuvette Ouest Department between April and May. The two index cases were infected while poaching. The sanitary response consisted of active surveillance and contact tracing, public awareness campaigns and community mobilization, case management

Dieudonné Nkoghe; Mamadou Lamine Kone; Adamou Yada; Eric Leroy

2011-01-01

298

Mountain sickness, retinal haemorrhages, and acclimatisation on Mount Everest in 1975  

Microsoft Academic Search

During the 1975 British Everest Expedition, which made the first ascent of the south-west face, observations were made in relation to mountain sickness and the appearance of retinal changes. Two Sherpas with cerebral oedema and one Briton with pulmonary oedema were treated. Retinal haemorrhages occurred in four out of six Britons who were newcomers to altitudes over 6000 m (19

C Clarke; J Duff

1976-01-01

299

Effect of bedding on the incidence of exercise induced pulmonary haemorrhage in racehorses in Hong Kong  

Microsoft Academic Search

An investigation into the incidence of exercise induced pulmonary haemorrhage (EIPH) in thoroughbreds in Hong Kong was carried out between the 1981 and 1983 racing seasons. A total of 1039 post race endoscopic examinations were performed in 1982-1983 and the results indicated that 46.8 per cent of runners had EIPH. This was not statistically different from the percentage of horses

DK Mason; EA Collins; KL Watkins

1984-01-01

300

Women's breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study  

Microsoft Academic Search

BACKGROUND: Postpartum haemorrhage (PPH) is a significant and increasing contributor to maternal mortality and morbidity. Following a PPH, women may have difficulties initiating and sustaining breastfeeding, although little has been published on this issue. The aim of this study was to describe breastfeeding experiences in a cohort of women following a significant PPH. METHODS: This is a descriptive study based

Jane F Thompson; Laura J Heal; Christine L Roberts; David A Ellwood

2010-01-01

301

Nosocomial infection of Crimean-Congo haemorrhagic fever in eastern Iran: case report.  

PubMed

An outbreak of Crimean-Congo haemorrhagic fever occurred in the county of Birjand in eastern Iran in November 2011. Four cases were involved in this outbreak. Two patients died after admission to hospital, one of whom was a nurse who acquired the infection nosocomially, and the others were treated successfully. PMID:23266037

Chinikar, Sadegh; Shayesteh, Majid; Khakifirouz, Sahar; Jalali, Tahmineh; Rasi Varaie, Fereshteh Sadat; Rafigh, Mahboubeh; Mostafavi, Ehsan; Shah-Hosseini, Nariman

2013-01-01

302

The role of angiography in the management of haemorrhage from major fractures of the pelvis  

Microsoft Academic Search

n a series of 150 consecutive patients with unstable fractures of the pelvis, angiography was performed in 23 (15%) who had uncontrolled hypotension. There were three anteroposterior compression (APC), eight lateral compression (LC) and 12 vertical shear (VS) injuries. Arterial sources of haemorrhage were identified in 18 (78%) patients and embolisation was performed. Angiography was required in 28% of VS

R. E. Cook; J. F. Keating; I. Gillespie

2002-01-01

303

Initial enlargement of the opposite pupil as a false localising sign in intraparenchymal frontal haemorrhage  

Microsoft Academic Search

Ipsilateral third nerve palsy with early pupillary enlargement is an important sign of transtentorial herniation from a supratentorial mass lesion. A case of frontal, intraparenchymal haemorrhage is reported in which the first ocular manifestation of transtentorial herniation was enlargement of the contralateral pupil. The ipsilateral pupil dilated only after complete oculomotor palsy of the contralateral eye. After partial frontal lobectomy

R Chen; R Sahjpaul; R F Del Maestro; L Assis; G B Young

1994-01-01

304

Experimental respiratory Marburg virus haemorrhagic fever infection in the common marmoset (Callithrix jacchus)  

PubMed Central

Marburg virus causes a highly infectious and lethal haemorrhagic fever in primates and may be exploited as a potential biothreat pathogen. To combat the infection and threat of Marburg haemorrhagic fever, there is a need to develop and license appropriate medical countermeasures. To determine whether the common marmoset (Callithrix jacchus) would be an appropriate model to assess therapies against Marburg haemorrhagic fever, initial susceptibility, lethality and pathogenesis studies were performed. Low doses of virus, between 4 and 28 TCID50, were sufficient to cause a lethal, reproducible infection. Animals became febrile between days 5 and 6, maintaining a high fever before succumbing to disease between 8 and 11 days postchallenge. Typical signs of Marburg virus infection were observed including haemorrhaging and a transient rash. In pathogenesis studies, virus was isolated from the animals’ lungs from day 3 postchallenge and from the liver, spleen and blood from day 5 postchallenge. Early signs of histopathology were apparent in the kidney and liver from day 3. The most striking features were observed in animals exhibiting severe clinical signs, which included high viral titres in all organs, with the highest levels in the blood, increased levels in liver function enzymes and blood clotting times, decreased levels in platelets, multifocal moderate-to-severe hepatitis and perivascular oedema. PMID:23441639

Smither, Sophie J; Nelson, Michelle; Eastaugh, Lin; Laws, Thomas R; Taylor, Christopher; Smith, Simon A; Salguero, Francisco J; Lever, Mark S

2013-01-01

305

Ebola haemorrhagic fever among hospitalised children and adolescents in nothern Uganda : Epidemiologic and clinical observations  

Microsoft Academic Search

Background A unique feature of previous Ebola outbreaks has been the relative sparing of children. For the first time, an out break of an unusual illness-Ebola haemorrhagic fever occurred in Northern Uganda - Gulu district. Objectives To describe the epidemiologic and clinical aspects of hospitalised children and adolescents on the isolation wards. Methods A retrospective descriptive survey of hospital records

Kaducu O. F

2001-01-01

306

Genetic background and risk of postpartum haemorrhage: results from an Italian cohort of 3219 women.  

PubMed

Postpartum haemorrhage (PPH) is a leading cause of maternal mortality, particularly in the developing countries, and of severe maternal morbidity worldwide. To investigate the impact of genetic influences on postpartum haemorrhage, in association with maternal and intrapartum risk factors, using a candidate gene approach. All women (n = 6694) who underwent a vaginal delivery at the Obstetric Unit of a large University hospital in Milan (Italy) between July 2007 and September 2009 were enrolled. The first consecutive 3219 women entered the genetic study. Postpartum haemorrhage was defined as ?500 mL blood loss. Eight functional polymorphisms in seven candidate genes were chosen because of their potential role in predisposing to or protecting from haemorrhagic conditions: tissue factor (F3), factor V (F5), tissue factor pathway inhibitor (TFPI), platelet glycoprotein Ia/IIa (ITGA2), prothrombin (F2), platelet glycoproteins Ib? (GP1BA) and angiotensin-converting enzyme (ACE). After correction for the already known PPH risk factors, only the promoter polymorphism of the tissue factor gene (F3 -603A>G) showed a significant association with PPH, the G allele exerting a protective effect (P = 0.00053; OR = 0.79, 95% CI = 0.69-0.90). The protective effect against PPH of the TF -603A>G polymorphism is biologically plausible since the G allele is associated with an increased protein expression and Tissue Factor is strongly represented in the placenta at term, particularly in decidual cells of maternal origin. PMID:25333208

Biguzzi, E; Franchi, F; Acaia, B; Ossola, W; Nava, U; Paraboschi, E M; Asselta, R; Peyvandi, F

2014-11-01

307

Viral haemorrhagic septicaemia virus induces vig -2, a new interferon-responsive gene in rainbow trout  

Microsoft Academic Search

An mRNA differential display methodology was used to study the rainbow trout response to viral infection. A new transcript (vig -2) induced by viral haemorrhagic septicaemia virus (VHSV) in rainbow trout leucocytes was identified from the head-kidney. vig -2 was also induced in vivo during experimental infection and following DNA immunisation with a plasmid containing a gene encoding the viral

Pierre Boudinot; Samia Salhi; Mar Blanco; Abdenour Benmansour

2001-01-01

308

Encephalitis complicating smallpox vaccination.  

PubMed

A smallpox vaccination program has been initiated. The vaccine is a live virus that was used in the last century. Postvaccinal encephalitis is a complication of this vaccine. The clinical presentation, course, neuroimaging findings, and spinal fluid abnormalities are similar to a disorder that physicians are familiar with, acute disseminated encephalomyelitis. This complication can be prevented with the administration of antivaccinia gamma globulin at the time of vaccination. Antivaccinia gamma globulin is not efficacious once this complication occurs. Intravenous methylprednisolone is the recommended therapy, although intravenous immunoglobulin and plasmapheresis should be investigated in the treatment of postvaccinal encephalitis. PMID:12873847

Miravalle, Augusto; Roos, Karen L

2003-07-01

309

Syringomyelia and spinal arachnoiditis resulting from aneurysmal subarachnoid hemorrhage: Report of two cases and review of the literature  

PubMed Central

Syringomyelia resulting from arachnoiditis secondary to aneurysmal subarachnoid hemorrhage (SAH) is an extremely rare clinical entity with few cases reported in the literature. The presentation, management, and pathogenesis of syringomyelia in this setting is poorly understood. We describe the presentation, radiology, management, and outcomes in two patients with syringomyelia resulting from arachnoiditis secondary to aneurysmal SAH and review the literature on this rare condition. Case number 1 was treated successfully with syrinx-subarachnoid shunt after extensive lysis of adhesions. Case number 2 was treated with syringoperitoneal shunt. Both patients had radiographic decreased syrinx size postoperatively. These patients add to the small literature on syringomyelia occurring secondary to SAH-associated arachnoiditis. The radiographic outcomes demonstrate that in the appropriately selected patient, syrinx-subarachnoid or syringoperitoneal shunting are viable options. PMID:25013348

Abel, Taylor J.; Howard, Matthew A.; Menezes, Arnold

2014-01-01

310

Filament perforation model for mouse subarachnoid hemorrhage: Surgical-technical considerations.  

PubMed

Abstract Objective. Mouse subarachnoid hemorrhage (SAH) models are becoming increasingly important. We aimed to report and discuss the detailed technical-surgical approach and difficulties associated with the circle of Willis perforation (cWp) model, with reference to the existing literature. Methods. First, the cWp model was reproduced using ddY mice following scarification at 0 h, Days 1, 2, and 3 after SAH. Second, C57BL/6 mice were subjected to SAH with histological examination on Days 1, 2, and 3. Sham-operated mice were sacrificed on Day 2. Neurological performance, amount of subarachnoid blood, cerebral vasospasm (CVS), and neuronal injury were assessed. Relevant articles found in the MEDLINE database were reviewed. Results. Induction of SAH was successfully reproduced. The volume of subarachnoid blood decreased with time due to resorption. Neurological performance was worse in SAH compared with sham. Signs of CVS could be confirmed on Days 2 and 3, but not Day 1. The cumulative number of microthrombi was significantly higher on Days 2 and 3, but not Day 1. Apoptotic and degenerative neurons were found in the cortex and hippocampal area. Our review of the literature revealed the cWp model to be the most frequently used. The present findings largely confirmed previously published results. However, detailed technical-surgical description and its discussion were sparse, which we provide here. Conclusions. The current study provides additional useful information characterizing the cWp model. This model may be of first choice at present, as important pathologies can be reproduced and most findings in the literature are based on it. PMID:24842082

Muroi, Carl; Fujioka, Masayuki; Okuchi, Kazuo; Fandino, Javier; Keller, Emanuela; Sakamoto, Yuya; Mishima, Kenichi; Iwasaki, Katsunori; Fujiwara, Michihiro

2014-12-01

311

International subarachnoid aneurysm trial - ISAT Part II: Study protocol for a randomized controlled trial  

PubMed Central

Background The International Subarachnoid Aneurysm Trial (ISAT) demonstrated improved one-year clinical outcomes for patients with ruptured intracranial aneurysms treated with endovascular coiling compared to surgical clipping. Patients included in ISAT were mostly good grade subarachnoid hemorrhage (SAH) patients with small anterior circulation aneurysms. The purported superiority of coiling is commonly extrapolated to patients not studied in the original trial or to those treated using new devices not available at the time. Conversely, many patients are treated by clipping despite ISAT, because they are thought either to be better candidates for surgery, or to offer more durable protection from aneurysm recurrences. These practices have never been formally validated. Thus, for many ruptured aneurysm patients the question of which treatment modality leads to a superior clinical outcome remains unclear. Methods/trial design ISAT II is a pragmatic, multicenter, randomized trial comparing clinical outcomes for non-ISAT patients with subarachnoid hemorrhage allocated to coiling or clipping. Inclusion criteria are broad. The primary end-point is the incidence of poor clinical outcome (defined as mRS >2) at one year, just as in ISAT. Secondary end-points include measures of treatment safety for a number of pre-specified subgroups, with efficacy end-points including the presence of a major recurrence at one year; 1,896 patients (862 each arm plus 10% losses) are required to demonstrate a significant difference between coiling and clipping, hypothesizing 23% and 30% poor clinical outcome rates, for coiling and clipping, respectively. The trial should involve at least 50 international centers, and will take approximately 12 years to complete. Analysis will be by intention-to-treat. Trial registration ISAT II is registered at clinicaltrials.gov: NCT01668563. PMID:23714335

2013-01-01

312

Prolongation of subarachnoid block by intravenous dexmedetomidine for sub umbilical surgical procedures: A prospective control study  

PubMed Central

Background: Intravenous dexmedetomidine is used as adjuvant during general anesthesia due to its sedative and analgesic effects. The present study was aimed to evaluate the effects of intravenous dexmedetomidine on sensory and motor block characteristics, hemodynamic parameters and sedation during subarachnoid block. Materials and Methods: In this double-blind randomized placebo control study, 60 patients of American Society of Anesthesiologist I and II were randomized into two groups by computer generated table. Patients of Group D administered intravenous dexmedetomidine 0.5 ?g/kg and patients of Group C received similar volume of normal saline, administered after 20 min of subarachnoid block with 0.5% hyperbaric bupivacaine. The cephalic level of sensory block, total duration of sensory analgesia and motor block were recorded. Sedation scores using Ramsey Sedation Score (RSS) and hemodynamic changes were also assessed. Results: Demographic profile, duration of surgery and cephalic level of sensory block were comparable. The time for two segments regression was 142.35 ± 30.7 min in Group D, longer than Group C (98.54 ± 23.2 min). Duration of sensory blockade was 259.7 ± 46.8 min in the Group D versus 216.4 ± 31.4 min in Group C (P < 0.001). The mean duration of motor blockade showed no statistically significant difference between groups. There was clinically significant decrease in heart rate and blood pressure in patients of Group D. The RSS was higher (arousable sedation) in patients of Group D. No respiratory depression was observed. Conclusion: Intravenous dexmedetomidine in dosage of 0.5 ?g/kg, administered after 20 min of subarachnoid block prolonged the duration of sensory and motor blockade with arousable sedation.

Gupta, Kumkum; Tiwari, Vaibhav; Gupta, Prashant K.; Pandey, M. N.; Agarwal, Salony; Arora, Ankush

2014-01-01

313

Subarachnoid and Intraventricular Hemorrhage due to Ruptured Aneurysm after Combined Spinal-Epidural Anesthesia  

PubMed Central

A patient received combined spinal-epidural anesthesia for a scheduled total knee arthroplasty. After an injection of spinal anesthetic and ephedrine due to a decrease in blood pressure, the patient developed a severe headache. The patient did not respond to verbal command at the completion of the operation. A brain CT scan revealed massive subarachnoid and intraventricular hemorrhages, and a CT angiogram showed a ruptured aneurysm. Severe headaches should not be overlooked in an uncontrolled hypertensive patient during spinal anesthesia because it may imply an intracranial and intraventricular hemorrhage due to the rupture of a hidden aneurysm. PMID:20376909

Chun, Duk-Hee; Kim, Na-Young

2010-01-01

314

Biportal neuroendoscopic microsurgical approaches to the subarachnoid cisterns. A cadaver study.  

PubMed

A preclinical cadaver study was performed to develop the technique of biportal neuroendoscopic dissection in the subarachnoid space of the basal cisterns and to test the feasibility, utility, and safety of this new technique. In 23 fresh post-mortem adult human cadavers and 2 formalin-fixed adult human head specimen a total of 33 biportal endomicrosurgical dissections into and within the basal cisterns were carried out. Following suction of cerebrospinal fluid from the subarachnoid space 0 degree-, 30 degrees-, and 70 degrees-lens-scopes (Aesculap AG, Tuttlingen, Germany) with outer diameters of 4.2 mm and trochars with outer diameters of 5 to 6.5 mm were introduced into the surgical field. 6 different endoscopic routes to the basal cisterns and a total of 10 different combinations of these approaches for biportal endoneurosurgery could be described, but it was found that not all of them were useful and safe. The transventricular approach to the prepontine cisterns through the foramen of Monro and the floor of the third ventricle, biportally combined with a subfrontal or a subtemporal approach, turned out to be not safe enough as it was accompanied by traumatization of the fornix at the interventricular foramen and of the hypothalamus at the level of the tuber cinereum due to relaxation and caudal shift of the brain following suction of cerebrospinal fluid to clear the basal cisterns for the subfrontal or subtemporal approaches. Useful and safe endomicrosurgical approaches to the basal cisterns were: 1st subfrontal, either epidural or intradural, 2nd subtemporal, either anterior or posterior, and 3rd frontal interhemispheric. Various biportal combinations of these approaches are estimated to be feasible, useful, and safe enough to be performed during microsurgical procedures in the operating room. The biportal endomicrosurgical strategy allows for effective and safe dissections within the subarachnoid spaces of the basal cisterns. The tip of the microinstruments as well as the neighboring anatomical structures can be nicely controlled at angles of about 60 degrees to 180 degrees depending on the viewing angles of the scopes used and depending on the individual shape of the head. A variety of microsurgical instruments has been tested. A number of these will have to be redesigned for this new technique. Regions suitable for biportal neuroendoscopic subarachnoid preparations are the olfactory groove, the prechiasmatic cistern, the region of the optic chiasm, the entire suprasellar area, parts of the parasellar area, the pre- and perimesencephalic cisterns, and the prepontine cistern. PMID:9007826

Fries, G; Reisch, R

1996-12-01

315

[Neurological complications in uremia].  

PubMed

Neurological complications due to the uremic state or hemodialysis, contribute to the important cause of mortality in patients with uremia. Despite continuous advances in uremic treatment, many neurological complications of uremia, like uremic encephalopathy, peripheral neuropathy and myopathy fail to fully respond to hemodialysis. Moreover, hemodialysis or kidney transplantation may even induce neurological complications. Hemodialysis can directly or indirectly be associated with Wernicke's encephalopathy, dialytic dementia, dysequilibrium syndrome, cerebrovascular accidents, osmotic myelinolysis and mononeuropathy. Renal transplantation can give rise to rejection encephalopathy and acute femoral neuropathy. The use of immunosuppressive drugs after renal transplantation can cause reversible posterior leukoencephalopathy encephalopathy. The clinical, pathophysiological and therapeutical aspects of central nervous system, peripheral nervous system and myopathy complications in uremia are reviewed. PMID:18686653

Fong, Chin-Shih

2008-06-01

316

Complications of Circumcision  

PubMed Central

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events. PMID:22235177

Krill, Aaron J.; Palmer, Lane S.; Palmer, Jeffrey S.

2011-01-01

317

Pregnancy Complications: Shoulder Dystocia  

MedlinePLUS

... In the NICU Home after the NICU Your premature baby Birth Defects Loss and grief Pregnancy loss Newborn loss ... and the baby do well and have no permanent damage. But there may be some complications. For ...

318

Systemic Amyloidosis Complicating Dermatoses.  

National Technical Information Service (NTIS)

Certain dermatoses may be complicated by systemic amyloidosis. The underlying disorders in eight of 100 patients with secondary systemic amyloidosis studied at autopsy were: hidradenitis suppurativa, stasis ulcers, psoriatic arthritis, basal cell carcinom...

M. H. Brownstein, E. B. Helwig

1970-01-01

319

Tetanus: Symptoms and Complications  

MedlinePLUS

... of the muscles of the jaw, or "lockjaw". Tetanus symptoms include: Headache Jaw cramping Sudden, involuntary muscle ... sweating High blood pressure and fast heart rate Tetanus complications include: Uncontrolled/involuntary muscular contraction of the ...

320

Chickenpox (Varicella) Complications  

MedlinePLUS

... People at High Risk for Complications Interpreting Lab Tests Assessing Immunity Managing People at Risk for Severe Varicella Preventing Varicella in Healthcare Settings Monitoring the Impact of Varicella Vaccination Conducting Varicella Surveillance Laboratory Testing ...

321

Complications of circumcision  

Microsoft Academic Search

Circumcision remains the most common operation performed on males. Although, not technically difficult, it is accompanied\\u000a by a rate of morbidity and can result in complications ranging from trivial to tragic. The reported incidence of complications\\u000a varies from 0.1% to 35% the most common being infection, bleeding and failure to remove the appropriate amount of foreskin.\\u000a Forty patients suffering from

O. Latifoglu; R. Yavuzer; S. Ünal; A. Sari; S. Çenetoglu; N. K. Baran

1999-01-01

322

[Type 2 diabetes complications].  

PubMed

People with type 2 diabetes are at increased risk of many complications, which are mainly due to complex and interconnected mechanisms such as hyperglycemia, insulino-resistance, low-grade inflammation and accelerated atherogenesis. Cardi-cerebrovascular disease are frequently associated to type 2 diabetes and may become life threatening, particularly coronaropathy, stroke and heart failure. Their clinical picture are sometimes atypical and silencious for a long time. Type 2 diabetes must be considered as an independent cardiovascular risk factor. Nephropathy is frequent in type 2 diabetes but has a mixed origin. Now it is the highest cause of end-stage renal disease. Better metabolic and blood pressure control and an improved management of microalbuminuria are able to slowdown the course of the disease. Retinopathy which is paradoxically slightly progressive must however be screened and treated in these rather old patients which are globally at high ophthalmologic risk. Diabetic foot is a severe complication secondary to microangiopathy, microangiopathy and neuropathy. It may be considered as a super-complication of several complications. Its screening must be done on a routine basis. Some cancer may be considered as an emerging complication of type 2 diabetes as well as cognitive decline, sleep apnea syndrome, mood disorders and bone metabolism impairments. Most of the type 2 diabetes complications may be prevented by a strategy combining a systematic screening and multi-interventional therapies. PMID:23528336

Schlienger, Jean-Louis

2013-05-01

323

Phenotypic transformation of smooth muscle in vasospasm after aneurysmal subarachnoid hemorrhage.  

PubMed

Differentiated smooth muscle cells (SMC) control vasoconstriction and vasodilation, but they can undergo transformation, proliferate, secret cytokines, and migrate into the subendotherial layer with adverse consequences. In this review, we discuss the phenotypic transformation of SMC in cerebral vasospasm after subarachnoid hemorrhage. Phenotypic transformation starts with an insult as caused by aneurysm rupture: Elevation of intracranial and blood pressure, secretion of norepinephrine, and mechanical force on an artery are factors that can cause aneurysm. The phenotypic transformation of SMC is accelerated by inflammation, thrombin, and growth factors. A wide variety of cytokines (e.g., interleukin (IL)-1?, IL-33, matrix metalloproteinases, nitric oxidase synthases, endothelins, thromboxane A2, mitogen-activated protein kinase, platelet-derived vascular growth factors, and vascular endothelial factor) all play roles in cerebral vasospasm (CVS). We summarize the correlations between various factors and the phenotypic transformation of SMC. A new target of this study is the transient receptor potential channel in CVS. Statin together with fasdil prevents phenotypic transformation of SMC in an animal model. Clazosentan prevents CVS and improves outcome in aneurysmal subarachnoid hemorrhage in a dose-dependent manner. Clinical trials of cilostazol for the prevention of phenotypic transformation of SMC have been reported, along with requisite experimental evidence. To conquer CVS in its complexity, we will ultimately need to elucidate its general, underlying mechanism. PMID:24323729

Shimamura, Norihito; Ohkuma, Hiroki

2014-06-01

324

A Non-Human Primate Model of Aneurismal Subarachnoid Hemorrhage (SAH).  

PubMed

Aneurismal subarachnoid hemorrhage (SAH) is relatively rare form of hemorrhagic stroke, which produces significant social and medical challenges. As it affects people in their high productivity age and leaves 50 % of them dead and almost 70 % of survivors disabled, many of them severely, the reasons of such a dismal outcome have been intensively researched all over the world. Nevertheless, despite more than a half a century of clinical and scientific effort and dramatic improvement of surgical repair of aneurysms, the causes of poor outcome remain enigmatic. Introduction of numerous in vitro and in vivo models to study the unleashed by SAH mechanisms that injured the brain significantly advanced our understanding of biology of cerebral vessels, brain responses to intracranial pressure changes, and the presence of blood clot in subarachnoid space. One of the most important animal models that significantly contributed to those advances has been a non-human primate model introduced at the Bryce Weir laboratory in the University of Alberta, Canada, in 1984. Since then, this model, with some modifications, has been successfully used in several animal laboratories in the USA, Canada, and Japan. We present the model characteristics and describe in details medical, surgical, imagining techniques that we have used at the Surgical Neurology Branch of the National Institute of Neurological Disorders and Stroke from 1989. PMID:25216692

Pluta, Ryszard M; Bacher, John; Skopets, Boris; Hoffmann, Victoria

2014-12-01

325

Postmortem dynamic cerebral angiography for detecting aneurysm and bleeding sites in cases of subarachnoid hemorrhage.  

PubMed

One of the advantages of postmortem imaging is its ability to obtain diagnostic findings in a non-destructive manner when autopsy is either difficult or may destroy forensic evidence. In recent years, efforts have been made to incorporate computed tomography (CT) based postmortem angiography into forensic pathology; however, it is not currently clear how well the modality can determine sites of bleeding in cases of subarachnoid hemorrhage. Therefore, in this study, we investigated the utility of postmortem cerebral angiography using multi-detector row CT (MDCT) by injecting a contrast medium through a catheter inserted into the internal carotid and vertebral arteries of 10 subarachnoid hemorrhage cases. While postmortem MDCT angiography (PMCTA) was capable of detecting aneurysms in a non-destructive manner, it was sometimes difficult to identify the aneurysm and bleeding sites because of a large amount of contrast medium leaking into the extravascular space. To overcome this problem, we developed the novel contrast imaging method "dynamic cerebral angiography," which involves scanning the same area multiple times while injecting contrast medium to enable real-time observation of the contrasted vasculature. Using multiphase contrast images acquired by this method, we successfully captured the moment when contrast medium leaked from the hemorrhage site. This method will be useful for identifying exact bleeding sites on PMCTA. PMID:25074715

Inokuchi, Go; Yajima, Daisuke; Hayakawa, Mutsumi; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Makino, Yohsuke; Iwase, Hirotaro

2014-12-01

326

[Diabetes and cardiovascular complications].  

PubMed

The prevalence of obesity and diabetes is increasing dramatically. Currently, 800,000 patients are suffering from diabetes mellitus in Austria. Chronic hyperglycemia results in micro- and macrovascular complications, which reduce life expectancy up to 8 years. Furthermore, diabetes is among the most important risk factors for premature atherosclerosis and coronary artery disease. The incidence of coronary artery disease in diabetics is relatively high with about 146 cases per 10,000 patient years. Apart, it could be demonstrated that the presence of diabetes mellitus worsens the prognosis after an acute coronary syndrome. Considering ischemic stroke, the situation is nearly the same, as it is known that diabetes mellitus increases the risk for ischemic stroke events up to 5 times. Beside the macrovascular complications, microvascular complications like diabetic retinopathy, diabetic nephropathy and diabetic neuropathy also play a critical role. Retinopathy can be detected in nearly every patient after a diabetes duration of 20 years. Diabetic nephropathy, which is a major complication of diabetes mellitus, accounts for 19% of end stage renal disease. Microalbuminuria, which is an early marker of diabetic nephropathy, can be found in 30% of the patients after 10 years of diabetes. Due to the severity of the diabetic complications an early intensified antidiabetic treatment is highly important for the prevention of micro- and macrovascular events. PMID:20229155

Resl, Michael; Clodi, Martin

2010-01-01

327

Comparative Study of Processing of Haemorrhagic Body Fluids by Using Different Techniques  

PubMed Central

Background: Haemorrhagic fluids are samples which are commonly received for cytological examination. The diagnostic efficacy suffers when large numbers of red blood cells are present in the sample. Haemorrhagic fluids are processed by a variety of techniques and the common goal of each technique is selection and concentration of an adequate number of tumour cells with intact cell morphologies, without losing them during processing. Aim: Present study was undertaken to improve the quality of haemorrhagic fluid by using three different haemolysing agents, namely Carnoy’s Fixative (CF), saline in Normal Saline Rehydration Technique (NSRT) and Glacial Acetic Acid (GAA) for haemolysis and to find out the most effective processing technique for better cytomorphological assessment. Material and Methods: This study was carried out on 51 haemorrhagic fluids. Processing of haemorrhagic fluid was done by using haemolysing agents, namely CF, GAA and NSRT. After processing fluids with these three techniques, three smears were prepared from each of them, out of which one was air dried and two were wet fixed. Fourth type of smear made without application of haemolysing agent was used as control.The smears were stained with Leishman’s stain and wet fixed smears were stained with Hematoxylin and Eosin (H and E) , and Papanicolou’s stain (Pap) respectively. Results: NSRT showed lysis of red blood cells (RBCs) in 72.5% of cases, followed by that of CF in 60.8% cases and that of GAA in only 3.9% of cases. Retention of epithelial/mesothelial cells was seen in 70.5% cases with NSRT, followed by that of CF in 57.8% of cases and then by that of GAA in 50.9% of cases. Cytomorphological details were best preserved in CF in 60.6% of cases, followed by GAA in 58.8% of cases and NSRT in 52.9% of cases. Conclusion: The most effective method for RBC lysis in smear background and cell retention is NSRT and cytomorphological details are best preserved with CF. But, considering the overall results and procedural simplicity, it was concluded that NSRT was a better technique for processing of haemorrhagic fluid. PMID:24298471

Shabnam, Mirza; Sharma, Sangeeta; Upreti, Sanjay; Bansal, Rani; Saluja, Mahip; Khare, Anjali; Tripathi, Meenakshi; Khanna, Shrey

2013-01-01

328

Complications of hysterectomy.  

PubMed

Hysterectomy is the most common gynecologic procedure performed in the United States, with more than 600,000 procedures performed each year. Complications of hysterectomy vary based on route of surgery and surgical technique. The objective of this article is to review risk factors associated with specific types of complications associated with benign hysterectomy, methods to prevent and recognize complications, and appropriate management of complications. The most common complications of hysterectomy can be categorized as infectious, venous thromboembolic, genitourinary (GU) and gastrointestinal (GI) tract injury, bleeding, nerve injury, and vaginal cuff dehiscence. Infectious complications after hysterectomy are most common, ranging from 10.5% for abdominal hysterectomy to 13.0% for vaginal hysterectomy and 9.0% for laparoscopic hysterectomy. Venous thromboembolism is less common, ranging from a clinical diagnosis rate of 1% to events detected by more sensitive laboratory methods of up to 12%. Injury to the GU tract is estimated to occur at a rate of 1-2% for all major gynecologic surgeries, with 75% of these injuries occurring during hysterectomy. Injury to the GI tract after hysterectomy is less common, with a range of 0.1-1%. Bleeding complications after hysterectomy also are rare, with a median range of estimated blood loss of 238-660.5 mL for abdominal hysterectomy, 156-568 mL for laparoscopic hysterectomy, and 215-287 mL for vaginal hysterectomy, with transfusion only being more likely after laparoscopic compared to vaginal hysterectomy (odds ratio 2.07, confidence interval 1.12-3.81). Neuropathy after hysterectomy is a rare but significant event, with a rate of 0.2-2% after major pelvic surgery. Vaginal cuff dehiscence is estimated at a rate of 0.39%, and it is more common after total laparoscopic hysterectomy (1.35%) compared with laparoscopic-assisted vaginal hysterectomy (0.28%), total abdominal hysterectomy (0.15%), and total vaginal hysterectomy (0.08%). With an emphasis on optimizing surgical technique, recognition of surgical complications, and timely management, we aim to minimize risk for women undergoing hysterectomy. PMID:23635631

Clarke-Pearson, Daniel L; Geller, Elizabeth J

2013-03-01

329

Complicated necrotizing otitis externa.  

PubMed

Necrotizing (malignant) otitis externa (NOE) is a rare and invasive infection originating in the external acoustic meatus seen most commonly in diabetes and other immunocompromised states. After a protracted course, disease can smolder and extend into the mastoid, skull base, dural sinuses, and intracranially. We present a case of NOE complicated by mastoiditis, dural sinus thrombosis, and Bezold's abscess in an uncontrolled diabetic presenting with a prolonged course of facial nerve palsy. We stress the importance of maintaining a high index of clinical suspicion for NOE in diabetic patients and offering timely, aggressive treatment to mitigate its complications. PMID:23927998

Nawas, Mariam T; Daruwalla, Vistasp J; Spirer, David; Micco, Alan G; Nemeth, Alexander J

2013-01-01

330

Artifact quantification and tractography from 3T MRI after placement of aneurysm clips in subarachnoid hemorrhage patients  

PubMed Central

Background The application of advanced 3T MRI imaging techniques to study recovery after subarachnoid hemorrhage (SAH) is complicated by the presence of image artifacts produced by implanted aneurysm clips. To characterize the effect of these artifacts on image quality, we sought to: 1) quantify extent of image artifact in SAH patients with implanted aneurysm clips across a range of MR sequences typically used in studies of volumetry, blood oxygen level dependent signal change (BOLD-fMRI), and diffusion-weighted imaging (DW-MRI) and 2) to explore the ability to reconstruct white matter pathways in these patients. Methods T1- and T2-weighted structural, BOLD-fMRI, and DW-MRI scans were acquired at 3T in two patients with titanium alloy clips in ACOM and left ACA respectively. Intensity-based planimetric contouring was performed on aligned image volumes to define each artifact. Artifact volumes were quantified by artifact/clip length and artifact/brain volume ratios and analyzed by two-way (scan-by-rater) ANOVAs. Tractography pathways were reconstructed from DW-MRI at varying distances from the artifacts using deterministic methods. Results Artifact volume varied by MR sequence for length (p = 0.007) and volume (p < 0.001) ratios: it was smallest for structural images, larger for DW-MRI acquisitions, and largest on fMRI images. Inter-rater reliability was high (r = 0.9626, p < 0.0001), and reconstruction of white matter connectivity characteristics increased with distance from the artifact border. In both patients, reconstructed white matter pathways of the uncinate fasciculus and inferior fronto-occipital fasciculus were clearly visible within 2 mm of the artifact border. Conclusions Advanced 3T MR can successfully image brain tissue around implanted titanium aneurysm clips at different spatial ranges depending on sequence type. White matter pathways near clip artifacts can be reconstructed and visualized. These findings provide a reference for designing functional and structural neuroimaging studies of recovery in aSAH patients after clip placement. PMID:21970560

2011-01-01

331

Use of 31P Magnetic Resonance Spectroscopy to Study the Effect of Cortical Magnesium and Energy Metabolism after Subarachnoid Hemorrhage  

Microsoft Academic Search

Background: Flow metabolism coupling ensures adequate cerebral oxygenation. When subarachnoid hemorrhage (SAH) occurs, the flow metabolism coupling lost its balance and results in cerebral ischemia and infarction second to cortical magnesium and energy metabolism alternation. During chronic vasospasm, change in cortical energy metabolism is coupled with change in cerebral blood flow after SAH. Methods: What kind of noninvasive technique can

Heping Yang; Xiangqi Tang; Lihua Tan; Liuwang Zeng; Zhiping Hu

2008-01-01

332

Spinal subarachnoid adrenal medullary transplants reduce hind paw swelling and peripheral nerve transport following formalin injection in rats  

Microsoft Academic Search

Previous studies have demonstrated that adrenal medullary chromaffin cells transplanted into the spinal subarachnoid space significantly reduced pain-related behavior following hind paw plantar formalin injection in rats. The data suggests a centrally mediated antinociceptive mechanism. The spinal transplants may have effects on sciatic nerve function as well. To address this, the current study examined the effects of spinal adrenal transplants

Uri Herzberg; Aldric Hama; Jacqueline Sagen

2008-01-01

333

Tattoos: dermatological complications  

Microsoft Academic Search

From the Eskimo in Greenland to the tribes in Polynesia­the whole world knows the art of tattoo. Despite their wide popularity the relation between the skin diseases and the tattooed pictures aren't studied in depth. With the appearance of professional tattoo studios, the risk of infectious complications was reduced. Simultaneously, on a global scale there has been an increase in

Jana Kazandjieva; Nikolai Tsankov

2007-01-01

334

Treatment of complicated grief  

PubMed Central

Following the death of a loved one, a small group of grievers develop an abnormal grieving style, termed complicated or prolonged grief. In the effort to establish complicated grief as a disorder in DSM and ICD, several attempts have been made over the past two decades to establish symptom criteria for this form of grieving. Complicated grief is different from depression and PTSD yet often comorbid with other psychological disorders. Meta-analyses of grief interventions show small to medium effect sizes, with only few studies yielding large effect sizes. In this article, an integrative cognitive behavioral treatment manual for complicated grief disorder (CG-CBT) of 25 individual sessions is described. Three treatment phases, each entailing several treatment strategies, allow patients to stabilize, explore, and confront the most painful aspects of the loss, and finally to integrate and transform their grief. Core aspects are cognitive restructuring and confrontation. Special attention is given to practical exercises. This article includes the case report of a woman whose daughter committed suicide. PMID:22893810

Rosner, Rita; Pfoh, Gabriele; Kotoucova, Michaela

2011-01-01

335

Hypoglycemia: The neglected complication  

PubMed Central

Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications. PMID:24083163

Kalra, Sanjay; Mukherjee, Jagat Jyoti; Venkataraman, Subramanium; Bantwal, Ganapathi; Shaikh, Shehla; Saboo, Banshi; Das, Ashok Kumar; Ramachandran, Ambady

2013-01-01

336

Pulmonary complications of hemoglobinopathies.  

PubMed

Hemoglobinopathies are diseases caused by genetic mutations that result in abnormal, dysfunctional hemoglobin molecules or lower levels of normal hemoglobin molecules. The most common hemoglobinopathies are sickle cell disease (SCD) and the thalassemias. In SCD, an abnormal hemoglobin alters the erythrocyte, causing a chronic hemolytic anemia, which can lead to pulmonary parenchymal damage and impaired vascular function. Pulmonary complications of SCD include the acute chest syndrome (ACS), reactive airways disease, pulmonary hypertension (PH), and pulmonary fibrosis. Episodes of ACS and the development of PH both increase the risk of death in patients with SCD. Both ? and ? thalassemia are characterized by impaired production of hemoglobin subunits, and severity of disease varies widely. Although screening studies suggest that PH is a common complication for patients with thalassemia, its impact on survival is unknown. Understanding the pathogenesis, diagnostic options, and prevention and treatment strategies for such complications is critical for clinicians who care for these patients. In this review, we discuss the mechanisms and clinical presentation of pulmonary complications associated with hemoglobinopathies, with a focus on recent advances in pathogenesis and treatment. PMID:20923801

Vij, Rekha; Machado, Roberto F

2010-10-01

337

Neurological Complications of Transplantation  

PubMed Central

Hematopoietic cell transplantation (HCT) is the preferred treatment for an expanding range of neoplastic and nonmalignant conditions. Increasing numbers of solid organ transplantations (SOTs) add an additional population of immunosuppressed patients with multiple potential neurological problems. While the spectrum of neurological complications varies with conditioning procedure and hematopoietic cell or solid organ source, major neurological complications occur with all transplantation procedures. This 2 part review emphasizes a practical consultative approach to central and peripheral nervous system problems related to HCT or SOT with clinical and neuroimaging examples from the authors’ institutional experience with the following conditions: the diversity of manifestations of common infections such as varicella zoster virus, Aspergillus, and progressive multifocal leukoencephalopathy (PML), drug therapy-related complications, stroke mechanisms, the spectrum of graft versus host disease (GVHD), and neurologically important syndromes of immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD). These complications preferentially occur at specific intervals after HCT and SOT, and neurological consultants must recognize an extensive spectrum of syndromes in order to effect timely diagnosis and expedite appropriate treatment. PMID:23983885

Pruitt, Amy A.; Graus, Francesc; Rosenfeld, Myrna R.

2013-01-01

338

Complications of sphenoid sinusitis  

Microsoft Academic Search

Regarding the skull base, no structure is as centrally located as the sphenoid sinus. It sits at the junction of the anterior and middle cranial fossae, and is surrounded by vital structures. Although relatively rare, complications of the inflammatory and infectious conditions of sphenoid sinusitis are the result of direct extension of disease to the surrounding tissues, or a propagated

Andrew Goldman

2003-01-01

339

Emergency cholecystectomy and hepatic arterial repair in a patient presenting with haemobilia and massive gastrointestinal haemorrhage due to a spontaneous cystic artery gallbladder fistula masquerading as a pseudoaneurysm  

PubMed Central

Background Haemobilia usually occurs secondary to accidental or iatrogenic hepatobiliary trauma. It can occasionally present with cataclysmal upper gastrointestinal haemorrhage posing as a life threatening emergency. Haemobilia can very rarely be a complication of acute cholecystitis. Here we report a case of haemobilia manifesting as massive gastrointestinal haemorrhage in a patient without any prior history of biliary surgery or intervention and present a brief review of literature. Case presentation A 22 year old male admitted with history suggestive of acute cholecystitis subsequently developed waxing waning jaundice and recurrent episodes of upper gastrointestinal bleed. Endoscopy showed an ulcer in the first part of duodenum with a clot, no active bleed was visible. Angiography was suggestive of a ruptured pseudoaneurysm in the vicinity of the right hepatic artery probably originating from the cystic artery. Coil embolization was tried but the coil dislodged into the right branch of hepatic artery distal to the site of pseudoaneurysm. Review of angiographic video in light of operative findings demonstrated a fistulous communication between cystic artery and gallbladder as the cause, a simultaneous cholecystoduodenal fistula was also noted. Retrograde cholecystectomy, closure of cholecystoduodenal fistula and right hepatic arteriotomy with retrieval of the endo-coil and hepatic arterial repair was performed. Conclusion Fistula between the cystic artery and gallbladder has been commonly reported to occur after laparoscopic cholecystectomy. Spontaneous fistulous communication, i.e. in the absence of any prior trauma or intervention, between cystic artery and gallbladder is rare with very few reports in literature. Aetiopathogenesis of the disease, in the context of current literature is reviewed. The diagnostic dilemma posed by the confounding finding of an ulcer in the duodenum, the iconic video angiographic depiction as also the therapeutic challenge of a failed embolization with consequent microcoil migration and primary hepatic arterial repair in the emergency situation is discussed. PMID:23452779

2013-01-01

340

Skin rash, headache and abnormal behaviour: unusual presentation of intracranial haemorrhage in dengue fever  

PubMed Central

Dengue viral infections are one of the most important mosquito borne diseases in the world. The dengue virus is a single stranded RNA virus belonging to the Flaviviridae family. There are four serotypes (DEN 1–4) classified according to biological and immunological criteria. Patients may be asymptomatic or their condition may give rise to undifferentiated fever, dengue fever, dengue haemorrhagic fever (DHF), or dengue shock syndrome. Annually, 100 million cases of dengue fever and half a million cases of DHF occur worldwide and 2.5 billion people are at risk. At present, dengue is endemic in 112 countries. Early recognition and prompt initiation of appropriate treatment are vital if disease related morbidity and mortality are to be limited. We present an interesting case of dengue fever with headache, skin rash and abnormal behaviour who had a massive intracranial haemorrhage with fatal outcome. PMID:22242067

Wani, Abdul Majid; Mejally, Mousa Ali Al; Hussain, Waleed Mohd; Maimani, Wail Al; Hanif, Sadia; Khoujah, Amer Mohd; Siddiqi, Ahmad; Akhtar, Mubeena; Bafaraj, Mazen G; Fareed, Khurram

2010-01-01

341

Hereditary haemorrhagic telangiectasia with pulmonary arteriovenous malformations: a treatable cause of thromboembolic cerebral events  

Microsoft Academic Search

Hereditary haemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu syndrome is associated with mucocutaneous telangiectases and iron deficiency anaemia caused by epistaxis or blood loss from the gastrointestinal tract. We describe a 41-year-old Chinese man who presented with amaurosis fugax secondary to emboli from pulmonary arteriovenous malformations associated with HHT. He was diagnosed with the disorder in adolescence but follow-up in the outpatient

J K C Yoong; M M Htoo; V Jeyaseelan

342

Risk Factors for Neonatal Intraventricular Haemorrhage in Spontaneous Prematurity at 32 Weeks Gestation or Less  

Microsoft Academic Search

In this study we aimed to establish which clinical and histopathological factors are associated with early-onset neonatal intraventricular haemorrhage (IVH) in non-iatrogenic preterm delivery before 32 weeks of gestation.We retrospectively reviewed all singleton pregnancies delivered before 32 weeks of gestation after spontaneous onset of preterm labour or preterm membrane rupture during the period January 1993 to June 1997. Clinical and

P. Vergani; L. Patanè; P. Doria; C. Borroni; A. Cappellini; J. C. Pezzullo; A. Ghidini

2000-01-01

343

Primary Supratentorial Haemorrhage – Surgery or no Surgery in an Indian Setup  

PubMed Central

Introduction: Rise of hypertension among younger age group has increased the prevalence of intracranial haemorrhage. Conflicting reviews regarding the mode of treatment has been a concern to the treating physicians especially in a developing country like India. This study was undertaken to underline the importance of management and propose a local protocol for primary supra-tentorial haemorrhage. Materials and Methods: Patients presenting with primary supratentorial (ST) haemorrhage fulfilling inclusion criteria are included in the study. Decompression craniotomy done in all the patients and the patient particulars noted. The primary outcome of death is correlated with various particulars and statistical analysis done with SPSS version 16. Results: Mean age of presentation was 54.2 years, ranging from 38-71years. Male comprised 82.1% (23 patients). Seven out of eight patients with Glasgow coma scale (GCS) ?7 (87.5%) expired whereas only 3 out of 20 (15%) patients with GCS >7 expired. 50% of the patients with intracranial haemorrhage (ICH) in temporo-pari et al., (2/4) or in basal ganglia with cortical extension (5/10) expired whereas the mortality in cases of ICH in parietal lobe and frontal lobes were 25% (1/4) and 20% (2/10) respectively. Clot volume ?100ml had a mortality of 19% (4/21) whereas the mortality was as high as 85.7% (6/7) with clot volume >100ml. Conclusion: Emergency Craniotomy and Evacuation of the Hematoma could be a feasible option in between 40 ml to 100ml of Primary ST ICH without intra-ventricular extension. In cases of intra-ventricular extension of haematoma surgery is less helpful. Midline shift of 5 mm or more might be a poor prognostic factor. PMID:25386479

Singh, Th Gojendra; Ghalige, Hemanth S; S, Abhilash; Singh, Motilal; Berma, Subrata Kishore Deb; N, Prasanna Kumar

2014-01-01

344

Relationship of pulmonary arterial pressure to pulmonary haemorrhage in exercising horses.  

PubMed

Exercise-induced pulmonary haemorrhage (EIPH) is characterised by blood in the airways after strenuous exercise and results from stress failure of the pulmonary capillaries. The purpose of this experiment was to establish a threshold value of transmural pulmonary arterial pressure at which haemorrhage occurs in the exercising horse. Five geldings, age 4-14 years, were run in random order once every 2 weeks at 1 of 4 speeds (9, 11, 13, 15 m/s); one day with no run was used as a control. Heart rate, pulmonary arterial pressure and oesophageal pressure were recorded for the duration of the run. Transmural pulmonary arterial pressure was estimated by electronic subtraction of the oesophageal pressure from the intravascular pulmonary arterial pressure. Within 1 h of the run, bronchoalveolar lavage was performed and the red and white blood cells in the fluid were quantified. Red cell counts in the lavage fluid from horses running at 9, 11 and 13 m/s were not significantly different from the control value, but after runs at 15 m/s, red cell counts were significantly (P<0.05) higher. White cell counts were not different from control values at any speed. Analysis of red cell count vs. transmural pulmonary arterial pressure indicated that haemorrhage occurs at approximately 95 mmHg. Red cell lysis in the lavage fluid was also apparent at transmural pulmonary arterial pressures above 90 mmHg. We conclude that, in the exercising horse, a pulmonary arterial pressure threshold exists above which haemorrhage occurs, and that pressure is often exceeded during high speed sprint exercise. PMID:11037258

Langsetmo, I; Meyer, M R; Erickson, H H

2000-09-01

345

Mortality among cattle and buffaloes in Sri Lanka due to haemorrhagic septicaemia  

Microsoft Academic Search

Data on the mortality of cattle and buffaloes in 62 epizootics of haemorrhagic septicaemia (HS) in the HS enzootic and non-enzootic regions of Sri Lanka was collected and subjected to statistical analysis. It was found that the overall mortality for buffaloes was higher than for cattle (45.2 and 15.8% respectively,P<0.001). For buffaloes in enzootic areas only the overall mortality was

M. C. L. Alwis

1981-01-01

346

Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage  

Microsoft Academic Search

AimsOptic nerve sheath diameter (ONSD) enlargement is detectable in patients with increased intracranial pressure. The aim was to detect an enlargement of the ONSD using optic nerve sonography in patients with acute intracerebral haemorrhage (ICH) within 6 h of the onset of symptoms.MethodsThirty-one acute ICH patients, 15 age-matched acute ischaemic stroke patients and 16 age-matched healthy volunteers were enrolled consecutively

David Školoudík; Roman Herzig; Tá?a Fadrná; Michal Bar; Pavel Hradílek; Martin Roubec; Monika Jelínková; Daniel Ša?ák; Michal Král; Jana Chmelová; Miroslav He?man; Kate?ina Langová; Petr Ka?ovský

2010-01-01

347

A Brain Parenchyma Model-Based Segmentation of Intraventricular and Intracerebral Haemorrhage in CT Scans.  

PubMed

Accurate quantification of haemorrhage volume in a computed tomography (CT) scan is critical in the management and treatment planning of intraventricular (IVH) and intracerebral haemorrhage (ICH). Manual and semi-automatic methods are laborious and time-consuming limiting their applicability to small data sets. In clinical trials measurements are done at different locations and on a large number of data; an accurate, consistent and automatic method is preferred. A fast and efficient method based on texture energy for identification and segmentation of hemorrhagic regions in the CT scans is proposed. The data set for the study was obtained from CLEAR-IVH clinical trial phase III (41 patients' 201 sequential CT scans from ten different hospitals, slice thickness 2.5-10 mm and from different scanners). The DICOM data were windowed, skull stripped, convolved with textural energy masks and segmented using a hybrid method (a combination of thresholding and fuzzy c-means). Artifacts were removed by statistical analysis and morphological processing. Segmentation results were compared with the ground truth. Descriptive statistics, Dice statistical index (DSI), Bland-Altman and mean difference analysis were carried out. The median sensitivity, specificity and DSI for slice identification and haemorrhage segmentation were 86.25%, 100%, 0.9254 and 84.90%, 99.94%, 0.8710, respectively. The algorithm takes about one minute to process a scan in MATLAB(®). A hybrid method-based volumetry of haemorrhage in CT is reliable, observer independent, efficient, reduces the time and labour. It also generates quantitative data that is important for precise therapeutic decision-making. PMID:24028979

Bhanu Prakash, K N; Morgan, T C; Hanley, D M; Nowinski, W L

2012-07-01

348

Haemorrhage in intracerebral arteriovenous malformations: detection with MRI and comparison with clinical history  

Microsoft Academic Search

Fifty-one patients with 59 angiographically proven cerebral arteriovenous malformations (AVMs) were examinded by high-field MRI to detect blood breakdown products. Results were correlated with the history of intracranial bleeding. Evidence of previous episodes of haemorrhage was seen in 10 of 12 patients (83.3%) with verified bleeding, in 4 of 9 patients (44.4%) with symptoms which could suggest bleeding and in

L. Prayer; D. Wimberger; R. Stiglbauer; J. Kramer; B. Richling; G. Bavinzski; T. Czech; H. Imhof

1993-01-01

349

Subarachnoid Hemorrhage  

MedlinePLUS

... left with physical limitations or problems with their thinking. In those cases, long periods of rehabilitation are ... one dedicated to the care of patients with critical brain disease. Patients with SAH may need a ...

350

A quantitative study of lung dysfunction following haemorrhagic shock in rats  

PubMed Central

Haemorrhagic shock occasionally causes an episode of lung dysfunction, the severity of which appears to correlate with fatal outcome. Our previous study indicated that proinflammatory cytokines, such as tumour necrosis factor (TNF)-? and interleukin (IL)-1?, played a key role in the development of lung dysfunction through recruitment of activated neutrophils by causing pulmonary endothelial cell damage. Here, we examined this issue quantitatively by grading four groups of severity of bleeding in rats. As the amount of bleeding increased, the expression of mRNA for TNF-? and IL-1? in the lung tissue and the pulmonary serum levels of both cytokines increased progressively up to 5 h, and the frequency of activated neutrophils increased likewise. The lung dysfunction indices serum lactic dehydrogenase-3 isozyme (LDH-3), partial pressure of arterial oxygen (PaO2) and alveolar-arterial oxygen tension difference (AaDO2) in blood deteriorated as the amount of bleeding increased. The frequency of activated neutrophils in the lung correlated well with the LDH-3 level 5 h after haemorrhagic shock. The present results demonstrate that the increase of proinflammatory cytokines and the recruitment of activated neutrophils into the lung following haemorrhagic shock are quantitatively related to progression of lung dysfunction as the amount of bleeding increases. PMID:20041965

Sato, Hiroaki; Tanaka, Toshiko; Kita, Toshiro; Tanaka, Noriyuki

2010-01-01

351

Ranitidine and oxygen derived free radical scavengers in haemorrhagic shock induced gastric lesions.  

PubMed Central

The role of oxygen derived free radicals in gastric lesions induced by haemorrhagic shock and the protective effect of oxygen radical scavengers, allopurinol and ranitidine, were investigated. Forty five rabbits underwent haemorrhagic shock for 30 minutes and reinfusion of shed blood. They were killed 30 minutes later. The animals were divided in five groups: A (n = 10): Control, B (n = 10): intravenous ranitidine pretreatment, C (n = 10): oral allopurinol, 24 and 2 h before surgery; D (n = 10): intravenous pretreatment with superoxide Dismutase plus catalase, E (n = 5): 60 minute haemorrhagic shock without reinfusion and treatment. Erosions and/or petechiae in all animals in Group A were observed. Three animals in group B and C and 2 in group D (p less than 0.005, p less than 0.001) had gastric lesions. The lesions in the pretreatment groups were significantly smaller than in controls. Oxygen radicals plus HCl play an important role in shock induced gastric lesions. Oxygen radical antagonists show a significant protective role. PMID:3384367

Tsimoyiannis, E C; Sarros, C J; Tsimoyiannis, J C; Moutesidou, K; Akalestos, G; Kotoulas, O B

1988-01-01

352

Ranitidine and oxygen derived free radical scavengers in haemorrhagic shock induced gastric lesions.  

PubMed

The role of oxygen derived free radicals in gastric lesions induced by haemorrhagic shock and the protective effect of oxygen radical scavengers, allopurinol and ranitidine, were investigated. Forty five rabbits underwent haemorrhagic shock for 30 minutes and reinfusion of shed blood. They were killed 30 minutes later. The animals were divided in five groups: A (n = 10): Control, B (n = 10): intravenous ranitidine pretreatment, C (n = 10): oral allopurinol, 24 and 2 h before surgery; D (n = 10): intravenous pretreatment with superoxide Dismutase plus catalase, E (n = 5): 60 minute haemorrhagic shock without reinfusion and treatment. Erosions and/or petechiae in all animals in Group A were observed. Three animals in group B and C and 2 in group D (p less than 0.005, p less than 0.001) had gastric lesions. The lesions in the pretreatment groups were significantly smaller than in controls. Oxygen radicals plus HCl play an important role in shock induced gastric lesions. Oxygen radical antagonists show a significant protective role. PMID:3384367

Tsimoyiannis, E C; Sarros, C J; Tsimoyiannis, J C; Moutesidou, K; Akalestos, G; Kotoulas, O B

1988-06-01

353

N-Butyl Cyanoacrylate Is Very Effective for Massive Haemorrhage during the Perinatal Period  

PubMed Central

Objective The liquid embolic agent n-butyl cyanoacrylate (NBCA) is a tissue adhesive used as an immediate and permanent embolic agent when mixed with oil-based contrast medium. In this study, the preservation of fertility with TAE using NBCA for massive haemorrhage during pregnancy or the peripartum period and the utility of this therapy were investigated. Methods Cases from January 2005 to October 2010 in which TAE was performed for massive haemorrhage in pregnant women, particularly during the peripartum period, were investigated. Results TAE was performed in 27 pregnant women. The embolic agent used was GS only in five cases, NBCA only in 19 cases, and additional embolization with NBCA when the effect with GS was insufficient in three cases, one each of abruptio placentae, cervical pregnancy, and uterine atony.A comparison of mean blood loss when each embolic agent was used for haemostasis showed a significant difference between cases in which GS only was used and cases in which NBCA only was used. In a comparison of mean transfusion volume, a significant difference was seen between cases in which both GS and NBCA were used and cases in which NBCA only was used. In a postoperative follow-up survey, menses resumed in eight patients, including four patients who later became pregnant and three who delivered. Conclusions TAE with NBCA, which has an embolic effect unrelated to clotting dysfunction for massive haemorrhage during the peripartum period, is a minimally invasive and very effective treatment method for patients with severe DIC. PMID:24223099

Igarashi, Suguru; Izuchi, Shinichirou; Ogawa, Yukihisa; Yoshimathu, Misako; Takizawa, Kenji; Nakajima, Yasuo; Tanaka, Mamoru; Ishizuka, Bunpei; Suzuki, Nao

2013-01-01

354

Update on the Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II): statistical analysis plan  

PubMed Central

Background Previous studies had suggested that the outcome for patients with spontaneous lobar intracerebral haemorrhage (ICH) and no intraventricular haemorrhage (IVH) might be improved with early evacuation of the haematoma. The Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II) set out to establish whether a policy of earlier surgical evacuation of the haematoma in selected patients with spontaneous lobar ICH would improve outcome compared to a policy of initial conservative treatment. It is an international, multi-centre, prospective randomised parallel group trial of early surgery in patients with spontaneous lobar ICH. Outcome is measured at six months via a postal questionnaire. Results Recruitment to the study began on 27 November 2006 and closed on 15 August 2012 by which time 601 patients had been recruited. The protocol was published in Trials (http://www.trialsjournal.com/content/12/1/124/). This update presents the analysis plan for the study without reference to the unblinded data. The trial data will not be unblinded until after follow-up is completed in early 2013. The main trial results will be presented in spring 2013 with the aim to publish in a peer-reviewed journal at the same time. Conclusion The data from the trial will provide evidence on the benefits and risks of early surgery in patients with lobar ICH. Trial registration ISRCTN: ISRCTN22153967 PMID:23171588

2012-01-01

355

Blepharoplasty complications: prevention and management.  

PubMed

This article presents common and rare complications following blepharoplasty, with discussion of avoidance of these complications through presurgical planning and review. Management of the complications is provided, with surgical details supported by images and advice for the best approaches. The complications discussed include hemorrhage, infection, corneal abrasion, ptosis, lacrimal gland injury, and residual excess skin. PMID:23186771

Whipple, Katherine M; Lim, Lee Hooi; Korn, Bobby S; Kikkawa, Don O

2013-01-01

356

Multiple small-intestine intussusceptions: a complication of purpura haemorrhagica in a horse.  

PubMed

A Belgian draft horse stallion presented with classical signs of purpura haemorrhagica: oedema of the distal limbs, ventral abdomen and head, ecchymotic haemorrhage of mucous membranes, epistaxis, fever, lethargy, reluctance to move, and anorexia. Serum chemistry revealed a highly elevated gamma-globulin fraction. Streptococcal lymphadenitis (strangles) had been present on a neighbouring farm in the past few months. After an initial positive response to therapy with benzylpenicillin, flunixin and dexamethasone, the horse's condition deteriorated suddenly on day 4 of hospitalization, with signs of severe endotoxaemia and small-intestine obstruction. The horse was euthanized because of its poor prognosis and because of economic considerations. On necropsy, large serosal haemorrhages in the small and large intestine and multiple jejunojejunal intussusceptions were found. Intussusception is a well-known complication in children with Henoch-Schonlein purpura, a human autoimmune disease resembling purpura haemorrhagica in horses. To the author's knowledge, this is the first report to describe intussusception as a complication of purpura haemorrhagica in a horse. PMID:21699093

Dujardin, C L L

2011-06-01

357

Extra-cerebral severe infections associated with haemorrhagic hereditary telangiectasia (Rendu-Osler-Weber Disease): five cases and a review of the literature.  

PubMed

Hereditary haemorrhagic telangiectasia (HHT) is one of the most common autosomal dominant disorders and is characterized by genetically determined abnormalities of vascular structure. People affected by HHT are predisposed to severe infections such as cerebral abscesses, typical of patients with pulmonary arteriovenous malformations, and extra-cerebral infections such as bacteraemia, septic arthritis, osteomyelitis, hepatic abscesses, skin infections and infective endocarditis. We present a retrospective series of severe bacterial extra-cerebral infections in five patients affected by HHT, admitted to our Institute from January 2007 to June 2013. We also reviewed the literature of the last five years concerning infectious complications in people affected by HHT. Our study shows that HHT patients with infectious complications exclusively localized in extra-cerebral sites are usually fragile, old and affected by comorbidities. Moreover, we recognized a trend of Staphylococcus aureus (SA) severe infection recurrence in such patients, both in our series and in the literature. In our opinion these results suggest the need to evaluate the possible benefits of SA nasal colonization screening and decolonization in such patients. PMID:24651092

Musso, Maria; Capone, Alessandro; Chinello, Pierangelo; Di Bella, Stefano; Galati, Vincenzo; Noto, Pasquale; Taglietti, Fabrizio; Topino, Simone; Petrosillo, Nicola

2014-03-01

358

A pediatric case of reversible cerebral vasoconstriction syndrome with cortical subarachnoid hemorrhage.  

PubMed

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare disorder characterized by acute onset, severe headache, with reversible vasoconstriction of cerebral arteries often accompanied by additional neurological symptoms. This syndrome is seen mainly in middle-aged adults, predominantly women. Herein, we report on a pediatric case of RCVS with cortical subarachnoid hemorrhage (SAH). A 12-year-old boy developed acute, severe headache with paralysis of lower extremities causing gait disturbance after administration of eletriptan. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries, whereas magnetic resonance imaging (MRI) demonstrated sulcal hyperintensity on fluid-attenuated inversion recovery, consistent with cortical SAH. The patient's clinical symptoms resolved spontaneously after a few days and the MRI and MRA findings disappeared 3 months later, suggesting a diagnosis of RCVS. Eletriptan might cause vasoconstriction of cerebral arteries. Although most patients with RCVS are adults and pediatric cases are rare, RCVS should be considered in a child complaining of severe headache. PMID:22285527

Yoshioka, Seiichiro; Takano, Tomoyuki; Ryujin, Fukiko; Takeuchi, Yoshihiro

2012-10-01

359

Spontaneous resolution of an isolated cervical anterior spinal artery aneurysm after subarachnoid hemorrhage  

PubMed Central

Background: Isolated cervical anterior spinal artery aneurysms are extremely rare. Subarachnoid hemorrhage (SAH) secondary to such lesions have been described only in six cases to the best of our knowledge. Case Description: We describe an unusual clinical picture of SAH due to rupture of anterior spinal artery aneurysm in a patient with previous normal angiogram. Due to the location of the aneurysm and clinical status of the patient, conservative management was proposed, and she was discharged to further follow-up. Monthly routine angiograms revealed resolution of the aneurysm 90 days after bleeding, which was highly suggestive of vascular dissection. Conclusion: We highlight the need to consider these aneurysms in the differential diagnosis of SAH, especially when occurring in the posterior fossa and when angiography findings are inconclusive. PMID:25317354

Pahl, Felix Hendrik; de Oliveira, Matheus Fernandes; Rotta, Marcus Alexandre Cavalcanti; Dias, Guilherme Marcos Soares; Rezende, Andre Luiz; Rotta, Jose Marcus

2014-01-01

360

Fistulas complicating diverticulitis  

Microsoft Academic Search

This study was undertaken to assess the appropriate management of patients with diverticulitis complicated by fistula formation.\\u000a A retrospective chart review was conducted on patients with symptoms of a fistula who presented between 1975 to 1995. There\\u000a were 42 patients (32 women, 76%; 10 men, 24%) who ranged in age from 46 to 89 years (mean 69.8±9.8). Six patients had

C.-A. Vasilevsky; P. Belliveau; J. L. Trudel; B. L. Stein; P. H. Gordon

1998-01-01

361

Neurologic Complications of Sarcoma  

Microsoft Academic Search

Sarcomas are a heterogeneous group of tumors that rarely involve the nervous system. Neurologic effects of sarcoma are more\\u000a often due to tumors outside of the central nervous system. However, as long-term survival rates in childhood sarcoma improves,\\u000a reports of late neurologic complications have increased. With recent advances in treating local sarcomas with targeted molecular\\u000a therapies, the incidence of late

Santosh Kesari; Lara J. Kunschner

362

Inhibition of the Sur1-Trpm4 Channel Reduces Neuroinflammation and Cognitive Impairment in Subarachnoid Hemorrhage  

PubMed Central

Background and Purpose Subarachnoid hemorrhage (SAH) can leave patients with memory impairments that may not recover fully. Molecular mechanisms are poorly understood, and no treatment is available. The sulfonylurea receptor 1–transient receptor potential melastatin 4 (Sur1-Trpm4) channel plays an important role in acute central nervous system injury. We evaluated upregulation of Sur1-Trpm4 in humans with SAH and, in rat models of SAH, we examined Sur1- Trpm4 upregulation, its role in barrier dysfunction and neuroinflammation, and its consequences on spatial learning. Methods We used Förster resonance energy transfer to detect coassociated Sur1 and Trpm4 in human autopsy brains with SAH. We studied rat models of SAH involving filament puncture of the internal carotid artery or injection of blood into the subarachnoid space of the entorhinal cortex. In rats, we used Förster resonance energy transfer and coimmunoprecipitation to detect coassociated Sur1 and Trpm4, we measured immunoglobulin G extravasation and tumor necrosis ? overexpression as measures of barrier dysfunction and neuroinflammation, and we assessed spatial learning and memory on days 7 to 19. Results Sur1-Trpm4 channels were upregulated in humans and rats with SAH. In rats, inhibiting Sur1 using antisense or the selective Sur1 inhibitor glibenclamide reduced SAH-induced immunoglobulin G extravasation and tumor necrosis ? overexpression. In models with entorhinal SAH, rats treated with glibenclamide for 7 days after SAH exhibited better platform search strategies and better performance on incremental and rapid spatial learning than vehicle-treated controls. Conclusions Sur1-Trpm4 channels are upregulated in humans and rats with SAH. Channel inhibition with glibenclamide may reduce neuroinflammation and the severity of cognitive deficits after SAH. PMID:24114458

Tosun, Cigdem; Kurland, David B.; Mehta, Rupal; Castellani, Rudy J.; deJong, Joyce L.; Kwon, Min Seong; Woo, Seung Kyoon; Gerzanich, Volodymyr; Simard, J. Marc

2013-01-01

363

The Association between Meteorological Parameters and Aneurysmal Subarachnoid Hemorrhage: A Nationwide Analysis  

PubMed Central

Prior research has suggested that regional weather patterns impact the risk of rupture of cerebral aneurysms, but the findings in the literature have been inconsistent. Furthermore, no nationwide analysis to date has examined the association between meteorological factors and the post-procedural outcomes of patients after the treatment for ruptured cerebral aneurysms. The purpose of this study was to use a nationwide sample to analyze the association between specific meteorological parameters—temperature, precipitation, sunlight, and humidity—and hospital admission rate for and outcome after aneurysmal subarachnoid hemorrhage. Patients were identified using the Nationwide Inpatient Sample (2001–2010): Those with an ICD-9 diagnosis code for subarachnoid hemorrhage and a procedural code for aneurysm repair were included. Climate data were obtained from the State of the Climate Report 2010 released by the National Climatic Data Center. Multivariate regression models were constructed to analyze the association between average state monthly temperature, precipitation, and percent possible sunlight, as well as relative morning humidity and both monthly hospital admission rate, adjusted for annual state population in millions, and in-hospital mortality. 16,970 admissions were included from 723 hospitals across 41 states. Decreased daily sunlight and lower relative humidity were associated with an increased rate of admission for ruptured cerebral aneurysms (p<0.001), but had no association with differential inpatient mortality. No significant changes in these observed associations were seen when multivariate analyses were constructed. This is the first nationwide study to suggest that decreased sunlight and lower relative humidity are associated with admission for ruptured cerebral aneurysms. While it has been postulated that external atmospheric factors may cause hormonal and homeostatic changes that impact the risk of rupture of cerebral aneurysms, additional research is needed to confirm and further understand these relationships. PMID:25393630

Lai, Pui Man Rosalind; Dasenbrock, Hormuzdiyar; Du, Rose

2014-01-01

364

Neuropsychological assessments in patients with aneurysmal subarachnoid hemorrhage, perimesencephalic SAH, and incidental aneurysms.  

PubMed

Subarachnoid hemorrhage (SAH) is known to be associated with long-term cognitive deficits. Neurosurgical manipulation on the brain itself has been reported to have influence on neuropsychological sequelae. The following is a comparative study on perimesencephalic and aneurysmal subarachnoid hemorrhage patients as well as elective aneurysm patients that was carried out to determine the isolated and combined impact of surgical manipulation and hemorrhage, respectively, on long-term neuropsychological outcome. Inclusion criteria were good neurological recovery at discharge (modified Rankin Scale 0 or 1) without focal neurological deficit. Standardized psychological testing covered attention, memory, executive functions, and mood. Thirteen aneurysmal SAH patients, 15 patients undergoing elective clipping, and 14 patients with perimesencephalic SAH were analyzed. Standardized neuropsychological testing and social/professional history questionnaires were performed 2 years (mean) after discharge. Memory impairment and slower cognitive processing were found in the aneurysmal and perimesencephalic SAH groups, while elective aneurysm patients showed signs of impaired attention. However, compared with norm data for age-matched healthy controls, all groups showed no significant test results. In contrast, signs of clinical depression were seen in 9/42 patients, 45 % of all patients complained of stress disorders and 55 % of patients were unable to work in their previous professions. Nearly normal neuropsychological test results on long-term follow-up in SAH patients were unexpected. However, a 50 % rate of unemployment accompanied with stress disorders and depression manifests insufficient social and workplace reintegration. Therefore, even more specific rehabilitation programs are required following inpatient treatment to attain full recovery. PMID:23949148

Krajewski, Kara; Dombek, Susanne; Martens, Tobias; Köppen, Johannes; Westphal, Manfred; Regelsberger, Jan

2014-01-01

365

Preemptive analgesia of oral clonidine during subarachnoid block for laparoscopic gynecological procedures: A prospective study  

PubMed Central

Background: Preemptive analgesia is known modality to control the peri-operative pain. The present study was aimed to evaluate the effects of oral clonidine on subarachnoid block characteristics, hemodynamic changes, sedation and respiratory efficiency in patients undergoing laparoscopic gynecological procedures. Patients and Methods: A total of 64 adult consenting females of American Society of Anesthesiologist physical status I and II were randomized double blindly into two groups of 32 patients each. Patients in the clonidine group received oral clonidine (100 ?g) and patients of the control group received placebo capsule, 90 min before subarachnoid block with 0.5% hyperbaric bupivacaine (3.5 ml). The onset of sensory and motor block, maximum cephalic sensory level and regression times of sensory and motor blockade were assessed. Intra-operative hemodynamic changes, respiratory efficiency, shoulder pain and sedation score were recorded. The other side-effects, if any were noted and managed. Results: The onset of sensory blockade was earlier in patients of clonidine group with prolonged duration of analgesia (216.4 ± 23.3 min vs. 165.8 ± 37.2 min, P < 0.05), but no significant difference was observed on motor blockade between groups. The hemodynamic parameters and respiratory efficiency were maintained within physiological limits in patients of clonidine group and no patient experienced shoulder pain. The Ramsey sedation score was 2.96 ± 0.75. In the control group, 17 patients experienced shoulder pain, which was effectively managed with small doses of ketamine and 15 patients required midazolam for anxiety. Conclusion: Premedication with oral clonidine (100 ?g) has enhanced the onset and prolonged the duration of spinal analgesia, provided sedation with no respiratory depression. The hemodynamic parameters remained stabilized during the pneumoperitoneum.

Gupta, Kumkum; Singh, Ivesh; Singh, V. P.; Gupta, Prashant K.; Tiwari, Vaibhav

2014-01-01

366

[Complications of hemorrhoids].  

PubMed

The most common and serious complications of haemorrhoids include perianal thrombosis and incarcerated prolapsed internal haemorrhoids with subsequent thrombosis. They are characterised by severe pain in the perianal region possibly with bleeding. In a short history of the perianal thrombosis, acute surgical incision or excision is indicated, which can result in rapid relief of the painful symptoms. In incarcerated prolapsed internal haemorrhoids, emergency haemorrhoidectomy may also be indicated. Segmental haemorrhoidectomy in the most affected quadrants followed by further elective surgery for haemorrhoids in the next stage is preferred. PMID:24881480

Slauf, P; Antoš, F; Marx, J

2014-04-01

367

[Acute hepatic vascular complications].  

PubMed

Acute hepatic vascular complications are rare. Acute portal vein thrombosis (PVT) and the Budd-Chiari syndrome (BSC) are the leading causes. Coagulopathy and local factors are present in up to 80% of cases. Diagnosis is established by colour-coded Doppler sonography, contrast-enhanced computed tomography or magnetic resonance imaging. Patients with acute PVT present with abdominal pain and disturbed intestinal motility. In the absence of cirrhosis anticoagulation with heparin is established followed by oral anticoagulation. In severe cases, surgical thrombectomy or transjugular thrombolysis with stent shunt may be necessary. Acute or fulminant BCS may require emergency liver transplantation or a transjugular intrahepatic portosystemic stent shunt, if patients present with acute liver failure. Milder cases receive anticoagulation for thrombolysis of occluded hepatic veins. Sinusoidal obstruction syndrome (SOS) is diagnosed after total body irradiation or chemotherapy, the term SOS replacing the former veno-occlusive disease. The treatment of congenital vascular malformations, complications in the setting of OLTX as well as patients with hepatic involvement of hereditary hemorrhagic telangiectasia requires significant expertise in a multidisciplinary approach. PMID:21667100

Ochs, A

2011-07-01

368

Gastrointestinal complications of diabetes.  

PubMed

Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications. PMID:18619079

Shakil, Amer; Church, Robert J; Rao, Shobha S

2008-06-15

369

Osteomyelitis complicating Streptococcus milleri endocarditis.  

PubMed Central

A patient with osteomyelitis of the spine complicating bacterial endocarditis due to Streptococcus milleri is discussed. To our knowledge, this is the first time this organism has been associated with this complication. Images Figure 1 PMID:2385559

Barham, N. J.; Flint, E. J.; Mifsud, R. P.

1990-01-01

370

Tumor necrosis factor-alpha mediates hemolysis-induced vasoconstriction and the cerebral vasospasm evoked by subarachnoid hemorrhage.  

PubMed

Hypertension can lead to subarachnoid hemorrhage and eventually to cerebral vasospasm. It has been suggested that the latter could be the result of oxidative stress and an inflammatory response evoked by subarachnoid hemorrhage. Because an unavoidable consequence of hemorrhage is lysis of red blood cells, we first tested the hypothesis on carotid arteries that the proinflammatory cytokine tumor necrosis factor-alpha contributes to vascular oxidative stress evoked by hemolysis. We observed that hemolysis induces a significant increase in tumor necrosis factor-alpha both in blood and in vascular tissues, where it provokes Rac-1/NADPH oxidase-mediated oxidative stress and vasoconstriction. Furthermore, we extended our observations to cerebral vessels, demonstrating that tumor necrosis factor-alpha triggered this mechanism on the basilar artery. Finally, in an in vivo model of subarachnoid hemorrhage obtained by the administration of hemolyzed blood in the cisterna magna, we demonstrated, by high-resolution ultrasound analysis, that tumor necrosis factor-alpha inhibition prevented and resolved acute cerebral vasoconstriction. Moreover, tumor necrosis factor-alpha inhibition rescued the hemolysis-induced brain injury, evaluated with the method of 2,3,5-triphenyltetrazolium chloride and by the histological analysis of pyknotic nuclei. In conclusion, our results demonstrate that tumor necrosis factor-alpha plays a crucial role in the onset of hemolysis-induced vascular injury and can be used as a novel target of the therapeutic strategy against cerebral vasospasm. PMID:19470883

Vecchione, Carmine; Frati, Alessandro; Di Pardo, Alba; Cifelli, Giuseppe; Carnevale, Daniela; Gentile, Maria Teresa; Carangi, Rosa; Landolfi, Alessandro; Carullo, Pierluigi; Bettarini, Umberto; Antenucci, Giovanna; Mascio, Giada; Busceti, Carla Letizia; Notte, Antonella; Maffei, Angelo; Cantore, Gian Paolo; Lembo, Giuseppe

2009-07-01

371

Complications of neuroimaging.  

PubMed

Modern imaging techniques with computed tomography (CT) and magnetic resonance imaging (MRI) have revolutionized neuroimaging. While eliminating the risks of invasive procedures, new risks must now be considered before ordering neuroimaging. Advanced imaging techniques with CT may pose a risk of significant radiation exposure. Contrast may pose a risk in patients with pre-existing renal failure. MR is associated with risks related to the static magnetic field, to risks associated with the magnetic field gradients, and to risk from contrast media. Neurointervenional techniques allow for nonoperative treatment of a variety of intracranial and spinal pathologies, but with associated risks of embolization, radiation exposure, bleeding complications at the access site and a potential for contrast-related nephropathy. PMID:24365444

Rosenblum, Jordan D; Pasternak, Olga; Mitchell, Myrosia M

2014-01-01

372

Enteropathy associated T-cell lymphoma presenting with multiple episodes of small bowel haemorrhage and perforation  

PubMed Central

Enteropathy-associated T cell lymphoma (EATCL) is an intestinal neoplasm of intra-epithelial T lymphocytes associated with coeliac disease. Although the incidence is rare, EATCL runs an aggressive disease course and produces multi-focal ulcerative lesions most commonly in the proximal small bowel. As such, patients may present with intestinal perforation, obstruction or haemorrhage. Management of EATCL requires a combination of early diagnosis and treatment by surgical resection followed by chemotherapy to achieve treatment success. Overall however, the treatment completion rate remains at 50% and EATCL carries a poor prognosis with a 5-year survival rate of <20%. PMID:24876396

Pun, Amy H.; Kasmeridis, Harry; Rieger, Nicholas; Loganathan, Arun

2014-01-01

373

[Three consecutive operations for chronic subdural haemorrhage in an 87-year-old man].  

PubMed

We describe a man aged 87 with a subdural haemorrhage which needed to be evacuated three times over an eight-week period. After the third operation the patient's physical and cognitive performance increased markedly, even though his performance had been assessed as "normal for his age" during his illness. The case illustrates the impressive regenerative capacity of the aged brain, the challenge in differentiating between disease symptoms and age-associated functional decline, the difficulties in deciding when to operate on an old patient, and the importance of functional assessments in health care for the elderly. PMID:15559927

Møinichen, Einar; Wyller, Torgeir Bruun; Gjølberg, Tor

2004-11-01

374

Partial Recovery of Audiological, Vestibular, and Radiological Findings following Spontaneous Intralabyrinthine Haemorrhage  

PubMed Central

The diagnosis, work-up, and treatment of sudden sensorineural hearing loss and sudden vestibular loss vary widely between units. With the increasing access to both magnetic resonance imaging and objective vestibular testing, our understanding of the various aetiologies at hand is increasing. Despite this, the therapeutic options are limited and without a particularly strong evidence base. We present a rare, yet increasingly diagnosed, case of intralabyrinthine haemorrhage (ILH) together with radiological, audiological, and vestibular test results. Of note, this occurred spontaneously and has shown partial recovery in all the mentioned modalities. PMID:24455375

Pezier, Thomas; Hegemann, Stefan

2013-01-01

375

Ebola haemorrhagic fever in Sudan, 1976. Report of a WHO/International Study Team.  

PubMed

A large outbreak of haemorrhagic fever (subsequently named Ebola haemorrhagic fever) occurred in southern Sudan between June and November 1976. There was a total of 284 cases; 67 in the source town of Nzara, 213 in Maridi, 3 in Tembura, and 1 in Juba. The outbreak in Nzara appears to have originated in the workers of a cotton factory. The disease in Maridi was amplified by transmission in a large, active hospital. Transmission of the disease required close contact with an acute case and was usually associated with the act of nursing a patient. The incubation period was between 7 and 14 days. Although the link was not well established, it appears that Nzara could have been the source of infection for a similar outbreak in the Bumba Zone of Zaire.In this outbreak Ebola haemorrhagic fever was a unique clinical disease with a high mortality rate (53% overall) and a prolonged recovery period in those who survived. Beginning with an influenza-like syndrome, including fever, headache, and joint and muscle pains, the disease soon caused diarrhoea (81%), vomiting (59%), chest pain (83%), pain and dryness of the throat (63%), and rash (52%). Haemorrhagic manifestations were common (71%), being present in half of the recovered cases and in almost all the fatal cases.Two post mortems were carried out on patients in November 1976. The histopathological findings resembled those of an acute viral infection and although the features were characteristic they were not exclusively diagnostic. They closely resembled the features described in Marburg virus infection, with focal eosinophilic necrosis in the liver and destruction of lymphocytes and their replacement by plasma cells. One case had evidence of renal tubular necrosis.Two strains of Ebola virus were isolated from acute phase sera collected from acutely ill patients in Maridi hospital during the investigation in November 1976. Antibodies to Ebola virus were detected by immunofluorescence in 42 of 48 patients in Maridi who had been diagnosed clinically, but in only 6 of 31 patients in Nzara. The possibility of the indirect immunofluorescent test not being sufficiently sensitive is discussed.Of Maridi case contacts, in hospital and in the local community, 19% had antibodies. Very few of them gave any history of illness, indicating that Ebola virus can cause mild or even subclinical infections. Of the cloth room workers in the Nzara cotton factory, 37% appeared to have been infected, suggesting that the factory may have been the prime source of infection. PMID:307455

1978-01-01

376

[Complications of treatment of neuroblastoma].  

PubMed

This article is based on two patients whose tumorous growths were successfully treated and who were cured of tumours and whose treatment had severe consequences. In one female patient, surgical removal of the tumour from the thoracic cavity resulted in haemorrhage into the spinal canal, leading to an irreversible transverse lesion of the cord with paraplegia. In the second patient, irradation with x-rays resulted in extremely severe radiation damage ultimately causing the death of the patient. Within the framework of this discussion, these problems are illuminated in detail. The emphasis is on severe damage in patients in whom the tumour itself has been cured in the course of the requisite therapeutic procedure. The author draws special attention to a stage-correlated treatment of neuroblastoma. PMID:7180204

Hopfgartner, L

1982-11-01

377

Gastrointestinal complications of oncologic therapy.  

PubMed

Gastrointestinal complications are common in patients undergoing various forms of cancer treatment, including chemotherapy, radiation therapy, and molecular-targeted therapies. Many of these complications are life-threatening and require prompt diagnosis and treatment. Complications of oncologic therapy can occur in the esophagus (esophagitis, strictures, bacterial, viral and fungal infections), upper gastrointestinal tract (mucositis, bleeding, nausea and vomiting), colon (diarrhea, graft-versus-host disease, colitis and constipation), liver (drug hepatotoxicity and graft-versus-host disease), and pancreas (pancreatitis). Treatment of the different gastrointestinal complications should be tailored to the individual patient and based on the underlying pathophysiology of the complication. PMID:18941434

Davila, Marta; Bresalier, Robert S

2008-12-01

378

Protective effects of PARP inhibition on liver microcirculation and function after haemorrhagic shock and resuscitation in male rats  

Microsoft Academic Search

Objective  The aim of this study was to investigate the impact of the water-soluble poly-(ADP)-ribose-polymerase (PARP) inhibitor 5-aminoisoquinolinone (5-AIQ) on liver microcirculation and function after haemorrhagic shock and resuscitation.Design  Controlled, randomized animal study.Setting  University animal care facility and research laboratory.Subject  Male Sprague–Dawley rats were subjected to haemorrhagic shock for 1?h, followed by resuscitation with shed blood and crystalloid solution for a total of 5 h.Interventions  The

J. P. Roesner; D. A. Vagts; T. Iber; C. Eipel; B. Vollmar; G. F. E. Nöldge-Schomburg

2006-01-01

379

Luminal platelet aggregates in functional deficits in parenchymal vessels after subarachnoid hemorrhage  

PubMed Central

The pathophysiology of early ischemic injury after aneurysmal subarachnoid hemorrhage (SAH) is not understood. This study examined the acute effect of endovascular puncture-induced SAH on parenchymal vessel function in rat, using intravascular fluorescent tracers to assess flow and vascular permeability and immunostaining to assess structural integrity and to visualize platelet aggregates. In sham-operated animals, vessels were well filled with tracer administered 10 seconds before sacrifice, and parenchymal escape of tracer was rare. At ten minutes and 3 hours after hemorrhage, patches of poor vascular filling were distributed throughout the forebrain. Close examination of these regions revealed short segments of narrowed diameter along many profiles. Most vascular profiles with reduced perfusion contained platelet aggregates and in addition showed focal loss of collagen IV, a principal component of basal lamina. In contrast, vessels were well filled at 24 hours post-hemorrhage, indicating that vascular perfusion had recovered. Parenchymal escape of intravascular tracer was detected at 10 minutes post-hemorrhage and later as plumes of fluorescence emanating into parenchyma from restricted microvascular foci. These data demonstrate that parenchymal microvessels are compromised in function by 10 minutes after SAH and identify focal microvascular constriction and local accumulation of luminal platelet aggregates as potential initiators of that compromise. PMID:20654597

Friedrich, Victor; Flores, Rowena; Muller, Artur; Sehba, Fatima A.

2010-01-01

380

Pharmacologic blockade of vascular adhesion protein-1 lessens neurologic dysfunction in rats subjected to subarachnoid hemorrhage.  

PubMed

Aneurysmal subarachnoid hemorrhage (SAH) is a potentially devastating clinical problem. Despite advances in the diagnosis and treatment of SAH, outcome remains unfavorable. An increased inflammatory state, one that is characterized by enhanced leukocyte trafficking has been reported to contribute to neuronal injury in association with multiple brain insults, including hemorrhagic and ischemic stroke. This study was designed to investigate, in rats, the neuropathologic consequences of heightened leukocyte trafficking following SAH, induced via endovascular perforation of the anterior cerebral artery. Experiments focused on the initial 48h post-SAH and sought to establish whether blockade of vascular adhesion protein-1 (VAP-1), with LJP-1586, was able to provide dose-dependent neuroprotection. Treatment with LJP-1586 was initiated at 6h post-SAH. An intravital microscopy and closed cranial window system, that permitted examination of temporal patterns of rhodamine-6G-labeled leukocyte adhesion/extravasation, was used. Effects of LJP-1586 on neurologic outcomes and leukocyte trafficking at 24h and 48h post-SAH were examined. In VAP-1-inhibited vs control rats, results revealed a significant attenuation in leukocyte trafficking at both 24h and 48h after SAH, along with an improvement in neurologic outcome. In conclusion, our findings support the involvement of an amplified inflammatory state, characterized by enhanced leukocyte trafficking, during the first 48h after SAH. VAP-1 blockade yielded neuroprotection that was associated with an attenuation of leukocyte trafficking and improved neurologic outcome. PMID:25175836

Xu, Hao-Liang; Garcia, Maggie; Testai, Fernando; Vetri, Francesco; Barabanova, Alexandra; Pelligrino, Dale A; Paisansathan, Chanannait

2014-10-24

381

Impact of clipping versus coiling on postoperative hemodynamics and pulmonary edema after subarachnoid hemorrhage.  

PubMed

Volume management is critical for assessment of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). This multicenter prospective cohort study compared the impact of surgical clipping versus endovascular coiling on postoperative hemodynamics and pulmonary edema in patients with SAH. Hemodynamic parameters were measured for 14 days using a transpulmonary thermodilution system. The study included 202 patients, including 160 who underwent clipping and 42 who underwent coiling. There were no differences in global ejection fraction (GEF), cardiac index, systemic vascular resistance index, or global end-diastolic volume index between the clipping and coiling groups in the early period. However, extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were significantly higher in the clipping group in the vasospasm period. Postoperative C-reactive protein (CRP) level was higher in the clipping group and was significantly correlated with postoperative brain natriuretic peptide level. Multivariate analysis found that PVPI and GEF were independently associated with high EVLWI in the early period, suggesting cardiogenic edema, and that CRP and PVPI, but not GEF, were independently associated with high EVLWI in the vasospasm period, suggesting noncardiogenic edema. In conclusion, clipping affects postoperative CRP level and may thereby increase noncardiogenic pulmonary edema in the vasospasm period. His trial is registered with University Hospital Medical Information Network UMIN000003794. PMID:24818154

Horie, Nobutaka; Iwaasa, Mitsutoshi; Isotani, Eiji; Ishizaka, Shunsuke; Inoue, Tooru; Nagata, Izumi

2014-01-01

382

The rodent endovascular puncture model of subarachnoid hemorrhage: mechanisms of brain damage and therapeutic strategies  

PubMed Central

Subarachnoid hemorrhage (SAH) represents a considerable health problem. To date, limited therapeutic options are available. In order to develop effective therapeutic strategies for SAH, the mechanisms involved in SAH brain damage should be fully explored. Here we review the mechanisms of SAH brain damage induced by the experimental endovascular puncture model. We have included a description of similarities and distinctions between experimental SAH in animals and human SAH pathology. Moreover, several novel treatment options to diminish SAH brain damage are discussed. SAH is accompanied by cerebral inflammation as demonstrated by an influx of inflammatory cells into the cerebral parenchyma, upregulation of inflammatory transcriptional pathways and increased expression of cytokines and chemokines. Additionally, various cell death pathways including cerebral apoptosis, necrosis, necroptosis and autophagy are involved in neuronal damage caused by SAH. Treatment strategies aiming at inhibition of inflammatory or cell death pathways demonstrate the importance of these mechanisms for survival after experimental SAH. Moreover, neuroregenerative therapies using stem cells are discussed as a possible strategy to repair the brain after SAH since this therapy may extend the window of treatment considerably. We propose the endovascular puncture model as a suitable animal model which resembles the human pathology of SAH and which could be applied to investigate novel therapeutic therapies to combat this debilitating insult. PMID:24386932

2014-01-01

383

Subarachnoid hemorrhage model in the rat: modification of the endovascular filament model.  

PubMed

The present study describes modifications to the endovascular filament model of subarachnoid hemorrhage (SAH) in rats. Specifically, we sought to improve the percentage yield of SAH, reduce mortality rates and better simulate human cerebral aneurysmal rupture. Instead of using a 4-0 prolene suture to induce SAH in the existing endovascular filament model, a hollow and flexible polyetrafluoroethylene (PTFE) tube was maneuvered into the proximal anterior cerebral artery (ACA) to ensure that advancement occurred without producing trauma to the vessels. SAH was induced by advancing a tungsten wire through this tube, perforating the ACA at the desired location. These modifications produced significant improvements over the endovascular filament model. Mortality rate declined from 46 to 19%, and SAH was produced more frequently. With the prolene suture, only 48% of our attempts produced a SAH, and unsuccessful attempts typically resulted in an acute subdural hematoma (ASDH). In contrast, the wire/tubing technique was 90% successful at inducing SAH, and led to a significant reduction of ASDH incidence from 44 to 6%. Additionally, the modified technique produced vasospasm in basilar and middle cerebral arteries post-SAH as well as pseudoaneurysms in the proximal ACA which indicated the location of vessel perforation. PMID:18562012

Park, Ik-Seong; Meno, Joseph R; Witt, Cordelie E; Suttle, Timothy K; Chowdhary, Abhineet; Nguyen, Thien-Son; Ngai, Al C; Britz, Gavin W

2008-07-30

384

Changes in responsiveness of the canine basilar artery to endothelin-1 after subarachnoid hemorrhage  

SciTech Connect

The effect of endothelin-1 (ET-1) on the basilar arteries from control and subarachnoid hemorrhage (SAH) dogs were examined. The maximal contraction of the basilar artery in response to ET-1 was markedly decreased in the SAH group. Treatment with 10{sup {minus}8}M phorbol 12-myristate 13-acetate (PMA) reduced the contractile responses to ET-1 in the basilar arteries from control dogs. ET-1-induced contractions of the basilar arteries from control dogs were similar to those in strips from SAH dogs by the treatment with 10{sup {minus}8}M PMA. Ca{sup 2+}-induced contraction of the basilar arteries which were depolarized with isotonic K{sup +} were significantly attenuated in SAH dogs. Treatment with PMA also reduced the contractile responses to Ca{sup 2+} in the basilar arteries from control dogs. These results indicate that decreased contractile responses of the basilar arteries to ET-1 and Ca{sup 2+} in the SAH group may be related to changes in the activity of the protein kinase C in vascular smooth muscle.

Kamata, Katsuo; Nishiyama, Hiroshi; Kasuya, Yutaka (Taisho Pharmaceutical Co. Ltd., Saitama (Japan)); Miyata, Noriyuki (Hoshi Univ., Tokyo (Japan))

1991-01-01

385

Angio negative spontaneous subarachnoid hemorrhage: Is repeat angiogram required in all cases?  

PubMed Central

Background: In some cases of spontaneous subarachnoid hemorrhage (SAH), the cause of bleed remains obscure on initial evaluation. These patients may harbor structural lesions. We aim to determine the utility of repeat angiogram in these subsets of patients. Methods: In this prospective study, patients with SAH with a negative computed tomographic angiogram (CTA) and digital subtraction angiogram (DSA) were included. A repeat angiogram was done after 6 weeks of initial angiogram. Patients were divided into perimesencephalic SAH (PM-SAH) and diffuse classic SAH (Classic-SAH) groups. Outcome was determined by modified Rankin score (mRS). Results: A total of 22% (39/178) of all SAH were angio-negative. A total of 90% (n = 35) of these were in Hunt and Hess grade 1-3. A total of 22 patients had PM-SAH and 17 had a Classic-SAH. Repeat angiogram did not reveal any pathology in the PM-SAH group, whereas two patients with Classic-SAH were found to have aneurysms. At 6 months follow-up, 95% patients of PM-SAH and 83.3% of Classic-SAH had mRS of 0. Conclusion: Repeat angiogram is probably not necessary in patients of PM-SAH and they tend to have better outcome. Classic-SAH pattern of bleed is associated with fair chances of an underlying pathology and a repeat angiogram is recommended and these cases and they have poorer outcome. PMID:25140284

Kumar, Rajan; Das, Kuntal Kanti; Sahu, Rajni K.; Sharma, Pradeep; Mehrotra, Anant; Srivastava, Arun K.; Sahu, Rabi N.; Jaiswal, Awadhesh K.; Behari, Sanjay

2014-01-01

386

CO2 has no therapeutic effect on early microvasospasm after experimental subarachnoid hemorrhage.  

PubMed

In addition to delayed vasospasm also early brain injury, which occurs during the first few days after subarachnoid hemorrhage (SAH) when large cerebral arteries are still fully functional, plays an important role for the outcome after SAH. In the current study, we investigated the hypothesis that carbon dioxide (CO2), a strong cerebral vasodilator, has a therapeutic potential against early posthemorrhagic microvasospasm. C57BL/6 mice (n=36) and Sprague-Dawley rats (n=23) were subjected to sham surgery or SAH by filament perforation. The pial microcirculation in the mice was visualized 3 and 24 hours after SAH using intravital fluorescence microscopy. Partial pressure of CO2 (PaCO2) was modulated by hyper- or hypoventilation or by inhalation of 10% CO2. In rats, CO2-mediated changes in cerebral blood flow (CBF) were measured at the same time points using laser Doppler fluxmetry. Increased PaCO2 caused vasodilatation in sham-operated animals. Following SAH, however, cerebral arterioles were nonreactive to CO2. This lack of microvascular CO2 reactivity was accompanied by a complete loss of CO2-induced hyperemia. Our data show that CO2 is not able to dilate spastic microvessels and to increase CBF early after SAH. Future therapeutic approaches will therefore need to address mechanisms beyond CO2. PMID:24865999

Friedrich, Benjamin; Michalik, Radoslaw; Oniszczuk, Anna; Abubaker, Khalid; Kozniewska, Ewa; Plesnila, Nikolaus

2014-08-01

387

Time intervals from aneurysmal subarachnoid hemorrhage to treatment and factors contributing to delay.  

PubMed

In the management of aneurysmal subarachnoid hemorrhage (aSAH), aneurysm treatment as early as feasible is mandatory to minimize the risk of a rebleed and may thus improve outcome. We assessed the different time intervals from the first symptoms of aSAH to start of aneurysm treatment in an effort to identify which factors contribute mostly to a delay in time to treatment. In 278 aSAH patients, time intervals between the different steps from initial hemorrhage to aneurysm treatment were retrospectively reviewed, and delaying factors were determined. Half of the patients presented to a hospital within 115 min (IQR 60-431). The median (IQR) interval from hemorrhage to diagnosis was 169 min (96-513), and from diagnosis to treatment 1,057 min (416-1,428), or 17.6 h. Aneurysm treatment started within 24 h in 76 % of treated patients. Independent factors predicting delay to treatment were primary presentation at a referring hospital and admission to the treatment center later in the day. Delay in treatment was not independently related to poor outcome. The interval to aneurysm treatment might be improved upon by immediate and direct transport to the treatment center combined with optimization of in-hospital logistics, following the 'time-is-brain' concept so successfully adopted in the treatment of ischemic stroke. PMID:24366653

R Germans, Menno; Hoogmoed, Jantien; van Straaten, H A Stéphanie; Coert, Bert A; Peter Vandertop, W; Verbaan, Dagmar

2014-03-01

388

Imatinib preserves blood-brain barrier integrity following experimental subarachnoid hemorrhage in rats.  

PubMed

Blood-brain barrier (BBB) disruption and consequent edema formation contribute to the development of early brain injury following subarachnoid hemorrhage (SAH). Various cerebrovascular insults result in increased platelet-derived growth factor receptor (PDGFR)-? stimulation, which has been linked to BBB breakdown and edema formation. This study examines whether imatinib, a PDGFR inhibitor, can preserve BBB integrity in a rat endovascular perforation SAH model. Imatinib (40 or 120 mg/kg) or a vehicle was administered intraperitoneally at 1 hr after SAH induction. BBB leakage, brain edema, and neurological deficits were evaluated. Total and phosphorylated protein expressions of PDGFR-?, c-Src, c-Jun N-terminal kinase (JNK), and c-Jun were measured, and enzymatic activities of matrix metalloproteinase (MMP)-2 and MMP-9 were determined in the injured brain. Imatinib treatment significantly ameliorated BBB leakage and edema formation 24 hr after SAH, which was paralleled by improved neurological functions. Decreased brain expressions of phosphorylated PDGFR-?, c-Src, JNK, and c-Jun as well as reduced MMP-9 activities were found in treated animals. PDGFR-? inhibition preserved BBB integrity following experimental SAH; however, the protective mechanisms remain to be elucidated. Targeting PDGFR-? signaling might be advantageous to ameliorate early brain injury following SAH. © 2014 Wiley Periodicals, Inc. PMID:25196554

Zhan, Yan; Krafft, Paul R; Lekic, Tim; Ma, Qingyi; Souvenir, Rhonda; Zhang, John H; Tang, Jiping

2015-01-01

389

Double cisterna magna blood injection model of experimental subarachnoid hemorrhage in dogs.  

PubMed

Several animal subarachnoid hemorrhage (SAH) models have been proposed to study the etiology and treatment for cerebral vasospasm. We describe the experimental procedures of a canine double-hemorrhage model of SAH and discuss the pathophysiological parameters and occurrence of angiographic delayed cerebral vasospasm using magnetic resonance (MR) imaging and digital subtraction angiography. Autologous blood was injected twice on days 1 and 3 into the cerebellomedullary cistern of 36 female beagles. All animals showed delayed angiographic vasospasm in the vertebrobasilar arteries on day 7. The degree of vasospasm was 29-42 % of the arterial diameter. However, this model showed no symptomatic vasospasm or ischemic changes detected by MR imaging. This animal model can produce reproducible delayed vasospasm without detectable cerebral infarction on MR imaging. This model allows evaluation of the effect of treatment on delayed vasospasm in the same animals. The canine double-hemorrhage model of SAH is suitable for the quantitative and chronological study of delayed angiographic vasospasm, but not for investigating early brain injury and delayed cerebral ischemia. PMID:24986149

Mori, Kentaro

2014-12-01

390

Glibenclamide reduces inflammation, vasogenic edema, and caspase-3 activation after subarachnoid hemorrhage.  

PubMed

Subarachnoid hemorrhage (SAH) causes secondary brain injury due to vasospasm and inflammation. Here, we studied a rat model of mild-to-moderate SAH intended to minimize ischemia/hypoxia to examine the role of sulfonylurea receptor 1 (SUR1) in the inflammatory response induced by SAH. mRNA for Abcc8, which encodes SUR1, and SUR1 protein were abundantly upregulated in cortex adjacent to SAH, where tumor-necrosis factor-alpha (TNFalpha) and nuclear factor (NF)kappaB signaling were prominent. In vitro experiments confirmed that Abcc8 transcription is stimulated by TNFalpha. To investigate the functional consequences of SUR1 expression after SAH, we studied the effect of the potent, selective SUR1 inhibitor, glibenclamide. We examined barrier permeability (immunoglobulin G, IgG extravasation), and its correlate, the localization of the tight junction protein, zona occludens 1 (ZO-1). SAH caused a large increase in barrier permeability and disrupted the normal junctional localization of ZO-1, with glibenclamide significantly reducing both effects. In addition, SAH caused large increases in markers of inflammation, including TNFalpha and NFkappaB, and markers of cell injury or cell death, including IgG endocytosis and caspase-3 activation, with glibenclamide significantly reducing these effects. We conclude that block of SUR1 by glibenclamide may ameliorate several pathologic effects associated with inflammation that lead to cortical dysfunction after SAH. PMID:18854840

Simard, J Marc; Geng, Zhihua; Woo, S Kyoon; Ivanova, Svetlana; Tosun, Cigdem; Melnichenko, Ludmila; Gerzanich, Volodymyr

2009-02-01

391

Comparison of Incidence and Risk Factors for Shunt-dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage Patients  

PubMed Central

Objective The objective of this study was to compare the incidence of ventricular shunt placement for shunt-dependent hydrocephalus (SDHC) after clipping versus coiling of ruptured aneurysms. Materials and Methods A retrospective review was conducted in 215 patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent surgical clipping or endovascular coiling during the period from May 2008 to December 2011. Relevant clinical and radiographic data were analyzed with regard to the incidence of hydrocephalus and ventriculo-peritoneal shunt (VPS). Patients treated with clipping were assigned to Group A, while those treated with coiling were assigned to Group B. Results Of 215 patients (157 clipping, 58 coiling), no significant difference in the incidence of final VPS was observed between treatment modalities (15.3% vs. 10.3%) (p = 0.35). Independent risk factors for VPS for treatment of chronic hydrocephalus were as follows: (1) older than 65 years, (2) poorer Hunt-Hess grade IV and V, (3) Fisher grade III and IV, and (4) particularly initial presence of an intraventricular hemorrhage. Conclusion In this study comparing two modalities for treatment of aneurysm, there was no difference in the incidence of chronic hydrocephalus requiring VPS. A significantly higher rate of shunt dependency was observed for age older than 65 years, poor initial neurological status, and thick SAH with presence of initial intraventricular hemorrhage. By understanding these factors related to development of SDHC and results, it is expected that management of aneurysmal SAH will result in a better prognosis. PMID:25045646

Bae, In-Seok; Choi, Kyu-Sun; Chun, Hyoung-Joon

2014-01-01

392

Aneurismal subarachnoid hemorrhage in a Chilean population, with emphasis on risk factors  

PubMed Central

Background Subarachnoid Hemorrhage (SAH) is caused principally by the rupture of intracranial aneurisms. Important risk factors have been described such as age, sex, hypertension (HT) and season of the year, among others. The objective is to investigate the demographic characteristics and possible risk factors in a population of Chilean patients. Methods This retrospective study was based on the analysis of 244 clinical records of patients diagnosed with aneurismal SAH who were discharged from the Instituto de Neurocirugía ASENJO in Santiago, Chile. Results The mean age of patients was 49.85 years and the male:female ratio was 1:2.7. The signs and symptoms were not different between sexes; cephalea (85.7%) was predominant, followed by loss of consciousness, vomiting/nausea and meningeal signs. Risk factors included sex, age and HT. Concordant with other reports, the incidence of SAH was greatest in spring. Conclusions The demographic characteristics and risk factors observed in patients with aneurismal SAH treated in ASENJO were comparable to those of other populations. We were not able to conclude that tobacco and alcohol consumption were risk factors for this population. PMID:22035203

2011-01-01

393

Beneficial effects of systemic administration of recombinant human erythropoietin in rabbits subjected to subarachnoid hemorrhage  

PubMed Central

Cerebral vasospasm and ischemic damage are important causes of mortality and morbidity in patients affected by aneurysmal subarachnoid hemorrhage (SAH). Recently, i.p. administration of recombinant human erythropoietin (r-Hu-EPO) has been shown to exert a neuroprotective effect during experimental SAH. The present study was conducted to evaluate further the effect of r-Hu-EPO administration after SAH in rabbits on neurological outcome, degree of basilar artery spasm, and magnitude of neuronal ischemic damage. Experimental animals were divided into six groups: group 1 (n = 8), control; group 2 (n = 8), control plus placebo; group 3 (n = 8), control plus r-Hu-EPO; group 4 (n = 8), SAH; group 5 (n = 8), SAH plus placebo; group 6 (n = 8), SAH plus r-Hu-EPO. r-Hu-EPO, at a dose of 1,000 units/kg, and placebo were injected i.p. starting 5 min after inducing SAH and followed by clinical and pathological assessment 72 h later. Systemic administration of r-Hu-EPO produced significant increases in cerebrospinal fluid EPO concentrations (P < 0.001), and reduced vasoconstriction of the basilar artery (P < 0.05), ischemic neuronal damage (P < 0.001), and subsequent neurological deterioration (P < 0.05). These observations suggest that r-Hu-EPO may provide an effective treatment to reduce the post-SAH morbidity. PMID:11943864

Grasso, Giovanni; Buemi, Michele; Alafaci, Concetta; Sfacteria, Alessandra; Passalacqua, Marcello; Sturiale, Alessio; Calapai, Gioacchino; De Vico, Gionata; Piedimonte, Giuseppe; Salpietro, Francesco M.; Tomasello, Francesco

2002-01-01

394

Does dexamethasone prevent subarachnoid meperidin-induced nausea, vomiting and pruritus after cesarean delivery?  

PubMed Central

Background: Opioid-induced side effects such as nausea and vomiting and pruritus are common and may be more debilitating than pain itself. We performed a study to assess the efficacy of dexamethasone in reducing postoperative nausea, vomiting, and pruritus in patients receiving neuraxial anesthesia with meperidine. Methods: Fifty-two women undergoing cesarean section were enrolled in the study. The control group and dexamethasone group received intravenously normal saline and dexamethasone, respectively, before spinal anesthesia. The occurrence of postoperative nausea, vomiting, and pruritus was assessed for 24 h in both groups. Results: The overall incidence of nausea and vomiting during the 24 h follow-up period was 37% and 22.2% for group saline and 20% and 12% for group dexamethasone, respectively (P=0.175, 0.469). The incidence of pruritus was not significantly different between the two groups. Pruritus severity was significantly less in the dexamethasone group than in the saline group (P=0.019). Conclusion: Prophylactic dexamethasone does not reduce the incidence of subarachnoid meperidine-induced nausea, vomiting, and pruritus in women undergoing cesarean delivery. PMID:23956711

Banihashem, Nadia; Hasannasab, Bahman; Alereza, Hakimeh

2013-01-01

395

A novel method for subarachnoid hemorrhage to induce vasospasm in mice  

PubMed Central

Mouse models take advantage of genetic manipulations that can be achieved in this species. There are currently two accepted mouse models of subarachnoid hemorrhage (SAH) and cerebral vasospasm (CVs). Both are technically demanding and labor intensive. In this study, we report a reproducible and technically feasible method to induce SAH, and subsequently CVs, in mice. We tested this model in multiple strains of mice that are commonly used for genetic manipulation. Methods SAH was induced in C57BL/6NCr, FVB, 129S1, BalbC and SJL mice, weighing 28–32 g, by an intracisternal vessel transection technique. Animals were perfused with India ink at 24 h postprocedure and vessel diameters were quantified. Brain slices were obtained for hematoxylin–eosin staining (H&E) to look for vascular changes consistent with CVs. Results There was no mortality during or after the procedure. Four of the five mouse strains showed significant CVs at 24 h postprocedure characterized by decreased vessel diameter of the middle cerebral artery close to the Circle of Willis. Histologically, the vessel wall displayed significant corrugation and thickening, consistent with CVs. Conclusion A novel mouse model to induce SAH is described and tested in several mouse strains. Four of the five strains used in this study developed CVs after the induction of SAH. The procedure is brief, straightforward, reproducible with low mortality, and applicable to commonly used background strains for genetically engineered mice. PMID:19576247

Altay, Tamer; Smithason, Saksith; Volokh, Nina; Rasmussen, Peter A.; Ransohoff, Richard M.; Provencio, J. Javier

2009-01-01

396

Signal transduction in cerebral arteries after subarachnoid hemorrhage--a phosphoproteomic approach  

PubMed Central

After subarachnoid hemorrhage (SAH), pathologic changes in cerebral arteries contribute to delayed cerebral ischemia and poor outcome. We hypothesize such changes are triggered by early intracellular signals, targeting of which may prevent SAH-induced vasculopathy. We performed an unbiased quantitative analysis of early SAH-induced phosphorylations in cerebral arteries and evaluated identified signaling components as targets for prevention of delayed vasculopathy and ischemia. Labeled phosphopeptides from rat cerebral arteries were quantified by high-resolution tandem mass spectrometry. Selected SAH-induced phosphorylations were validated by immunoblotting and monitored over a 24-hour time course post SAH. Moreover, inhibition of key phosphoproteins was performed. Major SAH-induced phosphorylations were observed on focal adhesion complexes, extracellular regulated kinase 1/2 (ERK1/2), calcium calmodulin-dependent kinase II, signal transducer and activator of transcription (STAT3) and c-Jun, the latter two downstream of ERK1/2. Inhibition of ERK1/2 6-hour post SAH prevented increases in cerebrovascular constrictor receptors, matrix metalloprotease-9, wall thickness, and improved neurologic outcome. STAT3 inhibition partially mimicked these effects. The study shows that quantitative mass spectrometry is a strong approach to study in vivo vascular signaling. Moreover, it shows that targeting of ERK1/2 prevents delayed pathologic changes in cerebral arteries and improves outcome, and identifies SAH-induced signaling components downstream and upstream of ERK1/2. PMID:23715060

Parker, Benjamin L; Larsen, Martin R?ssel; Edvinsson, Lars IH; Povlsen, Gro Klitgaard

2013-01-01

397

Delayed cerebral ischemia and spreading depolarization in absence of angiographic vasospasm after subarachnoid hemorrhage  

PubMed Central

It has been hypothesized that vasospasm is the prime mechanism of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Recently, it was found that clusters of spreading depolarizations (SDs) are associated with DCI. Surgical placement of nicardipine prolonged-release implants (NPRIs) was shown to strongly attenuate vasospasm. In the present study, we tested whether SDs and DCI are abolished when vasospasm is reduced or abolished by NPRIs. After aneurysm clipping, 10 NPRIs were placed next to the proximal intracranial vessels. The SDs were recorded using a subdural electrode strip. Proximal vasospasm was assessed by digital subtraction angiography (DSA). 534 SDs were recorded in 10 of 13 patients (77%). Digital subtraction angiography revealed no vasospasm in 8 of 13 patients (62%) and only mild or moderate vasospasm in the remaining. Five patients developed DCI associated with clusters of SD despite the absence of angiographic vasospasm in three of those patients. The number of SDs correlated significantly with the development of DCI. This may explain why reduction of angiographic vasospasm alone has not been sufficient to improve outcome in some clinical studies. PMID:22146193

Woitzik, Johannes; Dreier, Jens P; Hecht, Nils; Fiss, Ingo; Sandow, Nora; Major, Sebastian; Winkler, Maren; Dahlem, Yuliya A; Manville, Jerome; Diepers, Michael; Muench, Elke; Kasuya, Hidetoshi; Schmiedek, Peter; Vajkoczy, Peter

2012-01-01

398

Incidences of unruptured intracranial aneurysms and subarachnoid hemorrhage: results of a statewide study  

PubMed Central

Background The incidence of unruptured intracranial aneurysms (UIAs) and the current public health impact may be higher than that reported in previous studies owing to an increase in the elderly population in the United States. Objective To report the current incidences of UIAs and subarachnoid hemorrhages (SAH) by using a population-based methodology. Methods Statewide estimates of patients admitted with UIAs and SAH were obtained from the data obtained by the Minnesota Hospital Association. We calculated the annual incidences per 100,000 persons by using the 2010 census data from the U.S. Census Bureau. For the denominator, total persons in each year were categorized into 10-year intervals. Results The incidences of UIAs and SAH were 15.6 and 7.7 per 100,000 persons, respectively. There were higher incidences of both UIAs and SAH among women (22.5 and 9.6 per 100,000 persons, respectively). The highest incidence of UIAs occurred in those aged between 75 and 84 years (61.6 per 100,000 persons). The highest incidence of SAH occurred in those aged 85 years and older (30.1 per 100,000 persons). Conclusion An increase in both incidences of UIAs and SAH can be expected owing to the continued increase of the elderly population, particularly women. PMID:25298853

Asaithambi, Ganesh; Adil, Malik M; Chaudhry, Saqib A; Qureshi, Adnan I

2014-01-01

399

Intravenous Flat-Detector Computed Tomography Angiography for Symptomatic Cerebral Vasospasm following Aneurysmal Subarachnoid Hemorrhage  

PubMed Central

The study evaluated the diagnostic accuracy of intravenous flat-detector computed tomography (IV FDCT) angiography in assessing hemodynamically significant cerebral vasospasm in patients with subarachnoid hemorrhage (SAH) with digital subtraction angiography (DSA) as the reference. DSA and IV FDCT were conducted concurrently in patients suspected of having symptomatic cerebral vasospasm postoperatively. The presence and severity of vasospasm were estimated according to location (proximal versus distal). Vasospasm >50% was defined as having hemodynamic significance. Vasospasms <30% were excluded from this analysis to avoid spectrum bias. Twenty-nine patients (311 vessel segments) were measured. The intra- and interobserver agreements were excellent for depicting vasospasm (k = 0.84 and 0.74, resp.). IV FDCT showed a sensitivity of 95.7%, specificity of 92.3%, positive predictive value of 93.6%, and negative predictive value of 94.7% for detecting vasospasm (>50%) with DSA as the reference. Bland-Altman plots revealed good agreement of assessing vasospasm between the two tests. The discrepancy of vasospasm severity was more noted in the distal location with high-severity. However, it was not statistically significant (Spearman's rank test; r = 0.15, P = 0.35). Therefore, IV FDCT could be a feasible noninvasive test to evaluate suspected significant vasospasm in SAH. PMID:25383367

Jeon, Jin Pyeong; Sheen, Seung Hun; Cho, Yong-Jun

2014-01-01

400

Neuroprotective Effect of Tea Polyphenols on Oxyhemoglobin Induced Subarachnoid Hemorrhage in Mice  

PubMed Central

Tea polyphenols are of great benefit to the treatment of several neurodegenerative diseases. In order to explore the neuroprotective effects of tea polyphenols and their potential mechanisms, an established in vivo subarachnoid hemorrhage (SAH) model was used and alterations of mitochondrial function, ATP content, and cytochrome c (cyt c) in cerebral cortex were detected. This study showed that the alteration of mitochondrial membrane potential was an early event in SAH progression. The trend of ATP production was similar to that of mitochondrial membrane potential, indicating that the lower the mitochondrial membrane potential, lesser the ATP produced. Due to mitochondrial dysfunction, more cyt c was released in the SAH group. Interestingly, the preadministration of tea polyphenols significantly rescued the mitochondrial membrane potential to basal level, as well as the ATP content and the cyt c level in the brain cortex 12?h after SAH. After pretreatment with tea polyphenols, the neurological outcome was also improved. The results provide strong evidence that tea polyphenols enhance neuroprotective effects by inhibiting polarization of mitochondrial membrane potential, increasing ATP content, and blocking cyt c release. PMID:23840920

Mo, Haizhen; Chen, Ying; Huang, Liyong; Zhang, Hao; Li, Juxiang; Zhou, Wenke

2013-01-01

401

The role of the microcirculation in delayed cerebral ischemia and chronic degenerative changes after subarachnoid hemorrhage  

PubMed Central

The mortality after aneurysmal subarachnoid hemorrhage (SAH) is 50%, and most survivors suffer severe functional and cognitive deficits. Half of SAH patients deteriorate 5 to 14 days after the initial bleeding, so-called delayed cerebral ischemia (DCI). Although often attributed to vasospasms, DCI may develop in the absence of angiographic vasospasms, and therapeutic reversal of angiographic vasospasms fails to improve patient outcome. The etiology of chronic neurodegenerative changes after SAH remains poorly understood. Brain oxygenation depends on both cerebral blood flow (CBF) and its microscopic distribution, the so-called capillary transit time heterogeneity (CTH). In theory, increased CTH can therefore lead to tissue hypoxia in the absence of severe CBF reductions, whereas reductions in CBF, paradoxically, improve brain oxygenation if CTH is critically elevated. We review potential sources of elevated CTH after SAH. Pericyte constrictions in relation to the initial ischemic episode and subsequent oxidative stress, nitric oxide depletion during the pericapillary clearance of oxyhemoglobin, vasogenic edema, leukocytosis, and astrocytic endfeet swelling are identified as potential sources of elevated CTH, and hence of metabolic derangement, after SAH. Irreversible changes in capillary morphology and function are predicted to contribute to long-term relative tissue hypoxia, inflammation, and neurodegeneration. We discuss diagnostic and therapeutic implications of these predictions. PMID:24064495

?stergaard, Leif; Aamand, Rasmus; Karabegovic, Sanja; Tietze, Anna; Blicher, Jakob Udby; Mikkelsen, Irene Klaerke; Iversen, Nina Kerting; Secher, Niels; Engedal, Thorbj?rn S?ndergaard; Anzabi, Mariam; Jimenez, Eugenio Gutierrez; Cai, Changsi; Koch, Klaus Ulrik; Naess-Schmidt, Erhard Trillingsgaard; Obel, Annette; Juul, Niels; Rasmussen, Mads; S?rensen, Jens Christian Hedemann

2013-01-01

402

New hope: community-based misoprostol use to prevent postpartum haemorrhage.  

PubMed

The wide gap in maternal mortality ratios worldwide indicates major inequities in the levels of risk women face during pregnancy. Two priority strategies have emerged among safe motherhood advocates: increasing the quality of emergency obstetric care facilities and deploying skilled birth attendants. The training of traditional birth attendants, a strategy employed in the 1970s and 1980s, is no longer considered a best practice. However, inadequate access to emergency obstetric care and skilled birth attendants means women living in remote areas continue to die in large numbers from preventable maternal causes. This paper outlines an intervention to address the leading direct cause of maternal mortality, postpartum haemorrhage. The potential for saving maternal lives might increase if community-based birth attendants, women themselves, or other community members could be trained to use misoprostol to prevent postpartum haemorrhage. The growing body of evidence regarding the safety and efficacy of misoprostol for this indication raises the question: if achievement of the fifth Millennium Development Goal is truly a priority, why can policy makers and women's health advocates not see that misoprostol distribution at the community level might have life-saving benefits that outweigh risks? PMID:22879523

Prata, Ndola; Passano, Paige; Bell, Suzanne; Rowen, Tami; Potts, Malcolm

2013-07-01

403

Case definition for Ebola and Marburg haemorrhagic fevers: a complex challenge for epidemiologists and clinicians.  

PubMed

Viral haemorrhagic fevers (VHFs) represent a challenge for public health because of their epidemic potential, and their possible use as bioterrorism agents poses particular concern. In 1999 the World Health Organization (WHO) proposed a case definition for VHFs, subsequently adopted by other international institutions with the aim of early detection of initial cases/outbreaks in western countries. We applied this case definition to reports of Ebola and Marburg virus infections to estimate its sensitivity to detect cases of the disease. We analyzed clinical descriptions of 795 reported cases of Ebola haemorrhagic fever: only 58.5% of patients met the proposed case definition. A similar figure was obtained reviewing 169 cases of Marburg diseases, of which only 64.5% were in accordance with the case definition. In conclusion, the WHO case definition for hemorrhagic fevers is too specific and has poor sensitivity both for case finding during Ebola or Marburg outbreaks, and for early detection of suspected cases in western countries. It can lead to a hazardous number of false negatives and its use should be discouraged for early detection of cases. PMID:20128442

Pittalis, Silvia; Fusco, Francesco Maria; Lanini, Simone; Nisii, Carla; Puro, Vincenzo; Lauria, Francesco Nicola; Ippolito, Giuseppe

2009-10-01

404

Ischaemic and haemorrhagic brain lesions in newborns with seizures and normal Apgar scores.  

PubMed Central

Serial ultrasound scans and conventional and diffusion weighted magnetic resonance imaging (MRI) were performed on 16 neonates who presented with seizures. The Apgar scores were normal and subsequently no metabolic or infective cause could be found. The aim of the study was to evaluate the extent to which early sequential imaging can elucidate the cause of seizures in apparently neurologically normal infants. Fourteen of the infants had haemorrhagic or ischaemic lesions on MRI and these were detected by ultrasound scanning in 11. Early ultrasound scanning detected the haemorrhagic lesions but the ischaemic lesions were often not seen until the end of the first week of life. Early MRI, however, was able to detect all the ischaemic lesions. The evolution of the insult could be timed by using serial ultrasound scans and a combination of diffusion weighted and conventional MRI during the first week of life, confirming a perinatal insult even in the absence of fetal distress. Although the aetiology of these lesions remains obscure, serial ultrasound scans will detect the presence of cerebral lesions in neonates presenting with isolated seizures but additional MRI sequences will give better definition on type, site, and extent of the pathology. Images Figures 5 and 6 Figure 2 Figures 3 and 4 Figure 1 PMID:7583609

Mercuri, E.; Cowan, F.; Rutherford, M.; Acolet, D.; Pennock, J.; Dubowitz, L.

1995-01-01

405

Epistaxis related to exercise-induced pulmonary haemorrhage in south African Thoroughbreds.  

PubMed

This study investigated if environmental factors had an effect on the incidence of epistaxis related to exercise-induced pulmonary haemorrhage (EIPH) among racehorses in southern Africa. Data covering the period 1986-2001 and involving 778 532 race runs were analysed. This included the following information: date of race, age, sex, name of breeder, trainer, distance, jockey, state of going, weight carried, racing centre and altitude. Veterinarians employed by the Jockey Club suspended officially entered horses that presented with epistaxis (frank bleeding from the nostrils) after racing. On-course endoscopy is not performed as a standard practice at any southern African racetrack. Epistaxis was identified in 1287 horses (0.165%). More horses presented with EIPH-related epistaxis (a) at sea level, (b) from May to October, (c) when older (> 3 years), (d) after 1995, (e) on Fridays and Sundays, and (f) more in geldings than in mares or entire males. No association could be established between epistaxis and breeder, trainer, distance run, jockey, state of going and weight carried. It is concluded that the frequency of EIPH-related epistaxis is associated with altitude, winter and spring, sex and age. It is suggested that racing at lower altitudes may increase the probability of exercise-induced pulmonary haemorrhage. PMID:15038426

Weideman, H; Schoeman, S J; Jordaan, G F; Kidd, M

2003-12-01

406

First dengue haemorrhagic fever epidemic in the Americas, 1981: insights into the causative agent.  

PubMed

Historical records describe a disease in North America that clinically resembled dengue haemorrhagic fever during the latter part of the slave-trading period. However, the dengue epidemic that occurred in Cuba in 1981 was the first laboratory-confirmed and clinically diagnosed outbreak of dengue haemorrhagic fever in the Americas. At that time, the presumed source of the dengue type 2 strain isolated during this epidemic was considered controversial, partly because of the limited sequence data and partly because the origin of the virus appeared to be southern Asia. Here, we present a molecular characterisation at the whole-genome level of the original strains isolated at different time points during the epidemic. Phylogenetic trees constructed using Bayesian methods indicated that 1981 Cuban strains group within the Asian 2 genotype. In addition, the study revealed that viral evolution occurred during the epidemic - a fact that could be related to the increasing severity from month to month. Moreover, the Cuban strains exhibited particular amino acid substitutions that differentiate them from the New Guinea C prototype strain as well as from dengue type 2 strains isolated globally. PMID:25091743

Rodriguez-Roche, Rosmari; Hinojosa, Yoandri; Guzman, Maria G

2014-12-01

407

Viral haemorrhagic fevers in Europe--effective control requires a co-ordinated response.  

PubMed

Viral haemorrhagic fevers (VHF) have attracted the attention of the medical world and general public for many reasons, some based in reality and more on misinformation. They are amongst the highest profile infections in the public mind, because they are thought to be highly infectious and to kill most of their victims in a dramatic way (1,2). To add to the intrigue, mysteries remain about the source of some of the viruses involved. They emerge and re-emerge in many countries, most recently Ebola in Uganda in 2000 (3) and Gabon in 2001/02 (4), and Congo Crimean Haemorrhagic Fever (CCHF) in Kosovo (5) and Pakistan in 2001 (6). Large outbreaks have affected populations in endemic areas, living mainly in inaccessible areas or refugee camps where living conditions are very difficult. Poorly resourced medical facilities have played a role in amplifying transmission and infection control measures have been difficult or virtually impossible to establish. These viruses are likely to remain a threat until the reservoir is identified and as long as endemic areas are afflicted with ecological change, poverty and social instability. Recent events since September 11 2001 remind us of their potential to be used as weapons, and that fear can present a risk to public health. PMID:12631941

Crowcroft, N S; Morgan, D; Brown, D

2002-03-01

408

Blood, sweat and tears: androgenic-anabolic steroid misuse and recurrent primary post-tonsillectomy haemorrhage.  

PubMed

A 30-year-old male body builder and androgenic-anabolic steroid and insulin abuser was admitted for day case elective tonsillectomy (bipolar). He returned with primary post-tonsillectomy haemorrhage 18?h after the operation and required bipolar cautery to the multiple small bleeding points in the right and left tonsillar fossa. Thorough coagulation screen was normal. Recurrent primary haemorrhage occurred 3?h post-operatively requiring immediate surgical intervention, removal of the inferior poles, precautionary throat packs, intubation and observation on the intensive treatment unit (ITU). Re-examination in theatre revealed a bleeding left superior pole that was under-run to achieve haemostasis and the patient returned to ITU. Hypertensive episodes were noted in the emergency department and intraoperatively including one recording >200?mm?Hg. Haemostasis was eventually achieved once the blood pressure was adequately controlled. A slow wean of steroids was also instigated and the patient was managed on a surgical ward for 2?weeks post-tonsillectomy. PMID:25398921

Fox, Richard; Varadharajan, Kiran; Patel, Bhavesh; Beegun, Issa

2014-01-01

409

RAPID RISK ASSESSMENT Outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo  

E-print Network

An outbreak of Ebola haemorrhagic fever is ongoing in the Democratic Republic of Congo (DRC) with 15 cases reported, including nine deaths in Orientale province. It is the first time that the Ebola species Bundibugyo has been laboratory confirmed as the cause of an Ebola outbreak in DRC. This finding indicates that the current outbreak in DRC is not related to the recently ended outbreak in Uganda, which was caused by the Ebola species Sudan. The epidemiological features of this outbreak are consistent with previous outbreaks of Ebola haemorrhagic fever, although the currently observed case fatality rate is significantly higher than the one observed in the first outbreak of Bundingbuyo virus in 2007 in Uganda. However, it is premature to draw final conclusions about the pathogenicity of this Bundingbuyo viral strain. As the incubation period can last up to three weeks, it is likely that additional cases will be identified in the coming weeks. However, control measures currently implemented in DRC with the support of international partners, e.g. isolation of cases and active monitoring of contacts, should prevent further spread of the disease. It is unlikely, but not impossible, that travellers infected in DRC could arrive in the EU while incubating the disease and develop symptoms while in the EU. These cases would seek medical attention and be isolated, preventing further transmission.

Main Conclusions

2012-01-01

410

Crimean-Congo haemorrhagic fever virus infection in the western province of Saudi Arabia.  

PubMed

In 1990, an outbreak of suspected viral haemorrhagic fever involving 7 individuals occurred in Mecca in the Western Province of Saudi Arabia. Congo-Crimean haemorrhagic fever (CCHF), not previously known to be present in Saudi Arabia, was incriminated. A study of the epidemiology of this virus was therefore carried out in Mecca, and in nearby Jeddah and Taif in 1991-1993; 13 species of ixodid ticks (5 Hyalomma spp., 5 Rhipicephalus spp., 2 Amblyomma spp., 1 Boophilus sp.) were collected from livestock (camels, cattle, sheep, goats), and of these 10 were capable of transmitting CCHF. Camels had the highest rate of tick infestation (97%), and H. dromedarii was the commonest tick (70%). Attempts to isolate virus from pools of H. dromedarii and H. anatolicum anatolicum were unsuccessful. The source of infection in 3 confirmed cases of CCHF was contact with fresh mutton and, in a suspected case, slaughtering sheep. An investigation in Mecca, which included a serological survey of abattoir workers, identified 40 human cases of confirmed or suspected CCHF between 1989 and 1990, with 12 fatalities. Significant risk factors included exposure to animal blood or tissue in abattoirs, but not tick bites. It is suspected that the CCHF virus may have been introduced to Saudi Arabia by infected ticks on imported sheep arriving at Jeddah seaport, and that it is now endemic in the Western Province. PMID:9231193

el-Azazy, O M; Scrimgeour, E M

1997-01-01

411

Genital herpes complicating pregnancy.  

PubMed

Approximately 22% of pregnant women are infected with herpes simplex virus (HSV)-2, and 2% of women will acquire HSV during pregnancy. Remarkably, up to 90% of these women are undiagnosed because they are asymptomatic or have subtle symptoms attributed to other vulvovaginal disorders. Diagnosis of genital herpes relies on laboratory confirmation with culture or polymerase chain reaction assay of genital lesions and type-specific glycoprotein G-based serologic testing. Neonatal herpes is the most severe complication of genital HSV infection and is caused by contact with infected genital secretions at the time of labor. Maternal acquisition of HSV in the third trimester of pregnancy carries the highest risk of neonatal transmission. Despite advances in the diagnosis and treatment of neonatal herpes, little change in the incidence or serious sequelae from this infection has occurred. As such, prevention of the initial neonatal infection is critically important. Obstetricians are in a unique position to prevent vertical HSV transmission by identifying women with genital lesions at the time of labor for cesarean delivery, prescribing antiviral suppressive therapy as appropriate, and avoiding unnecessary invasive intrapartum procedures in women with genital herpes. Enhanced prevention strategies include identification of women at risk for HSV acquisition during pregnancy by testing women and possibly their partners for HSV antibodies and providing counseling to prevent transmission to women in late pregnancy. PMID:16199646

Brown, Zane A; Gardella, Carolyn; Wald, Anna; Morrow, Rhoda Ashley; Corey, Lawrence

2005-10-01

412

Gastrointestinal complications of oncologic therapy  

Microsoft Academic Search

Gastrointestinal complications are common in patients undergoing various forms of cancer treatment, including chemotherapy, radiation therapy, and molecular-targeted therapies. Many of these complications are life-threatening and require prompt diagnosis and treatment. Complications of oncologic therapy can occur in the esophagus (esophagitis, strictures, bacterial, viral and fungal infections), upper gastrointestinal tract (mucositis, bleeding, nausea and vomiting), colon (diarrhea, graft–versus–host disease, colitis

Marta Davila; Robert S Bresalier

2008-01-01

413

Complications of shoulder instability surgery.  

PubMed

Complications of shoulder instability surgery may results from errors made during the preoperative, intraoperative, or postoperative periods. Some complications are preventable whereas the risk of others can be reduced. A few complications remain unpreventable. Two sources of error in the preoperative period that can lead to complications are an incorrect diagnosis and failure to address a patient's expectations of treatment. These errors and their subsequent complications are preventable. Preventing complications during the intraoperative period begins with proper patient positioning and a thorough knowledge of shoulder anatomy. Understanding the indications and limitations of the various stabilization procedures, as well as applying proper surgical technique, is essential to avoid a surgical misadventure. Complications recognized in the postoperative period include recurrent instability, limitation of motion, inability to return to the previous level of sport, problems related to hardware, pain, development of osteoarthritis, and neurovascular injuries. Infection and hematoma formation may also occur; both need to be recognized and treated early to maximize outcome. A protocol for treating each complication that may occur often is helpful. Knowledge of the complications that can arise is paramount to preventing their occurrence. This knowledge comes through experience, study, and continued research. PMID:8582009

Wall, M S; Warren, R F

1995-10-01

414

A critical review of anaesthetised animal models and alternatives for military research, testing and training, with a focus on blast damage, haemorrhage and resuscitation.  

PubMed

Military research, testing, and surgical and resuscitation training, are aimed at mitigating the consequences of warfare and terrorism to armed forces and civilians. Traumatisation and tissue damage due to explosions, and acute loss of blood due to haemorrhage, remain crucial, potentially preventable, causes of battlefield casualties and mortalities. There is also the additional threat from inhalation of chemical and aerosolised biological weapons. The use of anaesthetised animal models, and their respective replacement alternatives, for military purposes -- particularly for blast injury, haemorrhaging and resuscitation training -- is critically reviewed. Scientific problems with the animal models include the use of crude, uncontrolled and non-standardised methods for traumatisation, an inability to model all key trauma mechanisms, and complex modulating effects of general anaesthesia on target organ physiology. Such effects depend on the anaesthetic and influence the cardiovascular system, respiration, breathing, cerebral haemodynamics, neuroprotection, and the integrity of the blood-brain barrier. Some anaesthetics also bind to the NMDA brain receptor with possible differential consequences in control and anaesthetised animals. There is also some evidence for gender-specific effects. Despite the fact that these issues are widely known, there is little published information on their potential, at best, to complicate data interpretation and, at worst, to invalidate animal models. There is also a paucity of detail on the anaesthesiology used in studies, and this can hinder correct data evaluation. Welfare issues relate mainly to the possibility of acute pain as a side-effect of traumatisation in recovered animals. Moreover, there is the increased potential for animals to suffer when anaesthesia is temporary, and the procedures invasive. These dilemmas can be addressed, however, as a diverse range of replacement approaches exist, including computer and mathematical dynamic modelling of the human body, cadavers, interactive human patient simulators for training, in vitro techniques involving organotypic cultures of target organs, and epidemiological and clinical studies. While the first four of these have long proven useful for developing protective measures and predicting the consequences of trauma, and although many phenomena and their sequelae arising from different forms of trauma in vivo can be induced and reproduced in vitro, non-animal approaches require further development, and their validation and use need to be coordinated and harmonised. Recommendations to these ends are proposed, and the scientific and welfare problems associated with animal models are addressed, with the future focus being on the use of batteries of complementary replacement methods deployed in integrated strategies, and on greater transparency and scientific cooperation. PMID:24329746

Combes, Robert D

2013-11-01

415

Evolutionary history and molecular epidemiology of rabbit haemorrhagic disease virus in the Iberian Peninsula and Western Europe  

Microsoft Academic Search

BACKGROUND: Rabbit haemorrhagic disease virus (RHDV) is a highly virulent calicivirus, first described in domestic rabbits in China in 1984. RHDV appears to be a mutant form of a benign virus that existed in Europe long before the first outbreak. In the Iberian Peninsula, the first epidemic in 1988 severely reduced the populations of autochthonous European wild rabbit. To examine

Fernando Alda; Tania Gaitero; Mónica Suárez; Tomás Merchán; Gregorio Rocha; Ignacio Doadrio

2010-01-01

416

An information value based analysis of physical and climatic factors affecting dengue fever and dengue haemorrhagic fever incidence  

Microsoft Academic Search

BACKGROUND: Vector-borne diseases are the most dreaded worldwide health problems. Although many campaigns against it have been conducted, Dengue Fever (DF) and Dengue Haemorrhagic Fever (DHF) are still the major health problems of Thailand. The reported number of dengue incidences in 1998 for the Thailand was 129,954, of which Sukhothai province alone reported alarming number of 682. It was the

Kanchana Nakhapakorn; Nitin Kumar Tripathi

2005-01-01

417

EFFECTS OF THE SYMPATHETIC NERVOUS SYSTEM AND THE ADRENAL MEDULLARY HORMONES ON DOG HIND LIMB BLOOD FLOW AFTER HAEMORRHAGE  

Microsoft Academic Search

The contributions of the sympathetic nervous system and the adrenal medullary catecholamines to the response of dog hind limb resistance vessels to haemorrhage were examined. Anaesthetized dogs were bled either 30% or 45% of blood volume. There was little difference between the vascular conductance response in untreated hind limbs and sympathectomized limbs. Conductance in limbs that had been both sympathectomized

WP Anderson; J Ludbrook

1976-01-01

418

Antenatal onset of haemorrhagic and\\/or ischaemic lesions in preterm infants: prevalence and associated obstetric variables  

Microsoft Academic Search

AIMTo assess the prevalence of an antenatal onset of haemorrhagic and\\/or ischaemic lesions in preterm infants; to identify possibly related obstetric risk factors.METHODSA prospective cohort study was made of 1332 infants born at less than 34 completed weeks, using cranial ultrasound, for the presence of antenatal brain lesions (group A) involving the periventricular white matter (PVWM) or central grey matter.

L S de Vries; P Eken; F Groenendaal; K J Rademaker; B Hoogervorst; H W Bruinse

1998-01-01

419

Reliability of the ECASS Radiological Classification of Postthrombolysis Brain Haemorrhage: A Comparison of CT and Three MRI Sequences  

Microsoft Academic Search

Background: Postthrombolysis brain haemorrhagic transformations (HT) are often categorized with the CT-based classification of the European Cooperative Acute Stroke Study (ECASS). However, little is known about the reliability of this classification and its extension to MRI. Our objective was to compare the inter- and intraobserver reliability of this classification on CT and 3 MRI sequences. Methods: Forty-three patients with postthrombolysis

P. Renou; I. Sibon; T. Tourdias; F. Rouanet; C. Rosso; D. Galanaud; A. Drier; M. Coudert; S. Deltour; S. Crozier; D. Dormont; Y. Samson

2010-01-01

420

Detection and differentiation of epizootic haemorrhagic disease of deer and bluetongue viruses by serogroup-specific sandwich ELISA  

Microsoft Academic Search

A serogroup specific sandwich ELISA was developed for the detection of epizootic haemorrhagic disease of deer viruses (EHDV) in infected insects and tissue culture preparations. Polyclonal rabbit antiserum against purified EHDV core particles was used to capture viral antigen and specific binding detected using guinea pig antisera against EHDV core particles followed by anti-guinea pig immunoglobulin enzyme-labelled conjugate. The assay

J. A. Thevasagayam; M. P. Wellby; P. P. C. Mertens; J. N. Burroughs; J. Anderson

1996-01-01

421

Leukocyte–hepatocyte interaction in calicivirus infection: differences between rabbits that are resistant or susceptible to rabbit haemorrhagic disease (RHD)  

Microsoft Academic Search

Calicivirus infection is lethal for adult rabbits, whereas young rabbits (less than 8-weeks-old) are resistant to the same infectious agent. The virus replicates in the liver and causes a fulminant hepatitis in adult rabbits leading to rabbit haemorrhagic disease (RHD); this is in contrast with the mild and transient hepatitis observed in infected young rabbits. We have used electron microscopy

P. G. Ferreira; A. Costa-E-Silva; M. J. R. Oliveira; E. Monteiro; A. P. Águas

2005-01-01

422

A comparison of different cloned genome segments of Epizootic haemorrhagic disease virus as serogroup-specific probes  

Microsoft Academic Search

Summary The eight largest double-stranded (ds) RNA genome segments of Epizootic haemorrhagic disease virus (EHDV) serotype 2 (Alberta strain) have been cloned. Of these, segments 4, 5, 6, 7, and 8 are represented by clones that correspond in size to those predicted for full-length clones. The different clones were used as nucleic acid probes to study the nucleic acid homology