Spontaneous hemorrhage of the kidney

A young hypertensive man with hypertensive nephrosclerosis presented with an acute abdominal emergency due to a spontaneous renal hemorrhage. Investigations demonstrated a large left perinephric hematoma. This was managed conservatively. With control of his hypertension, renal function has remained stable.     

Subarachnoid hemorrhage and the heart

Electrocardiographic abnormalities, both morphological and rhythmic, are frequently seen in association with spontaneous subarachnoid hemorrhage. These changes, which often reflect subendocardial damage, seem to be caused by hypothalamic stimulation leading to an acute increase in sympathetic tone. As a result, potentially life-threatening ventricular arrhythmias may develop in subarachnoid hemorrhage patients. These arrhythmias have responded to sympathetic blocking agents, which may also have a protective effect on subendocardial tissue in this setting. There is no evidence that the prophylactic administration of propranolol or other autonomic blockers significantly alters outcome in these patients. Ultimate morbidity and mortality are clearly related to the degree of intracerebral-intraventricular hemorrhage and vasospasm. This article reviews experimental and clinical evidence regarding the causes of cardiac abnormalities after subarachnoid hemorrhage, the types of abnormalities most frequently seen, their relationship with subendocardial lesions, and the role of autonomic blockers.     

子宫收缩乏力性出血的临床分析

目的探讨子宫收缩乏力性产后出血的原因及处理方法。方法回顾性分析2006年1月～2009年1月治疗子宫收缩乏力性产后出血27例患者,给予加强子宫收缩药物等方法治疗。结果 27例患者经治疗全部痊愈,无一例孕产妇死亡。结论子宫收缩乏力性出血的发病原因为精神因素导致的交感神经舒缩功能变化、产前合并症的存在及产程延长。对产后出血中子宫收缩乏力的病因,进行积极预防、治疗可避免子宫切除,利于保留患者生育功能。     

Neurogenic gastrointestinal hemorrhage in hypertensive cerebral hemorrhage

The purpose of this paper is to obtain the correlation between CT scan findings and neurogenic gastrointestinal bleeding in hypertensive intracerebral hemorrhage. Fifty patients with hypertensive intracerebral hemorrhage were operated upon during past nearly 3 years in our clinic. Of these, 27 patients (54%) showed macroscopic gastrointestinal bleeding (GI-bleeding) demonstrated by stomach catheter after the onset of hypertensive intracerebral hemorrhage. GI-bleeding was about 46% in the survived patients and about 77% in the expired ones. Most patients revealed neurogenic GI-bleeding within 9 days (85.2%) and more than half of the cases (51.9%) in 4 to 6 days after the onset. Neurogenic GI-bleeding was frequently complicated in patients with disturbed consciousness, over 60 gram hematoma (particularly 60-80 gram hematomas), severe ventricular hemorrhage and right-sided hematomas. It was also exclusively observed in patients with extension of hemorrhage into the midbrain and recurring hypertensive intracerebral hemorrhage.     

Magnetic resonance imaging of brain abscess with hemorrhage: implications for the mechanism of hemorrhage

A 68-year-old woman presented with an extremely rare brain abscess associated with old and acute hemorrhages manifesting as gradual onset of symptoms of headache and fever. Magnetic resonance imaging clearly visualized the hemorrhage as heterogeneously hyperintense on diffusion-weighted imaging, concentric hypo-isointense on T(1)-weighted imaging, and homogeneously hyperintense with a hypointense rim on T(2)(*)-weighted imaging. T(1)-weighted imaging with contrast medium revealed a well-enhanced cyst wall. In spite of treatment with antibiotics, the neurological status of the patient deteriorated due to expansion of the abscess and perifocal edema. Needle aspiration of the cyst yielded bloody purulent fluid. The magnetic resonance imaging findings indicate that neovascularization of the cyst wall is involved in the mechanism of hemorrhage in brain abscess. Careful follow-up examinations are recommended in patients with brain abscess to detect warning signs of neurological deterioration.     

Gastrectomy in the treatment of gastric hemorrhage

The results of gastrectomies performed in 7 women and 13 men (aged from 41 to 73) with various diseases of the stomach (cancer, non-epithelial tumors, erosive and ulcerous gastritis, ulcer and phlegmonous gastritis) are analyzed. The surgical interventions included operations from gastrectomy to gastropancreatosplenoduodenocholecystectomy with phleboplasty of the portal vein and extended parietal lymphadenectomy. Ten operations were made for profuse bleedings with 4 fatal outcomes. During the first 48 hours after the appearance of the complication 10 patients were operated upon for the recurrence of the risk of recurrent hemorrhage. The formation of muff-like variants of esophagojejunostomy was preferred. The results are considered to be promising.     

Scintigraphy in the diagnosis of intestinal hemorrhage

13 patients with gastrointestinal hemorrhage underwent a scintigraphic examination to localize the bleeding. In 6 patients Tc-99m labeled red blood cells, in 7 patients Tc-99m sulfur colloid were used. Scintigraphy could demonstrate an intestinal bleeding in ten patients, in whom the conventional examinations, and among them 7 abdominal angiographies had failed. 5 of them had to be operated after that, whereby the scintigraphic findings were verified. One of the three patients with negative scintigraphy had to undergo an operation because of continuous bleeding. The methods of scintigraphy and their indication in gastrointestinal hemorrhage are discussed.     

Bilateral traumatic hemorrhage of the basal ganglia

Hemorrhage of the basal ganglia is common in hypertensive patients, and most of the cases are spontaneous unilateral hemorrhage. Traumatic basal ganglia hemorrhage is uncommon, while bilateral hemorrhage of the basal ganglia after trauma is an extremely rare entity. This report described a rare case of bilateral hemorrhage of the basal ganglia after head trauma. We also analyzed the mechanisms and reviewed relative literatures.