Drug-induced iatrogenic intraparenchymal hemorrhage

Intracerebral hemorrhage is bleeding into the brain parenchyma with possible extension into the ventricles and subarachnoid space. Each year, approximately 37,000 to 52,400 people suffer from intraparenchymal hemorrhage (IPH) in the United States. This rate is expected to rise dramatically in the next few decades as a result of the increasing age of the population and a change in racial demographics. IPH accounts for 8% to 13% of all stroke cases and is associated with the highest mortality rate.     

Magnesium homeostasis in premature and full-term neonates

Renal handling of magnesium (Mg) has not been comprehensively studied in the newborn period due to the difficulty, until recently, of measuring the diffusible fraction of plasma Mg (UfMg). In the present study this methodology was used to assess Mg homeostasis in 84 newborn infants of different postconceptional age (26–42 weeks), weight (720–4,830 g) and postnatal age (1–72 days). Very premature infants (postconceptional age less than 35 weeks) had significantly higher values of plasma Mg than mature newborn infants. Plasma Mg related inversely to postconceptional age, weight, plasma total protein and plasma calcium, and directly to plasma potassium. Stepwise multiple regression analysis revealed that postconceptional age was the unique factor contributing to variations in plasma Mg. Plasma values of UfMg were the same in preterm as in term infants but, when expressed as a fraction of total plasma Mg (UfMg/Mg), they were significantly lower in very preterm infants. Fractional excretion of Mg and the ratio of urine Mg to urine creatinine did not vary as a function of postconceptional age. These results indicate that plasma UfMg is kept constant at different gestational ages despite variations in total plasma Mg; furthermore, no functional immaturity is present for renal tubular reabsorption of Mg, even in very low birth weight infants.     

Multiple intraparenchymal brain plasmacytomas with spontaneous intratumoral hemorrhage

The case of a patient with two intraparenchymal brain plasmacytomas without cranial or dural attachment and with intratumoral hemorrhage is presented. Computed tomographic (CT) findings are described. Autopsy revealed two discrete intraparenchymal plasmacytomas with intratumoral hemorrhage, one cerebral and one cerebellar. There have been few case reports of brain plasmacytoma without cranial or dural attachment, and this case of multiple such intracranial, intraparenchymal plasmacytomas with hemorrhage is certainly unique. Intratumoral hemorrhage with intracranial plasmacytoma is extraordinarily rare. The literature of intracranial involvement with myeloma and plasmacytoma and the CT appearance of intracranial plasmacytoma are surveyed.     

Blood pressure in non-critically ill preterm and full-term neonates

The neonatal period is a time of extensive hemodynamic changes. It is expected that these changes are most prominent in premature infants during the first week of life. The aim of this study was to examine arterial blood pressure (BP) measured by an oscillometric device in the first month of life in a stable premature population admitted to our neonatal intensive care unit (NICU), and to evaluate the influence of gestational age, postnatal age, birth weight, gender, and sleep state on BP. This prospective study was conducted over 27 months. The study population consisted of 373 hemodynamically stable infants (292 preterm and 81 full-term infants). Overall 12,552 BP measurements were carried out using a non-invasive oscillometric blood pressure monitor. Both systolic and diastolic blood pressure progressively increased during the first month of life. BP increased more rapidly in preterm infants than in full-term infants, and was higher in groups with higher birth weight. Multiple regression analysis showed that mean BP during the first week and on the 30th day increased with gestational age, and also that it was higher in the awake than in the sleep state.     

Spontaneous retroperitoneal hemorrhage

BACKGROUND: We evaluated patients with spontaneous retroperitoneal hemorrhage for reliable predictors of early diagnosis and improved outcomes. METHODS: A retrospective chart review was done to determine patient demographic and laboratory findings, presenting symptoms, time to diagnosis, anticoagulant and/or antiplatelet agent use, transfusions, and patient outcome. RESULTS: One hundred nineteen patients were identified; 14 (12%) died (mean age 77 +/- 9 years vs. 74 +/- 10 years for survivors [P = 0.235]). All nonsurvivors were on anticoagulants: 8 of 89 (9%) were on heparin or warfarin alone, and 6 of 23 (26% [P = 0.028]) were on a combined anticoagulant-antiplatelet regimen. Symptom onset to computed axial tomography (CAT) scan averaged 1.3 +/- 1.3 days for nonsurvivors versus 1.5 +/- 1.9 days for survivors (P = 0.778). Hemoglobin was 9.07 +/- 3.35 for nonsurvivors versus 9.60 +/- 2.07 for survivors (P = 0.435). Eighty-eight patients were transfused, and 10 died; 31 patients had no transfusion, and 4 of these died (P = 0.821). CONCLUSIONS: A high index of clinical suspicion is necessary for diagnosis of spontaneous retroperitoneal hemorrhage because these patients present with a variety of symptoms. Prospective studies are necessary to determine whether earlier diagnosis combined with aggressive resuscitation can impact the high mortality rate seen in these patients.     

自发性肾上腺出血

目的　提高自发性肾上腺出血的诊治水平。　方法　回顾性总结 1 1例自发性肾上腺出血患者的诊治资料。　结果　 1 0例仅表现为患侧腰痛 ,1例为输尿管癌术中发现肾上腺肿物。肾上腺功能均正常。B超检查 1 1例 ,3例表现为囊性肿物 ,其内可见点状、分隔样强回声 ,7例表现为低回声肿物 ,1例输尿管癌术前肾上腺B超正常。 1 0例CT扫描表现为卵圆形、边界清楚低密度病灶 ,CT值 34 .7～ 85 .0HU ,>50 .0HU者 6例 ,其中 1例可见液平面 ;增强CT扫描 3例 ,肿物无强化。MRI检查 3例 ,显示肾上腺区不均匀肿物 ,T1加权像为等信号 ,T2加权像为低信号。行肾上腺及肿物切除术 6例 ;行部分肾上腺及肿物切除术 5例。术后病理为肾上腺髓质内出血 ,血肿外包绕肾上腺组织。术后肾上腺皮质功能正常 ,随访 7个月～ 8年 ,无肾上腺皮质功能低下表现。　结论　B超、CT、MRI可以帮助诊断自发性肾上腺出血。双侧肾上腺出血、腰腹痛症状明显、单侧肾上腺出血但血肿 >5cm者应采取手术治疗 ,行部分肾上腺及血肿切除术 ,尽量保存血肿周围健康肾上腺组织。     

Spontaneous intracerebral hemorrhage

We report on 146 patients with spontaneous intracerebral hemorrhage treated in the period between 1984 and 1988. The aim of this retrospective study was to point out factors for operative respectively conservative treatment.Looking for etiology, age, unconsciousness, localization and extension of hematoma as well as bleeding into the ventricles our results showed that patients over 70 years of age and/or in coma III and IV (Brussels Coma Scale) have a bad prognosis as well as patients with intraventricular bleeding. Patients seem to benefit from operation if hematoma is located in the hemisphere or cerebellar and the extension ranges from 3 to 5 cm.     

Spontaneous renal hemorrhage

This report of 9 cases of spontaneous renal hemorrhage illustrates the wide variety of responsible conditions that may be found in a small series and the tendency for some of these conditions to coexist. In particular, all 3 patients with a bleeding diathesis had an associated anatomic lesion, and it was concluded that this group of patients required aggressive radiologic investigation. Three main clinical presentations were identified: sudden severe flank pain, symptomless hypertension, and a palpable mass with few or no symptoms. The radiologic signs are reviewed with emphasis on a recently described sign of streaky retroperitoneal fat. Treatment is discussed briefly.     

Effects of intraparenchymal hemorrhage on extracellular cortical potassium in experimental head trauma

A model of intraparenchymal hemorrhage was created in 11 cats. The development of the parenchymal hemorrhage was accompanied by a massive cellular depolarization and K+ release in anatomically intact areas in the vicinity of the hematoma. The K+ clearance was rapid and in most instances total. This initial K+ release was not ischemic in origin but was the result of mechanical and chemical factors of the extravasated blood on cellular membranes. In contrast, an increased water content of the white matter did not affect the cellular function or levels of K+ in the extracellular space of the cerebral cortex in the recording area. The experimental results suggest that K+ release takes place at the onset of trauma in subcritically injured cellular areas in the vicinity of a hemorrhage. The cellular elements undergo massive depolarization which is accompanied by a number of chemical and biochemical changes that lead to cellular swelling. Cellular depolarization and K+ release appear to be the initial response of the central nervous system to trauma. The extent of this response may strongly influence the final degree of cellular damage and, thus, the neurological deficit in patients with head trauma.     

Two cases of intracerebral hemorrhage in full-term neonatal infants

Intracranial hemorrhage in neonatal infants is mostly noted in the subependymal or subdural space. The former is characteristically noted in premature infants and is attributed to hemorrhage from the subependymal germinal matrix layer. The latter is prevalently noted in full-term neonatal infants and is thought to be associated with injury in the vicinity of the falx cerebri or tentorium cerebelli. We report two cases of intracerebral hemorrhage, which is relatively rare in full-term neonatal infants. In both of them hematoma was located in the left frontal area adjacent to the coronal suture. Angiogram did not reveal any causative abnormality. From CT scan and intraoperative findings it is speculated that the hemorrhage was caused by moulding at the coronal suture. In other words, moulding made the frontal bone slipped in beneath the parietal bone at the coronal suture causing pressure over the brain. The hemorrhage is thought to be caused by contusion of fragile vasculature of neonatal infants.     

Spontaneous perforation of bile ducts in neonates

Three neonates with spontaneous perforation of the common bile duct have been described. All were treated by laparotomy in the seventh week, with attempted closure of the perforation and a simple biliary diversion by cholecyst-jejunostomy with jejunojejunostomy below it. They have done well and represent 100% salvage of our cases to date. One is now 12 years of age. As far as we are aware, this method of dealing with the condition has not been described before.