Giant basilar aneurysm--a case report (author's transl)]

A case of a giant aneurysm arising from the basilar artery is presented. The patient a 41--year-old female, had recent memory disturbance, miscalculations and hemiparesis on admission. Vertebral angiograms displayed a giant aneurysm measuring approximately 66 mm in diameter arising from the basilar artery, a tortuous vertebral artery, an extremely dilated basilar artery and an agenesis of the left carotid artery. Due to the enormous size of the aneurysm and its location in the deep intracranial portion, radical surgery was abandoned. Six months following her discharge, she died. At autopsy, the giant aneurysm arising from the top of the basilar artery was found, existing just beneath the third ventricle and extending to the left basal ganglia. The lateral ventricle, the third ventricle and the Sylvian fissure were filled by hematoma resulting from the rupture of the aneurysm. It is possible that this giant aneurysm could be considered a vascular anomaly, and hence be distinguished from saccular aneurysms.     

Quantitative measurement of the tendon reflexes. A study on Achilles tendon reflex (author's transl)]

Quantitative analyses of tendon reflexes were performed for the purpose of clinical application. Tendon tap was marked with a WNS-5D semiconductor load cell inserted in the hammer to measure tapping force. Achilles tendon reflex (ATR) was measured with a LAS-0.1 displacement transducer in kneeling position on the chair. In ATR, six factors, i.e. duration of reaction time, the height of the wave, the time from the hammer tap to the top of the wave, the maximum speed of contraction, the time from the hammer tap to the maximum speed and half relaxation time, were analyzed. Correlation between these six factors were discussed. From the analyses of these factors, half relaxation time may serve as the best indicator of clinical status among the factors obtained by analysis of ATR.     

Arterial occlusion following cerebral vasospasm (author's transl)]

1. The present study analysed the clinical course, the serial angiograms and the CT scans of the patients with angiographic arterial occlusion following vasospasm after subarachnoid hemorrhage. The occlusion was observed in 6 out of 84 patients with vasospasm. 2. The angiograms which showed this phenomenon were obtained between the 11th and the 30th day of the illness. The affected vessels were the branches of middle cerebral artery. 3. Thrombus formed on the intima which had been injured by vasospasm is suspected to be a genesis of this arterial occlusion. The pathological findings of a case in this series support this concept. 4. The surgical procedure during the direct aneurysmal operation performed in the period of "smooth narrowing" seems to be a contributing factor to the arterial occlusion. There was no correlation between antifibrinolytic therapy and this phenomenon except in one case. 5. Fibrinolytic therapy after clipping of aneurysm may be a treatment of choice for this arterial occlusion following vasospasm.     

A valve to facilitate indirect measurement of arterial blood pressure (author's transl)]

A conveniently sized valve has been designed to replace the customary bellows used for inflation of a sphygmomanometer or oscellotonometer cuff. It can be inserted in a length of thin plastic tubing connecting the cuff with the usual wall socket for compressed air. The arterial pressure is measured in the usual manner.     

Dimer-X in the intracranial subarachnoid space--its toxicity (author's transl)]

The reaction of the rats to injection of Dimer-X into the intracranial subarachnoid space or the cerebrum was examined. When 28% iodine Dimer-X was injected into the subarachnoid space, 7 of 10 rats showed agitation, which is the most severe complication, and all died within one hour. All of the reactions were reduced with the lower concentrations of Dimer-X. The rats which were premedicated with Valium and/or Decadron revealed fewer and less severe complications. It is believed that the intracerebral injection method has many disadvantages, the results of its experiment are therefore reported without further elaboration. From the results of the experiment it is concluded as follows: 1) Dimer-X should not be injected into the intracranial subarachnoid space. 2) Dimer-X of low concentration in the subarachnoid space reduces the complications. 3) Complications from the subarachnoid application of Dimer-X can be reduced by premedication with Valium and Decadron.     

Experimental study of acute brain swelling under acute intracranial hypertension (author's transl)]

There are many problems about the cause, pathophysiology and treatment of acute brain swelling under intracranial hypertension frequently encountered in the neurosurgical clinics. Generally, rapid increase of the cerebral vasoparesis caused by unknown etiology is thought to be the main cause of acute brain swelling under intracranial hypertension. Moreover, disturbance of the cerebral venous circulatory system is discussed recently by many authors. But, research from the point of systemic respiration and hemodynamics is necessary for resolving these problems. This experiment was designed to study the effects of respiration and hemodynamics on the cerebral vasoparesis. Method: Using 22 adult dogs, acute intracranial hypertension was produced by epidural balloon inflation sustained at the level of 300 - 400 mmH2O. Simultaneously with measurement of intracranial pressure at the epidural space, superior sagittal sinus pressure, respirogram, systemic blood pressure (femoral artery), central venous pressure, common carotid blood flow, EKG and bipolar lead EEG were monitored continuously. The experimental group was divided by the respiratory loading into 5 groups as follows: control (6 cases), 10% CO2 hypercapnia (4 cases), 10% O2 hypoxia (4 cases), stenosis of airway (5 cases), 100% O2-controled respiration (3 cases). Results and conclusions: 1) Cerebral vasoparesis under acute intracranial hypertension took place earlier and showed more rapid progression in groups of stenosis of airway, hypercapnia and hypoxia than control group of spontaneous respiration in room air. No occurrence of cerebral vasoparesis was found out in a group of 100% O2 controlled respiration. It is proved that increased airway resistance or asphyxia, hypercapnia and hypoxia have strictly reference to the occurrence and progression of cerebral vasoparesis and for the prevention of cerebral vasoparesis, correct 100% O2 cont rolled respiration is effective. 2) From the hemodynamic change, the progression of rapid increase of cerebral blood volume with increase of blood volume in the superior sagitta sinus during cerebral vasoparesis under intracranial hypertension is presumed. It is suggested from the superior sagittal sinus pressure in various experimental groups that the site, reactivity and disturbed degree of the cerebral venous system are changed by the difference of respiratory or ventrilatory state and the cerebral venous circulatory disturbance has also reference to the occurrence of acute brain swelling. 3) During cerebral vasopareris under acute intracranial hypertension, remarkable supression of respiration, increased central venous pressure and increased common carotid blood flow were observed. It is concluded that the reaction of systemic hemodynamics following respiratory change effects on cerebral circulation markedly and they are being important factors to occurrence of acute brain swelling.     

Haemodilution and cerebral blood flow (author's transl)]

Cerebral blood flow has been estimated in 10 patients during acute haemodilution and during the consecutive operation. Cerebral blood flow showed a lasting increase during the time of haemodilution, but this increase did not parallel the decrease of haematocrit value. The increase of cerebral blood flow became pronounced only, when the haematocrit become lower than 30%. Assumably the elevation of cerebral flow is mainly due to autoregulative mechanisms of cerebral blood flow to sustain oxygenation. It is concluded, that haemodilution below values of 30% hc might be dangerous in patients suffering from cerebral sclerosis.     

Ileofemoral flaps--a clinical study (author's transl)]

The authors reveiw the anatomy, circulation, planning and techniques of preparing ileofemoral flaps. The possibilities of application of these flaps, advantages and disadvantages of the procedure are discussed. The authors use ileofemoral flaps as a new effective procedure for covering sores of the trochante area.