The outcome from acute subdural haematoma following decompressive hemicraniectomy

Summary Retrospective analysis of 15 cases with acute subdural haematoma receiving decompressive hemicraniectomy was carried out in an effort to clarify the beneficial effect and limitation of this operative procedure. The patients in this series were divided into three groups according to postoperative intracranial pressure (ICP). Decompressive hemicraniectomy was effective in lowering ICP in all patients except for the cases that developed acute brain swelling. Overall mortality rate was 66.7% in this series. Preoperative clinical status, and intra- and postoperative ICP and CT findings obtained within 24 hours of operation were correlated with the operative outcome.The summary of this paper was presented at the 6th European Congress of Neurosurgery (Paris, 1979).     

Cranioplasty with split lateral skull plate segments for reconstruction of skull defects

This paper reports the use of cranioplasty using segments of split lateral skull plate to correct large skull defects (larger than 8 x 8 cm). The subjects consisted of 10 patients with head trauma who had undergone decompression surgery, and two patients who had undergone tumour resection. Bone grafts were obtained by cutting approximately 2 cm wide strips from the lateral skull plate using a bone saw that was inserted from a free margin of the bone defects. By cutting strips laterally from the bone defect, the necessary amount of split lateral skull plate can be obtained without performing craniotomy. The pieces of split lateral skull plate are then fixed to the defect using wire or titanium mini-plates. At this point, the selection of bone grafts that match the curvature of the dura mater is important, so that no dead spaces are created between the dura mater and the bone grafts. Infection was not detected in any of the 12 patients, and all bone grafts took completely. One of the 12 patients suffered from a pathological fracture and bone resorption 6 months after surgery. The fracture occurred because the use of basket-shaped reconstruction plates resulted in large spaces between the plate segments, and in addition the intracranial pressure was kept low by a V-P shunt, thus rendering the patient more vulnerable to atmospheric pressure.     

Conversion of Antinuclear Antibody Specificity as a Marker of Deterioration of Cutaneous Lupus Erythematosus into Lupus Nephritis

A 34-year-old male systemic lupus erythematosus patient (SLE) with cutaneous vasculitis developed renal failure after switching anti-nuclear antibody (ANA) specificity. He developed cutaneous lupus erythematosus with homogeneous and speckled type ANA and a high titer of anti-DNA antibody without renal involvement at 21 years of age. After developing lupus nephritis at the age of 27, the original ANA disappeared gradually. Two years later, a discrete speckled type ANA titer elevated abruptly to as high as 1:640 with low complementemia and without DNA antibody. Within five years, he suffered renal failure. This case of SLE suggests a direct correlation with ANA pattern and organ involvement.     

Cardiovascular Responsiveness After Isotonic Exercise in Cirrhotic Patients: Study on Sympathoadrenergic and Renin-angiotensin Systems

Objectives: The aim of this study was to evaluate cardiovascular responsiveness after isotonic exercise in cirrhotic patients. Methods: Included were 11 cirrhotic patients and 10 age-matched normal suhjects, who served as controls. Hemodynamic data were obtained on each subject before and after muscle exercise on a treadmill (7 metabolic units). Plasma noradrenaline concentration and plasma renin activity also were determined. Results: In both groups, isotonic exercise increased heart rate and systolic arterial pressure, whereas diastolic arterial pressure was not modified. The increase in heart rate and systolic arterial pressure did not differ significantly between the two groups. Plasma noradrenaline concentration and plasma renin activity also were increased. The changes in plasma noradrenaline concentration and plasma renin activity was higher in cirrbotic patients than in controls ( P < 0.05, P < 0.05), although the differences were not significant when calculated as a percentage. Conclusions: Cardiovascular responsiveness to isotonic exercise is almost intact in cirrhotic patients. However, supernormal activation of the sympathoadrenergic and renin-angiotensin systems is required to maintain cardiovascular homeostasis in these patients.     

Evaluation of upper lip hypoesthesia with a trigeminal somatosensory-evoked potential following Le Fort I osteotomy in combination with mandibular osteotomy.

PURPOSE: The purpose of this study was to objectively evaluate hypoesthesia of the upper lip following Le Fort I osteotomy in combination with mandibular osteotomy with trigeminal somatosensory evoked potential (TSEP). SUBJECTS AND METHODS: The subjects consisted of 25 patients with mandibular prognathism with maxillary retrognathism mandibular prognathism with or without asymmetry, who underwent Le Fort I osteotomy in combination with sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO).Trigeminal nerve hypoesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The electrodes were placed exactly above the highest point of the vermilion border and on the mucosa of the upper lip. An electroencephalograph recording system (Neuropack Sigma; Nihon Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated preoperatively and then postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. RESULTS: The average measurable period and standard deviation of TSEP of the upper lip was 7.8 +/- 10.7 weeks following Le Fort I osteotomy, TSEP of the lower lip was 4.6 +/- 9.2 weeks in the patients who underwent SSRO with Le Fort I osteotomy, and 1.2 +/- 0.4 weeks in the patients who underwent IVRO with Le Fort I osteotomy. CONCLUSION: This study objectively proved that hypoesthesia could appear in the upper lips following Le Fort I osteotomy with TSEP. The measurable period for the upper lip following Le Fort I osteotomy tended to be longer than that for the lower lip in the patients who underwent SSRO and IVRO with Le Fort I osteotomy.     

Effects of nerve growth factor and basic fibroblast growth factor on survival of cultured septal cholinergic neurons from adult rats

We have established a primary culture technique for neuronal cells from rat basal forebrain from postnatal day 58 (P58) to study the effects of neurotrophic factors on the neurons. The survival of acetylcholinesterase (AChE)-positive neurons of 2-week-old rat septum has already been reported to be strongly supported by nerve growth factor (NGF) in culture. In this culture study of neurons from adult rat brains, the survival of AChE-positive neurons from P58 rat septum was slightly improved by NGF, although low affinity NGF receptor expression was also observed on cultured P58 rat septum neurons as well as on those from 2-week-old rats. The addition of basic fibroblast growth factor (bFGF) improved the survival of AChE-positive neurons cultured from P58 rat septum, but did not promote the survival of neurons from P12 rat septum. These results suggest that NGF changes to a maintenance factor in adult rat brain from a survival factor in postnatal 2-week-old rats. The survival of cholinergic neurons in culture of adult rat septum might be supported by factor(s) other than NGF, such as bFGF.     

Angiographic features of anoxic encephalopathy in the acute phase: a case report]

We present an angiographic feature of anoxic encephalopathy in the acute phase. A 68-year-old woman suddenly presented with deep coma. Examinations of her blood and electrocardiography did not reveal the origin of consciousness disturbance, and computed tomographic (CT) scans demonstrated no significant findings. We immediately performed cerebral angiography because we suspected brain stem infarction. A 3-vessel study (bilateral carotid and left vertebral angiography) revealed remarkable delays in cerebral circulation time or arteriovenous circulation time, although it did not show occlusion of cerebral vessels. The follow-up brain magnetic resonance (MR) images revealed anoxic encephalopathy, which might be derived from transient cardiac arrest. The patient has been in a vegetative state for one year. Although many reports have described CT scans and MR images of anoxic encephalopathy in the acute or subacute phases, there have been no reports about the angiographic features. We found remarkable delays in cerebral circulation time in the acute phase of anoxic encephalopathy, which was considered to be caused by cytotoxic edema from severe hypoxia or ischemia.