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PubMed2003

Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident.

Penetration of the mandibular cortex during dental implant surgery may damage 3 important arteries and could lead to life-threatening circumstances. To lessen the likelihood of lateral angulations and cortical perforations, dental implants of less than 14 mm may be considered for the mandible. The courses of the inferior alveolar, facial, and lingual arteries and their branches are reviewed. Management of hemorrhage from a branch of the lingual or facial arteries may require an extraoral approach for ligation, because the mylohyoid, sublingual, and submental arteries can anastomose and be anatomically variable as well. A violation of 1 of these may be difficult to manage and lead to a compromise of the airway. A cortical perforation may be avoided by studying the anatomy of the ridge being treated. This article discusses what procedures to perform to obtund bleeding from 1 of these arteries and the technique of performing an emergency tracheotomy.

Arteries↗
PubMed1988

[Disorders of microcirculation in subarachnoid hemorrhage and intracerebral hemorrhage].

The pathophysiological notions of hemodilution treatment of ischemic seizures with plasma expanders indicates the significance of microcirculation. Microcirculation disorders arise from the interrelations of hemodynamic, vascular, and hemorrheologic factors. It seems that hemodilution with hydroxyethyl starch reduces peripheral microcirculation disorders, thus inhibiting the development of cerebral edema. In the case of subarachnoid hemorrhage, the hemorrheologic factors deteriorate less severely when given antifibrinolytic treatment with Aprotinin. Simultaneous hemodilution with hydroxyethyl starch can counterbalance the already existing changes.

Blood Coagulation Tests↗
PubMedDate not supplied

A controlled clinical trial of cimetidine in the recurrence of variceal hemorrhage: implications about the pathogenesis of hemorrhage.

In a prospective randomized double-blind controlled trial, 51 patients, 16 with cirrhosis and 35 with extrahepatic portal hypertension all of whom presented with variceal bleeding, were given either long-term cimetidine in a dosage of 1.6 gm daily (24 patients) or placebo tablets (27 patients). Thirty-eight patients completed 2 years of treatment. For 16 patients with cirrhosis, there was no significant difference in the frequency of rebleeding between the cimetidine (62.5%) and placebo (75.0%) groups. Similarly, in 35 patients with extrahepatic portal hypertension, the frequency with which bleeding recurred in the cimetidine (37.5%) and placebo groups (36.8%) was not significantly different. Gastric acid and esophageal function studies, including basal acid output, lower esophageal sphincter pressure, esophageal acid reflux, and clearance measurements, showed no significant differences between patients with cirrhosis or extrahepatic portal hypertension both before and after variceal bleeding and in healthy control subjects. These results suggest that it is unlikely that gastric acid reflux is a significant factor in the pathogenesis of variceal hemorrhage, and cimetidine does not prevent recurrent episodes of bleeding.

Adolescent↗
PubMed1979

[The significance of blocked arteries in the pathogenesis of hemorrhages and of minor hemorrhagic infarctions in the human lung in fat embolism (author's transl)].

The significance of blocked arteries with regard to minor hemorrhagic infarctions in the lung in venous and systemic fat embolism is discussed. In an experiment it is proved that blood in the anastomoses between the arteria bronchialis and arteria pulmonalis (blocked arteries) contains fat emboli. It is suggested that these fat emboli may in addition be transported into an area of the lung, which is no longer functional following embolic occlusion of a branch of the arteria pulmonalis.

Bronchial Arteries↗
PubMed2003

Quadrigeminal non-aneurysmal subarachnoid hemorrhage--a true variant of perimesencephalic subarachnoid hemorrhage. Case report.

Spontaneous non-aneurysmal subarachnoid hemorrhage (SAH) centered in the quadrigeminal cistern has been proposed as a variant of perimesencephalic non-aneurysmal SAH (PNSH). Some authors contest the existence of this entity, claiming it results either from head trauma or an undiscovered P2-P3 aneurysm, and conclude that all PNSH arise in front of the brainstem in a 'pretruncal' location. We report a patient with a quadrigeminal pattern of subarachnoid blood who was investigated with two digital catheter angiograms, including 3-D angiography, plus a high-resolution computed tomography angiogram. No abnormal findings were present and the patient had an excellent outcome. We propose that the more common pretruncal PNSH and less common quadrigeminal PNSH are two types of perimesencephalic SAH with separate, distinct etiologies, both of which have a more benign clinical course than aneurysmal SAH.

Cerebral Angiography↗
PubMed2000

Simple hemostatic procedure for hemorrhagic duodenal ulcer: two cases of arterial hemorrhage quickly controlled by balloon compression.

We utilized balloon compression in two cases of arterial hemorrhage from duodenal ulcers. The bleeding was quickly controlled in both cases. The advantages of this technique are its simplicity and ease of performance, and the fact that it does not require precise identification of the bleeding point in the duodenal bulb. No serious complications, such as perforation or stenosis, are associated with this technique. During the healing of the ulcer, balloon expansion may result in decreased duodenal bulb deformity. The following points, however, should be clarified in future studies: a) the stability of the duodenal bulb after longer-term balloon compression, and b) the optimum amount of cold water to be injected into the balloon and the optimum compression time.

Adult↗
PubMed1990

[Intracranial hemorrhages in the magnetic resonance tomogram. Studies on sensitivity, on the development of hematomas and on the determination of the cause of the hemorrhage].

One hundred and forty-six intracranial hematomas in 129 patients were examined by MRI (136 examinations) and CT (147 examinations). Even using a high field MR system (1.5 T) and gradient-echo sequences, CT was the more sensitive method during the acute phase (46% compared with 93%). During the sub-acute phase, MR was superior to CT (97% compared with 58%), as it was in the chronic phase (93% compared with 17%). Petechial bleedings and discreet foci of contusion could only be demonstrated by MRI. Moreover, MRI showed evidence of residues from hemorrhage (signal reduction due to hemosiderin deposition) long after CT has become normal. Analyses of MRI images allows one to date the bleed and to distinguish between a) the formation of clot in a haemorrhagic cavity, b) bleeding into the tissues and c) a liquefying hematoma. Bearing in mind this classification, the localisation of the hematoma and the clinical findings mostly allow it is possible to determine the cause of the bleeding. Another advantage is the certain detection of vessels supplying arterio-venous malformations and cavernous hemangiomas.

Adolescent↗
PubMed2005

Rapid warfarin reversal in anticoagulated patients with traumatic intracranial hemorrhage reduces hemorrhage progression and mortality.

BACKGROUND: A prospective cohort study at our institution demonstrated a 48% mortality rate in warfarin anticoagulated trauma patients sustaining intracranial hemorrhage (ICH) compared with a 10% mortality rate in nonanticoagulated patients. Forty percent of patients demonstrated progression of their ICH, despite anticoagulation reversal, with a resultant 65% mortality rate. Seventy-one percent of these patients initially presented with a Glasgow Coma Scale (GCS) score > or = 14 and a 'minor' ICH. We postulated that early diagnosis of ICH and rapid anticoagulation reversal would reduce ICH progression rates and mortality. METHODS: All anticoagulated patients with known or suspected head trauma were entered into the Coumadin protocol. The protocol ensured immediate triage and physician evaluation, head computed tomography (CT) scan, and fresh frozen plasma administration in patients with documented ICH. RESULTS: Eighty-two patients were entered into the protocol with ICH documented in 19 (23%). Sixteen of 19 patients (84%) presented with GCS > or = 14. Median international normalized ratio (INR) for treated patients with ICH was 2.7 versus 2.5 for patients without ICH (p = 0.546). Mean time to initiate warfarin reversal was 1.9 hours for protocol patients versus 4.3 hours for preprotocol patients (p < 0.001). Two of 19 (10%) protocol patients with ICH died. However, both patients presented >10 hours after injury with a severe ICH. This 10% mortality rate is significantly less than the 48% mortality rate seen previously (p < 0.001) and is now consistent with that observed in similarly injured patients not on anticoagulation. CONCLUSION: Neither the initial GCS nor INR in anticoagulated trauma patients reliably identifies patients with ICH. Rapid confirmation of ICH with expedited head CT scan combined with prompt reversal of warfarin anticoagulation with fresh frozen plasma decreases ICH progression and reduces mortality.

Aged↗
PubMed2000

Decreased perihematomal edema in thrombolysis-related intracerebral hemorrhage compared with spontaneous intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Intracerebral hemorrhage (ICH) is a highly morbid disease process. Perihematomal edema is reported to contribute to clinical deterioration and death. Recent experimental observations indicate that clotting of the intrahematomal blood is the essential prerequisite for hyperacute perihematomal edema formation rather than blood-brain barrier disruption. METHODS: We compared a series of patients with spontaneous ICH (SICH) to a series of patients with thrombolysis-related ICH (TICH). All patients were imaged within 3 hours of clinical onset. We reviewed relevant neuroimaging features, emphasizing and quantifying perihematomal edema. We then analyzed clinical and radiological differences between the 2 ICH types and determined whether these factors were associated with perihematomal edema. RESULTS: TICHs contained visible perihematomal edema less than half as often as SICHs (31% versus 69%, P<0.001) and had both lower absolute edema volumes (0 cc [25th, 75th percentiles: 0, 6] versus 6 cc [0, 13], P<0.0001) and relative edema volumes (0.16 [0.10, 0.33] versus 0.55 [0.40, 0.83], P<0.0001). Compared with SICHs, TICHs were 3 times larger in volume (median [25th, 75th percentiles] volume 69 cc [30, 106] versus 21 cc [8, 45], P<0.0001), 4 times more frequently lobar in location (62% versus 15%, P<0.001), 80 times more frequently contained blood-fluid level(s) (86% versus 1%, P<0.001), and were more frequently multifocal (22% versus 0%, P<0.001). CONCLUSIONS: The striking qualitative and quantitative lack of perihematomal edema observed in the thrombolysis-related ICHs compared with the SICHs provides the first substantial, although indirect, human evidence that intrahematomal blood clotting is a plausible pathogenetic factor in hyperacute perihematomal edema formation.

Aged↗
PubMed2000

Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand: incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS).

BACKGROUND AND PURPOSE: More data on the epidemiology of subarachnoid hemorrhage (SAH) are required to increase our understanding of etiology and prevention. This study sought to determine the incidence and case fatality of SAH from 4 prospective, population-based registers in Australia and New Zealand. METHODS: We identified all cases of "aneurysmal" SAH from November 1995 to June 1998 in Adelaide, Hobart, Perth (Australia), and Auckland (New Zealand), a total population of approximately 2.8 million, using standard diagnostic criteria and uniform community-wide surveillance and data extraction procedures. RESULTS: A total of 436 cases of SAH were registered, including 432 first-ever events and 4 recurrent events. The mean age of cases was 57 years (range, 16 to 94 years), and 62% were female. From the 400 first-ever events registered over whole years, the crude annual incidence for the total population was 8.1 per 100 000 (95% CI, 7.4, 9.0), with rates higher for females (9. 7; 95% CI, 8.6, 11.0) than for males (6.5; 95% CI, 5.5, 7.6). Age-specific rates showed a continuous upward trend with age, although the shape and strength of this association differed between the sexes. Standardized annual incidence of SAH varied across centers, being highest in Auckland largely because of the high rate in Maori and Pacific people. The 28-day case fatality rate for the total population was 39% (95% CI, 34%, 44%), with little variation in ratios across centers. CONCLUSIONS: There is variation in the incidence of SAH in Australia and New Zealand, but the rates are consistently higher for females. A monotonic increase in incidence with age suggests that exposures with cumulative effects and long induction times may be less relevant in the etiology of SAH.

Adolescent↗
PubMedDate not supplied

Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Antifibrinolytic therapy in recent onset subarachnoid hemorrhage.

In this cooperative study among 13 institutions, 502 patients were treated with antifibrinolytic medication (epsilon-aminocaproic acid or tranexamic acid) within a 14-day period following rupture of an intracranial aneurysm. Mortality at the end of 14 days was 11.6%; proved rebleed rate was 12.7%. Patients with an internal carotid or anterior cerebral aneurysm had the highest mortality and rebleed rate. Most rebleeds occurred between the sixth and eleventh days following the initial bleed. Significantly higher mortality was reported among patients with cerebral vasospasm, yet rebleed rate was no different among those patients with or without vasospasm. The same pattern was observed among patients with a mean blood pressure value above and below 110 mm Hg. We conclude that antifibrinolytic therapy provides beneficial treatment to patients with recent onset subarachnoid hemorrhage (SAH) following rupture of an intracranial aneurysm.

Age Factors↗
PubMed1977

Adrenal hemorrhage in the newborn. The phenomenon of "enclosed" hemorrhage as a cause of neonatal jaundice and later adrenal calcifications.

In an infant with unexplained hyperbilirubinemia, abdominal mass and a fall in hematocrit, an IVP with total body opacification should be considered so that the diagnosis of adrenal hemorrhage, which is almost always a benign conditions, may be made. Follow-up abdominal films at 3 months of age may further substantiate the etiology by revealing calcifications in the involved areas.

Adrenal Gland Diseases↗
PubMed2000

Health outcomes 1 year after subarachnoid hemorrhage: An international population-based study. The Australian Cooperative Research on Subarachnoid Hemorrhage Study Group.

BACKGROUND: There is limited information about the long-term consequences of subarachnoid hemorrhage (SAH). METHODS: Data were obtained from a population-based study of aneurysmal SAH conducted in Australia and New Zealand between 1995 and 1998. The authors report health outcomes for survivors 1 year after the onset of SAH. RESULTS: From a total of 432 first-ever cases of SAH (76% due to confirmed cerebral aneurysm rupture) registered in four cities in Australia and New Zealand, 242 (56%) were alive approximately 1 year later (mean time 1.2 years), with 230 (95%) available for interview. Of those interviewed, 105 (46%) reported an incomplete recovery, with ongoing problems with memory (50%), mood (39%), speech (14%), and self-care (10%). Compared with age- and sex-adjusted Australian population norms, health-related quality of life, as determined by Short Form-36, was significantly lower for cases in the domains of role limitations that result from physical problems. However, there were no patient or disease characteristics that predicted complete recovery from SAH. CONCLUSIONS: A high proportion of long-term survivors of SAH experience ongoing deficits in high level (neuropsychological) functioning. These deficits result in impairment in social roles.

Activities of Daily Living↗
PubMed2001

Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage.

OBJECTIVE: To characterize the rates of recurrent intracranial hemorrhage (ICH), ischemic stroke, and death in survivors of primary ICH. METHODS: Systematic review of studies reporting recurrent stroke in survivors of primary ICH, identified at index ICH and followed forward. Studies were identified by computerized search of the literature and review of reference lists. RESULTS: Ten studies published between 1982 and 2000 reporting 1,880 survivors of ICH, followed for a total of 6,326 patient-years (mean follow-up, 3.4 patient-years), were included. The aggregate rate of all stroke from five studies was 4.3% per patient-year (95% CI, 3.5% to 5.4%). The rate in the three population-based studies was higher than in the two hospital-based studies, 6.2% versus 4.0% per patient-year (p = 0.04). About three fourths of recurrent strokes were ICH. Considering all 10 studies, a total of 147 patients had a recurrent ICH, an aggregate rate of 2.3% per patient-year (95% CI, 1.9% to 2.7%). Based on data from four studies, patients with a primary lobar ICH had a higher rate of recurrent ICH than those with a deep, hemispheric ICH (4.4% versus 2.1% per patient-year; p = 0.002). The aggregate rates of subsequent ischemic stroke and mortality were 1.1% per patient-year (95% CI, 0.8% to 1.7%) and 8.8% per patient-year (95% CI, 5.2% to 11.0%). CONCLUSIONS: Recurrent stroke among survivors of primary ICH occurs at a rate of about 4% per patient-year, and most are recurrent ICH. Survivors of ICH have a higher risk of recurrent ICH than of ischemic stroke, and this has implications for the use of antithrombotic agents in these patients.

Brain Ischemia↗
PubMed1993

Cerebral hemodynamics in subarachnoid hemorrhage evaluated by transcranial Doppler sonography. Part 2. Pulsatility indices: normal reference values and characteristics in subarachnoid hemorrhage.

In previous publications on the diagnostic value of transcranial Doppler sonography (TCD), conflicting results concerning predictive capacities for evaluating vasospasm by measuring flow velocities were reported, and the necessity to examine pulsatility indices (PIs) was stressed. PIs are known to give useful information on cerebral hemodynamics in cases of stenosis of the extracranial internal carotid artery and cerebral arteriovenous malformations. Whether the examination of PIs can give additional information in cases of subarachnoid hemorrhage (SAH) and allow prediction of impending delayed ischemic deficits (DIDs) is still unclear. Normal reference values for the Gosling pulsatility index, the Pourcelot resistance index, and the first Fourier pulsatility index were established in a series of 97 normal subjects. A significant increase in the indices was found as age increased, and there was a strong relation between the indices. There were no statistically significant differences between the right and left sides. An inverse relation was found between the flow velocity and PIs in the middle cerebral artery. In a prospective study of 455 follow-up TCD examinations in 66 SAH patients treated routinely with nimodipine, three different groups were analyzed separately: Group I, patients without DIDs; Group II, patients with DIDs; and Group III, patients with neurological deficits not strictly classifiable as DIDs. The analysis of all three groups together showed a typical time course after the onset of SAH: initially elevated PIs normalized around the tenth day after bleeding. According to Fisher grading, the amount of subarachnoid blood influences the increase in PIs significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Dissecting aneurysm of the vertebral artery causing subarachnoid hemorrhage after non-hemorrhagic infarction--case report.

A 45-year-old male presented with lateral medullary infarction. Cerebral angiography showed dissecting aneurysm as pearl and string sign in the right vertebral artery (VA). Conservative treatment was administered with antiplatelet agent. However, subarachnoid hemorrhage occurred 2 days after admission, inducing coma. Intraaneurysmal embolization and proximal occlusion of the right VA by intravascular surgery resulted in only mild neurological deficits. Conservative treatment including strict control of blood pressure is the first choice of treatment. Antiplatelet therapy and anticoagulant therapy should not be administered. Patients must be followed up by serial angiography and surgery considered if signs of aneurysmal progression are seen.

Aortic Dissection↗
PubMed2003

Comparison between perimesencephalic nonaneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage caused by posterior circulation aneurysms.

OBJECT: Some authors have questioned the need to perform cerebral angiography in patients presenting with a benign clinical picture and a perimesencephalic pattern of subarachnoid hemorrhage (SAH) on initial computerized tomography (CT) scans, because the low probability of finding an aneurysm does not justify exposing patients to the risks of angiography. It has been stated, however, that ruptured posterior circulation aneurysms may present with a perimesencephalic SAH pattern in up to 10% of cases. The aim of the present study was twofold: to define the frequency of the perimesencephalic SAH pattern in the setting of ruptured posterior fossa aneurysms, and to determine whether this clinical syndrome and pattern of bleeding could be reliably and definitely distinguished from that of aneurysmal SAH. METHODS: Twenty-eight patients with ruptured posterior circulation aneurysms and 44 with nonaneurysmal perimesencephalic SAH were selected from a series of 408 consecutive patients with spontaneous SAH admitted to the authors' institution. The admission unenhanced CT scans were evaluated by a neuroradiologist in a blinded fashion and classified as revealing a perimesencephalic SAH or a nonperimesencephalic pattern of bleeding. Of the 28 patients with posterior circulation aneurysms, five whose grade was I according to the World Federation of Neurosurgical Societies scale were classified as having a perimesencephalic SAH pattern on the initial CT scan. The data show that the likelihood of finding an aneurysm on angiographic studies obtained in a patient with a perimesencephalic SAH pattern is 8.9%. Conversely, ruptured aneurysms of the posterior circulation present with an early perimesencephalic SAH pattern in 16.6% of cases. CONCLUSIONS: This study supports the impression that there is no completely sensitive and specific CT pattern for a nonaneurysmal SAH. In addition, the authors believe that there is no specific clinical syndrome that can differentiate patients who have a perimesencephalic SAH pattern caused by an aneurysm from those without aneurysms. Digital subtraction angiography continues to be the gold standard for the diagnosis of cerebral aneurysms and should be performed even in patients who have the characteristic perimesencephalic SAH pattern on admission CT scans.

Adult↗
PubMed1975

Factors affecting liver fat accumulation and liver hemorrhages associated with fatty liver-hemorrhagic syndrome in laying chickens.

A series of four experiments was conducted with a commercial strain of laying chickens in an attempt to experimentally produce Fatty Liver-Hemorrhagic syndrome (FLHS). Different dietary energy sources, environmental temperatures and feeding schedules were the experimental variables. Increasing the environmental temperature from 12.2 degrees C. (experiment 1) to 27.8 degrees C. (experiment 2) did not drastically alter total liver fat, 2.7 g. (experiment 1) vs. 2.9 g. (experiment 2) or the incidence of FLHS, 0.0% (experiment 1) vs. 1.0% (experiment 2). Likewise, in experiment 4, changing the environmental temperature from 22.2 degrees C. to 30.6 degrees C. or from 30.6 degrees C. to 22.2 degrees C. did not significantly (P greater than .05) alter total liver fat or liver wet weight. The greatest incidence (50%) of FLHS occurred in birds which were restricted in feed intake and exposed to an environmental temperature of 30.6 degrees C. from 32-36 weeks of age followed by ad libitum feeding at a temperature of 22.2 degrees C. from 36-40 weeks of age. These birds ate 26.8% more feed than the control birds during the ad libitum feeding period. Restricted feed schedules (experiment 3) resulted in significantly (P less than .05) lower 40 week liver wet weights and total fat when applied during the growing (14-20 weeks of age) and early lay (20-28 weeks of age) periods.

Age Factors↗