Clinical study of chronic subdural hematoma : a review of 645 cases : with special reference to elderly and non-elderly groups

Between January 1982 and October 1991, 645 patients with chronic subdural hematoma were treated at Tokushima University Hospital and its affiliated hospitals. All patients received standard treatment consisting of one burr hole and irrigation. Clinical features in a consecutive series of 645 adult patients with chronic subdural hematoma were studied, comparing two groups: 309 cases classed as elderly of 70 years of age or older (elderly group) and 336 cases below the age of 70 (non-elderly group) . In comparison with the non-elderly group, the elderly group had a higher percentage of females. The reason is considered to be the increase in the number of females in the general elderly population. Left sided hematomas were 1.6 times more common than right sided hematomas. The reason for this discrepancy was believed to be a greater degree of atrophy of the left cerebral hemisphere. An episode of head injury was noted less often in the elderly than non-elderly, so it is also assumed brain atrophy or other conditions caused by aging may play a role in the pathogenesis. In the elderly group, motor weakness and mental disturbance were seen in 66.3 % and 29.4 % respectively. The results were similar to those previously reported. When associated diseases, such as neurodegenerative disease, cerebrovascular disease, dementia and malignancy, are excluded from the analysis, functional prognosis is improved in the non-eldery group. Functional recovery in the elderly tends to be poor in cases with a longer interval between the symptomatic neurological deficit and the operative procedure, while poor operative outcome in the non-elderly group was noted even in cases with a shorter operative interval because of the severity of the condition. It is thought that early diagnosis and surgery would be required in cases of chronic subdural hematoma to obtain good functional recovery regardless of the patient's age

ノウシュッケツ ト クモマクカ シュッケツ ノ チリョウ

We reviewed recent advances in the treatment of hypertensive intracerebral hemorrhage(HIH) and subarachnoid hemorrhage (SAH). The mortality rate of patients with HIH, approximately50% in McKissock’s time (around 1960), was reduced to 20% due to the disseminationof improved diagnostic imaging technologies, advances in medical and surgical treatmentregimens, and an increase in the detection rate of mild cases of HIH. On the otherhand, the mortality rate of SAH patients remained unchanged (approximately 50%) becausepatients experiencing the insult were often of advanced age and because the number ofpatients graded as poor has increased.To treat patients with HIH, we developed a new surgical approach that we call “CT-guidedstereotactic aspiration surgery (SAS)”. We also devised an ultrasonic hematoma aspirator.SAS is beginning to supplant conventional open surgery. SAS may be indicated for patientswith putaminal hemorrhage where the hematoma volume is greater than 30ml, and forpatients with cerebellar hemorrhage with a hematoma volume greater than 15ml. On theother hand, open surgery may be indicated for patients with subcortical hemorrhage wherethe hematoma volume is greater than 40ml. It is not indicated for patients with pontine andthalamic hemorrhage. The efficacy and safety of SAS in patients with pontine and thalamichemorrhage remain to be determined and to our knowledge, no randomized study of role ofSAS in patients with HIH has been reported. Such a study (Surgical Trial in IntracerebralHemorrhage, STICH) is planned in the UK to ascertain operative indications.There have been some advances with respect to diagnostic equipment and the managementof SAH. Three-dimensional CT angiography (3D-CTA), using a helical CT scan, andmagnetic resonance imaging angiography (MRA) have yielded superior images of cerebralaneurysms when compared with digital subtraction angiography (DSA). The titanium clipmarkedly reduces metallic artifacts on CT images. The complete clipping of aneurysms withtitanium clips can be ascertained by postopertive 3D-CTA. A recent Japanese cooperativestudy revealed a decrease in the mortality rate of SAH patients graded as poor. However,grade V patients (World Federation of Neurological Surgery) continue to have a poor outcome.Mild hypothermia induced with indomethacine, an antagonist of cyclooxygenase,may improve the treatment outcome. The cumulative rate of rupture of cerebral aneurysmswas estimated at approximately 1 - 2% per year, however a recent paper shows it tobe 0.05% per year. An unruptured cerebral aneurysms study (UCAS Japan) will start nextyear in Japan. It will reveal ruptre risk and the risks inherent in surgical intervention inpatients with unruptured cerebral aneurysms

ビョウインマエ シンパイ テイシ ニオケル キュウキュウ キュウメイシ ノ キカン ソウカン ニツイテ : ホンケン ノ ゲンジョウ ト コンゴ ノ カダイ

Activities of Japanese Paramedics have increased and advanced year by year. Especially, intubation for OHCPA（out of hospital cardiopulmonary arrest） is approved since July 2004, but it is necessary to finish the training in Fire-fighter’s school and intubation practice in hospitals. In Fire-fighter’s school, Paramedics attend lectures and simulation, and in hospital, intubation practice for patients. Medical-control is the system for keeping the qualities and verification of details in the scene of pre-hospital medical care. This report discusses the states and problems of paramedic intubation, practice in hospital, airway management, from the questionnaire survey

Deep ice coring at Dome Fuji Station, Antarctica

Deep ice coring was carried out at Dome Fuji Station, Antarctica in 1995 and 1996 following a pilot borehole drilled and cased with FRP pipes in 1993,and reached 2503.52m in December 1996. Total numbers of ice coring runs below the pilot borehole and chip collection were 1369 and 837 respectively. The mean coring depths per run and per day were 1.75m and 8.21m respectively. We report the outline of the coring operation, the system, coring method, and troubles encountered during the coring work

ナンキョク ドーム フジ カンソク キョテン ニオケル ヒョウソウ シンソウ コア クッサク

南極ドームふじ観測拠点において, 1993年パイロット孔の掘削とケーシングが行われたのに引き続き, 1995年から2カ年にわたり本格的な深層コア掘削が進められ, 1996年12月に2503.52m深に達した。本掘削におけるコア掘削の総回数は1369回, チップ回収作業は837回に及んだ。1回の平均コア掘削長は1.75m, 一日の平均コア掘削長は8.21mであった。本報告では, 現地で使用された掘削システムの概要とともに, 掘削の経過, および掘削の方法を述べるとともに, 掘削中に生じたさまざまなトラブルについても取られたその対策とともに報告し, 併せて今後の課題を示した。Deep ice coring was carried out at Dome Fuji Station, Antarctica in 1995 and 1996 following a pilot borehole drilled and cased with FRP pipes in 1993,and reached 2503.52m in December 1996. Total numbers of ice coring runs below the pilot borehole and chip collection were 1369 and 837 respectively. The mean coring depths per run and per day were 1.75m and 8.21m respectively. We report the outline of the coring operation, the system, coring method, and troubles encountered during the coring work