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Intensive Care Med. 2002 Dec;28(12):1724-8. Epub 2002 Oct 25.
Usefulness of venous oxygen saturation in the jugular bulb for the diagnosis of brain death: report of 118 patients.
Diaz-Reganon G, Minambres E, Holanda M, Gonzalez-Herrera S, Lopez-Espadas F, Garrido-Diaz C.
Polytrauma Intensive Care Unit, Service of Intensive Care Medicine, Hospital Universitario Marques de Valdecilla, Avenida Valdecilla s/n, 39008 Santander, Cantabria, Spain. mivdvumv.es
OBJECTIVE: To assess the usefulness of venous oxygen saturation in the jugular bulb (SjO(2)) as a complementary test for the diagnosis of brain death. DESIGN: Prospective observational study. SETTING: Polytrauma intensive care unit (ICU) of an acute-care teaching hospital in Santander, Spain. PATIENTS: We studied 118 (44%) out of 270 patients with severe head injury and intracranial hemorrhage meeting criteria of brain death (lack of cardiac response to atropine, unresponsive apnea, and iso-electric EEG in the absence of shock, hypotension and treatment with muscle relaxants and/or central nervous system (CNS) depressant drugs). MEASUREMENTS AND RESULTS: At the moment at which clinical diagnosis of brain death was made and an iso-electric EEG was obtained, simultaneous oxygen saturation in central venous blood (right atrium) (SvO(2)) and jugular venous bulb (SjO(2)) samples was measured. The ratio between SvO(2) and SjO(2), expressed as CvjO(2) (the so-called central venous-jugular bulb oxygen saturation rate; CvjO(2) = SvO(2)/SjO(2)) was calculated. CvjO(2) less than 1 was obtained in 114 patients [mean (SD): 0.89 (0.02)], whereas CvjO(2) greater than 1 was obtained in only 4 (3.38%). In the group of 152 survivors, a single patient was discharged from the ICU in a vegetative state in which CvjO(2) was below 1. CvjO(2)as a complementary test for the diagnosis of brain death showed 96.6% sensitivity, 99.3% specificity, and 99.1% and 97.4% positive and negative predictive values, respectively. CONCLUSION: Central venous-jugular bulb oxygen saturation rate below 1 together with accepted clinical criteria (unresponsive coma with brainstem areflexia) provides non-invasive assessment of cerebral circulatory arrest that can help to suspect brain death.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12447514&dopt=Abstract hemorrhage
No Shinkei Geka. 2003 Jan;31(1):27-33.
[Surgical treatment of proximal middle cerebral artery (M1) aneurysms at the origin of the lenticulostriate artery]
[Article in Japanese]
Nishioka H, Haraoka J, Miki T, Akimoto J, Yamanaka S, Hasegawa K, Matsumura H.
Department of Neurosurgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
In contrast to aneurysms of the middle cerebral artery at the bifurcation, aneurysms at the origin of the lenticulostriate arteries (LSA) are uncommon. Six surgically treated patients (34 to 70 year-old; 3 men, 3 women) were reviewed. 5 patients presented with subarachnoid hemorrhage (H&H grade 2:3, 3:1, 4:1; Fisher type 2:1, 3:3, 4:1) and 2 patients had multiple aneurysms. All aneurysms arose from the postero-superior surface of the M1. Although neck clipping was achieved in every patient, re-application of the clip was necessary during surgery in 3 patients because the tip of the blade extended to the other perforators that ran parallel to the M1. Results were as follows: GR 3, MD1, SD 1, D1. Apart from a 70 year-old patient who died of vasospasm (H & H 4), fair results in two patients were accompanied by ischemic complications of the LSA. All 3 patients who required re-application of the clip during surgery showed a lacunar infarct of perforating arteries on post-operative CT. Special care of perforating arteries not only around the neck (the LSA) but also behind the aneurysm is essential for successful neck-clipping of aneurysms at this location.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12533902&dopt=Abstract hemorrhage
Mund Kiefer Gesichtschir. 2002 Nov;6(6):442-5. Epub 2002 Jul 30.
[Life threatening oral hemorrhage after implantation into the distal right mandible]
[Article in German]
Weibrich G, Foitzik Ch, Kuffner H.
Klinik fur Mund-, Kiefer- und Gesichtschirurgie, Johannes-Gutenberg-Universitat Mainz, Augustusplatz 2, 55131 Mainz, weibrickg.klinik.uni-mainz.de
In dental practice, surgical implant procedures are frequently conducted for pre-prosthetic surgery. Intra-operative complications are rare and can mostly be prevented effectively with adequate preparatory measures. However, not all risks can be anticipated a priori. Anatomical variation, such as variation in the path of blood vessels, is often unpredictable. This paper describes a life-threatening hemorrhage that occurred in a 60-year-old male during the insertion of an implant in the distal right mandible. It was impossible to stop the bleeding using local measures. Only extraoral ligation of the facial artery proved effective in suppressing the hemorrhage. The submentalis artery, a branch of the facial artery, had an atypical path directly below the caudal ridge of the mandible. The possibility of similar complications should make us re-evaluate preoperative preventive measures, and places greater demands on intra-operative complication prophylaxis. The international literature on this topic is discussed.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12447658&dopt=Abstract hemorrhage
Ann Neurol. 2002 Dec;52(6):825-9.
Focal laminar cortical MR signal abnormalities after subarachnoid hemorrhage.
Dreier JP, Sakowitz OW, Harder A, Zimmer C, Dirnagl U, Valdueza JM, Unterberg AW.
Department of Neurology, Charite Hospital Standort Mitte, Humboldt University, Schumannstrasse 20/21, 10117 Berlin, Germany. jens.dreieharite.de
In the autopsy studies of patients with delayed ischemic neurological deficits after subarachnoid hemorrhage, a predominance of cortical lesions has been observed. Similar to the autopsy descriptions in the literature, we present magnetic resonance images visualizing focal laminar cortical lesions around a fissure or sulcus in two patients, who initially did not undergo surgery, with delayed ischemic neurological deficits. This magnetic resonance imaging pattern may provide a clue to the diagnosis if the patient does not present to the emergency room with the acute hemorrhage but with delayed ischemic neurological deficits.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12447937&dopt=Abstract hemorrhage
Mund Kiefer Gesichtschir. 2002 Sep;6(5):303-8.
[Indications for primary surgical therapy of vascular abnormalities in infancy]
[Article in German]
Wolff KD, Holzle F, Eufinger H.
Klinik fur Mund-, Kiefer- und Plastische Gesichtschirurgie, Klinikum der Ruhr-Universitat, Knappschaftskrankenhaus Bochum-Langendreer, In der Schornau 23-25, 44892 Bochum-Langendreer. klaus.wolfuhr-uni-bochum.de
LASER THERAPY: Since the introduction of laser therapy for treatment of hemangiomas and vascular malformations, primary surgical therapy has gradually lost importance. Particularly hemangiomas, but also venous malformations and lymphangiomas, are nowadays primarily treated by different types of lasers. Especially the Nd:YAG laser with a percutaneous or transcutaneous application technique often leads to satisfying results. SURGICAL THERAPY: Surgical therapy is mostly used secondarily in late childhood or in adults after several laser applications for excision of residual scars or other corrective procedures. Despite these improvements in laser therapy, there is still an indication for primary surgical treatment in subcutaneous vascular malformations and in rapidly growing hemangiomas after unsuccessful laser therapy. Even in large vascular anomalies, safe excision with only a little blood loss is possible if the tumors are encapsulated. CASE REPORTS: In this paper we want to point out the necessity of primary surgery in three children in whom complications such as loss of sight, facial nerve palsy, and a lethal outcome due to massive hemorrhage in a cystic lymphangioma could be avoided.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12448231&dopt=Abstract hemorrhage
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