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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the past 14 years, 1000 cases of aneurysms were submitted to surgical operations without using microscope. In this report 346 cases of anterior communicating artery aneurysms were studied. The operative result at discharge was as follows; 19 cases (5.5%) were dead, 27 poor, 39 fair, 64 good and 197 excellent. In the follow-up, out of 300 cases 29 were dead (16 were related to the operation), 7 were poor, 13 fair, 26 good and 226 excellent. Out of 19 dead cases during hospitalization, 14 were operated within two weeks after SAH. Ten out of 14 cases operated within two weeks died due to vasospasm and all these 10 cases were operated between five to 11 days after SAH. These results and results of ultra-early surgery on other sites of aneurysm suggested that the surgery should be avoided on the cases from third to 10th day after SAH. After the 3rd day, the operation should be decided by taking vasospasm into consideration. If the SAH attack is a mojor one accompanying loss of consciousness more than one hour, the operation should be postponed until the 14th day. If the SAH attack is a moderate one accompanying loss of consciousness within one hour, it should be postponed until the 9th or 10th day. When the SAH attack doesn't accompany loss of consciousness, the surgery can be done any time. If stiff neck is obvious, it should be performed on the 9th or 10th day. Our approach for anterior communicating artery aneurysms is a interhemispherical approach following the bifrontal craniotomy. Hypothermic anesthesia around 27 degrees C was used in order to prolong the temporary occlusion time until 1971. Since 1972, 500 approximately 800 ml of 20% mannitol was applied intravenously for preventing the infarction following the temporary occlusion under the normothermic general anesthesia. Details of the operative records of 346 cases were analyzed and our operative method, technique and technical points were discussed.
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PMID:[Surgery of anterior communicating artery aneurysm--from the experiences of 346 cases (author's transl)]. 70 9

Mild barbiturate-moderate hypothermia therapy was established for severe head injury and cerebrovascular disease. This study was conducted on 152 patients from April 1984 through July 1995. In this study were included patients with Glagow Coma Scale score of less than 8 points but those with serious systemic complications and elderly and infantile patients were excluded. Our protocol consisted of administration of thiamylal Na 1.25-2.5 mg/kg/h and droperidol 20-40 micrograms/kg/h (mild barbiturate) while maintaining a core temperature of 32-34 degrees C (moderate hypothermia). The clinical outcome was good (GR, MD) in 58 cases, poor (SD) in 24 cases and bad (PVS, D) in 70 cases. This therapy was found to be particularly effective for preventing ischemic neurological damage in the vasospasm stage following SAH and severe head injury in young patients. However, this therapy did not prevent pneumonia, cardiac failure, arrhythmia and hypopotassemia from occurring frequently. We conclude that this therapy is contraindicated in the elderly, i.e., those older than 65 years.
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PMID:[Analysis of mild barbiturate-moderate hypothermia therapy on the authors' 152 cases]. 918 90

Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age>70 years, subacute stage (4--14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0--3, grade 4 (GCS 9--12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0--3 days after bleed). The patient's outcome was measured using GOS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8 % and 48 % of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16 % of clipping cases and 44.06 % of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.
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PMID:The effect of clipping and coiling in acute severe subarachnoid hemorrhage after international subarachnoid aneurysmal trial (ISAT) results. 1617 68