[Aneurysms of the vertebro-basilar arterial system].
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Biomedical subjects
Publications and source records attributed to J Bromowicz.
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On the basis of a material of 561 patients with ruptured intracranial aneurysms treated at the Department of Neurosurgery, Institute of Neurology, Medical Academy in Cracow in the years 1971 to 1977 the authors discuss the effectiveness of conservative treatment for prevention of recurrent bleeding from these aneurysms. The whole group of 561 patients were divied into two subgroups: 361 patients (group A) receiving standard antifibrilytic treatment, drugs preventing oedema formation and reducing the arterial blood pressure, and 254 patients (group B) who were not given antifibrinolytic agents and the other pharmacological agents were given to them only sporadivally. Recurrent bleeding developed in 8.86% of cases of group A and 11.02% in group B. The difference was not significant.
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The authors discuss the problem of recurrent haemorrhage in neurosurgical practice on the basis of a material of 36 cases out of a groups of 401 treated surgically for arterial aneurysms in the years 1971--1975. They describe the methods of prevention of recurrent haemorrhage by administration of pharmacological agents, methods of transport to neurosurgical units and selection of time of operation as well as the principles of qualification of patients according to Botterell's scale.
A female patient is reported with a fusiform aneurysm of the anterior cerebral artery. It is stressed that fusiform aneurysms rarely cause haemorrhages, this risk is always present and they should be excluded from cerebral circulation if only the haemodynamic conditions make this possible.
Two patients are reported with pituitary adenomas growing through the wall of the cavernous sinus. The authors stress diagnostic difficulties and emphasize the value of computer tomography in the diagnosis.
In a period of 15 months in a material of 235 surgically verified brain tumours in 8 cases (3.4%) hemorrhages into the tumour mass were found. In 3 of these cases the tumours were anaplastic astrocytomas, the remaining tumours were: oligodendroglioma, meningioma, pituitary adenoma and metastases of renal carcinoma and skin melanoma. The clinical manifestations associated with haemorrhage are discussed stressing that haemorrhage into the tumour worsened the prognosis.
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In a group of 556 patients with ruptured intracranial aneurysms in 80 (14%) prodromal manifestations were present before haemorrhage. They included most frequently headaches vomiting, disturbances of eye movements and transient disturbances of consciousness. Prodromal symptoms were most frequent in cases of vertebral-basilar aneurysms.