The recommended treatment for posterior fossa epidural hematoma has been prompt surgical evacuation. We report 2 patients who were treated conservatively. Both patients were younger than 10 years of age and developed subacute symptoms and signs. Serial computed tomography demonstrated complete resolution of the hematomas and no development of hydrocephalus during nonsurgical treatment. They recovered well without any neurologic deficits. In order to evaluate an indicative factor for nonsurgical treatment in young children with posterior fossa epidural hematoma, we review both of our patients and 36 well-documented patients from the literature, all of whom were younger than 10 years of age. The results demonstrate that the development of hydrocephalus is a critical factor in clinical progression. Nonsurgical management can be applied in these circumstances until spontaneous resolution of the hematoma unless early signs of medullary compression appear acutely after head trauma or serial computed tomography demonstrates the development of hydrocephalus followed by medullary compression.

Child↗

PubMedDate not supplied

Focal nodular hyperplasia of the liver: arterial angio-CT and microangiography.

To differentiate focal nodular hyperplasia (FNH) from other hepatic tumors, especially hepatocellular carcinoma, we evaluated the hemodynamics of histologically proved FNH in three patients, two by arterial angio-CT and one by microangiography of the resected specimen. These studies demonstrated the centrifugal blood supply of FNH (early filling of central tumor vessels radiating to periphery, and lobulated tumor stains with central low density area in the late phase), which could not be demonstrated by dynamic CT or hepatic angiography. Arterial angio-CT is useful as a further study, when differential diagnosis of FNH is uncertain by other imaging techniques.

Adolescent↗

PubMedDate not supplied

Simple hypothermic retrograde cerebral perfusion during aortic arch surgery.

We have found that retrograde cerebral perfusion can be performed by simply elevating central venous pressure during aortic arch surgery. During hypothermia (15 degrees C) venous blood rich in oxygen perfuses the brain, while the lower half of the body is perfused with the descending aorta occluded. Fourteen cases of aortic arch aneurysm (11 males, 3 females) were treated by this method and evaluated. Median and lateral thoracotomies were performed in 6 and 8 cases, respectively. Cerebral circulatory arrest time was 65 +/- 14 min (32-93 min), and significant oxygen and lactate extraction were noted in the brain. Eleven cases showed no neurologic deficit, but loss of consciousness due to other causes occurred in 3. In conclusion, this method maintained the aerobic metabolism of the brain and protected it during prolonged cerebral circulatory arrest, simplifying the procedure and permitting both median and lateral approaches.

Age Factors↗

PubMedDate not supplied

[Evaluation of the lumen-plaque-wall alterations by intravascular ultrasound imaging after percutaneous transluminal laser angioplasty in peripheral arteries: comparison with angiographic findings].

Intravascular ultrasound imaging was compared to angiography for evaluation of the changes in arterial lumen, atherosclerotic plaque and arterial walls after percutaneous transluminal laser angioplasty (PTLA) in peripheral arteries. Seventeen procedures using an argon laser angioplasty system (LASTAC system II) were performed in 13 patients with totally occluded lesions in the superficial femoral and iliac arteries. During or immediately after PTLA, a 30 MHz intravascular ultrasound catheter was inserted into the channel created by laser irradiation and adjunctive balloon dilatation. The outcome of PTLA was considered morphologically successful if the residual stenosis measured by intravascular ultrasound was 75% or less. Intravascular ultrasound showed eccentric plaques in 12 (71%), calcified plaques in 11 (65%), intraluminal thrombi in 2 (12%) and arterial wall injuries in 13 (76%) of the 17 lesions. PTLA was successful in 13 lesions and failed in 4. Occurrence of arterial dissections (38%) and mean residual stenoses (44 +/- 13%) were significantly (p < 0.05) lower in successful PTLA than in unsuccessful PTLA (100%, 89 +/- 3%). Eccentric stenoses, calcified plaques and arterial wall injuries were associated with poor success. Intravascular ultrasound detection of eccentric stenoses (71%), calcified plaques (65%) and arterial wall injuries (76%) was better than by angiography (29, 29, 47%). However, no significant correlation between intravascular ultrasound and angiographic findings could be found in quantitative estimation of the residual stenoses. Intraluminal thrombi were identified only by intravascular ultrasound. Angiography showed abnormalities in five (83%) of six lesions with medial injuries demonstrated by intravascular ultrasound, but none of the seven lesions with intimal injury. Intravascular ultrasound provides accurate diagnosis of eccentric stenosis, calcification, and arterial wall injury, and can quantitatively estimate residual stenosis and arterial wall injury during and immediately after PTLA in peripheral artery disease.

Aged↗