1 0 0 0 OA 椎骨動脈解離性動脈瘤の治療
- 著者
- 恩田 英明 谷川 達也 竹下 幹彦 荒井 孝司 川俣 貴一 氏家 弘 井沢 正博 加川 瑞夫 高倉 公朋
- 出版者
- 一般社団法人 日本脳卒中の外科学会
- 雑誌
- 脳卒中の外科 (ISSN:09145508)
- 巻号頁・発行日
- vol.22, no.4, pp.293-299, 1994-07-30 (Released:2012-10-29)
- 参考文献数
- 20
- 被引用文献数
- 20 16
The authors present 33 patients with dissecting aneurysm of the intracranial vertebral artery, of whom subarachnoid hemorrhage developed in 26 patients and cerebral ischemia in 7 patients. Sixteen patients were surgically treated and 17 were conservatively treated. In this series, recurrent hemorrhage occured in 9 (35%) of 26 patients who presented with subarachnoid hemorrhage within 2 weeks after the initial ictus. The outcome of the cases with recurrent hemorrhage was very poor-7 of these 9 patients died. Therefore, surgical intervention during the acute stage is required to avoid the early rerupture. Comparative study with surgical and conservative treatment for dissecting aneurysms of the vertebral artery indicated that the outcome of patients with surgical treatment was much better than with conservative treatment. In surgical procedures, proximal clip-occlusion of the vertebral artery at the site distal to the PICA (DTP) was performed in 5 cases, at proximal to the PICA (PTP) in 4, trapping of the vertebral artery with dissecting aneurysm in 2, coating in 3, and proximal occlusion of the vertebral artery with detachable balloon in 2 patients. Postoperatively, transient lower cranial nerve palsy or cerebellar signs developed in 2 cases with trapping, in 1 with PTP and permanent hemiparesis due to thromboembolism at the top of the basilar artery in 1 with balloon-occlusion of the vertebral artery. In spite of surgical intervention, rerupture occured postoperatively in 1 case with coating and in 1 with DTP. Trapping procedure is most reliable to prevent rerupture of dissecting aneurysm, but it is difficult to expose the distal part of the vertebral artery beyond the aneurysm for trapping. Although proximal clip-occlusion is not completely satisfactory for prevention of rebleeding, it is simple as a method and useful for dissecting aneurysm of the vertebral artery.
1 0 0 0 OA シンポジウム
- 著者
- 金谷 春之 湯川 英機 伊藤 善太郎 加川 瑞夫 神野 哲夫 桑原 武夫 水上 公宏
- 出版者
- 一般社団法人 日本脳卒中の外科学会
- 雑誌
- 脳卒中の外科研究会講演集 (ISSN:03878031)
- 巻号頁・発行日
- vol.7, pp.265-273, 1978
In regard to hypertnsive intracerebral hemorrhage, different neurological gradings for clinical evaluation of the patient and different classifications for hematoma location on computed tomography have been used up to the present. To compare one clinical data to others, however, a standard neurological grading and a classification are required. For this reason, the authors tried to make a standard neurological grading and a classification on computed tomography based on 410 patients who had been treated in 6 different neurosurgical facilities in Japan.<BR>In the course of this study, it was found that the factors such as patient's age, level of consciousness, abnormal size and reaction to light of the pupils, and decerebrate or decorticate rigidity are directly influential to operative results. As to evaluation of the postoperative patient, the activities of daily living (ADL) was described as follows: full work, minimal disability and vegetative state.
1 0 0 0 OA くも膜下出血の就労中発症に関与する諸因子の検討
- 著者
- 塩川 和彦 高倉 公朋 加川 瑞夫 佐藤 和栄
- 出版者
- 公益社団法人 日本産業衛生学会
- 雑誌
- 産業衛生学雑誌 (ISSN:13410725)
- 巻号頁・発行日
- vol.37, no.3, pp.169-175, 1995 (Released:2009-03-27)
- 参考文献数
- 25
- 被引用文献数
- 2 1
くも膜下出血411例について,その発症に影響する因子をretrospectiveに解析し,労働との関連について検討した.発症時間では7時と16-17時の2つのピークがみられた.就労中発症は全くも膜下出血例の15.1%に見られ,運動,性交なども含めて,何らかの外的ストレスの関与が示唆されるものは66.7%に見られた.職務内容では,就労中発症例はその他の発症例に比較して,管理職を除く男性会社事務と肉体労働に多かった.就労中発症例はその他の発症例に比較して,高血圧症,喫煙歴,不眠の既往に有意差はみられなかったが, 40-59歳男性の就労中発症例(特に事務労働中発症例)はその他の発症例に比較して,有意に喫煙歴が高かった.労働そのものがくも膜下出血発症の原因になるか否かは未だ不明の点も多いが,就労中発症の機転として外的ストレスによる-過性の血圧上昇が示唆され,肉体的および精神的ストレス(外的ストレス)に対する個人の反応性が問題と考えられた.したがってその予防には新しい健康診断方法や健康管理が必要と思われる.