SYNOPSISThe isolated human basilar artery suspended in Krebs' solution contracts to 5-hydroxytryptamine, noradrenaline, and histamine, which stimulate specific receptors. Normal human serum contains an unidentified contractile substance, and erythrocytes relax the artery. Serum and erythrocytes potentiate 5-HT contractions. This preparation is suitable for studying vasoactive substances released during vasospasm after subarachnoid haemorrhage.
SummarySubarachnoid haemorrhage from intracranial aneurysms has a poor prognosis. Operative management of intracranial aneurysms was once considered ineffective. The first 100 cases treated by microsurgery were analysed to see whether mortality and morbidity were reduced. Modern surgical techniques halved the total mortality but the morbidity was unaltered. Results can be improved by delaying surgery seven days and by treating any hypertension before surgery.
There is a high mortality and morbidity in patients with subarachnoid hamorrhage (SAH) following rupture of cerebral arterial aneurysms. The reason for this is not definitely established but it is associated with constriction of the major cerebral arteries. This cerebral arterial spasm (CAS) is a salient feature of the clinical condition, and appears as a pronounced constriction of one or more of the major cerebral arteries (Fig 1). It may
The immediate mortality of subarachnoid haemorrhage (SAH) secondary to ruptured intracranial aneurysms is 43%. The studies by McKissock and his colleaguesl 2 3 comparing conservative and surgical treatments at six months showed that the overall results were not improved by surgery (mortality rate 35%). However, Pakarinen's4 study showed that those survivors from a first SAH who were managed conservatively, had a 35% mortality within a year and a 51 % mortality within five years, the remainder dying subsequently at a rate of 3-3 % per year. As the rate of rebleeding continues to be high in conservatively treated patients beyond six months after the first SAH, it is now generally accepted that surgery is justifiable, as long as the operative mortality is lower than the natural one.Since the introduction of the operating microscope, the results of surgery for intracranial aneurysms reported by various authors have varied widely. The mortality has ranged between 3%,5 4-3%,6 6%7 and 15%.8 We present the operative results on a series of 256 patients with ruptured intracranial aneurysms. Selection was carried out exclusively on preoperative neurological status. The importance of various clinical factors in combination for prognosis has been
in either site the deconjugated bile salts might be acting on the colon to produce microscopic colitis and diarrhoea. The patient underwent cholecystectomy, and although no organisms could be isolated from either the gall bladder or bile duct bile both her diarrhoea and the histological abnormality of the rectal mucosa remitted and have not recurred over the ensuing two years. This case suggests that gall stones may be one cause of microscopic colitis, and we would be most interested to know whether any of the cases reported by Dr Kingham and others also had gall stones.
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