We present a series of 61 traumatic subdural hygromas, and discuss the pathogenic mechanisms and natural history of this condition. It commonly occurred in patients over 50 years of age and before 5 years of age. Fifty-two cases (85.2%) were diagnosed 3 days after head injury. Glasgow Coma Score (GCS) on admission was 3-8 in 24 (39.3%), 9-12 in 15 (24.6%) and 13-15 in 22 patients (36.1%). Although three patients (4.9%) showed slow deterioration, most hygromas were clinically 'silent'. Thirty-eight patients (62.3%) were managed conservatively and 23 patients (37.7%) underwent surgery. Only five patients (21.7%) showed gross improvement after surgery, even though surgery was performed only for enlarged hygromas shown by serial computed tomography. In five patients (8.2%), a chronic subdural haematoma subsequently developed from a hygroma. A favourable outcome (good recovery or moderate disability) occurred in 59%, an unfavourable outcome (severe disability and vegetative state) in 28%, and death resulted in 13%. Outcome was closely related to the severity of primary head injury.

We compared the ultrasound (US) findings of gallbladder (GB) perforation with computed tomography (CT) in 13 patients with GB perforation confirmed at surgery. The common findings of GB perforation were pericholecystic fluid collection and layering of GB wall on US, pericholecystic fluid collection, streaky omentum or mesentery, and GB wall defect on CT. Pericholecystic fluid collection, layering of GB wall, and cholelithiasis were similarly detected on US or CT. GB wall defect and/or bulging of the GB wall suggested a site of perforation was revealed in five patients (38.5%) on US and nine (69.2%) on CT. CT further disclosed the findings of streaky omentum or mesentery (84.6%). CT was superior to US for diagnosis of GB perforation.

We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.

This study is the first to demonstrate that A20 overexpression has anti-inflammatory effects and blocks osteoclastic differentiation in a nicotine- and LPS-stimulated hPDLC model. Thus, A20 overexpression may be a potential therapeutic target in inflammatory bone loss diseases, such as periodontal disease.

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The authors prospectively treated 10 consecutive patients with multiloculated empyemas with intracavitary instillation of urokinase via a percutaneous drainage catheter. Urokinase (100,000 IU) in 100 mL of 5% dextrose in water was instilled into the pleural cavity via a percutaneous drainage catheter. After overnight clamping, the catheter was opened and the empyema drained with use of negative suction (20 cm H2O). Intermittent irrigation of the catheter with normal saline was performed to prevent clogging of the catheter. Complete drainage of multiloculated empyemas was accomplished in nine patients by means of intracavitary instillation of urokinase via a single 8-F catheter. One patient showed complete drainage of multiloculated empyema, but recurrent empyema appeared in the site of a previous tube thoracostomy. A total of 100,000-700,000 IU (mean, 400,000 IU) of urokinase were needed for complete drainage in all patients. Plasminogen and fibrin degradation product levels in empyema fluid were determined before instillation of urokinase to demonstrate any fibrinolytic action. No complications occurred.

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