Neurosurgery
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Cerebrovascular vasomotor reactivity reflects changes in smooth muscle tone in the arterial wall in response to changes in transmural pressure or the concentration of carbon dioxide in blood. We investigated whether slow waves in arterial blood pressure (ABP) and intracranial pressure (ICP) may be used to derive an index that reflects the reactivity of vessels to changes in ABP. ⋯ Computer analysis of slow waves in ABP and ICP is able to provide a continuous index of cerebrovascular reactivity to changes in arterial pressure, which is of prognostic significance.
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We report a case of head injury, in which a hyperosmolar state evolved during the course of treatment, complicated by severe rhabdomyolysis and acute renal failure, which subsequently resulted in a good recovery after intensive supportive treatment. To our knowledge, such high levels of creatine kinase in a patient with head injury and rhabdomyolysis have not been reported. ⋯ We postulate that the hyperosmolar state of the patient was the major cause of his severe rhabdomyolysis. Associated hypokalemia and hypophosphatemia are also predisposed to rhabdomyolysis. The most serious complication in rhabdomyolysis is acute renal failure, but most patients who receive supportive treatment and can survive despite the complications can expect to have normal renal function restored.
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To develop a new saccular aneurysm model in vitro using elastase to study aneurysm initiation, growth, and rupture and to create a new in vivo aneurysm model to test endovascular therapies. ⋯ After empirically testing several methods of elastase delivery, we were able to induce saccular, bifurcation-type aneurysms in animal arterial specimens. These aneurysms are histologically similar and more authentic than surgical models. The procedure is easy and reproducible. Our results suggest a possible enzymatic role in aneurysm formation and highlight the dramatic effects of selective arterial elastic damage. Also, the rapid growth of our experimental aneurysms may reflect the speed of the natural process.