Size Of Hemorrhage Research Articles

Venous Hypertension and Cerebral Aneurysm Rupture

To investigate the correlation between the sinus asymmetry and aneurysm rupture. We retrospectively reviewed all diagnostic and therapeutic conventional angiograms of patients with cerebral aneurysms in our hospital from January 2000 to April 2008. Cases were categorized according to gender, presence or absence of aneurysm rupture, and presence or absence of symmetric dural sinuses. Exclusion criteria included patients with underlying fibromuscular dysplasia, dissecting aneurysms, pseudoaneurysms, and the presence of arteriovenous malformations or fistulas. The venous pressure was measured by MR phase contrast with standard fluid dynamics notation as Poiseuille's Law. A total of 193 cases (131 females and 62 males) were included for Chi-squared analysis, which showed significant difference (p < 0.05) between aneurysm rupture and venous asymmetry in the entire group as well as in females, but not in males. There was an association between side of rupture and side of asymmetry as well as between the size of hemorrhage. Ruptured aneurysm is more frequent at the same side of dominant dural sinus than the side of hypoplasia venous sinus. MRA phase contrast is able to show the venous pressure gradient of asymmetrical dural sinuses. With our preliminary data, we propose that dural sinus asymmetry is associated with aneurysm rupture.

An optimized 3D spoiled gradient recalled echo pulse sequence for hemorrhage assessment using inversion recovery and multiple echoes (3D SHINE) for carotid plaque imaging

Intraplaque hemorrhage into the carotid atherosclerotic plaque has been shown to create instability and progression. We have developed an optimized 3D Spoiled Gradient recalled echo pulse sequence for Hemorrhage assessment using INversion recovery and multiple Echoes (3D SHINE) for carotid plaque imaging. The sequence was developed by incorporating multiecho acquisition to its clinically validated optimized single-echo counterpart 3D inversion recovery prepared fast spoiled gradient recalled sequence. With similar scan time (4 min), 3D spoiled gradient recalled echo pulse sequence for hemorrhage assessment using inversion recovery and multiple echoes maintained comparable high-resolution volumetric coverage, black-blood effect, contrast, signal-to-noise and contrast-to-noise ratios, and similar sensitivity and specificity in detecting whether intraplaque hemorrhage was present on an artery. The multiple echoes acquired with 3D SHINE allowed the estimation of intraplaque hemorrhage T*(2) and then the subsequent characterization of intraplaque hemorrhage (T*(2) for type I < 14 msec, and for type II > 14 msec). The type I intraplaque hemorrhage size estimated by 3D SHINE was significantly and positively correlated with the size estimated manually by an expert reviewer using the histology-validated multicontrast MRI technique (r = 0.836 ± 0.080, p < 0.001). With only one fast sequence, 3D SHINE can detect and characterize intraplaque hemorrhage that has previously required a multicontrast approach using a combination of black-blood T(1)-weighted, black-blood T(2)-weighted, and time-of-flight imaging techniques.

Three-dimensional susceptibility-weighted imaging and two-dimensional T2*-weighted gradient-echo imaging of intratumoral hemorrhages in pediatric diffuse intrinsic pontine glioma

We compared the sensitivity and specificity of T2*-weighted gradient-echo imaging (T2*-GRE) and susceptibility-weighted imaging (SWI) in determining prevalence and cumulative incidence of intratumoral hemorrhages in children with diffuse intrinsic pontine glioma (DIPG) undergoing antiangiogenic and radiation therapy. Patients were recruited from an institutional review board-approved prospective phase I trial of vandetanib administered in combination with radiation therapy. Patient consent was obtained before enrollment. Consecutive T2*-GRE and SWI exams of 17 patients (F/M: 9/8; age 3-17 years) were evaluated. Two reviewers (R1 and R2) determined the number and size of hemorrhages at baseline and multiple follow-ups (92 scans, mean 5.4/patient). Statistical analyses were performed using descriptive statistics, graphical tools, and mixed-effects Poisson regression models. Prevalence of hemorrhages at diagnosis was 41% and 47%; the cumulative incidences of hemorrhages at 6 months by T2*-GRE and SWI were 82% and 88%, respectively. Hemorrhages were mostly petechial; 9.7% of lesions on T2*-GRE and 5.2% on SWI were hematomas (>5 mm). SWI identified significantly more hemorrhages than T2*-GRE did. Lesions were missed or misinterpreted in 36/39 (R1/R2) scans by T2*-GRE and 9/3 scans (R1/R2) by SWI. Hemorrhages had no clinically significant neurological correlates in patients. SWI is more sensitive than T2*-GRE in detecting hemorrhages and differentiating them from calcification, necrosis, and artifacts. Also, petechial hemorrhages are more common in DIPG at diagnosis than previously believed and their number increases during the course of treatment; hematomas are rare.

Clinical Evaluation of a Portable Near-Infrared Device for Detection of Traumatic Intracranial Hematomas

The purpose of this multicenter observational clinical study was to evaluate the performance of a near-infrared (NIR)-based, non-invasive, portable device to screen for traumatic intracranial hematomas. Five trauma centers collected data using the portable NIR device at the time a computed tomography (CT) scan was performed to evaluate a suspected traumatic brain injury (TBI). The CT scans were read by an independent neuroradiologist who was blinded to the NIR measurements. Of 431 patients enrolled, 365 patients were included in the per-protocol population analyzed. Of the 365 patients, 96 were determined by CT scan to have intracranial hemorrhages of various sizes, depths, and anatomical locations. The NIR device demonstrated sensitivity of 88% (95% confidence interval [CI] 74.9,95.0%), and specificity of 90.7% (95% CI 86.4,93.7%), in detecting the 50 intracranial hematomas that were large enough to be clinically important (larger than 3.5 mL in volume), and that were less than 2.5 cm from the surface of the brain. For all 96 cases with intracranial hemorrhage, regardless of size and type of hemorrhage, the sensitivity was 68.7% (CI 58.3,77.6%), and specificity was 90.7% (CI 86.4,93.7%). These results confirm the results of previous studies that indicate that a NIR-based portable device can reliably screen for intracranial hematomas that are superficial and of a size likely to be of clinical importance. The NIR device cannot replace CT scanning in the diagnosis of TBI, but the device might be useful to supplement clinical information used to triage TBI patients, and in situations in which CT scanning is not readily available.

Association of TNF-α gene with spontaneous deep intracerebral hemorrhage in the Taiwan population: a case control study

BackgroundGenetic factors may play a role in susceptibility to spontaneous deep intracerebral hemorrhage (SDICH). Previous studies have shown that TNF-α gene variation was associated with risks of subarachnoid hemorrhage in multiple ethnicities. The present case-control study tested the hypothesis that genetic variations of the TNF-α gene may affect the risk of Taiwanese SDICH. We examined the association of SDICH risks with four single nucleotide polymorphisms (SNPs) within the TNF-α gene promoter, namely T-1031C, C-863A, C-857T, and G-308A.MethodsGenotyping was determined by PCR-based restriction and electrophoresis assay for 260 SDICH patients and 368 controls. Associations were tested by logistic regression or general linear models with adjusting for multiple covariables in each gender group, and then in combined. Multiplicative terms of gender and each of the four SNPs were applied to detect the interaction effects on SDICH risks. To account for the multiple testing, permutation testing of 1,000 replicates was performed for empirical estimates.ResultsIn an additive model, SDICH risks were positively associated with the minor alleles -1031C and -308A in men (OR = 1.9, 95% CI 1.1 to 3.4, p = 0.03 and OR = 2.6, 95% CI 1.3 to 5.3, p = 0.005, respectively) but inversely associated with -863A in females (OR = 0.5, 95% CI 0.2 to 0.9, p = 0.03). There were significant interaction effects between gender and SNP on SDICH risks regarding SNPs T-1031C, C-863A, and G-308A (p = 0.005, 0.005, and 0.007, respectively). Hemorrhage size was inversely associated with -857T in males (p = 0.04).ConclusionsIn the Taiwan population, the associations of genetic variations in the TNF-α gene promoter with SDICH risks are gender-dependent.

Digitally quantifying cerebral hemorrhage using Photoshop® and Image J

A spectrophotometric hemoglobin assay is widely used to estimate the extent of brain hemorrhage by measuring the amount of hemoglobin in the brain. However, this method requires using the entire brain sample, leaving none for histology or other assays. Other widely used measures of gross brain hemorrhage are generally semi-quantitative and can miss subtle differences. Semi-quantitative brain hemorrhage scales may also be subject to bias. Here, we present a method to digitally quantify brain hemorrhage using Photoshop® and Image J, and compared this method to the spectrophotometric hemoglobin assay. Male Sprague–Dawley rats received varying amounts of autologous blood injected into the cerebral hemispheres in order to generate different sized hematomas. 24h later, the brains were harvested, sectioned, photographed then prepared for the hemoglobin assay. From the brain section photographs, pixels containing hemorrhage were identified by Photoshop® and the optical intensity was measured by Image J. Identification of hemorrhage size using optical intensities strongly correlated to the hemoglobin assay (R=0.94). We conclude that our method can accurately quantify the extent of hemorrhage. An advantage of this technique is that brain tissue can be used for additional studies.

Symptomatologic Versus Neuroimaging Predictors of In-Hospital Survival after Intracerebral Haemorrhage

Symptomatological prediction of Intracerebral haemorrhage (ICH) mortality is a simple and effective method compared to pathological predictors. In this study we considered consciousness level as an easily measurable predictor and compared it to haemorrhage location, intraventricular penetration and haemorrhage size derived from Computerized Tomography (CT) to predict mortality using a parametric survival analysis model. Two hundred and thirty eight ICH patients from a neurology hospital ward were enrolled into this comparative study. Patient history was documented with respect to mortality and a questionnaire outlining background variables and medical history was completed for them. Consciousness level was clinically evaluated by a physician while haemorrhage size and location were determined via computerized tomographic scanning reports. Data were entered into the computer and analyzed according to the Weibull parametric survival analysis model using STATA 8 statistical software. Males constituted 47.1% of the 238 patients, 52.9% were females. The age range of the patients varied from 13 to 88 years, with a mean age of 62.4 +/- 13.6 (Mean +/- SD). Half of the patients survived more than 20 days. Using the Weibull regression model, the only significant independent symptomatological predictor of mortality was found to be the level of consciousness. Cumulative hazard during the 90 days was compared for different levels of consciousness. Application of Weibull to pathological predictors of ICH mortality showed that the two independent predictors were haemorrhage size and intraventricular penetration. Results of statistical modelling didn't provide evidence of priority for pathological predictors of survival compared to easily measurable levels of consciousness as a symptomatological predictor. Easily measurable symptoms of level of consciousness can be used as a survival predictor of stroke due to intra-cerebral haemorrhage when compared to pathological indicators.

Intra-Arterial Iodinated Radiographic Contrast Material Injection Administration in a Rat Middle Cerebral Artery Occlusion and Reperfusion Model

Observations in human interventional stroke treatment led us to hypothesize that iodinated radiographic contrast material use may contribute to intracerebral hemorrhage. Effects of intra-arterial iodinated radiographic contrast material on hemorrhagic transformation after middle cerebral artery occlusion and reperfusion were studied in a placebo-controlled, blinded preclinical study in rats. Four groups of male Sprague-Dawley rats were studied: saline group (n=8), contrast group (n=12), heparin group (n=9), and contrast+heparin group (n=9). The middle cerebral artery was occluded for 5 hours using suture placement. Heparin was infused before suture removal and reperfusion. Saline and/or contrast were infused immediately during reperfusion. Incidence, location, and size of hemorrhage were determined by brain necropsy inspection at 24 hours. There was a significant increase in incidence of cortical hemorrhage from control (37.5%), contrast (75.0%), heparin (77.8%) to contrast+heparin (100%; Cochran-Mantel-Haenszel correlation, P<0.01). Both pooled contrast groups (85.7%) and pooled heparin groups (88.9%) had higher rates of cortical intracerebral hemorrhage compared with the control group (P<0.05). Similar trends for increased cortical intracerebral hemorrhage were seen in the contrast-only (P=0.18) and heparin-only (P=0.18) groups. There was a trend for decreased infarct edema in rats receiving contrast versus those without (P=0.06). Intraarterial iodinated radiographic contrast material may increase cortical intracerebral hemorrhage, similar to heparin. Iodinated radiographic contrast material effect may be additive to heparin effect on the incidence of cortical intracerebral hemorrhage.

Carotid Intraplaque Hemorrhage Imaging at 3.0-T MR Imaging: Comparison of the Diagnostic Performance of Three T1-weighted Sequences

To compare the diagnostic performances of three T1-weighted 3.0-T magnetic resonance (MR) sequences at carotid intraplaque hemorrhage (IPH) imaging, with histo logic analysis as the reference standard. Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. Twenty patients scheduled for carotid endarterectomy underwent 3.0-T carotid MR imaging, including two-dimensional fast spin-echo, three-dimensional time-of-flight (TOF), and three-dimensional magnetization-prepared rapid acquisition gradient-echo (RAGE) sequences. Two reviewers blinded to the histologic findings assessed the presence, area, and signal intensity of IPH with each sequence. Detection statistics (sensitivity, specificity, and Cohen kappa values) and agreement between area measurements (Pearson correlation coefficient [r] values) were calculated for each sequence. When all 231 available MR sections were included for analysis, the magnetization-prepared RAGE (kappa = 0.53) and fast spin-echo (kappa = 0.42) sequences yielded moderate agreement between MR and histologic measurements, while the TOF sequence yielded fair agreement (k = 0.33). However, when 47 sections with either small IPHs or heavily calcified IPHs were excluded, sensitivity, specificity, and kappa values, respectively, were 80%, 97%, and 0.80 for magnetization-prepared RAGE imaging; 70%, 92%, and 0.63 for fast spin-echo imaging; and 56%, 96%, and 0.57 for TOF imaging. MR imaging-histologic analysis correlation for IPH area was highest with magnetization-prepared RAGE imaging (r = 0.813), followed by TOF (r = 0.745) and fast spin-echo (r = 0.497) imaging. The capability of these three sequences for IPH detection appeared to be in good agreement with the quantitative contrast of IPH versus background plaque tissue. The magnetization-prepared RAGE sequence, as compared with the fast spin-echo and TOF sequences, demonstrated higher diagnostic capability for the detection and quantification of IPH. Potential limitations of 3.0-T IPH MR imaging are related to hemorrhage size and coexisting calcification.

Brain interstitial fluid TNF-α after subarachnoid hemorrhage

Objective TNF-α is an inflammatory cytokine that plays a central role in promoting the cascade of events leading to an inflammatory response. Recent studies have suggested that TNF-α may play a key role in the formation and rupture of cerebral aneurysms, and that the underlying cerebral inflammatory response is a major determinate of outcome following subrarachnoid hemorrhage (SAH). Methods We studied 14 comatose SAH patients who underwent multimodality neuromonitoring with intracranial pressure (ICP) and cerebral microdialysis as part of their clinical care. Continuous physiological variables were time-locked every 8 h and recorded at the same point that brain interstitial fluid TNF-α was measured in brain microdialysis samples. Significant associations were determined using generalized estimation equations. Results Each patient had a mean of 9 brain tissue TNF-α measurements obtained over an average of 72 h of monitoring. TNF-α levels rose progressively over time. Predictors of elevated brain interstitial TNF-α included higher brain interstitial fluid glucose levels ( β = 0.066, p < 0.02), intraventricular hemorrhage ( β = 0.085, p < 0.021), and aneurysm size > 6 mm ( β = 0.14, p < 0.001). There was no relationship between TNF-α levels and the burden of cisternal SAH; concurrent measurements of serum glucose, or lactate–pyruvate ratio. Interpretation Brain interstitial TNF-α levels are elevated after SAH, and are associated with large aneurysm size, the burden of intraventricular blood, and elevation brain interstitial glucose levels.

Serial Changes of the Splenic Volume after Traumatic Intraperitoneal Hemorrhage

Purpose: We wanted to evaluate the serial changes of the splenic volume in patients with traumatic intraperitoneal hemorrhage. Materials and Methods: 20 consecutive patients with traumatic intraperitoneal hemorrhage and who underwent initial CT, early follow-up CT within 30 days and late follow-up CT examinations thereafter were included in this study. The volume of the spleen on each CT examination was measured and the relative splenic volume (RSV) on the initial and early follow-CT examinations was calculated on the basis of the splenic volume on the late follow-up CT. The hemoperitoneum score was calculated on the basis of the size of the intraperitoneal hemorrhage. Results: The average RSVs of the initial and early follow-up CT were 62.0% and 133.3%, respectively, and all the patients showed an increase of the splenic and relative splenic volumes on the early follow-up CT, as compared with those on the initial CT. Initial splenic contraction was seen in 18 patients (90.0%) and early splenomegaly was seen in 14 patients (70.0%). Patients with initial splenic contraction and early splenomegaly were the most common (12 patient, 60.0%). Conclusion: Initial physiologic splenic contraction was seen in most of the patients with hemoperitoneum, and thereafter early splenomegaly was commonly seen before normalization of the splenic volume.

Anatomical Non-Responder to Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration

Purpose: To analyze the characteristics of anatomical non-response to intravitreal bevacizumab (IVB) in patients with neovascular age-related macular degeneration (AMD). Methods: Neovascular AMD patients who were treated with IVB were studied. A non-responder was defined as a patient whose eyes had no change in choroidal neovascularization (CNV) lesion size or fluorescein leakage and no change in foveal thickness (FT) after at least two administrations of IVB. Demographic findings and efficacy outcomes were compared between responders and non-responders based on patient gender, age, visual acuity (VA), FT, CNV lesion type, CNV lesion size, presence of serous retinal detachment (SRD), presence of pigment epithelial detachment (PED), PED size, and presence of sub-macular hemorrhage (SMH). Results: Five patients (six eyes; 13.6%) were identified as non-responders to treatment with IVB. The mean age of the non-responder group (75.17 3.66 yers) was greater (p = 0.237) than that of the responder group (71.89 8.06 years), and the proportion of occult CNV (85.7% versus 55.3%, p = 0.375) was higher in the non-responder group, although there was no significant difference compared with that of the responder group. The PED size of the non-responder group (4.42 1.56 ) was significantly larger than that of the responder group (1.51 2.33 , p = 0.001). Conclusions: The authors report a group of patients in AMD with poor treatment response to IVB. The PED size of the non-responder group was confirmed to be significantly larger than that of the responder group.

Subretinal Hemorrhages Associated with Age-Related Macular Degeneration in Patients Receiving Anticoagulation or Antiplatelet Therapy

To evaluate the incidence of and risk factors for subretinal hemorrhages in age-related macular degeneration (AMD) patients on anticoagulation or antiplatelet therapy. Retrospective, observational case series. We retrospectively reviewed the medical and photographic records of 71 consecutive patients who sought treatment at our institution with acute subretinal hemorrhages complicating age-related macular degeneration. The size of the subretinal hemorrhage was measured in standardized Macular Photocoagulation Study disc areas. Data on the use of medications and medical indications for anticoagulation and antiplatelet therapy were obtained. Overall, patients receiving antithrombotic therapy had a significantly larger subretinal hemorrhage size (mean, 9.71 disc areas) than patients not receiving anticoagulant or antiplatelet therapy (mean, 2.99 disc areas). Subgroup analysis revealed that both antiplatelet (P < .0001) and anticoagulant therapy (P = .003) were associated with a significantly larger bleeding size. Moreover, subgroup analysis among patients with arterial hypertension revealed that individuals receiving antithrombotic therapy had a statistically significantly larger hemorrhage size than hypertensive patients who did not receive anticoagulants or antiplatelet agents (P < .0001). Our results indicate that anticoagulants and antiplatelet agents are strongly associated with the development of large subretinal hemorrhages in AMD patients. Moreover, arterial hypertension is a strong risk factor for large subretinal hemorrhages in AMD patients receiving anticoagulants or antiplatelet agents. Physicians should be aware of an increased risk of extensive subretinal hemorrhage in AMD patients when deciding on the initiation and duration of anticoagulant and antiplatelet therapy.

Letters to the Editor

21 November 2008 Dear Editor, NEONATAL TESTICULAR TORSION OR NOT? Neonatal adrenal haemorrhage commonly manifests with anaemia, jaundice, vomiting and abdominal mass. It may be diagnosed incidentally if the haemorrhage is not significant. Neonatal adrenal haemorrhage can present as scrotal discoloration and swelling mimicking acute scrotum. Awareness of this clinical association helps in avoiding unnecessary neonatal scrotal exploration. Baby B presented on the 11th day of life with scrotal swelling and discoloration. He was a full-term male baby weighing 3485 g, born of normal vaginal delivery with a short duration of labour due to rapid second stage. He developed jaundice on the second day of life. His unconjugated bilirubin was 383 µmol/L. His jaundice was unresponsive to phototherapy, and his gamma-glutamyl transferase levels were 806 IU/L. Hepatitis and Coomb's serology was negative. He was noted to have a right scrotal mass and scrotal discoloration on the right side. The whole testis felt to be enlarged and firm with an odd shape. There were no abdominal masses palpable. The differentials considered were perinatal torsion and testicular tumour. He was otherwise well, tolerating feeds without vomiting. Work-up for jaundice revealed reticulocytosis and falling haemoglobin (167–155 g/L) and haematocrit (0.486–0.448 L/L) over 3 days. This prompted us to look for an intra-abdominal bleed as cause of jaundice and scrotal swelling. He had a scrotal and abdominal ultrasound that revealed a scrotal haematoma and an avascular right adrenal mass suggestive of adrenal haemorrhage (Fig. 1). The testis was normal. Laboratory tests for urinary catecholamines were within normal limits. Ultrasound showing 4-cm adrenal mass with central necrosis. The patient was managed conservatively with a plan to monitor the mass with regular ultrasounds. Follow-up ultrasound showed decrease in the size of the adrenal haemorrhage with liquefaction. In 12 weeks time, the mass was only 1 cm in size (from the initial size of 4 cm) (Fig. 2). Follow-up ultrasound showing decrease in size from the initial scan. Neonatal adrenal haemorrhage occurs in about 0.2% of neonates.1 It is associated with hypoxia, birth trauma, but is also known to be spontaneous. Adrenal haemorrhages are more common in males and on the right side. Clinical features depend on the amount of bleeding. The common presentation is anaemia, jaundice, abdominal distension and abdominal mass. It can be an incidental finding in asymptomatic babies.1 Twenty-two cases of scrotal haematoma as an association with adrenal haemorrhage have been reported in the literature. Nine (41%) have had surgical scrotal exploration to exclude torsion as it may be difficult to feel the testis separate from the scrotal haematoma or haemorrhage could have tracked down a patent processus around the testis. The reason for delayed presentation in our case could be time taken to track down the retroperitoneum. The rest of the cases had non-surgical management after further evaluation.2 One of the cases reported in the literature developed disseminated intravascular coagulation after having an unnecessary scrotal exploration. It was detected to have adrenal haemorrhage by a post-operative abdominal ultrasound scan.3 It is emphasised that an awareness of the condition and a scrotal/abdominal ultrasound helps make the diagnosis and prevent an unnecessary operation. This association should be kept in mind in the clinical scenario of neonatal anaemia, jaundice and acute discoloured scrotum (scrotal haematoma). On rare occasions, computed tomography may be needed to confirm the diagnosis.4

Bleeding in the brain: Amyloid-beta may keep clots away.

Bleeding in the brain: Amyloid-beta may keep clots away.

Tumor-mimicking primary angiitis of the central nervous system: initial and follow-up MR features

Primary angiitis of the central nervous system (PACNS) is an extremely rare vasculitis of unknown etiology. The purpose of this study was to describe the initial and follow-up magnetic resonance (MR) imaging features of the tumor-mimicking PACNS. We retrospectively reviewed a total of 21 initial and follow-up brain MR images obtained in four patients with biopsy-proven PACNS mimicking brain tumor on MR images during the periods from 1 to 8.1 years. In the initial study, diffusion-weighted imaging (DWI; n = 4), MR angiogram (n = 4), conventional catheter angiogram (n = 3), perfusion MR (n = 1), and computed tomography (n = 1) and proton MR spectroscopy (MRS; n = 2) were included. The lesions of the brain were qualitatively assessed in terms of location, number, size, shape, signal intensity, absence or presence of hemorrhage, enhancement pattern, and changes on the follow-up studies. Initially, the lesion manifested as single suprasellar (n = 1) and frontal hemispheric (n = 1) mass and as multiple-enhancing lesions in the unilateral supratentorial hemisphere (n = 2). A patient showed steno-occlusive lesions in the internal carotid and middle cerebral arteries. DWI, perfusion imaging, and MRS revealed inconsistent findings among the patients. On the follow-up studies, a patient had two relapses but there was either significant decrease in size and extent or disappearance of the lesions with immunosuppressive therapy in all patients. Tumor-mimicking PACNS shows variable features on initial MR images but shows good responses to appropriate immunosuppressive therapy on follow-up MR images.

Active extravasation of the abdomen and pelvis in trauma using 64MDCT

The objective of this study was to determine the clinical and management implications of the finding of active extravasation in blunt or penetrating trauma patients evaluated with abdomino-pelvic computed tomography (CT) using 64MDCT technology. This HIPAA compliant, retrospective study was IRB-approved, and the need for consent was waived. All adult patients scanned with 64MDCT who sustained blunt or penetrating abdomino-pelvic trauma and had findings of active extravasation at our Level I trauma center during a 30-month period were included. Two radiologists reviewed all abdomino-pelvic CT scans and characterized the active hemorrhage by location, extent, and attenuation on all available phases of imaging. Subsequent therapy and disposition were determined by reviewing the patients' medical records. The relationship between the location of a source of extravasation and subsequent clinical outcome was evaluated using Fischer's exact test. The relationship between the size and attenuation of the active hemorrhage and patient outcome were compared using the Wilcoxon rank sum test. One hundred and twenty-five patients with active extravasation were included. Patients with solid organ or pelvic injuries that were managed conservatively or had a negative digital subtraction angiogram had statistically significant smaller areas of active extravasation when compared to those that required intervention or died. When the attenuation values of extravasation are normalized to the intravascular attenuation achieved after intravenous contrast injection, no significant differences were seen based on subsequent clinical outcome. Based on location, those patients with solid organ, gastrointestinal/mesenteric, and pelvic sources of bleeding showed statistically significant higher likelihood of requiring subsequent intervention or dying, compared with those patients with subcutaneous, intramuscular, or retroperitoneal sources of active extravasation who were more likely to be managed conservatively (p < 0.0001, p = 0.005, p = 0.006, respectively). In blunt and penetrating trauma patients evaluated using 64MDCT technology, the location and size of the region of active extravasation are predictive of the type of subsequent clinical management. Normalized attenuation values of the active extravasation, however, are not predictive of subsequent management.

Apolipoprotein E Modifies Neurological Outcome by Affecting Cerebral Edema but not Hematoma Size after Intracerebral Hemorrhage in Humans

To address the mechanisms by which apoE polymorphism affects functional outcome after intracerebral hemorrhage in humans, we tested the hypothesis that the presence of the APOE4 allele results in amplified inflammatory responses and increased cerebral edema. We prospectively enrolled and collected data on 21 adult patients consecutively admitted to Duke University Hospital with supratentorial intracerebral hematoma including hemorrhage volume, midline shift, modified Rankin Score, Glasgow Outcome Score, and APOE genotype. Hemorrhage size (cm(3)) and midline shift (mm), at the level of the thalamus, were measured by computed tomography within 36 hours of admission. Rankin and Glasgow Scores were determined at discharge. Student's t-test was used to analyze hemorrhage size, midline shift, and Glasgow Outcome Score and logistical regression were used to measure allele affect on modified Rankin Score. When analyzing modified Rankin Score, patients were grouped by favorable outcome (0-2) or unfavorable (3-6). Out of 21 patients, 11 possessed at least 1 APOE4 allele (APOE4+). There was no difference in hemorrhage volume (25.8 v 38.3 mm for APOE4- v APOE4+, respectively) between the groups, but there was a significant difference in midline shift (P = .04, 0.7 v 4 mm). Functional outcomes were worse for the patients possessing at least 1 APOE4 allele (P = .04) The presence of APOE4 is associated with poor functional outcomes in humans after intracerebral hemorrhage. Our data suggest that the mechanism for this may be increased cerebral edema and not larger hematoma volume.

The clinical study of prevention and cure local hemorrhage with compound prescribe 37 spread after low molecular weight heparin subcutaneous Injection

Objective To resolve subcutaneous hemorrhage, extravasated blood, causing a patient pain and sufferings, spirit strain, aggravate mental state burden after injecting the low molecular weight beparin (LM-WH) . Methods The patients who received LMWH for 14 times were selected. Each patient's 14 times of subcu-tanenus injection were randomized into 4 groups. 1 ～ 3 groups all adopt compound prescribe 37 spread pressing pin-prick after injecting, pressing time for a minute, 2 minutes, 3 minutes. 4 set adopts common cotton label to press for 3 minutes. The incidence and the size of subcutaneous hemorrhage were measured. The size of subcutaneous hemorrhage witch is larger than 2 cm × 2 cm is divided into treatment group and matched control group random-ly. The treatment group uses compound prescribe 37 spread external application. The matched control groups adopts a natural dissipation toothed. Results With regard to beth the incidence and the size of subcutaneous hemorrhage , there was no significantly difference inl, 2 , 3 group and there was significantly difference between 1～3 group and 4 group (x2 = 17. 67, P＜0. 01) . Compare with the matched control group , the absorption of subcutaneous hemorrhage are significantly difference (P ＜ 0. 05) in the treatment set. Conclusion Compound prescribe 37 spread can effectively reduce the incidence and the size of hemorrhage resulted from subcutaneous injection of LM-WH. Key words: Sanqiereha spread; Subcutaneous injection; Low molecular weight heparin; Subcutaneous hemorrhage

Pharmacogenomic Effects of Apolipoprotein E on Intracerebral Hemorrhage

The purpose of the study was to evaluate the effect of APOE genotype and the feasibility of administering an apolipoprotein E-mimetic therapeutic to modify outcomes in a murine model of intracerebral hemorrhage. Intracerebral hemorrhage was induced via stereotactic injection of 0.1 U Clostridial collagenase into the left basal ganglia of wild-type and apolipoprotein-E targeted-replacement mice, consisting of either homozygous 3/3 or 4/4 genotypes. Animals were randomized to receive either vehicle or apolipoprotein E-mimetic peptide. Outcomes included functional neurological tests (21-point neuroseverity score and Rotorod latency) over the initial 7 days after injury, radiographic and histological hemorrhage size at 3 and 7 days, brain water content for cerebral edema at 24 hours, and quantitative polymerase chain reaction for inflammatory markers at 6, 24, and 48 hours. Apolipoprotein-E targeted-replacement mice consisting of homozygous 3/3 demonstrated superior neuroseverity scores and Rotorod latencies over the first 3 days after intracerebral hemorrhage, decreased cerebral edema at 24 hours, and reduced upregulation of IL-6 and endothelial nitric oxide synthase at 6 hours when compared to their apolipoprotein-E targeted-replacement mice consisting of homozygous 4/4 counterparts. After intravenous administration of 1 mg/kg apolipoprotein E-mimetic peptide, both wild-type and apolipoprotein-E targeted-replacement mice consisting of homozygous 4/4 exhibited improved functional outcomes over 7 days after intracerebral hemorrhage, less edema at 24 hours, and reduced upregulation of IL-6 and endothelial nitric oxide synthase when compared to mice that did not receive the peptide. Our data indicate that APOE genotype influences neurological outcome after intracerebral hemorrhage in a murine model. In particular APOE4 is associated with poor functional outcome and increased cerebral edema. Additionally, this outcome can be modified by the addition of an apolipoprotein E mimetic-peptide, COG1410.