A clinical study of high-dose urokinase for the treatment of the patients with hypertension induced ventricular hemorrhage

OBJECTIVE

This study discusses the therapeutic effect of high-dose urokinase treatment for hypertension ventricular hemorrhage.

METHODS

A total of 60 patients with hypertension ventricular hemorrhage were randomly assigned to two groups: treatment group (n=30) and control group (n=30). Both groups received bilateral external ventricular drain. The treatment group was injected with 50,000IU urokinase to the lateral ventricle every day; the total injection volume per day was 100,000IU. The control group was injected with 20,000IU urokinase to the lateral ventricle every day with a total injection volume per day of 40,000IU. Lumbar puncture was performed in both groups after the later ventricular drain was removed to release cerebrospinal fluid (CSF). Head Computed tomography(CT) examination was performed regularly to observe changes in the ventricular hematoma as well as the occurrence of complications such as intracranial infection and hydrocephalus. Patient prognosis 6 weeks after surgery was compared between the two groups.

RESULTS

In the treatment group, the intraventricular hemorrhage clearance time and the number of instances of urokinase treatment were significantly less than those of the control group (P<0.05). The total urokinase dosage of the treatment group was significantly higher than that of the control group (P<0.05). With respect to post-surgery complications, in the treatment group, there were three cases of hydrocephalus and one case of intracranial infection. In the control group, there were four cases of hydrocephalus and three cases of intracranial infection. Intraventricular re-hemorrhage was not observed in either group. Intracranial infection was relieved after strengthened anti-infective therapy and continuous drainage. There was a statistically significant difference in the occurrence of complications between the treatment group and the control group (P<0.05). The rate of good prognosis in the treatment group was higher than that of the control group (P<0.05), and the inefficiency rate was lower (P<0.05).

CONCLUSIONS

High-dose urokinase treatment produces a significant therapeutic effect in hypertension ventricular hemorrhage. This treatment can quickly eliminate intraventricular hemorrhage, shorten the ventricular drain tube indwelling time, decrease the occurrence of intracranial infection, and increase the likelihood of a good prognosis.

A novel intelligent microcatheter-shaping method for embolization of intracranial aneurysm

Objective:

This study proposed and validated an intelligent microcatheter-shaping algorithm for interventional embolization of intracranial aneurysms.

Methods:

A stepwise microcatheter simulation algorithm constrained by a vessel center line was developed based on the geometry of aneurysms and parent arteries, and a collision correction factor of vessel walls was introduced to automatically calculate the optimal microcatheter path and tip shape. The efficacy of this intelligent shaping method was verified in an in vitro aneurysm model experiment.

Results:

The microcatheter path can be automatically generated using the intelligent microcatheter-shaping algorithm. Furthermore, the experiment verified that the delivery performance of an intelligently shaped microcatheter was excellent with 100% placement accuracy, superior to that of three pre-shaped microcatheters: straight (0°), 45°, and 90°. In three typical cases, the microcatheter could not be placed in the aneurysms successfully within 5 min with the aid of a microwire using a manual shaping scheme; however, it can be placed in the aneurysms successfully within 5 min using an intelligent microcatheter- shaping scheme, and the time of microcatheter placement in aneurysms was short.

Conclusion:

This intelligent microcatheter-shaping algorithm based on three-dimensional image data is effective and reasonable. This approach has advantages over standard pre-shaped microcatheters, with a potential clinical application value.

Red blood cell distribution width and mortality of spontaneous intracerebral hemorrhage patients

OBJECTIVES

Two studies have found an association between hematoma expansion and red blood cell distribution width (RDW) in the diagnosis of spontaneous intracerebral hemorrhage (SIH); however, its association with SIH mortality has been not reported. Thus, the objectives of this study were to determine whether RDW in patients with SIH could be associated with mortality and could be used as mortality biomarker.

PATIENTS AND METHODS

Observational and prospective study of patients with severe supratentorial SIH (Glasgow Coma Scale < 9) from Intensive Care Units of 6 Spanish hospitals. RDW was recorded at days 1, 4 and 8 of SIH. Thirty-day mortality was considered the end-point study.

RESULTS

Non-surviving patients (n = 54) compared to surviving patients (n = 63) had higher RDW (p ≤ 0.001) at days 1, 4 and 8 of SIH. The area under curve (95 % confidence interval) to predict 30-day mortality by RDW at days 1, 4, and 8 of SIH was 0.87 (0.79-0.92; p < 0.001), 0.74 (0.64-0.83; p < 0.001) and 0.79 (0.68-0.87; p < 0.001) respectively. In the regression analysis an association between RDW and 30-day mortality was found controlling for early evacuation of SIH, midline shift, ICH score and glycemia (Odds ratio = 1.159; 95 % CI = 1.046-1.284; p = 0.005).

CONCLUSIONS

The higher RDW during the first week of SIH in non-surviving than in surviving patients, and the potential role of RDW at any time during the first week as mortality biomarker are the main novelties of our study.