A number of intracranial aneurysms complicating polycystic kidney disease (PKD) have been reported; however they include only 29 domestic cases. Cerebral hemorrhage with PKD is also not rare. PKD is considered a hereditary malformation with autosomal dominant transmission. Recently we had two cases of intracranial hemorrhage that were coincidentally associated PKD. One patient had an aneurysmal subarachnoid hemorrhage. In the other case, although no aneurysm was detected by four-vessel angiography, the patient had three cerebral hemorrhages. The third hemorrhage resulted in death in spite of successful control of the blood pressure. The coexistence of intracranial hemorrhage and PKD could be due to blood vessel fragility caused by collagen disease and connective tissue diseases. Furthermore hypertension due to PKD could become an accepted risk factor for arteriolar changes besides those congenital disorders of the blood vessels. Adequate treatment of hypertension as well as detecting cerebrovascular disorders could be the most beneficial medical approach for patients with PKD.
A 22-year-old man sustained burn injuries over the face, bilateral upper extremities and the upper chest wall (35% as burned surface area) during toluene sniffing in a closed space. Facial burns and singed nasal hair were observed on admission. He was conscious and complained of dyspnea. Bronchoscopy revealed soot and a pale mucosa of the trachea and the bronchi as well. On the 3rd day after the injury, the PaCO2 level had increased. Repeated suctioning and irrigation were necessary to remove a tenacious secretion mixed with soot, coagula, and tissue debris. On the 10th day, under bronchoscopic visualization, congestion of the tracheal wall, and denuded cartilage were observed in some places, and bronchial lumens distal to the carina were partially obstructed by tissue debris. It became more difficult for the patient to eliminate carbon dioxide (PaCO2 60∼70mmHg), while the oxygenation property of the lungs was still maintained (PaO2/FIO2 200∼400). The peak inspiratory pressure was as high as 60∼70cmH2O. Pulmonary infection made adequate ventilation more difficult. Ultimately, pneumothorax due to barotrauma occurred and the patient died because of respiratory insufficiency accompanying pyothorax. This single case is worth reporting because the pulmonary parenchyma was spared burn injury evidenced by the maintenance of oxygenation, while the major bronchi and proximal bronchioli sustained severe burn injuries, ultimately leading to bronchial obstruction with difficulty in CO2 elimination.
Recently, we applied digital subtraction angiography in peripheral veins (ivDSA) in 2 cases of severe electrical injury of the extremities in early stages. In these early stages, occlusion, tapering, wall irregularities, and stenosis could be seen in the main arteries. Also, we found collateral blood vessels from the main artery and arterial network defect that could not be clearly depicted with the usual angiograms. Tissues in the defective portions of the collateral blood vessels and arterial network were necrotic. IvDSA also revealed aneurysm formation which was histopathologically confirmed as a pseudoaneurysm from the torn elastic fibers of the tunica media. In a non-invasive manner and without special maneuvering, ivDSA can be performed frequently to examine blood vessel lesions and blood flow impairment in severe electrical injury of the extremities. This method is useful especially for estimating necrotic lesions from an early stage and investigating aneurysm formation.