Disseminated intravascular coagulation (DIC) may play an important role in producing symptoms in many diseases. We operated 72 consecutive patients with cerebrovascular disorders for the past 3 years and 2 cases out of them developed DIC after STA-MCA by-pass surgery. Case 1. This 53-year-old woman with 3 times previous TIA episodes in the past 5 years suddenly developed right hemiparesis. Arteriogram showed a narrowing of branches of the It-MCA. Two days after STA-MCA anastomosis, blood pressure rose progressively to more than 200mm Hg and bleeding diathesis appeared. Wound exploration disclosed subcortical intracerebral hematoma in the temporal lobe. The site of anastomosis was intact and arteries were all patent. The laboratory data indicated an existence of DIC for more several days. Case 2. This 62-year-old man suddenly suffered from right hemiparesis. Arteriogram revealed irregularity and stenosis of the wall of internal carotid artery and branches of It-MCA. The STA-MCA anastomosis was performed. He was uneventful immediately after the surgery, but 6 hours later massive bleeding was suddenly noted in the epidural drain. Only a small subgaleal hematoma was found by wound exploration. Platelet count was noted gradually decreased by repeated tests on the same day, and also other laboratory data indicated a status of DIC. The patient died 3 days after the surgery. First case developed Colitis ulcerosa 14 days after a by-pass surgery. But in the second case, no other basic disorders were noted. Although an etiology of DIC has still been controversial, we suppose that cerebral ischemic lesion per se could be an etiologic factor in DIC.

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We conducted a prognostic study of 78 cases with hemifacial spasm by questionaire from January to June, 1980. On the avarage 11.5 years had passed since consultation with a physician. There were 44 respondents, the response rate being 56.4 percent. Excluding 2 deceased, the results obtained from 42 cases were compared mainly with the reports of Ehni and Wakasugi. There were 29 female cases (69.0%) and 13 male cases (31.0%). As to the age at onset, the disease started from the age of 20 on but developed most frequently in their 20s-50s. Aggravation of symptoms due to psychological stress was seen in many of the cases. Three cases (7.0%) showed a family history of facial spasm. According to the clinical course after medical treatment, 7 cases became worsen (15.9%), 10 remained unchanged (22.7%), 20 improved (45.5%), 5 remitted (11.4%) and 2 died (4.5%), which was nearly in agreement with the results of Ehni. As to the treatment, pharmacotherapy led to improvement in symptoms in about half of the cases but the duration of effectiveness was not satisfactory. As for fifteen cases which had been under facial nerve block, all but one case showed recurrence of the symptoms within three years. Psychological factors were concerned with the clinical course of this disease. In the treatment, therefore, it appeared necessary to give enough consideration to the psychosomatic aspect.

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We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary ab­normalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16 – 93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean GCS on admission was 4.4 (range 3 – 9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21 – 50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma.

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We treated a rare case of coxa vara with pseudoarthrosis of the femoral neck resulting from septic arthritis of the hip at birth. The patient had been treated at another medical center, and was referred to our hospital because pathological dislocation was suspected. We performed valgus femoral osteotomy when he was two years old. The hip remained stable and the development of the femoral head was good, but coxa vara and leg length discrepancy progressed.

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Self-retaining retractors are indispensable in the modern aneurysm surgery. It is, however, well known that these spatulas sometimes deliver focal ischemic brain damage. Much attention should, therefore, be paid to control the pressure of brain spatula during retraction in order to avoid resultant focal deficit. Ninety-four patients with ruptured aneurysm were closely examined by CT scans pre and postoperatively on the presence of focal ischemic brain damage. In 77 patients out of 94 of the early series of the surgery, the duration of the retraction by a spatula was not restricted and was variable depending on the condition of the brain cortex. In 17 patients of the late series, a brain spatula was applied rep eatedly with a duration of less than 5 minutes with more than 2 minutes intervals. Pre and postoperative CT scans in both series were shown in the following table.
Positive CT scan findings indicating focal ischemic damage
Early series 14/77 cases (18. 2%)
Late series 2/17 cases (11. 8%)
There are some reports concerning the relationship between the pressure of brain retractor and the focal brain ischemia. In an experimental work using a rat brain, r-CBF under the brain retractor pressure of 30 mmHg for 30 minutes decreased to 0-40 ml/100 g/min. Another experimental study using an awake monkey demonstrated that r-CBF below 23 ml/100 g/min produced a transient focal paralysis and r-CBF below 18ml/100 g/min generated more profound neurological deficits.
The authors supposed that the decrease in r-CBF was caused not only by capillary compression, but also by stasis of the cortical arteries and their penetrating arterioles after cortical compression by a brain spatula and that our results of the surgery with an intermittent brain compression method revealed favorable outcome in the condition of the brain after aneurysm surgery.

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