The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter.

ABSTRACT:Background:P53 expression and increased MIB-1 proliferation index have been shown to correlate with invasive behavior in pituitary adenomas. The purpose of this study was to determine whether these indices could be used to predict a higher likelihood of recurrence in clinically nonfunctional pituitary adenomas and thus guide adjuvant therapy.Methods:Fifty-one clinically nonfunctional pituitary adenomas were selected from the database at the Vancouver Hospital and Health Sciences Center between the years 1990-1998. Included were 32 nonrecurrent and 19 recurrent adenomas.Results:The mean initial labelling index for p53 in nonrecurrent tumours was 0.38% (0-1.58%), while it was 0.46% (0-3.65%) for recurrent adenomas. The mean initial MIB-1 index for nonrecurrent tumours was 1.63% (0.08-9.36%), while for recurrent tumours it was 1.92% (0-7.76%). The percentage of p53 positive adenomas was 66% for nonrecurrent tumours and 68% for recurrent tumours. None of the differences in the labelling indices between the recurrent and nonrecurrent groups was statistically significant. As 12 patients (38%) in the nonrecurrent group had undergone radiotherapy as initial adjuvant therapy after surgery and none of the recurrent group had done so, patients who did not receive radiotherapy in the nonrecurrent group were analyzed separately. Again, none of the differences in the labelling indices between the recurrent and nonrecurrent groups was statistically significant when the effect of radiotherapy was removed from the analysis.Conclusions:The results demonstrate no statistical difference in the p53 or MIB-1 labelling indices between recurrent and nonrecurrent nonfunctional pituitary adenomas. Concern should be raised in attaching too much clinical significance to these labelling indices, especially with respect to p53 as a predictor of the clinical behavior of nonfunctional pituitary adenomas.

Subdural hematomas (SDH) from ruptured aneurysm (RA) are much less common than intracerebral (ICH) hematomas or subarachnoid (SAH) or intraventricular hemorrhage (IVH). With computerized tomography, preoperative diagnosis is now made more often. The authors have collected 18 such cases from a review of 897 cases of RA admitted to eleven medical centers in 1980 and 1981. Nine (50%) of these patients died prior to discharge from hospital. Four (22%) had surgery and died postoperatively and 9 (50%) were operated upon and survived. Thirteen (72%) of the patients showed anisocoria, decreased consciousness and unilateral weakness prior to surgery. Eight (89%) of the fatalities had shown preoperative herniation as opposed to only 5 (56%) of the survivors. The overall incidence of delayed ischemia due to vasospasm was 11% (2 cases). Those who died had greater midline shift and larger SDH on the admission CT scan. Sixteen (89%) of these patients were female. Thirteen (72%) had ruptured aneurysms on the internal carotid artery. All of these hematomas were unilateral and uniformly hyperdense, and the convexity hematomas were crescentic in shape. Seventeen (94%) had evidence of blood in locations other than the subdural space. If the patient is potentially salvageable and has a midline shift, the SDH should probably be evacuated immediately and the aneurysm clipped at the same operation since the development of a tentorial herniation has such an adverse effect on outcome. RESUME: A la suite de la rupture d'un an6vrysme, I'hdmatome sous-dural est beaucoup moins frequent que 1'hematome intracerebral ou l'h6morragie sous-arachnoidienne. La tomodensitom&rie en permet plus frdquemment le diagnostic pr6-op£ratoire. Le auteurs ont collige" dix-huit de ces cas apres revision de 897 cas d'an£vrysmes ruptures admis dans onze centres m6dicaux en 1980 et 1981. Neuf (50%) de ces patients dec6derent avant leur conge" de I'hdpital. Quatre (22%) avaient ixi trails chirurgicalement et moururent dans la periode post-ope>atoire. Neuf (50%) furent operas et survdcurent. Treize (72%) des patients pr6senterent une anisocorie, une diminution de l'6tat de conscience et une faibiesse unilat6rale avant la chirurgie. Chez huit (89%) de ces patients d£c6des, on avait trouv6 une engagement cerebral, alors que ceci se pr6senta seulement dans cinq (56%) des survivants. L'incidence globale de l'ischemie tardive secondaire au vasospasme fut de 11% (2 cas). Ceux qui moururent avaient un plus grand defacement de la ligne mddiane et un HSD plus volumineux sur la tomodensitom6trie a l'admission. Seize (89%) de ces patients etaient des femmes. Treize (72%) £taient porteurs d'un an£vrysme rupture" de la carotide interne. Tous ces h^matomes Etaient unilateYaux et d'une hyperdensite homogene et les h^matomes de la convexite avaient une forme de croissant. Chex dix-sept (94%), on d£cela la presence de sang dans d'autres sites que l'espace sous-dural. Si le patient est potentiellement r£cuperable et a un defacement de la ligne mediane, l'HSD devrait probab...