Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown.(ABSTRACT TRUNCATED AT 250 WORDS)

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We studied the relations of age, sex, hypertension, alcohol consumption, liver dysfunction, and thrombocyte count to the volume of the hematoma in 141 patients with spontaneous putaminal hemorrhage. Hematomas were significantly larger in men, regular alcohol consumers, those with liver dysfunction, and those with low platelet counts. Our findings reflect the fact that almost all of the alcohol consumers were men, most of them had liver disorders, and the volume of hematoma in such patients was relatively large. (Stroke 1988; 19:987-990) S everal authors have pointed out the correlation between spontaneous intracerebral hemorrhage and liver dysfunction. 1 -3 We have also reported 4 that among men with cerebral hemorrhage, many had abnormal liver functions due to excessive alcohol use. As a result, the men had significantly lower platelet counts and serum fibrinogen concentrations, factors that may have contributed to a condition in which hemorrhage is likely to occur.These considerations led us to hypothesize that patients with liver disorders, specifically those with deficits in the mechanisms of hemostasis, may have hematomas of unusually large size due to the fact that, once bleeding begins, hemostasis does not easily occur. To test this hypothesis, we studied 141 patients with putaminal hemorrhage who came to our clinic over 3 years. We studied these patients with regard to the relations of age, sex, presence of hypertension, alcohol consumption, liver dysfunction, and thrombocytopenia to the volume of the putaminal hemorrhage. Our predictions were confirmed. Subjects and MethodsBetween January 1984 and December 1986, we examined 189 patients with spontaneous putaminal hemorrhage in whom diagnoses of vascular anomaly, such as cerebral aneurysm, arteriovenous malformation, or moyamoya disease, were excluded on the basis of cerebral angiography. There were 141 patients (98 men and 43 women) admitted ^24From the Division of Neurosurgery, Institute of Brain Diseases, Tohoku University School of Medicine, Sendai, Japan.Address for reprints: Hiroshi Niizuma, MD, Division of Neurosurgery, Institute of Brain Diseases, Tohoku University School of Medicine, Seiryo-cho 1-1, Sendai, Japan 980.Received January 25, 1988; accepted March 24, 1988. hours after the onset of symptoms and on whom computed tomography (CT scans), platelet counts, and examinations of liver functions (glutamic oxaloacetic transaminase [GOT], glutamic pyruvic transaminase [GPT], gamma-glutamyl transpeptidase [y-GTP], and y-globulin fractions) were carried out. The men ranged in age from 30 to 84 (mean±SD 53.5 ±11.5) years and the women from 41 to 77 (mean±SD 59.2 ±8.0) years. A history of hypertension was found in 73 men (74%) and 35 women (81%). Histories of liver or gall bladder disorders were found in seven men (three had had acute viral hepatitis, two chronic hepatitis, one liver cirrhosis, and one Weil's disease) and two women (with cholelithiasis). There were, in addition, three cases of renal failure (one of whom had severe anemia and a pro...

Thirty-five consecutive patients with ventricular septal defect (VSD) associated with aortic insufficiency (AI) who underwent corrective surgery are presented. There were seven operative and three late deaths among the patients operated upon before 1968. No death, however, was encountered among the most recent 18 consecutive patients. The VSD was closed directly in 14 patients and with a Teflon patch in 21. The aortic valve was repaired in 16 patients, replaced in eight, and no interference was indicated in 11. They were classified from the surgical viewpoint according to the location of the VSD, the anatomic type of the right ventricular outflow tract, and the severity of the aortic herniation as follows: type Ia, supracristal VSD and AI without aortic cusp herniation; type lb, supracristal VSD and AI with aortic cusp herniation and conal muscular rim beneath the pulmonic valve; type Ic, supracristal VSD and AI with aortic cusp herniation without conal muscular rim beneath the pulmonic valve; type IIa, infracristal VSD and AI without aortic cusp herniation; type IIb, infracristal VSD and AI with aortic cusp herniation; type III, infracristal VSD and AI with infundibular pulmonic stenosis (PS); type IV, supracristal VSD and AI with infundibular PS. In type Ia and IIa, VSD was closed directly and the aortic valve was replaced. In most of type Ib, VSD was closed directly and no direct procedure was performed upon the aortic valve. In most of type Ic, VSD was closed with a Teflon patch and the aortic valve was repaired. In type IIb, VSD was closed with a Teflon patch and the procedure upon the aortic valve was not uniform. In type III, VSD was closed with a Teflon patch and the aortic valve was repaired in most of them. In type IV, VSD was closed with a Teflon patch and no direct procedure was performed upon the aortic valve. The basic policy for repair of this association of anomalies is selected according to the above mentioned anatomic classification.

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