In this study, GCS less than 8 is a pure risk factor unfavorable outcome in patients with post-trepanation EDH hematoma evacuation. Most patients with unfavorable outcome in this study came with low GCS (82.4%), suggesting that unfavorable outcomes in patients EDH show more likely to be influenced by severe primary brain injury, it is reflected by the low GCS. These conclusions were consistent with studies McKissock, which states that the GCS is the most important determinant factor in assessing prognosis of patients with EDH. Low GCS associated with unfavorable outcomes also found in many studies. 5,6,7,8,9,10,11,12,13,14,15
The results for our series of 12 patients show a trend toward improvement in GCS after treatment with minimally invasive intraparenchymal clot evacuation and drain placement at the bedside; although, it did not reach statistical significance. There was a reduction in clot size after treatment, which was statistically significant. In addition, a single case of re‑bleeding was noted and 2 cases of catheter placement that required repositioning. These, however, did not affect the reduction in clot size posttreatment nor result in a drop in mental status. In addition, the 30‑day mortality actually observed in our patients was lower than that estimated using ICH score. Based on our experience this procedure can be safely performed at the bedside. The use of electromagnetic emitter or other frameless stereotaxy may be beneficial
Background: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty‑five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty‑one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre‑operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.
To our best of knowledge till date no previous case has been reported regarding evacuation of ASDH concomitantly with EDH in large ventricular septal defect patient through conventional craniotomy under local anesthesia. This case embraces a significant character as craniotomy for subdural and extradural hematoma is a common procedure under general anesthesia is common practice but for subdural hematoma associated with ventricular septal defect, craniotomy is not yet reported under local anesthesia.
53 patients with traumatic acute subdural hematoma were operated upon. We performed hematoma evacuation and decompressive craniotomy in all patients. The removed bone was placed subcutaneously in the abdomen. We had 39 (73.5%) males and 14 (26.5%) females (Table 1). Age ranged between 7 and 65 years old with mean 35.3 (Table 2). Outcome was evaluated based on Glasgow outcome score (GOS); 23 deaths (43.4%), 10 persistent vegetative (18.87%) state, 10 severe disability (18.87%), 8 moderate disability (15.1%) and 2 good recovery (3.76%) (Chart 1). On admission GCS ranged between 4 and 11.Regards time lag between onset of trauma and performed surgery, it was ranged between 3 hours and 18 hours (Table 3 and Table 4).
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selected when the route provided the shortest distance between the cortical surface and the hematoma on the preoperative CT scan. A transparent plastic sheath (10 mm in outer diameter; Weike Company, Changzhou, Jiangsu, China) was inserted into the clot via a bur hole in the skull. A 4 mm 0 ° rod lens endoscope (HOPKINS II; Karl Storz Company, Tuttlingen, Germany) was introduced into the sheath to provide illumina- tion and visualization during hematoma evacuation. All of the blood clot that could be observed during an operation was evacuated using an aspirator (20 cm in length, 1.5 mm in inner diameter, and 2.0 mm in outer diameter; Hujiang Company, Shanghai, China). Hemorrhagic spots were coagulated using a bipolar coagulator.
[27,28,31]. Therefore, administering MMP-9 antagonist to reduce its effect might be beneficial for protecting BBB from disruption [19,32]. However, MMP inhibition in spontaneous ICH has solely been made under experimen- tal conditions, and the basic research has yet to yield sig- nificant advancements for clinical practice. So, reducing the production of perihematomal MMP-9 by surgical procedures for hematoma evacuation might be a better option. Standard open craniotomy for clearance of intra- cerebral hematoma often causes damage to the uninjured brain tissue overlying the hematoma. Minimally invasive surgery combines the benefits of surgical clot removal with limited tissue damage and shorter surgery duration . In the present study, we prepared a rabbit model of ICH to observe the impact of performing the minimally invasive procedure at different stages on perihematomal MMP-9 and its correlation with BBB permeability. The results showed that perihematomal MMP-9 significantly decreased after surgery within different time windows for the evacuation of intracerebral hematoma as compared with the MC group. The quantity of perihematomal MMP-9 was different among the MI subgroups. It was lowest in the 6 h group, and increased gradually as the time window prolonged, reaching the highest level in the 48 h group. The decrease of MMP-9 level in the 6 h and 12 h subgroups was more significant compared to that of the other subgroups, suggesting that the MI procedures for evacuating intracerebral hematoma in early stages could significantly reduce the perihematomal MMP-9 content. The Evans blue content also deceased at each time point as compared with the MC subgroups, suggesting that the permeability of BBB were decreased corresponding to the decreased MMP-9.
The discouraging results of conventional hematoma evac- uation may be attributed to the type of surgical approach. While standard craniotomy is effective in hematoma evac- uation and maintenance of hemostasis, this approach fre- quently causes damage to uninjured brain over the hematoma. Minimally invasive surgical strategies have been designed to reduce this damage [9,15,18,19]. They include image-guided and frameless stereotactic procedures. These approaches are commonly combined with the use of thrombolytic agents and require more time for the preoperative preparation and hema- toma evacuation. In addition, the hemostasis is difficult. The endoscopic-assisted evacuation of ICHs is gaining a growing attention as a suitable minimally invasive alternative due to its effectiveness and possibility to evacuate the hematoma imme- diately and completely, with good hemostasis [5,20,15]. Here, we presented such surgical approach. There is no difference in the placement or size of a burr hole, and the principle of hematoma evacuation is similar as in craniotomy. For thor- ough visualization, an endoscope is used, and in our case, it was supplemented with a microscope. The use of easily acces- sible microscope is especially important in urgent cases, where emergency surgery is needed [5,20]. When an endoscope is not available, minimal craniotomy or burr hole is an appropri- ate selection. The aspiration of blood and hemostasis is pos- sible with the use of a microscope, providing a good control over the hematoma through the burr hole and corticotomy.
To the best of our knowledge this is the first RCT com- paring irrigation-fluid temperatures used during surgical evacuation of cSDH. Chronic subdural hematoma is an increasingly common condition affection older people, believed to be linked to demographic changes, extensive use of anticoagulants/anti-platelet therapy and easy access to radiological examination of the brain . The recurrence rate is rather high, with a need for RCTs in an effort to optimize treatment strategies in hope of re- ducing the recurrence rates. A possible variable influen- cing the recurrence rate is the temperature of the irrigation fluid used during hematoma evacuation, by affecting solubility of the hematoma and/or coagulation. To test this theory, the current study was initiated.
groups to enhance their orientation, visualization, and safety [9, 22]. One of the most important inventions was the transparent sheath that was used as a working chan- nel for neuroendoscope and surgical instruments [14, 18]. In 2000, Nihishara first reported this improvement , and it was widely adopted by many surgeons for endoscopic hematoma evacuation surgery [13, 15, 20, 22, 28–30]. Compared with a steel sheath, the transpar- ent sheath has the obvious advantage that the residual hematoma and hematoma-brain border can be easily identified through the transparent wall of the sheath (Additional file 1: Video 1). A deeper hematoma cavity can be clearly identified through the endoscope, which helps reduce bleeding and improve effectiveness and safety. This technique was first called neuroendoscopic control technology (NECT). In NECT, all the surgical in- struments were used outside of the endoscope, and the main role of the endoscope was illumination. This surgi- cal technique to remove the hematoma is effective, but several features, such as its non-visual implantation, lar- ger sheath diameter, and difficulty in removing hard hematomas, still have room for improvement. In this study, we improved the transparent sheath and devel- oped a hematoma smashing suction apparatus to achieve more minimally invasive removal of the hematoma.
On postoperative day 1, approximately 5 h after the second surgery, the primary nurse found that the size of the patient’ s left pupil gradually increased from 2.0 mm to 3.5 mm. An immediate brain CT scan revealed evidence of left-side DEH of the posterior cranial fossa (Fig. 4). Owing to mass effect of the DEH, a third surgery was offered. He underwent left posterior cranial fossa hematoma evacuation and decompressive craniect- omy. During the third surgery, it was determined that the DEH was caused by a ruptured transverse sinus. A brain CT following the third surgery was performed (Fig. 5). The patient recovered to a GCS of 7 within 40 days after surgery, and was transferred to the rehabilitation hospital. He was ultimately discharged from the rehabilitation hospital with a Glasgow Out- come Score of 4. He underwent cranioplasty 1 year later and has since recovered well.
In the MVP group via frontal tuber approach, a sub- stantial removal of intraventricular hematoma was achieved in all cases, the average evacuation rate of intraventricular hematoma reached 80.10 ± 10.16 %, the average time of catheter drainage was 3.17 ± 0.87 days, the average GOS was 3.80 ± 0.92, and no intracranial infection and secondary hemorrhage were observed following surgery in all cases. Shunt-dependent hydro- cephalus occurred in 2 cases. In the control group, the hematoma evacuation rate was an average of 21.21 ± 7.81 %, the time of drainage was an average of 7.63 ± 2.87 days, and the GOS was an average of 3.20 ± 1.12, intracranial infection after surgery occurred in 5 cases, secondary hemorrhage was observed in 1 case, and shunt-dependent hydrocephalus occurred in 8 cases. Be- tween two groups there were significantly statistical dif- ference in the hematoma evacuation rate, drainage duration, infection rate and GOS (all P < 0.05).
values for each curve. ‘d’ refers to a weekday scenario, ‘e’ to a weekend scenario. The number following ‘d’ or ‘e’ refers to the hour of the day (24 hr clock). A: Mean P V E and 95% conﬁdence intervals based on 500 simulations for the Febru- ary weekday 02:00 exposure scenario; B: Diurnal variation in evacuation time for February weekday and weekend scenarios; C: Seasonal variation in evacuation time for a weekend 12:00 scenario; D: Comparison of evacuation time curves for a February 02:00 scenario, with and without evacuation departure time; E: Com- parison of analysis with distributed travel speeds compared to ﬁxed speeds for a February 02:00 scenario; and F: The impact of applying a different probabilities that unimpaired adults and children run to evacuate. . . . . . . . . . . . . . . . . . 203 7.5 Minimum and maximum bounds of evacuation departure time, represented by
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Abstract— Goal of our project is the development of “indoor refuge system using mobile devices” that can provide evacuation route and information about a hazardous situation to users immediately and clearly. The aim of this study is the development of a design of the system with cognitive engineering approaches. The situation assumed is where the network system failed down; the Global Positioning System (GPS) and the compass function are unavailable; and guidance by building’s caretakers is limited. The targets of this empirical study are two: designing of an indicator for route guidance and a display to urge the user to follow the guidance. A QR code with arrow marks is proposed as the indicator for the guidance. A user is requested to follow an arrow of the same color displayed on the user’s mobile device. An experiment with participants shows that they could select the correct direction without difficulty, and that the appropriate size of the QR code is 35 cm by 35 cm. The second topic is about user’s trust in the guidance of the system. An experiment with participants was conducted to confirm the effectiveness of a display design describing details on the dangers, which are acquired by the network sensors. The result shows that the ratio of who followed the guided route was higher when they used the display than a display without the description. Through the studies, we acquired the practical knowledge about effective guidance methods, usage of information on hazardous situations, and user interface design to obtain user's trust in the guidance route.
The National Nuclear Crisis Management Agency needs to transform the crisis management paradigm and develop concepts, including signs of a nuclear attack, and preemptive, active and aggressive responses to prevent and minimize damage through alarms and radio waves, depending on the permanence of time and the infinite nature of measures, and the severity of responsibility. In other words, the Nuclear Crisis Management should identify preemptive preparedness and response measures for ensuring survival and preventing, mitigating and maintaining damage, and should coordinate and link various measures, including R. O. K-U.S. unified joint crisis management and decision-making steps, through SOP. They include the system of early alert-warning, evacuation to underground evacuation facilities, vertical and horizontal command control, protection of government facilities, and national crisis management plans. The establishment of an intelligent and smart integrated alert system should allow for transmission within 2minutes without alarm blind spots, and ensure continuity of situation propagation for control of damage, thus preventing damage from spreading. The role of control tower is important in order to prevent, mitigate and maintain nuclear explosion damage to response through an organized and systematic ways.
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To incorporate all of these properties we propose the following model (in discrete time-steps): The regions within the area to be evacuated and the zones within each region as well as the set of available shelters are known. For each of the zones, there is a latest notification time at which the evacuation order should be issued at latest. The violation of these target times will be the criterion when determining an optimal evacuation plan. Furthermore, the total number of evacuees in a zone (the demand) is known but, moreover, we know the response profile of the zone: the total demand is split into the number of people leaving directly after receiving the evacuation order, the number leaving one time step after that, two time steps delayed, etc. This profile is given independently for each zone. This allows to model the fact that usually an evacuee living closer to the waterside will leave earlier than somebody living more inland and we assume these values to be fixed (e.g. estimated due to evacuees’ behavior in earlier flooding situations).
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Soft tissue sarcoma accounts for about 1% of adult malignancy. It usually presents as a painless lump and can occur at any site over the whole body. Almost 45% of the soft tissue sarcoma appears adjacent to the long bone of the extremities, especially in the lower limb . However, few people know that soft tissue sarcoma occasionally accompanies large hematoma . In certain situation, soft tissue sarcoma may be initially misdiagnosed as deep intramuscular hematoma. Clinicians should be aware of the possibility of soft tissue sarcoma masquerading hematoma after trauma. MRI is a powerful tool for diagnosing soft tissue masses due to high contrast tissue resolution . It remains the gold standard to distinguish the soft tissue tumor from hematoma. The
A novel approach is proposed in this paper for personnel and vehicle iterative evacuation optimization to tackle crowd evacuation problem in emergency. The paper analyzes the mechanism to coordinate people flow evacuation with traffic stream evacuation, and explores optimization model from a personnel and vehicle coordination evacuation perspective. The evacuation is classified as two categories, namely evacuation with intervention and evacuation without intervention, which depends on whether intervention can be applied to path selection for evacuees. Scheduling scheme of evacuation vehicles is derived from improved ant colony algorithm, and then we integrate personnel evacuation simulation with micro traffic simulation system based on distributed collaborative simulation platform. Finally the optimal scheduling solution of system is searched out through constantly modifying evacuation plan by improved genetic algorithm.
9.0) that reflect asperity characteristics of the 1797 histor- ical event in the same region. The generation of the earth- quake scenarios involves probabilistic models of earthquake source parameters and stochastic synthesis of earthquake slip distributions. In total, 300 source models are gener- ated to produce comprehensive tsunami evacuation plans in Padang. The tsunami hazard assessment results show that Padang may face significant tsunamis causing the maximum tsunami inundation height and depth of 15 and 10 m, respec- tively. A comprehensive tsunami evacuation plan – including horizontal evacuation area maps, assessment of temporary shelters considering the impact due to ground shaking and tsunami, and integrated horizontal–vertical evacuation time maps – has been developed based on the stochastic tsunami simulation results. The developed evacuation plans highlight that comprehensive mitigation policies can be produced from the stochastic tsunami simulation for future tsunamigenic events.
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Frame-based stereotaxy is the most accepted form of minimally invasive procedures used for resection of the hematoma . In all of our cases, we started evacuation of the hematomas by gentle simple syringe aspiration to remove the fluid part of the hematoma and this was followed by handmade model of Archimedes screw in- sertion (made to be compatible with the used stereotaxy frame as regards the dimensions and diameters) for clot fragmentation and aspiration. Some authors put strict criteria for the catheter left in the hematoma and used for injection of clot lysing materials. These catheters should be in the center and run through the long axis of the clot to avoid reopening of the ruptured vessel caus- ing rebleeding [15, 16].