Abdominal aortic aneurysm involving the renal arteries

A woman aged 49 years with a leaking abdominal aortic aneurysm. The aneurysm was known to be present for 8 years and was found to involve both renal arteries. She had an aortic aneurysmmectomy with implantation of both renal arteries, into a Dacron prosthesis. She has survival after a period of renal arteries, into and cardiac failure and cerebral haemorrhage and has a return of good renal function in both kidneys in spite of suspected infarction of the left kidney, in the postoperative period. (AU)

The pattern of fatal cerebrovascular disease in Jamaica

The data presented shows that the pattern of fatal cerebrovascular disease as seen at necropsy in Jamaica is very different from that in comparable studies in white communities. In a 15-year period (1952-1967) cerebro-vascular disorders accounted for 296 (9.9 percent) of all adult necropsies performed in a large general teaching hospital. Of these no less than 77 percent were due to haemorrhage whereas only 23 percent were due to infarction. This high incidence of haemorrhagic strokes probably reflects the high incidence of hypertension which has been shown to exist on the Island. 89 percent of spontaneous intracerebral haemorrhages are associated with hypertension and there is a far lower proportion of hind brain as compared with cerebral hemisphere haemorrhages. A small but significant group appears to be due to hypertension occurring during or shortly after childbirth. Subarachnoid haemorrhages due to rupture of berry aneurysms of the circle of Willis also present unusual features. 70 percent of all such aneurysms occur at the junction of the internal carotid arteries and their branches whereas middle cerebral and anterior communicating artery aneurysms are relatively uncommon. Multiple aneurysms of the Willisian vessels and intracerebral extensions of haemorrhages from ruptured aneurysms also appear to be far less common than generally reported elsewhere.Cerebral infarction due to atheroma and thrombosis is rare - only 54 cases being encountered during the period under consideration. This is even more surprising in view of the fact that cerebral artery atheroma is probably as common as in North America and Europe (Summary)

Some aspects of acute oedema of the lungs

A case is described of subarachnoid haemorrhage in a boy of fourteen years followed at once by fatal oedema of the lungs. The prevalent theory as to the cause of pulmonary oedema i.e. ventricular imbalance was propounded by Welchin 1878. Sufficient clinical and experimental observations have now been made to suggest that there are cases of pulmonary oedema of strictly neurologic origin, i.e. without any cardiac pathology. A part of the syndrome of cerebral haemorrhage is congestion of the lungs which may go on to oedema. It is suggested that the cough and other signs and symptoms of 'chestiness' (which are so frequently observed in patients who have had a 'stroke' and which rarely last more than the first few days of the illness) are central in origin (AU)