ABSTRACT
OBJECT: The purpose of this community-based study was first to estimate the incidence rates of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) in Izumo City, Japan, and second to investigate whether there were seasonal and diurnal periodicities in their onset. METHODS: During 1991 through 1996, 267 patients with primary ICH and 123 with aneurysmal SAH were treated in Izumo City. The crude and the age- and sex-adjusted annual incidence rates per 100,000 population for all ages were 52 and 48 for ICH and 24 and 23 for SAH, respectively. These incidence rates were higher than those previously published for any other geographical region. The incidence rates of both ICH and SAH increased almost linearly with age. For ICH, a significant seasonal pattern was observed in men and in patients younger than 65 years, with a peak in winter and a trough in summer. However, no significant seasonal fluctuation was found in women or in individuals aged 65 years or older. There was no significant seasonal periodicity for SAH, even when patients were analyzed according to sex and age. Diurnal variations in the onset of both ICH and SAH were significant (except in men with SAH), with a nadir between midnight and 6:00 a.m. CONCLUSIONS: The actual incidence rates of both primary ICH and aneurysmal SAH seem to be much higher than have been reported so far. In addition, the data indicate the existence of seasonal periodicity for men and younger patients with ICH, and that the risk of both ICH and SAH is lower during nighttime.
Subject(s)
Cerebral Hemorrhage/epidemiology , Circadian Rhythm , Intracranial Aneurysm/epidemiology , Seasons , Subarachnoid Hemorrhage/epidemiology , Urban Population/statistics & numerical data , Adult , Aged , Aged, 80 and over , Cerebral Hemorrhage/etiology , Cross-Sectional Studies , Female , Humans , Incidence , Intracranial Aneurysm/etiology , Japan/epidemiology , Male , Middle Aged , Periodicity , Risk Factors , Subarachnoid Hemorrhage/etiologySubject(s)
Thyroid Diseases/diagnostic imaging , Thyroid Gland/pathology , Tomography, X-Ray Computed , Adenoma/diagnostic imaging , Adenoma/pathology , Adolescent , Adult , Female , Goiter/diagnostic imaging , Goiter/pathology , Humans , Male , Middle Aged , Models, Structural , Organ Size , Thyroid Diseases/pathology , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/pathologySubject(s)
Biliary Tract Diseases/diagnostic imaging , Liver Diseases/diagnostic imaging , Liver/physiopathology , Organotechnetium Compounds , Pyridoxal/analogs & derivatives , Technetium , Tryptophan/analogs & derivatives , Adult , Aged , Biliary Tract/physiopathology , Biliary Tract Diseases/physiopathology , Female , Humans , Liver Diseases/physiopathology , Liver Function Tests , Male , Middle Aged , Radionuclide ImagingABSTRACT
Congenital stenosis involving the entire length of the trachea has generally been regarded as a fatal disease. Tracheoplasty using costal cartilage grafts to enlarge the lumen was successfully employed in such a case, and the technique is described. A 12-mo-old female was referred with recurrent severe respiratory distress since birth. By tracheoscopy and bronchography, the entire trachea was seen to be stenotic. The left bronchus was of normal caliber by bronchogram and the left lung was over inflated, while the right lung was aplastic. Through a midsternal thoracotomy, the left bronchus was incised and cannulated for ventilation. Longitudinal incision of the entire length of the anterior wall of the trachea permitted the advance of a nasotracheal tube along the inner surface of the divided trachea to the carina. Two pieces of costal cartilage were used to fill the defect in the anterior wall of the trachea. The grafts were attached to the tracheal edges by interrupted 5-0 Dexon sutures. The endotracheal tube was successfully removed two months later. The subsequent course of the patient has been satisfactory.
