Tehran University Medical Journal

Background: Chronic Subdural Hematoma (CSDH) is one of the most common challenges of neurosurgeons. Most predominant among the elderly, the incidence increases incrementally with age and might lead to permanent severe complications. The aim of this study is to outline the symptoms and signs and to compare the outcomes and complications among two groups of patients who underwent two different surgical procedures.
Methods: In a cross-sectional and descriptive-analytical study performed on 125 patients with CSDH from 2000 to 2005. Computed tomography scan was used for diagnostic imaging in all cases and magnetic resonance imaging was also obtained for six patients. In one center, group 1, which included 82 patients, underwent surgery with a single burr hole and closed drainage, and, at another center, group 2, which included 43 patients, was treated with a method using two burr holes and close drainage.
Results: Of the 125 patients, 102 were male and 23 were female. The mean age of patients was 65.79±16.41 years. The most common symptoms were weakness in extremities (78.4%), headache (72.8%) and decreased level of consciousness (24%), respectively. At presentation, 88 (70.4%) of the patients had several symptoms and 37 (29.6%) had only one symptom. A history of mild head trauma, such as falling, was observed in 83 (68%) of the patients. The interval between head trauma and the onset of symptoms ranged from 10 to 120 days (mean: 46 days). Hematoma recurred in five cases from group 1, whereas two cases from group 2 had recurrence of hematoma. Postoperative epidural hematoma developed in one case from group 2 and tension pneumocephalus also occurred in one group 2 patients.

Background: Vascular complications, as the most common complications of diagnostic catheterization and percutaneous coronary intervention (PCI), are important factors in the morbidity of patients undergoing such procedures thus, this study was done to evaluate the prevalence of these complications and their related factors.

Methods: This is a descriptive study composed of 2097 consecutive patients who underwent percutaneous coronary intervention in Shahid Rajaei Cardiovascular Center in Tehran, Iran from January 2008 to January 2009. Occurrence of vascular complications in course of hospitalization and the related factors leading to the complications were investigated.

Results: Out of 2097 patients, 1544 (73.6%) were male and 553 (26.4%) were female, and the mean age of the participants was 57±10 years. Vascular complications from the time of PCI to the time discharge were observed in 19 (0.9%) patients. The other complications included: hematoma in 10 cases (52.6%), pseudoaneurysm in five cases (26.3%), retroperitoneal hemorrhage and arteriovenous fistula in 2 (10.5%) patients each. The complications were significantly more common in female patients (P=0.003), in patients with a history of hypertension (P=0.02), people of shorter stature (P=0.004), and being on gp IIIa/IIb inhibitors (P=0.003).

Conclusion: The rate of vascular complications post-percutaneous coronary interventions is low and it is considered to be a good treatment option for patients with coronary stenosis provided that sufficient compression is applied on the vascular access point in the right time after removal of the arterial sheath. PCI is of fewer vascular complications, especially in female patients, history of hypertension, and higher anticoagulant concentrations.