title: [Treatment of subarachnoid hemorrhages in an isolated mountainous area].
abstract: From January 1997 to December 2001, patients with subarachnoid hemorrhage (SAH) among 14,008 residents in an isolated mountainous area; Oguni and Minamioguni towns in Kumamoto Prefecture, were evaluated. The subjects were patients being treated at Oguni Municipal Hospital. Over a period of 5 years, 19 patients were found to be suffering from SAH in this area, 3 of whom were visitors (residing outside this area). The annual incidence rate of SAH in this area was calculated as 22.9 per 100,000. The sex ratio (men:women) was 4:12. The average age was 67.9 years; 65.0 years for men and 68.8 years for women. Eleven patients were older than 65, and constituted 68.8% of the subjects. The risk factors of SAH were recognized, and both hypertension and smoking constituted 31.6%. Alcohol was 21.1% and hyperlipemia was 15.8%. In 13 clipping operated cases excluding 1 test craniotomy, Hunt & Kosnik's Grades at admission were G.I: 2, G.II: 5, G.III: 3, G.IV: 2 and G.V: 1, and Fisher's Groups were G.I: 0, G.II: 8, G.III: 3 and G.IV: 2. The sites of 16 operated aneurysms were internal carotid-posterior communicating artery (IC-PC): 2, anterior communicating artery (A Co.A): 4, middle cerebral artery (MCA): 10 and vertebral artery-basilan artery (VA-BA): 0. The aneurysmal size were < 5 mm: 5, 6-10 mm: 9 and 11 mm < :2 (average 7.6 mm, 2-15 mm). The results were evaluated at discharge, excluding 1 SAH of unknown etiology. 9 were good, 2 were dependent and 7 including 5 non-operative cases had died. We were satisfied with these results, because we were treating older patients. Although we attempted the clipping operation using only a three dimensional computed tomographic angiograply (3D-CTA; X-Vision GX (TOSHIBA) & X-Tension), we had no problem, except for 1 test craniotomy. 3D-CTA was useful during the clipping operation in the small hospital, especially, in regard to cost.
authors.affiliation: Department of Neurosurgery, Oguni Municipal Hospital, Oguni-town, Aso-gun 869-2501, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ohta
authors.forename: Seiichirou
authors.initials: S
authors.lastname: Kawano
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Yamada
authors.forename: Masanori
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Eiichirou
authors.initials: E
authors.lastname: Urasaki
authors.forename: Akira
authors.initials: A
authors.lastname: Yokota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012423:Rural Health; D012907:Smoking / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D036542:Tomography, Spiral Computed