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[The stress ulcer in the neurosurgical disease and the warning data (author's transl)]
Abstract:
Twelve cases of G.I. tract bleeding, treated in the Department of Neurosurgery, Kobe University School of Medicine, were analyzed with the special reference to clinical data before the episode of G.I. tract bleeding. These 12 cases consist of 10 cases of aneurysm, 1 of metastatic brain tumor, and 1 of chronic subdural hematoma. The anterior communicating artery has the majority in the case of aneurysm by 50 per cent. In each case, C.B.C., bleeding time, coagulation time, serum electrolytes, serum glucose, glucosuria, steroid administration, blood pressure, hyperthermia, and water balance were reviewed retrospectively. Only serum glucose showed the specific abnormality with the average of 135 mg/dl (Hoffman method) before the episode of G.I. tract bleeding among them. In 1931, Cushing reported the clinical case of G.I. tract bleeding with intracranial disease and also experimental G.I. tract bleeding, in which discussion he concluded only parasympathetic nerve system has the involvement in the mechanism. In 1952, French, however, certified also the involvement of sympathetic nerve system in G.I. tract bleeding with the experimental results. In addition to this report, many experimental works under the standpoint of hypothalamus involvement in stress ulcer were undertaken. On the other hand, hyperglycemia and glycosuria in the stress have been reported as the results of clinical and experimental works. In 1971, Frohman concluded that only ventromedial nuclei has relation to the control of glycogen metabolism in hypothalamus from his experimental results. We concluded that this hyperglycemia before the evidence of G.I. tract bleeding due to the involvements of hypothalamus or other parts of C.N.S. in the neurosurgical disease is one clinical sign of the stimualtion to sympathetic nerve system that also can be a cause of G.I. tract bleeding, and this hyperglycemia before the evidence of G.I. tract bleeding should be paid attention as a warning datum.