No to hattatsu. Brain and development
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In the management of severe pediatric brain injury, attention has previously been paid to brain edema, ICP elevation and low cerebral perfusion pressure (CPP). However, in the acute stage within 3-6 hours after trauma, brain hypoxia and hyperglycemia associated with diffuse brain injury are often observed. We have pointed out brain thermo-pooling (elevation of brain tissue temperature) and brain hypoxia caused by defective release of oxygen from hemoglobin (due to decrease in red blood cell enzyme (DPG)) as a new mechanism of brain injury. ⋯ Another problem is immune crisis associated with secondary pulmonary infections. To prevent them, early enteral nutrition and replacement of L-arginine were most useful, as well as preconditioning for rewarming as follows: serum albumin > 3.0 g/dl; lymphocyte > 1500/mm3; T-H (CD4) lymphocytes > 55%; serum glucose, 120-140 mg/dl; vitamin A > 50 mg/dl; Hb > 12 g/dl and 2,3 DPG, 10-15 mumol/gHb; O2 ER, 23-25% and AT-III, > 100%. The clinical benefit of this therapy is still controversial.
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Trauma victims are directly transferred to a level I trauma center bypassing local hospitals. First, airways and cervical stability are secured. Intracranial hematoma should be promptly evacuated. ⋯ The goal of intracranial pressure (ICP) management is to maintain the ICP at less than 15 mmHg and to maintain minimum cerebral perfusion pressure at 45-55 mmHg. External ventricular drainage provides direct control of the ICP by allowing intermittent drainage of the CSF (5-10 ml/hour). Mannitol is effective but hyperventilation is not recommended.
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The age at the first clinical referral or diagnosis of cerebral palsy (CP), the age at the onset of treatment, the route of referral, and the kind of school entered were investigated in 202 cases of CP in Shiga Prefecture (69 with spastic diplegia, 62 with tetraplegia, 33 with hemiplegia, 23 with the dyskinetic type and 15 with the ataxic type) born between April 1977 and March 1987. In the hemiplegia, spastic diplegia and ataxic types, the age at the first clinical referral or diagnosis, was above 1 year in 42%, 39% and 33%, respectively. In the tetraplegia and the dyskinetic types, by contrast, such a delay occurred in only 9% and 4%, respectively. ⋯ Fifty-three percent of the cases entered an elementary school (ordinary classes in 30% and special classes in 23%), 41% a special school, and 5% entered a protective institution. The early diagnosis of hemiplegia, spastic diplegia and the ataxic type of CP was difficult in some cases. Cases with suspected signs of CP should be referred to clinic early in the absence of definite diagnosis.