Der Nervenarzt
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The clinical and computed tomographic findings in 22 civilian cases of craniocerebral gunshot injury are reported. Fifteen out of the 19 male cases were suicidal attempts; the 3 women were shot by their husbands. In 2 cases the injuries resulted from use of a slaughterer's gun. ⋯ CT findings such as bihemispheric injury and detection of intraventricular blood or air were associated with a poor outcome. Surgical intervention appears to be justified only in patients with extensive subdural or epidural hematoma. The mortality rate in this study was 45%.
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Case Reports
[Unchanged ability following temporal gunshot injury with multiple intracerebral gunshot pellets].
The case of a 25-year-old male schizophrenic patient is reported, who with suicidal intent wounded himself in the left temporal region, using a shotgun. Despite having about 30 intacerebral smallshot, he remained continuously conscious. ⋯ The differing results of CT and NMR examination are reported. Finally, the complications reported in the literature are discussed.
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In order to evaluate significance and frequency of valproic acid (VPA)-induced hyperammonemia we measured venous serum ammonia, SGOT, G-GT, platelets and antiepileptic drug levels in three groups of subjects: 1.) 30 pediatric patients treated with VPA, alone or in combination 2.) 30 healthy age and sex matched subjects 3.) 30 pediatric unselected patients treated with various antiepileptic drugs except VPA. In the VPA group serum ammonia was significantly (p less than 0.01) higher than in controls and in the group 3. Patients on VPA-polytherapy had significantly higher serum ammonia values than patients on VPA-monotherapy (p less than 0.01). ⋯ The etiology of hyperammonemia in VPA treated patients is not yet fully explained. It may be related to the fatal VPA induced hepatic failure reported in the literature. Some risk factors which may facilitate hepatic injury during VPA therapy (young age, co-medication, polytherapy, infectious disease, protein overload, low caloric intake) are discussed and some practical consequences are indicated.
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After surgery in the area of the armpit, and particularly after axillary lymphonodectomy during mastectomy, severe pain and paraesthesia can occur in the region of the medial and posterior side of the proximal upper arm. It is shown by means of four case reports that this discomfort can be caused by a lesion in the intercostobrachial nerve. The differential diagnosis must consider injury to the brachial plexus or a local metastasis.