Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 1997
Biphasic pathophysiological response of vasogenic and cellular edema in traumatic brain swelling.
The objective of this study was to quantify the temporal water content changes and document the type of edema (cellular versus vasogenic) that is occurring during both the acute and the late stages of edema development following closed head injury. Adult Sprague rats (n = 50) were separated into two groups: Group I: Sham (n = 8), Group II: Trauma (n = 42). The measurement of brain water content (BWC) was based on T1, whereas the differentiation of edema on the measurement of the random, translational motion of water protons (apparent diffusion coefficients-ADC) by MRI. ⋯ This transient increase; however, was followed by a continuing decrease in ADC beginning at 45 minutes post injury and reaching a minimum at days 7-14 (-103%). Since the BWC continued to increase during the next day (10.3%), it is suggested cellular edema formation started to develop soon after injury and became dominant between 1-2 weeks post injury. In conclusion we may consider, that there is a predominantly vasogenic edema formation immediately after injury and later a more widespread and slower edema formation due to a predominantly cellular swelling.
-
Acta Neurochir. Suppl. · Jan 1997
Comparative StudyBlood-brain barrier breakdown occurs early after traumatic brain injury and is not related to white blood cell adherence.
The time course of blood-brain barrier (BBB) breakdown after traumatic brain injury (TBI) has important implications for therapy. This study was conducted in order to test post-traumatic BBB dysfunction in a model of fluid-percussion induced TBI in rabbits at 1 and 6 hours after TBI and relate it to white blood cell (WBC) activation. Ten anesthetized rabbits had chronic cranial windows implanted three weeks prior to experimentation. ⋯ We conclude that after fluid-percussion injury the BBB is damaged at 1 h post-trauma and that its function is restored 6 h later. Increased WBC sticking at 6 h is not associated with BBB breakdown. Whether WBCs may cause vascular permeability changes at a later point needs further investigation.
-
Acta Neurochir. Suppl. · Jan 1997
Clinical TrialComparison of the interleukin-6 and interleukin-10 response in children after severe traumatic brain injury or septic shock.
Inflammation may play an important role in the evolution of damage after traumatic brain injury (TBI). IL-6 and IL-10 are markers of inflammation that are pro- and anti-inflammatory in nature, respectively. They have been used as an index of the degree of inflammation in diseases including sepsis and meningitis. ⋯ CSF IL-6 after TBI is similar to serum IL-6 levels previously reported in children with septic shock. In contrast, the CSF IL-10 response was markedly attenuated following TBI compared to sepsis. These data suggest a unique balance between pro- and anti-inflammatory cytokines in brain after TBI.
-
Board certification and accreditation of training programs began as measures of quality in the United States. Both functions were done initially by the American Board of Neurological Surgery (ABNS). In 1954, certification of trainees and accreditation of programs became separate functions in order to eliminate potential conflicts of interest. ⋯ Accreditation of training programs is a separate function administered by the Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education. Individual programs are reviewed on a periodic basis for quality of the curriculum, facilities, faculty, and patient volume. The ABNS and the RRC are separate groups, both comprised of neurosurgeons with a strong commitment to the educational process.
-
Acta Neurochir. Suppl. · Jan 1997
Comparative StudyIntracranial pressure in a modified experimental model of closed head injury.
Intracranial pressure (ICP) was studied in a modified experimental model of closed head injury, in which the dynamic process of impact versus impulse loading was separately controlled. In this model, mortality of Wistar rats was considerably higher as compared to Sprague-Dawley rats subjected to similar traumatic conditions. Therefore Sprague-Dawley rats were used for all further experiments. ⋯ At the moment of impact there was a momentary blood pressure peak immediately followed by a transient period of hypotension. ICP measurements following directly to an impact-acceleration trauma, revealed an abrupt rise in ICP reaching pathological levels within 5 minutes. In conclusion, this modified model of closed head injury produces a predictable and reproducible pathologic ICP in Sprague-Dawley rats.