Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1999
Case Reports Comparative StudyMonitoring by subcutaneous microdialysis in neurosurgical intensive care.
Microdialysis is an in vivo sampling technique which provides a powerful approach to monitoring metabolic events. We have performed a study to determine the feasibility and effectiveness of subcutaneous microdialysis in monitoring patients on the Neurosurgical Intensive Care Unit (NICU). A microdialysis probe was placed in the subcutaneous fat of the anterior abdominal wall and perfused with Ringer's solution. ⋯ In one patient, following an apparently brief period of hypoxia, there was a prolonged disturbance of tissue chemistry. Another patient with obesity had significantly higher concentrations of dialysate glucose, lactate and glutamate. Monitoring by subcutaneous microdialysis on intensive care units is feasible, reveals unexpected changes in tissue metabolism and might be an important adjunct for the interpretation of intracerebral data.
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Acta Neurochir. Suppl. · Jan 1999
Glucose and lactate metabolism after severe human head injury: influence of excitatory neurotransmitters and injury type.
The survival of traumatized brain tissue depends on energy substrate delivery and consumption. Excitatory amino acids produce a disturbance of ion homeostasis and thus, increase energy demand. In head-injured patients, massive release of glutamate has been reported, especially in patients with focal contusions. ⋯ The interrelationship was more pronounced in diffusely injured brain (normal CT appearance) compared to the contused tissue. The results demonstrate that glutamate clearly influences the release of lactate following injury, supporting the hypothesis that glutamate "drives" glycolysis in astrocytes. The strong positive correlation between glutamate and glucose might indicate an effect of glutamate upon glucose uptake by cells which differs according to the type of injury.
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Acta Neurochir. Suppl. · Jan 1999
System analysis of patient management during the pre- and early clinical phase in severe head injury.
Head injury with or without polytrauma is the most important cause of death and severe morbidity in an age bracket of up to 45 years. Two major factors are determining its outcome, the extent and nature of the primary irreversible brain injury, and the subsequently developing manifestations of secondary brain damage, which in principle can be prevented by the management procedures and therapeutical interventions. Therefore, a better outcome from severe head injury depends exclusively on a higher efficiency of the management and treatment in order to inhibit secondary brain damage. ⋯ The data flow during the investigation was maintained among others by regular conferences of the Study Group including the crew of documentation assistants at regular intervals. The presently reported phase-1 study was concluded in October 1997. It is followed by a phase-2 study with the attempt to collect prehospital- and early clinical management and care data in the catchment area on an epidemiological basis. (ABSTRACT TRUNCATED)
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Acta Neurochir. Suppl. · Jan 1999
Theory and practice of microdialysis--prospect for future clinical use.
The application of microdialysis for neurochemical monitoring in neurosurgery and neurointensive care is rapidly expanding in a number of clinical centers around the world. In order for microdialysis to become a future routine method in these clinical settings a number of problems, outlined in this communication, must be solved by the clinical researchers and the commercial companies. Regardless of the future success as a routine method, it is already obvious that microdialysis will be an important clinical research tool for years to come, providing new important insights into the pathophysiology of acute human brain injury.