The Western journal of medicine
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A study involving 79 patients who were considered for surgical treatment for craniocerebral gunshot injuries between 1972 and 1978 was carried out to develop criteria for radiographic assessment and surgical operation, as well as to improve operative techniques and preoperative planning. The study focused on differences between military and civilian injuries, as well as criteria for gross prediction of outcome. Of note in the overall perspective of the series were (1) the predominance of low-velocity missiles, (2) the high rate of self-inflicted injuries (34 percent), (3) the overall mortality of 23 percent with the rate for persons older than 60 being approximately 70 percent, (4) the correlation between preoperative patient assessment and mortality, (5) complications predominated by cerebrospinal fluid fistulas (10 percent), (6) the value of computerized axial tomographic (CAT) scanning in patient assessment and operative strategy and (7) the ultimate employability rate in survivors (78 percent). An historical review of the development of management principles based on operative experience in the military sector as well as other recent civilian literature also deserves consideration.
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Five nondiabetic, chronically alcoholic patients presented in a comatose state during a two month prospective study and were found to be ketoacidotic. All of the patients were men, 28 to 59 years old. The usual history was one of chronic heavy, daily alcohol consumption until one to three days before presentation, when persistent anorexia, abdominal distress, nausea and vomiting commenced, with abstention from food thereafter. ⋯ Follow-up after three months showed no repeated difficulties. The combination of alcoholic ketoacidosis and hypoglycemic coma in nondiabetic persons has not been described in the literature as a clinical entity; it may, however, represent a common but unrecognized syndrome. Therefore, because of its potentially serious consequences and because treatment is simple and effective, this entity must be thought of in alcoholic patients with altered mental status.