Articles: trauma.
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Eur J Trauma Emerg S · Feb 2009
Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours.
Under the trimodal distribution, most trauma deaths occur within the first hour. Determination of cause of death without autopsy review is inaccurate. The goal of this study is to determine cause of death, in hourly intervals, in trauma patients who died in the first 24 h, as determined by autopsy. ⋯ The temporal distribution of the cause of death varies in the first 24 h after admission. Hemorrhage should not be overlooked as the cause of death, even after survival beyond 1 h. Understanding the temporal relationship of causes of early death can aid in the targeting of management and surgical training to optimize patient outcome.
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Eur J Trauma Emerg S · Feb 2009
Cost-Drivers in Acute Treatment of Severe Trauma in Europe: A Systematic Review of Literature.
Throughout the world, trauma is a leading cause of morbidity and mortality in the young and most active group of society. While specialist trauma centers play a critical role in the survival after severe trauma, the assessment of trauma-related costs, budgeting for adequate trauma capacity, and determining the cost-effectiveness of interventions in critical care are fraught with difficulties. Through a systematic review of the European literature on severe trauma, we aimed to identify the key elements that drive the costs of acute trauma care. ⋯ Irrespective of the idiosyncrasies of the national healthcare systems in Europe, severity of injury, length of stay in ICU, surgical interventions and transfusion requirements represent the key drivers of acute trauma care for severe injury.
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Emerging research implicates the participation of spinal dorsal horn (SDH) neurons and astrocytes in nerve injury-induced neuropathic pain. However, the crosstalk between spinal astrocytes and neurons in neuropathic pain is not clear. Using a lumbar 5 (L5) spinal nerve ligation (SNL) pain model, we testified our hypothesis that SDH neurons and astrocytes reciprocally regulate each other to maintain the persistent neuropathic pain states. ⋯ Meanwhile, L-AA shortened the duration of neuronal activation by SNL. Our data offers evidence that neuronal and astrocytic activations are closely related with the maintenance of neuropathic pain through a reciprocal "crosstalk". The current study suggests that neuronal and non-neuronal elements should be taken integrally into consideration for nociceptive transmission, and that the intervention of such interaction may offer some novel pain therapeutic strategies.
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Unsteady gait is a relatively common presentation to the pediatric emergency and neurology services. Unsteadiness can be due to a wide variety of causes, however, the primary concern on initial assessment is to exclude serious disorders such as meningitis, encephalitis, or brain tumors. Recognizing benign and non-neurological causes of unsteady gait is essential to avoid unnecessary investigations and hospital admission. ⋯ It may result from trauma, infections, metabolic, degenerative disease, space occupying lesions, or congenital anomalies. Sensory ataxia is due to peripheral neuropathy involving large myelinated fibers that carry vibration and position sense, or due to posterior spinal column dysfunction. Accurate assessment depends on detailed history, examination, and then formulation of a differential diagnosis list to guide laboratory investigations.
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Neurosurg. Clin. N. Am. · Jan 2009
ReviewFrom the battlefront: peripheral nerve surgery in modern day warfare.
Warfare historically causes a large number of peripheral nerve injuries. During the current global war on terror, an increased use of advanced regional anesthesia techniques appears to have significantly reduced pain syndromes that have been previously reported with missile-induced nerve injuries. Additionally, a new program has been established to develop advanced prosthetic devises that can interface with neural tissue to obtain direct neural control. As this technology matures, the functional restoration gained from these new generation prosthetic devices may exceed that which can be obtained by standard nerve repair techniques.