Articles: brain-injuries.
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A retrospective study was carried out of 202 patients with traumatic intracerebral haematomas (TICH) noted on CT, to determine which factors most affected outcome. There were 151 (75%) males and 51 (25%) females, whose ages ranged from 1 to 84 years. One-hundred-and-two (51%) had a good outcome (Glasgow Outcome Score 1 and 2). ⋯ No patient with three or more haematomas had a good outcome. Single factor logistic regression analysis identified Glasgow Coma Score (GCS), haematoma volume and difficulty with airway maintenance or poor arterial oxygenation as important factors in determining outcome. A four-factor logistic regression analysis model was developed which revealed that, when all other factors had been taken into consideration, craniotomy significantly improved the probability of a good outcome.
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The Authors present a case of a young man who drowned in sea water after the shock caused by a lightening that fell close to him as the swam. The Authors discuss and analyze the effects of the two events (drowning and lightening) which developed similar cerebral injuries but with a different origin.
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Curr Opin Neurol Neurosurg · Dec 1992
ReviewIntracranial pressure measurement/cranial vault mechanics: clinical and experimental observations.
The absolute value of intracranial pressure (ICP) should be considered in conjunction with evaluation of a patient's clinical condition. In addition, other aspects of cranial vault mechanics may be important in multiple disease states. Among the important physiological measures of cranial vault sufficiency are hydrodynamic interaction between brain tissue, blood and cerebrospinal fluid (CSF)--volume-pressure relation, CSF dynamics--CSF outflow resistance, CSF production rate, sagittal sinus pressure, and appearance of ICP waves. Clinical and experimental studies brought together in this review provide an insight into the dynamics of ICP and the cranial vault.
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In the management of patients with acute cerebral disturbances, it is essential to determine precisely the degree of impaired consciousness. In order to secure the accuracy of observations, one must use a reliable coma scale. We have evaluated the Edinburgh 2 coma scale (E2CS) and explored the relationship between levels of the E2CS and the final outcome. ⋯ It was shown at the same time that each level has different prognostic significance and that the distance between each level is not identical. The recommendation is made to separate the levels on a chart not by an ordinal number but by the distance calculated on the basis of either mortality or morbidity rates. This will make it possible to get a rough estimate of the patients' prognoses by simply looking at a daily clinical chart.
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Aktuelle Traumatologie · Dec 1992
[Epidural "sulmycin implant" coverage for local prevention of infection in surgical management of open craniocerebral injuries].
In various series reported in the literature on the operative management of severe head injuries with compound depressed skull fractures and penetrating wounds of the brain, the rates of infection differ from 1 to 17%. In this paper the operative experience with 22 cases of penetrating head injuries is discussed. In conventional operative therapy, depressed skull fracture and lacerated dura were covered by "Sulmycin Implant" containing Gentamycin as a helpful bacteriological barrier. 18 patients survived, 7 patients had severe neurological defects, 5 patients had mild neurological deficits and 6 patients recovered completely. ⋯ Another patient with a frontal base skull fracture suffered a pneumatocele because the fracture was not correctly covered. The revision was done successfully using the "Sulmycin Implant". Presently, however, the intradural use of "Sulmycin Implant" is not recommended without further testing for the level of gentamycin in the cerebrospinal fluid which is released by the "Sulmycin Implant".