Articles: brain-injuries.
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Acta neurochirurgica · Jan 1991
The effects of indomethacin on intracranial pressure, cerebral blood flow and cerebral metabolism in patients with severe head injury and intracranial hypertension.
In five head-injured patients with cerebral contusion and oedema in whom it was not possible to control intracranial pressure (ICP) (ICP greater than 20 mmHg) by artificial hyperventilation (PaCO2 level 3.5-4.0 kPa) and barbiturate sedation, indomethacin was used as a vasoconstrictor drug. In all patients, indomethacin (a bolus injection of 30 mg, followed by 30 mg/h for seven hours) reduced ICP below 20 mmHg for several hours. Studies of cerebral circulation and metabolism during indomethacin treatment showed a decrease in CBF at 2 h. ⋯ In the other patients a return of ICP and CBF to pretreatment levels was observed. In all patients indomethacin treatment was followed by a fall in rectal temperature. These results suggest that indomethacin due to its cerebral vasoconstrictor and antipyretic effect should be considered as an alternative for treatment of ICP-hypertension in head-injured patients.
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The effects of high velocity missiles are described. A series of cases of craniocerebral tangential gunshot wounds over a 6 year period is presented with unsuspected cerebral contusion shown by CT. ⋯ The short- and long-term sequelae and the extent of cerebral damage belie the innocent appearance of the scalp wound. This influences the management of this unusual type of head injury.
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We investigated retrospectively 761 acute head trauma patients, who were admitted to our intensive care unit from 1983 to 1989. The objective of our study was to investigate the influence of pre-hospital acute care and intensive care protocols on mortality and outcome. We showed that the introduction of organized pre-hospital emergency care and well organized interdisciplinary patient management in the hospital and in the intensive care unit had a significant effect on outcome.
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A suicidal injury from a livestock stunner ("humane killer") serves to demonstrate the reconstruction possibilities presented by the morphology of the bolt entrance wound and the imprimata. There are differences to common bullet entrance holes with regard to caliber and soot deposits but also with regard to the wound margin features and the characteristics with shots fired at an oblique angle.