Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Jan 1991
[Stereotactic evacuation and early rehabilitation in space-occupying cerebral hemorrhage].
The choice of treatment in intracerebral hematoma remains controversial as long as there are no prospective, randomized trials from multiple centers. Recent experiences showed a lower mortality rate after stereotactic evacuation of intracerebral hematoma. However according to the present study (60 patients) the quality of survival and duration of hospital stay seems to be dependent on early and intensified rehabilitation and physiotherapy.
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As a result of increased traffic and enlarged leisure offers the number of severe head injuries climbed significantly in the last years. Due to the improvement of preclinic care, including the transport of severe head injured patients to a neurosurgical clinic as well as the availability of modern neuroradiological techniques such as CT and MRI and the performance of ICP-monitoring at an early stage the prognosis of severe head injured patients was significantly improved.
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Between the years 1976 und 1989 147 patients were operated on cervical disc herniation at the Neurosurgical Clinic of Innsbruck. 122 of these cases underwent a posterior approach according to Frykholm, 25 patients were treated by an anterior approach according to Cloward and Smith and Robinson, respectively. All patients received a descending myelography followed by a CAT-Scan of the questionable cervical segments the latter was available. In patients with disc herniation and only mild degenerative changes of the cervical spine a dorsal foraminotomy was chosen whereas the cases with nerve root compressions primarily due to spondylosis the ventral approach was preferred. Patients revealed a convincing benefit of motoric deficits after foraminotomy whereas disturbances of sensibility showed minor improvement either by ventral or posterior approach.
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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.