Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1997
Comparative StudyBlood-brain barrier breakdown occurs early after traumatic brain injury and is not related to white blood cell adherence.
The time course of blood-brain barrier (BBB) breakdown after traumatic brain injury (TBI) has important implications for therapy. This study was conducted in order to test post-traumatic BBB dysfunction in a model of fluid-percussion induced TBI in rabbits at 1 and 6 hours after TBI and relate it to white blood cell (WBC) activation. Ten anesthetized rabbits had chronic cranial windows implanted three weeks prior to experimentation. ⋯ We conclude that after fluid-percussion injury the BBB is damaged at 1 h post-trauma and that its function is restored 6 h later. Increased WBC sticking at 6 h is not associated with BBB breakdown. Whether WBCs may cause vascular permeability changes at a later point needs further investigation.
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Acta Neurochir. Suppl. · Jan 1997
Clinical TrialComparison of the interleukin-6 and interleukin-10 response in children after severe traumatic brain injury or septic shock.
Inflammation may play an important role in the evolution of damage after traumatic brain injury (TBI). IL-6 and IL-10 are markers of inflammation that are pro- and anti-inflammatory in nature, respectively. They have been used as an index of the degree of inflammation in diseases including sepsis and meningitis. ⋯ CSF IL-6 after TBI is similar to serum IL-6 levels previously reported in children with septic shock. In contrast, the CSF IL-10 response was markedly attenuated following TBI compared to sepsis. These data suggest a unique balance between pro- and anti-inflammatory cytokines in brain after TBI.
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Acta Neurochir. Suppl. · Jan 1997
Cerebral vascular response to hypertonic fluid resuscitation in thermal injury.
The purpose of this project was to study the effects of various resuscitation fluid protocols in a systemically thermally injured rat sustaining 70% body surface area third degree burn using the pial window model in rats. The results show that there was a significant albumin leak in the cerebral vessels in both the experimental group which underwent no resuscitation fluid, as well as the experimental group that was resuscitated with Lactated Ringer's solution using the Parkland formula. When this was compared to the control group, as well as to the experimental group which received hypertonic hyperosmotic saline (HMS) boluses every hour, there was little if any leakage seen.
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Acta Neurochir. Suppl. · Jan 1997
Morphologic analysis of the cerebral microcirculation after thermal injury and the response to fluid resuscitation.
Using the pial window model, we have previously demonstrated that there is a disruption of the blood brain barrier with distal thermal injury [1-3]. Our laboratory has shown that treatment with Lactated Ringer's Solution did not improve labeled albumin leakage. ⋯ The results show that there was significant progressive arterial dilatation over six hours in the thermally injured animals treated with HHS. There was also a significant increase in leukocyte number if the animals were thermally injured and had no resuscitation fluid or if the animals were thermally injured and underwent resuscitation fluid with Lactated Ringer's compared to either the control group or the group that was treated with HHS after thermal injury.
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Over the past ten years, an average of 135 residents have entered neurosurgical training in the United States each year. These neurosurgeons-to-be come from about 250 applicants who annually enter the national matching program for neurosurgery. After completing training, they join a pool of practicing neurosurgeons that includes about 3,260 board certified neurosurgeons and an additional 390 practicing neurosurgeons who are still in the certification process. ⋯ We do need to restrict the number of trainees to that number we can train properly. The quality of our neurosurgeons needs to be maintained. Beyond that, the market place, however imperfect, is a better long-term regulator of numbers than any governmental or privately-based committee.