Articles: brain-injuries.
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To examine the occurrence of hypotensive episodes in patients with severe traumatic brain injuries that are not of hypovolemic origin and to investigate possible neurogenic or iatrogenic causes of such episodes. ⋯ (1) Some episodes of severe traumatic brain injury-related hypotension may be of neurogenic origin. (2) The risk/benefit ratio of early diuretic use in patients with severe traumatic brain injuries may be too high to support liberal use. These data strongly support the need for a study involving prospective collection of data describing the early blood pressure courses in such patients.
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Despite increasing understanding of the cellular and molecular mechanisms that cause pathology in children who suffer traumatic brain injury, few advances have been made in developing new effective therapies for such injury. In the past, clinicians treated some neurologically injured patients with the sustained application of systemic hypothermia. This practice was largely abandoned when patients experienced complications; however, interest has been renewed in treatment with milder forms of hypothermia. ⋯ Promising results from two clinical trials are presented. Moreover, evidence is discussed in support of the notion that some children with traumatic brain injury, more so than adults, may benefit from hypothermic therapy. Lastly, putative mechanisms for the effects of hypothermia, including attenuation of injury caused by inflammation, excitotoxic amino acids, nitric oxide, and free radicals, are discussed.
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The recovery of injured neurons in primely brain damage, neuroprotection to the secondary brain damage (such as brain edema, brain ischemia, free radicals, neuroexcitation and ICP elevation), activation of gene-tropic regeneration, and prevention of apobiosis are major targets on the management of severe brain injury. However, excess release of catecholamines (catecholamine surge) make a very difficult to control of cerebral hypoxia by changes of systemic blood circulations. ⋯ We developed new technique, cerebral hypothermia that control brain tissue temperature at 32-34 degrees C with more than 800 ml/min. oxygen delivery at acute stage. Combination therapy with these cerebral hypothermia and replacement of cerebral dopamine-pituitary hormone-estrogen was very successful to prevent of vegetation after severe brain injury.
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La Tunisie médicale · Jun 1998
Review Comparative Study[Decision algorithm in hospital management of severe head injury].