Articles: brain-injuries.
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Given that clinical and laboratory studies suggest that ethanol and hemorrhagic shock (HS) potentiate traumatic brain injury (TBI), the authors studied the effects of ethanol in a model of combined TBI and HS. ⋯ In this TBI/HS model, ethanol administration decreased survival time, impaired the hemodynamic response, and worsened measures of cerebral tissue perfusion.
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To assess the relative importance of multiple organ failure (MOF) and cerebral damage on the mortality rate following trauma we analyzed retrospectively the records from 99 polytrauma patients admitted to a multidisciplinary European intensive care unit in a 2 year period. In all, 93% of the trauma was non-penetrating and 73% was the result of road accidents. 28 patients died giving an overall mortality of 28.3%. ⋯ A total of six deaths occurred after 24 h, four due to extensive cerebral lesions, one due to hemorrhagic shock and one due to multiple organ failure. In our experience, cerebral damage was a more common cause of death than MOF following multiple non-penetrating trauma.
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Review the existing literature on the incidence, neurobiological and psychosocial correlates, and methods of assessment and treatment of depression following traumatic brain injury (TBI). ⋯ Depression occurs with sufficient frequency to be considered a significant consequence after TBI. Depression can impede the achievement of optimal functional outcome, whether in the acute or chronic stages of recovery. It appears that a combination of neuroanatomic, neurochemical, and psychosocial factors is responsible for the onset and maintenance of depression. Its treatment is typically psychopharmacologic, with best results obtained from nontricyclic antidepressants. These results have not been confirmed in double-blind clinical trials, however. Future research should use comprehensive, integrative models of depression that include demographic, biologic, and psychosocial factors; enhanced functional neuroimaging techniques; controlled studies of psychopharmacologic and other interventions; and prospective designs with long-term follow-up.