Articles: brain-injuries.
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Critical care medicine · Aug 1993
Combined continuous monitoring of systemic and cerebral oxygenation in acute brain injury: preliminary observations.
To continuously evaluate the relationship between global systemic and cerebral oxygenation during temporary profound hypocapnia, which was attempted for prompt management of posttraumatic intracranial hypertension. ⋯ In young adults with severe acute brain trauma who require prompt management of intracranial hypertension, transient profound hypocapnia is effective in lowering the intracranial pressure, as well as in offsetting the cerebral luxury perfusion, while improving or maintaining adequate systemic oxygenation. The systemic-cerebral oxygenation index and the systemic-cerebral ventilatory index are potentially useful, physiologically monitorable variables for the combined assessment of global systemic and cerebral oxygenation in a variety of areas involving physiologic and/or therapeutic approaches.
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The purpose of this study was to examine the relationship of the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) scores in pediatric and adult patients having surgical entry into the cranium for diagnostic or therapeutic purposes after brain insult. In this retrospective record review, the predictor variable was the coma-associated GCS score (GCS score 3-8) obtained 24 hours after surgery. The outcome variable was the combined Glasgow Outcome category: recovery/moderate disability; severe disability/vegetative state; and death; ascertained 14 days postoperatively. ⋯ Considering the GCS components, the eye scores significantly discriminated one outcome, the motor scores two outcomes, and the verbal scores two outcomes (p < .001 to .005). The unweighted GCS scores in adults significantly discriminated all three outcomes and in children two outcomes; the weighted GCS scores in both children and adults significantly discriminated all three outcomes. The approximately 25% misclassification rate for outcomes, however, would preclude using the scales in a predictive or prescriptive manner.
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Journal of neurosurgery · Aug 1993
The effect of resuscitative moderate hypothermia following epidural brain compression on cerebral damage in a canine outcome model.
A canine model of temporary epidural cerebral compression and standardized intensive care was developed to evaluate the effect of resuscitative (postinsult) moderate systemic hypothermia. A balloon was inflated over the temporal region to maintain contralateral intraventricular pressure (IVP) at 62 mm Hg for 90 minutes. For a 66-hour period after initiation of brain compression, the intubated dogs received controlled ventilation and standard intensive care. ⋯ The mean necrotic volume was 741 +/- 599 cu mm in the normothermic versus 263 +/- 346 cu mm in the hypothermic group (p = 0.07). Microscopically, the damaged regions consisted of ischemic neurons, reactive glia, edema, vascular endothelial hypertrophy, and erythrocyte extravasation. It is concluded that, in this model, immediate postinsult hypothermia of 31 degrees C (not 35 degrees C) for 5 hours prevents a rise in IVP and significantly decreases cerebral tissue damage, but does not prevent brain herniation during rewarming.
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Aktuelle Traumatologie · Aug 1993
Case Reports[Measuring intracranial pressure after trepanation in traumatized patients].
Between 1.1.1990 and 30.9.1991 32 neuro-traumatological operations were carried out. With 22 patients the intracranial pressure probe was used. With 11 injured persons the ICP (intracranial pressure) values were unchanged. ⋯ In this way expansive intracranial changes which occur postoperatively can immediately be seen and diagnosed or treated. On the other hand, if the intracranial pressure values are unchanged, postoperative computed tomography may be carried out later i.e. after the vulnerable phase. Further advantages result from monitoring the patients in the intensive care unit.
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Randomized Controlled Trial Clinical Trial
Soybean oil, blackcurrant seed oil, medium-chain triglycerides, and plasma phospholipid fatty acids of stressed patients.
Thirty-six adult severe head injury and cerebral stroke patients in four intensive-care units were randomized to receive one of three enteral diets for 21 days. These diets, which supplied 45% of calories from fat, differed only in lipid composition. Diet A was comprised of 100% soybean oil, diet B contained a 50:50 (wt/wt) mixture of soybean oil and medium-chain triglycerides (MCTs), and diet C contained 42.5% MCT, 50% soybean oil, and 7.5% blackcurrant seed oils. ⋯ Furthermore, 18:3 omega 6 change was significantly different between groups A and C and that of 20:3 omega 6 between group A and both groups B and C. Throughout the study, arachidonic acid (20:4 omega 6) exhibited remarkable steady-state levels regardless of the diet. This study shows that providing the injured body with high amounts of 18:2 omega 6 does not lead to high levels of its upper derivatives in plasma phospholipids.(ABSTRACT TRUNCATED AT 250 WORDS)