Absorción mineral y retención ósea en ratas normales en crecimiento por el consumo de un yogur experimental reducido en lactosa que contiene galactooligosacáridos (GOS) / Mineral absorption and bone retention in normal growing rats by consumption of an experimental lactose-reduced yogurt containing galactooligosaccharides (GOS)

Introducción: Los GOS son prebióticos naturales presentes en la leche materna que pue-den obtenerse enzimáticamente a partir de la lactosa de leche de vaca durante la fabricación de yogur. El producto lácteo resultante será reducido en lactosa y contendrá prebióticos y bacterias potencialmente probióticas. Sin embargo, mantendrá la baja relación Ca/Pi que aporta la leche de vaca, lo que podría alterar el remodelamiento óseo y la mineralización. Objetivo: comparar si un yogur reducido en lactosa que contiene GOS (YE) ofrece ventajas adicionales respecto de un yogur regular sin GOS (YR) sobre las absorciones (Abs) de Ca y Pi, retención y calidad ósea durante el crecimiento normal. Al destete, ratas machos fueron divididas en 3 grupos alimentados con AIN ́93-G (C), YE o YR durante 28 días. Resultados: YE mostró el mayor aumento de lactobacilos fecales; producción de ácidos grasos de cadena corta especialmente p, profundidad de las criptas colónicas y menor pH cecal. El %AbsCa y %AbsPi aumentó en el siguiente órden: YE> YR> C (p < 0,05). El contenido de Ca y Pi en fémur, la densidad y contenido mineral óseos y los parámetros biomecánicos fueron similares en YE y C, mientras que YR mostró valores significativa-mente menores (p < 0,05). Conclusiones: YE aumentó las Abs y biodisponibilidad de minerales, alcanzando la retención y calidad ósea de C. El aumento en las Abs observado en YR no logró obtener la retención y calidad ósea de C. Conclusión: YE habría contrarrestado el efecto negativo del mayor aporte de Pi de la leche de vaca y sería una buena estrategia para lograr el pico de masa ósea y calidad del hueso adecuados, especialmente en individuos intolerantes a la lactosa. (AU)

Breast milk contains an optimal calcium/phosphate (Ca/Pi) ratio and GOS. These natural prebiotics can be enzymatically produced via cow's milk lactose inyogurt manufacture. This milk product is low in lactose and contains prebiotics and potentially probiotic bacteria but maintains a low Ca/Pi ratio that could alter bone remodeling and mineralization. We evaluated if a lactose-reduced yogurt containing GOS (YE) offers additional advantages over regular yogurt without GOS (YR) on Ca and Pi absorption (Abs), bone retention and quality during normal growth. Weaning male rats were divided into 3 groups fed AIN'93-G (C), YE or YR for 28 days. Results: YE showed the highest increase in fecal lactobacilli; short-chain fatty acids production, especially propionate and butyrate; intestine crypt depth, and the lowest cecal pH. AbsCa% and AbsPi% increased in this order: YE> YR> C (p <0.05). Ca and Pi content in femur, bone density and mineral content, and biomechanical parameters were similar in YE and C, while YR showed the significantly lowest value (p < 0.05). Conclusions: YE increased mineral Abs reaching the retention and bone quality of C. Although YR increased Abs, bone retention and quality did not achieve C values. Seemingly, YE compensated for the negative effect of the higher Pi supply and would be a good strategy to achieve adequate peak bone mass and bone quality, especially in lactose intolerant individuals. (AU)

Effect of early electroacupuncture intervention on conscious state of patients after traumatic brain injury surgery / 中国针灸

OBJECTIVE@#To evaluate recovering consciousness effect of electroacupuncture (EA) on patients after traumatic brain injury (TBI) surgery.@*METHODS@#A total of 100 patients with traumatic coma were randomly divided into an observation group and a control group, 50 cases in each group. The control group was mainly treated with awakening drugs and neurotrophic drugs; on the basis of treatment in the control group, the observation group was treated with EA at Neiguan (PC 6) and Shuigou (GV 26) with disperse-dense wave, 2 Hz/100 Hz in frequency, 0.1-5 mA in intensity. After 30 min of EA, the needles were stayed 60 min. The treatment was performed once a day for 14 consecutive days. The changes in Glasgow coma score (GCS) was observed in the two groups before treatment and after 7, 14 days of treatment; and the two groups were followed up for 3 months after treatment to evaluate the Glasgow outcome scale (GOS) and Barthel index (BI) scores.@*RESULTS@#After 7, 14 days of treatment, the GCS scores of the two groups were higher than those before treatment (<0.05), and the increase degree in the observation group was significantly larger than that in the control group (<0.05). At 3 months of follow-up, the GOS and BI scores of the observation group were better than those of the control group (<0.05).@*CONCLUSION@#Early electroacupuncture intervention can effectively promote the recovery of consciousness after traumatic brain injury surgery, and has a curative long-term effect.

Curative effect of microscopic surgical treatment on 88 patients with intracranial aneurysms in acute stage / 局解手术学杂志

Objective To study the clinical effect of microsurgical surgery for the treatment of intracranial aneurysms in the acute phase. Methods 88 patients with intracranial aneurysm who were treated with the microscopic surgery in our hospital were selected as the research object. The prognosis was evaluated by Glasgow scale ( GOS) ,and the mortality rate during the follow-up period and postoperative complications were observed. Results All the patients received surgery success. The operation time was (60. 5 ± 20. 3) min,and the intraop-erative blood loss was (45. 2 ± 21. 5) mL. 12 months after operation,according to the GOS score of daily living ability,42 patients were of good prognosis and the other 46 cases were of poor prognosis. The good prognosis rate was 47. 7% and it is significantly higher than that of 3 months and 6 months after surgery. The difference was statistically significant (P<0. 05). There were 4 cases died among the 88 patients with a mortality of 4. 5%. Conclusion Using microsurgical treatment to treat intracranial aneurysms can receive good prognosis and low mortality rate. Complications were significantly improved after symptomatic treatment.

The invertebrate's community in adjacent Alto Iguaçu's anthropic lakes of different environmental factors / A comunidade de invertebrados em lagos antrópicos adjacentes com diferentes fatores ambientais no Alto Iguaçu

Environmental differences occur between lentic and lotic communities' establishment, especially because of water time residence. Here we used a combination of field measurements and statistical analysis to evaluate the influent factors on the aquatic macroinvertebrates' composition and structure in 15 anthropogenic lakes from Alto Iguaçu's region. Macroinvertebrates were sampled from the marginal vegetation (with or without macrophytes) and sediment. Chemical parameters ranged among the anthropogenic lakes, mainly those which are connected to the Iguaçu River, beyond the presence or absence of macrophytes, interfering on the community's structure. Lake's morphometric data were measured in each lake and its relation to community was tested. The community structure was not related to the margin development index (Ds), macrophytes and altitude. Higher equitability was associated to the macrophytes presence in more than 30% of water surface and also where the riparian vegetation was more complex. Chironomids and oligochaetes densities were associated to lakes with the water surface completely covered by macrophytes and complex riparian vegetation. We observed a close association between productivity (phosphorous and nitrogen) and the community equitability (R = 0.3; p < 0.05) and Oligochaeta dominance (R = 0.32; p < 0.05), and not to Ostracoda's (R = 0.33; p > 0.05) and Chironomidae's (R = 0.34; p > 0.05) dominances, although we had not weighty difference among analyzed biological indexes. The obtained values from the BMWP' and EPT indexes resulted in acceptable, doubtful or critical water quality, what corroborates with the macroinvertebrate's structure of the composition and with the environmental variables observed in field.

Diferenças ambientais ocorrem entre o estabelecimento de comunidades de ambientes lênticos e lóticos, especialmente por causa do tempo de residência da água. Foi usada uma combinação de métricas de campo e análise estatística para avaliar os fatores influentes sobre a composição e estrutura de macroinvertebrados aquáticos em 15 lagos antropogênicos da região do Alto Iguaçu. Os macroinvertebrados foram amostrados da vegetação marginal (com ou sem macrófitas) e sedimento. Parâmetros químicos variaram entre os lagos antrópicos, principalmente aqueles conectados ao Rio Iguaçu, além da presença ou ausência das macrófitas, interferindo na estrutura da comunidade. Dados de morfometria de lagos foram mensurados e sua relação com a comunidade foi testada. A estrutura da comunidade não foi relacionada ao índice de desenvolvimento da margem (Ds), macrófitas e altitude. Maior equitabilidade foi associada à presença de macrófitas em mais de 30% da superfície da água e também onde a vegetação ripária foi mais complexa. Densidades de quironomídeos e oligoquetas foram associadas a lagos com a superfície completamente coberta por macrófitas e complexa vegetação ripária. Foi observada associação entre a produtividade (fósforo e nitrogênio) e a equitabilidade da comunidade (R = 0.3; p < 0.05) e dominância de Oligochaeta (R = 0.32; p < 0.05) e não para a dominância de Ostracoda (R = 0.33; p > 0,05) e Chironomidae (R = 0.34; p > 0.05), apesar de não haver diferença entre os índices biológicos analisados. Os valores obtidos através do Índice BMWP' e EPT/C resultaram em ambientes de qualidade aceitável, duvidosa ou crítica, o que corrobora com a estrutura da composição de invertebrados e com as características ambientais observadas em campo.

The Prognostic Factors Related to Traumatic Brain Stem Injury

OBJECTIVE: This study was conducted to assess the clinical significance of traumatic brain stem injury (TBSI) reflected on Glasgow Coma Score (GCS) and Glasgow Outcome Score (GOS) by various clinical variables. METHODS: A total of 136 TBSI patients were selected out of 2695 head-injured patients. All initial computerized tomography and/or magnetic resonance imaging studies were retrospectively analyzed according to demographic- and injury variables which result in GCS and GOS. RESULTS: In univariate analysis, mode of injury showed a significant effect on combined injury (p<0.001), as were the cases with skull fracture on radiologic finding (p<0.000). The GCS showed a various correlation with radiologic finding (p<0.000), mode of injury (p<0.002), but less favorably with impact site (p<0.052), age (p<0.054) and skull fracture (p<0.057), in order of statistical significances. However, only GOS showed a definite correlation to radiologic finding (p<0.000). In multivariate analysis, the individual variables to enhance an unfavorable effect on GCS were radiologic finding [odds ratio (OR) 7.327, 95% confidence interval (CI)], mode of injury (OR; 4.499, 95% CI) and age (OR; 3.141, 95% CI). Those which influence an unfavorable effect on GOS were radiologic finding (OR; 25.420, 95% CI) and age (OR; 2.674, 95% CI). CONCLUSION: In evaluation of TBSI on outcome, the variables such as radiological finding, mode of injury, and age were revealed as three important ones to have an unfavorable effect on early stage outcome expressed as GCS. However, mode of injury was shown not to have an unfavorable effect on late stage outcome as GOS. Among all unfavorable variables, radiological finding was confirmed as the only powerful prognostic variable both on GCS and GOS.

Management Strategy and Outcome of Epidural Haematoma in Relation to Volume.

Epidural Haematoma (EDH) develops in 1-3% of all major head injuries and most common in the young. This crosssectional descriptive study was done to find out the management strategy and outcome of EDH in relation to clot volume. This study was performed from December'2006 to November'2007, by purposively selecting 77 cases of EDH from the Department of Neurosurgery, Dhaka Medical College Hospital (DMCH), Dhaka. The study showed that highest number of patients was in most active period of life, with male predominance (Male: Female =7.5:1). Causes of EDH were mostly due to assault (37.7%), followed by RTA (32.5%) and fall from height (29.8%). The study showed Patient having EDH Volume (EDHV) > 30ml will have 8.55 times more chance of having unfavorable outcome than patient having EDHV < 30 ml. Patient having EDHV > 30 ml will have 187.83 times more chance of requiring surgical intervention than those having EDHV <30 ml, which is statistically highly significant (p<0.001). Mortality rate of EDH can be reduced by giving early management either conservative or surgery. Delay in the management of EDH patients with poor level of consciousness and EDHV >30 ml has adverse effect on mortality and morbidity.

Factors influencing the outcome of patients with acute extradural haematomas undergonig surgery.

Background: Acute extradural haematoma (EDH) remains most common cause of mortality and disability resulting from traumatic brain injury. In the last three decades, improvements in rescue, neuromonitoring, diagnostic procedure and intensive care have led to better outcomes. The purpose of this study was to evaluate the factors influencing the outcome in patients with EDH undergoing surgery treated in a tertiary hospital in Bangladesh. Methods: In this retrospective study, 102 consecutive patients with acute EDH who underwent craniotomy were included. The study was carried out from July 2003 to December 2005. The diagnosis was made clinically and radiologically by CT scan. Patients were grouped on the basis of Glasgow Coma Scale (GCS) and operative outcomes were evaluated by Glasgow Outcome Scale (GOS) Results: More than half sampled respondents’ (57%) age were more than 20 years while rests of the patients below 20 years with male predominance (Male: Female -12:1). About 7 in 10 respondents (70.6%) were working. Similarly, majority of the respondents (79.4%) had lost more than 30 ml blood. A notable proportion of the respondents (73.5%) had good GCS score (9-15 score) during admission. Similarly majority of the respondents (70.6%) had GCS score 9-15 and 29.4% had GCS score 3-8 before surgery. Road Traffic Accident (RTA) (65%) is the most common cause of EDH followed by assault (20%) and fall from height (12%). Temporal and temporo-parietal locations were the most common site of EDH (56%). Patients with good GCS before surgery had significantly better outcome (89%) compare to those who had bad GCS (10%). Conclusion: Level of consciousness before surgery is the most important factor affecting the outcome. Hence, early diagnosis and surgical intervention is very essential.

Research of the safety of multi-slice computer tomography angiography as the evaluative criteria before aneurismal microsurgical clipping / 中华急诊医学杂志

Objective To evaluate if MS-CTA can be the primary and sole evaluative criteria for the treatment of intracranial aneurysms by microsurgery clipping. Methods Between January 2008 and October 2010, 105 patients with intracranial aneurysm underwent microsurgery clipping in our institution were respectively analyzed, out of which 39 patients with preoperative MS-CTA (64- or 320-slice CT scanner) examinations (MS-CTA group) , 21 with MS-CTA combined with DSA and 45 with DSA ( DSA group). The aneurismal size, neck, morphous and peripheral branches were compared between the CTA data and operative results, and the concordance between which were analyzed. The rate of operative complication and the GOS scale at discharge were also compared between MS-CTA group and DSA group. t test, Chi-Square test or Rank test were used for analysis of the patients' baseline data, Kappa test for the concordance between MS-CTA and operative results, Kruskal-Wallis test for operative complication and Mann-whitney test for the GOS at discharge between MS-CTA group and DSA group. Results Thirty-seven patients out of the MS -CTA group obtained successful microsurgery clipping, with 1 transferred to coil embolization because of the difficulty in exposing the aneurismal neck and 1 to decompressive craniectomy because of aneurismal rebleeding at removal cranium. There was a good concordance between MS-CTA and operative results on depicting aneurysmal size and neck ( κ =0.726 ,κ =0. 756) and a ordinary concordance on morphous and peripheral branches ( κ =0.524, κ =0.473). There was no significant difference on the rate of operative complication (P =0.509) and GOS scale (P =0.239) at discharge. Conclusions MS-CTA can reveal the important characteristics of intracranial aneurysms, and has a high safety as being the primary and sole criteria before microsurgery clipping.

Hip Structure Associated With Hip Fracture in Women: Data from the Geelong Osteoporosis Study (Gos) Data Analysis-Geelong, Australia

Aging leads to changes in bones to be highly fragile causing fractures. In this research, changes in the dimensions of the hip structure can be measured by using a computer program called ‘Hip Structural Analysis (HSA)’. The objective of this study is to estimate the association between hip geometries in Femoral Neck (FN) and the risk of hip fracture in older women. A case control study was performed to explore the objective respectively using the data of participants from population cohort and fracture cohort of the Geelong Osteoporosis Cohort Geelong, Southern Victoria, Australia. Simple and multiple logistic regressions were performed.Of total of 598, comparing Fracture group (44 subjects) and nonfracture group (454 subjects) aged over 63 years, the odds of hip fracture increased by approximately 2 fold for each 1 SD increase in width (OR=1.70(1.18-2.45,p 0.005), endocortical diameter (OR=1.80 (1,23-2.62, p=0.002), and buckling ratio (OR=1.85(1.32- 2.61, p <0.0001) and for each 1 SD decrease in BMD (OR=1.98(1.21-3.23,p.0.006) and average cortical thickness (OR=2.02(1.23-3.34), p.0.006) controlling for age, height, weight and menopausal status. Findings suggest that not only is BMD associated with hip fractures, but also other hip geometry dimensions, including WID, ENDO, AVCO and AVBR, independent of age, height, weight and physical activity.These results provide additional insights that the geometries of FN is associated with fracture neck of femur in older women and strongly suggest its potential value, not only BMD, as clinical predictors for assessing the risk of hip fracture in older women. In addition to this, utilization of some combined parameters of bone geometries in FN might be a more effective method in screening than case findings to reduce the burden of hip fracture in the future. Further statistical methods is needed to analyze the combined hip structure to predict hip fracture.

Evolución de los pacientes con trauma craneoencefalico en el Hospital Universitario del Valle: Seguimiento a 12 meses / Traumatic brain injury patients at Hospital Universitario del Valle: a 12 months study

Introducción: La principal causa de muerte en Colombia son las muertes violentas y de éstas entre 49 por ciento y 70 por ciento corresponden a trauma craneoencefalico. Existen publicaciones en Colombia que indican la epidemiología de esta catastrofe nacional, pero no realizan un seguimiento para conocer el estado neurológico-funcional posterior de estos pacientes. Objetivos: Conocer el estado funcional al a±o en pacientes con trauma craneoencefalico. Métodos: Se realizó seguimiento a una cohorte de personas que ingresaron al Hospital Universitario del Valle, Cali, Colombia, con trauma craneoencefalico entre julio de 2003 y junio de 2004. Ademas de recoger información sociodemogrßfica y clínica, se aplicó la escala Glasgow Outcome Score (GOS) al egreso, al mes y al año de sufrido el trauma. Resultados: Se incluyeron 2,049 pacientes de los cuales 83 por ciento eran hombres. Por escala de Glasgow 53 por ciento con trauma leve, 31 por ciento moderado y 16 por ciento severo. La mortalidad hospitalaria fue de 13 por ciento (10 por ciento en urgencias y según la severidad, 0.3 por ciento, 1.4 por ciento y 8 por ciento, respectivamente). Al año del trauma la mortalidad fue 14 por ciento y el 85 por ciento se encontraba entre un GOS de 4 a 5. Conclusiones: La incidencia de las variables evaluadas en los pacientes con traumatismo craneoencefalico en el presente estudio, son muy semejantes a las series descritas en la literatura mundial. En cuanto al seguimiento a 12 meses el grado de funcionalidad y mortalidad son también semejantes a la de países con alta tecnología y desarrollo.

Introduction: The main cause of death in Colombia is the violence, in which 49 percent to 70 percent correspond to traumatic brain injury (TBI). There are publications in Colombia that expose the epidemiology of this national catastrophe, but there are a few studies that follow the neurological-functional state after the head injury on this patient. Objectives: To know the functional state after one year following a traumatic brain injury on patients. Methods: A cohort of patients that were hospitalized on the Hospital Universitario del Valle, Cali, Colombia, with traumatic brain injury between July 2003 and June of 2004. The Glasgow Outcome Score (GOS) scale was apply when the patient leave the hospital, and at the first and twelve month after the brain injury. Results: 2049 patients were include on the study. 83 percent were men. 53 percent of them were classified as mild TBI, 31 percent moderate and 16 percent severe by the Glasgow Score Scale. The mortality was 13 percent intrahospital (0.3 percent, 1.4 percent y 8 percent of mortality en mild, moderate and severe respectly), and after a year of TBI the mortality was 14 percent, and 85 percent of the patients was on GOS of 4 and 5. Conclusions: The incidences of the variables evaluated on the TBI patients on the present study are similar to the world literature series. After 12 months, the followed up of functional state and the mortality of TBI patients were similar to the data of countries of high technology and developed.

The Relationship Between the Dynamic Change of High-sensitivity C-reactive Protein,IL-1?,IL-6 and the Prognosis of the Patients with Acute Traumatic Brain Injury / 医学研究杂志

Objective To study the dynamic change of high-sensitivity C-reactive protein(hCRP),interleukin-1(IL-1?)interleukin-6(IL-6)in acute traumatic brain injury,and the correlation between the dynamic change and the scale of brain injury and the prognosis of the patients.Methods 192 cases patients were divided into different groups according to the Glasgow Coma Scale(GCS)and the Glasgow outcome Scale(GOS)three months later discharged from hospital respectively.The concentration of serum CRP,IL-1?,IL-6 were detected with immunoturbidimetry and ABC-ELISA 24 with in hours after traumatic brain injury and the concentration of serum after iniwn at ond day,three days and seven days was detected as well.Results Serum hCRP levels were remarkably elevated and reached peak value within 24 hours,and then gradually decreased.There were a negative correlation between hCRP,IL-1?,IL-6 and the patient's GCS groups(r=-0.162,P

Prognostic Factors in Head Trauma Patients

BACKGROUND: Predicting outcome after head trauma is of great interest for clinicians, especially in the early stage. It may provide a basis for therapeutic strategies and may be helpful to select different approaches. But, reliable outcome prediction from head trauma is still unresolved. The purpose of this study is to determine which clinical parameters can be used effectively after an event of head trauma. METHODS: In our study we studied head trauma patients who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of June 1998 to 31th of January 2000, looked into medical records, and studied the records in a retrospective manner. The head trauma patients were divied into two group, a) favourable outcome-related and b) unfavourable outcome-related. The two groups were then subdivided according to their sex, age, the mechanism of their injury, the time they came in, alcohol drinking, loss of consciousness, vomiting, pupil change, previous medical illness, associated injuries and were seperately compared and analyzed. And the factors affecting Glasgow Outcome Scale(GOS) were analyzed in the parameters of Injury Severity Score(ISS), Revised Trauma Score(RTS), Glasgow Coma Scale(GCS), motor score of GCS(mGCS), Marshall Computed Tomographic Classification(MCTC). Statistically, t-test and Mann-Whistney rank sum test using Jandelsigma were used in the study and then were assessed in Chi-square analysis methods. The statistical significance was determined at a level of p less than 0.05. RESULTS: The total of the head trauma patients, added up to 129 people, 99:males and 30:females. Among this sum, 99 patients showed a favourable outcome and 30 patients showed an unfavourable outcome at discharge. The causes of injury included: automobile accident in 42 cases; falls in 26; assaults in 6; and accidental-slipping injury etc in 55 cases. 12 patients had bilateral unreactive pupils on admission, 2 had unilateral reactive pupils, and 113 had bilateral reactive pupils. Compared to the favourable outcome-related head trauma group, the unfavourable outcome-relared head trauma group had more history of loss of consciousness, unreactive pupils and tended to have previous medical illness. There were no difference in alcohol related, vomiting and associated injuries between two groups(favourable outcome-related head trauma group: unfavourable outcome-related head trauma group). Substantial difference were observed in GCS, mGCS, ISS, RTS, MCTC between two groups. Patients with unfavourable outcome had a significantly higher ISS, lower RTS, lower mGCS. After MCTC, patients with mass lesion had unfavourable outcome than patients with diffuse injury. CONCLUSION: Age, history of loss of consciousness, previous medical illness and unreactive pupil change are predictives of outcomes of head trauma patients with respect to Glasgow outcome scale. The lower GCS, lower RTS, lower mGCS, higher ISS, mass lesion based on CT scan provide poorer prognostic outcome in patients with head trauma. Use of prognostic factors thorough complete history taking and physical examination would provide useful prognostic information and facilitate improved therapeutic decision-making in head-injuried patients.

Clinical Analysis of Combined Head and Spine Trauma

Among 1350 craniocerebral trauma patients treated between January 1992 and December 1995. The authors analyzed 25 who had suffered combined head and spine trauma and had been subject to follow up. The ratio of males to females was 4 : 1 ; their ages ranged from less than twenty to over sixty. As clinical parameters, we use of the Glasgow Coma Scale(GCS), Revised Trauma Score(RTS) and Glasgow Outcome Scale(GOS) at discharge, and for clinical statistics, used the chi-square test. The results of the study were as follows : 1) Among craniocerebral trauma patients, the incidence of combined head and spine trauma was 2%(25/1350). 2) In cases with combined craniospinal trauma, the incidence of intracranial hemorrhage and cervical spine injury was 76% and 68%, respectively. 3) Among cases with spinal injury, head trauma combined with cervical spine injury showed the worst outcome (p<0.05). 4) Combined high cervical spine injury showed a poorer outcome than did lower cervical spine injury(p<0.05). 5) Initial GCS was significantly related to initial RTS(p<0.05). 6) At discharge, there was a very highly significant correlation between initial GCS and GOS(p<0.01), but not between initial RTS and GOS(p<0.081). 7) Especially in patients who are unconscious because of head trauma, it is important to investigate the possibility of spinal injury other than that of at cervical level.

Delayed Traumatic Intracranial Lesion

A retrospective analysis of 33 cases with operated delayed intracranial lesion who were admitted to EU1 Ji General Hospital from January 1990 to December 1992 was made according to their age and sex, etiology, lesion site, time interval to finding delayed intracrainal lesion, brain CT findings, relationship of GCS in initial and delayed lesion, associated injuries, treatment and prognosis(GOS). The results were follows : 1) The young males on first to second decade were most frequently affected. 2) The most common caused was pedestrian accident by motor vehicle, followed by fall down. 3) The most common associated injury was skull fracture, followed by skeletal injury of extremity. 4) The most common delayed intracranial lesion was delayed epidural hematoma on youth. 5) The most frequent time interval when the delayed intracranial lesion may be occurred was from 12 hr to 24 hr after admission. 6) The most possible intial lesion which the delayed epidural hematoma may be occurred was scanty hematoma with pnumocephalus or CSF leakage. 7) The GOS(Glasgow Outcome Scale) of analysed 33cases were good in 60% and poor in 40%, i.e good recovery(42%), moderate disability(18%), severe disability(15 %), vegetative state(12%), death(12%).

The Clinical Analysis of Alcohol and Creatine Kinase-BB(CK-BB) in Acute Head Injury

Patients suffering a head-injury were often drinking alcohol shortly before the trauma, and it has been suggested that the degree of brain damage may be exacerbated due to high alcohol serum levels. To evaluate this, we assessed the level of consciousness, alcohol and creatinine kinase-bb(CK-BB) serum levels in 140 consecutive head-injured patients. Level of consciousness(GCS score) was strongly correlated to outcome(p<0.001) and serum CK-BB(P<0.05), but not to alcohol serum levels.

A Clinical Observation on Head Injuries in Infants and Children

A clinical analysis was carried out with 400 cases of head injuries under 15 years of age admitted at the Department of Neurosurgery, Inha University Hospital during 4 years from 1987 to 1990. The material was classified into three groups according to main lesions, i.e. 1) simple cerebral contusion without skull fractures, 2) various types of skull fractures, 3) intracranial hemorrhagic lesions, representing such lesions as follows;a) epidural hematoma, b) subdural hematoma, c) intracerebral hematoma, intraventricular and subarachnoid hemorrhage. The results were as follows; 1) The age incidence was greatest in 7 years of age, and 188 cases(47%) were included in the age group between seven and ten. The accident occurred mostly from March to May, especially in April. 2) The head injuries were caused by traffic accident(203 cases:51%), fall down(152 cases:38%), etc. In clinical pictures, neck sprain(52.8%), nausea and vomiting(47.5%), and early epilepsy)9%) were developed. 3) The linear skull fracture was higher than other type fractures(74.6%) and the locations of skull fractures were parietal, occipital, temporal and frontal bone in order of frequency. 4) Among the intracranial hemorrhagic lesions, EDH was most common lesion, 73 cases(79%) of the patients with intracranial hemorrhagic lesions were accompanied by skull fractures but of the patients with skull fracture, 51.4% were accompanied by hemorrhagic lesions. Lucid interval was observed in 15 of the cases with intracranial hemorrhagic lesions and contre-coup injury was developed in 19(12%). 5) In the GOS, the high scored cases on the GCS were better than the low scored cases. 4 cases of 23 people scored under 8 on the GCS died. 14 cases of them were included in the age between 6 and 10(61%). 6) Associated injuries were found in about 16% of the total patient, the most common injury was clavicle fracture and most frequent sequala was post traumatic syndrome. The late epilepsy was occurred in about 13% of the early epilepsy cases except the cases had pre-traumatic epilepsy history.

Clinical Analysis of Interhemispheric Subdural Hemorrhage and Tentorial Hemorrhage

A propecive analysis of 50 patients with acute interhemisphric subdural hemorrhage and tentorial hemorrhage, an unusual pattern of acute subdural hematoma, who were managed in a uniform way was analyzed to related outcome to hemorrhagic site, initial Glasgow Coma Scale(GCS) and combined injuries. The incidence of acute interhemisphric subdural hemorrhage(ISH) and tentoria hemorrhage(TH) after head trauma was 3.83%, 50 cases among 1303 head injured cases. And 80% of the above hemorrhage disapperaed within two weeks after trauma. There was no significant relationship between feature of hemorrhage and intial GCS(P>0.05), but there was highly significant relationship between initial GCS and Glasgow Outcome Scale(GOS) (p<0.001). There noted significant relationship between initial combined injury and GOS(p<0.01), and also brainstem injury and GOS(p<0.001).

The Clinical Significance of Serum Creatine Kinase-BB(CK-BB) in Acute Head Injury

Serial enzymatic determinations by electrophoresis were confined in serum of CK-BB(creatine kinase brain fraction), which were performed on 150 patients with acute head injury. The purpose of this study was to re-evaluate the usefulness of this serum enzyme value as a prognostic correlates. The results obtained are as follows : 1) 125 cases(83.3%) among 150 cases with head injury were revealed as CK-BB positive finding, whereas 25 cases (16.7%) with negative results have generally good outcome. 2) 3 cases (11.5%) of false positive finding were shown among 26 control group with back pain. 3) The maximum value of CK-BB(CK-BBmax) was een within 1st day(38.4%), and 3rd days (80.8%) following injury. 4) The appearance of mean CK-BBmax had two varieties of peak incidence on 1st-and 4th day following injury. 5) The Glasgow Coma Scale(GCS) Score on admission had close relationship to the value of inital CK-BB(CK-BBin) and CK-BBmax, respectively (P or =1 IU.L) to outcome (P or =1 IU/L) to outcome did not (P=0.126). 8) The Glasgow Outcoem Scale (GOS) was strongly correlated to mean GCS Score (P<0.000) and mean CK-BBin (P<0.000), but not to mean CK-BBmzs (P<0.139). 9) The correlationship between mean value of CK-BBin and CK-BBmax was statistically significant only in good recovery and moderate disability group, respectively (P<0.000 & P<0.003).

Clinical Analysis of Traumatic Basal Ganglia Hematoma(TBGH)

Recently, the detection of traumatic intracerebral hematoma has been greatly expedited by the advent of computed tomography. However, Traumatic Basal Ganglia Hematoma(TBGH) has remained rare and its prognosis has been regarded as poor. The authors obtained following results from the analysis of clinical features and outcome on 50 cases of TBGH who has been treated at the department of neurosurgery, Wonju Christian Hospital from January, 1984 to June, 1988. 1) The incidence of TBGH was 2% of all head-injured patients. 2) The average age of patient was 26.6 years, and the most common cause was motorvehicular accident(80%). 3) The clinical features revealed mental deterioration on 44 cases, followed by motor weakness(23 cases), and decerebrate rigidity(16 cases). 4) The frequent location of hematoma was putamen(27 cases, >50%), internal capsule(9 cases, 14%). 5) The combined lesion showed mostly lower GCS(Glasgow Coma Scale) than solitary lesion(P<0.001). 6) The groups of both GCS above 8(P<0.001) and small hematoma volume below < 15ml(P<0.001) showed relatively good outcome.