Effect of butylphthalide injection to mitochondrial function of porcine cerebral neuron after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To investigate the mechanism of cerebral protection by treatment of butylphthalide (NBP) and its effect to mitochondria in a porcine model of cardiac arrest (CA) after cardiopulmonary resuscitation (CPR). Methods Healthy Wuzhishan pigs weighting (30±2) kg were divide into three groups randomly(random number): The sham group (n=6), the control group (n=12) and the NBP group (n=12). Operation was performed in the sham group. Cardiac arrest of ventricular fibrillation was induced by programed electrical stimulation in the control and NBP group. After CPR, asynchronous defibrillation of 150J was performed to achieve the restoration of spontaneous circulation. NBP was injected at the rate of 2.5 mg?kg-1 in the NBP group. Hemodynamics were recorded at baseline, 1 hr, 2 hr, 3 hr and 4 hr after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were calculated under light and electrical microscope respectively. Mitochondria were separated by differential centrifugation. Mitochondrial respiratory function was measured with oxygen consumption of R3 and R4, respiratory control rate (RCR), ADP/oxygen. Mitochondrial permeability transition pore (MPTP) open was tested by colorimetric. Results After CPR, the mean artery pressure, coronary perfusion pressure and cardiac output decreased significantly, whereas no significant differences were found between the control and NBPgroup (P>0.05). Significant cerebral injury was found after CPR. The number of injured neurons, apoptosis index and evaluation of mitochondrial injury were improved significantly by the NBP treatment (P<0.05). Compared with the sham group, oxygen consumption of R3 and R4, R3/R4 and ADP/O decreased significantly in the cerebral frontal cortex mitochondria of the control group (P<0.01), whereas they were increased in the NBP group (P<0.01). MPTP increased in the control group, which could be improved by the NBP treatment. Conclusions NBP can improve the neurologic outcome after CPR and decrease the apoptosis of neurons by improving the respiratory function of mitochondria and inhibiting the MPTPopening.

Neurologic outcome of Filipino children diagnosed with central nervous system infection

@# Neurologic infections are related to chronic and life-long neurologic impairment. We aim to describe the outcomes of Filipino children with neurologic infections upon, and within one year from discharge. This data will be useful in developing programs for the prevention and improvement of outcomes in children with neurologic infections. Methods: This is a multicenter, cross-sectional, retrospective cohort study at six tertiary hospitals across the Philippines within four years (2007-2010). A standardized report form was used to collect clinical profile and outcome using inpatient and outpatient records. Neurologic outcome was classified and staged at 3-, 6-, 9- and 12-months postdischarge. Results: A total of 480 patients were included in the analysis (mean age 4.7 ± 5.3 y), most were bacterial in etiology (275 cases, or 57.3%). Severity of illness on admission (Stage 3, p <0.001) and etiologic agent (viral, p <0.001) were correlated with poor neurologic outcome on discharge. Of the 154 patients that had follow-up, 91 cases were observed to have neurologic deficits (severe, 50; moderate, 29; and mild 12). Twenty patients had improvement of neurologic impairment on subsequent follow-up. Motor deficits (64 cases), cognitive disorders (26 cases) and seizures (17 cases) are the most common neurologic sequela

Hemoglobin concentration is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management

OBJECTIVE: The objective of this study was to test the hypothesis that hemoglobin concentration after return of spontaneous circulation (ROSC) is associated with neurologic outcome after cardiac arrest in patients treated with targeted temperature management. METHODS: We studied consecutive adult patients with out-of-hospital cardiac arrest treated with targeted temperature management between January 2009 and December 2015. We investigated the association between post ROSC hemoglobin concentrations and good neurologic outcome (defined as Cerebral Performance Category of 1 and 2) at hospital discharge using multivariate logistic regression analysis. RESULTS: A total of 246 subjects were ultimately included in this study. The mean age was 54 years (standard deviation, 17); 168 (68%) subjects were male. Eighty-seven (35%) subjects had a good neurologic outcome at hospital discharge. Hemoglobin concentrations were higher in the good outcome group than in the poor outcome group (14.4±2.0 vs. 12.8±2.5 g/dL, P < 0.001). Multivariate logistic regression analysis showed that hemoglobin concentrations were associated with good neurologic outcome at hospital discharge after adjusting for other confounding factors (adjusted odds ratio, 1.186; 95% confidence interval, 1.008 to 1.395). CONCLUSION: In post ROSC patients, hemoglobin concentrations after ROSC were associated with neurologic outcome at hospital discharge.

Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients

OBJECTIVE: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance.METHODS: One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was 56.3±14.3 (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality.RESULTS: Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007).CONCLUSION: The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients’ outcome and timely treatment decision.

Comparison of neurologic outcome between active abdominal compression-decompression cardiopulmonary resuscitation and standard cardiopulmonary resuscitation in asphyxia cardiac arrest / 中华危重病急救医学

Objective To compare the neurologic outcome after the active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) and chest compression cardiopulmonary resuscitation (STD-CPR) in asphyxia cardiac arrest (CA). Methods A prospective multicenter randomized controlled trial (RCT) was conducted. Adult patients with CA because of asphyxia such as drowning, airway obstruction admitted to Zhengzhou People's Hospital and Sanmenxia Central Hospital from June 2014 to December 2017 were enrolled. With the informed consent of patients' families, patients were divided into AACD-CPR group and STD-CPR group according to random number table method. The blood from median cubital vein or basilic vein were extracted at 1, 6, 12, 24 and 48 hours after the return of spontaneous circulation (ROSC), and the levels of S100B protein and neuron-specific enolase (NSE) were detected by enzyme linked immunosorbent assay. Neurological outcome was classified according to cerebral performance classification (CPC) after 3 months. Results A total of 183 patients were selected, including 78 ROSC patients after CPR. Patients with CA > 8 minutes and rescue time > 1 hour were excluded, 69 ROSC patients (36 in STD-CPR group and 33 in AACD-CPR group) were finally included. After ROSC, the levels of S100B protein and NSE in blood of two groups were increased gradually, reaching the peak at 6 hours, and then decreased gradually. The levels of S100B protein and NSE in AACD-CPR group at different time points after ROSC were significantly lower than those in STD-CPR group [S100B protein (μg/L): 1.62±0.52 vs. 1.88±0.46 at 1 hour, 1.71±0.41 vs. 2.02±0.58 at 6 hours, 1.24±0.37 vs. 1.52±0.59 at 12 hours, 1.05±0.23 vs. 1.28±0.37 at 24 hours, 0.82±0.29 vs. 1.05±0.36 at 48 hours; NSE (μg/L):24.76±3.02 vs. 26.78±4.29 at 1 hour, 58.78±5.58 vs. 61.68±5.44 at 6 hours, 53.87±4.84 vs. 56.78±5.68 at 12 hours, 40.96±3.52 vs. 43.13±4.50 at 24 hours, 33.23±2.89 vs. 35.54±3.44 at 48 hours; all P < 0.05]. 3 months after ROSC, the CPC classification of AACD-CPR group was lower than that of the STD-CPR group (average rank: 28.86 vs. 42.46, Z = -3.375, P < 0.001). Conclusion After suffering asphyxia CA, patients who accepted AACD-CPR had better neurologic outcome than STD-CPR.

Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients

OBJECTIVE: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance. METHODS: One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was 56.3±14.3 (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality. RESULTS: Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007). CONCLUSION: The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients’ outcome and timely treatment decision.

Clinical Results of the Intra-Arterial Thrombolysis with Stent Retriever Device Weather Perfusion Diffusion Mismatching and Intravenous Tissue Plasminogen Activator Administration

OBJECTIVE: Intraarterial thrombolysis (IA-Tx) with stent retriever is accepted as an additional treatment for selected patients and the clinical benefit is well reported. Each intravenous tissue plasminogen activator administration (IV-tPA) and perfusion diffusion mismatching (P/D-mismatching) is well known the beneficial effects for recanalization and clinical outcomes. In this report, authors analyzed the clinical outcomes of additional IA-Tx with retrieval stent device, according to the combined IV-tPA and P/D-mismatching or not. METHODS: Eighty-one treated IA-Tx with the Solitaire stent retriever device, diagnosed as anterior circulation larger vessel occlusion were included in this study. Computed tomography-angiography (CTA) was done as an initial diagnostic image and acute stroke magnetic resonance image (MRI) followed after the IV-tPA. Forty-two patients were in the tPA group and 39 patients were in the non-tPA group. Recanalization rate, clinically significant hemorrhagic (sICH) and clinical outcomes were recorded according to the IV-tPA and P/D-mismatching. RESULTS: Recanalization rate was 81.0% in IV-tPA group, and it was 69.2% in non-tPA group (p = 0.017). While sICH were 19.9% and 25.6%, respectively (p = 0.328). Neurologic outcomes did not influence by IV-tPA administration or not. But according to the P/D-mismatching, the recanalization rate and sICH were 91.9% and 16.7% in the mismatched group and 46.7% and 46.7% in the matched group (p = 0.008 and p = 0.019, respectively). CONCLUSION: For patients treated with IA-Tx with retrieval stent, IV-tPA infusion does not influence on the sICH, recanalization rate and neurologic outcomes. But P/D-mismatching was correlated well with sICH, recanalization rate and clinical outcomes.

Correlation between Preoperative Magnetic Resonance Imaging Signal Intensity Changes and Clinical Outcomes in Patients Surgically Treated for Cervical Myeloradiculopathy

STUDY DESIGN: This was a single surgeon, single center-based retrospective study with prospective data collection. PURPOSE: To assess the correlation between T2-weighted magnetic resonance imaging (MRI) signal intensity (SI) changes and factors such as age, duration of symptoms, baseline modified Japanese Orthopedic Association (mJOA) score and to determine its prognostic value in predicting recovery after surgery. OVERVIEW OF LITERATURE: Whether intramedullary cord T2-weighted MRI SI changes can predict operative outcomes of cervical myeloradiculopathy remains debatable, with only a few prospective studies analyzing the same. METHODS: Forty-six consecutive patients who underwent cervical myeloradiculopathy were included and were followed up for an average of 1 year. Preoperative T2-weighted MRI SI grading was performed for all patients. The correlation between MRI SI changes and age, duration of symptoms, preoperative mJOA score, and mJOA score at 1-year follow-up were analyzed. RESULTS: Fifteen patients had single-level (21.73%) or double-level (10.86%) prolapsed discs; 54.34% had degenerative cervical spondylosis with canal stenosis or multilevel disc prolapse and 13.07% had ossified posterior longitudinal ligaments. The mean age was 56.17±9.53 years (range, 35–81 years). The mean baseline mJOA score was 10.83±2.58 (range, 6–16), which postoperatively improved to 13.59±2.28 (range, 8–17; p<0.001). There was a statistically significant correlation between mJOA score at 1 year and MRI T2 SI grading (p=0.017). CONCLUSIONS: Patients with longer symptom durations had high grades of intramedullary cord T2-weighted MRI SI changes. Age and preoperative neurological status were not significantly correlated with the existence of intramedullary cord SI changes. However, patients without or with mild and diffuse intramedullary cord T2-weighted MRI SI changes had better postoperative neurological recovery than those with sharp and focal SI changes.

Impact of early coronary angiography on the survival to discharge after out-of-hospital cardiac arrest

OBJECTIVE: Acute myocardial infarction is a major cause of out-of-hospital cardiac arrest (OHCA). Coronary angiography (CAG) enables diagnostic confirmation of coronary artery disease and subsequent revascularization, which might improve the prognosis of OHCA survivors. Non-randomized data has shown a favorable impact of CAG on prognosis for this population. However, the optimal timing of CAG has been debated. METHODS: The clinical outcomes of 607 OHCA patients registered in CAPTURES (Cardiac Arrest Pursuit Trial with Unique Registration and Epidemiologic Surveillance), a nationwide multicenter registry performed in 27 hospitals, were analyzed. Early CAG was defined as CAG performed within 24 hours of emergency department admission. The primary outcome was survival to discharge, with neurologically favorable status defined by cerebral performance category scores ≤2. RESULTS: Compared to patients without CAG (n=469), patients who underwent early CAG (n=138) were younger, more likely to be male, and more likely to have received bystander cardiopulmonary resuscitation, pre-hospital defibrillation, and revascularization (P<0.01 for all). Analysis of 115 propensity score-matched pairs showed that early CAG is associated with a 2.3-fold increase in survival to discharge with neurologically favorable status (P<0.001, all). Survival to discharge increased consistently according to the time interval between emergency department visit and CAG (P<0.05). CONCLUSION: Early CAG of OHCA patients was associated with better survival and favorable neurologic outcomes at discharge. However, there was no clear time threshold for CAG that predicted survival to discharge.

Prognostic value of neuron-specific enolase and bispectral index in patients after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective To evaluate the prognostic value of the neuron-specific enolase ( NSE ) and bispectral index ( BIS) in patient with mild therapeutic hypothermia ( MTH) after cardiopulmonary resuscitation ( CPR ) .Methods Forty-six patients with restoration of spontaneous circulation ( ROSC ) after CPR were treated with MTH.The BIS values were recorded and the serum NSE was measured at the following times:24 h, 48 h, and 72 hours after ICU admission.Neurological outcome was classified according to the Pittsburgh cerebral performance category ( CPC 1 to 5) at 3 months after ICU discharge.Results Fourteen patients had a good neurological outcome with CPC score 1-3, and thirty-two patients had a poor neurological outcome with CPC 4-5 at 3 month.Compared with good outcome group, the NSE values were significantly higher in the poor outcome group on day 2 and day 3 after admission [48 h: (90.1 ±42.7) ng/mL vs.(33.2 ±17.5) ng/mL;72 h: (95.4 ±37.0) ng/mL vs. (29.2 ±17.0) ng/mL, P<0.05].NSE increased markedly in the poor neurological outcome group at 48h and 72h, and decreased significantly in the good group at the same time [△NSE 24 h-48 h: (37.3 ±28.7) ng/mL vs.(-10.7 ±12.1) ng/mL; △NSE 48 h-72h: (5.3 ±13.2) ng/mL vs.(-4.0 ±4.5 ng/mL), P<0.05].Over the 72 h of monitoring, the mean BIS values were lower in the poor outcome group compared to the good outcome group at 48 h [ (39.2 ±24.1) vs.(78.0 ±12.4); 72 h: (45.7 ±26.4) vs.(89.0 ±7.3), P<0.05].Conclusions The values of NSE and BIS were effective prognostic indicators for the neurological outcome of patients with MTH after CPR.

Neurologic Outcomes of Preoperative Acute Silent Cerebral Infarction in Patients with Cardiac Surgery

BACKGROUND: Acute cerebral infarction is a major risk factor for postoperative neurologic complications in cardiac surgery. However, the outcomes associated with acute silent cerebral infarction (ASCI) have not been not well established. Few studies have reported the postoperative outcomes of these patients in light of preoperative Diffusion-weighted magnetic resonance imaging (DWI). We studied the postoperative neurologic outcomes of patients with preoperative ASCI detected by DWI. METHODS: We retrospectively studied 32 patients with preoperative ASCI detected by DWI. None of the patients had preoperative neurologic symptoms. The mean age at operation was 68.8+/-9.5 years. Five patients had previous histories of stroke. Four patients had been diagnosed with infective endocarditis. Single cerebral infarct lesions were detected in 16 patients, double lesions in 13, and multiple lesions (>5) in three. The median size of the infarct lesions was 4 mm (range, 2 to 25 mm). The operations of three of the 32 patients were delayed pending follow-up DWI studies. RESULTS: There were two in-hospital mortalities. Neurologic complications also occurred in two patients. One patient developed extensive cerebral infarction unrelated to preoperative infarct lesions. One patient showed sustained delirium over one week but recovered completely without any neurologic deficits. In two patients, postoperative DWI confirmed that no significant changes had occurred in the lesions. CONCLUSION: Patients with preoperative ASCI showed excellent postoperative neurologic outcomes. Preoperative ASCI was not a risk factor for postoperative neurologic deterioration.

Long-Term Incidence and Predicting Factors of Cranioplasty Infection after Decompressive Craniectomy

OBJECTIVE: The predictors of cranioplasty infection after decompressive craniectomy have not yet been fully characterized. The objective of the current study was to compare the long-term incidences of surgical site infection according to the graft material and cranioplasty timing after craniectomy, and to determine the associated factors of cranioplasty infection. METHODS: A retrospective cohort study was conducted to assess graft infection in patients who underwent cranioplasty after decompressive craniectomy between 2001 and 2011 at a single-center. From a total of 197 eligible patients, 131 patients undergoing 134 cranioplasties were assessed for event-free survival according to graft material and cranioplasty timing after craniectomy. Kaplan-Meier survival analysis and Cox regression methods were employed, with cranioplasty infection identified as the primary outcome. Secondary outcomes were also evaluated, including autogenous bone resorption, epidural hematoma, subdural hematoma and brain contusion. RESULTS: The median follow-up duration was 454 days (range 10 to 3900 days), during which 14 (10.7%) patients suffered cranioplasty infection. There was no significant difference between the two groups for event-free survival rate for cranioplasty infection with either a cryopreserved or artificial bone graft (p=0.074). Intergroup differences according to cranioplasty time after craniectomy were also not observed (p=0.083). Poor neurologic outcome at cranioplasty significantly affected the development of cranioplasty infection (hazard ratio 5.203, 95% CI 1.075 to 25.193, p=0.04). CONCLUSION: Neurologic status may influence cranioplasty infection after decompressive craniectomy. A further prospective study about predictors of cranioplasty infection including graft material and cranioplasty timing is necessary.

Clinical characteristics and prognosis of acute disseminated encephalomyelitis based on the lesions on MRI / 소아과

PURPOSE: Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system and mostly develops after viral illness or vaccinations. We investigated the clinical differences and neurologic outcomes according to the distribution of the lesions on brain MRI. METHODS: The study group was composed of 21 patients from January 1995 to August 2003 in Kyunghee University hospital. We grouped the patients according to the MRI findings as follows. Group I (14 cases): Multi- or unifocal lesions only in the cerebral white matter. Group II (7 cases): lesions in the gray matter with or without white matter involvement. RESULTS: 1.Preceding events were as follows: no defined prodrome (38.1%), upper respiratory tract infection (28.6%), nonspecific febrile illness (19.0%), gastointestinal disturbance and vaccination. 2.Presenting symptoms were as follows: seizures (76.2%), headache/vomiting (47.6%), altered consciousness (38.1%), hemiparesis, cerebellar ataxia, visual disturbance and facial nerve palsy. 3.Laboratory findings were as follows: CSF pleocytosis (76.2%), leucocytosis (38.1%) and elevated CSF protein (28.6%). 4.Fifteen patients were recovered completely without neurological sequelae. Three patients in group I and 1 patient in group II had intractable seizures. Two patients in group I and 2 patients in group II had motor disturbance. CONCLUSION: There were no statistically significant differences in preceding events, presenting symptoms, and neurological outcomes according to the distribution of the lesions on brain MRI. However, the ADEM have quite diverse clinical manifestations and neuroimage findings. MRI plays an important role in making diagnosis of the patients who are suspected of ADEM.

Prognostic Factors and Treatment Strategies for Acute Viral Encephalitis / 대한소아신경학회지

PURPOSE: Encephalitis is a cranial nervous system infection that is caused by various etiologies. Most of the patients with encephalitis undergo severe or fatal clinical course with sequelae. This study was conducted to estimate the clinical outcomes and to evaluate factors which can be used to predict clinical outcomes among pediatric patients with encephalitis METHODS: We retrospectively reviewed 46 patients with encephalitis who were admitted to the Department of Pediatrics of Chonbuk National University Hospital, from July 1995 to July 2003. Encephalitis was diagnosed based on the presence of neurologic abnormalities, CSF, Brain CT or MRI findings. Information on sequelae was obtained in the outpatient clinic. RESULTS: In this study, five patients(11.6%) were expired, 17 patients(39.5%) developed neurologic sequelaes and 21 patients(46.5%) were recovered without sequelae. Infants had poorer outcomes compared to older age groups. Twenty nine cases who had seizures showed high morbidity rate(48.3%) compared to the seizure-free group(17.6%). Among six patients with status epilepticus, four(66.7%) developed neurologic sequelae and two(33.3%) expired. The group with normal brain MRI findings had better outcomes (70%) than the group with abnormal MRI findings(55.5%). Gray matter involved patients on MRI had poorer recovery rate(33.3%) than white matter involved patients(69.2%). The group treated with intravenous immunoglobulin(IVIG) had better outcomes(64.7%) than the other group(37.9%). CONCLUSION: The presence of seizure, younger patients, and presence of abnormal findings of brain MRI, especially gray matter lesions were associated with poor clinical outcomes in children with encephalitis.

The effect of hyperthermia on neurologic outcome during the post-resuscitation period

PURPOSE: This study is to clarify the clinical characteristics of hyperthermia and to evaluate the correlation between hyperthermia and neurologic outcome after successful cardiopulmonary resuscitation (CPR). METHODS: This retrospective study was performed from Aug. 1995 to Dec. 2001 at the Ewha Womans University Mokdong Hospital. We reviewed the medical records of 41 adult patients who survived for longer than 72 h after successful CPR. The patients were divided into two groups: favorable neurologic outcome group (n=17) and unfavorable neurologic outcome group (n=24). The hyperthermic group was composed of patients whose highest body temperature had been more than 38 degrees C. In the hyperthermic group, we analyzed the correlation between evidence of infection and neurologic outcome. We considered evidence of infection to be a positive result for a blood, sputum, or urine culture, and pneumonic infiltration on chest X-ray. RESULTS: The average of the highest body temperature within 72 h after successful CPR was 38.4+/-0.9 degrees C for the unfavorable neurologic outcome group, which was significantly higher than the value of 37.7+/-0.5 degrees C for the favorable neurologic outcome group (p =0.002). No significant correlation existed between neurologic outcome and age, place of cardiac arrest, duration of arrest, causes of cardiac arrest, and initial blood pressure after uccessful resuscitation. In hyperthermic group (n=18), eight patients showed the evidence of i nfection, but no significant correlation existed between the evidence of infection and neurologic outcome (p =0.850). CONCLUSION: Hyperthermia is a potential factor for an unfavorable neurologic recovery after successful CPR.

The Significance of the Early Electroencephalographic Findings in Severely Asphyxiated Newborn Infants

PURPOSE: Perinatal asphyxia occurring in newborn is one of the major causes of acute mortality and chronic neurological disability in survivors. We have studied the relationship between early electroencephalography(EEG) findings and clinical course and neurologic outcome in severe asphyxiated neonates. METHODS: Between the period of July 1999 and June 2002, 25 neonates who were diagnosed with severe perinatal asphyxia(1-minute Apgar score of < or =3 and initial pH is less than 7.2) at NICU in Dongsan Medical Center were enrolled. An EEG was recorded and analyzed within three days of life and divided into two groups - group 1(normal or focal change on EEG) and group 2(generalized abnormal EEG). Between the two groups, clinical courses and neurologic outcomes were compared. RESULTS: Fifteen infants(60%) were group 1 and ten infants(40%) were group 2(polyspikes, burst- suppression, generalized low voltage). Associated maternal disease, days of hospitalization, need for ventilator support, delay of oral feeding and convulsion duration are significantly higher and longer in group 2. Also, poor neurologic outcome(expire, developmental delay) was significantly higher in group 2(60%) than group 1(13.3%). CONCLUSION: Thus, the early neonatal EEG in asphyxiated newborn can be a predictable diagnostic tool in assessment of neurologic outcome.

Risk Factors for Periventricular Echodensities and Neurologic Outcome in Preterm Infants

PURPOSE: In preterm infants with brain injury, periventricular echodensity is increased transiently or becomes cyst with neurologic sequelae. This study was done to identify the infants who need early rehabilitation treatment by evaluating the risk factors and neurologic outcome in cystic change group and transient echodensity group. METHODS: Thirty one preterm infants with periventricular echodensity on cranial ultrasonography were divided into cystic change group and transient echodensity group. The prenatal, natal, postnatal risk factors and neurologic outcome were evaluated in each group. RESULTS: The risk factors for periventricular cystic change included gestational age, ventilator use, oxygen administration, surfactant use and anemia. The risk factors for transient periventricular echodensity were the same as the cystic change group except gestational age. The development of cerebral palsy occurred in 3 cases out of 10 cases, 2 cases out of 21 cases in each group. CONCLUSION: The preterm infants with periventricular cysts or transient periventricular echodensity need to be observed closely for the development of adverse neurological outcomes especially of those with aforementioned risk factors.

Risk Factors for Periventricular Echodensities and Neurologic Outcome in Preterm Infants

PURPOSE: In preterm infants with brain injury, periventricular echodensity is increased transiently or becomes cyst with neurologic sequelae. This study was done to identify the infants who need early rehabilitation treatment by evaluating the risk factors and neurologic outcome in cystic change group and transient echodensity group. METHODS: Thirty one preterm infants with periventricular echodensity on cranial ultrasonography were divided into cystic change group and transient echodensity group. The prenatal, natal, postnatal risk factors and neurologic outcome were evaluated in each group. RESULTS: The risk factors for periventricular cystic change included gestational age, ventilator use, oxygen administration, surfactant use and anemia. The risk factors for transient periventricular echodensity were the same as the cystic change group except gestational age. The development of cerebral palsy occurred in 3 cases out of 10 cases, 2 cases out of 21 cases in each group. CONCLUSION: The preterm infants with periventricular cysts or transient periventricular echodensity need to be observed closely for the development of adverse neurological outcomes especially of those with aforementioned risk factors.

The Relationship between Hyperglycemia and Neurologic, Functional Outcome with Traumatic Brain Injury

OBJECTIVE: Traumatic brain injury is related to the acute stress response, and this can be accompanied by an elevated serum glucose level. So we estimated the influence of hyperglycemia on neurologic, functional status and outcome. METHOD: We studied the 139 traumatic brain injured patients who had been admitted to the department of neurosurgery from 1996 to 2000, retrospectively. We reviewed initial serum glucose level, postoperative glucose level, and Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS). We compared these values with functional independence measure (FIM) scores. Patients were divided into two groups according to the initial serum glucose level, then we analyzed the correlation between glucose level and GCS, GOS, FIM. RESULTS: The correlations of early hyperglycemia with GCS, GOS, initial FIM scores were significant (p0.05). Patients with unfavorable neurologic outcome after 10 days from head injury had significantly high serum initial and postoperative glucose levels than those with favorable neurologic outcome (p<0.01). CONCLUSION: In patients who had received rehabilitation therapy with moderate or severe head injury, early hyperglycemia were significantly correlated with initial FIM scores, GCS, GOS, but not with the plateau FIM scores.

Neonatal hypocalcemia: clinical manifestations and prognosis

No abstract available.