RESUMEN
Pneumocephalus is defined as the presence of air in the intracranial cavity. In most cases, its evolution is asymptomatic and benign. Pneumocephalus post-surgery is a frequent complication of cranial surgery. We herein report delayed tension pneumocephalus after craniotomy for pituitary macroadenoma. A 73-year-old man with recurrent pituitary macroadenoma underwent subtotal resection via subfrontal approach. The postoperative course was uneventful and the patients regained his normal daily living activities. Two months after the surgery the patients developed decreased level of consciousness and was diagnosed to suffer from tension pneumocephalus. Another craniotomy was performed and the dural defect at the base was repair with secondary graft and bone wax. The patient improved neurologically and had no pneumocephalus. The follow-up revealed good condition and outcome. In conclusion, tension pneumocephalus can occur at any time after craniotomy and post-surgical deterioration after resection of a giant pituitary tumor should be immediately assessed. There is not enough evidence to correlated tumor size with rates of pneumocephalus in this particular report, but further cases may need to be studied to come to a conclusion
RESUMEN
Objective: To compare the shock index [SI . which is the ratio of heart rate to systolic blood pressure] and Age SI [Age in years multiplied by SI] with survival outcome of the patients across multicenter trauma registry in India
Methods: Study is based on Towards Improved Trauma Care Outcomes [TITCO] project. Records with valid details of age, heart rate, systolic blood pressure, Injury Severity Scale [ISS] and Glasgow Coma Scale [GCS] score was considered. SI was categorized into four groups; Group I [SI<0.6] as no shock, group II [SI>/=0.6 to <1.0] as mild shock, group III [SI >/=1.0 to <1.4] as moderate shock and group IV [SI>/=1.4] as severe shock. Age SI was categorized decade wise into six groups. Mortality was dependent variable. GCS and ISS were considered as secondary variables
Results: 10843 participants from TITCO registry satisfying inclusion-exclusion criteria were considered for study. Mean SI score in group I to IV was increasing with 0.53 to 1.72 respectively. Age SI was seen to be increasing across its six groups. Gender wise no difference was found among SI group. For severe ISS and critical ISS, mortality in SI group IV was 50% and 56 % respectively. Mortality was increasing across mild to severe GCS among all SI groups
Conclusion: The categorized SI and Age SI had shown increase in death percentages from mild to severe severity of injuries. Similar to GCS and ISS, SI and Age SI should also be calculated and categorized in all health care and further plan for management aspects