[Treatment of patients with acute head injury in Vestfold 1987-96]. / Behandling av pasienter med akutt hodeskade i Vestfold 1987-96.

BACKGROUND: In Norway, patients with severe head injuries are transported to a regional, neurosurgical department for surgery, but some are operated on by surgeons without neurosurgical training in local hospitals. MATERIAL AND METHODS: Data were retrospectively collected from the records of all patients (n = 161) hospitalised alive with a severe head injury occurring within Vestfold County (1987-96). RESULTS: Overall lethality was 27%. 54 patients (34%) underwent decompressive surgery. 31 patients were operated in the local hospital, by 13 different surgeons. 30 of these patients had extracerebral haematomas. These patients had a significantly worse outcome than the 23 patients operated in a regional neurosurgical department. Patients with an epidural haematoma had a better outcome than patients with an acute subdural haematoma. We retrospectively classified ten operations in the local hospital as inadequate. INTERPRETATION: In Norway and countries with a similar hospital system, local hospitals should establish guidelines for safe and swift transport of head injury patients to the nearest neurosurgical department, and should not try to perform neurosurgical decompression in such patients.

Selective imaging of biofilms in porous media by NMR relaxation.

Nuclear magnetic resonance imaging (NMRI) techniques were employed to identify and selectively image biological films (biofilm) growing in aqueous systems. Biofilms are shown to affect both the longitudinal (T1) and transverse (T2) NMR relaxation time values of proximal water hydrogens. Results are shown for biofilm growth experiments performed in a transparent parallel-plate reactor. A comparison of biofilm distributions by both NMR and optical imaging yielded general agreement for both an open-flow system and an idealized porous system (the reactor without and with packed glass beads, respectively). The selective imaging of biofilm by relaxation NMRI is dependent upon the resolution of relaxation times for the fluid phases, dynamic range, and signal-to-noise ratio. For open-flow systems, the use of a rapid and quantitative T2-sorted NMRI technique was preferred. For porous systems where T2 values are generally more similar, a T1-weighted technique was preferred.

Decompressive surgery in acute head injuries: where should it be performed?

BACKGROUND: In Norway, most patients with severe head injuries are transported to, and operated in, the neurosurgical unit of the regional university hospital. However, some patients are still occasionally operated on in county central hospitals by orthopedic or general surgeons who do not have neurosurgical expertise. The aim was to analyze this surgical activity outside the neurosurgical units. METHODS: Data were collected from two sources: a nation-wide survey and the records of all patients with a severe head injury occurring within Vestfold county (1987-1996). RESULTS: The Norwegian county central hospitals perform each only 2.5 to 3 surgical evacuations of intracranial hematomas per year. In Vestfold county, a total of 161 patients were hospitalized alive with an acute severe head injury. One third of the patients (54 patients) underwent decompressive surgery, mostly evacuations of intracranial hematomas. The patients operated on in the central hospital had a significantly worse outcome than the patients who were transferred to and operated on in the neurosurgical unit of the regional hospital. Only patients with extracerebral hematomas were operated on in the central hospital. Patients with an extradural (epidural) hematoma had a better outcome than patients with an acute subdural hematoma. Based on the surgery records and preoperative and postoperative computed tomographic scans, one third of the operations (10 operations) in the central hospital were classified retrospectively as inadequate, because the hematoma was not evacuated or found or because the surgeons did not achieve control of the perioperative bleeding. The overall mortality rate was 29.8%. CONCLUSION: The present study indicates that, in Norway and countries with a similar hospital system, it must be difficult for general and orthopedic surgeons to achieve and maintain the skills required for emergency operations in patients with acute severe head injuries. Thus, it is probably to the patients' benefit to improve the general hospitals' competency and speed in the detection of candidates for surgical decompression, and stress the importance of these patients being transferred without unnecessary delay to a neurosurgical unit.