ABSTRACT
BACKGROUND: Animal studies have shown that the dura mater contains mast cells. We investigated the density of mast cells in the human dura mater, and the changes associated with subdural haemorrhage (SDH). METHODS: Samples of the human dura were stained with tryptase antibody and were examined for mast cells. We used control cases with no dural bleeding (n = 9) and cases of fresh (n = 24) and old (n = 18) dural haemorrhage. RESULTS: Mast cells were easily found in dural samples. The mean density in controls (11.05 cells per mm(2)) was less than that in fresh SDH (15.69), which was less than that in old SDH (23.09). CONCLUSIONS: Subdural haemorrhage is associated with an increase in dural mast cell density, and the density increases as the haematoma ages. We hypothesise that dural mast cells may contribute to neurogenic inflammation and the clinical features of subdural haemorrhage.
Subject(s)
Cellular Senescence , Dura Mater/cytology , Hematoma, Subdural/pathology , Mast Cells , Adult , Aged , Cell Count/methods , Cellular Senescence/physiology , Child , Child, Preschool , Dura Mater/pathology , Dura Mater/physiopathology , Fetus , Hematoma, Subdural/physiopathology , Humans , Infant , Infant, Newborn , Mast Cells/physiology , Middle Aged , Young AdultABSTRACT
In 72 patients with combined trauma the impact of volume and consistence of infusion therapy on severity of the disease, frequency and severity of infectious complications, duration of MV and ICU stay was assessed. The patients were divided into 2 groups depending on the volemic status control method and infusion algorithm. The main group (35 patients) was controlled by transesophageal dopplerography Cardio Q apparatus ("Deltex Medical", GB) and the infusion therapy was carried out under the control of stroke volume and Ftc. In the control group (37 patients) the volemic status was assessed clinically: BP, CVP, HR, diuresis. The volume of the infusion therapy during the first 12 hours in the main group was significantly higher than in the control group which proved that patients were suffering from hypovolemia, which was not diagnosed by traditional clinical criteria. The ICU stay in the main group was significantly shorter compared to the control group 15.3 +/- 8.2 and 29.5 +/- 10.4 days respectively. Infectious complications occurred in 12 patients out of 35 in main group and 25 out of 37 in the control group. The conclusion of this study is that infusion therapy control with central hemodynamic parameters can shorten the MV time and ICU stay an lower the rate of infectious complications in patients with combined trauma. A mortality decrease in patients with transesophageal dopplerography controlled infusion is not shown.
Subject(s)
Echocardiography, Transesophageal , Fluid Therapy/methods , Hemodynamics/physiology , Multiple Trauma/therapy , Ultrasonography, Doppler , Acute Disease , Adolescent , Adult , Aged , Blood Volume/physiology , Blood Volume Determination/instrumentation , Blood Volume Determination/methods , Crystalloid Solutions , Female , Humans , Hydroxyethyl Starch Derivatives/administration & dosage , Hypovolemia/etiology , Hypovolemia/prevention & control , Isotonic Solutions/administration & dosage , Length of Stay , Male , Middle Aged , Multiple Trauma/complications , Multiple Trauma/physiopathology , Plasma Substitutes/administration & dosage , Trauma Severity Indices , Treatment Outcome , Young AdultABSTRACT
The paper describes two clinical cases of aortic rupture of traumatic and nontraumatic genesis, which was difficult to diagnose due to evident neurological symptoms. The analysis of these cases and the data available in the literature leads to the conclusion that aortic rupture is not a nosological entity with a known fatal outcome. Timely diagnosis based on widely practiced up-to-date ultrasound and radiological methods allows one to perform surgical or endovascular treatment in good time, by showing good long-term outcomes.
Subject(s)
Aortic Rupture/diagnosis , Aortic Rupture/surgery , Diagnostic Errors , Myocardial Infarction/diagnosis , Adult , Aortic Rupture/etiology , Diagnosis, Differential , Fatal Outcome , Female , Humans , Male , Middle Aged , Treatment Outcome , Young AdultABSTRACT
The study was undertaken to define the effect of hyperosmolar solutions on arterial blood oxygen levels. Analysis of arterial blood oxygenation after hyperosmolar solution infusions revealed a drop in partial pressure of oxygen (132.14 +/- 70.36, 120.0 +/- 66.48, and 119.24 +/- 70.10 mm Hg). At the same time there was a reduction in the extravascular lung water index (p < 0.05) as compared with the baseline values (7.93 +/- 2.17, 7.31 +/- 1.7), and Z62 +/- 1.99 ml/kg), respectively. This effect is particularly marked in a group of patients in whom the arterial blood content of oxygen is in the lower normal range. To evaluate and eliminate the above effect in reducing the arterial blood level, it is necessary to estimate respiratory indices during hyperosmolar solution infusion.
Subject(s)
Intracranial Hypertension/prevention & control , Oxygen/blood , Saline Solution, Hypertonic/administration & dosage , Adult , Carbon Dioxide/blood , Female , Hemodynamics/physiology , Humans , Intracranial Hypertension/blood , Intracranial Hypertension/etiology , Male , Monitoring, Physiologic , Osmolar Concentration , Saline Solution, Hypertonic/chemistry , Sodium/blood , Thermodilution , Treatment OutcomeABSTRACT
The investigation is aimed at determining whether it is necessary to include 20% albumin preparations into infusion-transfusion therapy for acute intracranial hemorrhage. An insignificant improvement of central hemodynamic parameters was shown in a group wherein 20% albumin solution was used. At the same time there was a significant increase in the pulmonary extravascular water index as compared with a control group (10.1 +/- 0.5 and 9.0 +/- 0.22 ml/kg, respectively; with no differences in the severity of lung injury, LIS was 0.71 +/- 0.23 scores; while in the group receiving no albumin solution it was 0.65 +/- 0.06 scores. Thus, the routine use of 20% albumin preparation as part of infusion-transfusion therapy for acute intracranial hemorrhage is not effective and rather safe.
