Neurophysiological prediction of neurological good and poor outcome in post-anoxic coma.

OBJECTIVE: Investigation of the utility of association between electroencephalogram (EEG) and somatosensory-evoked potentials (SEPs) for the prediction of neurological outcome in comatose patients resuscitated after cardiac arrest (CA) treated with therapeutic hypothermia, according to different recording times after CA. METHODS: Glasgow Coma Scale, EEG and SEPs performed at 12, 24 and 48-72 h after CA were assessed in 200 patients. Outcome was evaluated by Cerebral Performance Category 6 months after CA. RESULTS: Within 12 h after CA, grade 1 EEG predicted good outcome and bilaterally absent (BA) SEPs predicted poor outcome. Because grade 1 EEG and BA-SEPs were never found in the same patient, the recording of both EEG and SEPs allows us to correctly prognosticate a greater number of patients with respect to the use of a single test within 12 h after CA. At 48-72 h after CA, both grade 2 EEG and BA-SEPs predicted poor outcome with FPR=0.0%. When these neurophysiological patterns are both present in the same patient, they confirm and strengthen their prognostic value, but because they also occurred independently in eight patients, poor outcome is predictable in a greater number of patients. SIGNIFICANCE: The combination of EEG/SEP findings allows prediction of good and poor outcome (within 12 h after CA) and of poor outcome (after 48-72 h). Recording of EEG and SEPs in the same patients allows always an increase in the number of cases correctly classified, and an increase of the reliability of prognostication in a single patient due to concordance of patterns.

A radiometric and petrographic interpretation of discrepancies on uranium content in samples collected at Alte Madonie Mounts region (Sicily, Italy).

The main goal of this work is to evaluate a correlation between anomalous Uranium (U) content and petrographic features of some soil and rock samples collected at Alte Madonie Mounts region (North-central Sicily, Italy). A total of 41 samples of selected soils and rocks were collected, powdered, dried and sealed in "Marinelli" beakers for 20 days before the measurement to ensure that radioactive equilibrium between (226)Ra and (214)Bi was reached. Gamma-ray spectrometric analysis was used to quantify radioactivity concentrations. Mineralogical and chemical features of the samples were determined by X-ray Fluorescence (XRF), X-ray Diffractometry (XRD), Attenuated Total Reflection-Fourier Transform Infrared (ATR-FTIR) and Scanning Electron Microscope - Energy Dispersive Spectrometry (SEM-EDS) analyses. The average values of concentrations of (226)Ra, (228)Ac and (40)K were respectively 30, 17 and 227 Bq kg(-1) while the greatest values were 134, 59 and 748 Bq kg(-1). Linear relationships were observed between (226)Ra, (228)Ac and (40)K concentrations: the activities of (226)Ra and (228)Ac were comparable, while those of (40)K were about 10 times greater. An exception was highlighted for a group of samples where (226)Ra activities were much higher than expectations. Chemical compositions and mineralogical features of the samples have made it possible to justify these anomalies.

A radiometric and petrographic approach to risk assessment at Alte Madonie Mounts region (Sicily, Italy).

The main goal of this work was to assess the radiological hazard at Alte Madonie Mounts region (north-central Sicily, Italy) in response to rumours of an increase in the incidence of cancer in this area. A correlation between the natural radionuclide contents and the petrographic features of the soil and rock samples was also evaluated. A total of 41 samples of selected soils and rocks were collected, powdered, dried and sealed in 'Marinelli' beakers for 20 d prior to measurement to ensure that a radioactive equilibrium between (226)Ra and (214)Bi had been reached. A gamma-ray spectrometer was used to quantify the radioactivity concentrations. To determine (238)U and (232)Th activities, the 609.3-keV line from (214)Bi in secular equilibrium with (226)Ra and the 911-keV line from (228)Ac, with which (232)Th can be assumed to be in equilibrium, were used, respectively. The gamma transition of 1461 keV was used to determine (40)K activity. The average values of the concentrations of (214)Bi, (228)Ac and (40)K were 30, 17 and 227 Bq kg(-1), respectively, whereas the greatest values were 134, 59 and 748 Bq kg(-1), respectively. A linear relationship was found between the activity values of (214)Bi, (228)Ac and (40)K. An exception was found for a group of samples in which the (214)Bi activities were much higher than expected. The chemical compositions and mineralogical features of the samples permitted the justification of these anomalies. The results of the primordial radionuclide contents are reassuring from a radiation protection point of view because the activities of the uranium and thorium series products and of the (40)K do not present a significant radiological hazard.

Transient post-traumatic locked-in syndrome: a case report and a literature review.

INTRODUCTION: Post-traumatic locked-in syndrome may be particularly difficult to recognize, especially when it follows a state of coma and presents the clinical feature of a "total" locked-in syndrome. PATIENT AND METHODS: A 56-year-old male with a closed head injury was admitted in intensive care unit (ICU) with GCS=4 (V1, M2, E1). Computed tomography (CT) scan disclosed a limited subarachnoid haemorrhage in the sylvian region without any brain oedema or ventricular shift. The GCS did not change until day 6. At the same time EEG showed a reactivity to acoustic stimuli consisting in the paradoxical appearance of a posterior rhythm in alpha range (10-12c/s), blocked by passive eye opening. Early cortical components (N20-P25) of somatosensory evoked potentials were normal on both hemispheres; middle components were also clearly evident. Magnetic resonance imaging of the brain showed both diffuse and midbrain axonal injuries, particularly in a strategic lesion involving both cerebral peduncles. Event related potentials showed N2 and P3 components to stimulation by rare tones. CONCLUSIONS: A comprehensive multimodal neurophysiological approach, using the more informative tests and the proper time of recording, should be included in protocols for patients with severe head trauma, in order to establish the actual patient's clinical state and to avoid that a locked-in syndrome state be mistaken for prolonged coma, vegetative state, minimally conscious state or akinetic mutism. Neurophysiological evaluation before discharge from ICU can be a baseline evaluation useful for the follow-up of low-responsive patients in the neuro-rehabilitation unit.