ABSTRACT
BACKGROUND: Severe and moderate head injury can cause misdiagnosis of a spinal cord injury, leading to devastating long-term consequences. The objective of this study is to identify risk factors involving spine trauma and moderate-to-severe brain injury. METHODS: A prospective study involving 1617 patients admitted in the emergency unit was carried out. Of these patients, 180 with moderate or severe head injury were enrolled. All patients were submitted to three-view spine series X-ray and thin cut axial CT scans for spine trauma investigations. RESULTS: 112 male patients and 78 female patients, whose ages ranged from 11 to 76 years (mean age, 34 years). The most common causes of brain trauma were pedestrians struck by motor vehicles (31.1%), car crashes (27.7%), and falls (25%). Systemic lesions were present in 80 (44.4%) patients and the most common were fractures, and lung and spleen injuries. 52.8% had severe and 47.2% moderate head trauma. Fourteen patients (7.8%) suffered spinal cord injury (12 in cervical spine, one in lumbar, and one thoracic spine). In elderly patients, the presence of associated lesions and Glasgow Coma Scale (GCS) < 9 were statistically significant as risk factors (P < 0.05) for spine injury. CONCLUSION: Spinal cord injury related to moderate and severe brain trauma usually affects the cervical spine. The incidence of spinal lesions and GCS < 9 points were related to greater incidence of spinal cord injury.
ABSTRACT
BACKGROUND: The purpose of this article was to assess if high-risk, mildly head-injured patients with normal CT scan present an outcome similar to the group with "low-risk MHI." METHODS: A total of 379 hospital charts of inpatients with Glasgow Coma Scale scores of 13, 14, and 15 were reviewed. Information regarding age, fGCS, trauma mechanism, cranial CT scan findings, hospital course, and follow-up using the GOS were obtained from all patients. RESULTS: Patients were separated in 3 groups: fGCS 13 (46 patients), fGCS 14 (138 patients), and fGCS 15 (195 patients). The groups with different scores on fGCS did not differ regarding CT scan abnormalities, surgical treatment, or outcome. Patients were also separated in 2 groups based on CT scan findings: 266 patients had CT interpreted as abnormal and 113 had CT interpreted as normal. The 2 groups differed statistically regarding surgical treatment and scores on GOS (P < .05). There was no statistically significant difference between the 2 groups regarding sex, trauma mechanism, fGCS, or age. CONCLUSIONS: Our findings support the idea that a normal cranial CT scan in patients with fGCS scores of 13 or higher ascertain a low-risk MHI outcome and, therefore, such patients must be included in this category of traumatic brain injury. On the other hand, patients with cranial CT scan abnormalities should be included in the group with moderate head injury.
Subject(s)
Craniocerebral Trauma/diagnostic imaging , Glasgow Coma Scale , Tomography, X-Ray Computed , Adult , Craniocerebral Trauma/surgery , Female , Follow-Up Studies , Humans , Male , Predictive Value of Tests , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
Avaliar a qualidade de vida, a ansiedade e a depressão de mulheres com câncerde mama antes e após a cirurgia. Métodos: Foram selecionadas 85 mulheres internadas na enfermaria de oncologia do Centro de Atenção Integral à Saúde da Mulher com indicação de mastectomia ou quadrantectomia. A escala utilizada foi a Functional Assessment of Cancer Therapy - General de Mama e a Functional Assessment of Cancer Therapy - Breast, antes da cirurgia e cerca de seis semanas depois. A ansiedade e a depressão foram avaliadas por meio da Escala Hospitalar de Ansiedade e Depressão. Para anßlise estatística foram utilizados os testes de ôtõ-Student, Wilcoxon, Kruskal-Wallis, qui-quadrado, exato de Fisher, correlação de Pearson e de Spearman.Resultados: Das 85 mulheres avaliadas antes da cirurgia, 64 também responderam seis semanas depois. Piores escores da Functional Assessment of Cancer Therapy - Breastestiveram significativamente associados com ansiedade e depressão e a ansiedade teve uma relação significativa com a depressão. O bem-estar emocional, físico e funcional apresentaram uma relação linear significativa com as preocupaçõesadicionais relacionadas ao câncer de mama, ansiedade e depressão no decorrer da observação. Houve melhora significativa nos escores da Functional Assessment of Cancer Therapy - Breast, da ansiedade e da depressão após a cirurgia, em relação ao pré-operatório. Apesar da melhora significativa das taxas de ansiedade e depressão após a cirurgia, esses sintomas se mantiveram numa freqüência elevada nessas mulheres (25% ansiosas e 14% deprimidas). Conclusão: A qualidade de vida tende a melhorar nas primeiras semanas após a cirurgia em mulheres com câncer de mama. Essas mulheres devem permanecer em avaliaçãodurante o tratamento adjuvante para verificar a evolução desses sintomas.
Subject(s)
Humans , Female , Anxiety , Depression , General Surgery , Mastectomy , Breast/surgery , Breast Neoplasms/surgery , Quality of Life , Neoplasms/surgeryABSTRACT
The bifrontal craniotomy approach used to be associated with a high percentage of olfactory tract damage. We present our experience with this technique, that was used with excellent results in a series of 11 patients that underwent the surgical approach described in this paper. We support the idea that bilateral subfrontal craniotomy allows a wide operative exposure as well as the complete anatomic and functional preservation of the olfactory tracts bilaterally.
Subject(s)
Brain Neoplasms/surgery , Craniotomy/methods , Olfactory Pathways/physiology , Adult , Brain Neoplasms/diagnosis , Child, Preschool , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Skull BaseABSTRACT
The bifrontal craniotomy approach used to be associated with a high percentage of olfactory tract damage. We present our experience with this technique, that was used with excellent results in a series of 11 patients that underwent the surgical approach described in this paper. We support the idea that bilateral subfrontal craniotomy allows a wide operative exposure as well as the complete anatomic and functional preservation of the olfactory tracts bilaterally
Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Middle Aged , Brain Neoplasms , Craniotomy , Olfactory Pathways , Brain Neoplasms , Magnetic Resonance Imaging , Skull BaseABSTRACT
É proposta modificação do método de Wright consistido no aumento da concentração de glicerol na mistura corante e introdução da hematoxilina aquosa, com a finalidade de tornar mais nítidas as estruturas dos elementos figurados do sangue (AU).