ABSTRACT
The authors have analyzed retrospectively a series of 288 consecutive patients with severe head injury observed between January, 1977, and May, 1980. Seventy-three patients were excluded as not being compatible with those of the International Data Bank. The remaining 215 patients complied with the definition of coma given by Jennett. All patients, after appropriate cardiopulmonary resuscitation, diagnostic measures, and, when required, surgical treatment, were managed in the Neurosurgical Intensive Care Unit with endotracheal intubation, controlled hyperventilation, mild dehydration, dexamethasone in standard doses, and sedation. The mortality rate was 39.5%. Of the survivors, 59.2% made a good recovery, 18.4% remained moderately disabled, 6.1% were severely disabled, and 1.5% were in a persistent vegetative state. The most reliable predictive criteria were: absence of brain-stem reflexes, neurological status, abnormal motor patterns, arterial hypotension, and presence of mass lesions. It is concluded that no sign has an absolute prognostic value when considered independently of its time course.
Subject(s)
Craniocerebral Trauma/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Coma/complications , Craniocerebral Trauma/complications , Craniocerebral Trauma/mortality , Craniocerebral Trauma/therapy , Female , Humans , Hypotension/complications , Male , Middle Aged , Nervous System/physiopathology , Outcome and Process Assessment, Health Care , PrognosisABSTRACT
PIP: The article reports on 1437 cases of narcosis for induced abortion conducted in the hospital of Niguarda, Italy, between June 1978-April 1979. As the majority of women treated were past the 10th week of pregnancy, general anesthesia was chosen, with little doses of thiapentol and NLA drugs; at the same time the patients were inhaling a mixture of O2 and N2O. This method proved far superior to other techniques experimented; there was perfect muscular relaxation, no obstetric or anesthesiological complications, no vomiting, and no necessity to help breathing at awakening. Most patients left the hospital the same day.^ieng
Subject(s)
Abortion, Induced , Anesthesia , Research , Developed Countries , Europe , Family Planning Services , Italy , TherapeuticsSubject(s)
Brain Ischemia/physiopathology , Carbon Dioxide/blood , Cerebrovascular Circulation , Homeostasis , Brain Diseases/physiopathology , Carbon Dioxide/pharmacology , Cerebrovascular Circulation/drug effects , Humans , Methods , Microcirculation , Partial Pressure , Tomography, Emission-ComputedSubject(s)
Acid-Base Equilibrium , Carbon Dioxide/cerebrospinal fluid , Oxygen/cerebrospinal fluid , Bicarbonates/cerebrospinal fluid , Biological Transport , Blood-Brain Barrier , Brain Diseases/cerebrospinal fluid , Glycolysis , Humans , Hypoxia, Brain/cerebrospinal fluid , Lactates/cerebrospinal fluid , Prognosis , Specimen HandlingABSTRACT
Lumbar CSF concentrations of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5HIAA) have been determined in ten patients suffering from chronic brain post-traumatic syndromes, at various length of time after the brain trauma. Lower concentrations of HVA (mean 21 +/- 14 mug/ml) compared to controls (mean 46 +/- 10 mug/ml) was observed in 7 cases; 5HIAA levels were within normal values. The 5HIAA/HVA ratio (1.59 +/- 0.66) was significantly higher (p less than 0.001) than the one recorded in controls (0.66 +/- 0.10). Monitoring of lumbar HVA and 5HIAA over time, before, during and after L-dopa treatment, revealed interesting correlations between modification of clinical picture and the levels of monoamines acid metabolites. The data indicate a profound alteration of brain monoamines in chronic syndromes following a severe head injury and suggest that measurements of lumbar HVA and 5HIAA in these patients may be of euristic and diagnostic value.
Subject(s)
Brain Damage, Chronic/cerebrospinal fluid , Homovanillic Acid/cerebrospinal fluid , Hydroxyindoleacetic Acid/cerebrospinal fluid , Phenylacetates/cerebrospinal fluid , Adolescent , Adult , Brain Damage, Chronic/drug therapy , Child , Child, Preschool , Coma , Female , Humans , Levodopa/therapeutic use , MaleABSTRACT
Ventricular concentrations of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5HIAA) were measured in 7 patients a few days after a severe traumatic brain injury. Both acid metabolites were elevated in respect to control patients values, however, the rise was more consistent for 5HIAA (258 +/- 86 ng/ml) with a 5HIAA/HVA ratio of 0.85 +/- 0.35. The data support previous hypothesis on the profound involvement of serotoninergic structures in the early stages of acute traumatic brain syndromes and on the role of 5HT in maintaining edema and vasospasm.
Subject(s)
Brain Injuries/cerebrospinal fluid , Homovanillic Acid/cerebrospinal fluid , Hydroxyindoleacetic Acid/cerebrospinal fluid , Phenylacetates/cerebrospinal fluid , Adolescent , Adult , Brain Injuries/metabolism , Brain Neoplasms/metabolism , Child, Preschool , Female , Humans , Male , Serotonin/metabolismABSTRACT
Twelve patients who were comatose after head injuries were studied with serial determinations of regional cerebral blood flow, jugular PO(2) tension, and intraventricular pressure. These determinations began a few hours after the injury, and were followed throughout the clinical course. Diffuse derangement of cerebral vasomotor regulation is confirmed after severe head trauma, which may contribute to deterioration and poor prognosis, and which indicates a need for therapeutic maintenance of rich oxygenation, hyperventilation with moderate hypocapnia, and steady blood pressure. Continuous recording of IVP (eventually sensitized by fluid infusion or CO(2) inhalation tests) may give an early indication of the subsequent clinical state and may suggest the need to submit the patients to further investigative and therapeutic procedures.
