[Early prognosis in severe cranio-cerebral trauma using the Glasgow Coma Score and evoked potentials]. / Frühzeitige Prognose beim schweren Schädel-Hirn-Trauma mittels Glasgow-Koma-Score und evozierter Potentiale.

During 72 h following severe head injury, 103 patients in acute posttraumatic coma were assessed by clinical examinations (documented by Glasgow Coma Score) and brain stem auditory evoked potentials (BAEP) as well as short-latency somatosensory evoked potentials (SEP) following median-nerve stimulation. Patient outcomes were classified at 6 months or more according to the following categories: good recovery, severely disabled or vegetative, and brain dead. Patients who had died of systemic complications (pneumonia, septicemia, renal failure, etc.) were excluded from the study. The Glasgow Coma Score was reliable in forecasting a favorable outcome; all patients with a Score over 9 points had a good recovery. The Glasgow Coma Score was not reliable in predicting an unfavorable outcome, however; some patients with the lowest possible Glasgow Coma Score (3 points) at the early clinical examination survived with good recovery. The BAEPs were reliable predictors of an unfavorable outcome; the outcome was unfavorable when a missing wave V or more missing waves pointed toward a secondary brainstem lesion. Normal BAEPs were not reliable, however, in predicting a favorable outcome. SEP data served as a prognostic indicator of unfavorable as well as favorable outcomes. In summary, evoked potentials add valuable information to the clinical examination in assessing a patient's outcome after severe head injury.

[Early prognostic assessment using evoked potentials in severe craniocerebral trauma]. / Frühzeitige prognostische Aussage mittels evozierter Potentiale beim schweren Schädel-Hirn-Trauma.

103 patients in acute posttraumatic coma were assessed during 72 hours following severe head injury by clinical examinations (documented with a modified Glasgow-Coma-Score and a brain-stem-score and brainstem auditory evoked potentials (BAEP) as well as short latency somatosensory evoked potentials (SEP). Patient outcomes were classified at 6 months or more, according to the following categories: good recovery, severely disabled or vegetative, and brain dead. Patients who had died by systemic complications were excluded from the study. The Glasgow-Coma-Score was reliable in forecasting a favorable outcome, but tended to produce false-pessimistic predictions. The brainstemscore and the BAEPs were reliable predictors of an unfavorable but not a favorable outcome. SEP data however, performed well as a prognostic indicant in predicting an unfavorable as well as a favorable outcome. Using the BAEP, the amplitude ratio Wave V/Wave I is more sensitive to detect a lesion than the interpeak-latency Wave I-Wave V, and--using the SEP--the amplitude ratio N20/N13b (over C2) is more sensitive than the central conduction time (N13a (over C7)--N20).

Loss of fat, water, and protein during very low calorie diets and complete starvation.

The magnitude and composition of weight loss obtained in obese women on two forms of very low calorie protein-supplemented diets (Cambridge diet, Dresden drink) as well as by complete starvation has been investigated. With the VLCD, nitrogen equilibrium was reached on the 10th day of fasting, the cumulative nitrogen balance also being compensated. Nearly half of the body weight loss is due to loss of fat. In order to assess the benefit of fasting regimes, we propose to measure at least two parameters which are independent of each other, e.g., nitrogen balance and total body water. Both types of VLCD were equally effective, safe, and acceptable in achieving rapid body weight reduction.