[Comparative evaluation of drainage methods used for penetrating gunshot cerebral injuries].

The paper presents a comparative evaluation of the methods of gunshot craniocerebral wounds draining, applied when the primary surgical treatment at the stages of medical evacuation of the limited contingent of Soviet troops in Afghanistan. An analysis of occurring infectious complications and outcomes of surgical treatment of the wounded is given. Based on clinical observations revealed most effective method of the active drainage gunshot traumatic brain injuries. The advantages of tidal drainage, appropriate for mechanical cleaning of wounds, allows controlling hemostasis, using antibacterial solutions are given.

Alterations of myelin basic protein and ultrastructure in the limbic system at the early stage of trauma-related stress disorder in dogs.

BACKGROUND: The secondary injury and related complications after trauma are still the focus of trauma research. However, whether the remote effects on the central nervous system could be induced by high-energy missile extremity impact remains unclear. Also, the possible biomarker for brain damage in traumatic stress disorder has not been determined. METHODS: Forty-two healthy adult dogs were divided into three groups: the control group (n = 12), the high-speed trauma group (n = 15), and the low-speed trauma group (n = 15). Bilateral thighs of dogs were wounded with a smoothbore 6.2-mm rifle at a speed of 1,368 m/s (1.03-g steel bullet) for the high-speed trauma group and 625 m/s for the low-speed trauma group. The expression of myelin basic protein (MBP) in cerebrospinal fluid (CSF), hypothalamus and hippocampus of the limbic system, and temporoparietal cortex was investigated by enzyme-linked immunosorbent assay and dot-blot analysis. Also, the ultrastructure of the above areas was observed with light and electron microscopy. RESULTS: Neuronal degeneration and nerve fiber demyelination were seen in the hypothalamus and hippocampus in the high-speed trauma group at 8 hours after impact. The MBP level was markedly increased in the CSF (p < 0.01) in the two trauma groups, in the hypothalamus of the low-speed trauma group (p < 0.05), and in both the hypothalamus and the hippocampus of the high-speed trauma group (p < 0.01). The expression of MBP mRNA was also significantly enhanced in these areas at the same time. The increase of MBP content in the CSF was positively correlated with the elevation of MBP concentration in the hypothalamus and hippocampus. CONCLUSION: The hypothalamus and hippocampus of the limbic system in the central nervous system are vulnerable to damage after high-energy missile extremity impact, indicating that it might be one of the important pathologic bases involved in the development of trauma-related complications. Meanwhile, the MBP level in the CSF may be a sensitive biological indicator for brain damage at the early stage of trauma-related stress disorder.

[The morphological bases of the pathology of the cerebrospinal fluid circulatory system in gunshot wounds of the head]. / Morfologicheskie osnovy patologii sistemy likvoroobrashcheniia pri ognestrel'nykh raneniiakh golovy.

Pathomorphology of structural elements of the liquor circulation system and its three components (liquor production, circulation, and outflow) in gunshot wounds of the head is discussed. Their role in the development of traumatic diseases of the brain and its complications is analyzed. Classification and characteristics of the main pathomorphological variants of liquor circulation disorders in gunshot wounds of the skull and brain are presented.

The expression of tumor necrosis factor-alpha in the rat brain after fluid percussive injury.

To investigate the role of tumor necrosis factor-alpha (TNF alpha) after traumatic head injury in rats, moderate brain injury of 1000 mmHg was generated by an original fluid percussion injury device. TNF alpha levels in cerebrospinal fluid (CSF) gradually increased during the first 1 h, rose to a maximal elevation at 3 h and 6 h and returned to basal values by 24 h. Horseradish peroxidase tracer experiments revealed that primary microvascular damage appeared as early as 15 min after impact, but rapidly recovered and 1 h after impact secondary microvascular damage occurred in the hippocampus and parasagittal cortex. By immunoelectron microscopy, TNF alpha reactions were detected in the lysosomes of microglia accumulated at the impact site of the cortex 30 min after impact, and 1 h after impact these reactions were mainly detected at the glial cells (such as microglia and astrocytes) in the hippocampus and parasagittal cortex. Therefore the delayed microvascular damage observed in sites remote from the impact may be induced by TNF alpha which is synthesized mainly by glial cells. The present study suggests that TNF alpha conveyed from the microglial cells is one co-factor contributing to the fluid percussive brain edema formation after moderate brain injury.

[The characteristics of the biochemical reactions of the cerebrospinal fluid in victims with gunshot wounds of the skull and brain in relation to treatment outcome]. / Osobennosti biokhimicheskikh reaktsii tserebrospinal'noi zhidkosti u postradavshikh s ognestrel'nymi raneniiami cherepa i golovnogo mozga v zavisimosti ot iskhoda lecheniia.

Biochemical reactions of the liquor were investigated in 68 patients with gunshot wounds of the skull and brain and in closed treatment of the brain wound. The reactivity of biochemical system plays a certain role in the development of infectious complications. In dead people the developing pathogenetical biochemical syndromes having a sanogenic role of clearance from antigens of the injured tissues turn pathogenesis into thanatogenesis.

Hyaluronan in cerebrospinal fluid after head injury.

Hyaluronan (HYA) is a large molecular weight polysaccharide which functions in various roles throughout the body. Little is known regarding HYA in human cerebrospinal fluid (CSF). We measured CSF and serum HYA concentrations in eleven patients with varying degrees of head injury. In these patients, CSF HYA ranged from 46 to 772 micrograms/l and serum HYA from 16 to 573 micrograms/l. We did not find any relationship between HYA values in CSF or serum and underlying disease or Glasgow Coma Scale (GCS). The role of CSF HYA in the injured human brain has yet to be elucidated.

[The adaptation of the human central nervous system to ecological job factors]. / Adaptatsiia tsentral'noi nervnoi sistemy cheloveka k ékologo-professional'nym faktoram.

The EEG, quantity of cation proteins in neutrophils, the opioid peptides concentration in the CSF, were analysed in military personnel after a prolonged climatic and specific stress complicated by traumas, at the Kabul military hospital in Afghanistan. The brain functional reserve was significantly lower in the control subjects. A positive correlation between the brain functional reserve and the average cytochemical coefficient, was found in certain phases of traumatic disease alone. Accumulation of opioid peptides occurred under the adaptation to stress, being more evident in wounded soldiers.

[The immune reactions of the cerebrospinal fluid in victims of gunshot wounds of the skull and brain in relation to the treatment procedure and outcome]. / Immunnye reaktsii tserebrospinal'noi zhidkosti u postradavshikh s ognestrel'nymi raneniiami cherepa i golovnogo mozga v zavisimosti ot taktiki i iskhoda lecheniia.

The paper shows the formation of immunopathological syndromes in the cerebrospinal fluid in the victims with gunshot wounds in relation to the policy and outcome of treatment. Suturing the dura mater during a primary surgical treatment should be regarded as a protective process to limit antigen release, the development of immunological paralysis and autoimmunization. Deaths are caused by the neurogenic immune dysfunction induced by the inadequate functioning of the psychoneuroimmunoendocrine connections of the whole body.