Electrocardiographic abnormalities associated with raised intracranial pressure.
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Serial electrocardiographic (E.C.G.) recordings were taken in seven patients suffering from intracranial conditions, for which their intracranial pressure was directly and continuously monitored with a Konigsberg extradural transducer. The E.C.G. changes observed in patients with raised intracranial pressure were prominent U waves, ST-T segment changes, notched T waves, and shortening and prolongation of Q-T intervals. Two patients with normal intracranial pressure showed no E.C.G. abnormalities but also establish a relationship between E.C.G. abnormalities and changing intracranial pressure. (+info)
Non-fatal injuries sustained by back seat passengers.
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Of 2,275 cases of non-fatal injuries sustained by all categories of road users 185 were inflicted on back seat passengers. Twenty-six such passengers sustained severe and 66 moderately severe injuries. Only two patients (aged 18 months and 3 years) wore any form of restraint. Back seat passengers may be injured by impact with the rear of the front seat or other objects in the rear compartment; by objects in the front compartment; or by being thrown out of the car completely. An adequate restraint system, such as the lap-and-diagnoal type of seat belt, would reduce the incidence and severity of injuries. (+info)
A practical outcome scale for paediatric head injury.
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Traumatic brain injury (TBI) is the commonest cause of acquired disability in childhood. A major obstacle to the evaluation of acute and rehabilitative therapies after TBI is the lack of simple descriptors of outcome. We developed the King's Outcome Scale for Childhood Head Injury (KOSCHI), as a specific paediatric adaptation of the original adult Glasgow Outcome Scale (GOS). The KOSCHI expands the five category GOS to provide increased sensitivity at the milder end of the disability range. The GOS category of "persistent vegetative state" was replaced by "vegetative". "Good recovery" was allocated two categories, in acknowledgement of the long term importance of relatively minor sequelae in a developing child. The scale was quick and easy to use. Inter-rater reliability studies show that even with such an apparently simple scale, some training may be required. The KOSCHI provides a practical scale for paediatric head injury which will enable clinicians to describe rate and extent of recovery, and evaluate the effects of service and research interventions. (+info)
Excitatory amino acids in cerebrospinal fluid and their relations with clinical features and outcomes in acute head injury.
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OBJECTIVE: To determine the contents and dynamics of excitatory amino acids (EAAs), glutamate (GLU) and aspartate (ASP) in the cerebrospinal fluid (CSF) of patients with acute head injury and to clarify the relationship of EAAs with clinical features and outcomes. METHODS: Forty-two adults with acute head injury were included. Glasgow coma scale (GCS) obtained at admission and Glasgow outcome scale (GOS) obtained three months post-injury were assessed. Samples of CSF were obtained via ventricular or lumbar puncture every 24 hours. GLU and ASP in CSF were analyzed by reversed-phase HPLC with a fluorescent detector. Nine control subjects were adults with lumbar anesthesia but without neurological diseases. RESULTS: The peak concentration of GLU and ASP of head-injured group was significantly higher than that of the control group. Dynamic research on severely injured ones indicated that the peak value of GLU mostly appeared within 48 hours post-injury; it decreased with the improving or remaining of the neurological status, and increased with the deterioration, but was still higher than that of the control seven days post-injury. The peak value of EAAs of severely injured patients was conspicuously higher than that of mildly injured group. There was a significant negative correlation between the peak values of GCS and EAAs. The peak value of EAAs in patients with poor outcome was remarkably higher than that in patients with good outcome. GOS was closely correlated to the peak value of EAAs. When the concentration of GLU was over 7 mumol/L, the rate of poor-outcome increased markedly. CONCLUSION: The content of EAAs in CSF increases following acute head injury and remains higher at least a week post-injury in severely injured patients. The more severe the trauma, the more obvious the excitotoxicity induced by EAAs; the more serious the secondary brain insult and the brain edema will be, the worse the outcome, naturally. (+info)
Head trauma and neuroprotection.
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Traumatic brain injury is a serious clinical problem connected with high mortality rate and long-term neurobehavioral and socioeconomic consequences. Pathomechanism of such insult is complex and not clear in all aspects as yet. Thus, a primary mechanistic insult to the brain initiates metabolic and inflammatory processes which exacerbate the primary traumatic injury to neurons, leading to secondary brain damage. In this paper we present the main components of destructive cascade with relevant theoretical strategy for neuroprotection. It should be emphasized that pathological processes involved in secondary brain damage are complex and interrelated. It makes blockade of a single mechanism unlikely to prevent either early or delayed cellular death. (+info)
Foreign body in injury--an important evidence.
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In the present paper, a complete case is discussed, that is from the crime upto judgement in the court of law, from the Forensic point of view. The postmortem examination was conducted by the author in which a metallic fragment of size of a mustard seed was found in a incised wound. On chemical analyzers examination, the metal fragment matched with the suspected weapon, in respect of spectrochemical contents. This evidence became an important part in the investigation for conviction of the accused in the court of law. This indicates that when-ever any foreign body, whatever it may be or of whatever size, should not be neglected while examining the injury before death of after death, since it can become an important piece of evidence. (+info)
Effects of pediatric head trauma for children, parents, and families.
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Severe pediatric head injury has negative consequences for children of all ages. Even mild and moderate head injury results in residual impairment for school-age children and adolescents. Data are needed on the effects of these less severe insults, especially for preschoolers. Although research on the impact of the child's head injury on the parent-child relationship and family functioning is limited, the experience is likely to be very stressful for the parent and the family. Indeed, family integrity may be at risk. Research is needed that examines the effects of a child's head injury for the parent and the family over time and identifies factors related to these outcomes. (+info)
Surgery of violence. V. Missile wounds of the head and spine.
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The patient with a cerebral gunshot wound has a very unstable condition. In Belfast emphasis has been laid on rapid evacuation and on starting resuscitation within a few minutes of injury. Early and adequate transfusion combats shock; controlled ventilation helps limit the rise in intracranial pressure. Intracranial haematomata should be sought by early operation. Operation seldom improves neurological function in missile wounds of the spine. (+info)