Coagulation abnormalities in patients with head injury.

The Authors have studied five coagulation parameters (platelets count, prothrombin time, activated partial thromboplastin time, fibrinogen and fibrinogen degradation products) in 60 head traumatized patients. These parameters were alterated in a high percentage of patients. Moreover 5 patients presented laboratory values indicative of disseminated intravascular coagulation (DIC). DIC could be an important factor of mortality in the head traumatized patients. So coagulation system must be carefully evaluated in any patient with head injury.

Validation of a prognostic system in severe brain-injured patients.

Seventy-six patients with severe isolated head trauma (GCS score of 7 or less) were prospectively studied in order to valuate the prognostic power of the APACHE II system. In nonsurvivor patients the APACHE II score was higher than in survivor patients (24.7 +/- 3.2 (SD) vs 18.7 +/- 3.1; p less than .001). With an APACHE II cut-off point of 20 the sensitivity was 100% and the specificity was 70% while a cut-off point of 21 the sensibility decreased to 97.2% but the specificity increased to 72.5%. We conclude that the APACHE II is an effective mean to predict the prognosis of severe brain-injured patients.

Effect of dexamethasone on nitrogen metabolism in brain-injured patients.

A randomized prospective clinical trial was conducted to determine the influence of dexamethasone therapy on nitrogen metabolism in patients with isolated head trauma without any pathologies. One group of 12 patients was not given steroids (groups NS). To the 12 patients of the second group, a dose of 0.36 mg/kg/day of dexamethasone was administered for the first nine days of stay (group S) in hospital. At the beginning of the study, between the two groups, there were no differences in age, sex, Glasgow Coma Scale Score, type of injury. In order to avoid bias, phenytoin, barbiturates and muscle-relaxant drugs were not given and the same caloric and protein intake was prefixed for both groups. The urea excretion, nitrogen output, nitrogen balance and cumulative nitrogen balance were not statistically different in the two groups throughout the period of study. Similar were also weight losses, blood glucose, blood urea nitrogen, albumin and creatinine levels. The outcome, evaluated at 3 months, was also similar. The incidence of sepsis, pulmonary and urinary infections, gastric reflux duration and quantity, was not higher in the steroid group compared with non-steroid treated patients.

[Role of total parenteral nutrition in determining liver insufficiency in patients with cranial injuries. Glucose vs glucose + lipids]. / Ruolo della nutrizione parenterale totale nel determinismo dell'insufficienza epatica nei traumatizzati cranici. Glucosio vs glucosio + lipidi.

Total parenteral nutrition (TPN) rich in glucose may cause a deposition of triglycerides in the liver with consequent steatosis. We have valued the role of different nutrients in the determinism of liver failure. Sixty-five patients with severe and isolated head trauma (GCS score of 7 or less), 50 men and 15 women, of mean age 28 years (range: 15-68 years) were prospectively studied. All patients have a negative history for liver disease. In 24 randomly selected patients only glucose (group G) was administered as non-protein caloric source, while other 41 patients received glucose and Intralipid 10% (group GL) in ratio 70:30. The global incidence of cholestasis was 52.3% (34 patients): 17 patients (70.8%) of the group G and other 17 patients (41.5%) of the group GL (less than 0.025). No significant differences regarding the day of beginning of the cholestasis, the duration of TPN and the mean caloric and protein supply were pointed out. The liver steatosis was observed in 10 cases: 8/15 (53.3%) of the group G and 2/12 (16.7%) of the group GL (p 0.05). In conclusion, a TPN with glucose plus lipids is least toxic for the liver than only glucose.

[Changes in AI, B and E apolipoproteins induced by infusion of lipid emulsions in critical patients]. / Modificazioni delle apolipoproteine AI, B ed E indotte dall'infusione di emulsioni lipidiche nei pazienti critici.

In 24 critically ill patients HDL, LDL and VLDL values and those of apolipoproteins (apo) AI, B and E were evaluated just before (T0) and after 1 (T1), 3 (T3), 5 (T5) hours of intralipid infusion. Baseline levels of such parameters were compared with those obtained in 26 healthy volunteers. The critically ill patients showed lower values of apo AI and B (p less than 0.001) than control patients. In intensive care unit patients, a close relationship between HDL and apo AI (p less than 0.001) and between LDL and apo B (p less than 0.001) was observed in addition to the evidence of apo B and E interconversion. In fact, these apolipoproteins were always significantly correlated (p less than 0.01 a T0 e T3; p less than 0.001 a T1; p less than 0.05 a T5). The knowledge of the apolipoproteins functions could be important for the understanding and the detection of the negative effects that could follow to the infusion of fat emulsions.