Prospective documentation and analysis of the pre- and early clinical management in severe head injury in southern Bavaria at a population based level.

Treatment of patients suffering from severe head injury is so far restricted to general procedures, whereas specific pharmacological agents of neuroprotection including hypothermia have not been found to improve the outcome in clinical trials. Albeit effective, symptomatic measures of the preclinical rescue of patients (i.e. stabilization or reestablishment of the circulatory and respiratory system) or of the early clinical care (e.g. prompt diagnosis and treatment of an intracranial space occupying mass, maintenance of a competent circulatory and respiratory system, and others) by and large constitute the current treatment based on considerable organizational and logistical efforts. These and other components of the head injury treatment are certainly worthwhile of a systematic analysis as to their efficacy or remaining deficiencies, respectively. Deficits could be associated with delays of providing preclinical rescue procedures (e.g. until intubation of the patient or administration of fluid). Delays could also be associated in the hospital with the diagnostic establishment of intracranial lesions requiring prompt neurosurgical intervention. By support of the Federal Ministry of Education and Research and under the auspices of the Forschungsverbund Neurotraumatology, University of Munich, a prospective system analysis was carried out on major aspects of the pre- and early clinical management at a population based level in patients with traumatic brain injury. Documentation of pertinent data was made from August 1998 to July 1999 covering a catchment area of Southern Bavaria (5.6 mio inhabitants). Altogether 528 cases identified to suffer from severe head injury (GCS < or = 8 or deteriorating to that level within 48 hrs) were enrolled following admission to the hospital and establishment of the diagnosis. Further, patients dying on the scene or during transport to the hospital were also documented, particularly as to the frequency of severe head injury as underlying cause of mortality. The analysis included also cases with additional peripheral trauma (polytrauma). The efficacy of the logistics and organization of the management was studied by documentation of prognosis-relevant time intervals, as for example until arrival of the rescue squad at the scene of an accident, until intubation and administration of fluid, or upon hospital admission until establishment of the CT-diagnosis and commencement of surgery or transfer to the intensive care unit, respectively. The severity of cases studied in the present analysis is evident from a mortality of far above 40% of cases admitted to the hospital, which was increased by about 20% when including prehospital mortality. The outcome data notwithstanding, the emerging results demonstrate a high efficacy of the pre- and early clinical management, as indicated by a prompt arrival of the rescue squad at the scene, a competent prehospital and early clinical management and care, indicative of a low rate of avoidable complications. It is tentatively concluded on the basis of these findings that the patient prognosis is increasingly determined by the manifestations of primary brain damage vs. the development of secondary complications.

Several methods utilized for the assessment of biocompatibility of perfluorochemicals.

An overview is presented on methods used to judge the effect of different perfluorochemicals (PFCs) on functional organ changes. By some of these methods the function of the reticuloendothelial system (RES) after a load with PFC was tested, either globally in form of the clearance of colloidal carbon particles or by a magnetometric method to test the phagocytosing function of macrophages within the liver of rats. An endotoxin test on survival of mice after the combined treatment with lipopolysaccharides of E. coli and PFCs showed the importance of a cumulative effect of multiple factors influencing phagocytosis. Other methods examined the influence of PFCs on lipid peroxidation during reperfusion of the ischemic intestine or on the effects of hyperbaric oxygen on the lung. The half-life (mean dwell time) of PFCs within organs with a high storage rate could optimally be determined by means of 19F magnetic resonance imaging in longitudinal studies within the same animal. An influence of PFCs on hepatocytes was tested by determining the time required for detoxifying pentobarbital as measured by the sleeping time (until reappearance of the righting reflex). By all these tests a strong dose-dependence was found, so that effects observed with a high load may become negligible with smaller dosages.