ABSTRACT
Background: Ruptured cerebral aneurysms [ICAs] are the most common non-traumaticcause of subarachnoid hemorrhage [SAH] that is associated with life threateningcomplications such as Vasospasm, Infarction, and Hydrocephalus [HCP]. The activeparticipation of macrophage/monocyte-mediated inflammatory response in thepathogenesis of cerebral aneurysm as labeled with Monocyte ChemoattractantProtein-1[MCP-1] is suggested
Objective: To measure the serum level of MCP-1 in rupturedCAs in different time intervals
Methods: We measured the serum levels of MCP-1 inSAH patients who had CAs and compared it with that of MCP-1 in two control groups:including patients with SAH without CAs, and the normal population of blood donors.We also measured the MCP-1 levels in patients with CAs one week afterward toevaluate the effect of treatment. Serum level of MCP-1 was measured by a commercial ELISA assay
Results: Mean serum MCP-1 level in patients with SAH and CAs was188.2168 Pg/ml and 331.3982 Pg/ml in the normal population. There was nostatistically significant difference between serum levels of MCP-1 on the first[mean=188.2168 Pg/ml] and 7th days after SAH onset [mean=171.8450 Pg/ml][p=0.739]. Serum level of MCP-1 increased significantly as Glasgow Coma Scaledecreased [p=0.078] and Hunt and Hess score increased [p=0.089]
Conclusion: Ourresults did not show an increasing MCP-1 serum level in patients with aneurysmalSAH. There was a relationship between poor clinical grade and MCP-1 levels inpatients with CAs. MCP-1 may be a local inflammatory marker for cerebral aneurysmswithout systemic manifestation
ABSTRACT
Objective: To describe the epidemiological characteristics of patients with cervical spine injury admitted to Rajaee hospital, Shiraz, Iran
Methods: This cross-sectional study includes all patients admitted with impression of cervical column injury with or without cervical cord injury from October 2009 to March 2012 to our level I trauma center in Shiraz. We recorded the patients' characteristics including age, sex, marital status, mechanism of injury, level of injury, concomitant injury, treatment [non-operative or operative] and clinical outcome. The data were described and compared with the international literature
Results: Among 261 patients referred with impression of spinal cord injury, the diagnosis of spinal column injury [with or without spine cord injury] was confirmed in 206 patients. The mean age of patients was 37.2 +/- 15.9 years with Male/Female ratio of 3:1. Car turn-over and car-collisions were the leading causes of injury. The most common spine fracture was C6 vertebra involving 60 [29.1%] patients. Fracture of upper and lower extremities were the most concomitant fractures observed in 31[15.1%] patients. Open surgery was performed in 65[31.6%].Mortality rate was 7.3% [15 patients].Patients with brain, lung and cord injuries had increased risk of death, among 15 deaths,9 patients had brain injury, 5 individuals had lung injury and 10 patients suffered from cord injury
Conclusion: Cervical spine injuries mostly affect young males, and comprise 206 [10%] cases out of 2100 spine injuries in our country. Preventive measures should be taken to reduce cervical spine injuries especially in young age group
ABSTRACT
Objective: To investigate the effects of intracranial pressure [ICP] monitoring on mortality rate and functional outcome of patients with severe traumatic brain injury [TBI]
Methods: This was historical cohort study being performed in Nemazee hospital of Shiraz during a 4-year period [from 2006 to 2010] including those patients with severe TBI who had undergone care based on ICP monitoring [case group] or clinical evaluation [control group].Patients and controls were matched regarding the age, sex, initial GCS, initial pupils, and CT findings. The functional outcome, complications and mortality rate were recorded and compared between those who underwent ICP monitoring and those who did not
Results: There was no significant difference between two study groups regarding the baseline characteristics. The rate of meningitis was significantly higher in those who underwent Ventriculostomy and ICP monitoring when compared to those who were managed without ICP monitoring. [14 [23.3%] vs. 7 [11.6%]; p=0.041]. We found that the mortality rate [28.3% vs. 11.6%; p=0.172] as well as the frequency of persistent vegetative state [5.0% vs. 5.0%; p=0.998] were comparable between two study groups. However the frequency of severe disability was higher in control group compared to case group [26.7% vs. 15.0; p=0.046]. In the same way, the frequency of good recovery [26.7% vs. 15.0; p=0.046] and favorable outcome [51.7% vs. 33.3%; p=0.021] was significantly higher in case group
Conclusion: Care based on ICP monitoring in patients with severe TBI was associated with increased frequency of good recovery and favorable outcome and decreased frequency of moderate disability. However higher meningitis rate was associated with Ventriculostomy and ICP monitoring