Serum S100B protein in early management of patients after mild traumatic brain injury.

BACKGROUND AND PURPOSE: Neuronal protein S100B assays are available now with a perspective of being an early screening tool for serious intracranial injury. The aim of the study was to correlate early S100B measurements and initial CCT findings in the patients sustaining mild traumatic brain injury (MTBI). METHODS: The prospective study included patients of all ages with a history of MTBI. CCT scans and venous blood sampling for S100B analysis were performed within 6 h after injury. Levels of S100B above 0.1 ng/ml (S100B+) and any CCT detectable trauma-relevant intracranial lesions were considered positive (CCT+). RESULTS: A series of 102 patients were involved in the study. CCT+ scans were present in eighteen (17.6%) and CCT- scans in 84 (82.4%) patients. There were 74 (72.5%) patients in S100B+ and 28 (27.5%) in S100B- group. Sensitivity of S100B assay attained 83.3% with a negative predictive value of 89.3%. Three patients from CCT+ group had negative plasma level of S100B. Two of them required surgical treatment. DISCUSSION: S100B serum protein marker seems to be an unrealiable screening tool for determination of an intracranial injury risk group due to low sensitivity and negative predictive value seen from samples taken greater than 3 h after an MTBI.

Adult Respiratory Distress Syndrome and alveolar epithelium apoptosis: an histopathological and immunohistochemical study.

Adult Respiratory Distress Syndrome results from a variety of different initial insults, including trauma, sepsis, pneumonia and aspiration, and represents a severe form of acute lung injury. The lung samples of a 20-year-old man who had suffered a serious motorbike accident were obtained for histological examination. He died on the seventh day as a consequence of respiratory failure. The typical histopathological features of syndrome overlapping the first exudative phase into the second proliferate phase were observed. The apoptotic index of the early apoptotic phase evaluated using M30CytoDEATH was 3.4+/-0.2. The average number of apoptotic cells in the intermediate and late phases measured using the TUNEL method was 9.8+/-0.7. Our findings indicate that alveolar epithelium apoptosis seems to be less important during the early phases of Adult Respiratory Distress Syndrome.

[CT findings in alcohol intoxicated patients after mild brain injury]. / CT nálezy etylizovaných pacientov po l'ahkom kraniocerebrálnom poranení.

OBJECTIVE: To find out severity of brain injury in alcohol intoxicated patients after mild (GCS 13-15) brain injury. METHODS: A retrospective study of all patients older than 15 years in whom cranial CT (CCT) scan was performed between October 2006 and September 2007. Information of alcohol intoxication, injury mechanism, details of facial/head injuries, admission GCS, CCT findings and type of treatment were retrieved from patients' medical records. RESULTS: There were 151 alcohol intoxicated patients. Thirty four (22.5%) patients had positive CCT scans for brain injury or basal/vault fracture. One hundred and three (68.2%) patients had no signs of head/facial injury on CCT scans, 14 (9.3%) patients had fractures of nasal bones or maxillary/frontal sinuses only. Five (3.3%) patients were operated, 3 (2%) for depressed skull fracture and 2 (1.3%) for subdural hematoma. The most frequent findings on CCT scan were vault fracture in 21 patients (61.8%) and subarachnoid haemorrhage in 15 patients (44.1%). CONCLUSION: The prevalence of brain injury in alcohol intoxicated patients after mild brain injury was 22.5% with the need for neurosurgical intervention in 3.3%.

[Histologic changes in the jejunal wall after autotransplantation in a dog]. / Histologické zmeny v stene jejuna po jeho autotransplantácii u psa.

INTRODUCTION: Damages to the small intestinal wall resulting from ischemic-reperfusion changes, represent common complications of the clinical transplantation of the small intestine. AIM: Evaluation and quantification of the histological changes in the jejunal wall following its autotransplantation in a dog using the scale according to Park. MATERIAL AND METHODS: In dogs (n = 8), mongrel of both sexes, aged from 6 months to 2 years, weighting from 10 to 25 kgs, a resection of the jejunum followed by its autotransplantation was performed. At the time of the jejunal harvest, then after one-hour-long cold ischemia, 20 minutes after its reperfusion and then the 10th and the 20th day after the transplantation, bioptic samples of the whole jejunal wall were taken to be examined histologically. After being stained with hematoxyllin-eosine, the samples were evaluated according to the Park grading system. STATISTICS: The severity of the jejunal wall damage at the respective biopsy samples collection times was evaluated using the t-test for two dependent samples. RESULTS: After an hour-long cold ischemia, signs of increasing damage to the intestinal wall were observed, when compared to the peroperative sample (0 +/- 0) up to the degree 0.68 +/- 0.5 of the Park grading schema (p < 0.05). This damage degree increased 20 minutes after the reperfusion up to the value of 4 +/- 0 (p < 0.05). On the 10th and the 20th day a practically normal histological picture of the jejunal wall was observed. The histological changes in both cases were graded 0.38 +/- 0.5 (p < 0.05). CONCLUSION: Maximum histological changes following the autotransplantation of the small intestine with an hour-long cold ischemia were observed 20 minutes after the reperfusion. After 10 postoperative days, a practically normal histological picture of the small intestinal wall structure was observed. It remained unchanged even on the 20th postoperative day.