Clinical Outcome of Epidural Hematoma Treated Surgically in the Era of Modern Resuscitation and Trauma Care.

OBJECTIVE: Patients from contemporary populations with traumatic brain injury (TBI) resulting from epidural hematoma (EDH) may differ regarding age, comorbidities, and coagulation status. We therefore analyzed predictors for the clinical outcome of patients with EDH treated surgically regarding modern approaches to resuscitation and trauma care. METHODS: A retrospective observational analysis was carried out. All patients included underwent surgery. The indication for surgery followed international guidelines. Retrospective data evaluation considered data reflecting the effectiveness of trauma care, baseline characteristics, and radiologic findings. In this analysis, we divided patients into 2 groups (isolated EDH vs. EDH plus other intracranial traumatic injuries). The neurologic outcome was assessed at discharge using the Glasgow Outcome Scale. RESULTS: Two hundred and sixty-eight patients with epidural hematoma, of whom 131 underwent surgery, were treated between January 1997 and December 2012 in our level-1 trauma center. The overall mortality was 6.8% (mortality for patients with Glasgow Outcome Scale score <9, 15%). As expected, factors with a highly significant (P < 0.01) impact on outcome were concomitant with other intracranial injuries, brain midline shift, and higher Injury Severity Score. Alcohol intoxication was a significant (P < 0.05) predictor of an unfavorable outcome. Anticoagulants and Glasgow Coma Scale score at admission had no significant impact on the outcome. CONCLUSIONS: The outcome for EDH is more favorable than decades ago, most probably reflecting a well-established chain of trauma care. Therefore, EDH is a treatable disease with a high probability of a favorable outcome.

"Here's to a Night of Drunken Mistakes": Exploring Experiences, Regrets, and Optimism in Young Adult Drinkers.

BACKGROUND: Studies exploring "anticipated regret" concerning alcohol rarely consider the broader consequences of excessive drinking that might be regretted. Even if specific regrettable experiences are identified, interventions targeting them may not succeed because individuals are often optimistic about their risk susceptibility. OBJECTIVES: This study examined the consequences young adult drinkers reported, and the extent to which these were regretted. It then explored whether consequences and regrets differentiated between high risk, low risk and light drinkers, and whether regret was related to optimism. METHODS: A cross-sectional on-line questionnaire measured drinking behavior, consequences (frequency) and regrets (extent of likely regret) and risk perceptions (in general, and compared to others). RESULTS: 273 participants were recruited (light (30%), low-risk (40%), and high-risk drinkers (30%). PCA detected three types of experience (common-e.g., vomiting; after-effects-e.g., being depressed; and "serious"-e.g., drunk-driving), and three types of regret ("serious"-e.g., being aggressive; "common"-e.g., wasting time; and "risky behavior regrets"-e.g., drugs). Multinomial regression found the high-risk drink group more likely to be male, had more experiences but regretted these experiences less than other groups. Regrets and optimism interacted, so that higher scores on common regrets were associated with greater optimism. The high-risk group was particularly characterized by optimism. CONCLUSIONS: High-risk drinkers may be unresponsive to anticipated regret manipulations as they do not regret post-alcohol "bad" experiences, and some regrets were associated with comparative optimism. Interventions may need to focus less on regret and aim to change risk perceptions.

[Surgical diseases in acute poisonings]. / Khirurgicheskie zabolevaniia pri ostrykh otravleniiakh.

Under analysis there were 104 case histories of patients with surgical diseases diagnosed in a toxicological center. In 34 patients the surgical diseases or mechanical traumas were combined with poisoning, in 106 patients they appeared due to acute poisoning. In the first group most frequent were closed craniocerebral injuries and acute destructive pancreatitis. In the second group prevailing were gastroesophageal bleedings.