Catecholamines and Paroxysmal Sympathetic Hyperactivity after Traumatic Brain Injury.

Paroxysmal sympathetic hyperactivity (PSH) affects a significant minority of people in the intensive care unit after severe traumatic brain injury. Systematic research has yet to elucidate or quantify the extent of the role of the catecholamines or adrenocortical and thyroid axis hormonal influences in the condition. Data were prospectively collected on 80 consecutive patients, 18 of whom developed clinical signs of PSH (22.5%). Catecholamine and hormonal data were collected sequentially at 4-h intervals or during and between episodes of PSH. Evaluated variables showed 200-300% increases in catecholamines and, to a lesser extent, adrenocortical hormones during paroxysms. The majority of PSH episodes (72%) were noted to be in response to an observable triggering event. These changes were not observed in subjects without PSH. These data go some way to explain why PSH produces adverse consequences in survivors of TBI with the condition.

[Extreme thrombocytopenia following abciximab therapy]. / Trombocitopenia extrema secundaria a abcixamab.

Antagonists of the glycoprotein IIb/IIIa receptor block the binding of fibrinogen and Von Willebrand factor to the platelet receptor. This effect can lead to bleeding and thrombocytopenia. We analyzed the incidence and clinical repercussions of severe thrombocytopenia (< 20 000 /microl) secondary to abciximab treatment in a prospective study of 375 patients (74% men) who underwent percutaneous coronary revascularization and received abciximab at our hospital. We recorded clinical and demographic characteristics, angiographic findings, laboratory results and platelet counts (before, 4 hours after and 12 hours after the procedure) and hematocrit. The incidence of severe acute thrombocytopenia was 1.1%. All patients were men, and none had relevant bleeding complications. Management consisted of monitoring the bleeding, discontinuing the drug and transfusing platelets. Clinicians should be alert to this complication during the initial hours after the administration of abciximab.