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1.
BMC Neurol ; 20(1): 394, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33121474

RESUMO

BACKGROUND: To investigate whether the administration of intravenous propofol before endotracheal suctioning (ES) in patients with severe brain disease can reduce the sputum suction response, improve prognosis, and accelerate recovery. METHODS: A total of 208 severe brain disease patients after craniocerebral surgery were enrolled in the study. The subjects were randomly assigned to the experimental group (n = 104) and the control group (n = 104). The experimental group was given intravenous propofol (10 ml propofol with 1 ml 2% lidocaine), 0.5-1 mg/kg, before ES, while the control group was subjected to ES only. Changes in vital signs, sputum suction effect, the fluctuation range of intracranial pressure (ICP) before and after ES, choking cough response, short-term complications, length of stay, and hospitalization cost were evaluated. Additionally, the Glasgow Outcome Scale (GOS) prognosis score was obtained at 6 months after the operation. RESULTS: At the baseline, the characteristics of the two groups were comparable (P > 0.05). The increase of systolic blood pressure after ES was higher in the control group than in the experimental group (P < 0.05). The average peak value of ICP in the experimental group during the suctioning (15.57 ± 12.31 mmHg) was lower than in the control group (18.24 ± 8.99 mmHg; P < 0.05). The percentage of patients experiencing cough reaction- during suctioning in the experimental group was lower than in the control group (P < 0.05), and the fluctuation range of ICP was increased (P < 0.0001). The effect of ES was achieved in both groups. The incidence of short-term complications in the two groups was comparable (P > 0.05). At 6 months after the surgery, the GOS scores were significantly higher in the experimental than in the control group (4-5 points, 51.54% vs. 32.64%; 1-3 points, 48.46% vs. 67.36%; P < 0.05). There was no significant difference in the length of stay and hospitalization cost between the two groups. CONCLUSIONS: Propofol sedation before ES could reduce choking cough response and intracranial hypertension response. The use of propofol was safe and improved the long-term prognosis. The study was registered in the Chinese Clinical Trial Registry on May 16, 2015 (ChiCTR-IOR-15006441).


Assuntos
Encefalopatias/fisiopatologia , Pressão Intracraniana/efeitos dos fármacos , Intubação Intratraqueal , Propofol/uso terapêutico , Sucção , Adulto , Feminino , Escala de Resultado de Glasgow , Humanos , Hipnóticos e Sedativos/uso terapêutico , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Sucção/efeitos adversos
2.
PLoS One ; 15(10): e0232561, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031373

RESUMO

BACKGROUND: Decompressive craniectomy is an important surgical treatment for patients with severe traumatic brain injury (TBI). Several reports have been published on the efficacy of non-watertight sutures in duraplasty performed in decompressive craniectomy. This study sought to determine the safety and feasibility of the non-suture dural closure technique in decompressive craniectomy. METHODS: A total of 106 patients were enrolled at a single trauma center between January 2017 and December 2018. We retrospectively collected data and classified the patients into non-suture and suture duraplasty craniectomy groups. We compared the characteristics of patients and their intra/postoperative findings such as operative time, blood loss, imaging findings, complications, and Glasgow Outcome Scale scores. RESULTS: There were 37 and 69 patients in the non-suture and suture duraplasty groups, respectively. There were no significant differences between the two groups concerning general characteristics. The operative time was significantly lower in the non-suture duraplasty group than in the suture duraplasty group (150 min vs. 205 min; p = 0.002). Furthermore, blood loss was significantly less severe in the non-suture duraplasty group than in the suture duraplasty group (1000 mL vs. 1500 mL; p = 0.028). There were no other significant differences. CONCLUSION: Non-suture duraplasty involved shorter operative times and less severe blood losses than suture duraplasty. Other complications and prognoses were similar across groups. Therefore, the non-suture duraplasty in decompressive craniectomy is a safe and feasible surgical technique.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/métodos , Dura-Máter/cirurgia , Adulto , Perda Sanguínea Cirúrgica , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos sem Sutura , Resultado do Tratamento
3.
Neurology ; 95(18): e2529-e2541, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-32913029

RESUMO

OBJECTIVE: To evaluate the association between systemic factors (mean arterial blood pressure, arterial partial pressures of carbon dioxide and oxygen, body temperature, natremia, and glycemia) on day 1 and neurologic outcomes 90 days after convulsive status epilepticus. METHODS: This was a post hoc analysis of the Evaluation of Therapeutic Hypothermia in Convulsive Status Epilepticus in Adults in Intensive Care (HYBERNATUS) multicenter open-label controlled trial, which randomized 270 critically ill patients with convulsive status epilepticus requiring mechanical ventilation to therapeutic hypothermia (32°C-34°C for 24 hours) plus standard care or standard care alone between March 2011 and January 2015. The primary endpoint was a Glasgow Outcome Scale score of 5, defining a favorable outcome, 90 days after convulsive status epilepticus. RESULTS: The 172 men and 93 women had a median age of 57 years (45-68 years). Among them, 130 (49%) had a history of epilepsy, and 59 (29%) had a primary brain insult. Convulsive status epilepticus was refractory in 86 (32%) patients, and total seizure duration was 67 minutes (35-120 minutes). The 90-day outcome was unfavorable in 126 (48%) patients. In multivariate analysis, none of the systemic secondary brain insults were associated with outcome; achieving an unfavorable outcome was associated with age >65 years (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.20-3.85; p = 0.01), refractory convulsive status epilepticus (OR 2.00, 95% CI 1.04-3.85; p = 0.04), primary brain insult (OR 2.00, 95% CI 1.02-4.00; p = 0.047), and no bystander-witnessed seizure onset (OR 2.49, 95% CI 1.05-5.59; p = 0.04). CONCLUSIONS: In our population, systemic secondary brain insults were not associated with outcome in critically ill patients with convulsive status epilepticus. CLINICALTRIALSGOV IDENTIFIER: NCT01359332.


Assuntos
Encéfalo/fisiopatologia , Estado Epiléptico/complicações , Estado Epiléptico/fisiopatologia , Idoso , Encéfalo/irrigação sanguínea , Feminino , Febre/complicações , Febre/fisiopatologia , Escala de Resultado de Glasgow/estatística & dados numéricos , Humanos , Hipercapnia/complicações , Hipercapnia/fisiopatologia , Hipotensão/complicações , Hipotensão/fisiopatologia , Hipotermia Induzida/estatística & dados numéricos , Hipóxia/complicações , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Estado Epiléptico/terapia
4.
Neurology ; 95(17): e2398-e2408, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-32907958

RESUMO

OBJECTIVE: To understand how, biologically, the acute event of traumatic brain injury gives rise to a long-term disease, we address the relationship between evolving cortical and subcortical brain damage and measures of functional outcome and cognitive functioning at 6 months after injury. METHODS: For this longitudinal analysis, clinical and MRI data were collected in a tertiary neurointensive care setting in a continuous sample of 157 patients surviving moderate to severe traumatic brain injury between 2000 and 2018. For each patient, we collected T1- and T2-weighted MRI data acutely and at the 6-month follow-up, as well as acute measures of injury severity (Glasgow Coma Scale), follow-up measures of functional impairment (Glasgow Outcome Scale-extended), and, in a subset of patients, neuropsychological measures of attention, executive functions, and episodic memory. RESULTS: In the final cohort of 113 subcortical and 92 cortical datasets that survived (blind) quality control, extensive atrophy was observed over the first 6 months after injury across the brain. However, only atrophy within subcortical regions, particularly in the left thalamus, was associated with functional outcome and neuropsychological measures of attention, executive functions, and episodic memory. Furthermore, when brought together in an analytical model, longitudinal brain measurements could distinguish good from bad outcome with 90% accuracy, whereas acute brain and clinical measurements alone could achieve only 20% accuracy. CONCLUSION: Despite great injury heterogeneity, secondary thalamic pathology is a measurable minimum common denominator mechanism directly relating biology to clinical measures of outcome and cognitive functioning, potentially linking the acute event and the longer-term disease of traumatic brain injury.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Adulto , Idoso , Atenção , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/psicologia , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Estudos de Coortes , Função Executiva , Feminino , Seguimentos , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Memória Episódica , Pessoa de Meia-Idade , Testes Neuropsicológicos , Teste de Stroop , Adulto Jovem
5.
Rev. méd. panacea ; 9(2): 130-134, mayo-ago. 2020.
Artigo em Espanhol | LILACS, LIPECS | ID: biblio-1121236

RESUMO

Introducción: El TEC constituye un grave problema de salud pública en el mundo, no solo por su magnitud como también por afectar a jóvenes en edad productiva. Objetivo: El objetivo principal de esta revisión bibliográfica es generar conocimiento sobre la relación de la clasificación de Marshall en la evaluación de pacientes con TEC. Materiales y métodos: Es un estudio descriptivo de búsqueda bibliografía y se ha realizado en Pubmed, Medline, Scielo, bibliotecas de universidades nacionales e internacionales. Resultados: Se observó que la media fue entre 35 y 46 años. La mayoría eran adultos jóvenes masculino entre el 60% y el 80%. El principal mecanismo de trauma fueron caídas 48%. La severidad del TEC, según la escala de coma de Glasgow se encontró frecuencias variadas con rangos similares: TEC leve entre 40% al 70%, TEC moderado del 20% al 40% y TEC severo alrededor del 10%. La distribución de los hallazgos tomográficos en adultos con TEC según escala de Marshall fué: Lesión difusa tipo I (53.87%) (8%-60%), Lesión difusa tipo II 21% (16%-26%); lesión difusa tipo III 8,5% (9.7%-18.3%); lesión difusa tipo IV 8,5% (4.98%-12%); lesión focal no evacuada 2.6% (0.51%-4.66%). Conclusiones: La mayor parte de pacientes fueron adultos jóvenes y varones. El TEC leve fue el más prevalente. Según la clasificación de Marshall, la lesión difusa tipo I, II fueron las más frecuentes. La clasificación tomográfica de Marshall se relacionan significativamente con el pronóstico para predecir la recuperación de los pacientes con TEC. (AU)


Introduction: ECT constitutes a serious public health problem in the world, not only because of its magnitude but also because it affects young people of productive age. Objective: The main objective of this bibliographic review is to generate knowledge about the relationship of the Marshall classification in the evaluation of patients with ECT. Materials and methods: It is a descriptive study of literature search and has been carried out in Pubmed, Medline, Scielo, libraries of national and international universities. Results: It was observed that the average was between 35 and 46 years old. Most were young male adults between 60% and 80%. The main mechanism of trauma were falls 48%. The severity of ECT, according to the Glasgow Coma Scale, varied frequencies with similar ranges were found: mild ECT between 40% to 70%, moderate ECT from 20% to 40% and severe ECT around 10%. The distribution of the tomographic findings in adults with ECT according to the Marshall scale was: Diffuse type I injury (53.87%) (8% -60%), Diffuse type II injury 21% (16% -26%); diffuse type III injury 8.5% (9.7% -18.3%); diffuse type IV injury 8.5% (4.98% -12%); focal lesion not evacuated 2.6% (0.51% -4.66%). Conclusions: Most of the patients were young adults and males. Mild ECT was the most prevalent. According to the Marshall classification, the diffuse type I, II injury was the most frequent. The Marshall tomographic classification is significantly related to the prognosis to predict the recovery of patients with ECT. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Escala de Resultado de Glasgow , Lesões Encefálicas Traumáticas , Epidemiologia Descritiva
6.
BMC Neurol ; 20(1): 315, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847526

RESUMO

BACKGROUND: Acute neck pain (ANP) has recently been demonstrated to be a predictor of persistent posttraumatic complaints after mild traumatic brain injury (mTBI). The aim of this study was to determine specific characteristics of patients with ANP following mTBI, their posttraumatic complaints and relationship with functional outcome. METHODS: Data from a prospective follow-up study of 922 mTBI patients admitted to the emergency department (ED) in three level-one trauma centres were analysed. Patients were divided into two groups: 156 ANP patients and 766 no acute neck pain (nANP) patients. Posttraumatic complaints were evaluated 2 weeks and 6 months post-injury using standardized questionnaires and functional outcome was evaluated at 6 months with the Glasgow Outcome Scale Extended (GOSE). RESULTS: ANP patients were more often female (p < 0.01), younger (38 vs. 47 years, p < 0.01) with more associated acute symptoms at the ED (p < 0.05) compared to nANP patients. More motor vehicle accidents (12% vs. 6%, p = 0.01) and less head wounds (58% vs. 73%, p < 0.01) in ANP patients indicated 'high-energy low-impact' trauma mechanisms. ANP patients showed more posttraumatic complaints 2 weeks and 6 months post-injury (p < 0.05) and more often incomplete recovery (GOSE < 8) was present after 6 months (56% vs. 40%, p = 0.01). CONCLUSIONS: MTBI patients with acute neck pain at the ED constitute a distinct group within the mTBI spectrum with specific injury and demographic characteristics. Early identification of this at risk group already at the ED might allow specific and timely treatment to avoid development of incomplete recovery.


Assuntos
Concussão Encefálica/complicações , Serviço Hospitalar de Emergência , Cervicalgia/etiologia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
7.
J Stroke Cerebrovasc Dis ; 29(8): 104976, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689623

RESUMO

BACKGROUND: Hip fractures are a significant post-stroke complication. We examined predictors of hip fracture risk after stroke using data from the Women's Health Initiative (WHI). In particular, we examined the association between post-stroke disability levels and hip fracture risk. METHODS: The WHI is a prospective study of 161,808 postmenopausal women aged 50-79 years. Trained physicians adjudicated stroke events and hip fractures. Our study included stroke survivors from the observational and clinical trial arms who had a Glasgow Outcome Scale of good recovery, moderately disabled, or severely disabled and survived more than 7 days post-stroke. Hip fracture-free status was compared across disability levels. Secondary analysis examined hip fracture risk while accounting for competing risk of death. RESULTS: Average age at time of stroke was 74.6±7.2 years; 84.3% were white. There were 124 hip fractures among 4,640 stroke survivors over a mean follow-up time of 3.1±1.8 years. Mortality rate was 23.3%. Severe disability at discharge (Hazard Ratio (HR): 2.1 (95% Confidence Interval (CI): 1.4-3.2), but not moderate disability (HR: 1.1 (95%CI: 0.7-1.7), was significantly associated with an increased risk of hip fracture compared to good recovery status. This association was attenuated after accounting for mortality. White race, increasing age and higher Fracture Risk Assessment Tool (FRAX)-predicted hip fracture risk (without bone density information) were associated with an increased hip fracture risk. After accounting for mortality, higher FRAX risk and white race remained significant. CONCLUSION: Severe disability after stroke and a higher FRAX risk score were associated with risk of subsequent hip fracture. After accounting for mortality, only the FRAX risk score remained significant. The FRAX risk score appears to identify stroke survivors at high risk of fractures. Our results suggest that stroke units can consider the incorporation of osteoporosis screening into care pathways.


Assuntos
Avaliação da Deficiência , Escala de Resultado de Glasgow , Fraturas do Quadril/epidemiologia , Osteoporose Pós-Menopausa/epidemiologia , Fraturas por Osteoporose/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/mortalidade , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/diagnóstico , Osteoporose Pós-Menopausa/mortalidade , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/mortalidade , Pós-Menopausa , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Estados Unidos/epidemiologia
8.
J Trauma Acute Care Surg ; 89(3): 523-528, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502089

RESUMO

BACKGROUND: Although age and coagulopathy are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear. OBJECTIVES: We assessed age-related differences in the impact of coagulopathy on the outcome following isolated TBI. METHODS: We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI (head Abbreviated Injury Scale ≥ 3 and other Abbreviated Injury Scale < 3) were selected and divided into the nonelderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio, >1.2) on the outcomes (Glasgow Outcome Scale-Extended [GOS-E] scores, in-hospital mortality, and ventilation-free days) in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of TBI-associated coagulopathy on GOS-E using a generalized additive model. RESULTS: The multivariate model showed a significant association of age and TBI-associated coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter ventilation-free days in the nonelderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with those older than 65 years. CONCLUSION: There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI. LEVEL OF EVIDENCE: Therapeutic study, Level IV.


Assuntos
Fatores Etários , Transtornos da Coagulação Sanguínea/etiologia , Lesões Encefálicas Traumáticas/complicações , Escala Resumida de Ferimentos , Adulto , Idoso , Transtornos da Coagulação Sanguínea/epidemiologia , Feminino , Escala de Resultado de Glasgow , Mortalidade Hospitalar , Humanos , Coeficiente Internacional Normatizado , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco
9.
PLoS One ; 15(6): e0234864, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555706

RESUMO

The purpose of this study was to develop the Glasgow Antipsychotic Side effects Scale for Clozapine Japanese version (GASS-C-J) and examine its reliability to assess clozapine-related side effects. We developed the GASS-C-J using forward and backward translation. Semantic equivalence of the GASS-C-J to the GASS-C was confirmed by the original author. We then administered the GASS-C-J twice to 109 patients on clozapine treatment at two psychiatric hospitals in Japan. We assessed the internal consistency and test-retest reliability of the GASS-C-J using Cronbach's alpha and weighted kappa coefficient, respectively. We also examined if discrepancies in each GASS-C-J item score between the first and second rating were correlated with items of the Brief Evaluation of Psychosis Symptom Domains (BE-PSD). The Cronbach's alpha coefficient of the GASS-C-J at the first and second rating was 0.78 (95% CI: 0.72 to 0.84) and 0.82 (95% CI: 0.76 to 0.88), respectively. The weighted kappa coefficient of individual and total GASS-C-J item scores ranged from 0.45 to 0.88. Some symptom domains were correlated with discrepancies in specific items of the GASS-C-J: psychotic symptoms and nausea/vomiting (rs = 0.27), thirst (rs = 0.31), and appetite/weight gain (rs = 0.27); disorganized thinking and urinary incontinence (rs = 0.26); depression/anxiety and myoclonus (rs = 0.25), hypersalivation (rs = -0.27), and blurred vision (rs = -0.22). These findings demonstrate that the GASS-C-J can be used in clinical and research settings as a reliable scale to assess clozapine-related side effects.


Assuntos
Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Escala de Resultado de Glasgow/normas , Esquizofrenia/tratamento farmacológico , Adulto , Antipsicóticos/sangue , Antipsicóticos/uso terapêutico , Clozapina/sangue , Clozapina/uso terapêutico , Estudos Transversais , Resistência a Medicamentos/efeitos dos fármacos , Feminino , Hospitais Psiquiátricos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários
10.
Acta Neurochir (Wien) ; 162(7): 1619-1628, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32405669

RESUMO

BACKGROUND: Evaluation of changes in quality of life (QOL) in ICU patients several years after traumatic brain injury (TBI) is not well documented. METHODS: A prospective cohort study was conducted in all patients with TBI admitted between 2004 and 2008 to the ICU of Regional Hospital of Malaga (Spain). Functional status was evaluated by Glasgow Outcome Scale (GOS) and QOL by PAECC (Project for the Epidemiologic Analysis of Critical Care patients) questionnaire between 0 (normal QOL) to 29 points (worst QOL). RESULTS: A total of 531 patients. Median(Quartile1,Quartile 3) age: 35 (22, 56) years. After 3-4 years, 175 died (33%). Survivor QOL was deteriorated (median total PAECC score: 5 (0, 11) points) although 75.76% of patients who survived showed good functional situation (GOS normal or mild dysfunction). An improvement in QOL scores between 1 and 3-4 years was observed (median PAECC score differences between 3-4 years and 1 year: - 1(- 4, 0) points). QOL score improved during this interval of time: 62.6% of patients. Change in QOL was related by multivariate analysis to admission cranial-computed tomography scan (Marshall's classification), age, and Injury Severity Score (ISS), with the biggest improvement seen in younger patients and with more severe ISS. Basic physiological activities were maintained in the majority of patients. Subjective aspects and working activities improved between 1 and 3-4 years but with a high proportion still impaired in these items after 3-4 years. CONCLUSIONS: ICU patients with TBI after 1 year show improvement in QOL between 1 and 3-4 years, with the biggest improvement in QOL seen in younger patients and in those with more severe ISS.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Qualidade de Vida , Adulto , Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/reabilitação , Cuidados Críticos , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
11.
World Neurosurg ; 142: 513-519, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32389868

RESUMO

BACKGROUND: Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. METHODS: We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. RESULTS: The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4-15). The median trauma to surgery time was 25 hours (range, 13-192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. CONCLUSIONS: Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.


Assuntos
Craniotomia/métodos , Hematoma Epidural Craniano/cirurgia , Adolescente , Adulto , Anestesia Local/métodos , Criança , Sedação Consciente/métodos , Traumatismos Craniocerebrais/complicações , Feminino , Escala de Resultado de Glasgow , Hematoma Epidural Craniano/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
J Clin Neurosci ; 78: 273-276, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402617

RESUMO

Subdural hygroma (SDG) represents a common complication following decompressive craniectomy (DC). To our knowledge we present the first meta-analysis investigating the role of clinical and technical factors in the development of SDG after DC for traumatic brain injury. We further investigated the impact of SDG on the final prognosis of patients. The systematic review of the literature was done according to the PRISMA guidelines. Two different online medical databases (PubMed/Medline and Scopus) were screened. Four articles were included in this meta-analysis. Data regarding age, sex, trauma dynamic, Glasgow Coma Scale (GCS), pupil reactivity and CT scan findings on admission were collected for meta-analysis in order to evaluate the possible role in the SDG formation. Moreover we studied the possible impact of SDG on the outcome by evaluating the rate of patients dead at final follow-up and the Glasgow Outcome Scale (GOS) at final follow-up. Among the factors available for meta-analysis only the basal cistern involvement on CT scan was associated with the development of a SDG after DC (p < 0.001). Moreover, patients without SDG had a statistically significant better outcome compared with patients who developed SDG after DC in terms of GOS (p < 0.001). The rate of patients dead at follow-up was lower in the group of patients without SDH (8.25%) compared with patients who developed SDG (11.51%). SDG after DC is a serious complication affecting the prognosis of patients. Further studies are needed to define the role of some adjustable technical aspect of DC in preventing such a complication.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/tendências , Complicações Pós-Operatórias/diagnóstico por imagem , Derrame Subdural/diagnóstico por imagem , Escala de Coma de Glasgow/tendências , Escala de Resultado de Glasgow/tendências , Humanos , Complicações Pós-Operatórias/etiologia , Derrame Subdural/etiologia , Tomografia Computadorizada por Raios X/tendências
13.
Arch Gynecol Obstet ; 301(6): 1543-1551, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32409927

RESUMO

PURPOSE: The Glasgow Prognostic Score or modified Glasgow Prognostic Score (GPS/mGPS), a novel inflammatory indicator, which acts as a prognostic predictor in various cancers. However, these results are still controversial. In this meta-analysis, we aimed to investigate the prognostic role of GPS/mGPS in patients with gynecologic cancers. METHODS: We explored eligible studies by searching the databases PubMed, the Cochrane Library, EMBASE, and Web of Science. The hazard ratio (HR) and odds ratios (OR) with 95% confidence intervals (CIs) were extracted to investigate the correlation between GPS/mGPS and overall survival (OS) and progression-free survival (PFS). Additionally, we performed subgroup analyses to detect the potential heterogeneity in our study. RESULTS: 11 studies involving 2830 patients were enrolled in this meta-analysis. The results revealed that a high GPS was significantly related to a shorter OS (pooled HR = 1.94; 95% CI = 1.54-2.43; P < 0.001) and PFS (pooled HR = 1.92; 95% CI = 1.56-2.35; P < 0.001) in patients with gynecologic cancers. Moreover, mGPS also predicted poor OS (pooled HR = 1.67; 95% CI = 1.41-1.96; P < 0.001) and PFS (pooled HR = 1.73; 95% CI = 1.47-2.04; P < 0.001) in gynecologic cancers patients. CONCLUSION: A higher GPS/mGPS is correlated with poor survival outcomes in patients with gynecologic cancers. Pretreatment GPS/mGPS is a valid prognostic predictor in gynecologic cancers.


Assuntos
Neoplasias dos Genitais Femininos/mortalidade , Escala de Resultado de Glasgow/estatística & dados numéricos , Feminino , Humanos , Masculino , Prognóstico , Intervalo Livre de Progressão , Análise de Sobrevida
14.
Ulus Travma Acil Cerrahi Derg ; 26(3): 418-424, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436966

RESUMO

BACKGROUND: Decompressive craniectomy (DC) is performed in the management of intracranial hyper-tension after traumatic brain injury (TBI). This study aims to investigate the effects of transcranial Dop-pler ultrasonography (TCD) measurements on the indication of decompressive surgery. METHODS: Sixteen TBI patients with a Glasgow Coma Score (GCS) <9 were included in this study. Intra-cranial pressure (ICP) monitoring and transcranial Doppler ultrasonography (TCD) measurements were recorded continuously. DC was performed according to the records of ICP and TCD. Glasgow Outcome Scale (GOS) scores were evaluated after three months. RESULTS: Mean age of the patients was 31.18±17.51; GCS ranged between three and 14 with a mean of 9.62±3.95. Mean GOS was 3.12±1.85. Craniectomy was performed in two patients (12.5%) and cra-niectomy and lobectomy together were performed in 14 (87.5%) of them. The decline in ICP (22.12±10.41, 22.62±7.35, 15.50±6.64) and pulsatility index (PI) (1.96±1.10, 1.64±0.75, 1.91±2.48) were strongly significant between days 3-5, and 1-5. The range of PI and Vmax values through five days did not present any significance. CONCLUSION: TCD, as a real-time monitor, may help for an early decision of surgical approach in the management of TBI patients.


Assuntos
Lesões Encefálicas Traumáticas , Craniectomia Descompressiva , Ultrassonografia Doppler Transcraniana , Adolescente , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/cirurgia , Escala de Resultado de Glasgow , Humanos , Pressão Intracraniana/fisiologia , Pessoa de Meia-Idade , Monitorização Fisiológica , Adulto Jovem
15.
Asia Pac J Clin Nutr ; 29(1): 55-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32229442

RESUMO

BACKGROUND AND OBJECTIVES: The severity of neurologic impairment is significantly associated with gastrointestinal (GI) hemorrhage. Therefore, the aim of this study was to compare the effect of two nutritional interventions in acute ischemic stroke patients with GI hemorrhage. METHODS AND STUDY DESIGN: We retrospectively studied consecutive ischemic stroke patients with GI hemorrhage from January 2014 to December 2018. They were stratified into two programs of nutritional therapy after GI hemorrhage: moderate feeding (more than 70% optimal caloric uptake, 50-100 mL/h) and trophic feeding (16-25% of the target energy expenditure, 25 kcal/kg per day, 10- 30 mL/h) with supplemental parenteral nutrition. RESULTS: The group receiving moderate feeding included 30 patients, and the group receiving trophic feeding and supplemental parenteral nutrition included 32 patients. There was no statistically significant difference between the two groups in the baseline characteristics of the patients. Mortality, Glasgow Coma Scale (GCS) score at discharge, and Glasgow Outcome Scale (GOS) score 3 months after discharge were compared between the two groups. In the moderate feeding group, the overall mortality was significantly lower than in the trophic feeding and supplemental parenteral nutrition group (p<0.05). Conscious state and neurological severity were assessed by the GCS score before discharge, and the score was higher in the moderate feeding group than in the other group (p<0.05). The GOS score 3 months after discharge was higher in the moderate feeding group than in the trophic feeding and supplemental parenteral nutrition group (p<0.05). These three items showed that moderate feeding led to a better prognosis: lower occurrence of mortality, higher GCS score at discharge, and higher GOS score 3 months after discharge. CONCLUSIONS: This study showed that moderate feeding had a much more profound effect on the outcomes than trophic feeding and supplemental parenteral nutrition, as it was associated with lower mortality, higher GCS score at discharge, and higher GOS score 3 months after discharge.


Assuntos
Nutrição Enteral/métodos , Hemorragia Gastrointestinal/terapia , Nutrição Parenteral , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemorragia Gastrointestinal/mortalidade , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
16.
Wien Klin Wochenschr ; 132(17-18): 499-505, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32333270

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. It is hypothesized, that with the adequate treatment of SDH in children and adolescence, excellent clinical and functional outcomes can be achieved. The aim of this study was to present the severity and outcome of traumatic SDH in children and adolescence as well as to analyze differences between patients treated surgically and conservatively. METHODS: In this study 47 infants and children with a subdural hematoma (SDH) were treated between 1992 and 2010 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow outcome scale (GOS) scores at hospital discharge and at follow-up visits were used. Severity of SDH was classified according to the Rotterdam score. RESULTS: In total, 47 cases were treated (21 surgically, 26 conservatively), with 10 patients needing delayed surgery. Overall, 89% of the patients were able to leave hospital, 5 patients died, 2 patients (5%) within 24 h, another 2 (5%) after 48 h and 1 (2%) within 7 days. In 25 patients (53%) a good recovery was recorded at the last follow-up visit. Outcome was mainly influenced by the following factors: age, severity of TBI, and neurological status. Overall, in 70% good clinical and neurological outcomes could be achieved. CONCLUSION: The results of this study confirmed that pediatric SDH is a rare, but serious condition. Despite a poor prognosis, most patients could be treated with good outcomes, given that the choice of treatment is correct. TRIAL REGISTRATION: Research registry 2686.


Assuntos
Lesões Encefálicas Traumáticas , Hematoma Subdural , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Criança , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/terapia , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Centros de Traumatologia
17.
World Neurosurg ; 138: e876-e882, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251815

RESUMO

OBJECTIVES: Decompressive craniectomy (DC) is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury (TBI). We report the association of comparative radiographic factors in predicting functional outcomes after DC in patients with severe TBI. METHODS: A retrospective analysis of a prospectively maintained database of cases between 2015 and 2018 at an academic tertiary care hospital was carried out. Univariate and multivariable regression analyses were performed for an array of comparative radiographic variables (pre- and post-DC) in relationship to functional outcome according to Glasgow Outcome Scale Extended (GOSE) at 180 days. GOSE was further dichotomized into favorable (GOSE:5-8) and unfavorable (GOSE:0-4) functional outcomes. All associations were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Statistical analysis included a cohort of 43 patients with a median age of 30.5 years (range: 18-62 years). The median GOSE at 180 days was 7. Multivariable regression analysis after adjusting for confounding variables (age, sex, comorbidities, site of surgery and size of decompression) showed that comparative radiographic findings of midline shift (MLS) > 10 mm (OR 3.2 (95% CI 1.25-8.04); P = 0.01); external cerebral herniation (ECH) > 2.5 cm (OR 2.5 [95% CI 1.18-5.2]; P = 0.02); and effacement of basal cisterns (OR 3.9 [95%CI 1.1-13.9]; P = 0.03), were significant independent predictors of poor functional outcome at 180 days after DC for severe TBI. However, the presence of infarction (OR 2.7 [95%CI 0.43-17.2]; P = 0.28) and absence of gray-white matter differentiation (OR 0.18 [95%CI 0.03-1.2]; P = 0.07) did not reach statistical significance. CONCLUSIONS: The comparative radiographic findings that include MLS > 10mm, ECH > 2.5cm, and effacement of basal cisterns are predictive of poor functional outcome in severe TBI.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Lesões Encefálicas Traumáticas/epidemiologia , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Neurology ; 94(16): e1684-e1692, 2020 04 21.
Artigo em Inglês | MEDLINE | ID: mdl-32269116

RESUMO

OBJECTIVE: To validate quantitative diffusion-weighted imaging (DWI) MRI thresholds that correlate with poor outcome in comatose cardiac arrest survivors, we conducted a clinician-blinded study and prospectively obtained MRIs from comatose patients after cardiac arrest. METHODS: Consecutive comatose post-cardiac arrest adult patients were prospectively enrolled. MRIs obtained within 7 days after arrest were evaluated. The clinical team was blinded to the DWI MRI results and followed a prescribed prognostication algorithm. Apparent diffusion coefficient (ADC) values and thresholds differentiating good and poor outcome were analyzed. Poor outcome was defined as a Glasgow Outcome Scale score of ≤2 at 6 months after arrest. RESULTS: Ninety-seven patients were included, and 75 patients (77%) had MRIs. In 51 patients with MRI completed by postarrest day 7, the prespecified threshold of >10% of brain tissue with an ADC <650 ×10-6 mm2/s was highly predictive for poor outcome with a sensitivity of 0.63 (95% confidence interval [CI] 0.42-0.80), a specificity of 0.96 (95% CI 0.77-0.998), and a positive predictive value (PPV) of 0.94 (95% CI 0.71-0.997). The mean whole-brain ADC was higher among patients with good outcomes. Receiver operating characteristic curve analysis showed that ADC <650 ×10-6 mm2/s had an area under the curve of 0.79 (95% CI 0.65-0.93, p < 0.001). Quantitative DWI MRI data improved prognostication of both good and poor outcomes. CONCLUSIONS: This prospective, clinician-blinded study validates previous research showing that an ADC <650 ×10-6 mm2/s in >10% of brain tissue in an MRI obtained by postarrest day 7 is highly specific for poor outcome in comatose patients after cardiac arrest.


Assuntos
Encéfalo/diagnóstico por imagem , Coma/diagnóstico por imagem , Parada Cardíaca/terapia , Hipóxia-Isquemia Encefálica/diagnóstico por imagem , Síndrome Pós-Parada Cardíaca/diagnóstico por imagem , Adulto , Idoso , Coma/etiologia , Imagem de Difusão por Ressonância Magnética , Feminino , Escala de Resultado de Glasgow , Parada Cardíaca/complicações , Humanos , Hipóxia-Isquemia Encefálica/etiologia , Masculino , Pessoa de Meia-Idade , Síndrome Pós-Parada Cardíaca/complicações , Prognóstico , Estudos Prospectivos
19.
Biol Res Nurs ; 22(3): 334-340, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32207313

RESUMO

Traumatic brain injury (TBI) is a leading cause of death and disability, with more than 5 million people in the United States living with long-term complications related to TBI. This study examined the relationship between TP53, the gene that codes for the protein p53, and outcome variability following severe TBI. The p53 protein impacts neuronal apoptosis following TBI, thus investigation into TP53 genetic variability as a prognosticator for TBI outcomes (mortality, Glasgow Outcome Scale [GOS], Neurobehavioral Rating Scale [NRS], and Disability Rating Scale [DRS]) is warranted. Participants (N = 429) with severe TBI (Glasgow Coma Scale score ≤8) were enrolled into a prospective study with outcomes assessed over 24 months following injury. The single-nucleotide polymorphism Arg72Pro (rs1042522), a functional missense polymorphism for which the CC homozygous genotype is most efficient at inducing apoptosis, was investigated. Individuals with the CC genotype (arginine homozygotes) were more likely to have poorer outcomes at 24 months following TBI compared to individuals with CG/GG genotypes (GOS: p = .048, DRS: p = .022). These findings add to preliminary evidence that p53 plays a role in recovery following TBI and, if further replicated, could support investigations into p53-based therapies for treating TBI.


Assuntos
Lesões Encefálicas Traumáticas/genética , Lesões Encefálicas Traumáticas/fisiopatologia , Genes p53 , Genótipo , Índice de Gravidade de Doença , Proteína Supressora de Tumor p53/genética , Adolescente , Adulto , Idoso , Feminino , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Estudos Prospectivos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
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