[Clinical aspects of the prognosis of skull and brain injuries. A study of 108 cases]. / Elementi clinici di prognosi nei traumatizzati cranio-encefalici. Studio di 108 case.

An assessment is made of the extent to which age and the degree an seriousness of the initial neurological picture influenced prognosis in a series of 108 subjects with brain injuries treated in the Siena Hospital Intensive Care Unit between 1974 and 1977. Neurological disease was classified according to Posner and Plum. Mortality was 46.2%. In most cases, age tended to exacerbate the neurological syndrome from the outset. It also facilitated the appearance of respiratory sepsis, which aggravated the brian picture in its turn. Age differences, however, seemed to be of lesser prognostic value when the neurological syndrome was very serious from the beginning.

Cranio-orbito-facial injuries: technical suggestions.

Eight per cent of 387 acutely head-injured patients had concomitant orbitofacial injuries. Irrespective of the magnitude of brain injury, the main surgical goals in such cases treated were closure of CSF fistulas, maximizing recovery of eye movement, visual and masticatory function, and esthetic reconstruction. The strictly neurosurgical lesions should be dealt with at once because of the risk of intracranial infection. Antibiotic acrylic and antibiotic wax are valuable in such intervention. In most cases it is advantageous to treat lesions of the upper two thirds of the facial complex in the same operative session. For this reason neurosurgeons who do not have ready access to a maxillofacial specialist should be prepared to cope with the problems presented by orbitofacial injuries.

[Dexamethasone-21-phosphate in the treatment of cerebral edema. Evaluation of the effects on diuresis, natremia and natriuria]. / II desametazone-21-fosfato nel trattamento dell'edema cerebrale. Valutazione degli effetti sulla diuresi, natriemia e natriuria.

An evaluation was made of variations in blood and urinary sodium following the administration of 24 mg/day desamethasone-21-phosphate for at least 9 days, starting from admission, as cerebral antioedemigenic therapy in 30 patients with nerve traumas. The changes observed were within normal limits. This absence of interference with the hydro-electrolyte balance is a strong point in favour of the use of the drug in the treatment of cerebral oedema. The exact mechanism of action of this type of glycocorticoid, however, is still unknown.