Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    ISSN: 1432-1238
    Keywords: Head trauma ; Brain oedema ; Capillary hydrostatic pressure ; Colloid osmotic pressure ; Dihydroergotamine ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate a new therapy of posttraumatic brain oedema, with the main concept that opening of the blood-brain barrier upsets the normal brain volume regulation, inducing oedema formation. This means that transcapillary fluid fluxes will be controlled by hydrostatic capillary and colloid osmotic pressures, rather than by crystalloid osmotic pressure. If so, brain oedema therapy should include reduction of hydrostatic capillary pressure and preservation of normal colloid osmotic pressure. Patients 11 severely head injured comatose patients with brain swelling, raised intracranial pressure (ICP), and impaired cerebrovascular response to hyperventilation. Interventions To reduce capillary hydrostatic pressure the patients were given hypotensive therapy (β1-antagonist, metoprolol and α2-agonist, clonidine) and a potential precapillary vasoconstrictor (dihydroergotamine). The latter may also decrease cerebral blood volume through venous capacitance constriction. Colloid osmotic pressure was maintained by albumin infusions. The concept implies the need of a negative fluid balance with preserved normovolaemia. Results ICP decreased significantly within a few hours of treatment with unaltered perfusion pressure in spite of lowered blood pressure. Of 11 patients 9 survived with good recovery/moderate disability, 2 died. This was compared to outcome in a historical control group with identical entry criteria, given conventional brain oedema therapy, where mortality/vegetativity/severe disability was 100%. Conclusion The results indicate that the therapy should focus on extracellular rather than intracellular oedema and that ischemia is not the main triggering mechanism behind oedema formation. We suggest that our therapy is superior to conventional therapy by preventing herniation during the healing period of the blood-brain barrier.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 3
    ISSN: 0942-0940
    Keywords: Head injury ; barbiturate therapy ; outcome ; cognitive impairment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study reports on clinical outcome in 38 patients with severe head injuries (posttraumatic coma for 6 hours or more) treated with barbiturate coma because of intracranial hypertension. Eighteen patients died, 4 patients remained in a severely disabled or a chronic vegetative state, and 16 patients reached the levels good recovery/ moderate disability. Six of these patients returned to work or school full time, 4 for half time and 3 were in a rehabilitation program. Fourteen patients were subjected to a comprehensive neuropsychological assessment. All patients except one exhibited varying degrees of cognitive dysfunction and 6 patients had signs of personality change. The quality of life for the majority of surviving patients was relatively good but the positive effects of barbiturate coma therapy in the age groups over 40 years appeared to be limited.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 4
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 94 (1988), S. 57-65 
    ISSN: 0942-0940
    Keywords: Brain abscess ; epidemiology ; cryptogenic ; clinical symptoms ; therapeutic results ; surgical treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Two groups of patients with non-traumatic focal intracranial suppurative diseases were studied retrospectively to illustrate epidemiology, clinical symptoms and therapeutic results. The first group consists of 87 patients treated for brain abscess in the Department of Neurosurgery in Lund. During the 36-year period investigated (1947–1982) marked epidemiological changes occurred. Thus otogenic abscesses, constituting 33% of the cases below the age of 30 during the first 12 years of the study, virtually disappeared. During the third 12-year period of this study a marked increase in the number of abscesses was noted. The increase was caused particularly by the number of cryptogenic abscesses amounting to 51% of the material during 1971–1982. The second group of patients consists of all patients with pre- or post-mortem diagnosed brain abscess in the city of Malmö during 1960–1981. Since during this period 85% of all persons who died in this city were subjected to post-mortem examination this material offers a unique possibility of epidemiological studies. The combined study of these two groups of patients lends no support to the view that a real increase in the number of brain abscesses has occurred. We conclude that in patients with cryptogenic brain abscess the clinical symptoms do not usually indicate the presence of an infectious disease. In the majority of these patients a correct diagnosis has presumably not been obtained until the last decade. Furthermore, the investigation confirms the view that a mortality below 10% is nowadays feasable in unselected cases of brain abscess.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 6
    ISSN: 0942-0940
    Keywords: Reaction Level Scale (RLS 85) ; inter-observer agreement ; Kappa statistics ; multicentre study ; neurosurgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A new scale for assessment of overall responsiveness, the Reaction Level Scale (RLS 85), which has been shown to have better reliability than the Glasgow Coma Scale (GCS), has been tested in four neurosurgical departments regarding inter-observer agreement and coveragei. e. the proportion of patients that could be assessed by the scale. In a carefully designed study 51 observers pairwise performed 164 tests on 88 patients. Reliability was studied by the Kappa method, which is defined as inter-observer agreement corrected for agreement by chance. The inter-observer agreement measured as overall Kappa was good (K=0.69 ±0.05) and there were no significant differences between the departments, professional categories or aetiologies. Regarding the separate RLS 85 levels the Kappa values were above 0.65, except for withdrawing (K=0.51) and flexor responses (K=0.55). There was good inter-observer agreement on coma (K=0.71). In conclusion, the RLS 85 proved to be easily learnt, it showed full coverage without pseudoscoring, and it was used in a consistent way by doctors, nurses and assistant nurses of four different neurosurgical departments in two Scandinavian countries.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 7
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Neurochemical studies of induced seizures have provided much information on metabolic capacity in the brain. However, there is no general agreement on the magnitude of changes in cerebral metabolic rate. Presumably, differences in results depend both on the models of epilepsy used and on methodological factors.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 8
    ISSN: 1471-4159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Restitution of cerebral cortex concentrations of organic phosphates, glycolytic metabolites, citric acid cycle intermediates, associated amino acids, and ammonia, following a 30 min period of complete ischemia, was studied in rats anaesthetized with either 70% N2O or 150 mg·kg-1 of phenobar-bital.Following a 90 min period of recirculation the pattern of restitution was similar in the two groups. Thus, all animals showed recovery of phosphocreatine concentrations, restitution of the adenylate energy charge to about 99% of control, and disappearance of lactate accumulated during the ischemia. Analyses of glycolytic metabolites indicated inhibition of glycolysis at the phosphofructokinase step, possibly caused by accumulation of citrate. Measured citric acid cycle intermediates indicated extensive normalization of mitochondrial metabolism. Changes in amino acid concentrations consisted of a fall in glutamate concentration, a rise in aspartate/glutamate ratio, a fall in GABA concentration, and a rise in alanine concentration. However, ammonia concentration was close to normal, and the size of the amino acid pool did not change.It is concluded that although the results do not exclude damage to a small part of the neuronal population, they demonstrate that, irrespective of the type of anaesthesia used, the majority of brain cells must have survived 30 min of complete ischemia without signs of irreversible metabolic damage.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...