Post-traumatic hydrocephalus following decompressive hemicraniectomy: Incidence and risk factors in a prospective cohort of severe TBI patients

BackgroundIn severe traumatic brain injury (TBI) patients undergoing decompressive hemicraniectomy (DHC), the rate of post-traumatic hydrocephalus (PTH) is high at 12–36%. Early diagnosis and shunt placement can improve outcomes. Herein, we examined the incidence of and predictors of PTH after craniectomy.MethodsA retrospective analysis of prospectively collected database of severe TBI patients at a single U.S. Level 1 trauma center from May 2000 to July 2014 was performed. Demographics, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), bleeding pattern and time-to-cranioplasty were analyzed. Glasgow Outcome Scale (GOS) scores at 6 and 12-months were studied. Statistical significance was assessed at p < 0.05.ResultsA total of 402 patients were enrolled and 105 patients had DHC. Twenty-two (21.0%) of 105 required ventriculoperitoneal shunt (VPS), compared to 18 (6%) of 297 patients without DHC. There was increased odds ratio for shunting after DHC at 3.62 (95%CI:1.62–8.07; p < 0.01). Mean age at time of DHC was 43.8 ± 17.7 years old, and 81.9% were male. Subdural hematoma (SDH) was most common at 57.1%. Median time from admission to cranioplasty was 63 days. Patients who experienced PTH after DHC were younger (35.5 ± 17.7 versus 46.0 ± 17.7 years, p < 0.01) and had higher ISS scores (35 versus 26, p = 0.04) compared to patients without shunt after DHC.ConclusionsAfter severe TBI requiring hemicraniectomy, shunt-dependent hydrocephalus was 21%. Younger patients and higher ISS score were associated with PTH. Shunt-dependent patients achieved similar 6- and 12-month outcomes as those without PTH. Early diagnosis and shunt placement can enhance long-term neurological recovery.     

骨科大手术前后血浆ET、TXB2、6-Keto-PGF1a的变化及其意义

目的：探讨骨科大手术前后血浆ET、TXB2和6-Keto-PGF1a的变化及其对监测DVT发生的意义。方法：对48例骨科大手术患者术前24h、术后24h和72h分别进行血浆ET、TXB2和6-Keto-PGF1a测定。结果：有9例并发DVT,其术前24h与术后24h和72h的ET、TXB2和6-Keto-PGF1a检测结果有显著性差异（P〈0.05）;并发DVT组与未并发DVT组比较,术前ET、TXB2和6-Keto-PGF1a检测结果无显著性差异（P〉0.05）,术后24h、72h有显著性差异（P〈0.05）。结论：血浆ET、TXB2和6-Keto-PGF1a动态监测,对骨科大手术后并发DVT具有早期诊断价值。     

浙江省江山市某部队士兵献血ALT筛查情况调查

目的:比较分析浙江省江山市某部队士兵实行献血前血液谷丙转氨酶筛检前后血液报废情况,以探讨有效降低血液报废率的策略。方法:对2010-2013年该部队献血后血液ALT检测情况进行统计分析。结果:2010-2013年该部队士兵献血后ALT检测情况比较具有显著性差异(P<0.01);与20-26岁地方青年献血后ALT检测情况比较,2010年和2011年具有显著性差异(P<0.05),2012年和2013年无显著性差异(P>0.05);与第一季度献血总人群比较,每年均无显著性差异,(P>0.05)。结论:军队人员虽然是典型的无偿献血低危人群,但献血前仍要对其进行ALT初筛,并对其进行无偿献血知识宣教和详尽的征询查体工作,才能有效控制部队献血者的ALT不合格率,从而降低无偿献血血液报废率。