The effect of nutritional support on outcome from severe head injury

Fifty-one brain-injured patients with peak 24-hour admission Glasgow Coma Scale (GCS) scores of 4 to 10 were prospectively randomly assigned to receive total parenteral (TPN) or enteral (EN) nutrition. Patients were studied from hospital admission to 18 days postinjury. Outcome was assessed by the Glasgow Outcome Scale at 3 months, 6 months, and 1 year postinjury. The TPN group received a significantly higher cumulative mean intake of protein than the EN group (mean +/- standard error of the mean: 1.35 +/- 0.12 vs. 0.91 +/- 0.9 gm/kg/day; p = 0.004). Mean cumulative caloric balance was also significantly higher in the TPN than in the EN group (75.6% +/- 5.13% vs. 59% +/- 4.26%; p = 0.02). Nitrogen balance was significantly more negative in the EN group during the 1st week postinjury (p = 0.002). The incidence of pneumonia, urinary tract infections, septic shock, and infections was not significantly different between groups. Classic nutritional assessment parameters such as anergy screens, total lymphocyte counts, and albumin levels were not significantly different between groups. The 11 patients in the EN group who did not tolerate tube feedings for 1 week postinjury had a significantly higher incidence of septic shock (p = 0.008). The change over time in GCS scores between groups was significantly different, with the TPN group showing a mean four-point increase in GCS score compared with a three-point increase in the EN group (p = 0.02). At 3 months the TPN group had a significantly higher percentage of favorable outcomes (43.5% vs. 17.9%, respectively; p = 0.05). At 6 months, 43.5% of the TPN group had a favorable outcome while 32.1% of the EN group had a favorable outcome (p = 0.29). By 1 year, 47.8% of the TPN group and 32.1% of the EN group had a favorable outcome (p = 0.20). In conclusion, more calories and protein usually can be administered to acute brain injury patients via the TPN route than by EN feedings via nasogastric or nasoduodenal routes. Traditional parameters for nutritional assessment are not useful in studying the efficacy of nutritional support during the first 2 weeks after head injury. Neurological recovery from head injury occurs more rapidly in patients with better early nutritional support.     

The crystallography behavior of carbamazepine under compression pressure

In the present paper the crystallographic behavior of the carbamazepine modifications I, II and III were studied under various conditions by means of X-ray powder diffraction, IR-spectroscopy and differential-scanning-calorimetry. It was found that the crystal lattice of the carbamazepine modification I is relative stable to the applied pressure forms, whereas modification II under similar conditions undergoes a polymorphic transformation into carbamazepine modification III, the extent of which depends on compression pressure and storage time of the tablets. In the compression samples of carbamazepine modification III neither IR-spectroscopically nor X-ray-diffractionally an influence of the pressure could be found on growing up of the enantiotrophic modification I.     

Task difficulty in the Morris water task influences the survival of new neurons in the dentate gyrus

Adult neurogenesis continues throughout life in the mammalian hippocampus. The precise function of the adult generated neurons remains uncertain although there is growing evidence that they are involved in hippocampus‐dependent learning and memory. Training rats on a hidden platform version of the Morris water task has been shown to increase or decrease the survival of newly produced cells in the dentate gyrus (DG) compared to training on a visible platform version. Here we investigated whether the difficulty of the task is related to the degree or direction of the change in neurogenesis. We trained rats on either a visible platform version of the Morris water task or one of three different hidden platform paradigms: four training trials per session version, two training trials per session, and reduced‐cue (a version in which the majority of the distal cues were removed from the room). BrdU was administered 6 days prior to training and rats were perfused 24 h after the last training session. As expected, training on the four trial hidden platform version increased cell survival compared to training on the visible platform version. However, training on the more difficult reduced‐cue hidden platform version resulted in a decrease in cell survival. Rats that received fewer trials per session did not differ in terms of cell survival in comparison to rats trained on the visible platform version. These findings demonstrate that altering the difficulty of the spatial task has an impact on the corresponding change in cell survival. The lack of obvious distal cues likely changed the strategy used by the rats to determine the location of the platform and resulted in a decrease, instead of an increase in cell survival in the hippocampus. In conclusion, different types of hippocampus‐dependent learning can differentially impact cell survival. © 2009 Wiley‐Liss, Inc.     

Die Versuchung des chronischen Schmerzes

This compilation of experiences gathered in Balint groups consisting of physicians involved in treatment of chronic pain aims to briefly show the inner horizons of both doctor and patient, which, by their emotions, reactions, and attitudes, complicate the already difficult task of treating individuals suffering from chronic pain. In addition, the author would like to turn the interest of colleagues – maxillofacial surgeons working in the field of chronic pain treatment – toward open attitudes regarding psychosomatic pathogenic models. He recommends studying these models and consulting appropriate psychosomatic cotherapists early in the course of treatment, for a late cry of help is a cry too late.     

Physiotherapie nach Verletzung

Trauma und Berufskrankheit - Auch seitens der gesetzlichen Unfallversicherungen wird überlegt, wie die verfügbaren Mittel gezielter und effizienter eingesetzt werden können. Diese...