Penetrating cranio-cerebral injuries due to unusual foreign bodies

Seven cases of penetrating cranio-cerebral injury by peculiar foreign bodies are described. The clinical-pathological picture is reported wherever possible. Lack of adequate safety measures and untrained careless handling of instruments were at the root of these tragic accidents.Greater awareness of such dangers in industry and in school might help to promote the adoption of adequate safety measures.     

交通事故幸存者急性应激障碍的流行情况及预测因素分析

目的 了解交通事故幸存者人群中急性应激障碍(Acute Stress Disorders,ASD)的流行情况,并分析相关的预测因素.方法 采用急性应激障碍量表(Acute Stress Disorders Scale,ASDS)对206名交通事故幸存者的急性应激症状进行评估,临床评估距离被试经历车祸时间为2 ～23d.结果 206名中国交通事故幸存者中共有61人为可能的ASD患者,发生率为29.6％;女性较男性ASD症状严重[(男(36.70±11.42)分;女(41.18±12.58)分;t=-2.14,P＜0.05],已婚者较单身者ASD症状严重[已婚(38.37±11.94)分;未婚/丧偶/离异(30.86±8.37)分;t=5.22,P＜0.01],文化程度低者较文化程度高者ASD症状严重[初中及以下(38.74±11.73)分;高中及以上(34.76±11.64)分;t=2.18,P＜0.05];年龄(r=0.43,P＜0.01)、车祸时是否有害怕/无助/惊恐经历(r=0.21,P＜0.01)与ASD的症状表现严重程度相关,且年龄能正向预测ASD严重程度(β=0.29,P＜0.01).结论 ASD在交通事故幸存者中是一种常见的心理疾患,其主要的预测因素包括性别、年龄、婚姻状况、文化程度、车祸时害怕/无助/惊恐的程度.     

Screening for Hazardous Drinking Using the Michigan Alcohol Screening Test–Geriatric Version (MAST-G) in Elderly Persons With Acute Cerebrovascular Accidents

Background: Effective and valid screening methods are needed to identify hazardous drinking in elderly persons with new onset acute medical illness. The goal of the current study was to examine the effectiveness of the Michigan Alcohol Screening Test–Geriatric Version (MAST‐G) in identifying hazardous drinking among elderly patients with acute cerebrovascular accidents (CVA) and to compare the effectiveness of 2 shorter versions of the MAST‐G with the full instrument. Methods: The study sample included 100 men and women who averaged 12 days posthemorrhagic or ischemic CVA admitted to a rehabilitation unit and who were at least 50 years of age and free of substance use other than alcohol. This cross‐sectional validation study compared the 24‐item full MAST‐G, the 10‐item Short MAST‐G (SMAST‐G), and a 2‐item regression analysis derived Mini MAST‐G (MMAST‐G) to the reference standard of hazardous drinking during the past 3 months. Alcohol use was collected using the Timeline Followback (TLFB). Recent and lifetime alcohol‐related consequences were collected using the Short Inventory of Problems (SIP). Results: Nearly one‐third (28%) of the study sample met the World Health Organization (WHO) criteria for hazardous drinking. Moderately strong associations were found for the MAST‐G, SMAST‐G, and MMAST‐G with alcohol quantity and frequency and recent and lifetime alcohol consequences. All 3 MAST‐G versions could differentiate hazardous from nonhazardous drinkers and had nearly identical area under the curve characteristics. Comparable sensitivity was found across the 3 MAST‐G measures. The optimal screening threshold for hazardous drinking was 5 for the MAST‐G, 2 for the SMAST‐G, and 1 for the MMAST‐G. Conclusions: The 10‐item SMAST‐G and 2‐item MMAST‐G are brief screening tests that show comparable effectiveness in detecting hazardous drinking in elderly patients with acute CVA compared with the full 24‐item MAST‐G. Implications for research and clinical practice are discussed.     

Accidents vasculaires cérébraux ischémiques transitoires récurrents chez une jeune patiente secondaire à un fibroélastome papillaire de la valve mitrale et une hyperhomocystéïnémie. À propos d’une observation

We describe a case of a young patient admitted for recurrent ischemic stroke caused by a papillary fibroelastoma of the mitral valve and a hyperhomocysteinemia. A papillary fibroelastoma is a benign cardiac tumor which can be associated with serious embolic complications. A moderate plasma level of hyperhomocysteinemia is considered as a risk factor of ischemic stroke. The authors suggest that this association increases the risk of ischemic stroke in their patient. The tumor was surgically removed to avoid new embolic events associated with a vitamin B supplementation. After surgery and acid folic supplementation, no recurrence was observed.     

Thrombophilic factors in divers with undeserved decompression sickness

In divers with a vascular disease in decompression sickness, who have not committed any technical error, thrombophilic risk factors were sought. Six cases of confirmed divers, without diving technical error, were investigated. Thrombophilic screening included proteins C, S, antithrombin III, and factor VIII assays, and circulating antibodies, Factor V Leiden, and mutation G20210A mutation in Factor II gene research. Total plasma homocysteine (Hcy), an atherosclerosis factor, even when slightly increased, nutitional factors: folate and vitamins B12 and B6, the cofactors of its metabolism, and inversely correlated with Hcy values, were assayed, and subjects were genotyped for mutation C677T in the MTHFR gene. RESULTS: In five divers, Hcy values were moderately increased, and in all the six, folate and/or B12 values were decreased. Three of them showed a genotype TT (mutation C677T), two, the genotype CT, and the sixth, an heterozygous Factor V Leiden. In these divers, a predisposition for vascular diseases, was detected, which was partially curable.     

Mortality following treatment for cannabis use disorders: Predictors and causes

The aim of the study was to determine excess mortality associated with cannabis use disorders. Individuals entering treatment for cannabis use disorders were followed by use of Danish registers and standardized mortality ratios (SMRs) estimated. Predictors of different causes of death were determined. A total of 6445 individuals were included and 142 deaths recorded during 26,584 person-years of follow-up. Mortality was predicted by age, comorbid use of opioids, and lifetime injection drug use. For different causes of death the SMRs were: accidents: 8.2 (95% CI 6.3–10.5), suicide: 5.3 (95% CI 3.3–7.9), homicide/violence: 3.8 (95% CI 1.5–7.9), and natural causes: 2.8 (95% CI 2.0–3.7). Following exclusion of those with secondary use of opioids, cocaine, amphetamine, or injection drug use, SMRs for all causes of death remained significantly elevated except for homicide/violence. The study underlines the need to address mortality risk associated with cannabis use disorders.