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Kuo-Sheng Hung MD Phd Chung-Ling Liang MD Cheng-Haung Wang MD Hsueh-Wen Chang PhD Naeun Park MS Suh-Hang Hank Juo MD PhD 《Journal of clinical neuroscience》2004,11(8):849-853
Frontal intracerebral haemorrhage (ICH) is a common result of cranial trauma. Outcome differences between bilateral and unilateral frontal ICH are not well studied but would be valuable to predict prognosis in clinical practice. Two aims are proposed in this study: first to compare the risk of developing delayed ICH after bilateral or unilateral frontal ICH, and second to determine the variables helpful to predict outcome according to the Glasgow Outcome Scale (GOS). Between January 1993 and December 1997, 694 consecutive patients with traumatic ICH were admitted to the Chang Gung Medical Center within 24 h of the trauma. Patients with ICH in sites other than the frontal lobes were excluded. A total of 161 cases (mean age 46.3+/-20.3 years), including 57 bilateral (mean age 52.5+/-18.7 years) and 104 unilateral (mean age 42.9+/-20.5 years) traumatic frontal ICH were studied. Twenty-eight of 57 patients (49%) with bifrontal ICH versus 17 of 104 patients (16%) with unilateral frontal ICH had a further, delayed ICH. In 42 of 45 patients (93%) with delayed ICH, this occurred within 5 days of the initial trauma. Multivariate logistic regression was used to select significant predictors of outcome. We found that delayed ICH (p<0.001), age (p=0.004) and mechanism of injury (p=0.001) explained the worse outcome in patients with bifrontal ICH. The best-fitting logistic regression model included three variables: delayed ICH (p=0.011), initial GCS (p=0.023), and a sum score of clinical and radiological variables (p=0.003). Bifrontal ICH tended to occur in older patients after a fall and was associated with a higher risk of developing delayed ICH or brain stem compression compared to unilateral ICH damage. Using these three variables - delayed ICH, initial GCS, and the sum score - in a logistical regression model is useful to predict outcome in patients with traumatic frontal ICH and may aid patient management. 相似文献
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Summary 115 traumatic extradural haematoma cases who were treated surgically at Cerrahpasa Medical Faculty Neurosurgery Department between 1987 and 1992 are evaluated.When factors affecting the outcome were examined, a strong correlation was found between the result andGlasgow coma scale (GCS) (p<0.00001). The existence of a fracture, the interval between onset of haematoma symptoms and intervention and the existence of an intracerebral haematoma together with contusion accompanying intradural haematoma, affect the outcome in a negative direction. There was no statistical correlation between the outcome and the age of patient, localization of the haematoma and aetiology. 相似文献
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Shuji Seki MD 《Surgery today》1987,17(2):123-129
The ratio of PaO2 to FiO2 was often low (300 or less) in four patients with complications of hyperosmolar hyperglycemic non-ketotic diabetic coma (HHNKDC)
following open heart surgery. Four of our patients had poor oxygenation and subsequent spontaneous recovery from in the immediate
post-operative period, although HHNKDC occurred only in one during this period. In the 3 others, poor oxygenation without
accompanying HHNKDC lasted for 1–6 days and HHNKDC developed about 2 weeks after open heart surgery at time when poor oxygenation
reoccurred. If a working diagnosis of congestive heart failure was made only on the basis of the most common probability,
and the fluid supply was restricted, HHNKDC would readily occur or be aggravated by the dehydration iatrogenically produced.
It is thus concluded that HHNKDC should be included in diagnoses for pulmonary dysfunction. 相似文献
6.
孙迎香 《安徽卫生职业技术学院学报》2005,4(4):14-14
目的:探讨老年糖尿病低血糖昏迷特点.方法:对12例老年低血糖昏迷患者回顾性分析.结果:本组患者均以昏迷为首发症状,且应用降糖药物不规范.结论:老年低血糖患者症状多不典型,很快进入昏迷状态,易误诊而延误治疗. 相似文献
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T.H. Brun P. Lagier J.M. Dejode T. Attali F. Soula C. Granthil 《Annales fran?aises d'anesthèsie et de rèanimation》1990,9(6):553-556
A case is reported of fatal acute cerebral oedema occurring in a 15-year-old child suffering diabetic ketoacidosis. He had severe gastro-enteritis, with a weight lose of 8 kg over a period of 8 days (initial weight = 50 kg). He was admitted in a stupor with pH 7.15, 129 mmol.l-1 natraemia, and 31 mmol.l-1 blood glucose concentration. Blood osmolaity was calculated to be 310 mosmol.l-1. He was rehydrated with 416 ml.h-1 normal saline and 416 ml.h-1 of 1.4% sodium bicarbonate. At the same time a total dose of 75 i.u. of ordinary insulin was given. After 2 h, the patient's condition suddenly worsened with unreactive coma, bilateral fixed mydriasis, respiratory pauses, and impairment of haemodynamic state (heart rate 150 b.min-1, blood pressure 80/50 mmHg). The diagnosis of cerebral oedema with severe intracranial hypertension was confirmed by different investigations. Despite ventilatory support and continued intensive care, the patient died a few hours later. It is concluded that some degree of subclinical brain swelling could be common occurrence during diabetic ketoacidosis, present maybe even before the start of treatment. Such cases of cerebral oedema are often reported, but the pathophysiological mechanisms remain unclear. However, unlike this case, rehydration must be moderate (less than 41.m-2.day-1), especially in case of hyponatraemia. Insulin and sodium bicarbonate must be used with care. Early rigorous clinical and biological monitoring is essential. Treatment should aim at a progressive correction of the metabolic disturbances. 相似文献
9.
本文报告50例肝硬化患者SCG含量的临床意义.结果表明,SCG测定诊断肝硬化的阳性率为92%,明显高于SGPT(53%)及ADA(78.6%)的阳性率.Child-pugh肝功能分级中A、B、C级SCG值分别为10.14±6.03,23.55±11.27和54.66±24.47μmol/L(P<0.01).相关分析表明,SCG与血清白蛋白含量呈负相关(r=-0.5018.P<0.01),与胆红素含量呈正相关(r=0.6964,P<0.01).并发肝性脑病和原发性肝癌者及死亡病例,其SCG升高更为明显.我们认为肝硬化患者SCG值大于40μmol/L预示病情危重,预后不良. 相似文献
10.
Prognostic value of somatosensory- and motor-evoked potentials in patients with a non-traumatic coma
Josef Zentner Alois Ebner 《European archives of psychiatry and clinical neuroscience》1988,237(3):184-187
Summary A total of 28 patients with non-traumatic coma were studied both with somatosensory- and motor-evoked potentials. While somatosensory-evoked potentials (SEP) have proved to be useful in predicting the outcome in patients with severe brain damage, the aim of this study was to find out whether the additional evaluation of motor-evoked potentials (MEP) could contribute to a better prediction of the outcome than SEP alone. Our results clearly indicate that in terms of prognostic value, SEP are superior to MEP. Nine patients with bilaterally preserved MEP died, while all of the patients with bilaterally preserved SEP and a central conduction time 6.5 ms survived, with a Glasgow outcome score of 1 to 3. Therefore, we cannot recommend the inclusion of MEP in the prognostic evaluation of patients with non-traumatic coma. 相似文献