Craniocerebral Injuries Research Articles

Craniocerebral injuries in war against terrorism—a contemporary series from Pakistan

ObjectiveTerrorism-related bomb attacks on civilian population have increased dramatically over the last decade. Craniocerebral injuries secondary to improvised explosive devices have not been widely reported in the context of unarmored civilians. This series intends to report the spectrum of these injuries secondary to suicidal and implanted bombs as encountered at the Aga Khan University Hospital, Pakistan (AKUH). Further, a few pertinent management guidelines have also been discussed MethodsThe hospital database and clinical coding during a 5-year period were examined for head injuries secondary to terrorism-associated blasts. In addition to patient demographics, data analysis for our series included initial Glasgow Coma Scale, presenting neurological complaints, associated non-neurological injuries, management (conservative or operative) to associated complications, and discharge neurological status ResultsA total of 16 patients were included in this series. Among them 9 were victims of suicidal blasts while 7 were exposed to implanted devices. The patients presented with diverse patterns of injury secondary to a variety of shrapnel. A follow-up record was available for 12 of the 16 patients (mean follow-up: 7.8months), with most patients having no active complaints. ConclusionThe results of this series show that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.

Normal Organ Weights in Women: Part I-The Heart.

Cardiac enlargement is a well-known independent risk factor for sudden cardiac death, though the definition of what constitutes cardiac enlargement is not universally established. A previous study was undertaken to establish a normal range for male hearts to address this issue; the present study was designed to address the issue and to determine normal cardiac weights in adult human females. A prospective study was undertaken of healthy females dying from sudden, traumatic deaths aged 18 to 35 years. Cases were excluded if: there was a history of medical illness, including illicit drug use; prolonged medical treatment was performed; there was a prolonged period between the time of injury and death; body length and weight could not be accurately assessed; if there was significant cardiac injury; or if any illness or intoxication was identified after gross, microscopic, and toxicologic analysis, including evidence of systemic disease. A total of 102 cases met criteria for inclusion in the study during the approximately 10-year period of data collection from 2004 to 2014. The decedents had an average age of 24.4 years and ranged in length from 141 to 182 cm (56.4 to 72.8 in.) with an average length of 160 cm (64 in.). The weight ranged from 35.9 to 152 kg (79 to 334 lbs) with an average weight of 65.3 kg (143 lbs). The majority of the decedents (86%) died from either ballistic or blunt force (including craniocerebral) injuries. Overall, the heart weights ranged from 156 to 422 g with an average of 245 g and a standard deviation of 52 g. Regression analysis was performed to assess the relationship between heart weight and body weight, body length, and body mass index, respectively, and found insufficient associations to enable predictability. The authors, therefore, propose establishing a normal range for heart weight in women of 148 to 296 g.

Normal Organ Weights in Women

Organomegaly can be a sign of disease and pathology, although standard tables defining organomegaly have yet to be established and universally accepted. This study was designed to address the issue and to determine a normal weight for the major organs in adult human females. A prospective study was undertaken of healthy females who had sudden, traumatic deaths at age 18 to 35 years. Cases were excluded if there was a history of medical illness including illicit drug use, prolonged medical treatment was performed, there was a prolonged period between the time of injury and death, body length and weight could not be accurately assessed, or if any illness or intoxication was identified after gross and microscopic analysis including evidence of systemic disease. Individual organs were excluded if there was significant injury to the organ that could have affected the weight. A total of 102 cases met criteria for inclusion in the study during the approximately 10-year period of data collection from 2004 to 2014. The decedents had an average age of 24.4 years and ranged in length from 141 to 182 cm (56.4-72.8 inches) with an average length of 160 cm (64 inches). The weight ranged from 35.9 to 152 kg (79-334 lb) with an average weight of 65.3 kg (143 lb). The majority of the decedents (86%) died of either ballistic or blunt force (including craniocerebral) injuries. The mean brain weight was 1233 g (range, 1000-1618 g); liver mean weight, 1288 g (range, 775-2395 g); spleen mean weight, 115 g (range, 51-275 g); right lung mean weight, 340 g (range, 142-835 g); left lung mean, 299 g (range, 108-736 g); right kidney mean weight, 108 g (range, 67-261 g); and the left kidney mean weight, 116 g (range, 55-274 g). Regression analysis was performed and showed that there were insufficient associations between organ weight and body length, body weight, and body mass index to allow for predictability. The authors therefore propose establishing a reference range for organ weights in women, much like those in use for other laboratory tests. Reference ranges (95% inclusion) are proposed: brain, 1033 to 1404 g; liver, 603 to 1767 g; spleen, less than 230 g; right lung, 101 to 589 g; left lung, 105 to 515 g; right kidney, 38 to 174 g; and left kidney, 35 to 192 g.

Paradigm Shift in Management Strategies of Craniocerebral Missile Injuries Improving Survival Rates and Functional Outcome Score

Introduction With development of firearms, civilian violence, ethnic clashes, militancy, terrorist attack, and military operations there is a worldwide increase in incidence of craniocerebral missile injuries. The mortality of patients with craniocerebral missile injuries is high, and if the victim survives, functional outcome is poor. In spite of high mortality, no proper attention was given in last five decades in improving surgical techniques and resuscitation patterns of patients with craniocerebral missile injuries. Problems Considered The problems are many, but the two problems highlighted are decreased survival because of the inadequate pre-op resuscitation and poor functional outcome due to aggressive surgery. Therefore, the study was performed to evaluate the outcome of early and less aggressive surgical strategy and aggressive preoperative resuscitation in patients with penetrating injuries and also to look for factors prognosticating outcome. Methods A series of 96 patients with craniocerebral missile injuries to head were managed at a single center over a period of 3 years is presented. Aggressive resuscitation was done in all hemodynamically unstable patients and patients with coagulopathy either with blood products, hyperosmolar therapy or ionotropic support on protocols of damage control resuscitation. Blood product therapy consisted of packed red blood corpuscles, fresh frozen plasma (FFP) and platelets. Hypertonic saline was used for hyperosmolar resuscitation, and for ionotropic support dopamine, adrenalin, and vasopressin were used. Minimum debridement of the missile tract was done and maximum cortical tissue was preserved. Results Neurosurgical procedures contemplated on 78 patients. Criteria for craniotomy were—Glasgow Coma Scale (GCS) of 8 with intracranial bone fragments/significant clot, and raised intracranial pressure. Surgical approach were frontotemporal exposure (41%, n = 32/78), frontoparietal exposure (22%, n = 18/78), retrosigmoid exposure (2%, n = 2/78), combined middle and posterior fossa approach (2%, n = 2/78), and decompressive craniectomy (43%, n = 24/78). Procedures done were debridement of devitalized tissue (100%, n = 78/78), extraction of bone fragment (43%, n = 17/39), extraction of metallic pellet (62%, n = 42/67), lax duraplasty (100%, n = 78/789), debridement of missile tract (100%, n = 78/78). Overall, 36 patients were operated within 8 hours and 22 patients were operated within 14 hours. Median age group were 26 years, 81% were male, surgical mortality of 18%, and overall mortality was 33%. Conclusion This study indicates the factors prognosticating outcomes and supports that less aggressive surgery and aggressive preoperative resuscitation has decreased surgical mortality rates and improved functional outcomes.

Craniocerebral Injuries and the Glasgow Coma Scale Score in the Patients under the Influence of Alcohol Admitted to Hospital Emergency Department

Introduction. Alcohol abuse constitutes a significant social and health problem in Poland. Consumption of even a small amount of alcohol causes an increase in the probability of the injury.Aim. The objective of the thesis was to determine the relationship between the scoring in the Glasgow Coma Scale and head injuries in the patients under the influence of alcohol admitted to the Hospital Emergency Department in an urgent mode.Material and Methods. On the basis of the retrospective analysis the group of 210 intoxicated patients of the Hospital Emergency Department of the University Hospital in Cracow (167 men and 43 women) who sustained head injuries during the period from 1st May 2011 to 1st May 2012 was examined. The data included in the medical documentation, such as: age, gender, result of the scoring in the Glasgow Coma Scale, blood alcohol level, sustained head injuries on the basis of the CT examination and selected co-existing post-traumatic disorders were taken into consideration.Results. Among the patients with high blood alcohol level there were people with both high and low results in the Glasgow Coma Scale. The patients with fractures of the facial bones and skull base, epidural haematoma, pericerebral haematoma, subdural haematoma, intracerebral haematoma, subarachnoid haematoma, cerebral edema, displacement of the ventricular system and blood in the location of the cerebellar tentorium had the lower scoring in the Glasgow Coma Scale than other patients. The lowest score in the Glasgow Coma Scale had the patients who fell from height, the highest one — patients after a suicide attempt.Conclusions. Blood alcohol level did not have an influence on the scoring in the Glasgow Coma Scale. There is a relationship between the scoring in the Glasgow Coma Scale and head injuries. The GCS score depended on the symptoms that co-exist with the head injuries. The mechanism (cause) of sustained head injury determined the score in the Glasgow Coma Scale. (JNNN 2015;4(2):56–61)

Revisiting neuroimaging of abusive head trauma in infants and young children.

The purpose of this article is to use a mechanism-based approach to review the neuroimaging findings of abusive head trauma to infants. Advanced neuroimaging provides insights into not only the underlying mechanisms of craniocerebral injuries but also the long-term prognosis of brain injury for children on whom these injuries have been inflicted. Knowledge of the traumatic mechanisms, the key neuroimaging findings, and the implications of functional imaging findings should help radiologists characterize the underlying causes of the injuries inflicted, thereby facilitating effective treatment.

Maxillofacial fractures and craniocerebral injuries - stress propagation from face to neurocranium in a finite element analysis.

BackgroundSevere facial trauma is often associated with intracerebral injuries. So it seemed to be of interest to study stress propagation from face to neurocranium after a fistlike impact on the facial skull in a finite element analysis.MethodsA finite element model of the human skull without mandible consisting of nearly 740,000 tetrahedrons was built. Fistlike impacts on the infraorbital rim, the nasoorbitoethmoid region, and the supraorbital arch were simulated and stress propagations were depicted in a time-dependent display.ResultsFinite element simulation revealed von Mises stresses beyond the yield criterion of facial bone at the site of impacts and propagation of stresses in considerable amount towards skull base in the scenario of the fistlike impact on the infraorbital rim and on the nasoorbitoethmoid region. When impact was given on the supraorbital arch stresses seemed to be absorbed.ConclusionsAs patients presenting with facial fractures have a risk for craniocerebral injuries attention should be paid to this and the indication for a CT-scan should be put widely. Efforts have to be made to generate more precise finite element models for a better comprehension of craniofacial and brain injury.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0117-z) contains supplementary material, which is available to authorized users.

Management of Craniocerebral Gunshot Injuries: A Review.

Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.

Analysis of 126 hospitalized elder maxillofacial trauma victims in central China.

BackgroundThe aim of this study was to analyzed the characteristics and treatment of maxillofacial injuries in the elder patients with maxillofacial injuries in central China.Material and MethodsWe retrospectively analyzed the characteristics and treatment of maxillofacial injuries in the patients over the age of 60 to analyze the trends and clinical characteristics of maxillofacial trauma in elder patients from the First Affiliated Hospital of Zhengzhou University (from 2010 to 2013) in central China and to present recommendations on prevention and management.ResultsOf the 932 patients with maxillofacial injuries, 126 aged over 60 years old accounting for 13.52% of all the patients (male:female, 1.74:1; mean age, 67.08 years old). Approximately 52% of the patients were injured by falls. The most frequently observed type of injuries was soft tissue injuries (100%), followed by facial fractures (83.05%). Of the patients with soft tissue injuries, the abrasions accounted the most, followed by lacerations. The numbers of patients of midface fracture (60 patients) were almost similar to the number of lower face fractures (66 patients). Eighty two patients (65.08%%) demonstrated associated injuries, of which craniocerebral injuries were the most prevalent. One hundred and four patients (82.54%) had other systemic medical conditions, with cardiovascular diseases the most and followed by metabolic diseases and musculoskeletal conditions. Furthermore, the study indicated a relationship between maxillofacial fractures and musculoskeletal conditions. Only 13 patients (10.32%) sustained local infections, of whom had other medical conditions. Most of the facial injuries (85.71%) in older people were operated including debridement, fixing loose teeth, reduction, intermaxillary fixation and open reduction and internal fixation (ORIF).ConclusionsOur analysis of the characteristics of maxillofacial injuries in the elder patents may help to promote clinical research to develop more effective treatment and possibly prevent such injuries. Key words: Maxillofacial, trauma, elderly, characteristics, treatment.

Femicide: A Retrospective Study in Indian Scenario

Femicide is considered as killing of women, regardless of motive or perpetrator status. In India, violence and crimes against women like rape, kidnapping & abduction, murder and dowry death have increased over the years and evolved as a major social problem. To find out correlation between the crime and social status of victim, the present study was carried out to analyse different aspects of femicide from victims’ profile. This retrospective study analysed 150 cases of femicide, which had been brought for medico-legal autopsy during a period of five years (November 2006 to October 2011). Females of 11–40 years of age were the common victims. In most of the killings, the alleged offender was a male relative of the victim. In majority of the cases, the weapons used were either hard & blunt or sharp cutting without any defence wounds. Death was commonly due to cranio cerebral injuries. Majority of the victims were illiterate, married, hailing from rural population & economically backward class and housewives by occupation. The findings may help the State and law making agencies to improve certain social issues, which indirectly reduce the crime against women.

Stability of rat models of fluid percussion-induced traumatic brain injury: comparison of three different impact forces.

Fluid percussion-induced traumatic brain injury models have been widely used in experimental research for years. In an experiment, the stability of impaction is inevitably affected by factors such as the appearance of liquid spikes. Management of impact pressure is a crucial factor that determines the stability of these models, and direction of impact control is another basic element. To improve experimental stability, we calculated a pressure curve by generating repeated impacts using a fluid percussion device at different pendulum angles. A stereotactic frame was used to control the direction of impact. We produced stable and reproducible models, including mild, moderate, and severe traumatic brain injury, using the MODEL01-B device at pendulum angles of 6°, 11° and 13°, with corresponding impact force values of 1.0 ± 0.11 atm (101.32 ± 11.16 kPa), 2.6 ± 0.16 atm (263.44 ± 16.21 kPa), and 3.6 ± 0.16 atm (364.77 ± 16.21 kPa), respectively. Behavioral tests, hematoxylin-eosin staining, and magnetic resonance imaging revealed that models for different degrees of injury were consistent with the clinical properties of mild, moderate, and severe craniocerebral injuries. Using this method, we established fluid percussion models for different degrees of injury and stabilized pathological features based on precise power and direction control.

Cranio-Cerebral Injuries in Victims of Fatal Road Traffic Accident: A 5-year Post-Mortem Study

Background : Victims of vehicular accident sustain different types of injuries, of which, head injury is considered as more fatal than injury to other systems. This study was carried out to know the incidence and pattern of cranio-cerebral injuries in victims of fatal vehicular accidents. Methods: Medico-legal autopsies conducted on victims of vehicular accidents from 01-01-2008 to 31-12-2012 at the Dept. of Forensic Medicine, Father Muller Medical College, Mangalore, Karnataka, India, were retrospectively analysed. Results: Deaths due to vehicular accidents constituted 69% of the total unnatural deaths. Cranio-cerebral injuries were present in 68.5% of victims of vehicular accident. Combination of skull fracture, intra-cranial haemorrhages and cerebral injury was seen in maximum number of victims (38.2%). If injuries are considered individually, most commonly observed injury was intracranial haemorrhage (90.7%), followed by skull fracture (78.9%). Subarachnoid haemorrhage was the commonest type of intracranial haemorrhage present (78.3%). In the skull vault, linear fracture was the commonest type (49%) and in the base, middle cranial fossa (68.3%) was the most commonly fractured fossa. Among the cerebral injuries, contusion of the brain tissue was the commonest injury seen. Frontal and temporal lobes were the most commonly injured parts of the cerebrum (65.8%). Conclusion: Most of the cranio-cerebral injuries cannot be treated successfully because of their anatomical configuration. But, morbidity and mortality due to vehicular accidents can be reduced by preventing the occurrence of accidents. Therefore, the old saying, “Prevention is better than cure” holds good even here.

THE ASSESSMENT OF SPECTRAL INDICES OF HEMODYNAMICS OF EXTRA- AND INTRACRANIAL ARTERIES IN AN ACUTE SEVERE craniocerebral injury

Objective: to identify the indices of spectral Doppler intra- and extracranial arteries, as well as the diagnostic value of the indices of internal carotid arteries to assess the cerebral blood flow in an acute severe craniocerebral injury. Material and methods. The state and hemodynamic indices of the internal carotid artery (ICA) were studied in 26 patients with severe craniocerebral injuries. In 23 (88.5 %) cases ultrasonic characteristics were evaluated in the artery cerebri media (MCA). All patients (n = 26) were divided into 2 groups based on the width of the transverse displacement of the medial structures of the brain: the first group (n = 19) had dislocation ≤ 5 mm, the second group (n = 7) - offset > 5 mm. For comparative analysis and identification of correlations between the ICA and MCA hemodynamic indices, patients (n = 23) who had underwent homolateral ultrasound scanning of the arteries were picked out from subgroups 1a (n = 17) and 2a (n = 6). Results. The comparative analysis of the ICA hemodynamic parameters in the groups 1 and 2 revealed an increase in the indices of peripheral resistance in the extracranial cerebral arteries in patients with lateral dislocation more than 5 mm (p < 0.05). The study of the spectral indices of the blood flow in the homolateral arteries in the 1a group showed the presence of a close inverse correlation between the Gosling index in the ICA and Vps in MCA and significant inverse correlation between Ved and TAMX. The patients of the 2a group showed a strong direct correlation between Vps, PI in the ICA and PI in the MCA, as well as RI of both the arteries. Conclusion. The spectral indices of the ICA blood flow (Vps, PI and RI) acquire diagnostic value in the evaluation of cerebral hemodynamics in patients with dislocation of midline structures more than 5 mm.

Clinical indications and methods of application of modified crowned cutters in surgical treatment of the patients with severe craniocerebral trauma

The aim of the research was to improve the results of treatment of severe craniocerebral traumas by development of the scientifically based technology of surgical management of various intracranial hematomas using modified crowned cutters of different diameters. Comparative analysis of the surgical treatment of the patients with craniocerebral injuries in the main group and in the control one showed clinical and practical efficiency of the modified structures of the crowned cutters in the surgical treatment versus the traditional cutters - 50 % shorter time of the bone stage craniotomy in the main group, 4.3 % lowered blood loss, and 14.7 % shorter period of hospitalization.

Therapeutic effectiveness analysis of Xuebijing, Xiyanping combined with naloxone in the treatment of acute coagulation disorders during severe thoracoabdominal injuries

Objective To observe the therapeutic effectiveness of the early intervention of Xuebijing (XBJ) Xiyanping and Naloxone (NX) in acute coagulation disorders during severe thoracoabdominal injuries.Methods Severe thoracoabdominal injury patients with trauma index (TI) ≥ 17 points except the ones associated craniocerebral injuries and died in emergency department were randomly divided into two groups:a intervention group (n=82) and a control group (n=47); The patients were all collected at 253th Hosptital of PLA between January 2009 and June 2012.The intervention group was tested at the time of arriving at the emergency department and the time of leaving the emergency department to the inpatient department for platelet count (PLT),D-dimer (D-D),activated partial thromboplastin (APPT),prothrombin time (PT),thromboplastin time (TT),tumor necrosis factor-α (TNF-α),lipopolysaccharide (LPS),interleukin-6 (IL-6),phospholipase A2 (PLA2) and platelet-activating factor (PAF).The control group was just tested at the time of leaving the emergency department for the same items.Results At the time of arriving at the emergency department,PLT was (83.44±38.52) 109/L,D-D was (1 823.89±608.02) U/L,APTT was (68.24±24.12) s,PT was (28.42± 10.83) s,TT was (58.27 ± 12.44) s,PLA2 (41.35 ± 14.26) ng/ml,PAF (15 765.31 ± 4431.65) ng/L; At the time of leaving the emergency department,PLT was (127.59±27.18) 109/L,D-D was (769.42± 106.34)U/L,APTT was (49.11 ±12.76) s,PT was (19.51 ±8.23) s,TT was (31.44±9.17) s,PLA2 (19.16±7.11)ng/ml,PAF (6 722.56± 1 049.34)ng/L;At the time of leaving the emergency department the records of the control group of severe thoracoabdominal injury patients,PLT was (89.22±31.27) 109/L,D-D was (1 814.45±643.18) U/L,APTT was (63.48±28.27) s,PT was (27.79 ± 11.94) s,TT was (60.51 ± 14.23) s,PLA2 (44.71 ± 16.52) ng/ml、PAF (15 933.07 ± 4573.19) ng/L.After the intervention the records of PLT were higher,the ones of D-D、APTT、PT、TT were lower; the records of TNF-α、LPS、IL-6、PLA2 and PAF were significantly lower than the time before intervention and the control group (all P＜0.01).Conclusion XBJ,Xiyanping and NX can significantly improve the acute coagulation disorders during severe thoracoabdominal injuries which have important significance in reducing incidence rate of complication,preventing multiple organ dysfunction score (MODS),improving prognosis and increasomg survival rate. Key words: Severe thoraco-abdominal injuries; Acute coagulation disorders; Xuebijing; Xiyanping; Naloxone; Treatment effectiveness analysis

Craniocerebral injury promotes the repair of peripheral nerve injury.

The increase in neurotrophic factors after craniocerebral injury has been shown to promote fracture healing. Moreover, neurotrophic factors play a key role in the regeneration and repair of peripheral nerve. However, whether craniocerebral injury alters the repair of peripheral nerve injuries remains poorly understood. Rat injury models were established by transecting the left sciatic nerve and using a free-fall device to induce craniocerebral injury. Compared with sciatic nerve injury alone after 6–12 weeks, rats with combined sciatic and craniocerebral injuries showed decreased sciatic functional index, increased recovery of gastrocnemius muscle wet weight, recovery of sciatic nerve ganglia and corresponding spinal cord segment neuron morphologies, and increased numbers of horseradish peroxidase-labeled cells. These results indicate that craniocerebral injury promotes the repair of peripheral nerve injury.

TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Piskorz J, Iłżecka J, Wójcik G. TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE. Health Problems of Civilization. 2014;8(2):4-9. doi:10.5114/hpc.2014.57071. APA Piskorz, J., Iłżecka, J., & Wójcik, G. (2014). TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE. Health Problems of Civilization, 8(2), 4-9. https://doi.org/10.5114/hpc.2014.57071 Chicago Piskorz, Jolanta, Joanna Iłżecka, and Gustaw Wójcik. 2014. "TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE". Health Problems of Civilization 8 (2): 4-9. doi:10.5114/hpc.2014.57071. Harvard Piskorz, J., Iłżecka, J., and Wójcik, G. (2014). TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE. Health Problems of Civilization, 8(2), pp.4-9. https://doi.org/10.5114/hpc.2014.57071 MLA Piskorz, Jolanta et al. "TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE." Health Problems of Civilization, vol. 8, no. 2, 2014, pp. 4-9. doi:10.5114/hpc.2014.57071. Vancouver Piskorz J, Iłżecka J, Wójcik G. TREATMENT OF ADULT PATIENTS WITH CRANIOCEREBRAL TRAUMA COMPLICATED BY VENITALORY FAILURE. Health Problems of Civilization. 2014;8(2):4-9. doi:10.5114/hpc.2014.57071.

Craniocerebral injuries in traffic accidents with fatal outcomes

Research into crainiocerebral injury (CCI) characteristics of traffic accidents with fatal outcomes, as well as certain types of CCIs and defined categories of traffic participants, has been conducted. The research data were obtained from autopsy protocols at the Institute of Forensic Medicine in Serbia. Out of the 202 cases of individuals who had been fatally injured in traffic accidents, CCIs were diagnosed in 82.7% of them. The highest percentage of CCIs was established for front-seat passengers (95%), while for drivers it was 86.2%, pedestrians 78%, and 76% for rear-seat passengers. The domination of males among the deceased was also found, mostly as drivers (92%). The majority of individuals who experienced a CCI were in the age group of 21 to 30 years old, while pedestrians were commonly older than 60. In these cases, a high frequency of skull fractures was usually localized in different cranial regions (67.7%). In the majority of cases with CCIs (81.4%), these injuries contributed to an ultimate fatal outcome, mainly in pedestrians (93%). Fatal and non-fatal CCIs resulting from traffic accidents can result in significant socio-economic consequences for the individual and society as a whole that include specifically the ongoing costs and outcomes in cases from non-fatal injuries.

Traumatic Vertebral Fractures with Concomitant Fractures of the First Rib

To investigate the characteristics of patients with traumatic vertebral fractures and concomitant fractures of the first rib and their management. From January 2001 to December 2010, 17/3142 patients (0.5%) with traumatic vertebral fractures who presented to our hospitals had concomitant fractures of the first rib. The study included 14 men (82.4%) and 3 women (17.6%) patients of age 32-57 years (mean, 46.6 years). The mechanisms of trauma were falls from heights in seven, motor vehicle accidents in five and direct collisions with blunt objects in five. Thirteen patients (76.5%) presented initially with pulmonary complications after sustaining trauma. Three patients sustained one rib fracture, two three rib fractures, three four rib fractures and 10 > five rib fractures. The injuries were right-sided in three cases, left-sided in three and bilateral in eleven. Four patients (23.5%) presented with craniocerebral injuries. According to the American Spinal Injury Association (ASIA) classification, 10 patients (58.8% of the total study group) had motor and sensory deficits (ASIA A-D). There were no vascular injuries or deaths. Traumatic vertebral fractures with concomitant fractures of the first rib are associated with multisystem injuries, but not always with morbidity and mortality. A multidisciplinary approach, early diagnosis, appropriate treatment and observation in the intensive care unit may prevent morbidity and/or mortality.

Civilian Craniocerebral Gunshot Injuries in a Developing Country: Presentation, Injury Characteristics, Prognostic Indicators, and Complications

Civilian craniocerebral gunshot injuries (CGIs) are rare but increasing in incidence in the developing world and there is scare literature on presentation, injury characteristics, prognostic indicators, and complications of brain trauma due to projectiles. A retrospective review of 51 civilian patients with CGI who presented to the Aga Khan University Hospital between 1998 and 2011 was carried out. Presentation, injury characteristics, and complications were analyzed with emphasis on outcomes and prognostic indicators. There were 43 male and 8 female patients with an average age of 28.92 (±12.33) years. Twenty-three patients had a Glasgow Coma Scale (GCS) score of 13-15, 6 patients had a GCS score of 9-12, and 22 patients had a GCS score of 3-8 on admission. The overall mortality rate was 22% (n = 11). The most common postoperative neurologic deficits were motor deficits (19 patients) followed by aphasias (11 patients). On univariate analysis, admission GCS score and bi- or multilobar injuries were found to be highly predictive of neurologic outcome. There was no difference in outcomes between penetrating and perforating injuries. We also failed to find a statistically significant correlation between ventricular injury and outcomes in our patients. Admission GCS and number of lobes involved are highly prognostic of outcome. Patients with a GCS score ≥9 and unilobar injury on computed tomographic scans may benefit the most from surgical management.