Preinjury Condition Research Articles

Conservative Treatment Using Platelet-Rich Plasma for Acute Anterior Cruciate Ligament Injuries in Highly Active Patients: A Retrospective Survey.

Background The recommended treatment for anterior cruciate ligament (ACL) injuries in active, sports-oriented patients is reconstructive surgery in order to regain stability and prevent secondary meniscal injuries. However, ACL reconstruction requires a long recovery period and poses issues such as decreased muscle strength due to tendon harvesting and postoperative osteoarthritis (OA) progression, thereby raising significant expectations for the advancement of conservative treatments. Recent studies have shown that platelet-rich plasma (PRP) therapy, which utilizes the tissue repair-promoting property of platelets, is effective for ACL injuries. Methods We administered PRP therapy within six weeks after ACL injury in patients who expressed the desire for an early return to sports through conservative care. After the treatment, patients wore a simple brace that limited deep flexion but placed no restrictions on weight bearing. Four months was the standard goal established for returning to pre-injury condition, and, depending on the target level, timing, and knee condition, we adjusted the additional PRP treatments and rehabilitation approach, gradually authorizing the patients' return to sport. We assessed the ligament repair status by magnetic resonance imaging (MRI) just before the full return to sports.A retrospective survey was conducted to evaluate the status of ligament repair and the condition of return-to-sport in patients with ACLinjuries who underwent conservative treatment using PRP. Results The average patient age was 32.7 years and the average treatment was 2.8 PRP sessions. MRI evaluations confirmed that ligament continuity was regained in all cases. All the patients returned to their pre-injury level (Tegner Activity Scale 7.0) in an average of 139.5 days, but there was one instance of re-rupture following the return to sports. Conclusion All patients with ACL injury who underwent PRP therapy regained ligament continuity and returned to sport successfully with only one case of re-rupture.

Acute subdural hematoma in an infant with a biphasic clinical course and late reduced diffusion

Background: Bright tree appearance (BTA) is a characteristic finding on diffusion-weighted magnetic resonance (MR) imaging with transient high intensity in the white matter. BTA is characteristic of infants with acute encephalopathy with biphasic seizures, but it has also been reported in head trauma cases. In this report, we describe an infant case of traumatic brain injury that demonstrated a biphasic clinical course and late reduced diffusion (TBIRD). Case Description: A 5-month-old boy suffered from head trauma and developed coma and seizures. Computed tomography scans revealed acute subdural hematoma on the right side. He underwent an emergency operation to remove the hematoma but subsequently had seizure clusters for three days. Diffusion-weighted MR imaging revealed BTA in the right cerebral hemisphere. He was treated with antiepileptic agents and fully recovered to pre-injury condition, and MR imaging no further revealed any BTA 20 days after head trauma. He developed no complications at the 10-month postoperative follow-up. Conclusion: We reported a case of TBIRD following head trauma in the infant. The pathogenesis remains unclear, but we consider the possibility of biphasic seizures in infant head trauma cases, and we should appropriately administer the anticonvulsants and carefully check for MR imaging.

Novel technique in fixation of complex peritrochanteric femur fracture: Case report

Peritrochanteric fracture among adult are very rare among adults, which needs to be reduced fractures and fixed appropriately for optimum outcome. Comminuted unstable peritrochanteric fractures are challenging injuries that can cause many complications. The current study presented a novel technique for reduction and fixation using a proximal femur locking plate and augmented by long distal tibia medial locked plate, which was placed anteriorly. As we know there is a lack of scientific literatures studied this augmented method as primary method of fixation. A 25-year-old male patient was brought to the emergency department having left hip pain and he was unable to bear his body weight since 12 hours after sustaining a high velocity gunshot injury to his left hip. Physical examination revealed stable hemodynamically status. Upon local physical examination of his affected limb revealed external rotation deformity and shortening of the limb approximately 2cm than healthy contra-lateral limb as shown in figure no.(1). There were two penetrated wounds, the first wound was in anteromedial proximal thigh 3cm length * 2 cm width, second wound was 10cm length *3cm width in posterolateral proximal thig. Neurovascular examination was normal. Past medical history was irrelevant and no any medical comorbidities. Laboratory tests revealed WBC and CRP within normal range. Imaging including pelvic, hip and lower limb x-rays and CT- scan showed complex comminuted peritrochanteric femoral fracture with comminution of greater trochanters. Because of lack of precise classification grade for this pattern of fracture, we diagnosed the fracture “open complex comminuted peritrochanteric femur fracture”. Due to the instability and complexity of the fracture, several discussions were conducted to figure out what the best strategy available for definitive fixation. The preoperative plan was to remove the external fixator and perform the internal fixation at the same sitting using a proximal femur locking plate and augmented by anteriorly placed long distal tibia medial locking plate. Postoperative follow up period was uneventful. At eight months postoperatively, patient was able to walk without any walk assist such crutches and patient return to his preinjury condition. Peritrochanteric femur fracture is rare, specifically in young adult. The complex peritrochanteric fracture is challenging fracture pattern which may associated with high complications such as nonunion, delayed union, malunion and implant failure. The optimal surgical treatment is controversial. We consider that treatment of this kind of fracture with augmented locking implants allowed achieving satisfactory reduction with stable fixation that permitted patient’s early functional rehabilitation which were the main goal of management.

수상레저스포츠 참여자의 스포츠 상해 빈도 결정요인

The purpose of this study is to identify the determinants of sports injuries caused by participating in water leisure sports, focusing on the preventive aspect. To achieve the purpose of this study, a decision tree analysis was conducted using the data of 2019 Sports Safety Accident Survey data provided from Korea Sports Safety Foundation's. As a result of the analysis, injury time, sports skill level, injury experience(severity), pre-injury condition, sports participation time, average sleeping time, intention to spend protective equipment, recognition of prevention methods, weather check, injury season were derived as a determinant of sports injury caused by participation in water leisure sports. The implications of this result are as follows. First, in order to reduce the frequency of injuries of participants in water leisure sports, it is necessary to increase participants' safety awareness and induce safety practice behavior. Second, the occurrence of injury to participants in water leisure sports is related to the level of proficiency and immersion of the participants.

A Comparative Study of Functional Outcome Following Dynamic Hip Screw and Proximal Femoral Nailing for Intertrochanteric Fractures of the Femur.

IntroductionIntertrochanteric fractures are common in the old age group. The goal/aim of the treatment for intertrochanteric fractures will be to nearly restore pre-injury condition as early as it is possible. Dynamic hip screw (DHS) and proximal femoral nailing (PFN) have been the two standard treatment methods used for treating these kinds of fractures. The main goal of this proposed study was to compare functional outcomes of two available fixation devices for inter-trochanteric fracture using Harris hip scoring. The aim of this study is to compare the functional outcome of the DHS and PFN for the treatment of Intertrochanteric hip fractures achieved by the patient based on Harris hip score.Methods and materialsThe clinical methodology for the study consists of 46 cases of Inter-trochanteric fractures of femur that meet the inclusion criteria of patients aged above 45 years diagnosed with closed intertrochanteric fractures that are less than three weeks duration who were able to walk prior to fracture and exclusion criteria, admitted to R L Jalappa Hospital, Tamaka, Kolar between November 2019 and November 2021. The patients were divided into two groups, group A treated with DHS and group B treated with PFN and followed up at six weeks, 12 weeks, and 24 weeks based on the functional outcome on the 24th week using Harris hip score.ResultsA total of 46 patients were included in the study. The mean age in Group DHS was 61.09 ± 11.69 and in Group PFN was 65 ± 14.98. In the group of DHS, nine out of 23 patients were male and 14 out of 23 patients were female patients. In a group of PFN, 12 out of 23 patients were male and 11 out of 23 patients were female. The mean six weeks score in Group DHS was 34.43 ± 3.23 out of 100 and in Group PFN was 34.35 ± 2.5 out of 100. The mean Harris hip score in Group DHS was 84.3 ± 7.68 out of 100. The mean Harris hip score in Group PFN was 89.26 ± 6.53 out of 100. In Group DHS, 52.17% had injuries on the left side and 47.83% had on the right side. In Group PFN, 39.13% had Injury on the left side and 60.87% had on the right side. In Group DHS, results were excellent in 34.78% (eight patients), good in 43.48% (10 patients), fair in 17.39% (four patients out of 23 patients), and poor in 4.35% (one patient). In Group PFN, results were excellent in 56.52% (13 patients), good in 34.78% (eight patients), and fair in 8.70% (two patients).ConclusionFrom the study, it can be concluded that PFN had a better outcome in intertrochanteric fractures compared to DHS. The highest percentage of subjects in the PFN group had excellent to a good outcome and none of them had poor outcomes when compared to the DHS group. PFN group had higher scores of Harris hip score at 12 weeks, 24 weeks, and at the end of follow-up.

The effect of bitter melon (Momordica charantia L.) ethanol extract on tibia bone fracture healing in the Wistar strain rats (Rattus novergicus) based on radiological assessment, histopathology, and alkaline phosphatase levels

Introduction: Fracture is one of the most common health problem cases in the community. The goal of treatment for fractures is to restore the condition of the bone to pre-injury condition. This research aims to obtain a novel treatment for fracture healing. Bitter melon is a plant that is easily found and widely consumed in Indonesia. According to previous research, Bitter melon extract (Momordica charantia L.) can accelerate bone growth and repair after a fracture.Method: Â In this study, parameters used to assed fracture healing were histological, radiological, and alkaline phosphatase levels. This study used Bitter melon extract with 70% ethanol. Research groups consist of 3 groups with different doses and 1 control group where each group consisted of 6 subjects. The dosage used is 200 mg/Kg BW (P1), 300 mg/Kg BW (P2), and 400 mg/Kg BW (P3). Before being treated the subjects underwent factorization procedure and then treated used using bandages and wooden sticks for immobilization of fracture segments. Furthermore, the subjects were given Bitter melon extract twice a day for 84 days. Then checked according to the parameters seen. The data obtained are quantitative data which will be tested for normality and homogeneity first, then ANOVA test.Result: Callus formation findings shows the P1 groups showed the highest mean of callus formation among treatment groups after induced by Bitter melon ethanol extract of 200 mg/kg BW The results of LSD test in alkali phosphatase parameter between groups showed significant differences between the P1 group with controls (p = 0.000), P2 with controls (p = 0.000), P3 with controls (p = 0.000), P3 with P1 (p = 0.000) and P3 with P2 (p = 0.021)Conclusion: There was a significant effect of the administration of bitter melon fruit extract on the formation of callus formation in animal model after osteotomy.

Nonoperative Treatment of Medial Ulnar Collateral Ligament Injuries in the Throwing Athlete: Indications, Evaluation, and Management.

* Ulnar collateral ligament (UCL) injuries are common in overhead throwing athletes, particularly baseball players. Appropriate diagnosis, treatment, and rehabilitation are important in order for athletes to return to their preinjury condition.* Many patients, including the noncompetitive athletes and those with partial ligament tears, benefit from nonoperative treatment. Elite athletes desiring a return to play benefit from UCL reconstruction.* Rest, anti-inflammatory drugs, focused physical therapy, and biologic adjuncts are options that may allow athletes to return to play while avoiding the morbidity associated with operative treatment.

Sensory deprivation disrupts homeostatic regeneration of newly generated olfactory sensory neurons after injury in adult mice.

Although it is well known that injury induces the generation of a substantial number of new olfactory sensory neurons (OSNs) in the adult olfactory epithelium (OE), it is not well understood whether olfactory sensory input influences the survival and maturation of these injury-induced OSNs in adults. Here, we investigated whether olfactory sensory deprivation affected the dynamic incorporation of newly generated OSNs 3, 7, 14, and 28 d after injury in adult mice. Mice were unilaterally deprived of olfactory sensory input by inserting a silicone tube into their nostrils. Methimazole, an olfactotoxic drug, was also injected intraperitoneally to bilaterally ablate OSNs. The OE was restored to its preinjury condition with new OSNs by day 28. No significant differences in the numbers of olfactory marker protein-positive mature OSNs or apoptotic OSNs were observed between the deprived and nondeprived sides 0-7 d after injury. However, between days 7 and 28, the sensory-deprived side showed markedly fewer OSNs and mature OSNs, but more apoptotic OSNs, than the nondeprived side. Intrinsic functional imaging of the dorsal surface of the olfactory bulb at day 28 revealed that responses to odor stimulation were weaker in the deprived side compared with those in the nondeprived side. Furthermore, prevention of cell death in new neurons 7-14 d after injury promoted the recovery of the OE. These results indicate that, in the adult OE, sensory deprivation disrupts compensatory OSN regeneration after injury and that newly generated OSNs have a critical time window for sensory-input-dependent survival 7-14 d after injury.

Anterior Horn Lateral Meniscus Tear, Repair, and Meniscectomy

The purpose of this study was to describe the effect of anterior horn of the lateral meniscus (AHLM) tears on tibiofemoral contact pressures and the ability to restore normal parameters with repair. Eight fresh-frozen cadaveric knees were used. The specimens were subjected to a load of 1,000 N at 0 and 30 degrees of flexion and peak pressure, force and contact area were recorded. The test was repeated for four different instances. Peak force in the lateral compartment was significantly increased at 0 degrees of knee flexion from 37 N intact to 47 N after the tear and 56 N postmeniscectomy. At 0 degrees of knee flexion, the peak pressure of the lateral meniscus was significantly increased from 1.1 MPa in the intact state to 1.9 MPa after meniscectomy. The peak pressure in the nontraumatized medial compartment was significantly increased after partial lateral meniscectomy (p < 0.05). This cadaveric study demonstrated a significant increase in tibiofemoral peak forces in both the medial and lateral compartments with a tear of the AHLM. It also showed an increase in peak contact pressure after meniscectomy. With repair, the preinjury condition peak forces were restored to normal, suggesting the importance of repairing tears of the AHLM.

How Inhibition Relates to Impulsivity after Moderate to Severe Traumatic Brain Injury

Impulsive behaviors and poor inhibition performances are frequently described in patients with traumatic brain injury(TBI). However, few studies have examined impulsivity and associated inhibition impairments in these patients.Twenty-eight patients with moderate to severe TBI and 27 matched controls performed a stop-signal task designed to assess prepotent response inhibition (the ability to inhibit a dominant or automatic motor response) in a neutral or emotional context and a recent negative task to assess resistance to proactive interference (the ability to resist the intrusion into memory of information that was previously relevant but has since become irrelevant). Informants of each patient completed a short questionnaire designed to assess impulsivity. Patients showed a significant increase in current urgency,lack of premeditation, and lack of perseverance when retrospectively compared with the preinjury condition. Group comparisons revealed poorer prepotent response inhibition and resistance to proactive interference performances inpatients with TBI. Finally, correlation analyses revealed a significant positive correlation between urgency (the tendency to act rashly when distressed) and prepotent response inhibition in patients with TBI. This study sheds new light on the construct of impulsivity after a TBI, its related cognitive mechanisms, and its potential role in problematic behaviors described after a TBI.

Preinjury Predictors of Life Satisfaction at 1 Year After Traumatic Brain Injury

Davis LC, Sherer M, Sander AM, Bogner JA, Corrigan JD, Dijkers MP, Hanks RA, Bergquist TF, Seel RT. Preinjury predictors of life satisfaction at 1 year after traumatic brain injury. ObjectiveTo investigate the predictive value of preinjury factors for satisfaction with life (SWL) at 1-year posttraumatic brain injury (TBI). DesignSecondary analysis of prospective, longitudinal registry using data collected during inpatient rehabilitation and at 1-year post-TBI. SettingFifteen specialized brain injury units providing acute rehabilitation care as part of the Traumatic Brain Injury Model Systems (TBIMS) program. ParticipantsCommunity-dwelling persons (N=444) with moderate to severe TBI aged 16 to 64 years enrolled in the TBIMS program between October 2007 and October 2008 with 1-year follow-up data. InterventionsNot applicable. Main Outcome MeasureSatisfaction With Life Scale (SWLS). ResultsHierarchical stepwise linear regression revealed that injury-related and demographic variables did not contribute significantly to the explained variance in SWLS scores. In contrast, the preinjury functioning (education, productivity/employment) and preinjury condition (psychiatric and substance use problems, severe sensory dysfunction, learning problems, prior TBI) blocks each contributed significantly to the explained variance in SWLS scores. Preinjury functioning accounted for 2.9% of the variance and preinjury conditions for 3.8%. ConclusionsAlthough their contributions are small, preinjury functioning and preinjury conditions are important to consider in the prediction of SWL post-TBI. Educational level and history of psychiatric and other premorbid difficulties are particularly important for clinicians to consider when implementing or developing interventions for persons with moderate to severe TBI.

Approaches to hip fractures in convalescent rehabilitation wards - Consideration of length of stay, number of sessions, and discharge destination

Maeshima S, Osawa A, Nishio D, Hirano Y, Kigawa H. Approaches to hip fractures in convalescent rehabilitation wards – Consideration of length of stay, number of sessions, and discharge destination. Jpn J Compr Rehabil Sci 2012; 3: 72-77. Purpose: Factors that infl uence activities of daily living (ADL) and the discharge destination of hip fracture patients hospitalized in convalescent rehabilitation wards were examined from the viewpoint of the amount of time spent in rehabilitation sessions and the duration of hospitalization. Methods: The study subjects were 50 patients suffering from hip fracture. We evaluated the preinjury condition, cognitive function, uninjured side leg extensor muscle strength, and activities of daily living (ADL) for each patient. The discharge destination was generally divided into a “home” group and a “facility/ hospital transfer” group, and a comparative examination was carried out regarding the relationship between the overall number of rehabilitation sessions conducted, including physiotherapy and occupational therapy, and the daily number of sessions. Results: FIM effi ciency declined greatly from 0.32 (n = 30) for the 4th through 6th weeks after hospitalization to 0.11 (n = 20) for the 6th to 8th weeks, and in a post hoc test, a signifi cant difference (p = 0.0069) was observed in FIM effi ciency between weeks 2�4 and weeks 6�8. Conclusion: The results suggest that for hip fracture patients, about 6 weeks after being admitted to a convalescent rehabilitation ward, post-discharge guidance including nursing care service and family coaching is necessary.

Use of sodium bicarbonate for acute dizziness after minor head injury

Objective Dizziness after minor head injury (mHI) is common. In some eastern countries, it is treated with 7% sodium bicarbonate solution (SB). This prospective study evaluated the clinical efficacy of SB compared with normal saline (NS). Material and methods From April 2009 to April 2010, we performed a prospective observational study on 228 patients (68% female, 32% male) with acute dizziness after mHI. At the emergency physician’s discretion, intravenous SB (1 mL/kg) in NS (250 mL) or NS (250 mL) was administered to 166 patients and 62 patients, respectively, as empiric antidizziness therapy. Outcome measures were severity of dizziness and treatment response, which were measured by a visual analog scale. Various characteristics were compared between treatment groups. Any continued dizziness of the patients during follow-up was also compared with their pre-injury condition, such as prior psychiatric disorders and the presence of vertigo. Results The SB group had their visual analog scale scores reduced by 25.4% compared with 24.6% in the NS group. Both groups showed a statistically significant reduction in dizziness ( p < 0.001); however, the dizziness improvement did not differ significantly between the two treatment groups ( p = 0.699). Sixty-four patients (28.1%) suffered from continued dizziness during follow-up (mean period, 22.4 ± 28.9 days). The prevalence of continued dizziness was higher in patients with prior psychiatric disorders, although this was not statistically significant (40% vs. 27.2%, p = 0.276), whereas patients with prior vertigo did not experience a higher dizziness relapse rate (27% vs. 28.2%). Conclusions SB and NS administrations are both effective individually when treating patients with acute dizziness from mHI; however, both results may be attributable to the placebo effect. Therefore more research is necessary to understand the complex conditions that determine the effects of SB on this disorder.

Preinjury Warfarin Worsens Outcome in Elderly Patients Who Fall From Standing

Fall from standing (FFS) has become one of the most common mechanisms of injury for admission to the trauma center in the elderly population. Many of these patients present anticoagulated with warfarin. This two-center study was designed to examine the effects of preinjury warfarin use on outcome in the elderly. A retrospective review of prospectively collected registry data at two Level I trauma centers was conducted from 2003 to 2006. The study population included patients age > or = 65 admitted to the trauma center after an FFS. These centers are relatively close geographically and have similar patient demographics. Data collected included: age, Injury Severity Score, Abbreviated Injury Score (AIS) for head, mortality, admission Glasgow Coma Score, and admission international normalized ratio (INR). Patients were divided into two groups based on the preinjury condition of warfarin use. Statistical differences were determined by unpaired t test for continuous variables and chi and odds ratios (ORs) for dichotomous variables. Of the 27,812 patients admitted to these two trauma centers over this time period, 2,791 (10.0%) were of age > or = 65 and admitted after an FFS. INR was 2.8 +/- 1.1 in warfarin group (+warf). The number of patients with AIS head 4 and 5 was similar between groups (-warf 22.1%, +warf 25.9%). Overall, preinjury warfarin use had a negative effect on the in-hospital mortality rate, +warf 8.6% and -warf 5.7% (OR 1.54, 1.09-2.19, p = 0.015). There was no difference in mortality between groups in patients with an AIS head < 4. The negative impact of preinjury warfarin use on mortality was most pronounced in patients with an AIS head 4 and 5 who presented awake (Glasgow Coma Score 14 and 15), +warf 13.5% and -warf 6.4% (OR 2.30, 95% confidence interval 1.12-4.70, p = 0.019). Preinjury warfarin use has an adverse effect on outcome (mortality) in elderly FFS patients. Importantly, this effect is most prominent in patients admitted awake with significant findings on computed tomography scan. This argues for rapid emergency department triage to computed tomography scan and rapid INR correction in this population.

A novel technique for treating auricular hematomas in mixed martial artists (ultimate fighters)

Purpose This study aimed to describe a “bolsterless” technique for managing auricular hematomas in professional fighters. Methods Eight auricular hematomas were drained under local anesthesia by incising along an anatomical auricular crease. After evacuation of the hematoma and copious irrigation, the resultant skin flap was replaced in anatomical position, and through-and-through absorbable mattress sutures were used to secure the flap in place. Incision sites were left open and dressed with antimicrobial ointment. No bolsters were placed. The patients were given 1 week of oral antibiotic therapy. Results All 8 hematomas resolved without further intervention. All 8 ears returned to their preinjury cosmetic state. Fighters were able to return to training within a week of the initial injury. No postoperative infections or other complications were noted. Conclusions In contrast to wrestlers, mixed martial artists (also called “ultimate fighters”) do not routinely wear protective head gear. As a result, they are at increased risk of recurrent auricular hematomas, often resulting in severe auricular deformities (cauliflower ear). These patients are anxious to return to training and fighting, and are reluctant to wear a bolster after repair. At their urging, we agreed to attempt this bolsterless technique. Although 2 patients in this series already had a significant cauliflower ear before being treated for the current hematoma, in all cases the auricle returned to its preinjury condition. Bolsterless treatment using mattress sutures and cosmetically placed incisions represents a successful technique for management of auricular hematomas in this population.

Preinjury warfarin does not impact outcome in trauma patients.

The objective of this study was to determine whether the preinjury condition of anticoagulation had an adverse impact on patients sustaining injury. A retrospective analysis was performed for prospectively collected registry data from 1995-2000 from all accredited trauma centers in Pennsylvania. The registry was queried for all trauma patients who had anticoagulation therapy as a preinjury condition (PIC). This group served as our experimental cohort. A control cohort (not having warfarin therapy as a PIC) was developed using case-matching techniques for age, sex, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), A Severity Characterization of Trauma (ASCOT) score, and in the head injured patients, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses. Head and non-head injured patients were evaluated separately. The cohorts were examined for 28-day mortality, intensive care unit length of stay (ICU-LOS), hospital length of stay (HOS-LOS), PICs, occurrences, discharge destinations, and functional status at discharge. Chi2 and Student's t test were used to evaluate the data; p values < 0.05 were considered significant. Two thousand nine hundred forty-two patients were available for analysis. The prevalence of PICs was significantly greater in the warfarin group for both the head and non-head injured populations (p < 0.003 and p < 0.0001, respectively). The incidence of occurrences in the non-head injured population was statistically higher for the warfarin patients (p < 0.001), but showed no difference in the head injured group regardless of warfarin use (p = 0.15). Functional status at discharge demonstrated no clinically significant difference between the warfarin and non-warfarin groups in both head and non-head injured populations. There was no difference in discharge destination in the head injured population; however, in the non-head injured population a greater percentage of non-warfarin patients was discharged to home when compared with the warfarin patients. Our data suggest that the PIC of anticoagulation with warfarin does not adversely impact mortality or LOS outcomes in both head and non-head injured patients. In non-head injured patients, however, the occurrence rates and discharge destination were different. More research needs to be done to determine whether this is related to anticoagulation or other reasons (i.e., number of PICs). These data should be used when weighing risk/benefit ratios of prescribing chronic anticoagulation.

Early hyperthermia after traumatic brain injury in children: Risk factors, influence of length of stay, and effect on short-term neurologic status.

Early hyperthermia after traumatic brain injury in children: Risk factors, influence of length of stay, and effect on short-term neurologic status. Natale JE, Joseph JG, Helfaer MA, Shaffner DH. Crit Care Med 2000; 28:2608–2615. Hyperthermia worsens outcome in virtually all animal models of acute brain injury. This is true whether hyperthermia occurs during or after the insult. In adult humans, the natural history of acute brain injury (for example, cardiac arrest, subarachnoid hemorrhage, and traumatic brain injury) includes a high incidence of spontaneous hyperthermia (Albrecht et al. Mayo Clin Proc 1998; 73:629—35). It has been argued that this hyperthermia should be treated to reduce severity of secondary insults after hospitalization. There is no data on the frequency of hyperthermia in children suffering from acute brain injury. Accordingly, the authors of this report retrospectively examined the medical records of 117 children hospitalized for traumatic brain injury (TBI). The cases occurred between 1995 and 1997. The median age of the children was 5.4 years. Patients with TBI were hospitalized in the pediatric intensive care unit (PICU) if their Glasgow Coma Scale (GCS) score was <15 or if there were other co-existing medical indications. Induction of mild hypothermia was not part of the treatment regimen. In addition to examining for evidence of fever, the investigators noted the following data: demographic characteristics, preinjury condition (especially recent preinjury antibiotic use), extracranial injuries, injury severity, initial computerized tomography (CT) scan, early physiologic response (such as glycemic and hemodynamic status), and medical care (for example, requirements for surgery). When possible, established scoring systems were used for each attribute. Outcome was measured by the PICU discharge GCS score and by the length of PICU stay. The data were subjected to bivariate analysis and logistic regression procedures to define risk factors for hyperthermia and to segregate the outcome predictive value of hyperthermia from known determinants other than length of PICU stay. All patients were neurologically intact before injury. Admission median GCS score was 12. Early hyperthermia (defined as a recorded value >38.5oC) was observed in 29.9% of patients. Early risk factors for hyperthermia were limited to injury severity, initial head CT, and early physiologic response to injury (primarily arterial hypotension). Factors associated with a low GCS score at PICU discharge were injury severity, early physiologic response (including hyperglycemia, leukocytosis, hypoxia, hypotension, and hyperthermia), and surgery during PICU stay. Factors associated with prolonged PICU stay were extracranial injuries, injury severity, early physiologic response including hyperthermia, and surgery during PICU stay. Logistic regression analysis showed that early hyperthermia predicted length of PICU stay independent from injury severity, hypotension, leukocytosis, or hyperglycemia. The results of this retrospective analysis in pediatric patients are in agreement with those found in adults. A hyperthermic response to TBI is common. However, the incidence of hyperthermia observed in this series was about one-half that observed in adults. This might be explained by the fact that this data was collected after it had become recognized that hyperthermia might be detrimental and therefore was more aggressively treated. Regardless, the incidence in children remained relatively high. There are no prospective controlled trials that have examined the effects of prophylactic avoidance of hyperthermia on outcome in patients with TBI and therefore any recommendations remain speculative. However there is no evidence for a beneficial effect of hyperthermia on the injured brain. In contrast, there is consistent evidence from laboratory models of acute brain injury that demonstrate adverse outcome effects from either early or delayed hyperthermia. This allows a reasonable conclusion to be made that hyperthermia, now known to frequently accompany TBI, should be aggressively treated. (DSW)

当科における急性喉頭気管外傷

Laryngotracheal trauma is one of the rarest and most difficult of trauma to reconstruct to normal pre-injury condition. This is because the larynx has complex multiple functions that involve respiration, phonation and swallowing.As our hospital has an emergency center, we have had several cases of laryngotracheal trauma among many cases trauma to the head and neck regions.We reported 6 cases of such trauma during 9 months in 1995. There are two primary cases that produce laryngeal trauma. One is mechanical force from outside that inflicts a range of damage from light to severe. The other is mechanical and/or chemical forces including heat injury from inside that results in the obstruction of and scar formation in the airway. It is most crucial to manage laryngotracheal trauma therefore we must think of not only structural reconstruction but also of functional reconstruction of the larynx to quickly restore the pre-injury life of the patient, even in the case of an emergency operation. Especially in the case of heat injury to the laryngotracheal region, intubation is not a good method but rather immediate tracheotomy is the best first aid treatment to keep the airway open in order to restore laryngeal functions with a minimum of complications.

The Proper Role of a Victim-Compensation System

Compensation to the victim of a criminal injury is not effective if it consists merely of financial remedy supplied by the state. It should take the form of punitive restitution; that is, it must come from the offender's resources (either money or service) and it must be part of the criminal court sentence by being tied to whatever reformative plan is contemplated. Correctional restitution goes a significant step further than compensation by requiring the of fender to maintain a relationship with the victim until the victim's pre-injury condition has been restored to the fullest extent possi ble. It compensates the victim, relieves the state of some burden of responsibility, and permits the offender to pay his debt to society and to his victim. Thus it makes a contribution to the reformative and corrective goals of criminal law and finds its proper place in the criminal justice system.