BACKGROUND: The use of cerebral oximetry monitoring in the care of extremely preterm infants is increasing. However, evidence that its use improves clinical outcomes is lacking. METHODS: In this randomized, phase 3 trial conducted at 70 sites in 17 countries, we assigned extremely preterm infants (gestational age, <28 weeks), within 6 hours after birth, to receive treatment guided by cerebral oximetry monitoring for the first 72 hours after birth or to receive usual care. The primary outcome was a composite of death or severe brain injury on cerebral ultrasonography at 36 weeks' postmenstrual age. Serious adverse events that were assessed were death, severe brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis. RESULTS: A total of 1601 infants underwent randomization and 1579 (98.6%) were evaluated for the primary outcome. At 36 weeks' postmenstrual age, death or severe brain injury had occurred in 272 of 772 infants (35.2%) in the cerebral oximetry group, as compared with 274 of 807 infants (34.0%) in the usual-care group (relative risk with cerebral oximetry, 1.03; 95% confidence interval, 0.90 to 1.18; P = 0.64). The incidence of serious adverse events did not differ between the two groups. CONCLUSIONS: In extremely preterm infants, treatment guided by cerebral oximetry monitoring for the first 72 hours after birth was not associated with a lower incidence of death or severe brain injury at 36 weeks' postmenstrual age than usual care. (Funded by the Elsass Foundation and others; SafeBoosC-III ClinicalTrials.gov number, NCT03770741.).
- MeSH
- bronchopulmonální dysplazie etiologie MeSH
- kojenec MeSH
- lidé MeSH
- mozkový krevní oběh MeSH
- nekrotizující enterokolitida etiologie MeSH
- nemoci nedonošenců * diagnóza mortalita terapie MeSH
- novorozenci extrémně nezralí * MeSH
- novorozenec MeSH
- novorozenecká sepse etiologie MeSH
- oxymetrie * metody MeSH
- poranění mozku diagnostické zobrazování etiologie MeSH
- retinopatie nedonošených etiologie MeSH
- ultrasonografie MeSH
- velký mozek MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.
- MeSH
- algoritmy MeSH
- fraktury lebky diagnostické zobrazování etiologie MeSH
- kraniocerebrální traumata komplikace diagnostické zobrazování MeSH
- lebka diagnostické zobrazování MeSH
- lidé MeSH
- mozek diagnostické zobrazování MeSH
- počítačová rentgenová tomografie MeSH
- poranění mozku diagnostické zobrazování MeSH
- rentgenové záření MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Transcranial color-coded sonography (TCCS) monitoring of severe brain injury patients may reveal various pathological hemodynamic changes. According to changes in flow velocities in basal brain arteries, the presence of brain hyperemia, vasospasms, and oligemia can be detected. The study included a group of 20 patients with severe brain injury. TCCS measured flow velocities and ICP values were monitored on a daily basis in the course of a week after injury. In nearly 50 % of patients significant hemodynamic changes occurred. The most frequent pathological finding was hyperemia (31.8 %), followed by vasospasm (10.9 %) and oligemia (9.1 %). In 42.7 % of patients increased flow velocities were registered and only 9.1 % of records were within the normal range of values. The most substantial elevation in time-averaged mean velocity occurred from the second to the sixth day after injury. In a subgroup of patients with raised intracranial pressure 41.6 % of flow velocity (FV) measuring met the TCCS criteria for hyperemia compared with 26 % in a subgroup of patients without intracranial pressure (ICP) elevation. The study showed that hemodynamic changes after severe brain injury are relatively common findings and that TCCS is a useful bed-side tool for the monitoring of intracranial hemodynamic changes.
- MeSH
- časové faktory MeSH
- intrakraniální tlak MeSH
- intrakraniální vazospazmus etiologie MeSH
- klinické kódování MeSH
- lidé MeSH
- mozkový krevní oběh MeSH
- následné studie MeSH
- poranění mozku komplikace diagnostické zobrazování MeSH
- rychlost toku krve MeSH
- ultrasonografie dopplerovská transkraniální * MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: To find out severity of brain injury in alcohol intoxicated patients after mild (GCS 13-15) brain injury. METHODS: A retrospective study of all patients older than 15 years in whom cranial CT (CCT) scan was performed between October 2006 and September 2007. Information of alcohol intoxication, injury mechanism, details of facial/head injuries, admission GCS, CCT findings and type of treatment were retrieved from patients' medical records. RESULTS: There were 151 alcohol intoxicated patients. Thirty four (22.5%) patients had positive CCT scans for brain injury or basal/vault fracture. One hundred and three (68.2%) patients had no signs of head/facial injury on CCT scans, 14 (9.3%) patients had fractures of nasal bones or maxillary/frontal sinuses only. Five (3.3%) patients were operated, 3 (2%) for depressed skull fracture and 2 (1.3%) for subdural hematoma. The most frequent findings on CCT scan were vault fracture in 21 patients (61.8%) and subarachnoid haemorrhage in 15 patients (44.1%). CONCLUSION: The prevalence of brain injury in alcohol intoxicated patients after mild brain injury was 22.5% with the need for neurosurgical intervention in 3.3%.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- otrava alkoholem komplikace MeSH
- počítačová rentgenová tomografie * MeSH
- poranění mozku diagnostické zobrazování etiologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: The aim of this study was to evaluate the correlation of neuron specific enolase (NSE), protein S100B and time-profile of Glasgow Coma Score (GCS) development with metallothionein (MT) blood levels in patients with traumatic brain injury (TBI) during 10 days of hospitalization. Patients were divided into 2 groups with respect to NSE and S100B levels - with (group I) and without (group II) GCS improvement. METHODS: Serum NSE and S100B concentrations were measured by immunochemical methods; serum metallothionein concentration by electrochemical technique. Cortical biopsies were investigated immunohistochemically and by electron microscope. A cDNA microarray containing 700 gene probes was used to study the changes in gene expression in the ipsilateral cortex. RESULTS: Values of MT in the blood of group I showed a non-significant decrease compared to group II during 1-3 days after admission. There was an increase of MT during 4-8 days in comparison with values of 1-3 days. The highest value of MT during hospitalization was found in a patient with diffuse axonal injury (group II). The data of cDNA microarray suggested an increase in expression of gene transcripts for oxygen free radical scavenger proteins corresponding with the increase of MT during 4-8 days in both groups. CONCLUSIONS: The experimental data indicate that monitoring the content of MT in patients with trauma brain injury would be a suitable approach to evaluate the degree of injury or duration of prolonging unconsciousness, particularly in diagnosis of diffuse axonal injury.
- MeSH
- fosfopyruváthydratasa krev metabolismus MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- metalothionein krev MeSH
- neurotrofní faktory krev metabolismus MeSH
- poranění mozku krev diagnostické zobrazování metabolismus MeSH
- proteiny S100 krev metabolismus MeSH
- radiografie MeSH
- S-100 kalcium vázající protein G, podjednotka beta MeSH
- stanovení celkové genové exprese MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- fosfopyruváthydratasa MeSH
- metalothionein MeSH
- neurotrofní faktory MeSH
- proteiny S100 MeSH
- S-100 kalcium vázající protein G, podjednotka beta MeSH
- S100B protein, human MeSH Prohlížeč
We present a group of 29 consecutive head injured comatose patients with the syndrome of transtentorial herniation. All patients had urgent surgery and then continuous monitoring of ICP, CPP, blood pressure and jugular bulb oximetry was instituted. Two postoperative CT and SPECT examinations were performed in each patient. 15 patients had a normal CPP (> 70 mmHg) throughout the postoperative period, 80% of them had a favourable outcome. On the other hand 14 patients had decreased CPP lasting at least one hour and only 36% of them had a favourable outcome (p < 0.05). Similar relationships were found comparing GOS in patients with normal and increased ICP (> 20 mmHg) and normal and decreased SjO2 (< 55%). All but 3 patients had ischaemia on SPECT. Ischaemia improved on the 2nd SPECT in 11 patients and 10 (91%) of them had a favourable outcome. GOS (mean follow up 9 months) is: 12 patients good, 5 moderately disabled, 2 vegetative, 10 died. We conclude that SPECT is able to disclose even reversible ischaemic changes. In these patients all effort has to be made to keep CPP on normal levels. Improvement in cerebral perfusion is related to a better outcome.
- MeSH
- dospělí MeSH
- intrakraniální hypertenze diagnostické zobrazování chirurgie MeSH
- intrakraniální tlak fyziologie MeSH
- jednofotonová emisní výpočetní tomografie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- poranění mozku diagnostické zobrazování patofyziologie chirurgie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
The authors present a report on the treatment of a female patient with a brain injury caused by a splint from an exploded sparklet used for making soda water. The rare occurrence of gunshot wounds in peace time leads to embarrassment as regards treatment of patients with this type of injury. It was found that in gunshot wounds of the head and brain it is necessary to revise the pathway of the splint after craniotomy, remove the foreign body, bone fragments and debris, then close carefully the opening in the dura mater, remove the margins of the bone contaminated with the object which caused the injury and stitch the skin. The authors draw attention to difficulties associated with localization of the foreign body in the pathway of the splint and to the possible use of peroperative two-dimensional ultrasonography.
- MeSH
- cizí tělesa * diagnostické zobrazování chirurgie MeSH
- exploze * MeSH
- lidé MeSH
- mladiství MeSH
- poranění mozku * diagnostické zobrazování chirurgie MeSH
- radiografie MeSH
- úrazy v domácnosti MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
The authors describe the advantages of two-dimensional ultrasound examination in patient with skull defects of various origin. It is better to use ultrasound transducer with high frequencies, which have higher discerning capability to distinguish fine anatomic details. In comparison to CT the two-dimensional echoencephalography is harmless for the patient, it enables the monitoring of intracranial situation through an "acoustic window" and examination in several planes.
- MeSH
- echoencefalografie metody MeSH
- kraniotomie * MeSH
- lidé MeSH
- nádory mozku diagnostické zobrazování chirurgie MeSH
- následné studie MeSH
- nemoci mozku diagnostické zobrazování chirurgie MeSH
- pooperační komplikace diagnostické zobrazování MeSH
- poranění mozku diagnostické zobrazování chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- mozek diagnostické zobrazování MeSH
- nádory mozku diagnostické zobrazování ekonomika MeSH
- počítačová rentgenová tomografie ekonomika přístrojové vybavení MeSH
- poranění mozku diagnostické zobrazování ekonomika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Československo MeSH