An unusual case of penetrating head injury with excellent recovery

We report the remarkable case of the passage of a heavy metal rod through the head of a 42-year-old man. The patient had an excellent outcome because of prompt and efficient rescue efforts combined with transport to a major neurosurgical trauma center. Reference is made to a somewhat similar case publicized over 130 years ago.     

Interhemispheric transfer after spontaneous recovery in 43 cases of severe closed head injury.

Examined the possibility of frequent callosal disconnection following closed head injury. Interhemispheric transfer was evaluated in 43 severe closed-head-injured patients (aged 18–51 yrs) using a wide-ranging battery of untimed behavioral tasks, after the period of spontaneous recovery. Only 1 S showed signs of callosal disconnection. Much effective interhemispheric transfer occurred in closed-head-injured Ss after the period of spontaneous recovery. More frequent occurrence of the disconnection syndrome in its acute phase is a possibility that cannot be excluded. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonepileptic seizures after head injury

PURPOSE: To examine the role of head injury as a risk factor in the development of nonepileptic seizures (NES). Specifically, we will determine the relative frequency of head injury among NES patients referred to our center and will describe several pertinent clinical features and personal characteristics. METHODS: Retrospective record review of patients referred to our center for evaluation of seizures over a 4-year period. All patients with NES were evaluated as in a previously described protocol, which included intensive video EEG monitoring, provocation by suggestion, and psychiatric interview. All NES patients with a history of head injury were extracted for this report. RESULTS: Of 102 patients with NES, nearly one-third (32%) had an antecedent head injury; 52% were male, mean age was 34 years, and 12% had coexisting epilepsy. Multiple psychiatric disorders were not uncommon (79%), and a history of abuse was found in 35%. All but four patients had documented financial gain from their injury. Follow-up at 1 year found poor long-term outcome with lasting disability; despite that, the majority (91%) of head injuries were minor. CONCLUSIONS: Our preliminary findings suggest that prior head injury is associated with the development of NES and may contribute to the pathogenesis of NES in vulnerable patients. Head injury and sexual or physical abuse appear to occur in comparable proportions in patients with NES. This suggests that head injury and abuse may be equally important risk factors in the development of NES.     

Involvement of nicotinergic mechanisms in thyrotropin-releasing hormone-induced neurologic recovery after concussive head injury in the mouse

It has recently been shown that distension of the uterus in anaesthetized pigs causes reflex haemodynamic responses through efferent sympathetic mechanisms. The present study was undertaken to determine whether these mechanisms include activation of the renin-angiotensin system. The same methods were used in 14 pigs which were anaesthetized with alpha-chloralose and artificially ventilated. Balloons positioned within the uterus were distended for periods of 30 min by injecting 20 ml of warm Ringer solution. The responses of arterial blood pressure and heart rate were respectively prevented by blockade of alpha-adrenergic receptors with phentolamine and atrial pacing. Changes in plasma renin activity (PRA) were assessed during the last minute of distension by radioimmunoassay of angiotensin I. In each of 10 pigs, distension of the uterus (mean uterine transmural pressure of 17 mmHg) caused an increase in PRA in the absence of changes of interfering haemodynamic variables. In the remaining four pigs, this response was graded by step increments of the distension. The increase in PRA caused by uterine distension was abolished by bilateral section of the renal nerves (five pigs) or by blockade of beta-adrenergic receptors with propranolol. The present study showed that distension of the uterus in anaesthetized pigs primarily caused a reflex increase in PRA. This reflex response was mediated by renal nerves and involved beta-adrenergic receptors.     

Effect of marzulene on the restitution of rat gastric mucosa after NaOH-induced injury

BACKGROUND/AIMS: The purpose of this study was to assess the effect of marzulene (L-glutamine plus azulene) on the repair of NaOH-induced gastric mucosal injury in rats. METHODOLOGY: Gastric mucosal injury was induced with intragastric instillation of 3.0 ml of 5% NaOH for 1 minute. From 2 days after the operation, the rats were orally given chow pellets containing 0%, 0.25%, or 0.5% of marzulene for 25 weeks. RESULTS: Oral administration of marzulene at both dosages significantly increased the mucosal heights of the fundic and antral mucosa at week 25. Marzulene also increased the labeling indices of the fundic and antral epithelial cells, but not the mucosal blood flow. CONCLUSIONS: These findings indicate that marzulene stimulates repair mechanisms of rat gastric mucosa after NaOH injury. This effect of marzulene may be associated with a stimulation of gastric epithelial cell proliferation.     

Transiet atrial fibrillation after minor head injury

Two patients developed transient rapid atrial fibrillation after a blow on the head. There was no evidence of neurological damage or organic heart disease on subsequent investigation. Neither patient was aware of the cardiac irregularity.     

Sagittal sinus thrombosis after closed head injury

We describe a patient with trisomy 8 mosaicism followed through a sixth pregnancy and discuss issues in phenotypic and genotypic variability, the risk for neoplasia, and reproductive risks.     

Induction of proliferation in isolated guinea pig gastric epithelium during restitution after superficial injury

Immediate repair of the gastrointestinal epithelium after superficial injury is called restitution. It is based on the migration of the surviving mucoid neck cells over the area of injury. The involvement of growth factors in the process has been recently documented. They are known to enhance the process (ie, EGF, FGF, TGF-beta) and to activate the basolateral Na+-H+-antiport (EGF). They may exert their effect by activating intracellular tyrosine kinases or by inducing chemotaxis. Yet, their precise mechanism of action in the process is unknown. The aim of the present study was to investigate the effect of modulation of the signal transduction pathway on the occurrence of proliferative mucoid neck and foveolar cells in guinea pig gastric epithelium. Therefore guinea pig gastric epithelium was mounted in Ussing chambers in vitro and perfused 4 hr after superficial injury with 1.25 M NaCl. The potential difference over the epithelium and tissue resistance were recorded simultaneously. The tissue was exposed either to cycloheximide, genistein, or to 4-phorbol myristate 13-acetate (PMA) during the 4-hr recovery, and the expression of proliferative cells was assessed by staining the tissue for proliferative cells (Ki-67). The mean proliferative index of tissues subjected to NaCl injury was significantly higher than that of uninjured control tissues after 4 hr of restitution. Inhibition of the signaling pathway with genistein decreased the proliferative index significantly, while its stimulation with phorbol myristate increased it. Both electrophysiologic and morphologic restitution were sensitive to genistein, but not to PMA or cycloheximide. Superficial epithelial injury results in a significantly increased occurrence of proliferative cells in isolated guinea pig gastric epithelium. This endogenous activation of the tissue is sensitive to inhibition by tyrosine kinases and to stimulation by protein kinases. Electrophysiologic and morphologic recovery are also affected by the modulation of the signaling pathway. This suggests that it is involved in the immediate repair process.     

Sustained attention after severe closed head injury.

Sustained attention was assessed in 20 patients with severe closed head injury (CHI) and 20 normal matched controls. Participants were presented with a visual continuous performance task (CPT) with 3 levels of complexity. Performance was assessed by examining response latencies and error rates. Across all levels of complexity, the CHI patients demonstrated a vigilance decrement, whereas the performance of the matched controls was stable across time. The vigilance decrement was not differentially affected by the manipulation of task complexity in the CHI patients. However, findings suggest that the overall vigilance performance of CHI patients was differentially affected by increasing the complexity of the task. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Visual selective attention after severe closed head injury

This study investigated the nature of selective attention deficits after severe closed head injury (CHI). Twenty participants with severe CHI (greater than 1 year postinjury) and 20 matched controls completed search and nonsearch visual selective attention tasks under conditions of low (Experiment 1) and high (Experiment 2) target-distractor similarity. In the search situations, participants searched visual displays that contained 1, 4, or 8 items for the targets. In the nonsearch situations, the location of the targets was visually cued with a peripheral arrow. The results revealed that in both the low and high target-distractor similarity search conditions. CHI participants required a longer time than controls to locate and identify the target. In contrast, in the nonsearch condition, CHI participants were able to successfully ignore irrelevant task information when target-distractor similarity was low. However, when target-distractor similarity was high, CHI participants had more difficulty than controls ignoring the irrelevant information. These results suggest that, in comparison to controls, CHI participants may be at a disadvantage in selective attention situations when visual search is required and when the discriminability between targets and distractors is difficult.     

Discourse after closed head injury in young children

This study examined narrative discourse in 23 children, ages 6 to 8 years, who sustained a severe closed head injury (CHI) at least 1 year prior to assessment. Narratives were analyzed at multiple levels using language and information structure measures. Results revealed significant discourse impairments in the CHI group on all measures of information structure, whereas differences in the linguistic domain failed to reach significance. In addition, effects of age at injury and lateralization of lesion on discourse were considered. Although no significant differences were found according to age at injury, a consistent pattern of generally poorer discourse scores was found for the early injured group (< 5 years). With regard to lesion focus, the group findings were unimpressive. However, preliminary examination of individual CHI cases with relatively large lateralized lesions suggested that the late injured children may show the language-brain patterns reported in brain-injured adults, whereas early injured children may not.     

Hypnosis and attention deficits after closed head injury

In a controlled study of patients attending a concussion clinic because of ongoing postconcussion symptoms, attention deficits were recorded in the head-injured group for the aspects of alertness, assessed by the Continuous Performance Test (CPT), and processing capacity, assessed by a version of the Paced Auditory Serial Addition Test (PASAT). Selective attention was intact. Hypnotizability was assessed by the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A), with normal means and standard deviations found in both the concussed and control groups. There was a significant correlation, however, between HGSHS:A scores and PASAT scores in the concussed group only. The results of this preliminary study suggest that slower processing capacity after a closed head injury may predict higher hypnotizability and that hypnosis could be an appropriate rehabilitation technique for these patients who present with postconcussion symptoms.     

Treatment of aggression and irritability after head injury

Epidemiological characteristics of colorectal cancer may differ by particular anatomical subsite, suggesting that the subsite-specific colorectal cancers may represent different disease entities. This study explored the time trends over a 23-year period in colorectal cancer incidence at various subsites by sex and age group. Data on the incidence of colorectal cancer were obtained from a population-based cancer registry in Shanghai, People's Republic of China. Between 1972 and 1994, 30,693 patients with colorectal cancer were registered at the Shanghai Cancer Registry. The overall age-adjusted colorectal cancer incidence rates increased > 50%, or 2% per year from 1972-1977 to 1990-1994, from 14 to 22 per 100,000 among men and from 12 to 19 per 100,000 among women. The increases in rates were considerably more rapid for colon cancer, with rates approximately doubling, than they were for rectal cancer. Proximal colon cancer was more common than distal colon cancer over the whole study period, whereas rates for both cancers rose with similar annual percentage changes (> 5% per year) and across virtually all age groups. The estimated annual increases rose from 2% at ages 35-44 years to 7% at ages 75-84 years for proximal colon cancer, but they were more uniform for distal colon cancer (5-6% per year). Age-adjusted and age-specific rectal cancer rates changed little. The male:female age-adjusted rate ratio for colorectal cancer was 1.19 in 1990-1994. The ratios increased over time and varied by subsites, with ratios increasing from the proximal colon to the distal colon and to the rectum. Furthermore, men had higher rates than women for distal colon and rectal cancers at ages 55 and older, whereas women had higher rates than men at younger ages for these two cancers. Male:female rate ratios for proximal colon cancer did not vary substantially with age. The findings from this study indicate that subsite-specific incidence rates of colorectal cancer differ by sex and age and in their time trends. Cancers arising in the proximal colon, distal colon, and rectum may have somewhat different disease etiologies.     

Jugular venous desaturation and outcome after head injury

Early experience with continuous monitoring of jugular venous oxygen saturation (SjvO2) suggested that this technology might allow early identification of global cerebral ischaemia in patients with severe head injury. The purpose of the present study was to examine the relationship between episodes of jugular venous desaturation and neurological outcome. One hundred and sixteen severely head-injured patients had continuous monitoring of SjvO2 during days 1-5 after injury. Episodes of jugular venous desaturation (SjvO2 < 50% for more than 10 minutes) were prospectively identified, and the incidence of desaturation was correlated with neurological outcome: 77 episodes of desaturation occurred in 46 of the 116 patients; 27 had one episode and 19 had multiple episodes of desaturation. The causes of these episodes were systemic (n = 36), cerebral (n = 35), or both (n = 6). Most of the episodes were less than 1 hour in duration, and it is probable that many of them would not have been detected without continuous measurement of SjvO2. Episodes of desaturation were most common on day 1 after injury, and were twice as common in patients with a reduced cerebral blood flow as in patients with a normal or elevated cerebral blood flow. The occurrence of jugular venous desaturation was strongly associated with a poor neurological outcome. The percentage of patients with a poor neurological outcome was 90% with multiple episodes of desaturation and 74% in patients with one desaturation, compared to 55% in patients with no episodes of desaturation. When adjusted for all co-variates that were found to be significant, including age, Glasgow coma score, papillary reactivity, type of injury, lowest recorded cerebral perfusion pressure, and highest recorded temperature, the incidence of desaturation remained significantly associated with a poor outcome. Although a cause and effect relationship with outcome cannot be established in this study, the data suggest that monitoring SvO2 might allow early identification and therefore treatment of many types of secondary injury to the brain.     

A prospective analysis of the recovery of attention following pediatric head injury

Free radical-mediated oxidation of proteins results in the formation of carbonyl groups in quantities that reflect the intensity of the oxidative stress. We have developed an immunochemical technique for the quantification of carbonyl groups in protein samples prepared from small tissue samples and cell cultures. Protein samples were slot-blotted onto a polyvinylidene difluoride membrane, which was sequentially treated with 2,4-dinitrophenylhydrazine (DNPH), a primary antibody specific for the 2,4-dinitrophenol group, and a peroxidase-labeled second antibody. After the blots were developed with a chemiluminescent substrate and exposed to X-ray film, the level of immunostaining was quantitated by densitometry. Using oxidized bovine serum albumin as a standard and loading 5 microg of protein per slot, the minimum detectable carbonyl content was approximately 60 pmol carbonyl/mg protein. When necessary, nonspecific staining by noncarbonyl constituents in complex sample matrices was accounted for by using sodium borohydride-treated blanks. Results by the new method were highly correlated (r = 0.932, P < 0.0001) with those of the standard DNPH-based spectrophotometric technique. The coefficient of variation at a carbonyl level of 1.5 nmol/mg protein was 9.7%. The utility of this new method was demonstrated by measuring protein oxidation in cultured human colon cells (SW620) that were briefly exposed to H2O2.     

Effect of L-glutamine and n-butyrate on the restitution of rat colonic mucosa after acid induced injury

BACKGROUND: L-glutamine and n-butyrate are important nutrients for colonocytes affecting both their structure and function. The effect of these epithelial substrates on resealing of rat distal colon after acid induced injury was studied. METHODS: Isolated colonic mucosa of 32 rats was mounted in Ussing chambers and exposed to Krebs-Ringer solution for four hours. Epithelial injury was induced by short-term exposure to luminal hydrochloric acid and resealing was studied with or without added glutamine or butyrate. RESULTS: Glutamine (luminal and serosal) reduced tissue conductance, mannitol and lactulose permeability, and permeation of enteropathogenic Escherichia coli. Glutamine (serosal) diminished conductance and mannitol permeability. Both interventions stimulated bromodeoxyuridine incorporation in nuclei of colonocytes. Luminal butyrate had no measurable effect on these parameters. CONCLUSIONS: These data suggest that L-glutamine stimulates repair mechanisms of rat colonic mucosa after acid injury. This effect on the gut barrier is associated with a stimulation of crypt cell proliferation. The addition of glutamine to parenteral solutions may be beneficial for patients under intensive care whose intestinal barrier is weakened in the course of sepsis and trauma.     

Behavioral changes after closed head injury in children.

This study provides a longitudinal follow-up of the behavioral adjustment of 45 children with mild, moderate, and severe closed head injuries. Two measures of behavioral adjustment, the Child Behavior Checklist (CBCL) and the Vineland Adaptive Behavior Scales (VABS), were obtained from a parent at the time of injury and at 6 and 12 months postinjury. The severely injured children obtained significantly poorer VABS scores than children with mild and moderate injuries over the year-long follow-up. In addition, on the CBCL, severely injured children had more school problems and engaged in fewer social activities than mild and moderately injured children. These results show that severe head injury in children was associated with declines in adaptive functioning, whereas scores for children with mild and moderate injuries did not differ, nor did they deviate from average levels at any follow-up interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of verbal learning after closed head injury.

Cluster analysis of the learning trials and delayed free-recall trials of 70 patients with closed head injury on the California Verbal Learning Test (CVLT) revealed 3 distinct patterns of memory performance. The clusters differed in the amount and rate of learning, retroactive interference, and the level of delayed recall. There was a significant positive relationship between performance on the CVLT and performance on concurrent measures of attention, semantic memory, and intellectual ability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Tinnitus after head injury: evidence from otoacoustic emissions

The ability of portal vein insulin to control hepatic glucose production (HGP) is debated. The aim of the present study was to determine, therefore, if the liver can respond to a selective decrease in portal vein insulin. Isotopic ([3H]glucose) and arteriovenous difference methods were used to measure HGP in conscious overnight fasted dogs. A pancreatic clamp (somatostatin plus basal portal insulin and glucagon) was used to control the endocrine pancreas. A 40-min control period was followed by a 180-min test period. During the latter, the portal vein insulin level was selectively decreased while the arterial insulin level was not changed. This was accomplished by stopping the portal insulin infusion and giving insulin peripherally at half the basal portal rate (PID, n=5). In a control group (n=5), the portal insulin infusion was not changed and glucose was infused to match the hyperglycemia that occurred in the PID group. A selective decrease of 120 pmol/l in portal vein insulin was achieved (basal, 150+/-36 to last 30 min, 30+/-12 pmol/l) in the absence of a change in the arterial insulin level (basal, 30+/-3 to last 30 min, 36+/-4 pmol/l). Neither arterial nor portal insulin levels changed in the control group (30+/-6 and 126+/-30 pmol/l, respectively). In response to the selective decrease in portal vein insulin, net hepatic glucose output (NHGO) increased significantly, from 8+/-1 (basal) to 30+/-6 and 14+/-2 micromol x kg(-1) x min(-1) by 15 min and the last 30 min (P < 0.05) of the experimental period, respectively. Arterial plasma glucose increased from 5.9+/-0.2 (basal) to 10.5+/-0.4 micromol/l (last 30 min). Three-carbon gluconeogenic precursor uptake fell from 11.2+/-2.9 (basal) to 5.9+/-0.7 micromol x kg(-1) x min(-1) (last 30 min), and thus a change in gluconeogenesis could not account for any of the increase in NHGO. With matched hyperglycemia (basal, 5.5+/-0.3 to last 30 min, 10.5+/-0.8 micromol/l) but no change in insulin, NHGO decreased from 12+/-1 (basal) to 0 (-1+/-6 micromol x kg(-1) x min(-1), last 30 min, P < 0.05) and hepatic gluconeogenic precursor uptake did not change (basal, 8.0+/-1.7 to last 30 min, 8.9+/-2.2 micromol x kg[-1] x min[-1]). Thus, the liver responds rapidly to a selective decrease in portal vein insulin by markedly increasing HGP as a result of increased glycogenolysis. These studies indicate that after an overnight fast, basal HGP (glycogenolysis) is highly sensitive to the hepatic sinusoidal insulin level.