Computed tomography of the normal feline nasal cavity and paranasal sinuses

We studied physical, cognitive, emotional and quality-of-life changes noted by relatives in a sample of 65 severely traumatic brain injured (TBI) patients several years after injury. The purpose of the present study was to evaluate the families perception of these changes and their need for information concerning the consequences of TBI. Our results indicated that the perceived changes in behavioural and affective symptoms and in the patient's quality of life were most closely associated with the need expressed by family members for information concerning, TBI. We also found that family relationships were especially affected by problems in the behavioral and affective domain, and the decrease in patient quality of life, as reported by relatives. These findings underline the importance of providing the relatives of TBI patients with information about the consequences of the injury with particular emphasis on behavioural and emotional disturbances, in order that they might cope better with these problems.     

Utilization of fine-needle aspiration cytology and flow cytometry in the diagnosis and subclassification of primary and recurrent lymphoma

The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life. One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed significantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was significantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not differ significantly. SCI and TBI persons did not differ significantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were significantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to affect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.     

Spontaneous complaints of long-term traumatic brain injured subjects and their close relatives

Long-term consequences of head injury for patients and families are not well known, given the complexity of variables that have to be studied. Subject's self-experience is one of these less studied aspects. The purpose of this study is to examine the spontaneous complaints of long-term brain injured adult subjects to be compared to the impression of their relatives. A total of 48 chronic head trauma subjects were studied more than 6 years after injury together with a relative, usually a mother or wife. At the beginning of the interview the participants were asked to freely refer their present complaints. In general, relatives referred more complaints about the injured subjects than the injured subjects referred about themselves. This occurred in several domains: somatic, physical, cognitive, and behavioural. Memory problems were highly reported by both groups. Somatic complaints were more frequently reported by patients and behavioural problems were more often reported by relatives. Mothers and wives had different profiles or responses. Mothers' opinions were identical to those of their TBI sons in all domains. These different results must be taken into consideration so that the real needs of patients and relatives can be addressed.     

Caring for a family member with a traumatic brain injury

The responses to a questionnaire on subjective burden are reported for 52 primary caregivers of a group of persons with traumatic brain injuries sustained an average of 6 years previously. The aim of the study was to examine satisfaction with social support, perception of coping skills, and appraisal of symptoms as predictors of strain in the carers. A range of responses, both positive and negative, to the work of caring for a relative with a head injury was reported. A high prevalence rate of emotional and behavioural changes in the persons with head injuries was found and the amount of distress caused by these symptoms was found to be predictive of burden. The other factor important in predicting burden was the carers' ratings of their satisfaction with their ability to cope with the work of caregiving. Social support, injury severity, and the demographic characteristics of the persons with head injury and their carers were not significant predictors. Depression in the carers was also investigated and the variable most predictive of elevated depression scores was coping satisfaction. These findings reinforce the importance of strengthening carers coping resources in rehabilitation work with head injured persons and their families.     

Diminished hyperaemic response of the hepatic artery to portal venous occlusion (the buffer response) in Asian hybrid minipigs: a comparison of the response to that observed in dogs

This study is part of a larger study of the effect of integrity-promoting care in a Swedish nursing home ward. Compared with assessments on a control ward, improvements were found in the patients' behaviour and in the quality of care after a three-month intervention period. This paper reports on parts of a questionnaire survey on the nursing staff's opinions of their working conditions and demented patients. Most staff members on both the intervention ward and the control ward found their jobs meaningful, engaging and stimulating, but they also felt that they had a heavy work-load. Most of the staff members experienced mental strain because of the patients' disturbed behaviour. Many did not think that the care on their ward would have been good enough for their own close relatives, if they had been suffering from dementia. Only slight changes were found in the staff members opinions after the intervention.     

Dopamine D2 receptors quantified in vivo in human narcolepsy

The correlation of clinical with psychological and social data is an attempt to find predictors of the definite long-term outcome after brain injury. 34 patients were reexamined 3 to 8 years after the accident using a number of psychological tests. Additionally, life quality was defined and evaluated. Only patients with an initial Glasgow Coma Scale-Score of 3-12, an intracranial traumatic lesion on computertomography and age 16-65 years at the time of accident were included in this study. Patients exhibited a uniform pattern of disturbances in psychosocial long-term outcome. These disturbances were compared with initial clinical data: memory, attention and learning were significantly correlated with the duration of coma and the presence of additional extracerebral injuries. From the initial computerized tomography, the findings 'compression of basal cisterns' and 'intracerebral contusion' showed to be predictors of the cerebral function. Late social status and behavior, defined as quality of life, were clearly related with initial clinical findings. In conclusion, there are early clinical predictors of the long term social and psychological outcome after brain injury.     

Suicide attempts among the elderly

The purpose of the study is to describe the life stories leading to the suicide attempts. In-depth interviews with nine persons who had attempted suicide (six females and three males, mean age 73 years) were analysed using a qualitative method. Five categories describe the main interview topics: "I had to leave home to survive." (childhood, youth), "You have to bear it." (adult life), "I will manage, I always have." (present life), "You have to give in order to get. If you have nothing to offer, then life is not worth living." (expectations for future life), "I want to decide my own life." (reflections concerning the suicide attempt). The life stories have a common theme; the patients grew up under very difficult conditions and had little emotional support. Their basic trust was poorly developed and their self-esteem was dependent on their capability to work and to give. Without this capability they felt worthless, and life was unbearable. Attempted suicide was the consequence.     

Psychotherapy consultation service in a trauma hospital

Psychotherapeutic consultation work with victims of accidents is an integrating approach, which is aiming at the emotional care of injured people, who already had mental disturbances before accident and/or following the trauma. During 12 years as psychotherapeutic consultant at an Accident Hospital in Vienna the necessary interventions during traumatologic treatment of stationary patients are demonstrated.     

The quality of life after the implantation of a cardioverter/defibrillator in malignant arrhythmias

Quality of life after implantation of an automatic implantable cardioverter/defibrillator (ICD) was assessed by questionnaire in 43 patients (38 males, 5 females; mean age 57 +/- 16 years) with treatment-resistant symptomatic ventricular arrhythmias. 37 of the 43 patients felt better after ICD implantation. 23 were always conscious of having an ICD, but 18 had got used to it in less than 2 months. 15 patients reported being afraid of an ICD shock, while eight noted physical discomfort caused by the ICD. Limitations concerning their professional, recreational and social activities were reported by six patients. 41 of the 43 patients confirmed that the ICD had been helpful, enabling 23 to return to an active life. 42 would recommend implantation to others if indicated. These data demonstrate that there is a remarkably high degree of acceptance of the ICD. Survival rate after implantation is thus not the only criterion of success. All aspects of the quality of life should be taken into consideration before implantation is decided upon.     

The Impact of Being a Support Provider to a Person Living in the Community With a Spinal Cord Injury.

Objective: To examine the personal impact of being a support provider (SP) to a community-dwelling person with a spinal cord injury (SCI). Study Design: Quantitative phase (interview-completed questionnaire; n=100), followed by qualitative phase (8 focus groups; n=46). Participants: Convenience sample; self-selected subsample in focus groups. Main Outcome Measures: Productivity status, satisfaction with community integration, quality of life. Results: Supporting a person with SCI brings significant life change. Greater support provision was related to lower productivity and community integration of the SPs. They felt underserved and unprepared emotionally and cognitively for their new, unanticipated role. Conclusions: More attention, understanding, and service directed to SPs are required to reduce trial-and-error learning and emotional and physical burden. Enhanced injury resource materials, peer networks, and knowledge-building opportunities may ameliorate SP difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of parental traumatic brain injury on the behaviour of parents and children

Little is known about the effects of a parent's brain injury and subsequent disabilities on the children in the family. This study examines 24 families in which one parent is brain injured. In each family the children were born before the parent's injury and still lived at home at the time of interview. Reports of the uninjured parent indicate that most of the children experienced some degree of negative behavioural change after the parent's injury. In 10 of the families, significant and problematic changes occurred. Types of problems included poor relationship with the injured parent, acting-out behaviour and emotional problems. Correlates of poor outcomes for the children were: (1) injured parent's gender, (2) compromised parenting performance of the injured parent, (3) compromised parenting performance of the uninjured parent and (4) depression in the uninjured parent. This study points to the importance of recognizing traumatic brain injury as a major family stressor.     

Injured pedestrians in Cape Town--the role of alcohol

OBJECTIVE: To establish a profile of injured adult pedestrians and attempt to define the role which alcohol plays in this regard. DESIGN: Prospective survey of injured pedestrians who presented consecutively over 9 weeks to Groote Schuur Hospital. Data on fatally injured pedestrians were retrospectively collected from the State Mortuary. SETTING: Hospital-based study conducted at the trauma unit, Groote Schuur Hospital. PARTICIPANTS: A total of 321 pedestrians--196 injured and 35 'dead on arrival'. MAIN OUTCOME MEASURES: Sociodemographics, blood alcohol concentration (BAC) and injury severity. RESULTS: Patients were predominantly male and, on average, 35.6 years old. They were most frequently injured at night and over weekends. The BAC was positive in 62.1% of pedestrians, and the mean BAC was 0.19 g/dl. Most pedestrians had at least one lower limb injury and nearly half had a head injury; however, BAC-positive pedestrians were 2.6 times more likely to have a head injury (P = 0.0009). Furthermore, BAC-positive pedestrians sustained more severe injuries, more frequently required admission to the ICU, had longer hospital admission and were more likely to die of their injuries. The overall case fatality rate was 19.5%. CONCLUSIONS: The influence of alcohol intoxication among injured adult pedestrians in Cape Town is high, suggesting that alcohol plays a major role in these accidents. Consequently, there should be some degree of culpability in those who cross the road while in an intoxicated state. However, equal attention should be given to safe and convenient crossing points, good lighting and education with regard to the wearing of reflective clothing after dark.     

Use of the Zung Self-Rating Depression Scale in cancer patients: feasibility as a screening tool

The impact of a traumatic brain injury on the family of the injured person is just beginning to be explored. In the current study, 61 primary caregivers were contacted at 1 year following injury. They completed the Relative and Friend Support Index, Social Support Index, Trauma Complaints List and the Life Change Question. The majority of caregivers indicated at least mild negative life change following the brain injury. Greater social support was correlated with less life change and greater injury severity was correlated with negative life change. Neither of these relationships was found to be significant at the 0.05 level. A significant positive correlation was found between caregivers' perception of deficits and the degree of negative life change. Perceived deficits accounted for the greatest amount of variance in life change followed by relative and friend support when all variables were entered into a stepwise regression. Further analyses indicated that the most significant factor of the Trauma Complaints List in predicting life change may be problems with cognition, which accounted for a significant amount of the variance in life change. Implications for counselling and further research regarding caregivers of persons with brain injury are discussed.     

Quality of life of relatives of mental patients

Usage of quality of life of psychiatric patients' relatives as the parameter of estimation of the quality of psychiatric care is considered. By means of standard questionnaire elaborated by the authors as well as by means of both individual and group conversations the quality of life was analyzed in 40 relatives which lived together with psychiatric patients. Different spheres of their life and difficulties (financial, social-psychologic, production) were examined in families with such patients. The defects of psychiatric care that had direct influence on the quality of life of the psychiatric patients' relatives are outlined.     

Urologic complications following abdominoperineal resection of the rectum

Perusal of the records of 111 consecutive patients who underwent abdominoperineal resection of the rectum for malignant diseases of the rectum or anal canal for postoperative urologic complications revealed that the urethra had been injured in two patients, the bladder in none, and the ureter in five. In only two of these last five patients was the late result of treatment of the ureteric injury satisfactory. The late result of treatment of the two urethra injuries was good. All the patients had been treated with an indwelling catheter for at least ten days after the operation. About one third of the patients still had disturbances of micturition two weeks after the operation, but only one required a permanent indwelling catheter.     

Severe head trauma. Review of the factors influencing the prognosis

A series of 72 severely head injured patients are reported, 24 (33%) with surgical intracranial hematomas. All patients were intensively cared for under the same therapeutic regime; intracranial pressure (ICP) was monitored and treated if increased. The series mortality was 39%. Uncontrollable increase of ICP (UI-ICP), always fatal, was observed in 18% of patients and in 13 of 28 deaths (46%); the incidence of UI-ICP among deaths was higher in patients less than in those more than 40 years old (55% vs 25%). Patients with UI-ICP were frequently deeply comatose and with arterial hypotension on admission; almost all died in the first days. Patients directly admitted from the scene with well staffed Life Flight Helicopter Emergency Care compared with those directly admitted from the scene with different type of ambulance service (paramedics, police, firemen and private) had a mortality rate significantly less (20% vs 54%) and an incidence of UI-ICP strongly lower both among patients (5% vs 29%) and among deaths (25% vs 54%). Thus in this small series intensive care after admission was not effective to obtain good results if patients had received poor preadmission emergency care. Review of the literature on main clinical predictors of outcome in severe head injury, have made possible some observations. Ischemic and intracranial hypertension brain lesions were generally present in patients killed by head trauma; while diffuse axonal injury, frequently responsible for vegetative, severe disability survival and late deaths, was observed only in 20-30% of postmortem examinations. Old age, poor neurological status and cardiocirculatory and respiratory disturbances prior to and upon admission positively worsened the outcome, while intracranial hematomas had a more variable predictive value. Intracranial hypertension was a definitively ominous predictor only if very high when the risk to be or become uncontrollable seems to be much elevated. UI-ICP, often fatal despite any aggressive therapy, was the single most frequent killer after severe head injury, responsible for about half of all deaths after admission. The different outcome among severe head injury series could be conceivably related to a different frequency of UI-ICP. Besides the severity of head injury and delay and mode of admission, we suggest that preadmission respiratory and cardiocirculatory and the quality of emergency medical system could strongly affect the incidence of uncontrollable increase of ICP in admitted patients and thus the mortality rate and favorable recovery of the series. The advanced preadmission emergency care service with intensive care after admission could significantly explain the better results often observed in severe head injury series.     

How many severely injured multiple-trauma patients can benefit from the biomechanical advantage of early mobilization following femoral intramedullary nailing?

The benefit of early operative stabilization of femoral fractures is established in patients with multiple injuries. In the last few years the unreamed femoral nail is favoured for internal fixation of femoral fractures despite pathophysiological concerns. The foremost advantage of femoral nails compared with plate fixation is the possibility of early full weight bearing. The aim of this retrospective study was to investigate, under consideration of the severity of injury, the extent of injury, and the clinical course, if multiple injured patients with concomitant femoral fractures benefit from the preferred intramedullary nailing with early weight bearing. Three hundred and two (23.8%) out of 1271 multiple injured patients (ISS > 17) had a concomitant femoral fracture. Fourty-seven out of 302 patients were children under 16 years of age, remaining 255 patients. Eighteen out of 255 patients died within the first 21 days after trauma and 66 patients required mechanical ventilation for more than three weeks (171/255). Thirty patients suffered from severe head injury (AIS-head > 3) and seven from severe pulmonary contusion with concomitant abdominal injury (134/255). Two patients had grade III open femoral fractures with vascular injury. Ipsilateral unstable pelvic fractures were seen in 11 patients, seven patients had ipsilateral intraarticular femoral fractures, and ipsilateral intraarticular fractures of the lower leg or foot were observed in 40 patients (74/255). The results demonstrate, that only 74 (29%) out of 255 multiple injured patients (> 16 years of age) had a theoretical benefit of early weight bearing. Seventy percent of the patients did not benefit from intramedullary nailing considering full weight bearing. With regard to pathophysiological concerns alternative methods of fracture fixation should be discussed for these patients. Primary fracture fixation with external fixators and secondary internal fixation proved to be a save alternative method. The complication rate of plating is comparable to intramedullary nailing but associated with less severe systemic risks. Primary plating of femoral fractures would not delay mobilization of most multiple injured patients.     

Permanent paraplegia following epidural and general anesthesia: two case reports

Two strains of rats, Sprague-Dawley and Wistar, were assayed in order to determine which strain is the more suitable experimental model for the study of pharmacokinetic alterations induced by spinal cord injury. Animals were submitted to spinal cord contusion at the T8-T9 level by the weight drop method. A single acetaminophen oral dose (100 mg/ kg) was administered 24 h after injury and blood samples were drawn for a period of 4 h. Acetaminophen concentration in whole blood was determined by high performance liquid chromatography and pharmacokinetic parameters were estimated. For both strains, Cmax and AUC were significantly lower, whereas tmax remained unchanged, in injured animals compared to sham-injured controls. Circulating acetaminophen concentrations were higher; therefore, pharmacokinetic alterations were more easily discerned, in Sprague-Dawley than in Wistar rats. It is concluded that the Sprague-Dawley strain is a more suitable model for the study of pharmacokinetic alterations induced by spinal cord injury.