[Controlled hypotension with sodium nitroprusside].
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Adult↗
Biomedical subjects
G Puig
Publications and source records attributed to G Puig.
[Epidemiology of head traumas. "Barcelona" data base. Objectives, design and analysis of 584 cases].
INTRODUCTION: Descriptive analysis of some features in patients with cranio-encephalic traumatisms (CET) admitted to our hospital and collected in a data base, in order to establish the prognosis of the lesions and apply the most appropriate diagnostic and therapeutic procedures. MATERIAL AND METHODS: Since July 1987 to June 1989 we collected data on 584 patients with CET who presented the following selection criteria: consciousness level lower than 13 points in the Glasgow scale and/or pathologic computerized tomography. According to the consciousness level (Glasgow scale) on admission, patients were classified into three groups: slight CET (Glasgow 15-13), moderate CET (Glasgow 12-9), and severe CET (Glasgow < 9). The traumatic mechanisms were divided into 8 categories (occupant, pedestrian, motorbike, aggression, labor, drop, sporting, cyclist). According to the main lesion we considered the following diagnoses: subdural hematoma, epidural hematoma, cerebral contusion (s), diffuse lesion with normal computerized tomography and/or subarachnoid hemorrhage, cerebral congestion, and diffuse axonal lesion. Results were evaluated six months after using the Glasgow scale. RESULTS: The mean age of patients with slight CET was 37.7 +/- 22.1 years, those with moderate CET 31.7 +/- 22.6 years, and those with severe CET 30.8 +/- 21.6 years. Four hundred and forty-two were men (75.6%). The time period between the accident and hospital admission could be determined in 512 cases (87.6%). Severe CET arrived to the hospital (4.8 +/- 7.3 hours) earlier than the other groups (6.6 +/- 11.9 hours in moderate CET and 14.2 +/- 23 hours in slight CET). Most of patients, 488 (83.5%), were referred from another hospital, whereas the remaining cases came directly from the accident place. Traumatic mechanisms according to the previous categories were: occupant 145 (25%), pedestrian 112 (20%), motorbike 104 (18%), cyclist 2 (0.003%), labor 39 (7%), drop 154 (27%), sporting 7 (1%), aggression 10 (2%). Percentage of traffic accident was higher in patients with severe CET (74.6, 64, and 47% in severe moderate, and slight CET, respectively). The main lesions were: acute subdural hematoma, 72 (12.3%); cerebral contusion, 207 (35.4%); epidural hematoma, 88 (15%); normal computerized tomography/subarachnoid hemorrhage, 87 (14.8%); swelling, 17 (2.9%); diffuse axonal injury, 74 (12.6%); and the remaining, 39 (6.6%) had other lesions such as hydrocephalus fracture-sinking, etc. Mortality was 44.2, 12.2, and 3.7% respectively in severe, moderate, and slight CET. CONCLUSIONS: Data base may contribute to establish the prognosis of CET and to determine the efficacy of therapeutic procedures as well as that of diagnostic and investigational methods.
Adolescent↗
[Evaluation of post-traumatic coma using evoked potentials].
In 130 cases of post-traumatic coma a study of multimodality evoked potentials (MEP) was carried out shortly after the traumatism (within 72 h). According to the morphology of the records they were classified in grades (I-IV) in agreement with Greenberg et al. The worst grade of EP in the different types was related to the outcome at 6 months, distinguishing between focal lesions and diffuse lesions. Only a group (22.9%) of the 109 patients in which the auditory brain-stem evoked potentials (ABEP) could be studied, showed severe disorders (grade III-IV). There was a significant correlation between the ABEP grades and the outcome in the focal lesions (p less than 0.001). In the diffuse lesions the ABEP grades did not show significant differences with the outcome. A 22.4% of the patients with diffuse lesions had some visual evoked potentials (VEP) in grades III-IV against almost the double (41.6%) in the focal lesions. The grades of the VEP in the focal lesions did not have differences with outcome and in the diffuse lesions they did (p less than 0.05). Approximately half of the cases with focal lesions and one third of the diffuse lesions showed severe disorders (grades III-IV) of the somatosensory evoked potentials (SEP). In the two types of lesions there were significant differences with the outcome (p less than 0.001) and (p less than 0.01). The multimodality evoked potentials (MEP) are useful for predicting the outcome, especially in the patients where the neurological examination is impossible. Among the different modalities, the SEP were shown to be more predictive.(ABSTRACT TRUNCATED AT 250 WORDS)
Brain Injuries↗