Biomedical subjects

M L Pasut

Publications and source records attributed to M L Pasut.

4 recordsLinked to original sources

PubMed1987

Changes produced by CT scanning in the outlook of severe head injury.

This is a study of the changes that have occurred in the field of severe head injury since the advent of CT scanning, comparing two homogeneous series of patients selected by clinical status (Glasgow Coma Scale less than or equal to 8), namely a series of 1,000 cases admitted to our Department between 1973 and 1976, already published in this Journal, and one of 385 cases cared for between 1979 and 1980, when CT scanning had become generally available. The two series of patients compare very closely in many respects, particularly in the incidence of surgical cases. In the more recent series the overall outcome was better both in surgical and in non-surgical cases. Among patients in the CT scan series the incidence of brain contusion associated with haematoma was greater than that of pure subdural haematomas. In non-surgical patients the CT scan, unlike cerebral angiography, afforded better identification of traumatic lesions and the grouping of patients into homogeneous categories correlating with a given outcome. On admission, cerebral angiography and CT scanning were equally effective in detecting lesions of surgical import; later in the course of the illness, however, CT scanning proved far more effective in detecting changes, with fully 15% of the patients being referred for surgery in the light of repeat CT scan findings as opposed to only 4% undergoing surgery on the indications of repeat angiography. Also, in the new series the mean interval from injury to surgery was shorter, with 64% of patients being operated on within 6 hours of the injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗

PubMed1987

Electrophysiological monitoring in the intensive care unit.

Spontaneous electrical activity (EEG) and event-related computer averaged brain electrical potentials (EPs) are becoming an integral part of CNS function monitoring in neurological intensive care patients. EEG monitoring using the compressed spectral array (CSA) computer analysis offers continuous information about cerebral electrical activity, permitting an accurate definition of the severity of brain injury, forecasting patient's course, and early detection of secondary intracranial changes. It offers more precise indications for treatment and prognosis. Combining EEG with multimodality EPs permits a finer diagnosis of the location and extent of CNS damage and contributes information, not otherwise obtainable, on the integrity of CNS pathways. Changes is electrophysiological patterns are often related to changes in other physiological parameters or events affecting the patient. Consequently, it appears advantageous to monitor simultaneously other CNS and body functions and record, process and display the data obtained in the patient care area. To make this comprehensive monitoring system reliable and useful, a wise application of advanced computer technology and a high degree of understanding of intracranial dynamics are required.

Brain↗

PubMed1984

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning.

This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS less than or equal to 8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with "negative" angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗

PubMed1984

CNS trauma: head injuries.

Head injuries are a common cause of death and permanent disability, particularly in the first decades of life. The high mortality and morbidity associated with head trauma is due mostly to the severity of the injury itself but also in part to the possible events that could aggravate the primary brain damage. This also occurs in patients with an initially mild head trauma. This article reviews imaging procedures, complications of head trauma, and the order of diagnostic evaluation.

Brain Concussion↗