Intensive versus conventional glucose control in critically ill patients with traumatic brain injury: long-term follow-up of a subgroup of patients from the NICE-SUGAR study

The adipokine visfatin, also termed pre-B-cell colony-enhancing factor (PBEF), is mainly derived from adipose tissue but has been implicated in the regulation of innate immune responses. We hypothesized that visfatin could be a potential circulating biomarker in critical illness and sepsis. We therefore measured serum levels of visfatin in a cohort of 229 critically ill medical patients upon admission to the intensive care unit (ICU). In comparison to 53 healthy controls, visfatin levels were significantly elevated in medical ICU patients, especially in patients with sepsis. Visfatin serum concentrations were strongly associated with disease severity and organ failure but did not differ between patients with or without obesity or type 2 diabetes. Visfatin levels correlated with biomarkers of renal failure, liver dysfunction, and other adipokines (e.g., resistin, leptin, and adiponectin) in critically ill patients. High visfatin levels at ICU admission indicated an increased mortality, both at the ICU and during long-term follow-up of approximately two years. Our data therefore demonstrate that circulating visfatin is a valuable biomarker for risk and prognosis assessment in critically ill patients. Furthermore, visfatin seems to be involved in the pathogenesis of excessive systemic inflammation, supporting further research on visfatin as a therapeutic target.

Download Full-text

Evaluation and Management of Frontal Sinus Fractures

Neurotrauma ◽

10.1093/med/9780190936259.003.0017 ◽

2019 ◽

pp. 143-154

Author(s):

Geoffrey Peitz ◽

Mark A. Miller ◽

Gregory W. J. Hawryluk ◽

Ramesh Grandhi

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Frontal Sinus ◽

Operative Management ◽

Intracranial Extension ◽

Long Term Follow Up ◽

Initial Injury ◽

Management Algorithms

Frontal sinus fractures are usually associated with traumatic brain injury and nasoorbitoethmoidal fractures. Much of the available evidence is retrospective, and management algorithms vary. In general, nondisplaced fractures without nasofrontal outflow tract (NFOT) obstruction may be managed with clinical and radiographic follow-up whereas fracture displacement, NFOT obstruction, and persistent CSF leaks are indications for operative management. The bicoronal incision and bifrontal craniotomy allow for proper access to the frontal sinus. If there is NFOT obstruction, the sinus should be cranialized or possibly obliterated if only the anterior table is fractured. The NFOT and sinus are packed with bone chips, fat, or muscle and then sealed with a pericardial graft, fascial graft, or synthetic dural substitute. Inadequate cranialization or obliteration can result in mucocele or mucopyocele, intracranial extension of which can lead to brain abscess or meningitis. Complications can occur years after the initial injury so long-term follow-up is necessary.

Download Full-text

Long-term follow-up of patients with mild traumatic brain injury: A mixed-method study

Journal of Rehabilitation Medicine ◽

10.2340/16501977-1182 ◽

2013 ◽

Vol 45 (8) ◽

pp. 758-764 ◽

Cited By ~ 45

Author(s):

S Åhman ◽

B Saveman ◽

J Styrke ◽

U Björnstig ◽

B Stålnacke

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Mixed Method ◽

Mixed Method Study ◽

Long Term Follow Up

Download Full-text

Low prevalence of hypopituitarism after traumatic brain injury: a multicenter study

Acta Endocrinologica ◽

10.1530/eje-11-0365 ◽

2011 ◽

Vol 165 (2) ◽

pp. 225-231 ◽

Cited By ~ 44

Author(s):

N E Kokshoorn ◽

J W A Smit ◽

W A Nieuwlaat ◽

J Tiemensma ◽

P H Bisschop ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Trauma ◽

Tolerance Test ◽

Pituitary Insufficiency ◽

Acth Stimulation ◽

Cross Sectional ◽

Long Term Follow Up

ObjectiveHypopituitarism after traumatic brain injury (TBI) is considered to be a prevalent condition. However, prevalence rates differ considerably among reported studies, due to differences in definitions, endocrine assessments of hypopituitarism, and confounding factors, such as timing of evaluation and the severity of the trauma.AimTo evaluate the prevalence of hypopituitarism in a large cohort of TBI patients after long-term follow-up using a standardized endocrine evaluation.Study designCross-sectional study.Patients and methodsWe included 112 patients with TBI, hospitalized for at least 3 days and duration of follow-up >1 year after TBI from five (neurosurgical) referral centers. Evaluation of pituitary function included fasting morning hormone measurements and insulin tolerance test (n=90) or, when contraindicated, ACTH stimulation and/or CRH stimulation tests and a GH releasing hormone–arginine test (n=22). Clinical evaluation included quality of life questionnaires.ResultsWe studied 112 patients (75 males), with median age 48 years and mean body mass index (BMI) 26.7±4.8 kg/m2. Mean duration of hospitalization was 11 (3–105), and 33% of the patients had a severe trauma (Glasgow Coma Scale <9) after TBI. The mean duration of follow-up was 4 (1–12) years.Hypopituitarism was diagnosed in 5.4% (6/112) of patients: severe GH deficiency (n=3), hypogonadism (n=1), adrenal insufficiency (n=2). Patients diagnosed with pituitary insufficiency had significantly higher BMI (P=0.002).ConclusionIn this study, the prevalence of hypopituitarism during long-term follow-up after TBI was low. Prospective studies are urgently needed to find reliable predictive tools for the identification of patients with a significant pre-test likelihood for hypopituitarism after TBI.

Download Full-text