scholarly journals Does Teleradiology Improve Inter-hospital Management of Head-Injury?

1997 ◽  
Vol 24 (3) ◽  
pp. 235-239 ◽  
Keyword(s):  
Head Injury ◽  
Adverse Events ◽  
Hospital Management ◽  
District General Hospital ◽  
Therapeutic Interventions ◽  
Head Injured ◽  
Hospital Transfer ◽  
Group 2 ◽  
Injured Patients ◽  
Group 1

ABSTRACT:Objective:In many countries, neurosurgical care is concentrated in regional centres, which often necessitates the inter-hospital transfer of patients with head injury for optimal treatment. The aim of this study was to evaluate the role of teleradiology in the management of head-injured patients when referred from a district general hospital to a tertiary neurosurgical centre.Methods:Prospective data were collected over a fifteen month period from March '95 to May '96. Head-injured patients referred without the facility of teleradiology (Group 1), were compared to similar patients referred with teleradiologie images (Group 2), with particular regard to therapeutic intervention before transfer and adverse events during transfer.Results:There were 28 patients in Group 1 and 35 in Group 2, of which 31 were transferred. Both groups were comparable with respect to age, admission Glasgow Coma Scale score, and intracranial pathology. For patients transferred with teleradiology consultation (Group 2), therapeutic interventions were more (32.1% vs. 10.7%, p = 0.06), adverse events during transfer were significantly lower (6.4% vs. 32.1%, p = 0.01), and transfer time was reduced (72 vs. 80 minutes, p = 0.38). Four patients in Group 2 were treated by a mobile neurosurgical team at the referring hospital because of rapid clinical deterioration.Conclusion:Our findings indicate that teleradiology has an important role in improving inter-hospital management of head-injured patients.

scholarly journals The Threshold of Admission Glycemia as a Predictor of Adverse Events in Diabetic and Non-Diabetic Patients with Acute Coronary Syndrome

2009 ◽  
Vol 3 ◽  
pp. CMC.S2289 ◽  
Author(s):  
Taysir S. Garadah ◽  
Salah Kassab ◽  
Qasim M. Al-Shboul ◽  
Abdulhai Alawadi
Keyword(s):  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Coronary Syndrome ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
High Level ◽  
Group 1

Recent studies indicated a high prevalence of hyperglycemia in non-diabetic patients presenting with acute coronary syndrome (ACS). However, the threshold of admission glucose (AG) as a predictor of adverse events in ACS is unclear. Objective The aim of this study was to assess the threshold of admission glucose (AG) as a predictor of adverse events including Major Acute Cardiac Events (MACE) and mortality, during the first week of admitting patients presenting with ACS. Material and Methods The data of 551 patients with ACS were extracted and evaluated. Patients were stratified according to their blood glucose on admission into three groups: group 1: <7 mmol/L (n = 200, 36.3%) and group 2: >7 mmol/L and <15 mmol/L (n = 178, 32.3%) and group 3: ≥15 mmol/L (n = 173, 31.4%). Stress hyperglycemia was arbitrarily defined as AG levels > 7 mmol/L (group 2 and 3). Patients with ACS were sub-divided into two groups: patients with unstable angina (UA, n = 285) and those with ST segment elevation myocardial Infarction (STEMI, n = 266) and data were analyzed separately using multiple regression analysis. Results The mean age of patients was 59.7 ± 14.8 years and 63% were males. The overall mortality in the population was 8.5% (5.4% in STEMI and 3.1% in UA) patients. In STEMI patients, the odds ratio of stress hyperglycemia as predictor of mortality in group 3 compared with group 1 was 3.3 (CI 0.99-10.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.75-8.07, P = 0.065) after adjustment for age and sex. Similarly, in UA patients, the odds ratio of stress hyperglycemia in group 3 compared with group 1 was 2.7 (CI 0.37-18.98, P < 0.05), while in group 2 compared with group 1 was 2.4 (CI: 0.4-15.2, P = 0.344) after adjustment for age and sex. The incidence of more than 2 MACE in both STEMI and UA patients was higher in group 3 compared with the other two groups. Regression analysis showed that history of DM, high level of LDL cholesterol, high level of HbA1c, and anterior infarction were significant predictors of adverse events while other risk factors such as BMI, history of hypertension and smoking were of no significance. Conclusion This study indicates that the stress hyperglycemia on admission is a powerful predictor of increased major adverse events and hospital mortality in patients with acute coronary syndrome.

scholarly journals Pharmacokinetics and safety of XAV-19, a swine glyco-humanized polyclonal anti-SARS-CoV-2 antibody, for COVID-19-related moderate pneumonia: a randomized, double-blind, placebo-controlled, phase IIa study

2021 ◽  
Author(s):  
Benjamin Gaborit ◽  
Eric Dailly ◽  
Bernard Vanhove ◽  
Régis Josien ◽  
Karine Lacombe ◽  
...  
Keyword(s):  
Adverse Events ◽  
High Serum ◽  
Serum Concentrations ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Good Tolerability ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: We assessed the pharmacokinetics and safety of XAV-19, a swine glyco-humanized polyclonal antibody against SARS-CoV-2, in COVID-19-related moderate pneumonia. To evaluate the optimal dose and safety of XAV-19 during this first administration to patients with COVID-19-related moderate pneumonia. Methods : In this phase 2a trial, adults with COVID-19-related moderate pneumonia of ≤10 days duration were randomized to infusion of XAV-19 0.5mg/kg at day 1 and day 5 (group 1), 2mg/kg at day 1 and day 5 (group 2), 2mg/kg at day 1 (group 3) or placebo. Results : Eighteen patients (n=7 for group 1, n=1 for group 2, n=5 for group 3, and n=5 for placebo) were enrolled. Baseline characteristics were similar across groups, XAV-19 serum concentrations (μg/mL, median, range) at C max and at day 8 were 9.1 (5.2-18.1) and 6.4 (2.8-11.9), 71.5 and 47.2, and 50.4 (29.1-55.0) and 20.3 (12.0-22.7) for groups 1, 2 and 3, respectively (p=0.012). Terminal half-life (median, range) was estimated at 11.4 (5.5-13.9) days for 2 mg/kg of XAV-19 at day 1. Serum XAV-19 concentrations were above the target concentration of 10 μg/mL (tow fold the in vitro 100% inhibitory concentration [IC 100 ]) from the end of perfusion to more than 8 days for XAV-19 2 mg/kg at day 1. No hypersensitivity or infusion-related reactions were reported during treatment, there was no discontinuation for adverse events and no serious adverse events related to study drug. Conclusions : Single intravenous dose of 2mg/kg of XAV-19 demonstrated high serum concentrations, predictive of potent durable neutralizing activity with good tolerability. Trial registration: ClinicalTrials.gov Identifier: NCT04453384

Impairment of helper T-cell function and lymphokineactivated killer cytotoxicity following severe head injury

1991 ◽  
Vol 75 (5) ◽  
pp. 766-773 ◽  
Author(s):  
Keith B. Quattrocchi ◽  
Edmund H. Frank ◽  
Claramae H. Miller ◽  
Asim Amin ◽  
Bernardo W. Issel ◽  
...  
Keyword(s):  
T Cell ◽  
Head Injury ◽  
Severe Head Injury ◽  
Cell Cytotoxicity ◽  
Content Type ◽  
Lak Cell ◽  
Head Injured ◽  
Injured Patients ◽  
Fine Print

✓ Infection is a major complication of severe head injury, occurring in 50% to 75% of patients who survive to hospitalization. Previous investigations of immune activity following head injury have demonstrated suppression of helper T-cell activation. In this study, the in vitro production of interferon-gamma (INF-γ), interleukin-1 (IL-1), and interleukin-2 (IL-2) was determined in 25 head-injured patients following incubation of peripheral blood lymphocytes (PBL's) with the lymphocyte mitogen phytohemagglutinin (PHA). In order to elucidate the functional status of cellular cytotoxicity, lymphokine-activated killer (LAK) cell cytotoxicity assays were performed both prior to and following incubation of PBL's with IL-2 in five patients with severe head injury. The production of INF-γ and IL-2 by PHA-stimulated PBL's was maximally depressed within 24 hours of injury (p < 0.001 for INF-γ, p = 0.035 for IL-2) and partially normalized within 21 days of injury. There was no change in the production of IL-1. When comparing the in vitro LAK cell cytotoxicity of PBL's from head-injured patients and normal subjects, there was a significant depression in LAK cell cytotoxicity both prior to (p = 0.010) and following (p < 0.001) incubation of PBL's with IL-2. The results of this study indicate that IL-2 and INF-γ production, normally required for inducing cell-mediated immunity, is suppressed following severe head injury. The failure of IL-2 to enhance LAK cell cytotoxicity suggests that factors other than decreased IL-2 production, such as inhibitory soluble mediators or suppressor lymphocytes, may be responsible for the reduction in cellular immune activity following severe head injury. These findings may have significant implications in designing clinical studies aimed at reducing the incidence of infection following severe head injury.

Abstract 16929: Are Patients Implanted with a Ventricular Assist Device as Destination Therapy Created Equal? Analysis of Outcomes by Implant Indications

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Simon Maltais ◽  
Mary E Davis ◽  
Nicholas A Haglund ◽  
John A Schirger ◽  
Keith Aaronson ◽  
...  
Keyword(s):  
Adverse Events ◽  
Ventricular Assist Device ◽  
Left Ventricular ◽  
Advanced Age ◽  
Destination Therapy ◽  
Gi Bleeding ◽  
Assist Device ◽  
Ventricular Assist ◽  
Group 2 ◽  
Group 1

Introduction: A growing number of patients are implanted with a continuous-flow left ventricular assist device (CF-LVAD) for destination therapy (DT). Hypothesis: We sought to determine if indication for DT was associated with adverse events and survival. Methods: Between May 2004 and May 2014, 211 patients (age 66 (19-82), 89% male) underwent implantation of a HeartMate II CF-LVAD. The cohort was stratified according to primary listed indication for DT at time of implant: Group 1=advanced age (n=124, 59%); Group 2=high BMI (n=33, 16%), and Group 3=end-organ comorbidities (n=54, 25%). DT patients who later became BTT were eliminated for homogeneity. Results: Follow-up was available in all patients for a total of 376 patient-years of support (median 1.4 years). Preoperative characteristics (creatinine 1.5, INTERMACS 3, IABP 49%) were comparable between groups (all p>0.05). Overall 1, 3 and 5-year survival was 81%, 58%, and 41%, respectively. Kaplan-Meier analysis revealed comparable survival between groups stratified by DT indications (Figure, p=0.07). While gastrointestinal (GI) bleeding was more frequent in patients implanted for advanced age DT indications (p=0.01, group 1 vs group 2 and 3), the incidence of adverse events (pump thrombus/exchange, stroke) was comparable between groups. After adjusting for covariates (creatinine, hemoglobin, prior sternotomy and diabetes), Cox regression analysis demonstrated only preoperative renal dysfunction (HR 1.86 CI 1.28, 2.69; p=0.001) and lower Hemoglobin (HR 0.82 CI 0.71, 0.95; p=0.008) were associated with late mortality after implantation. Conclusions: Advanced age remains the most frequent contemporary indication for DT in patients undergoing CF-LVAD implantation. Indication for DT implantation does not influence long-term survival. Elderly patients may be at greater risk of GI bleeding events. These results continue to favor a uniform selection process across the spectrum of DT indications.

scholarly journals Treatment of Optic Canal Decompression Combined with Umbilical Cord Mesenchymal Stem (Stromal) Cells for Indirect Traumatic Optic Neuropathy: A Phase 1 Clinical Trial

2020 ◽  
Vol 64 (3) ◽  
pp. 398-404
Author(s):  
Jia Li ◽  
Xu Bai ◽  
Xiaoyue Guan ◽  
Hongfeng Yuan ◽  
Xiang Xu
Keyword(s):  
Visual Acuity ◽  
Adverse Events ◽  
Phase 1 ◽  
Optic Canal ◽  
Traumatic Optic Neuropathy ◽  
Corrected Visual Acuity ◽  
Group 2 ◽  
Best Corrected Visual Acuity ◽  
Group 1

<b><i>Purpose:</i></b> This study was aimed to investigate the safety and feasibility of umbilical cord-derived mesenchymal stem cell (MSC) transplantation in patients with traumatic optic neuropathy (TON). <b><i>Methods:</i></b> This is a single-center, prospective, open-labeled phase 1 study that enrolled 20 patients with TON. Patients consecutively underwent either optic canal decompression combined with MSC local implantation treatment (group 1) or only optic canal decompression (group 2). Patients were evaluated on the first day, seventh day, first month, third month, and sixth month postoperatively. Adverse events, such as fever, urticarial lesions, nasal infection, and death, were recorded at each visit. The primary outcome was changes in best-corrected visual acuity. The secondary outcomes were changes in color vision, relative afferent pupillary defect, and flash visual evoked potential. <b><i>Results:</i></b> All 20 patients completed the 6-month follow-up. None of them had any systemic or ocular complications. The change in best-corrected visual acuity at follow-up was not significantly different between group 1 and group 2 (<i>p</i> &#x3e; 0.05); however, group 1 showed better visual outcome than group 2. Both groups showed significant improvements in vision compared with the baseline (<i>p</i> &#x3c; 0.05); however, there were no statistically significant differences between the groups (<i>p</i> &#x3e; 0.05). In addition, no adverse events related to local transplantation were observed in the patients. <b><i>Conclusions:</i></b> A single, local MSC transplantation in the optic nerve is safe for patients with TON.

scholarly journals Word-finding strategies in closed head injured adults

1988 ◽  
Vol 35 (1) ◽  
Author(s):  
Juleen Kleiman ◽  
Lesley Bucke
Keyword(s):  
Head Injury ◽  
Closed Head Injury ◽  
Differential Effectiveness ◽  
Language Deficit ◽  
Word Finding ◽  
Confrontation Naming ◽  
Wide Range ◽  
Head Injured ◽  
Closed Head ◽  
Injured Patients

Word-finding difficulties are a common and prominent language deficit following closed head injury. The word-finding difficulties of three closed head injured patients were investigated within the framework of compensatory strategies using Teicher's Taxonomy of Word-Finding Strategies (Teicher, 1986). The word-finding difficulties were evaluated during procedural discourse and two confrontation naming conditions. Each subject's communicative competence and language ability was determined. Results indicated that all subjects employed a wide range of strategies, particularly during confrontation naming, but with differential effectiveness. A relationship was noted between the strategy's effectiveness and the subject's pragmatic ability. The results are discussed in the light of the existing literature on head injury. The theoretical and clinical implications are considered.

High-risk mild head injury

1997 ◽  
Vol 87 (2) ◽  
pp. 234-238 ◽  
Author(s):  
John N. K. Hsiang ◽  
Theresa Yeung ◽  
Ashley L. M. Yu ◽  
Wai S. Poon
Keyword(s):  
Head Injury ◽  
High Risk ◽  
Mild Head Injury ◽  
Radiographic Findings ◽  
Content Type ◽  
Head Injured ◽  
Definition Of ◽  
Gcs Score ◽  
Injured Patients ◽  
Fine Print

✓ The generally accepted definition of mild head injury includes Glasgow Coma Scale (GCS) scores of 13 to 15. However, many studies have shown that there is a heterogeneous pathophysiology among patients with GCS scores in this range. The current definition of mild head injury is misleading because patients classified in this category can have severe sequelae. Therefore, a prospective study of 1360 head-injured patients with GCS scores ranging from 13 to 15 who were admitted to the neurosurgery service during 1994 and 1995 was undertaken to modify the current definition of mild head injury. Data regarding patients' age, sex, GCS score, radiographic findings, neurosurgical intervention, and 6-month outcome were collected and analyzed. The results of this study showed that patients with lower GCS scores tended to have suffered more serious injury. There was a statistically significant trend across GCS scores for percentage of patients with positive acute radiographic findings, percentage receiving neurosurgical interventions, and percentage with poor outcome. The presence of postinjury vomiting did not correlate with findings of acute radiographic abnormalities. Based on the results of this study, the authors divided all head-injured patients with GCS scores ranging from 13 to 15 into mild head injury and high-risk mild head injury groups. Mild head injury is defined as a GCS score of 15 without acute radiographic abnormalities, whereas high-risk mild head injury is defined as GCS scores of 13 or 14, or a GCS score of 15 with acute radiographic abnormalities. This more precise definition of mild head injury is simple to use and may help avoid the confusion caused by the current classification.

Use of Intraoperative Ultrasonography to Improve the Diagnostic Accuracy of Exploratory Burr Holes in Patients with Traumatic Tentorial Herniation

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 345-347 ◽  
Author(s):  
Brian T. Andrews ◽  
Joshua B. Bederson ◽  
Lawrence H. Pitts
Keyword(s):  
Head Injury ◽  
Brain Stem ◽  
Ct Scanning ◽  
Intraoperative Ultrasonography ◽  
Burr Hole ◽  
Ultrasound Images ◽  
Frontal Pole ◽  
Subdural Hematomas ◽  
Head Injured ◽  
Injured Patients

Abstract Seventeen head-injured patients with signs of brain stem compression at admission underwent emergency bilateral burrhole exploration before computerized tomographic (CT) scanning. After exploration of the epidural and subdural spaces, real-time ultrasonography was performed intraoperatively to identify intraaxial hematomas. Epidural or subdural hematomas were identified surgically in 11 patients (65%) and immediately evacuated through a craniotomy; in 2 patients, bilateral subdural hematomas were removed. Ultrasonography showed no evidence of intracerebral mass lesions in 14 (82%) of the 17 patients, demonstrated extensive contusions of the temporal lobe in 2 patients (prompting partial lobectomy in both cases), and revealed a small intraparenchymal hematoma deep within the dominant hemisphere, which was not removed, in 1 patient. The sensitivity of ultrasound images for identifying intraparenchymal lesions was evaluated postoperatively by CT or autopsy. In 15 patients (88%), the results of ultrasonography were confirmed. In 2 (12%), CT scans showed small but significant lesions at the frontal pole missed by ultrasonography; one patient had a residual subdural hematoma, and the other a small intraparenchymal hemorrhage. These results confirm that patients with clinical evidence of brain stem compression soon after head injury often have extraaxial hematomas that can be readily identified by burr-hole exploration. Although intraparenchymal hematomas are rare immediately after head injury, they can ususally be identified by intraoperative ultrasonography. This simple technique can reduce the risk of missing intractranial hematomas during emergency burr-hole exploration and improve intraoperative decision making in this population of severely head-injured patients.

WAIS Performance during the Acute Recovery Stage following Closed-Head Injury

1993 ◽  
Vol 76 (1) ◽  
pp. 99-109 ◽  
Author(s):  
Robert E. Correll ◽  
Shirley E Brodginski ◽  
Saundra F. Rokosz
Keyword(s):  
Head Injury ◽  
Function Analysis ◽  
Block Design ◽  
Closed Head Injury ◽  
Psychiatric Inpatients ◽  
Control Group ◽  
Head Injured ◽  
Closed Head ◽  
Information Processing Deficits ◽  
Injured Patients

WAIS profiles of 50 acute closed head-injured patients were examined and compared with those of 40 psychiatric inpatients. Patients with moderate and severe, but not with mild, head injury differed significantly from the control group on level of subtest performance. There was no significant interaction of group by subtest. The groups also differed significantly on a measure of between-subtest scatter. Discriminant function analysis incorporating measures of within-subtest scatter correctly classified 89% of all subjects. Within the head-injured group Similarities and Block Design scores were elevated, and the Digit Symbol score depressed. These results indicate that closed head-injured patients can be discriminated from psychiatric inpatients on the basis of WAIS performance, but that they do not necessarily show a characteristic WAIS profile. Within-subtest scatter may indicate information-processing deficits.

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