Histological examination of cranial synchondroses as functionally significant elements in the cranial osteopathic concept

Introduction. In recent decades, medical science has accumulated convincing evidence of the fact that the normal activity of a human brain depends on the functional integration of its vascular system, a circulation system of cerebrospinal fluid and biomechanical features of a skull, forming a single structural and functional system.The aim of the study is to research the histological structure of functionally significant cranial synchondroses in the middle and elderly age group, to find possible points of osteopathic influence application in their structure. Materials and methods. The study was performed on cadaver material of 27 persons (7 men — 26 %, 20 women — 74 %) who died at the age from 49 to 66 years (57,5±5,3 years) from various somatic pathologies, but had no history of craniocerebral injuries with fractures of osseous structures. Small bone fragments with sutures of interest/synchondroses (spheno-occipital synchondrosis, petro-jugular synchondrosis, sphenopetrosal synchondrosis) were subjected to standard histological processing followed by microscopy.Results. Evaluating histological specimens of spheno-occipital synchondrosis, we observed the similar pattern: highly mineralized tissues at the edges of the bodies of the sphenoid and occipital bones were connected without elements of cartilagi-nous or connective tissue. In all cases, no fibrous or nerve tissue elements were found during the in situ immunohistochemical reactions. Reactions with the CD34 antibody mark multiple vessels of the Volkmann's or Haversian canals. Evaluating histological specimens of petro-jugular and sphenopetrosal synchondroses, we found the presence of cartilage tissue in the suture in the form of small islands of various sizes (from 20 to 120 microns) with signs of degeneration and a small number of remained chondrocytes. When evaluating specimens with immunohistochemical reactions with antibodies against the S100 protein, no elements of the nervous tissue were detected.Conclusion. Spheno-occipital synchondrosis has a temporary nature. With age, its cartilaginous tissue is replaced by osseous one. According to the histological structure, sphenobasilar synchondrosis demonstrates the complete absence of a cartilaginous component in the middle and elderly age groups. Petro-jugular and sphenopetrosal synchondroses retain the cartilaginous component in their suture throughout lifetime. During histological examination of the petro-jugular and sphenopetrosal synchondroses, the cartilaginous component is represented by variety of small islands. In all synchondroses, there is an absence of vascular and nervous components. At the same time, we revealed the presence of a prominent vascular bed in the bone tissue. The fact requires emphasizing the importance of liquid potency and elastic component in cartilaginous and osseous tissues as an application point for osteopathic techniques.

Clinic and diagnostics of the non-penetrating gun-shoot craniocerebral injuries in the local war

Objective ‒ to evaluate the features of the clinical manifestations and effectiveness of multi-slice computed tomography (MSCT) of the head for the diagnosis of non-penetrating gun-shoot head injuries in the local war.Materials and methods. The medical data of 155 patients who received a non-penetrating gun-shoot head injuries during the war in the Eastern Ukraine between 2014‒2020 were analyzed. All patients were males between 18 and 60 years (average age ‒ 35.1 years). The peculiarities of clinical manifestations and results of diagnostic evaluation of non-penetrating gun-shoot head injuries during specialized neurosurgical care in medical institutions on the third and fourth levels of medical aid have been studied.Results. Wide diagnostic capabilities of MSCT were revealed for determination of the wounds localization, type of the projectile, the nature of the wound channel, gunshot skull fractures, and associated intracranial injuries. It was found that with non-penetrating bullet and shrapnel tangential cranio-cerebral wounds, incomplete and depressed fractures usually occurred, and with single and multiple shrapnel blind wounds, incomplete ‒ perforated and depressed fractures with the presence of bone fragments. The pathomorphological features of the nature of the wound channels and intracranial injuries were determined. They are always associated by traumatic subarachnoid hemorrhages and brain contusions, in most cases – focal. Intracranial hematomas were observed in 3.1 % of the patients.Conclusions. Clinical manifestations of the non-penetrating craniocerebral gunshot wounds depend not only on the type of cranial soft tissue injury, but also on the nature of the skull fracture and are mainly occurred because of the severity of the traumatic brain injury. MSCT of the head makes it possible to determine the localization of the wound, the type of the wounding projectile, the nature of the cranial soft tissues damage, wound channel, gunshot skull fractures and associated intracranial injuries.

Factors associated with hospital outcomes of patients with penetrating craniocerebral injuries in armed conflict areas of the Democratic Republic of the Congo: a retrospective series

Introduction Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI. Methods This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients’ admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4. Results The prevalence of PCCI was 9.1% (91/858 cases) among admitted TBI patients. More than one-third (36.2%) of patients were admitted with GCS < 13, and 40.6% of them were unstable hemodynamic. Hemiplegia was found in 23.1% on admission. Eight patients had an intracerebral hemorrhage. Among the 69 operated patients, complications, mainly infectious, occurred in half (50.7%) of patients. Poor hospital outcomes were observed in 30.4% and associated with an admission GCS < 13, hemodynamic instability, intracerebral hemorrhage, and hemiplegia (p < 0.05). Conclusion The hospital poor outcomes are observed when patients present with hemodynamic instability, an admission GCS < 13, intracerebral hemorrhage, and hemiplegia. There is a need for optimizing the initial care of patients with PCCI in armed conflict regions.

Fatal road traffic collisions-An autopsy based study

The Deaths due to Road Traffic Collision has become a Major Public Health issue, hence Understanding the Deaths and the Factors involved is important to prevent Fatalities and at the same time Prevent Road Traffic Collision in General. The present Study is a Retrospective Study conducted during the period 2013 to November 2020. Road Traffic Accidents constituted 39.35%[n-1168] of the Cases. Males formed the Majority of the Victims contributing to 83.04% of the cases. Majority of the Victims were I the age group 31-40 years, consisting of 422 victims. The least Age Group affected were those below the age 10years and those individuals above the age 70years. Light Motor Vehicle were the Major Contributor to the Accidents, contributing to 46.40%[n-542] of the cases. Head and Neck was the Major region affected in 795 cases. The Maximum Fatality reported were due to Head or Craniocerebral Injuries in 87% of the cases. Abrasions were Present in all the Victims. Majority of the Deaths were due to Traumatic Shock reported in on the Spot Deaths or Brought Dead Victims in 35.45% [n-414] cases. The commonest Cause of Death reported after 07days of Treatment, were Septicemia, Lung infections, Peritonitis, Coma. Craniocerebral Injuries were the Main Contributors to Fatality in 87% of Accidents. Majority of Deaths were due to Traumatic Shocks due to Multiple injuries involved. Importance of Emergency Care is well understood in this study.

ROUTING OF VICTIMS OF ROAD ACCIDENTS IN THE VORONEZH REGION

Предметом публикации является анализ динамики количества дорожно-транспортных происшествий в Воронежской области в 2017-2019 гг. на аварийно-опасных участках автодорог. Отмечен рост числа дорожно-транспортных происшествий в 2019 г., что может быть обусловлено неблагоприятной метеорологической обстановкой. Приведены статистические показатели Воронежского областного клинического центра медицины катастроф, характеризующие структуру травм при дорожно-транспортных происшествиях среди взрослого и детского населения, а также наличие осложнений и летальность на этапах эвакуации. Наиболее высокая летальность среди пострадавших с множественной травмой наблюдалась в 2018 г., что связано с преобладанием черепно-мозговых травм в структуре травматизма. Приведены характеристики структурной организации, оснащенности и локализации травмоцентров первого, второго и третьего уровней, регламентирующие объем оказания медицинской помощи пострадавшим. Рассматриваются вопросы маршрутизации пациентов с автодорожной травмой в травмоцентры Воронежской области с учетом тяжести состояния, наличия осложнений и критериев транспортабельности. На основании полученных данных можно сделать вывод, что в травмоцентры второго уровня доставляется наибольшее количество всех пострадавших, что связано с непосредственной близостью их расположения от наиболее аварийно-опасных участков автодорог The subject of the publication is an analysis of the dynamics of the number of road accidents in the Voronezh region in 2017-2019 on accident-prone sections of roads. There was an increase in the number of road accidents in 2019, which may be due to the unfavorable meteorological situation. Statistical indicators of the Voronezh Regional Clinical Center for Disaster Medicine are presented, which characterize the structure of injuries in road accidents among adults and children, as well as the presence of complications and mortality at the stages of evacuation. The highest mortality rate among victims with multiple injuries was observed in 2018, which is associated with the predominance of craniocerebral injuries in the structure of injuries. The characteristics of the structural organization, equipment and localization of trauma centers of the first, second and third levels, regulating the scope of medical care for victims, are given. The issues of routing patients with road injuries to trauma centers in the Voronezh region are considered, taking into account the severity of the condition, the presence of complications and criteria for transportability. Based on the data obtained, it can be concluded that the largest number of all victims is delivered to the second-level trauma centers, which is due to the close proximity of their location to the most dangerous sections of roads

Biophysical mechanisms of the formation of wound channels in non-penetrating gunshot craniocerebral wounds

Objective ‒ to develop recommendations for optimization of primary surgical treatment of gunshot penetrating craniocerebral wounds on the basis of theoretical and applied study of one of the sections of wound ballistics ‒ biophysical mechanisms of wound canal formation, concomitant impenetrable wounds and intracranial injuries.Materials and methods. The medical histories of 155 wounded who received a non-pe-netrating craniocerebral injury during the hostilities in the East of Ukraine in 2014‒2020 were studied. All of the wounded were males between 18 and 60 years old (mean age ‒ 35.1 years). To study the biophysical features of the formation of different types of wound canals at a given non-lethal kinetic energy transferred to the head tissues, the type of the wounding projectile, the flight trajectory, the nature of gunshot injuries to the soft tissues of the cranial vault and skull fractures and intracranial injuries were determined according to the data of clinical stu-dies and computed tomography and compared with the results of theoretical studies using the laws of wound ballistics.Results. There were 11 (7.1 %) bullet (only tangential) wounds, and 144 (92.9 %) shrapnel. The formation of wound channels depends on the type of the wounding projectile and its kinetic energy. Non-penetrating firearms bullet and shrapnel tangential craniocerebral wounds are caused by the destructive effect of injuring shells on the tissues, which at the moment of collision with the head have both destructive kinetic energy (>80 J) and less than destructive kinetic energy. Blind craniocerebral injuries are caused only by the traumatic effects of fragments with a small (<80 J) kinetic energy.Conclusions. With gunshot non-penetrating single shrapnel blind wounds, the wounds do not have a zone of secondary necrosis, and the zone of primary necrosis is small or insignificant, which makes it possible not to carve soft tissues around the wound during primary surgical treatment, but only to remove necrotic tissues. With gunshot non-penetrating shrapnel tangential and blind craniocerebral wounds, when the soft tissue wounds of the cranial vault do not gap, small size (damage to the skin, subcutaneous tissue to aponeurosis), primary surgical treatment is not performed. Such wounds are treated with a toilet and aseptic dressings. Wound canals ending in gunshot fractures are subject to primary surgical treatment in the same way as gunshot fractures.

THE IMPORTANCE OF THROMBOELASTOMETRY IN THE HEMOSTATIC DISORDERS DIAGNOSIS IN INTENCIVE CARE PATIENTS WITH TRAUMAS (CLINICAL CASE)

thromboelastometry and coagulogram in patients with polytrauma. Materials and methods. The results of thromboelastometry (TEM) and standard coagulogram of 12 patients aged 18 to 74 years with a diagnosis of trauma were analyzed. Analysis of thromboelastometry was performed using a ROTEM delta blood analyzer (Tem Innovations GmbH, Germany), which evaluates the physical properties of a clot. Patients' blood stabilized with sodium citrate was placed in special disposable microcuvettes with the addition of various activators of coagulation reactions. The following indicators of thromboelastometry were determined: CT, CFT, angle alpha (α), MCF, A5, A10 in the tests INTEM, EXTEM and FIBTEM. The determination of coagulogram parameters was carried out according to a standard method. The following parameters were identified: APTT, INR, fibrinogen A content, serum fibrin degradation products (SFDP) concentration. Results. Coagulogram and thromboelastometry data at different stages of treatment were compared. In patients with the development of traumatic shock, coagulogram indices were changed to varying degrees depending on the stage of a shock. At the first stage of shock, the analysis showed only a 2-fold increase in SFDP and a slight increase in fibrinogen in dynamics. In a patient with a third stage of traumatic shock, the coagulogram indices were within normal limits, but according to TEM (EXTEM and FIBTEM tests), hypocoagulation was observed due to platelets. Only a coagulogram was evaluated in dynamics, hypocoagulation was observed in parameters of internal and external hemostasis pathways (prolongation of APTT, decrease in IPT and increase in INR), increase in fibrinogen A and SFDP. In the group of male patients with closed craniocerebral injuries, an increase in SFMC in the coagulogram had always been combined with changes in the FIBTEM test during TEM. Conclusion. Thus, in most patients, there is no change in classic coagulogram tests immediately after the injury. At the same time, rotational thromboelastometry makes it possible to fill this deficiency at an earlier date, which indicates a high sensitivity of the method.

Modern aspects of the diagnosis of severe combined trauma using computed tomography

Relevance. The variety of options for combining injuries and disorders occurring in the body with a combined injury, the need for rapid decision-making on treatment require rapid diagnosis of the entire volume of injuries and determining the severity of the injury, but there is still no single protocol for examining such victims. The aim of the work was to present a modern CT study protocol for patients with concomitant trauma.Materials and methods. The results of computed tomography of 30 patients with severe concomitant trauma were analyzed. All the victims were admitted in the first hours after the injury. Men were 30 (67 %), women – 10 (33 %), the average age was 41.3 ± 7.6 (22–79) years. Traditional multiphase full-body MSCT was performed in 20 patients, in 10 patients a special protocol was used for the study of the "whole body" by the method of divided bolus.The results of the study. Craniocerebral injuries were detected in 15 (50 %), spinal injuries – in 7 (23.3 %). Simultaneous injuries to the chest and abdomen were detected in 19 (63.3 %) of the victims. When subjectively evaluated, the quality of the images obtained using the full-body MSCT protocol with bolus separation and the standard multiphase protocol for the diagnosis of traumatic injuries was equivalent. The average radiation load per patient with traditional multiphase full-body MSCT is 66 % higher than with the split-bolus protocol.Conclusions. Full-body MSCT using a split bolus is a modern technique that fully meets the diagnostic conditions for severe combined trauma and, with a decrease in the radiation dose, allows you to determine all possible injuries in the victim in a single study.

Age-Dependent Patient and Trauma Characteristics and Hospital Resource Requirements—Can Improvement Be Made? An Analysis from the German Trauma Registry

Background and objectives: The burden of geriatric trauma patients continues to rise in Western society. Injury patterns and outcomes differ from those seen in younger adults. Getting a better understanding of these differences helps medical staff to provide a better care for the elderly. The aim of this study was to determine epidemiological differences between geriatric trauma patients and their younger counterparts. To do so, we used data of polytraumatized patients from the TraumaRegister DGU®. Materials and Methods: All adult patients that were admitted between 1 January 2013 and 31 December 2017 were included from the TraumaRegister DGU®. Patients aged 55 and above were defined as the elderly patient group. Patients aged 18–54 were included as control group. Patient and trauma characteristics, as well as treatment and outcome were compared between groups. Results: A total of 114,169 severely injured trauma patients were included, of whom 55,404 were considered as elderly patients and 58,765 younger patients were selected for group 2. Older patients were more likely to be admitted to a Level II or III trauma center. Older age was associated with a higher occurrence of low energy trauma and isolated traumatic brain injury. More restricted utilization of CT-imaging at admission was observed in older patients. While the mean Injury Severity Score (ISS) throughout the age groups stayed consistent, mortality rates increased with age: the overall mortality in young trauma patients was 7.0%, and a mortality rate of 40.2% was found in patients >90 years of age. Conclusions: This study shows that geriatric trauma patients are more frequently injured due to low energy trauma, and more often diagnosed with isolated craniocerebral injuries than younger patients. Furthermore, utilization of diagnostic tools as well as outcome differ between both groups. Given the aging society in Western Europe, upcoming studies should focus on the right application of resources and optimizing trauma care for the geriatric trauma patient.

An algorithm for detecting events in video EEG monitoring data of patients with craniocerebral injuries

One of the problems solved by analyzing the data of long-term Video EEG monitoring is the differentiation of epileptic and artifact events. For this, not only multichannel EEG signals are used, but also video data analysis, since traditional methods based on the analysis of EEG wavelet spectrograms cannot reliably distinguish an epileptic seizure from a chewing artifact. In this paper, we propose an algorithm for detecting artifact events based on a joint analysis of the level of the optical flow and the ridges of wavelet spectrograms. The preliminary results of the analysis of real clinical data are given. The results show the possibility in principle of reliable distinguishing non-epileptic events from epileptic seizures.