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At least 865 records · Page 48Linked to original sources
PubMed1998

[Japan Coma Scale as a grading scale of subarachnoid hemorrhage: a way to determine the scale].

BACKGROUND: The grading scale for subarachnoid hemorrhage (SAH) with inter-grade outcome differences is essential for evaluating the effectiveness of newly developed therapeutic modalities. Although Hunt's grade and WFNS scale have been widely used, these grading scales do not meet this requirement. We previously proposed a revised WFNS scale based solely on the Glasgow Coma Scale (GCS) that has intergrade outcome differences of high-level significance. The Japan Coma Scale (JCS) has been long and widely used in Japan. The purpose of this study is to show whether it is possible to determine a reasonable SAH grading scale based on the JCS and to show a way to determine an SAH grading scale. PATIENTS AND METHODS: We retrospectively analyzed 1398 consecutive cases of aneurysmal SAH operated on within Day 7 of the latest onset. The preoperative JCS and GCS were evaluated just before the surgery and the Glasgow Outcome Scale (GOS), analyzed with numerical transformation (1 = dead to 5 = good recovery), was estimated at 6 months after the onset. All 510 possible combinations of scores of JCS were statistically tested under the following 2 assumptions; (1) JCS = 0 and JCS = 100 fall into a single independent grade. (2) No other single JCS score should fall into a single grade. RESULTS: The outcome differences between JCS 0 and 1, and 100 and 200 are significant. The outcome difference between JCS 30 and 100 is relatively higher than any other set of 2 scores of JCS. Only 5 combinations are practical among the candidates to be analyzed. Out of 510 combinations, the following combination shows the highest inter-grade outcome differences; I (JCS = 0, n = 375, mean GOS = 4.78) II (JCS = 1, 2; n = 310; mean GOS = 4.47) III (JCS = 3-30; n = 476; mean GOS = 3.96) IV (JCS = 100; n = 96; mean GOS = 3.10) V (JCS = 200, 300; n = 141; mean GOS = 2.33). In JCS, the mean outcome of JCS = 3 is worse than those of JCS = 10, 20, and 30. The outcome difference between JCS 0 and 1 is only significant in patients over 60 years old. CONCLUSION: Taking all the 510 possible combinations of JCS into consideration, we obtained a reasonable combination containing 5 grades. Although this grading scale showed good inter-grade outcome differences, JCS is not preferable to GCS as a consciousness evaluation system in the acute phase of SAH. We emphasize the importance of this way to determine a grading scale with a combinatorial approach, which can be applicable for re-evaluating the grading scales in the future.

Age Factors↗
PubMed1976

[Agonal coma in stroke].

The author describes the clinical symptomatology of coma dépassé in 19 patients with severe forms of brain strokes. Artificial pulmonary ventilation was performed until cardic arrest. The longest time of dissociated life of the organism in strokes was 5 days. Spinal automatisms were seen in 9 cases. Some possibilities of unreversible disintegration of separate structures in the CNS in different periods of coma dépassé (and in some cases prior to its development) are discussed.

Adolescent↗
PubMed1998

[Septic shock with coma revealing typhoid fever].

BACKGROUND: Typhoid fever may be difficult to distinguish from malaria. Septic shock, encephalopathy and leukopenia are common features of both diseases. CASE REPORT: A 20-year-old South Korean woman was admitted to the intensive care unit with coma and shock. Vomiting and abdominal pain were followed by headache, prostration, fever and diarrhea. Leukocytopenia, lymphocytopenia, thrombocytopenia, rhabdomyolysis and hepatitis were present. Clotting tests were normal. The thick peripheral blood film was negative. Salmonella typhi was isolated from 6 blood cultures. Treatment associated ceftriaxone 4 g per day for 5 days, colloid and crystalloid fluids and dopamine. The patient was discharged 2 weeks later. DISCUSSION: Typhoid fever should be considered as a diagnosis in patients with sepsis who come from endemic zones. Abdominal symptoms, prolonged fever, coma and delayed headache are particularly contributive signs. Specific treatment should be instituted.

Adult↗
PubMedDate not supplied

The use of a paediatric coma scale for monitoring infants and young children with head injuries.

Head injuries are a significant cause of morbidity and mortality in children. A descriptive multiple-case study was used to compare the accuracy of two assessment scales in children aged under 5 years. The study emphasised the importance of prompt and accurate assessment of children with head injuries. The Glasgow Coma Scale (GCS) is inappropriate for use in young children. The Adelaide Coma Scale (ACS) is a more appropriate tool for those aged under 5 years because it takes the child's age, and, therefore, neurological immaturity, into account. However, the ACS still does not give enough scope for assessment. If the ACS is used, therefore, additional information must be considered, including specific paediatric indicators, and an assessment of each child's behaviour according to the main care giver.

Age Factors↗
PubMed1978

Amanita mushroom poisoning with recovery from coma: a case report.

The incidence of Amanita mushroom poisoning seems to be increasing in the United States. Its neurological aspects contribute importantly to morbidity and mortality. In reported series, mortality has ranged from 50 to 90%, and survival following the appearance of coma was exceptional. The cause of nervous system involvement was uncertain. In the patient presented here, clinical and electroencephalographic observations were consistent with severe hepatic encephalopathy and correlated closely with liver function abnormalities. Despite the development of coma, full recovery followed the use of thioctic acid, an experimental therapeutic agent.

Amanita↗
PubMed1987

Infrared emission from P/Halley's dust coma during March 1986.

2 to 20 micrometers photometry of the inner dust coma of comet Halley was obtained at the NASA IRTF on Mar 6.85, 12.8, 13.75, 17.7, and 24.8. Positions offset 10" were measured as well as the central brightness. The strength of the 10 micrometers emission feature was observed to vary with location in the coma. The infrared emission is in general agreement with the dust size distribution measured from the Vega and Giotto spacecraft. Mar 6.8, 17.7, and 24.8 corresponded to strong dust jet activity. The strength of the 10 micrometers silicate emission is shown to be a sensitive indicator of grain size and thus of jet activity. Dust production rate on March 13.75, 6 h before Giotto encounter, was approximately 10(7) gm s-1.

Astronomy↗
PubMed1982

Severe hyperbilirubinemia and coma in chronic congestive heart failure.

A 64-year-old man developed severe hyperbilirubinemia of predominantly conjugated fraction in 1978, eight years after a myocardial infarction and development of congestive heart failure. In 1975, he was admitted elsewhere for symptoms suggestive of chronic hepatitis, but liver biopsy revealed replacement of hepatocytes by red blood cells which was interpreted as a result of left-sided cardiac failure. In 1978, liver biopsy showed congestive liver disease with cardiac sclerosis. Despite initial improvement, his condition deteriorated, he became encephalopathic, and died in a coma. This case is reported to illustrate that chronic congestive heart failure can present with severe jaundice and terminate in hepatic coma.

Cholestasis↗
PubMed2004

Irreversible apnoeic coma 35 years later. Towards a more rigorous definition of brain death?

The concept of brain death (BD) has been widely accepted by medical and lay communities in the Western world and is the basis of policies of organ retrieval for transplantation from brain-dead donors. Nevertheless, concerns still exist over various aspects of the clinical condition it refers to. They include the utilitarian origin of the concept, the substantial international variation in BD definitions and criteria, the equivalence between BD and the donor's biological death, the practice of retrieving organs from donors who are not brain-dead (as in non-heart-beating organ donor protocols), the proposal to abandon the dead donor rule and attempts to overcome these problems by adapting rules and definitions. Suggesting that BD, as it was originally proposed by the Harvard Committee, is more a moral than a scientific concept, we argue that current criteria do not empirically justify the definition of BD; yet they consistently identify a clinical condition in which organ retrieval can be morally and socially justified. We propose to revert to the old term of "irreversible coma" or, better yet, of "irreversible apnoeic coma", thus abandoning the presumption of diagnosing the death of all intracranial neurons and/or the patient's biological death. On the other hand, we think that a (re)definition of the vital status of donors identified on neurological criteria can only occur through a prior (re)definition of death, a task which is not only medical but societal.

Brain Death↗
PubMed1977

Total blood washout and exchange. A valuable tool in acute hepatic coma and Reye's syndrome.

Total body washout (TBW) was accomplished thirteen times in twelve patients, with response in five and survival in three. TBW can be done without apparent harm to patients and is less laborious and more rapidly effective than repeated exchange transfusion. Early application of TBW in stage III to stage IV hepatic coma may increase survival and possibly prevent progression of metabolic derangements. Patients with stage III to IV Reye's syndrome probably should have TBW promptly, without time-consuming attempts at exchange transfusion. Based on our experience, further application of TBW is warranted in coma due to acute hepatic failure and stage III to IV Reye's syndrome.

Adolescent↗
PubMed1984

Prostacyclin-synthesis-stimulating plasma factor in patients with different stages of hepatic coma.

In patients with acute hepatic coma the prostacyclin synthesis stimulating plasma factor is significantly enhanced. This increased activity has been verified by using various test systems. However, there is no correlation between the actual plasma factor activity and the coma stage, respectively. The increase of plasma factor activity in these patients might account at least in part for the increased bleeding tendency seen in these patients.

Adolescent↗
PubMed2005

Interpopulational variation in recovery time from chill coma along a geographic gradient: a study in the common woodlouse, Porcellio laevis.

Extreme temperatures restrict the performance of terrestrial arthropods and variations in low temperatures on a latitudinal scale influence physiological variables. Recovery time from chill coma is a measure of cold tolerance and it is a good index of climatic adaptation. We tested differences in recovery time of the common woodlouse (Porcellio laevis) exposed to different thermal conditions. Individuals were sampled from four different populations in Chile, spanning a latitudinal range of approximately 10 degrees . Significant differences were found in recovery time among experimental temperatures and among populations, but no interaction between these factors. The results of recovery time in P. laevis showed a positive increment with annual mean minimum temperature, indicating that there is geographical variation in recovery time. While body mass presented interpopulational variation, this variation was not associated with thermal variables or latitude. Overall, our results agree with previous studies in the sense that recovery time from chill coma decreases towards high latitudes, and it is independent of taxa, continent and hemisphere.

Adaptation, Physiological↗
PubMed2006

Successful treatment of a child with fulminant liver failure and coma due to Amanita phalloides poisoning using urgent liver transplantation.

Intoxication due to eating wild mushrooms presents with a variety of signs, ranging from mild diarrhea to severe organ failure. We present the case of an 11-year-old boy with fulminant liver failure and hepatic coma due to Amanita phalloides poisoning treated with an urgent pediatric orthotopic liver transplantation. Successful treatment of patients with fulminant liver failure and hepatic coma caused by Amanita phalloides poisoning is possible using urgent orthotopic liver transplantation when conservative medical treatment modalities are ineffective.

Amanita↗
PubMed1995

Carbonaceous matter in cometary dust and coma.

The analysis of carbonaceous matter in p/Halley's dust and coma via mass spectrometry of positive ions is reviewed. Dust impact generated ions were analyzed by the PUMA instrument aboard VEGA I, and coma plasma ions by the PICCA instrument aboard GIOTTO. For the organic molecules results an overall C:H:O:N ratio of 1.:1.4:0.6:0.1. Most of this polymer material can formally be understood as an aggregation of monomers C2H2, CH2O, and HCN. Special emphasis is given to possible aromatic, especially heterocyclic, and other unsaturated ions, and their importance for abiotic chemical and prebiotic evolution. Aspects of the potential heterogeneous catalysis in liquid water at the inorganic grain backbone structure found by this analysis, too, are also treated.

Acetylene↗
PubMedDate not supplied

HCO+ in the coma of comet Hale-Bopp.

Maps of comet C/1995 O1 (Hale-Bopp) in the millimeter-wave emission of the ion HCO+ revealed a local minimum near the nucleus position, with a maximum about 100,000 km in the antisolar direction. These observed features of the HCO+ emission require a low abundance of HCO+ due to enhanced destruction in the inner coma of the comet, within a region of low electron temperature (Te). To set constraints on the formation of HCO+ in the coma, as well as the location and magnitude of the transition to higher Te, the data are compared with the results of ion-molecule chemistry models.

Astronomical Phenomena↗
PubMed2005

Specific kinetic alterations of human CaV2.1 calcium channels produced by mutation S218L causing familial hemiplegic migraine and delayed cerebral edema and coma after minor head trauma.

Mutation S218L in the Ca(V)2.1 alpha(1) subunit of P/Q-type Ca(2+) channels produces a severe clinical phenotype in which typical attacks of familial hemiplegic migraine (FHM) triggered by minor head trauma are followed, after a lucid interval, by deep (even fatal) coma and long lasting severe cerebral edema. We investigated the functional consequences of this mutation on human Ca(V)2.1 channels expressed in human embryonic kidney 293 cells and in neurons from Ca(V)2.1 alpha(1)(-/-) mice by combining single channel and whole cell patch clamp recordings. Mutation S218L produced a shift to lower voltages of the single channel activation curve and a consequent increase of both single channel and whole cell Ba(2+) influx in both neurons and human embryonic kidney 293 cells. Compared with the other FHM-1 mutants, the S218L shows one of the largest gains of function, especially for small depolarizations, which are insufficient to open the wild-type channel. S218L channels open at voltages close to the resting potential of many neurons. Moreover, the S218L mutation has unique effects on the kinetics of inactivation of the channel because it introduces a large component of current that inactivates very slowly, and it increases the rate of recovery from inactivation. During long depolarizations at voltages that are attained during cortical spreading depression, the extent of inactivation of the S218L channel is considerably smaller than that of the wild-type channel. We discuss how the unique combination of a particularly slow inactivation during cortical spreading depression and a particularly low threshold of channel activation might lead to delayed severe cerebral edema and coma after minor head trauma.

Brain Edema↗
PubMed2001

DNA microarray analysis of Bacillus subtilis DegU, ComA and PhoP regulons: an approach to comprehensive analysis of B.subtilis two-component regulatory systems.

We have analyzed the regulons of the Bacillus subtilis two-component regulators DegU, ComA and PhoP by using whole genome DNA microarrays. For these experiments we took the strategy that the response regulator genes were cloned downstream of an isopropyl-beta-D-thiogalactopyranoside-inducible promoter on a multicopy plasmid and expressed in disruptants of the cognate sensor kinase genes, degS, comP and phoR, respectively. The feasibility of this experimental design to detect target genes was demonstrated by the following two results. First, expression of lacZ fusions of aprE, srfA and ydhF, the target genes of DegU, ComA and PhoP, respectively, was stimulated in their cognate sensor kinase-deficient mutants upon overproduction of the regulators. Secondly, by microarray analysis most of the known target genes for the regulators were detected and, where unknown genes were found, the regulator dependency of several of them was demonstrated. As the mutants used were deficient in the kinase genes, these results show that target candidates can be detected without signal transduction. Using this experimental design, we identified many genes whose dependency on the regulators for expression had not been known. These results suggest the applicability of the strategy to the comprehensive transcription analysis of the B.subtilis two-component systems.

Bacillus subtilis↗
PubMed1978

Alterations in plasma and CSF amino acids, amines and metabolites in hepatic coma.

The dog with an end-to-side portacaval shunt (PCS) has been extensively used as a model to investigate hepatic encephalopathy (HE) as it demonstrates a plasma amino acid pattern similar to patients with chronic liver disease. In adult mongrel dogs, the effect of PCS on plasma and CSF amino acids, octopamine (OCT), phenylethanolamine (PEA) and CSF 5-hydroxyindolacetic acid (5-HIAA), were studied. Moreover, the effect of correction of plasma amino acids by infusional techniques was investigated.Tyrosine, tryptophan and phenylalanine levels increased dramatically during the development of HE in plasma and CSF, while valine, leucine and isoleucine decreased in plasma only, but CSF levels remained stable. Plasma and CSF octopamine and phenylethanolamine and CSF 5-HIAA increased markedly as clinical features in the dogs' behavior, characteristic of hepatic encephalopathy occurred, including hypersalivation, ataxia, flapping tremor, somnolence and finally coma. Once in coma, the dogs were infused with an amino acid mixture (F080) calculated to normalize the plasma amino acid pattern. After one to eight hours, the dogs began to awake. Simultaneously, blood, and CSF aromatic amino acids returned to their control values, as did OCT, PEA and CSF 5-HIAA. If F080 infusion was stopped, biochemical alterations would appear within one week, again accompanied by clinical hepatic encephalopathy.The results indicate that the altered levels of aromatic and branched chain amino acids, octopamine and PEA in plasma and CSF correlate well with the development of HE and that correction of the plasma amino acid abnormalities improves encephalopathy simultaneously with correction of neurotransmitter derangements in CSF.

Amines↗
PubMedDate not supplied

Pentobarbital therapy for intracranial hypertension in metabolic coma. Reye's syndrome.

In severe Reye's syndrome, with nonspecific intensive supportive therapy, the mortality rate approaches 75%. In many instances, death is due to uncontrolled cerebral edema and elevated intracranial pressure. (ICP). Pentobarbital therapy, sufficient to maintain a blood barbiturate level between 2.5 mg% and 4.0 mg%, was used to control ICP in seven patients with metabolic coma complicated by intracranial hypertension (intracranial pressure greater than 30 mm Hg for 30 min). The nadir of their neurological function was characterized by no response to deep pain, absent or abnormal oculocephalic responses, bilaterally dilated, unreactive pupils, and markedly irregular or absent respirations. Before barbiturate administration hyperventilation, steroids, mannitol, and other supportive therapies commonly used in Reye's syndrome were begun. After institution of pentobarbital therapy, the daily mannitol dose required to maintain the intracranial pressure below 20 mm Hg was significantly reduced (p less than 0.001), from 3.7 +/- 0.3 to 0.5 +/- 0.2 g/kg/day. All the patients survived, and six have no obvious neurological sequelae. Pentobarbital is a useful adjunct for intracranial pressure control in advanced metabolic coma.

Adolescent↗