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At least 991 records · Page 55Linked to original sources
PubMed1981

Different behaviour of haemoglobin A1a-c and glycosyl-albumin levels during recovery from diabetic ketoacidosis and non-acidotic coma.

Glycosylated haemoglobin (HbA1a-c) and serum albumin (glycosyl-albumin) have been determined in patients with severe diabetic ketoacidosis and non-acidotic coma. Within one week of therapy the level of glycosyl-albumin decreased from 184 mmol 5-hydroxymethylfurfural (HMF)/mol albumin to 152 mmol HMF/mol albumin (p less than 0.01) and was gradually lowered by some 40% during a period of 17 days. In contrast, the level of HbA1a-c remained unchanged. From these observations and findings in a patient with insulinoma, it appears that glycosyl-albumin provides a more acute measure of variation in relative glycaemia than HbA1a-c, and may prove useful as a measure of medium-term diabetes control.

Adolescent↗
PubMed1977

Periodic synchronous and stereotyped myoclonus with postanoxic coma.

5 patients with cerebral anoxia of various etiology had postanoxic coma with the syndrome of periodic synchronous and sterotyped myoclonus first mentioned by Lance and Adams. These authors observed action myoclonus as a sequel to this syndrome which is rarely survived. Most reports have dealt mainly with its bad prognostic significance. Although the localization of action myoclonus has much been discussed, and is still controversial, little attention has been paid to the possible localizing significance of its acute precursor syndrome. Most patients with this type of myoclonus (all in our series) present a lower pontine/upper oblongata syndrome. The distribution patterns of the jerks are constant, do not represent topographic but functional relationships showing innervation patterns which are presumably integrated in the vestibular system and upper oblongata reticular formation. Interval histograms show that the jerks, unlike those in subacute sclerosing panencephalitis, are not repeated at regular intervals. Several rhythms might be intermingled, or a rhythmic (physiological?) pacemaker could be modified by proprioception of the jerks. The latter possibility is supported by the observation that EEG discharges in one patient became rhythmic when the jerks ceased. The only other instance of rhythmicity was in a very special observation of continuous seesaw alternations of slow jerks of m. levator palpebrae sup., and tonic contractions of m. corrugator glabellae. Rhythmicity in this case had a 1:2 relation to heart rate indicating the nucleus tractus solitarii region as a possible site of origin of the impulses. Our observations indicate an upper oblongata origin for this type of myoclonus. Autopsies in 3 of our cases revealed widespread severe anoxic damage but nothing to add to the pathological localization.

Coma↗
PubMed1986

Fresh cell therapy followed by fatal coma.

A 60-year-old woman received a 3-day course of nine injections of "fresh" cells from fetal lamb ovary, placenta, brain (hypothalamus) and liver. There were no immediate complications, but a few days later she developed headache, fever and hemiparesis. She subsequently fell into a coma and died 3 weeks after her fresh cell therapy and 2 weeks after the onset of her clinical symptoms. Autopsy revealed perivenous leucoencephalopathy with a probably steroid-treatment-induced paucity of perivascular inflammation. Fresh cell therapy, clinical symptomatology and morphological findings suggest, though do not prove, that this patient's monophasic and probably immune-mediated disease is a rare fatal complication of fresh cell therapy.

Blood-Brain Barrier↗
PubMed1979

Autonomic responses to meaningful and non-meaningful auditory stimuli in coma.

In a group of poisoned patients, the lowest MCS (Munich Coma Scale) vigilance grade at which patients responded when called by their names was determined. In 12 patients at this vigilance grade, the extent to which the meaning of the names contributed to their reactions was investigated. Their first name and a control stimulus (name backwards) were repeatedly presented via headphones. Stimulus intensity was 90 dB(A). During stimulus presentation, changes in heart rate, finger pulse amplitude, and electrodermal activity were recorded. A comparison between responses under both stimulus conditions revealed that the first reactions of poisoned patients to their names are primarily elicited by the physical properties of the stimulus.

Acoustic Stimulation↗
PubMed1987

Computed tomographic imaging of the brain in after hypoglycemia coma.

A case of severe hypoglycemic coma was studied by sequential Computed Tomographic Imaging (CT) of the brain. The CT 1) was normal in the early stage, 2) subsequently showed a low density area, which was enhanced by the contrast medium, in the cerebral cortex and the boundary zone between the major cerebral arteries, and 3) revealed marked enhancement in the entire cortical region and hypodensity in the periventricular region in the late stage. These CT findings, representing the course of neural cell damage by severe hypoglycemia, are discussed from the pathophysiological viewpoint.

Adult↗
PubMed1977

Serum free insulin concentrations during the treatment of diabetic coma and precoma with low dose intramuscular insulin.

Fifty patients in diabetic coma or precoma, 33 of whom had previously received insulin and had circulating insulin antibodies, were studied during treatment with a low-dose intramuscular insulin regime. In the presence of insulin antibodies, serum free insulin was separated from bound insulin by steady-state gel filtration. The initial mean serum free insulin concentration in the group of patients without insulin antibodies was 9 mU/1, 1 to 2 hours after intramuscular therapy it had risen to 22 mU/1, and after 7 to 8 hours to 73 mU/1. The corresponding concentrations for the group with insulin antibodies were 13, 23 and 74 mU/1. No relationship was found between the concentrations of serum free insulin attained and the age of the patients, their initial degree of acidosis, dehydration, and systolic blood pressure, the insulin antibody characteristics of their sera, nor the rate of decline of the blood glucose.

Adolescent↗
PubMed1979

Coagulation abnormalities in diabetic coma before and 24 hours after treatment.

A coagulation screen consisting of measurement of the prothrombin time, thrombin time, kaolin caphalin clotting time, platelet count, plasma fibrinogen level, fibrin degradation products and ethanol gelation test was performed on 24 patients with impairment of consciousness due to acute diabetic metabolic decompensation at the start of treatment and 24 hours later. 22 out of 24 patients showed at least one coagulation abnormality on admission of which the commonest were a prolonged prothrombin time, shortened kaolin cephalin clotting.time and raised plasma fibrinogen level. After 24 hours of treatment these values were more normal but 20 out of 22 patients still displayed some abnormality. 15 patients had two or more coagulation abnormalities on admission including 3 patients with haematological abnormalities suggestive of disseminated intravascular coagulation. This group was older and had higher blood ureas than those with fewer abnormalities, but plasma glucose, sodium, potassium and bicarbonate levels were similar in both groups of patients. All 5 patients with hyperosmolar non-ketotic coma and all 3 patients who died without recovering consciousness had two or more coagulation abnormalities on admission.

Adolescent↗
PubMed1976

Insulin coma therapy: decrease of plasma tryptophan in man.

A biochemical study was performed in two patients submitted to insulin coma therapy. The injection of insulin resulted in a decrease of free and total tryptophan as well as tyrosine in plasma, while NEFA were not influenced by this treatment. The ratio of tryptophan to tyrosine was enhanced. The administration of glucose after insulin provoked an increase of free and total tryptophan. The results support the hypothesis that in man insulin may favor the uptake of tryptophan by the brain, and enhance the synthesis of cerebral serotonin.

Adult↗
PubMed1992

Hyperammoniemic coma in a patient with ureterosigmoidostomy and normal liver function.

Hyperammoniemic encephalopathy has been reported after ureterosigmoidostomy. Its development is related to a problem of bacterial overgrowth and, most often, is favored by the presence of an underlying liver dysfunction. We report the case of a 43-year-old woman with a ureterosigmoidostomy done 28 years earlier who developed hyperammoniemic coma induced by an acute rectocolitis and in the absence of any detectable liver dysfunction. Neither administration of Lactilol and neomycin nor rectal tube drainage were effective; systemic antimicrobial therapy effective against the urease-producing gram-negative bacilli was required and led to a decrease in serum ammonia levels and a dramatic clinical improvement.

Acute Disease↗
PubMed1976

Initial state, outcome, and autopsy findings in a series of 200 consecutive traumatic comas. A computerised analysis.

Based on 200 nonselected consecutive cases of primary traumatic coma a preliminary mathematical model--computed, multiple linear regression analysis--has been developed, which seems to be suitable for calculating the prognosis from some initial anamnestic and clinical data. It is to be expected that the analysis of greater material will help to establish an even better model, e.g. by a more detailed age subdivision and choice of more or other factors. It is the aim of this report to encourage further work in this field.

Adolescent↗
PubMed1997

Follow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate.

BACKGROUND: The wide availability of computerized tomography (CT) scan has popularized its use in initial and follow-up evaluations of head trauma patients. Follow-up CT scans of clinically stable patients, however, may not provide additional information, but could potentially subject the patients to secondary injuries. The authors investigated the correlation between CT scans and Glasgow coma score (GCS), and complication rate during follow-up CT scans in an attempt to dissuade clinicians from obtaining unnecessary follow-up CT scans. METHODS: The medical records of 180 patients with blunt head trauma were retrospectively reviewed. Only patients (117) with moderate and severe head injuries were included in the study. A total of 319 follow-up brain CT's for 94 patients were obtained. RESULTS: The change in CT scans was compared to the GCS the day of the scan. These two variables were found to be positively correlated by Chi-square analysis (chi 2 = 81.2; alpha < 0.001). CPP trend was found also be correlated with CT scan evolution by the Chi-square analysis (alpha < 0.001). When patients had unchanged or improved GCS, 73.1% had improved or the same CT appearance. When patients had a worse GCS, the CT was worse in 77.9%. A 16.9% (54/319) complication rate was documented during the follow-up scans (hemodynamic instability, increased intracranial pressure, desaturation, and agitation). This rate was higher in severe head trauma (GCS 3-8) patients than in moderate head injury (GCS 9-12) patients. Hemodynamic instability was the most common complication, which comprises 42.6% (23/54) of all complications. CONCLUSION: Because of the correlation between the CT scan appearance and the clinical status, as well as the detrimental effect of mobilizing critically ill patients, the authors urge the use of follow-up CT scans only in patients with clinical deterioration unexplained by ICP changes alone.

Blood Pressure↗
PubMed1979

Metabolic acidosis and coma due to an overdose of nalidixic acid.

A case of severe metabolic acidosis and coma after taking 28 g of nalidixic acid is described. After administration of 600 mEq of sodium bicarbonate the patient developed a respiratory alkalosis with secondary tetany. She recovered her state of consciousness nine hours later and the acid-base disturbance resolved after sixty hours.

Acidosis↗
PubMed1993

Multiple organ failure and coma as initial presentation of pheochromocytoma in a patient with multiple endocrine neoplasia (MEN) type II A.

The unusual case of a 65-year-old woman with intermittent hypotension, fever, pulmonary edema and coma as initial presentation of pheochromocytoma is reported. The patient developed respiratory, cardiac and renal failure, disseminated intravascular coagulation and liver dysfunction. She had to be defibrillated on multiple occasions, occurring in periods of severe hypertension. After successful surgical removal of a pheochromocytoma a thyroid medullary carcinoma was detected. Several members of the patients family had presented with multiple endocrine neoplasia (MEN II).

Adrenal Gland Neoplasms↗
PubMed1991

Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma.

The prognosis of prolonged cardiac arrests is generally related to brain damage due to the cerebral anoxia. A neurological worsening leading to irreversibility is sometimes associated with an increase in intracranial pressure. We studied for 5 years the early intracranial and cerebral perfusion pressures in 84 patients with deep anoxic coma after cardiac arrest. Intracranial pressure monitoring was set up as soon as possible with an extradural screw over a period of 6 days. No complications occurred using this technique. We recorded the percentage of patients suffering from intracranial pressure peaks over 15 mmHg (a), over 25 mmHg (b) or cerebral perfusion pressures drops under 50 mmHg (c). We obtained during the 1st day of monitoring: (a) 46.4%, (b) 21.4%, (c) 39%; during the 2nd day: (a) 73.6%, (b) 26.3%, (c) 55.9%. Eight patients (9.5%) were still alive after a couple of months, 4 of whom had no neurological sequelae; among the 76 non-survivors 63 (82.9%) had died because of cerebral anoxic damage. A daily comparison between survivors and non-survivors points out that the survivors' intracranial pressures were always lower than in the non-survivors and the survivors' cerebral perfusion pressures higher than in the non-survivors. Moreover, none of the patients showing intracranial peak pressures over 25 mmHg survived without after-effects. It is clear that many patients suffer early periods of high intracranial pressures and low cerebral perfusion pressures leading to a bad neurological prognosis. Intracranial pressure monitoring may allow assessment of patients' neurological status and prognosis after cardiac resuscitation.

Adolescent↗
PubMedDate not supplied

Evaluation of the Glasgow Coma Scale score in critically ill infectious disease patients.

In this prospective study the Glasgow Coma Scale (GCS) score was evaluated in 107 critically ill infectious disease (ID) patients admitted to the Intensive Care Unit (ICU) during a 1-year period. Patients were separated into two groups: those affected by central nervous system (CNS) infections and those affected by infections other than of the CNS. There were no apparent differences in the first ICU day GCS score values between the two groups (11 +/- 4 vs. 11 +/- 4, p = 0.5318). Univariate logistic regression analysis confirmed a significant relationship between the first ICU day GCS score and the subsequent ICU mortality in the group of patients with CNS infections (r = 0.3152, p = 0.0015) but not in the group with infections not affecting the CNS (r = 0.0919, p = 0.1106). Our preliminary results suggest that the prognostic value of the GCS score is valid only in patients with CNS infections but not in other ID patients.

Aged↗
PubMed1996

Congenital non-progressive encephalopathy and deafness with intermittent episodes of coma and hyperkynureninuria.

Six of nine children born from first-cousin parents presented with the same clinical picture: non-progressive congenital encephalopathy with marked hypertonia resembling the stiff-baby syndrome, delayed milestones, mental deficiency and congenital deafness. Rare, usually reversible, episodes of sudden worsening of the neurological status, with progressive loss of consciousness and increase of hypertonia, occurred spontaneously or during febrile illnesses. During these periods, and sometimes on other occasions, transitory renal dysfunction was observed (nephrotic syndrome and/or tubular abnormalities). Death occurred before age 2 years in 4 patients; 2 are still alive (10 and 13 years old). Electrophysiological, biological and enzymatic investigations remained negative, particularly those concerning mitochondrial and peroxisomal metabolism. The only biochemical anomaly was a massive hyperkynureninuria, seen only during the periods of coma (up to 213 mumol/mmol creatinine; normal < 10) and after an intravenous protein loading test. This suggests an anomaly of tryptophan metabolism which has not been reported up to now.

Algeria↗
PubMed1982

Stuporous states or coma induced by the rapid administration of high doses of sodium valproate.

7 cases of stuporous states or coma induced in epileptic subjects by the rapid administration of high doses of sodium valproate are described. Progressive impairment of consciousness began 2 to 7 days after the administration of sodium valproate and induced a slowing of background EEG activity until the delta activity became of high amplitude, generalized, continuous and areactive. The authors believe that the impairment of consciousness in their patients was related to the rapid administration of high doses and a direct intrinsic action of sodium valproate on the brain, as no increase in plasma levels of the drugs in association with valproate was observed.

Adult↗