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PubMedDate not supplied

Prompt plasma-exchange treatment and coma reversibility in two patients with thrombotic thrombocytopenic purpura.

We report on the cases of two women with acute thrombotic thrombocytopenic purpura (TTP) whose clinical courses were characterized by the onset of a coma state. Prompt commencement of plasma-exchange (PE) treatment led to complete hematological and neurological remission, which can still be observed without any maintenance therapy. No CNS abnormalities were observed in either patient using brain CT and NMR scans.

Adult↗
PubMed1990

[Post-traumatic coma and pre-traumatic memory].

Instead of thinking that it is impossible to enter in the internal world of a comatose patient, we are now put before a new and encouraging prospective, that of the possibility, even though minimal, of influencing the vital residual organisation of the patient and to induce him perhaps to accept again external stimulations, which previously were too intense. As loss of conscience often causes loss of memory, our intention was to examine the problem of memory loss in comatose patients after accidents. The analysis of 50 questionnaires distributed to trauma-patients awakening from a comatose state and interviews give clear indications that: 1) the patients remember absolutely nothing during the time of the coma; 2) in the majority of cases (34) the patients remember in the moment preceding the accident a clear autodestructive tendency especially if they were the cause of the accident; and 3) almost all patients (41) agree to have benefited greatly from the trauma itself and from its memory.

Amnesia↗
PubMed1990

[Coma, dream and thinking: a semiotic approach].

The notion of "frontier-dream", with a high perceptive direct content, is defined from accounts of dream experienced during coma. Then, from discussions with nursing-team working in units for comatose patients in a wakeful state, a protocol is proposed based on semiotic and psychoanalytical factors which aims at ensuring the global care of the comatose patient considered as a person.

Attitude of Health Personnel↗
PubMed1990

The respiratory response to CO2 and O2 in patients with coma due to voluntary intoxication with barbiturates and carbamates.

We have investigated the respiratory response to CO2 and to O2 in comatose subjects self intoxicated with barbiturates and carbamates. The chemical drive of 12 such patients with coma was compared with that of comparable normal subjects. The ventilatory response to CO2 was depressed but the P0.1 response was of the same order of magnitude as in normals. O2 had little effect on the ventilatory parameters and occlusion pressure. There was no difference between the two groups of patients, indicating that the respiratory changes observed were more dependent on the intensity of the intoxication than on the nature of the drugs. In addition, mechanical factors seem mainly responsible for the depressed ventilatory response to CO2.

Adult↗
PubMed1990

Reversal of prolonged isoniazid-induced coma by pyridoxine.

Isoniazid overdose is known to result in the rapid onset of seizures, metabolic acidosis, and prolonged obtundation. Pyridoxine has been reported to be effective in treating isoniazid-induced seizures. We report three cases of obtundation secondary to isoniazid overdose that was immediately reversed by intravenous pyridoxine. In two of these cases, status seizures were stopped by intravenous pyridoxine administration, but the patients remained comatose for prolonged periods. The comas were immediately reversed by the administration of additional pyridoxine. In the third case, the patient's lethargy was treated by intravenous pyridoxine on presentation and was followed by immediate awakening. Pyridoxine is effective in treating not only isoniazid-induced seizures, but also the mental status changes associated with this overdose. The dose required to induce awakening may be higher than that required to control seizures.

Adolescent↗
PubMed1990

[Experience with the treatment of diabetic coma].

To investigate the effect of low-dose versus high-dose insulin treatment of Kussmaul's coma, the authors treated 2 groups of relevant patients. Group I treated with low-dose insulin in combination with other therapeutic measures achieved a progressive decrease of glycemia within 8 hours. Complications were not registered. Group II on high-dose insulin scheme exhibited a drop in blood sugar resultant in hypoglycemia in 4, hypotonia in 2, brain edema in 1 patient. The absence of complications, availability and simplicity support the advantages of the low-dose regime which is now widely introduced into clinical practice.

Adolescent↗
PubMedDate not supplied

Reliability of assessments by skilled observers using the Glasgow Coma Scale.

The management of patients at risk of neurological deterioration is often centred around serial assessments made by nursing and medical clinicians using the Glasgow Coma Scale. Although accepted throughout the world as a reliable and consistent tool for such assessments, little work has been done to validate the original claims of reliability. In this study a very high degree of inter-rater reliability was demonstrated between registered nurses (RNs) who were educated and experienced in use of the scale. Implications for clinical practice are discussed.

Coma↗
PubMed1990

Electroencephalographic findings in coma caused by fatal chloroquine poisoning.

A 19-year-old patient in deep anoxic coma after cardiopulmonary arrest due to suicidal acute overdosage of chloroquine was resuscitated at the intensive care unit. An EEG starting about 12 hours later and lasting for 93 minutes showed a rapid succession of diffuse ectopic rhythms, diffuse slow output, generalized periodic slow waves in paroxysmal episodes which preceded burst suppression patterns and definite establishment of electrocerebral silence. All these EEG patterns indicating a poor prognosis were registered about three hours before the patient died during irreversible ventricular fibrillation.

Adult↗
PubMedDate not supplied

[Intensive therapy of diabetic (ketoacidotic) coma].

Complex intensive therapy involving daily procedures of hyperbaric oxygenation combined with antioxidants in patients admitted to hospital in condition of ketoacidotic coma allows prompt elimination of hypoxia, acidosis, hyperglycemia and makes it possible to enhance resistance of cellular membranes and normalize free-radical parameters of lipid peroxidation.

Adolescent↗
PubMed1989

[Coma, hyperviscosity syndrome, hyperammonemia and myelofibrosis in a patient with IgG, lambda type multiple myeloma].

A 63-year-old man was admitted to our hospital with tremor and somnolence, followed soon by coma. Anemia and retinal bleeding were observed. The blood smear exhibited rouleaux formation and leukoerythroblastosis. A bone marrow aspiration resulted in dry tap. The biopsy specimens revealed remarkable infiltration of myeloma cells with fibrosis. The M-component of IgG-lambda type and hyper-ammonemia were detected in the serum. Liver and renal functions, however, were within normal range. His consciousness recovered after plasmapheresis. Two courses of VMCP (vincristine, melphalan, carboquone and prednisolone) did not affect the paraproteinemia. Five courses of VAD (vincristine, adriamycin and dexamethasone) could lower the level of IgG. He died of pneumonia. The plasma of some patients with multiple myeloma may contain unidentified factors which increase the plasma ammonia.

Ammonia↗
PubMed1989

Insulinoma complicating pregnancy presenting with hypoglycemic coma after delivery: a case report and review of the literature.

The incidence of insulinoma in pregnancy is unknown. All of the eight previously reported cases presented in the first trimester with hypoglycemic episodes. We report a case of a 24-year-old multigravida who presented with hypoglycemic coma after delivery. We discuss the possible protective role of pregnancy counter-regulatory hormones in keeping the patient asymptomatic until delivery, and present the difficulties in both diagnosis and differential diagnosis of insulinoma in the peripartum period. Chronic hypoglycemia in pregnancy has been associated with intrauterine growth retardation and increased perinatal mortality. However, this infant was at the 90th percentile for body weight, suggesting that asymptomatic maternal hypoglycemia had not been present during the gestation. Insulinoma complicating pregnancy, though very rare, should now be included in the differential diagnosis of postpartum hypoglycemia.

Adenoma, Islet Cell↗
PubMedDate not supplied

[Evaluation of post-traumatic coma using evoked potentials].

In 130 cases of post-traumatic coma a study of multimodality evoked potentials (MEP) was carried out shortly after the traumatism (within 72 h). According to the morphology of the records they were classified in grades (I-IV) in agreement with Greenberg et al. The worst grade of EP in the different types was related to the outcome at 6 months, distinguishing between focal lesions and diffuse lesions. Only a group (22.9%) of the 109 patients in which the auditory brain-stem evoked potentials (ABEP) could be studied, showed severe disorders (grade III-IV). There was a significant correlation between the ABEP grades and the outcome in the focal lesions (p less than 0.001). In the diffuse lesions the ABEP grades did not show significant differences with the outcome. A 22.4% of the patients with diffuse lesions had some visual evoked potentials (VEP) in grades III-IV against almost the double (41.6%) in the focal lesions. The grades of the VEP in the focal lesions did not have differences with outcome and in the diffuse lesions they did (p less than 0.05). Approximately half of the cases with focal lesions and one third of the diffuse lesions showed severe disorders (grades III-IV) of the somatosensory evoked potentials (SEP). In the two types of lesions there were significant differences with the outcome (p less than 0.001) and (p less than 0.01). The multimodality evoked potentials (MEP) are useful for predicting the outcome, especially in the patients where the neurological examination is impossible. Among the different modalities, the SEP were shown to be more predictive.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗
PubMed1989

[Prognosis of post-anoxic coma].

The outcome of anoxic coma following cardiac arrest depends on the aetiological circumstances, on pre-existing visceral deficiencies and on the duration of inefficient circulation. Outside the extreme cases of prompt return to consciousness or early death, in many patients this course is marked by neurological sequelae of varying severity which may result in a persistent vegetative state. Initially, there is nothing that can predict the quality of survival, but within 72 hours the neurological examination usually makes it possible to foresee irreversible situations with permanent loss of consciousness. The decisional problems that ensue are discussed.

Coma↗
PubMed1989

[Problems of surveillance and nursing in chronic coma].

Impaired consciousness after severe brain damage is coma, the next step being vegetative state with a high mortality rate. Some vegetative patients may in fact improve, although they usually stay dependent. The entire attending and rehabilitation team looks for responses to simple orders, which mean return of consciousness, and watches the patient's articular state and potential complications. It is also necessary to maintain the patient's dignity at this stage of wakefulness without awareness, and to prevent neuro-orthopaedic and cutaneous complications by positions and mobilizations, in order to provide optimal conditions for a possible physical and/or mental recovery and to reduce the degree of dependence.

Coma↗
PubMedDate not supplied

Spontaneous intracerebral haematomas: surgical versus conservative treatment based on Glascow Coma Scale score and computer tomography data.

Eighty cases of spontaneous intracerebral haematomas were studied retrospectively in order to find clinical and computer tomography parameters; such parameters would be useful for the neurosurgeon, as criteria in the process of deciding surgical or conservative treatment. We found Glascow Coma Scale (GCS) score on admission an excellent criterion. Scores between 3-5 and 12-14 were a contraindication for surgery. Scores between 6-8 indicated surgery, while scores between 9-11 indicated an increased level of readiness. Up to a haematoma size of 16 cm2, size had no influence on GCS score and surgical mortality. For haematoma size larger than 16 cm2, the percentage of patients with low GCS score had increased substantially as well as the surgically mortality. This study has not revealed any lethal haematoma size. No effect of midline shift on mortality was found when shift did not exceed 5 mm. Hypertension was found in 40% of the patients and increased mortality in both types of treatment.

Adult↗
PubMed1988

[Cervical chemodectoma disclosed by coma. Pathogenic hypotheses].

The authors reported a case of cervical paraganglioma. Patient had a coma suggesting secretary activity of the lesion or cerebral venous thrombosis. Angiography showed an hypervascular lesion characterized by venous reflux into the contro-lateral sinus. After neurological stabilization by tumor embolization, the tumor was surgically removed.

Coma↗
PubMed1988

Predictive value of Glasgow coma score for awakening after out-of-hospital cardiac arrest. Cerebral Resuscitation Study Group of the Belgian Society for Intensive Care.

The Glasgow coma score (GCS) during days 1-6 after cardiac arrest was used to predict neurological outcome in 360 resuscitated victims of out-of-hospital cardiac arrest. A predictive rule based on the best GCS of 216 patients resuscitated in 1983-84 (prediction group) was constructed, and its predictive power was tested on 133 patients treated in 1985 (test group). Neurological outcome was correctly predicted 2 days after cardiac arrest in 80% of the prediction group, with a best GCS of 10 or above and 4 or below as cutoff points. For patients with a best GCS of 5-9, prediction of outcome was possible 6 days after cardiac arrest, with a best GCS of 8 during the first 6 days as the single cutoff point. The rule was then validated in the test group: the sensitivity was 96%; the specificity 86%; the negative predictive value 97%; and the positive predictive value 77%. These data suggest that this simple GCS-based rule can be helpful in predicting outcome in patients resuscitated after out-of-hospital cardiac arrest, but confirmation of these data is required in a prospective study in a larger number of patients.

Belgium↗