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PubMed1983

[CT scan in severe head injury with special reference to Glasgow coma scale].

CT scan demonstrates the invaluable information about the parenchymal lesions of head injuries. The parenchymal lesions were classified into 6 categories; 1) isodensity without mass effect: I(-), 2) isodensity with mass effect: I(+), 3)high density: H, 4) high-low density complex: H-L, 5) low density: L, 6) diffuse cerebral swelling: DCS. Glasgow coma scale (GCS) and outcome scale (GOS) were international practical scales for the evaluation of severity and prognosis of severe head injuries. One hundred and seventy-four cases with severe head injury were analysed. I(+), H and H-L were common findings in the group of GCS 3-6, and I(-) was in GCS 7-12 and GCS 13-15. H and H-L were not related with GCS. DCS was most common in GCS 7-12. Acute epidural hematoma was frequent in the group of GCS 13-15, and acute subdural hematoma was in GCS 3-6. The prognosis was significantly poor in the group of GCS 3-6, with the mortality of 72 percents. On the other hand, the prognosis was quite good in GCS 7-12 and GCS 13-15. There were few reports about the traumatic subarachnoid hemorrhage (SAH). SAH was one of the important risk factors in severe head injuries and it was frequently associated with I(+), H and H-L. The prognosis of the patients with SAH was most unfavorable in the presence of I(+). Number of analyses were reported about the traumatic intraventricular hemorrhage (IVH). IVH was also one of the powerful risk factors and this was commonly associated with H and H-L. The prognosis of the patients with IVH was very poor. Finally, the groups of the patients, whose prognoses turned out to be unexpected results from GCS on admission, were analysed. First, the age was an important factor. In the patients, whose prognoses were good in spite of low GCS, I(-) was a mostly common finding, while SAH, IVH and obscured cisterns, esp. basal and quadrigeminal, were less common. In the patients, whose prognoses were poor despite of favorable GCS, H and H-L were common findings. SAH and IVH were also common. The poor prognosis was induced by secondary systemic complications, such as pneumonia and meningitis, etc.

Adolescent↗
PubMed1981

[Infection in patients with hepatic coma (author's transl)].

66 patients with hepatic coma were treated from 1972 to 1979 in the intensive care unit. Incidence and etiology of bacterial infections in these patients were evaluated retrospectively. Bacterial cultures were positive in a high proportion of the cases investigated as compared to the situation on a normal ward. Bacterial cultures were performed in 51 patients (77.3%); cultures from 35 patients were positive. Gramnegative bacteria accounted for 56.4%, grampositive bacteria for 34.8% and candida albicans for 8.8% of all the cases. It is pointed out, that invasive diagnostic and therapeutic manoeuvers in intensive care patients carry a high risk of infection.

Adolescent↗
PubMed1981

[On the neuro-psychiatric symptomatology of the so-called "hepatic coma" (author's transl)].

The definition of hepatic coma has been used for the most severe course of hepatic insufficiency, independent from the pathogenesis. This means, that from the psychiatric point of view the hole survey of the exogen reaction type was subdivided. The neurologic symptomatology was rather neglected. In this study an attempt is made to show--using the reports of 77 patients with severe hepatic insufficiency of different etiology--that with very exact and repeated examinations a typical course of neuro-psychiatric symptoms can be observed. A distinct hierarchy of symptoms is existing, which is similar to the well known princip of dissolution (Jackson). As a main factor one has to differentiate between an acute and a subacute course. The acute course is characterized by a rapid decrease of vigilance and increase of neurologic symptoms, which end in most of the cases with an acute midbrain- and bulbarbrain-syndrome, while the subacute course shows primary a disturbance of thymo- and noopsychic function in different relations. In addition to the organic "Achsensyndrom" amnestic or amentiell symptoms can be found, which might be covered by a decrease of the vigilance--if the primary noxis continoues--end up with unconsciousness. The parallel developing neurologic symptomatology shows a distraction of the general motoric, including so-called basic movements. later stereotypies and automatismes, and the delicate distal movements change into rough general-rotation-and pointing movements of the hole body. There is also a temporary bending of all extremities and at this time also a rigidospasticity. In the following course preponderate transient bending or stretching, finally there exists a lack condition, which does not respond to external provocations. The symptomatology is not always symmetric. Transient or longstanding hemiparetic symptoms and also crossed brainstem symptoms can be seen frequently. Sometimes there are general or focal epileptic seizures. If a brain edema occurs it leads to a tentorial herniation with the symptoms of an acute midbrain- or bulbarbrain syndrome, which exists in nearly every second patient. If the course turns, the clinical symptomatology is passed in reverse direction. A good relation exists to the known biochemical changes. The disturbed monoaminmetabolism influences the structures, which are important for the vigilance. The serotonin and 5-hydroxyindolaminoacid level in the tegmentum and the hippocampus are increased. Worth to mention, that this is not a specific hepatic disturbance. Additional one can find false transmitters, for example octopamin, which are concerning the excitation, less potent than dopamin or noradrenalin and also a decrease of the latter in the extrapyramidal structures, which corresponds very well with the motoric deficiency and defectsymptoms. Not all of the symptoms can be explained by disturbances of the catecholaminmetabolism. It seems, that electrolyt and acid-base disturbances are also of some value...

Acetoin↗
PubMed1982

Disability rating scale for severe head trauma: coma to community.

The objective of this study was to develop one instrument for assessing quantitatively the disability of severe head trauma patients so their rehabilitative progress could be followed from coma through different levels of awareness and functioning to their return to the community. This disability rating (DR) instrument was designed to be easily learned, quickly completed, valid, predictive of outcome and to have a high inter-rater reliability. The DR Scale consists of 8 items divided into 4 categories; 1. Arousal and awareness; 2. Cognitive ability to handle self-care functions; 3. Physical dependence upon others; 4. Psychosocial adaptability for work, housework, or school. Completed independently by several raters for more than 88 serious head injury patients, inter-rater correlations were highly significant. The admission DR was significantly related to clinical outcome at 1 year after injury and was significantly related to electrophysiologic measures of brain dysfunction as reflected in degree of abnormality of evoked brain potential patterns. The DR Scale is more sensitive than the Glasgow Outcome Scale in detecting and measuring clinical changes in individuals who have sustained severe head trauma. Also it can be used to help identify patients most likely to benefit from intensive rehabilitation care within a hospital setting. It provides a shorthand global description of a head injury patient's condition that facilitates understanding and communication.

Activities of Daily Living↗
PubMed1980

[Anaesthesia in hypercalcaemic coma (author's transl)].

Hypercalcaemic coma leads to changes in myocardial efficiency and skeletal muscle tone. It is difficult to recommend a favourable anaesthetic agent for such a rare but acute and serious clinical condition. Our experiences are against administration of enflurane. It seems to be that neurolept anaesthesia is the most suitable method for those patients.

Adrenalectomy↗
PubMed1979

Hypothermia, a grave prognostic sign in hepatic coma.

Hypothermia is a grave prognostic finding in hepatic coma. Occasionally, it is found in patients whose conditions are stabilized clinically or are improving. When hypothermia occurs, the patients usually die within 24 to 48 hours. All of the patients described herein who eventually improved sufficiently to be discharged from the hospital achieved normal temperatures.

Aged↗
PubMed1994

The interest of multimodality evoked potentials in the evaluation of chronic coma.

The clinical usefulness of three-modality evoked potentials (TMEPs) has been widely demonstrated in acute coma, but is still a matter of debate in the persistent vegetative state. We observed that TMEPs in vegetative patients could be situated along a continuum, one extremity of which corresponds to absent cortical, but preserved brain-stem activities, and the other extremity to major abnormalities of somatosensory conductions at the midbrain level, but variable involvement of auditory pontine and visual cortical pathways. The former pattern is most often associated with ischemic-anoxic encephalopathy, while the latter is most often consecutive to head trauma. However, all intermediate states may be observed. TMEPs can usefully complement the clinical evaluation in answering two questions. The first one concerns the chances of subsequent improvement that are lower in the absence of quantitative TMEP evolution, but are likely to be higher in the presence of non-fixed mesencephalic dysfunction associated with a relative preservation of cortical function. The second question concerns the evaluation of remaining cognitive abilities that are more likely to be present if only mild abnormalities of cortical activities are found and if some cognitive EPs are still obtained.

Adult↗
PubMedDate not supplied

[Endogenic hepatic coma in the course of acute hepatitis treated with arterialization of portal blood].

Symptoms of endogenic hepatic coma were observed in the course of acute hepatitis in 17 patients admitted to the I Clinic of Infectious Diseases of Silesian Medical School between 1987 and 1992. Five of them were treated with the arterialization of portal blood. At least one exchange transfusion preceded the arterialization in four cases. Recovery was obtained in 3 patients. Two patients died because of complications which occurred during the twenty-four hours after the intervention. In the first case the reason of the death was the extensive myocardial infarction, in the second one-DIC and ARDS. As it has been observed, the prothrombin rate should not be lower than 30% in these patients who are to undergo the arterialization of portal blood. This value of the prothrombin rate is provided by at least one exchange transfusion.

Adult↗
PubMed1976

[A new therapeutic principle in hepatic coma: parenteral supply of neutral amino acids].

The effect of two different amino acid solutions given i.v. was investigated in dogs with hepatic encephalopathy after portacaval shunt. The results suggest that (a) isocaloric protein-free nutrition has no impact on the characteristic plasma amino-gram, (b) the infusion of modified concentrations of 6 neutral amino acids may reduce mortality and morbidity in dogs with hepatic coma, and (c) manipulation and normalization of plasma amino acids may be efficacious in providing adequate nutrition while minimizing hepatic encephalopathy.

Amino Acids↗
PubMed1997

[Constrictive pericarditis complicated with hepatic coma--a case report].

A 39-year-old man with pedal edema and icterus was admitted to our hospital. Laboratory findings revealed hyperbilirubinemia. Echocardiography and chest CT revealed the calcified mass front of the right ventricle. As cardiac catheterization showed dip and plateau in right ventricle, the diagnosis of constrictive pericarditis was established. Considering his condition and bleeding tendency with hepatic failure, plasma exchange was done for three days before operation. As the patient's condition deteriorated with hepatic coma, pericardiectomy was performed. The median sternotomy approach without cardiopulmonary bypass was selected. The calcified mass was removed, and the thickened pericardium was excised. Postoperative hemodynamic findings were improved, and the serum bilirubin returned to normal. In conclusion even in this case with severe hepatic failure due to constrictive pericarditis, surgical treatment should have be considered.

Adult↗
PubMed1976

[Criteria for intensive treatment of hepatic coma].

Results observed over a period of two years in the intensive care of hepatic coma at the University of Genova surgical pathology department are briefly surveyed. A set of practical suggestions is offered for the management of patients whose prognosis is not open to change by the administration of conventional forms of treatment. A critical appraisal of the results achieved is presented along with the general series.

Adult↗
PubMedDate not supplied

Exchange transfusion with plasmapheresis in the management of hepatic coma.

In two cases of hepatic coma following advanced liver cirrhosis exchange transfusions were applied with plasmapheresis. In both cases the general condition of patients improved and consciousness returned. After exchange transfusions with plasmapheresis the serum levels of bilirubin, urea and ammonia decreased. Using appropriately selected fluids for erythrocyte suspension it is possible to affect selectively protein depletion and depletion of plasma blood clotting factors.

Adolescent↗
PubMed1964

[COMA].

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Brain Neoplasms↗