ISSN:0269-9052    

DOI:10.3109/02699058909029636

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

The purpose of this paper is to review the dynamics and functioning of families with a severely head-injured member. In order to stress the unique problems faced by persons with brain damage and their families, a comparison with spinal cord-injured persons is presented. The review's major conclusion is that a head injury exposes the family to a complex of problems that are unique to this disability and, therefore, necessitates the delivery of special family support services focused on the family, rather than on the head-injured person.

ISSN:0269-9052    

DOI:10.3109/02699058909029637

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

The research examined the effects of alcohol and other variables on cognitive outcome after severe head injury. Alcohol consumption habitually and at the time of injury were strongly related, and both were related to age and educational level but not injury severity. Covariance analysis to remove the effects of age and education showed a reduction in the main effects, so that only alcohol consumption at injury was a significant predictor of memory, but not other cognitive areas late after injury. There were significant interactions between severity of injury (post-traumatic amnesia), and alcohol habitually or at time of injury, with increasing alcohol consumption increasing the size of the memory deficit. To have a short post-traumatic amnesia and have drunk heavily led to a worse memory score than that found in patients with a considerably longer post-traumatic amnesia who had drunk lightly or not at all.

ISSN:0269-9052    

DOI:10.3109/02699058909029638

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

This paper illustrates the epidemiology and management of patients with severe traumatic brain injuries in Sweden. The study indicates that an overall outcome comparable to other reported series is feasible in a region with a relatively sparse population and rather large geographical distances. In our opinion there is a need for a detailed protocol for initial care in hospitals lacking neurosurgical experts. Such recommendations should be based on local facilities and epidemiological conditions.

ISSN:0269-9052    

DOI:10.3109/02699058909029639

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

During a 6 year period (1977-1982), 425 patients were treated in the Department of Neurosurgery, University Hospital of Lund, for severe traumatic brain lesions (coma>6 hours). From 1983 a more aggressive management protocol was introduced including early recording of intracranial pressure (ICP) and 162 patients were included in the study 1983-1984. A dangerous increase in ICP in spite of adequate surgical treatment and moderately controlled hyperventilation was the incentive for barbiturate coma therapy in selected patients. In the first part of the study overall mortality was 48% whereas 39% of the patients reached good recovery/moderate disability 6 months after injury. During the second part of the study the corresponding figures were 35% and 54%, respectively (in both casesp≤0.01). In the group of patients with focal intracranial mass lesions mortality decreased from 59% to 46% (p≤0.05) and good recovery/moderate disability increased from 30% to 42% (p≤0.05). Improvement in outcome was even more pronounced in patients with no-mass lesions, mortality decreased from 30% to 12% and good recovery/moderate disability increased from 56% to 80% (p≤0.05 andp≤0.01, respectively). No change occurred in age distribution or in the types of intracranial lesions that could explain these improvements. It is concluded that aggressive neurosurgical intensive care significantly improves outcome in patients with severe traumatic brain lesions.

ISSN:0269-9052    

DOI:10.3109/02699058909029640

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

The present study had two main objectives: Firstly, to document the economic differences between‘ordinary’and‘aggressive’neurosurgical intensive care and secondly, to evaluate the medical benefits in relation to costs for different subgroups of head-injured patients. The study compares patients injured in traffic accidents and treated in the Department of Neurosurgery, University Hospital of Lund, during 1977-1978 (n=67) with similar patients treated during 1983-1984 (n=87) after introduction of more vigorous neurosurgical intensive care. The economic analysis was performed by means of the CRISE-method (Cost Related Index Score Evaluation) and all costs were related to the monetary value in 1984. Adoption of a program for‘aggressive’neurosurgical intensive care increased the costs per treated patient by about 46% (from 70.887 Swedish Crowns (SEK) to 103.452 SEK). Mortality decreased significantly after the change in intensive care and the cost per surviving patient remained virtually unaffected (131.928 SEK vs. 132.357 SEK). Further, after introduction of the‘aggressive’programme a larger proportion of the economic expenditures were spent on patients who ultimately recovered well. It is concluded that the increase in costs following introduction of a more vigorous intensive care programme in patients with severe traumatic brain lesions is very reasonable in relation to the documented medical benefits.

ISSN:0269-9052    

DOI:10.3109/02699058909029641

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

This paper describes ten adolescents who made unequivocal suicide attempts which resulted in near-death and brain damage. As predicted from studies of successful suicide, this group was mostly male, in late adolescence, and with histories of psychiatric difficulties. The fact that each had tried to commit suicide was avoided by the medical care facilities and by the families. The term‘accident’was customary. This paper makes suggestions for mental health clinicians who consult to head-injury rehabilitation teams treating such adolescents. Two cases are presented to highlight the findings and recommendations of this study.

ISSN:0269-9052    

DOI:10.3109/02699058909029642

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

Relationships among pre-injury ability, post-injury verbal intelligence, duration of coma and age were analysed in 34 closed-head injury patients, 7-28 years of age, whose coma lengths ranged from 5 to 180 days. The results obtained suggest that moderate to severe closed-head injury uniformly impairs verbal intellectual functioning without regard to premorbid status. Premorbid ability test scores had a markedly low correlation (0.04) with Wechsler Verbal IQs, obtained after patients had plateaued in intellectual recovery. Even when the effects of coma and age were controlled, the correlation was not significant. Mean post-injury IQs for patients grouped according to pre-injury intelligence (above average, average, below average) were all in the 80s. The findings do not support the prevailing assumption that the greater the premorbid ability, the greater the potential for intellectual recovery and the better the outcome. This study instead suggests that the higher the pre-injury IQ, the greater the IQ point loss. This has important implications for rehabilitation, counselling, discharge planning and follow-up. The greater the disparity between pre- and post-injury IQs, the more profound the loss and, hence, the greater the need for patient and family adjustments, coping and modifications of future personal, educational and vocational plans.

ISSN:0269-9052    

DOI:10.3109/02699058909029643

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

摘要:

Although hypercalcaemia in young children or adolescents immobilized by fractures or spinal cord injury is well recognized, hypercalcaemia in adult immobilized patients is rare without a pre-existing bone disease. To our knowledge, hypercalcaemia in a head-injured, immobilized patient has not been previously reported. We report here a case where a previously normocalcaemic, immobilized, head-injured adult patient developed cognitive decline secondary to hypercalcaemia five months after injury, when transient interruption of enteral feedings led to mild dehydration. Indices of bone turnover were elevated and parathyroid hormone was appropriately suppressed. Possible predisposing factors in our patient included a severe degree of immobilization and a very high level of athletic activity prior to injury. Careful fluid management and specific monitoring of calcium levels, even several months post-injury, should be performed to avoid the added complications of hypercalcaemia in head-injured patients.

ISSN:0269-9052    

DOI:10.3109/02699058909029644

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor

ISSN:0269-9052    

DOI:10.3109/02699058909029645

出版商:Taylor&Francis    

年代:1989

数据来源: Taylor