RESUMEN
BACKGROUND: The influence of cerebral edema and resultant secondary complications on the clinical outcome of traumatic brain injury (TBI) is well known. Clinical studies of brain water homeostasis dynamics in TBI are limited, which determines the relevance of our work. The purpose is to study changes in brain water homeostasis after TBI of varying severity compared to corresponding cerebral microcirculation parameters. MATERIALS: This non-randomized retrospective single-center study complies with the Helsinki Declaration for patient's studies. The study included 128 patients with posttraumatic ischemia (PCI) after moderate-to-severe TBI in the middle cerebral artery territory who were admitted to the hospital between July 2015 and February 2022. PCI was evaluated by perfusion computed tomography (CT), and brain edema was determined using net water uptake (NWU) on baseline CT images. The patients were allocated according to Marshall's classification. Multivariate linear regression models were performed to analyze data. RESULTS: NWU in PCI areas were significantly higher than in patients with its absence (8.1% vs. 4.2%, accordingly; p < 0.001). In the multivariable regression analysis, the mean transit time increase was significantly and independently associated with higher NWU (R2 = 0.089, p < 0.01). In the PCI zone, cerebral blood flow, cerebral blood volume, and time to peak were not significantly associated with NWU values (p > 0.05). No significant differences were observed between the NWU values in PCI foci in different Marshall groups (p = 0.308). CONCLUSION: Marshall's classification does not predict the progression of posttraumatic ischemia. The blood passage delays through the cerebral microvascular bed is associated with brain tissue water content increase in the PCI focus.
Asunto(s)
Isquemia Encefálica , Agua , Humanos , Estudios Retrospectivos , Lesiones Traumáticas del Encéfalo/complicaciones , Isquemia Encefálica/etiologíaRESUMEN
AIM: to study aqueous humor secretion and outflow in patients, whose major blood vessels of the neck got compressed by thyroid nodules. MATERIAL AND METHODS: Ocular hydrodynamics was assessed in 60 patients (119 eyes) with uni- or bilateral benign thyroid nodules compressing the major neck blood vessels. RESULTS: Most patients demonstrated a significant decrease in parameters of aqueous humor secretion and outflow. After decompression, ocular hydrodynamics usually improved reaching its normal level. CONCLUSION: Compression of the major neck blood vessels by thyroid nodules impedes drainage of the aqueous humor and serves as a risk factor of secondary phlebohypertensive glaucoma.
Asunto(s)
Humor Acuoso/metabolismo , Descompresión Quirúrgica/métodos , Ojo , Glaucoma , Hidrodinámica , Cuello/irrigación sanguínea , Nódulo Tiroideo , Tiroidectomía/métodos , Adulto , Anciano , Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Ojo/metabolismo , Femenino , Glaucoma/diagnóstico , Glaucoma/etiología , Glaucoma/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector/métodos , Glándula Tiroides/diagnóstico por imagen , Glándula Tiroides/cirugía , Nódulo Tiroideo/complicaciones , Nódulo Tiroideo/patología , Nódulo Tiroideo/cirugía , Resultado del TratamientoRESUMEN
UNLABELLED: Cerebrovascular resistance is an important parameter of the microcirculation. The main objective of cerebrovascular resistance is to maintain the constancy of cerebral blood flow and protect downstream vessels when changing perfusion pressure. The purpose of the study was to assess cerebrovascular resistance (CVR) in patients with severe combined traumatic brain injury (CTBI) with and without intracranial hematomas (IHs). MATERIAL AND METHODS: We analyzed treatment outcomes in 70 patients with severe CTBI (42 males and 28 females). The mean age was 35.5 ± 14.8 years (min 15 years; max 73 years). All patients were divided into 2 groups, depending on the presence of intracranial hemorrhage. The first group included 34 patients without IH, and the second group included 36 patients with epidural (6), subdural (26), and multiple (4) hematomas. The GCS score was 10.4 ± 2.6 in the first group and 10.6 ± 2.8 in the second group. The ISS severity injury score was 32 ± 8 in the first group and 31 ± 11 in the second group. All patients were operated on within the first 3 days, with 30 (83.3%) patients being operated on during the first day. Perfusion computed tomography (PCT) of the brain was performed within 1-14 days after TBI in the first group and within 2-8 days after surgical evacuation of hematoma in the second group. After PCT, the mean arterial pressure was measured, and the blood flow rate in the middle cerebral artery was determined using transcranial dopplerography. Cerebrovascular resistance was calculated using the formula modificated by P. Scheinberg. Comparisons between the groups were performed using the Student t-test and χ² criterion. RESULTS: The mean CVR values in each group (both with and without hematomas) were statistically significantly higher than the mean normal value of this parameter. Intergroup comparison of CVR values demonstrated a statistically significant increase in the CVR level in group 2 on the side of removed hematoma compared to group 1 (p=0.037). CVR in the perifocal zone of removed hematoma remained significantly higher compared to the symmetrical zone of the contralateral hemisphere (p=0.0009). CONCLUSION: Cerebrovascular resistance in patients with combined traumatic brain injury is significantly increased compared to the normal value. Cerebrovascular resistance in the perifocal zone after evacuation of hematoma in patients with multiple injury remains significantly increased compared to the symmetrical zone in the contralateral hemisphere.
Asunto(s)
Lesiones Encefálicas/fisiopatología , Circulación Cerebrovascular/fisiología , Traumatismo Múltiple/fisiopatología , Resistencia Vascular/fisiología , Adolescente , Adulto , Anciano , Hemorragia Encefálica Traumática/diagnóstico , Hemorragia Encefálica Traumática/fisiopatología , Lesiones Encefálicas/diagnóstico , Femenino , Escala de Coma de Glasgow , Hematoma Epidural Craneal/diagnóstico , Hematoma Epidural Craneal/fisiopatología , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Transcraneal , Adulto JovenRESUMEN
20 corneas of patients after ultrasound cataract phacoemulsification were studied using contact polarization optical coherence tomography (OCT) and confocal microscopy (CM). It was concluded that results obtained using OCT and CM fairly present morphologic corneal changes after ultrasound cataract phacoemulsification. Thermal damage as a result of ultrasound exposure demonstrated as a corneal tissue shrinkage is better revealed using polarization OCT.