RESUMEN
BACKGROUND: The ability to predict outcome in patients with cerebral edema is important because it can influence treatment strategy. We evaluated whether differences in head computed tomographic (CT) measurements in Hounsfield units (HU) of white matter and gray matter can be used as a predictor of outcome in patients with subdural hematoma with cerebral edema. METHODS: We evaluated 34 patients who had subdural hematoma with cerebral edema following acute closed head trauma and had undergone head CT within a few hours of admission. We divided them into the survival (n = 24) group and death (n = 10) group, and measured the HU of white matter and gray matter at injury and non-injury sites. RESULTS: There were no significant differences in operation time or blood loss during surgery between the two groups. Only the HU of white matter in the injury site of patients in the death group were decreased significantly. A cut-off value of 31.5 for HU of white matter showed 80.0 % sensitivity and 99.9 % specificity for death; the area under the curve was 0.91. DISCUSSION: Our results are more evidence of the support of neurogenic edema in trauma rather than an important clinical tool at this stage. However, HU values in WM may be one factor in the decision-making process that affects patient outcome. Changing the treatment strategy in patients with a low HU value in the WM at the injury site may bring about an improvement in patient outcome. CONCLUSION: Measurement in HU of white matter at the injury site might be useful as a predictor of outcome in patients with subdural hematoma with cerebral edema.
Asunto(s)
Edema Encefálico/diagnóstico , Sustancia Gris/diagnóstico por imagen , Traumatismos Cerrados de la Cabeza/complicaciones , Hematoma Subdural/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Sustancia Blanca/diagnóstico por imagen , Anciano , Edema Encefálico/etiología , Edema Encefálico/mortalidad , Femenino , Traumatismos Cerrados de la Cabeza/diagnóstico , Traumatismos Cerrados de la Cabeza/mortalidad , Hematoma Subdural/etiología , Hematoma Subdural/mortalidad , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Tasa de Supervivencia/tendencias , Índices de Gravedad del TraumaRESUMEN
PURPOSE: The prediction of pulmonary deterioration in patients with smoke inhalation injury is important because this influences the strategy for patient management. We hypothesized that narrowing of the luminal bronchus due to bronchial wall thickening correlates to respiratory deterioration in smoke inhalation injury patients. METHODS: In a prospective observational study, all patients were enrolled at a single tertiary trauma and critical care center. In 40 patients, chest computed tomographic images were obtained within a few hours after smoke inhalation injury. We assessed bronchial wall thickness and luminal area % on chest computed tomographic images. Airway wall thickness to total bronchial diameter (T/D) ratio, percentage of luminal area, and clinical indices were compared between patients with smoke inhalation injury and control patients. RESULTS: The T/D ratio of patients with smoke inhalation was significantly higher than that of control patients (p<0.001), and the luminal area of these patients was significantly smaller than that of control patients (p<0.001). The number of mechanical ventilation days correlated with the initial infusion volume, T/D ratio, and luminal area %. ROC analysis showed a cut-off value of 0.26 for the T/D ratio, with a sensitivity of 79.0% and specificity of 73.7%, and a value of 23.4% for luminal area %, with a sensitivity of 68.4% and specificity of 84.2%. CONCLUSIONS: These data revealed the utility of computed tomography scanning on admission to show that the patients with smoke inhalation injury had airway wall thickening compared to control patients without smoke inhalation injury. Airflow narrowing due to airway wall thickening was related to the development of pneumonia and the number of mechanical ventilation days in patients with smoke inhalation injury. Airflow narrowing is one important factor of respiratory deterioration in smoke inhalation injury.
Asunto(s)
Puntaje de Gravedad del Traumatismo , Neumonía/etiología , Lesión por Inhalación de Humo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Bronquios/patología , Quemaduras/diagnóstico por imagen , Femenino , Volumen Espiratorio Forzado , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico por imagen , Estudios Prospectivos , Respiración Artificial/estadística & datos numéricos , Sensibilidad y Especificidad , Lesión por Inhalación de Humo/complicacionesRESUMEN
BACKGROUND: We experienced four Japanese patients with spontaneous retroperitoneal bleeding, a rare disease. We categorized the clinical characteristics of spontaneous retroperitoneal bleeding in these patients treated in our hospital and discuss the risk factors of spontaneous retroperitoneal bleeding. CASE PRESENTATION: Three of the 4 patients did not have a bleeding tendency as indicated by laboratory data obtained at the time of retroperitoneal bleeding. The causative blood vessels were the lumbar and superior gluteal arteries and the internal iliac artery. All patients were receiving an anticoagulant, heparin in one and nafamostat mesilate in the other three patients. Three patients were being treated with hemodialysis or continuous hemodiafiltration when the spontaneous retroperitoneal bleeding occurred. We achieved hemostasis with transcatheter arterial embolization in 3 patients and with surgical hemostasis in 1 patient. CONCLUSIONS: We suggest that in patients receiving anticoagulant therapy in whom progressive anemia and unstable vital signs are present, spontaneous retroperitoneal bleeding should be considered as a possible cause. Nafamostat mesilate may be one of the risk factors for spontaneous retroperitoneal bleeding.