Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury

OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.

Use of local muscle flaps to cover leg bone exposures

Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure.Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit.Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41); 42 were male and 11 female. The main initial injury was trauma (84.8%), consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%). The rank of 49 patients (92.5%) was excellent or good outcome, of three (5.6%) as regular and of one (1.9%) as unsatisfactory.Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay.

Complementary exams in blunt torso trauma. Perform only radiographs and fast: is it safe?

ABSTRACTObjective:to evaluate effectiveness of using chest X-ray (CXR), pelvis X-ray (RXP) and FAST (Focused Abdominal Sonography on Trauma) to exclude significant lesions of the body in blunt trauma.Methods:a prospective study involving 74 patients whom made the three tests (CXR, RXP and FAST) during the initial evaluation between October 2013 and February 2014. The results were compared to the tomography of the same patients or clinical outcome. If the patient did not have alterations on the CT scans or during the observation time, the initial workup was considered safe. All patients were evaluated at the Hospital João XXIII, Belo Horizonte, Brazil.Results:of the 74 patients studied the average age was 33 years, RTS: 6.98, ECG: 12. From 44 (59.45%) patients with exams (radiographs and FAST) unchanged, three had significant injuries (two splenic injuries and one liver injury) diagnosed by clinical monitoring. The remaining patients - 30 (40.55%) - had at least one alteration in conventional tests. Of these group 27 (90%) had significant injuries and three (10%) minor injuries. The sensitivity of all three tests for screening considerable lesions was 90% and the specificity was 93%. The negative predictive value was 93% and the positive predictive value 89%.Conclusion:this research showed that all the three exams - chest X-ray, pelvis and FAST - are safe to lead with the blunt trauma if well used and associated with clinical examination.

Associated factors to empyema in post-traumatic hemotorax

ABSTRACTObjective:to analyze the associated factors with empyema in patients with post-traumatic retained hemothorax.Methods:prospective observational study. Data were collected in patients undergoing PD during emergency duty. Variables analyzed were age, sex, mechanism of injury, side of the chest injury, intrathoracic complications of RH, laparotomy, specific injuries, rib fractures, trauma scores, days to diagnosis, diagnostic method of RH, primary indication of PD, initial volume drained, length of the first tube removal, surgical procedure. Cumulative incidence of empyema, pneumonia and pulmonary contusion and the proportion of patients with empyema or without empyema in each category of each variable analyzed were obtained.Results: the cumulative incidence of PD among trauma patients was 1.83% and the RH among those with PD was 10.63%. There were 20 cases of empyema (32.8%). Most were male in the age from 20 to 29, victims of injury by firearm on the left side of the thorax. The incidence of empyema in patients with injury by firearms was lower compared to those with stab wound or blunt trauma; higher among those with drained volume between 300 and 599 ml. The median hospital lenght of stay was higher among those with empyema.Conclusion:the incidence of PD was 1.83% and RH was 10.63%, these results are consistent with the low severity of the patients involved in this study and consistent with the literature. The incidence of empyema proved to be negatively associated with the occurrence of injury by firearms and positively associated with a drained volume between 300 and 599 ml, compared with lower or higher volumes.

Assessment of pelvic floor by three-dimensional-ultrasound in primiparous women according to delivery mode: initial experience from a single reference service in Brazil

PURPOSE: To evaluate changes to the pelvic floor of primiparous women with different delivery modes, using three-dimensional ultrasound. METHODS: A prospective cross-sectional study on 35 primiparae divided into groups according to the delivery mode: elective cesarean delivery (n=10), vaginal delivery (n=16), and forceps delivery (n=9). Three-dimensional ultrasound on the pelvic floor was performed on the second postpartum day with the patient in a resting position. A convex volumetric transducer (RAB4-8L) was used, in contact with the large labia, with the patient in the gynecological position. Biometric measurements of the urogenital hiatus were taken in the axial plane on images in the rendering mode, in order to assess the area, anteroposterior and transverse diameters, average thickness, and avulsion of the levator ani muscle. Differences between groups were evaluated by determining the mean differences and their respective 95% confidence intervals. The proportions of levator ani muscle avulsion were compared between elective cesarean section and vaginal birth using Fisher's exact test. RESULTS: The mean areas of the urogenital hiatus in the cases of vaginal and forceps deliveries were 17.0 and 20.1 cm², respectively, versus 12.4 cm² in the Control Group (elective cesarean). Avulsion of the levator ani muscle was observed in women who underwent vaginal delivery (3/25), however there was no statistically significant difference between cesarean section and vaginal delivery groups (p=0.5). CONCLUSION: Transperineal three-dimensional ultrasound was useful for assessing the pelvic floor of primiparous women, by allowing pelvic morphological changes to be differentiated according to the delivery mode.

Sourgrass densities affecting the initial growth and macronutrient content of coffee plants

The objective of this work was to evaluate the coexistence effects of coffee (Coffea arabica) with densities of sourgrass (Digitaria insularis) on crop macronutrient content and plant growth. The experiment was conducted in plots where one coffee plant was maintained in coexistence with 0 (weed-free check), 1, 2, 4, 8, and 16 sourgrass plants, using a completely randomized design with three replicates. Reduction of coffee growth and macronutrient content, except P that increased, started when the coexistence occurred with sourgrass plants in a density of 1 plant per plot. In general, macronutrient content was reduced by 18-50%, while growth characteristics were reduced by 9-41%, when coffee plants coexisted with 16 plants of sourgrass. Thus, sourgrass competition for nutrients was a strong factor limiting coffee plant growth.

Initial growth and competitive ability of yellow nutsedge and irrigated rice

Weeds cause significant reduction in the irrigated rice crop yield. Cyperus esculentus (yellow nutsedge) is adapted to irrigate environment. Information on the competitive ability of the weed to the culture, and their environmental adaptation, are scarce. In this study, we sought to determine the initial growth and competitive ability of yellow nutsedge and irrigated rice, as a function of cultivar growth cycle. Initial growth and competition studies were conducted in a randomized complete design in a greenhouse in the agricultural year 2010/11. For the initial growth study, the treatments consisted of a factorial combination of a biotype of yellow nutsedge and two rice cultivars in the function of the vegetative cycle (BRS Querência: early cycle - IRGA 424: intermediate cycle) and six evaluation times (10, 20, 30, 40, 50, and 60 days after emergence). Were evaluated: plant height, leaf area, aboveground dry biomass and root dry biomass. In the competitive ability study in the replacement series, the cultivar BRS Querência (early cycle) and yellow nutsedge were utilized and tested in different proportions of competition (100:0, 75:25, 50:50, 25:75, and 0:100). Were evaluated leaf area and aboveground dry biomass. In general, rice cultivars have an adaptive value equivalent to yellow nutsedge. IRGA 424 cultivar has less height than weed, becoming the weed control more important in this cultivar. For rice crop, intraspecific competition is more important, whereas for the weed, interspecific competition is the most pronounced.

Effect of desiccation and salinity stress on seed germination and initial plant growth of Cucumis melo

Smellmelon, an annual invasive weed of soybean production fields in the north of Iran, reproduces and spreads predominately through seed production. This makes seed bank survival and successful germination essential steps in the invasive process. To evaluate the potential of Smellmelon to invade water-stressed environments, laboratory studies were conducted to investigate the effect of desiccation and salinity at different temperatures on seed germination and seedling growth of Cucumis melo. Seeds were incubated at 25, 30, 35 and 40 ºC in the darkness in a solution (0, -0.2, -0.4, -0.6, -0.8, 1 and 1.2 MPa) of a salt (NaCl), and in a solution (0, -2, -4, -6, -8, -10, -12 bar) of PEG-6000 (Polyethylene glycol), in two separate experiments. The results showed that the highest percentage and rate of germination occurred at 35 ºC in salt concentrations of 0, -0.2, -0.4 MPa and PEG concentrations of 0, -2, -4 bar. Increasing the concentration of salt (NaCl) and PEG limited germination, seedling growth and water uptake but increased the sodium content in the seedlings. No significant difference was observed among 0, -0.2 and -0.4 MPa of NaCl and among 0, -2 and -4 bar of PEG concentration at 35 ºC. The negative effects of PEG were more than those of NaCl on germination percentage and germination rate. Increased stress levels lead to reduction of root and shoot length, and SVL of seedlings. Na+ content of seedling decreased with limited seedling growth of C. melo.

Initial growth and development of southern sandbur based on thermal units

Availability of basic information on weed biology is an essential tool for designing integrated management programs for agricultural systems. Thus, this study was carried out in order to calculate the base temperature (Tb) of southern sandbur (Cenchrus echinatus), as well as fit the initial growth and development of the species to accumulated thermal units (growing degree days - GDD). For that purpose, experimental populations were sown six times in summer/autumn conditions (decreasing photoperiod) and six times in winter/spring condition (increasing photoperiod). Southern sandbur phenological evaluations were carried out, on alternate days, and total dry matter was measured when plants reached the flowering stage. All the growth and development fits were performed based on thermal units by assessing five base temperatures, as well as the absence of it. Southern sandbur development was best fit with Tb = 12 ºC, with equation y = 0,0993x, where y is the scale of phenological stage and x is the GDD. On average, flowering was reached at 518 GDD. Southern sandbur phenology may be predicted by using mathematical models based on accumulated thermal units, adopting Tb = 12 ºC. However, other environmental variables may also interfere with species development, particularly photoperiod.

Grass Weeds Interfering with Eucalypt: Effects of the Distance of Coexistence on the Initial Plant Growth

Two experiments were carried out to evaluate the initial plant growth of Eucalyptus urograndis growing in coexistence with Urochloa decumbens and U. ruziziensis. In 100-L box, one plant of U. decumbens or U. ruziziensis grew in coexistence with one plant of E. urograndis clones C219H or H15, respectively, in the distances of 0, 5, 10, 15, 20, 25, 30, 35, and 40 cm from the crop. After 30, 60, 90 (both clones), and 150 days (just for H15), growth characteristics were evaluated. Plants of both clones, growing in weed-free situations, showed a better growth and development than plants that grew in weedy situations, independently of the distance, having the highest plant height, stem diameter, dry mass of stem, and dry mass of leaves. As the same way, the number of branches, number of leaves, and leaf area of the clone C219H were similarly affected. Urochloa ruziziensis reduced the dry mass accumulation of stem and leaves by the rate of 0.06 and 0.32 g per plant, respectively, per each centimeter growing nearest to the crop, while U. decumbens reduced by 0.03 and 0.14 g per plant. The interference of U. decumbens and U. ruziziensis with E. urograndis is more intense when weedy plants grow in short distances from the crop.

Megaspore germination and initial development of Regnellidium diphyllum Lindman (Pteridophyta, Marsileaceae) sporophytes in the presence of cadmium

Regnellidium diphyllum has its distribution restricted to Southern Brazil and adjoining localities in Uruguay and Argentina. Currently it is on the list of threatened species of Rio Grande do Sul. The conversion of wetlands into agricultural areas or soil contamination by the introduction of waste products and fertilizers may compromise the establishment and survival of this species. Among the pollutants are heavy metals, such as cadmium (Cd). Megaspores were germinated in liquid culture medium, with concentrations 0 (control), 0.39; 0.78; 1.56; 3.12; 6.25; 12.5; 25; 50 and 100 mg L-1 of Cd, starting from a standard solution of Titrisol® at 1000 mg L-1. The increase of Cd in the growth medium to 50 mg L-1 resulted in low germinability (58%), and no germination was observed on 100 mg L-1. In apomictical sporophytes, the growth of primary root and leaf was significantly reduced and no secondary leaf was formed at Cd concentrations of 12.5 and higher than this. The results indicated that R. diphyllum is tolerant to the presence of Cd up to considerably higher concentrations (0.78 mg L-1) than that normally found in unpolluted aquatic ecosystems (0.01 mg L-1), although the sensitivity to higher concentrations might endanger the establishment and permanence of this species in habitats exposed to contamination with this metal.

Germination, initial growth, and biomass allocation in three native Cerrado species

The parameters of germination, initial growth, and biomass allocation of three native plant species of Cerrado (Copaifera langsdorffii, Dipteryx alata and Kielmeyera coriacea) were established. The species had germination percentages above 88% and average germination times longer than 139 hours. The average time for the opening of the first leaf pair was more than 538 hours for all three species. The average root length of C. langsdorffii and D. alata seedlings after 80 days of growth was around 40cm, four times larger than the average shoot length (<10cm), although the root and shoot biomasses were similar for both species. The average root length (>20cm) of K. coriacea seedlings was four times larger than the average shoot length (<5cm), and the root biomass was 243% greater than the shoot biomass. Increase in seedling biomass was sustained primarily by the cotyledons in C. langsdorffii and D. alata, which acted as reserve organs and showed progressive weight reductions. Increase in seedling biomass in K. coriacea was sustained primarily by photosynthesis, since the cotyledons showed no significant weight reduction, acting primarily as photosynthetic organs. The length of the root systems was at least four times larger than the length of the shoots parts in all three species. Higher investment in root length rather than in root biomass suggest that the initial growth of these species is primarily to ensure access to water resources, apparently putting off the function of the radicular system as storage organ.

Effect of trolox C on cardiac contracture induced by hydrogen peroxide

Hydrogen peroxide (H2O2) perfused into the aorta of the isolated rat heart induces a positive inotropic effect, with cardiac arrhythmia such as extrasystolic potentiation or cardiac contractures, depending on the dose. The last effect is similar to the "stone heart" observed in reperfusion injury and may be ascribed to lipoperoxidation (LPO) of the membrane lipids, to protein damage, to reduction of the ATP level, to enzymatic alterations and to cardioactive compounds liberated by LPO. These effects may result in calcium overload of the cardiac fibers and contracture ("stone heart"). Hearts from male Wistar rats (300-350 g) were perfused at 31oC with Tyrode, 0.2 mM trolox C, 256 mM H2O2 or trolox C + H2O2. Cardiac contractures (baseline elevation of the myograms obtained) were observed when hearts were perfused with H2O2 (Tyrode: 5.9 ± 3.2; H2O2: 60.5 ± 13.9% of the initial value); perfusion with H2O2 increased the LPO of rat heart homogenates measured by chemiluminescence (Tyrode: 3,199 ± 259; H2O2: 5,304 ± 133 cps mg protein-1 60 min-1), oxygen uptake (Tyrode: 0.44 ± 0.1; H2O2: 3.2 ± 0.8 nmol min-1 mg protein-1) and malonaldehyde (TBARS) formation (Tyrode: 0.12 ± 0; H2O2: 0.37 ± 0.1 nmol/ml). Previous perfusion with 0.2 mM trolox C reduced the LPO (chemiluminescence: 4,098 ± 531), oxygen uptake (0.51 ± 0) and TBARS (0.13 ± 0) but did not prevent the H2O2-induced contractures (33.3 ± 16%). ATP (Tyrode: 2.84 ± 0; H2O2: 0.57 ± 0) and glycogen levels (Tyrode: 0.46 ± 0; H2O2: 0.26 ± 0) were reduced by H2O2. Trolox did not prevent these effects (ATP: 0.84 ± 0 and glycogen: 0.27 ± 0). Trolox C is known to be more effective than a -tocopherol or g -tocopherol in reducing LPO though it lacks the phytol portion of vitamin E to be fixed to the cell membranes. Trolox C, unlike vitamin A, did not prevent the glycogen reduction induced by H2O2. Trolox C induced a positive chronotropic effect that resulted in higher energy consumption. The reduction of energy level seemed to be more important than LPO in the mechanism of H2O2-induced contracture

Paraquat poisoning: an experimental model of dose-dependent acute lung injury due to surfactant dysfunction

Since the most characteristic feature of paraquat poisoning is lung damage, a prospective controlled study was performed on excised rat lungs in order to estimate the intensity of lesion after different doses. Twenty-five male, 2-3-month-old non-SPF Wistar rats, divided into 5 groups, received paraquat dichloride in a single intraperitoneal injection (0, 1, 5, 25, or 50 mg/kg body weight) 24 h before the experiment. Static pressure-volume (PV) curves were performed in air- and saline-filled lungs; an estimator of surface tension and tissue works was computed by integrating the area of both curves and reported as work/ml of volume displacement. Paraquat induced a dose-dependent increase of inspiratory surface tension work that reached a significant two-fold order of magnitude for 25 and 50 mg/kg body weight (P<0.05, ANOVA), sparing lung tissue. This kind of lesion was probably due to functional abnormalities of the surfactant system, as was shown by the increase in the hysteresis of the paraquat groups at the highest doses. Hence, paraquat poisoning provides a suitable model of acute lung injury with alveolar instability that can be easily used in experimental protocols of mechanical ventilation