Head injuries are the commonest cause of death in the surgical wards in Port Moresby and the commonest cause of death in road accidents. Three prospective and retrospective studies performed over the last decade aimed to determine the pathology and outcome in 274 head injuries admitted to Goroka in 1988-1991 (4 years) and Port Moresby in 1984-1985 and 1992-1993 (total 2.5 years). Head injuries were managed by general surgeons without CT scanning or intracranial pressure monitoring. There were 196 adults and 78 (28%) children; 195 were male and 79 female. Assaults (32%), motor vehicle accidents (49%) and falls (17%) were the commonest modes of injury. The case fatality rate was 21% (57 of 274 cases). Six of the deaths were avoidable. The fatality rates for admission Glasgow Coma Scores of 3-5, 6-8 and over 9 were 81%, 21% and 3% respectively. Two patients died of infection complicating open depressed fractures. The case fatality rate for extradural haematoma was 20% and subdural haematoma 67%. Nine patients died of associated abdominal injuries. Most of the deaths were unavoidable because of the severity of primary brain injury. The speed of diagnosis and quality of care could have been improved but the most important area is management of the airway. General surgeons properly trained in trauma care (which includes emergency airway management) are well able to cope with the majority of head-injured patients in Papua New Guinea.
Craniocerebral Trauma - epidemiology ; Craniocerebral Trauma - therapy ; Glasgow Coma Scale ; Retrospective Studies

Background: Cranial trauma is a major cause of death among types of trauma. So far, although pediatric cranial trauma can leave more severe consequences, it has not still been adequate attended.\r\n', u'Objectives: To study clinical characteristics and cranial trauma treatment of under 16 years old children in Binh Dinh General Hospital. Subjects and method: A retrospective study was conducted on 256 under 16 year old patients with cranial trauma (180 males, 76 female) in Binh Dinh General Hospital from January, 2005 to September, 2005. Results:Cranial trauma in children was common seen in male/female ratio as 70.31/29.69. Common aged between 3-16 years old (89%). Main cause of it was traffic accident (64.5%). 100% of patients admitted to hospital with a Glasgow score 11 points. In those aged 3-16 years old, 14.03% of them with score of Glasgow coma scale \ufffd?2 points. Cranial CT scans: 78 patients, Cranial X-rays: 122 patients. Surgical rate 10.6%. Mean surgical days was 5.12\xb13.80 days. Complication rate was 33.2%. Non-operative mortality was 1.56%. Conclusion: Cranial trauma was common seen in those aged 3-16 years old, in male more than female. According to Glasgow outcome scale, good recovery rate achieved 65.23%. \r\n', u'
Craniocerebral Trauma/ diagnosis ; surgery ; therapy ; Child ; Child ; Preschool ;

OBJECTIVETo observe the clinical effect of hyperbaric oxygen (HBO) therapy at different pressure levels on aphasia after craniocerebral injury and assess the patient adherence to the therapies.

METHODSThirty-one patients with aphasia after craniocerebral injury receiving 30 sessions of HBO therapy at the pressure level of 0.175 MPa and another 31 patients receiving 0.2 MPa therapy were recruited as the treatment groups 1 and 2, respectively; 31 patients who refused to have HBO therapy served as the control group. All the patients received routine therapy. The therapeutic effects were assessed using Western Aphasia Battery (WAB) before and after the therapy. The WAB item and AQ scores, curative effect, and recovery time of aphasia were compared between the 3 groups.

RESULTSThe total response rate was significantly lower in the control group as compared with those in treatment groups 1 and 2 (58.06% vs 83.87% and 87.1%). WAB item scores and AQ scores, curative effect, and recovery time of aphasia all showed significant differences between the control group and the two treatment groups (P<0.05), but not between the latter 2 groups (P>0.05). Compared with 0.20 MPa HBO therapy, 0.175 MPa HBO therapy showed a better patient adherence with a significantly lowered non-adherence rate (by 31.37%) an increased partial and total adherence rates (by 13.86% and 17.51%, respectively).

CONCLUSIONHBO therapy at the pressure level of 0.175 MPa is more appropriate for treatment of aphasia after craniocerebral injury to ensure the safety, efficacy and patient compliance.

Aphasia ; etiology ; therapy ; Craniocerebral Trauma ; complications ; therapy ; Humans ; Hyperbaric Oxygenation ; Patient Compliance ; Pressure

Acupuncture Therapy ; Adolescent ; Craniocerebral Trauma ; complications ; Humans ; Male ; Optic Nerve Injuries ; etiology ; physiopathology ; therapy ; Vision, Ocular

Posttraumatic tremor is often one of the causes of disability in head injury patients. Usually, pharmacotherapy for this type of tremor is not effective. Since early 1970s, surgical ablation of the ventral thalamus has been used to treat various types of tremor. Nowadays, deep brain stimulation (DBS) confirms its efficacy in alleviating different forms of tremor, including posttraumatic tremor. Such therapy has been reported achieving around 80% success rate in the treatment of posttraumatic tremor. These successful results suggest that the application of DBS therapy can be considered as one of the alternative treatments for minimizing the tremor occurring from different pathologies.
Adult ; Craniocerebral Trauma ; complications ; Deep Brain Stimulation ; methods ; Electrodes ; Humans ; Male ; Tremor ; therapy

OBJECTIVETo explore the optimal treatment for craniocerebral trauma complicated with thoraco-abdominal injuries.

METHODSA total of 2165 cases of craniocerebral trauma complicated with thoraco-abdominal injuries admitted to our hospital between July 1993 and June 2003 were retrospectively studied. Among them, 382 cases sustained severe craniocerebral trauma (in which 167 were complicated with shock), 733 thoracic injuries, 645 abdominal injuries and 787 thoraco-abdominal injuries. On admittance, 294 cases had developed shock. With the prime goal of saving life, respiratory and circulatory systems and encephalothilipsis were especially treated and monitored. Priority in management was directed to severe or open injures rather than to moderate or closed injures. For cases with cerebral hernia due to intracranial hematoma and severe shock due to blood loss, cerebral hernia and shock were treated concurrently.

RESULTSAfter treatment, 2024 (93.49%) cases survived and the other 141 (6.51%) died. Among patients who had severe craniocerebral injury with shock and those without, 78 (46.71%) and 53 (24.56%) died, respectively. For patients who had underwent craniocerebral and thoraco-abdominal operations concurrently and those who had not, the death rates were 58.49%-65.96% and 28.57% respectively, indicating a significant difference (P<0.05).

CONCLUSIONSTreatment for hematoma hernia, shock and disturbed respiration is the key in the management of multiple trauma of craniocerebral, thoracic or abdominal injuries, especially when two or three conditions occurred simultaneously. Unless it is necessary, operations at two different parts at the same time is not recommended. It is preferred to start two concurrent operations at different time.

Adult ; Craniocerebral Trauma ; surgery ; therapy ; Encephalocele ; etiology ; therapy ; Female ; Humans ; Male ; Multiple Trauma ; surgery ; therapy ; Retrospective Studies ; Shock, Hemorrhagic ; etiology ; therapy ; Thoracic Injuries ; surgery ; therapy

OBJECTIVETo improve the cure rate of patients with abdominal visceral injury complicated by craniocerebral injury.

METHODSClinical data of 176 cases of abdominal visceral injury complicated by craniocerebral injury were retrospectively analyzed.

RESULTSIn this series, 44 cases died and the mortality was 25.0. The main cause of death is abdominal visceral injury combined with shock and severe craniocerebral injury.

CONCLUSIONSIt is essential to improve the cure rate by accurate diagnosis at early stage. Abdominal paracentesis and CT should be performed promptly and dynamically. Priority should be given to the treatment of life-threatening injuries.

Abdominal Injuries ; diagnosis ; therapy ; Adolescent ; Adult ; Aged ; Child ; Craniocerebral Trauma ; diagnosis ; therapy ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; diagnosis ; therapy ; Viscera ; injuries

UNLABELLEDOBJECTIVE; To observe the effects of early acupuncture on motor function of the limb in the severe head injury patients.

METHODSNinety-six patients were randomly divided into an observation group and a control group, 48 cases in each group. The patient in the control group were treated by routine treatment of neurosurgical operation and drug treatment (Mannitol, Citioline Sodium, Cefeazidime, etc.). While the patient in the observation group were treated by the routine treatment and acupuncture treatment 48 h(-1) week after operation in different stages with different acupoints selected when the situation was stable. The selected main points were Neiguan (PC 6), Qu-chi (LI 11), Waiguan (TE 5), Hegu (LI 4), Binao (LI 14), Jianyu (LI 15), Fengshi (GB 31), Xuehai (SP 10), Yinlingquan (SP 9), Sanyinjiao (SP 6), Taichong (LR 3), etc.. The limb motor function was evaluated with Fugl-Meyer Assessment (FMA) scale before treatment and after 10-week treatment.

RESULTSThere was a significant improvement in the FMA score in the two groups after the treatment (P < 0.01). The comparison between the two groups after the treatment showed that the improvement of FMA score in the observation group was significantly better than the control group (P < 0.05 or P < 0.01).

CONCLUSIONEarly acupuncture can improve the limb motor function in the severe head injury patients.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Craniocerebral Trauma ; physiopathology ; therapy ; Extremities ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Motor Activity

OBJECTIVETo explore the early rehabilitation effect of acupuncture on brain arousal in severe craniocerebral injury.

METHODSOne hundred and two cases of severe craniocerebral injury were randomly divided into an observation group and a control group, 51 cases in each one. Based on the conventional nursing care in neurological external medicine, in observation group, acupuncture was applied at Shuigou (GV 26), Neiguan (PC 6) and Sanyinjiao (SP 6) mainly. In control group, functional electric stimulation was applied at stimulate the affected muscles of the upper limbs. Thirty days later, the lucid rate from coma, lucid interval and clinical efficacy were compared between two groups. RESULTS; The lucid rate from coma was 82.4% (42/51) in observation group, which was higher than 56.9% (29/51) in control group (P < 0.01). The lucid interval in observation group was shortened remarkably as compared with control group (P < 0.01), and the clinical efficacy was superior apparently to that in control group (P < 0.01).

CONCLUSIONOn the basis of conventional treatment, acupuncture intervention at early stage can accelerate the recovery of brain arousal function in patients with severe craniocerebral injury.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Arousal ; Brain ; physiopathology ; Child ; Craniocerebral Trauma ; physiopathology ; rehabilitation ; therapy ; Humans ; Male ; Middle Aged ; Young Adult

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; China ; Craniocerebral Trauma ; diagnosis ; therapy ; Female ; Hospitals, Community ; Humans ; Male ; Middle Aged