Objective: Adrenocorticotropic hormone (ACTH) and β-endorphin are pituitary neuro-peptides released by acute stress. We determined why the prognosis of patients with subarachnoid hemorrhages (SAH) due to aneurysmal rupture is not always dependent on the Hunt–Hess grading system (HHS) and delta-National Institutes of Health Stroke Scale (NIHSS), while studying endogenous neuropeptides, including ACTH and β-endorphin. Methods: We analyzed blood samples collected from patients with SAH (SAH group; n=37) and those with unruptured intracranial aneurysms (control group; n=37). Blood sampling was performed before any procedure or chemical agents administration. The results of ACTH and β-endorphin measurements were compared using the delta-NIHSS and HHS. The data were analyzed using descriptive statistics, independent samples t-tests, and Pearson’s correlations. Results: Of the 18 patients with low-grade HHS, 13 had low delta-NIHSS and five showed high delta-NIHSS. Of the 19 patients with high-grade HHS, the delta-NIHSS was ≥14 in the other five patients. ACTH concentration was high (497.3 pg/mL) in five patients with high-grade HHS and high delta-NIHSS. β-endorphin concentration was high (159.7 pg/mL) in 13 patients with low-grade HHS and low delta-NIHSS. Conclusions High ACTH levels in patients with massive bleeding and poor neurological status suggests increasing ACTH secretion in response to bleeding stress, which may aggravate neurological status. Contrary to ACTH, high β-endorphin levels in patients with low-grade HHS implied the involvement of additional factors in predicting fair outcomes related to low delta-NIHSS. These results may provide insight into the varying prognostic potential of HHS in SAH patients.

PURPOSE: The aim of this study was to evaluate the safety of the nonoperative management of traumatic liver injuries. METHODS: The medical records of 67 patients, with traumatic liver injury, between January 1998 and December 2001, were reviewed retrospectively, with respect to the cause of injury, combined injury, hemodynamic stability, amount of transfusion, liver injury grade, length of hospital stay and complications. RESULTS: Of the 67 patients, 30 were treated operatively (Group A), and 37 nonoperatively (Group B). The initial systolic blood pressure in Group A was significantly lower than that in Group B (81.33+/-23.00 vs 108.10+/-20.66 mmHg, P<0.001). The amount of transfusion for hemodynamic stability were 2.83 and 0.89 units (P<0.01), and the mean total transfusion requirement and injury grade were 10.30 and 1.29 units (P<0.001). 3.63+/-0.99 and 2.48+/-1.12 (P<0.001) for Groups A and B. The duration of intensive care unit stay in Group A was significantly shorter than that of Group B (6.70+/-6.12 vs. 3.13+/-4.00 days, P<0.01), but there was no difference in total length of hospital stay. The complication rates in Groups A and B were 63.3 and 21.8%, respectively (P<0.01), and the most common complications were respiratory problems, such as pleural effusion, pneumonia, atelectasis and pulmonary edema. Five patients in Group A died, 2 from hypovolemic shock, and one each from disseminated intravascular coagulation, multiple organ failure, and respiratory failure, but no patients in Group B died. CONCLUSION: Nonoperative management is safe for hemodynamically stable patients with traumatic liver injury, regardless of the injury severity, but close observation and frequent physical examinations must be adhered to.
Blood Pressure ; Disseminated Intravascular Coagulation ; Hemodynamics ; Humans ; Intensive Care Units ; Length of Stay ; Liver* ; Medical Records ; Multiple Organ Failure ; Physical Examination ; Pleural Effusion ; Pneumonia ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Insufficiency ; Retrospective Studies ; Shock