No description available.

<p> Clinical diagnosis, classification of injury and the reliable and detailed description of a patient's neurological status are key factors in determining intervention, rehabilitation programs and predicting recovery. The American Spinal Injury Association (ASIA) impairment scale (AIS) is a standardized method for spinal cord injury (SCI) classification and neurologic status examination. Studies have revealed the AIS classification to be a general assessment tool that fails to explain the varying degrees and patterns of neurological damage, especially in individuals with incomplete injuries. In addition, intragroup variability can be attributed to inaccuracies in examinations and improper assessment tools that have limited research findings. Transcranial Magnetic Stimulation (TMS) has been used as a non-invasive method of evaluating the integrity of the motor nervous system. The primary purpose of this study was to evaluate TMS as an assessment tool to describe motor impairment of SCI individuals. A second purpose of this study was to assess AIS accuracy and sensitivity to muscle activation by using surface electromyographic (sEMG) techniques during clinical examinations. Six incomplete SCI participants were clinically assessed to obtain their individual motor scores from key muscles following AIS assessment criteria. TMS was then used to stimulate the motor cortex to elicit motor evoked potentials (MEPs) in 4 key muscles. MEPs correlated with motor scores, where significantly higher and lower MEPs corresponded to the highest and lowest motor scores, respectively. Of the 48 muscles analyzed, 18 received a motor score of zero; however MEPs were obtained in 7 of these 18 muscles. In general, MEPs paralleled motor function as assessed by the AIS. Results suggest that TMS may provide information on the relationship between corticospinal integrity and the quality of motor function. In addition, TMS demonstrated adequate validity and sensitivity to SCI individual differences. MEPs provided additional information regarding the existence of spared neuronal pathways not identified by standard clinical evaluations. The therapeutic potential of these motor pathways has yet to be explored. EMG activity was significantly correlated to motor scores and MEPs however; EMG analysis revealed some inaccuracies in muscle examinations and supported MEP data. Results suggest that the implementation of electrophysiological assessment tools may be more sensitive to detect motor damage, adaptive movement patterns and overall muscle activation that may be misinterpreted during clinical examinations.</p> / Thesis / Master of Science (MSc)

In the present study, an anger management treatment program was compared to a pseudo-social skills training program (self-help group) and waiting list control group to determine its effectiveness in reducing irritable/angry behavior in head injured subjects. Subjects consisted of 28 adults with previous head injury trauma who had difficulty with excessive irritability and anger. Subjects averaged 35.4 years of age and had an average of 8.9 years post head injury. Treatment consisted of 10 group sessions over a five week period. Anger management training was designed to teach subjects self management skills aimed at reducing the frequency of angry acting out behavior. Training methods included role playing, relaxation training, assertiveness training and cognitive restructuring. The pseudo-social skills training group was a self-help group designed to encourage discussion of irritability problems without teaching specific coping techniques. To assure some degree of homogeneity in cognitive abilities among subjects, minimum eligibility scores were required on five subtests of the Wechsler Adult Intelligence Scale - Revised and the Peabody Picture Vocabulary Test. Dependent measures were pre and posttreatment scores obtained from five categories of the Katz Adjustment Scale - Relative form: belligerence, negativity, general psychopathology, social obstreperousness, and social role functioning. In addition, pre and posttreatment recordings of observed angry/irritable behavior in the subjects were obtained from a significant other. Results failed to reveal statistically significant differences on the dependent measures between the three study groups. In addition, analysis failed to reveal any significant variables that predicted outcome. It is evident that much more organized research is needed to further investigate the possibilities of treatment for various problems encountered by those with head injuries.

The problem with which this study was concerned involved the identification of minimally brain-injured children. The performance on the "Birch-Belmont Auditory-Visual Integration Test" by twenty-five minimally brain-injured students was compared to the performance of twenty-five non-brain-injured children. It was found that when ages and I.Q. scores were not significantly different, and when sexes were approximately proportionate, the M.B.I. children scored significantly lower than did the non-brain-injured children. While it was indicated that the minimally brain-injured children perform less adequately on auditory-visual integration, no comparison of intrasensory and intersensory functioning was made. It was suggested that the test not be employed for sole determination of minimal brain injury, but that it may be used as a screening device quite appropriately.

No description available.

Este trabajo se ha realizado ante el importante problema que supone los accidentes en todos los países del mundo. El objetivo primario ha sido el estudio de los accidentes domésticos y de ocio en la población en general, y proyectado sobre el conjunto de individuos accidentados que acudieron al Servicio de Urgencias del Hospital Nacional Marqués de Valdecilla en el periodo mencionado (36.388 accidentados, de ellos 18.951 varones y 17.437 mujeres). En la recogida de datos , se utilizó un modelo de ficha en la que figuraban las siguientes variables: -Fecha de tratamiento (año, mes, día), -Hora de asistencia, -Número de días de hospitalización, -Tratamiento y cuidados posteriores, -Edad del accidentado, -Sexo, -Mecánica del accidente, -Lugar del accidente, -Actividad realizada, -Diagnóstico de lesiones, -Parte del cuerpo afectada, -Producto implicado en el accidente, -Producto causante, -Descripción del accidente. Se estudiaron las distintas variables y la interacción entre ellas, para tener un conocimiento profundo de la realidad de los accidentes domésticos y de ocio. Estos accidentes originaron una gran demanda asistencial de urgencia, gran número de hospitalizaciones y estancias, así como de control sanitario en los centros de zona, ocasionando sufrimiento humano y gran carga económica. De este estudio se infiere el distinto papel que desarrolla cada sexo en la sociedad, a pesar de la igualdad teórica reconocida. Una vez estudiados estos accidentes nos permite sentar las bases para su prevención, y debido a que sobre ellos inciden gran número de variables, las medidas preventivas deben ser multifactoriales y factibles. / This work was made because of the important problem that these accidents suppose on all over the world.The primary aim was the study of the domestic and leisure accidents on the population in general, and as well as the inclusion of all the injured people who came to the National Marqués de Valdecilla Hospital Emergency Service, during the mentioned period (36,388 injured persons, 18,951 of them were men, and the remaining 14,437 were women).To gather information was used a standard form in which the following variables appeared:-Date of treatment (year, month, day).-Hour of attendance.-Number of days they stayed in the Hospital.-Treatment and following cares.-Age of injured person.-Sex.-Mechanics pertaining to the accident of the injured person.-Place where the accident took place.-Activity done when the accident took place.-Injury diagnosis.-Part of the body affected.-Product involved in the accident.-Causing product.-Description of the accident.Different variables and the reciprocal influence between them were studied, in order to have a profound knowledge of the reality in the domestic and leisure accidents. These accidents originated a great demand in urgent attendance, a great number of hospitations and stays, as well as the health control in local centres. All of this causes human suffering and as well as a great economical cost.From this study you can conclude the different role that is allotted to each sex in the Society, in spite of the theoretical equality accepted of both sexes. Once we have studied the accidents, this allowed us to stablish the rules in order to take precautions against them. Due to the great number of variables that affect them, the preventive measures must be multifactorial and feasible.

Studiens syfte är att undersöka hur det nationella målet för trafiksäkerhet går att följa upp på länsnivå via befintlig statistik från polis och sjukvård. Ger de två källorna en likartad bild av förändringen av antalet vägtrafikskadade under den gångna tjugoårsperioden? Undersök- ningen omfattar personer som skadats och överlevt vägtrafikolyckor i Västmanlands län. Data från 1989/1990 respektive 2008/2009 jämförs. De två statistikkällorna ger en likartad bild av förändringen av antalet vägtrafikskadade bilister, motorcyklister och mopedister. Skillnaderna är däremot stora beträffande gång- trafikanter och cyklister. Antalet skadade personer registrerade av sjukvården i länet har minskat under den studerade tidsperioden. Det beror på att antalet skadade gångtrafikanter och cyklister har blivit färre. På grund av förändringar inom sjukvården kan minskningen inte kvantifieras. Det lägre antalet frakturer, främst hos gångtrafikanter men även hos cyklister, visar att det varit en minskning. Antalet skadade bilister har däremot blivit fler, men de skadas lindrigare än 1989/1990. Gruppen allvarligt skadade bilister (ISS &gt; 8) har dock ökat. För perioden 1997 – 2009 har det inte funnits något nationellt definierat trafiksäkerhetsmål för allvarligt skadade. Enligt polisens statistik är antalet svårt skadade vägtrafikanter i länet oförändrat under perioden. Om allvarligt skadad i sjukvårdens mätning definieras som inlagd på sjukhus har antalet allvarligt skadade under perioden minskat med 27 %. Antalet allvarligt skadade definierat som ISS &gt; 8 är oförändrat. / The purpose of the study is to investigate the extent to which it is possible to make a follow- up on the regional level of the national road safety target by using existing police and hospital statistics. Do the two sources provide a similar picture of the changes of the number of persons injured in road traffic accidents during the past twenty years? The survey covers persons injured but survived in road accidents in the county of Västmanland. 2008/2009 figures are compared with 1989/1990 figures. Both sets of statistics provide a similar picture of the changes with regard to the number of injured motorists, motorcyclists and moped drivers. However, concerning pedestrians and cyclists there are significant differences. During the time period being studied, the number of injured persons registered by the hospitals of the county has decreased. This is due to the fact that the number of pedestrians and cyclists injured has decreased. However, it is due to structural changes of the health care difficult to quantify the reduction. The lower number fractures, primarily of pedestrians but also of cyclists, shows that there has been a decrease. On the contrary, the number of injured motorists has increased, but their injuries are less serious than in 1989/1990. However, the number of those motorists with serious injuries (ISS &gt; 8) has increased. For the period 1997 – 2009 there has not had an established national target for the number of seriously injured. According to police statistics, the number of severely injured road users in the county has remained unchanged during the time period being studied. If those being hospitalized in the medical statistics are defined as seriously injured, the number of seriously injured has decreased with 27 %. However, if seriously injured is defined as those with ISS &gt; 8, the number has remained unchanged.

Background: Whole-body Computed Tomography (CT) scan today is considered a crucial imaging technique in the diagnostic work-up of polytrauma patients implicating a potential survival benefit. Apart from prompt identification of life threatening injuries this imaging technique provides an additional benefit by diagnosing incidental non-trauma associated medical diseases. These incidental findings might be also life threatening and warrant urgent therapy. The downside of whole-body CT is a relatively high radiation exposure that might result in an increased life time cancer risk. The aim of this study was to investigate the frequency and type of non trauma associated incidental medical findings in relation to patient age and potential clinical relevance. Methods: Between January 1st 2011 and December 15th 2012, a total of 704 trauma patients were referred to our hospital’s emergency room that triggered trauma room alarm according to our trauma mechanism criteria. Of these 534 (75.8%) received a whole-body CT according to our dedicated multiple trauma protocol. Incidental Findings (IF) were assigned in three groups according to their clinical relevance. Category 1: IF with high medical relevance (urgent life threatening conditions, unless treated) needing early investigations and intervention prior to or shortly after hospital discharge. Category 2: IF with intermediate or low medical relevance, warranting further investigations. Category 3: IF without clinical relevance. Results: Overall 231 IFs (43.3%) were identified, 36 (6.7%) patients had IFs with a high clinical relevance, 48 (9.0%) with a moderate or minor clinical relevance and 147 (27.5%) with no clinical relevance. The distribution of incidental findings with high or moderate relevance according to age showed an incidence of 2.6%, 6.6% and 8.8% for patients younger than 40 years, 40 to 60 years and older than 60 years, respectively. Conclusion: Whole-body CT scans of trauma patients demonstrate a high rate of incidental findings. Potentially life-threatening, medical findings were found in approximately every 15th patient, predominantly aged over 40 years and presenting with minor to moderate injuries and an Injury Severity Score (ISS) of 10 or less.

Aus Punkt 1: "Jährlich werden in Deutschland etwa 15.000 Patienten mit thermischen Verletzungen stationär behandelt, davon etwa 1.400 Fälle mit schweren und schwersten Verbrennungen intensivmedizinisch in spezialisierten Verbrennungszentren. 20-30% der Patienten sind Kinder. Obwohl die Überlebenswahrscheinlichkeit auch von Patienten mit schwersten thermischen Verletzungen (80 %–90 % verbrannte Körperoberfläche, vKOF) in den letzten Jahrzehnten deutlich erhöht werden konnte, liegt die Sterblichkeitsrate noch immer bei ca. 20 %. (Hartmann & Ottomann 2009, Pallua & von Bülow 2006)"

Ce travail avait pour objectif la synthèse d’hydrogels d’alginates stables dans le temps et leur évaluation comme support de régénération des voies nerveuses lésées du Système Nerveux Central. Différents dérivés amphiphiles de l’alginate de sodium ont été préparés en fixant chimiquement des chaînes alkyles en C12 à différents taux sur le squelette polymère par l’intermédiaire, soit de liaisons ester (alginates esters), soit de liaisons amide (alginamides) moins sensibles à l’hydrolyse. Le comportement en solution des alginamides a été étudié en termes de stabilité dans le temps, de solubilité, de comportement rhéologique, et de taux de gonflement, puis comparé à celui des alginates esters. Les alginamides ont montré des propriétés en solution différentes de celles des alginates esters, en particulier des contraintes critiques faibles, qui sont les conséquences de la formation d’agrégats liée à l’existence d’une réaction secondaire de réticulation chimique lors de la synthèse. Néanmoins, à des concentrations et taux de greffage appropriés, il est possible d’obtenir un réseau polymère tridimensionnel stabilisé par des associations hydrophobes et pouvant servir de pont de régénération pour l’application visée. L’étude in vivo conclut à l’absence de signe de régénération des voies nerveuses chez les animaux lésées sur une durée d’un an. Toutefois, cette étude a permis de valider la stratégie d’implantation d’un gel physique rhéofluidifiant et thixotrope, de définir des méthodes d’analyse des tissus post mortem en présence d’hydrogel, d’examiner la possibilité d’encapsuler un traitement pharmacologique et de définir un cahier des charges élargi de ce biomatériau (pH, stabilité, gonflement …) / The aim of this work was to synthesise alginate hydrogels, stable in time, and to evaluate their potential use as scaffolds for the damaged nerve regeneration in central nervous system. Various amphiphilic derivatives of sodium alginate were prepared by covalent attachment of alkyl chains (12 carbons) onto the polysaccharide at different substitution ratio, either via ester (alginate ester) or amide (alginamide) linkages, these last ones being more stable toward hydrolysis. The properties in solution of the alginamide derivatives were studied in terms of solubility, stability as function of time, rheological behaviour and swelling ratio. Results were compared to those obtained with the alginate ester family and highlighted a different behaviour for the alginamide series in semi-dilute regime. In particular, alginamide hydrogels exhibited a low critical strain which has been attributed to the presence of aggregates in the solution. The formation of these aggregates was due to the occurrence of a secondary cross-linking reaction during the synthesis of polymers. Nevertheless, it was possible, by appropriate tuning of the substitution yield and of the solution concentration, to obtain a three-dimensional network stabilized by intermolecular hydrophobic interactions, which has been evaluated as regenerative support for the considered application. In vivo studies demonstrated the absence of nerve regeneration for the tested injured animals after one year. However, these studies allowed us to evaluate both the strategy for the implantation of a physical gel exhibiting a shear-thinning and thixotrope behavior and the possibility to encapsulate a pharmacological treatment. An enlarged project specification has also been defined for this biomaterial (pH, stability, swelling ratio…)