Kafa travmasında kafa içi basınç ve hipotalamo-hipofizer- gonadal aks arasındaki ilişkinin değerlendirilmesi

Objective: Head traumas have an important place among all traumatic injuries and it is an important public health problem worldwide. Novel methods predicting prognosis may contribute to a decrease in the mortality and morbidity rates.Materials and Methods: Continuous intracranial pressure '(ICP) measurements, initial cerebral computed tomography '(CT) and measurement of the hypothalamicpituitary- gonadal '(HPG) axis hormones between the 0th and 4th days were performed in 15 adult male patients with severe head trauma. The relationship of these parameters with the short-term results of the patients on the 15th day was evaluated. Additionally, provocation tests were carried out to evaluate the HPG axis function.Results: High ICP and compression of basal cisterna increased mortality and they were found to affect prognosis `(p=0.009 and p=0.033, respectively) No statistically significant association was found between midline shift and prognosis. No relationship was found between mortality and mean basal hormone values on the 0th day and between the 1st and 4th days.Conclusion: ICP measurement values and the presence of compression of basal cistern on the initial brain CT can be used to predict the prognosis in severe head injury but there is no significant relationship between hypophyseal hormone values and prognosis

Variations in management of A3 and A4 cervical spine fractures as designated by the AO Spine Subaxial Injury Classification System

© 2022 The authors.OBJECTIVE Optimal management of A3 and A4 cervical spine fractures, as defined by the AO Spine Subaxial Injury Classification System, remains controversial. The objectives of this study were to determine whether significant management variations exist with respect to 1) fracture location across the upper, middle, and lower subaxial cervical spine and 2) geographic region, experience, or specialty. METHODS A survey was internationally distributed to 272 AO Spine members across six geographic regions (North America, South America, Europe, Africa, Asia, and the Middle East). Participants’ management of A3 and A4 subaxial cervical fractures across cervical regions was assessed in four clinical scenarios. Key characteristics considered in the vignettes included degree of neurological deficit, pain severity, cervical spine stability, presence of comorbidities, and fitness for surgery. Respondents were also directly asked about their preferences for operative management and misalignment acceptance across the subaxial cervical spine. RESULTS In total, 155 (57.0%) participants completed the survey. Pooled analysis demonstrated that surgeons were more likely to offer operative intervention for both A3 (p < 0.001) and A4 (p < 0.001) fractures located at the cervicothoracic junction compared with fractures at the upper or middle subaxial cervical regions. There were no significant variations in management for junctional incomplete (p = 0.116) or complete (p = 0.342) burst fractures between geographic regions. Surgeons with more than 10 years of experience were more likely to operatively manage A3 (p < 0.001) and A4 (p < 0.001) fractures than their younger counterparts. Neurosurgeons were more likely to offer surgical stabilization of A3 (p < 0.001) and A4 (p < 0.001) fractures than their orthopedic colleagues. Clinicians from both specialties agreed regarding their preference for fixation of lower junctional A3 (p = 0.866) and A4 (p = 0.368) fractures. Overall, surgical fixation was recommended more often for A4 than A3 fractures in all four scenarios (p < 0.001). CONCLUSIONS The subaxial cervical spine should not be considered a single unified entity. Both A3 and A4 fracture subtypes were more likely to be surgically managed at the cervicothoracic junction than the upper or middle subaxial cervical regions. The authors also determined that treatment strategies for A3 and A4 subaxial cervical spine fractures varied significantly, with the latter demonstrating a greater likelihood of operative management. These findings should be reflected in future subaxial cervical spine trauma algorithms.N