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Purpose: This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall’s tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). Methods: This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. Results: We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p< 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. Conclusions: Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Tetrodotoxin is considered the most lethal toxin in the marine environment. Prior cases of intoxication previously described correspond to consumption of tetrodotoxin in tropical or subtropical regions of Asia or the Pacific Islands. Objectives: We present the first European case of tetrodotoxin intoxication in a patient who ingested part of a trumpet shellfish (Charonia sauliae) from the Atlantic Ocean in Southern Europe. Case Report: Our patient suffered general paralysis, including the respiratory muscles, a few minutes after the consumption of a few grams of C. sauliae. Intubation and mechanical ventilation were necessary for 52 h after the intoxication. The corresponding electrophysiologic studies showed complete non-excitability, with no recordable sensory or motor nerve conduction. We detected the presence of tetrodotoxin in the mollusk and the patient''s blood and urine by means of high-performance liquid chromatography-mass spectrometry analysis technique. A previous bioassay showed extremely high quantities of the toxin in the mollusk. Conclusions: This case alerts us to the possibility of a very harmful biotoxin in European coastal waters. This now should be included in the differential diagnosis of similar cases in Europe, and we must be vigilant for its possible presence in Europe. [Copyright &y& Elsevier]

Background: Dysautonomic crises represent a relatively unknown complication in patients with severe traumatic brain injury (TBI). Few studies have been undertaken of their pathophysiology and prognostic repercussions. We studied the prevalence of dysautonomic crises after TBI, their radiologic substrate, influence on the clinical course in the intensive care unit (ICU), and effect on neurologic recovery., Methods: A case-control study involving 11 patients with dysautonomic crises admitted with TBI during a span of 1 year and 26 patients admitted with TBI but no crises during the first 3 months of the same year. The initial severity was assessed from Apache II, Glasgow Coma Scale (GCS) scores, and computed tomography (CT) during the first 24 hours. Complications were assessed by the duration of ICU stay, days on mechanical ventilation, need for tracheotomy, and number of infectious complications. Neurologic recovery was assessed with the GCS at discharge from the ICU and with the Glasgow Outcome Scale 12 months later., Results: Both groups were similar at admission. The prevalence of dysautonomic crises was 9.3%. Patients with dysautonomic crises had more focal lesions on cranial CT than patients without crises, a significantly longer ICU stay, and a tendency to have a worse level of consciousness at discharge from the ICU but not 12 months later., Conclusions: Almost 10% of patients with severe TBI have dysautonomic crises during their ICU stay. Patients with dysautonomia were more likely to have focal intraparenchymal lesions, and crises were associated with greater morbidity and a longer ICU stay. Dysautonomic crises determined a worse short-term neurologic recovery.