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✓ The aim of the present study was to examine the glial cell response and the possible involvement of the complement cascade following a cerebral cortical contusion. The lesion was produced using a standardized weight-drop technique in adult rats. The blood-brain barrier was damaged, as demonstrated by a decrease of immunoreactivity for a tight junction protein normally expressed by endothelial cells of small vessels in the central nervous system. Increased immunoreactivity for microglial (OX42) and astroglial cells (glial fibrillary acidic protein), as well as macrophages expressing ED1-immunoreactivity (IR) were found in the vicinity of the lesion at all postoperative survival times (2–14 days). In the present study complement factor C3d- and C9-IR was found around the lesion, indicating that activation of the complement cascade had taken place. Furthermore, immunoreactivity for the putative complement inhibitor clusterin (sulfated glycoprotein-2) was found in some of the injured neurons. The contralateral hemisphere showed no evidence of the reaction found in the ipsilateral hemisphere. The balance between complement activation and complement inhibitors may have an impact on the degenerative components in the brain following traumatic injury and in particular on the events leading to nerve cell death.

Between 1968 and 1988, 2298 head-injured patients of all grades of severity were registered in the data bank of a single clinic. The majority of patients were admitted to a community hospital and transferred later to the neurosurgical clinic. The data included mechanism of injury and clinical status at admission, including the level of consciousness according to the Glasgow Coma Score (GCS) before and after resuscitation. After admission, nearly all patients below a score of 8 were intubated and treated with controlled ventilation until the patient awakened, died, or had remained in a steady state for approximately 3 weeks. Assessment of the final outcome was made according to the Glasgow Outcome Scale (GOS) both at discharge and again after the patient's status was stabilized. The results show a stable yearly outcome during the 21 years of recording but a significantly improved good recovery and mortality rate when compared with our previous results. Outcome was significantly correlated to age and type and severity of lesion, as judged by the postresuscitation GCS. The outcome of the 1264 most severely injured, comatose patients (GCS < 9) shows a good recovery rate of 55%, a severely disabled rate of 14%, a vegetative rate of 7%, and a mortality rate of 24%. We attribute these results, which compare favorably with others, to prompt airway control and controlled ventilation in unconscious patients.

The solution structure and rate of formation for a vanadium(V)-peptide complex, vanadium(V)-glycine-tyrosine (V-Gly-Tyr), is examined. Multinuclear NMR spectroscopic studies suggest the amide nitrogen is deprotonated and chelated to the vanadium as observed in peptide complexes of Ni(II) and Cu(II). The carboxylate and the amine groups in the dipeptide also appear to be chelated to the vanadium atom. The rate law for V-Gly-Tyr complex formation suggests that the complex is generated according to two major pathways, both involving H2VO4 − and deprotonated glycine-tyrosine dipeptide (Gly-Tyr−), one with and one without acid catalysis. The rate constant for the first pathway was 1.0 (±0.1) M−2 min‒1 (0.017 (±0.002) M‒2 s‒1), and the rate constant for the second pathway was 1.5 (±0.1) M‒1 min−1 (0.025 (±0.003) M−1 s‒1) The kinetics of complex formation were found to be significantly different from reported vanadate complexes such as vanadate dimer, vanadium(V)- alizarin, vanadium(V)-N-[tris(hydroxymethyl)methyl]glycine, vanadium(V)-EDTA, and vanadium(V)-ATPase. All of the previously studied complexes formed with H3O+ independent rate constants of about 104 M−1 s−1. The slow rates of formation of V-Gly-Tyr imply that equilibrium in such solutions is only slowly achieved. Time dependence curves reveal that the other complexes in the reaction between vanadate and Gly-Tyr form even more slowly however, such complexes are likely to be oxidation products since these complexes were not observed when oxygen was excluded from the solutions. Only low levels of vanadium(IV) complexes were observed in the absence or the presence of oxygen, despite significant concentrations of oxidation products. These observations are consistent with the recycling of the vanadium(IV) to vanadium(V) under the consumption of oxygen. Increasing temperatures also increase the V-Gly-Tyr concentration, however, since the vanadate monomer (V1) concentration increases, little variation in the formation constant is observed. The reaction of vanadate with Gly-Ser was also found to be significantly slower than the formation of vanadate esters and required incubation for more than an hour before equilibrium was achieved. It appears that complex formation between vanadate and ligands containing the peptide functionalities occurs slowly, analogous to formation of peptide complexes of Ni(II) and Cu(II). © 1995, American Chemical Society. All rights reserved. 34 10 2524 2534 Cited By :63

The experience with 2,492 patients treated during a 9-year period in a neurosurgical intensive care unit (NICU) integrated into the ordinary neurosurgical wards is reported. The basic admission criterion was the need for ventilator treatment. During the period studied, the stay in the NICU decreased from a mean of 17 to 10 days. With respect to diagnosis, the largest group was patients with brain injuries (36%), followed by subarachnoid hemorrhage (24%), other intracranial bleeding (17%), and tumors (15%). Treatment consisted mainly of controlled ventilation, the duration of which ranged between 1 and 93 days with a mean of 5 days. Invasive monitoring was done relatively seldom, primarily due to a lack of equipment and staff. The incidence of nonneurosurgical complications was low, and the clinical outcome satisfactory. Nevertheless, it is concluded that for the best care of the severely ill neurosurgical patient, a special, well-equipped NICU with an adequate number of highly qualified staff members closely attached to the neurosurgical clinic is crucial.