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Differential Treatment of Severe Cerebral Contusion Hotbeds


Author: Guranda Viorel
Degree:doctor of medicine
Speciality: 14.00.28 - Neurosurgery
Year:2010
Scientific adviser: Grigore Zapuhlih
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 24 March, 2010
Approved by NCAA on the 3 June, 2010

Abstract

Adobe PDF document0.66 Mb / in romanian

Keywords

severe cerebral contusion hotbeds, differential treatment, Glasgow Outcome Scale

Summary

The thesis contains 127 pages and is structured as follows: Introduction, 4 chapters, conclusions, practical recommendations, bibliography made up of 187 titles, 3 annexes, 18 tables, 32 figures, and one formula. The theses and the ideas of the research have been related in 8 scientific articles.

Field of Investigation: Patients with cerebral trauma complicated by severe cerebral contusion hotbeds who had undergone differential treatment.

Thesis Goals: to establish the rate of the biomechanical mechanisms specific for the production of severe cerebral contusion hotbeds; to study the structure of the clinical evolution forms of severe cerebral contusion hotbeds; to establish the criteria on which is based the differential treatment of patients with severe cerebral contusion hotbeds; to establish the surgical treatment pattern of patients with severe cerebral contusion hotbeds; to determine the efficiency of differential treatment of patients with severe cerebral contusion hotbeds, using the Glasgow Outcome Scale.

The scientific novelty and originality: for the first time there has been established the rate of the biomechanical mechanisms specific for the production of severe cerebral contusion hotbeds. Thus, 65,6% of the patients diagnosed with severe cerebral contusion hotbeds suffered from a direct trauma, by hitting the cephalic extremity in a resting state by a contondent body – type I. Type II – 15,6 % of the patients have been found affected by indirect impact, and type III – through a mixed or associated mechanism has been identified with 18,8% of the patients.

The most frequent form of clinical evolution with severe cerebral contusion hotbeds patients is the “evolutionary” one – 55,6%; the “hermatomic” form has been established among 28,9% of the patients, and only 15,5% of the patients have been diagnosed with the “slow” form. There have been established the criteria on which is based the differential treatment of the patients with severe cerebral contusion hotbeds.

It must include: the degree of consciousness alteration not lower than 8 by the Glasgow Scale, with no negative evolution; the volume of the severe cerebral contusion hotbed up to 50 cm with frontal lobe or occipital localization and up to 30 cm with temporal or temporal-parietal lobe localization; lateral brain dislocation with no more than 5mm.

Theoretical significance: Severe cerebral contusion hotbeds are produced because of the bone irregularities of the skull basis, especially in the anterior or middle level; they include the inferior face of the frontal lobe and the temporal lobe pole, these types of injury prevailing in this research.

The “evolutionary” form is the most frequent within the clinical evolution of severe cerebral contusion hotbeds. It denotes that severe cerebral contusion hotbeds manifest as an intracranial expansive process which develops in time.

The applicative value of the research: The present investigation allows us to recommend a differential treatment pattern for the group of neurosurgical patients with severe cerebral contusion hotbeds, which stipulates a primarily medicinal attitude in cases of both unique and multiple severe cerebral contusion hotbeds.

The use of a primarily surgical treatment diminishes the efficiency of the treatment during the early stage of the severe cerebral contusion hotbeds patients by the 30,3 increase of mortality compared to the primary application of medicinal treatment, where the mortality rate is 14%.