Trauma is the leading cause of death in individuals less than 45 years old worldwide, and up to 50% of trauma fatalities are because of brain injury. Prediction of outcome is one of the major problems associated with severe traumatic brain injury (TBI), and research efforts have focused on the investigation of biomarkers with prognostic value after TBI. Therefore, our aim was to investigate whether cell-free DNA concentrations correlated to short-term primary outcome (survival or death) and Glasgow Coma Scale (GCS) scores after severe TBI. A total of 188 patients with severe TBI were enrolled in this prospective study; outcome variables comprised survival and neurological assessment using the GCS at intensive care unit (ICU) discharge. Control blood samples were obtained from 25 healthy volunteers. Peripheral venous blood was collected at admission to the ICU. Plasma DNA was measured using a real-time quantitative polymerase chain reaction (PCR) assay for the b-globin gene. There was correlation between higher DNA levels and both fatal outcome and lower hospital admission GCS scores. Plasma DNA concentrations at the chosen cutoff point ( ‡ 171,381 kilogenomesequivalents/L) predicted mortality with a specificity of 90% and a sensitivity of 43%. Logistic regression analysis showed that elevated plasma DNA levels were independently associated with death ( p < 0.001). In conclusion, high cell-free DNA concentration was a predictor of short-term mortality after severe TBI.
A case of the rare condition pneumosinus dilatans of the maxillary sinus is presented. This is a rare differential diagnosis of a maxillary disease. The diagnostic imaging features of this condition are described, and a recommendation of views for adequately delineating this disorder is given. Only a few cases of pneumosinus dilatans of the maxillary sinus are described in the English-language literature, and the precise cause and pathogenesis remain obscure. We performed an enlargement of the maxillary ostium in order to increase the ventilation of the paranasal sinus. In the short-term follow-up, this patient has been asymptomatic. The postulated mechanism of air trapping in the sinus cavity seems to be logical in this case, because the symptoms were eliminated by surgically decompressing the sinus to overcome this valve mechanism.
Fall is generally meeting time, and each year most of us must pick and choose where to spend our travel budgets and how best to leverage our time away from our practices and work obligations. Meetings are vital for keeping up-to-date with the rapid advances in brain injury and the developments that are shaping our growing field. On a practical level, nothing can replace the face-to-face contact that comes from attending a professional conference or seminar, but for those of you unable to attend the NABIS meeting, we hope that the abstracts presented in the following pages will at least give you a feel for our annual event. In addition to the presentation of the abstracts included in this issue, over 50 invited speakers will present the latest advances in the science, rehabilitation and treatment of traumatic brain injury. The full conference program is posted on the NABIS Web site, We hope that you will consider submitting your work for our 2009 meeting. Better yet, we hope that you will also consider becoming a member of our multidisciplinary society. Whether it is in the area of research or clinical care, NABIS stands behind the premise that advances in science and practices based on application of the scientific evidence will ultimately provide the best outcomes for those with brain injuries and the community as a whole. ObjectivesTo review issues common to case management of people with acquired brain injury (BI), both as communitybased/external case managers and as facility-based case managers. This presentation will focus on issues involving managing a treatment team, working successfully with families, providing leadership toward targeted outcomes, customer service issues for all stake holders and developing and maintaining a positive relationship with clients so that they may reach an optimal level of independence and self-worth through improved productive activity and expanded social capital. MethodThe presenters will provide demographic data, literature reviews and multiple examples of "successes" and "failures" with community reintegration of BI clients with different types of case management. This didactic presentation will allow attendees to interact and ask questions of the presenters regarding case management strategies which may be implemented to improve the client's success. ResultsAttendees will have a good understanding of how case management can improve successful outcomes for people with BI and will learn strategies that may be implemented in their practices to help better the lives of their clients with brain injury. NABIS Abstracts
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