Significantly elevated S-100B and interleukin-8 serum levels 12 hrs after cardiac arrest suggest that primary brain damage and systemic inflammatory response are comparably serious with that of traumatic brain injury. In both collectives, increased S-100B values measured 12 hrs after insult correlated well with an unfavorable neurologic outcome after 12 months.

Alterations of the shoulder girdle motion have been suggested to be associated with shoulder disorders. The objective of this study was to perform a three-dimensional (3D) motion analysis of the supraspinatus muscle and shoulder girdle in patients with different stages of impingement syndrome. 20 patients with unilateral impingement and 14 normal controls were investigated at 30°, 90°, and 120" of abduction with and without abducting muscle activity. The spatial relationship between the shoulder girdle elements and the supraspinatus was quantified from open MRI data. N o significant alterations in glenoid rotation were observed between the patients and asymptomatic volunteers. However, while in the healthy volunteers the values showed a normal distribution (28.5 i 3.6" at 90" abduction with muscle activity), the patients (30.5" & 9.7") contained a subset of five individuals with an obvious increase in glenoid rotation angle (>40") compared with controls (>3S standard deviations higher than the mean) and with the healthy contralateral side. These five patients also displayed alterations in the scapulo-humeral rhythm and supraspinatus motion, but not in clavicular position. The study shows that only a specific subset of patients with impingement syndrome demonstrates complex changes in shoulder girdle and supraspinatus motion patterns, suggesting that this subset may benefit from an alternative type of treatment.

Management of patients with minor head trauma (MHT) continues to be debated in the literature. Measurement of S-100b in serum has been introduced into the discussion as an additional screening tool for intracerebral injuries because routine cranial computed tomography (CCT) of a large number of patients causes logistic difficulties, and the neurologic examination is often impaired by a high frequency of coincidental intoxication. The aim of our study was to determine the diagnostic value of measuring S-100b in the serum of MHT patients to identify risk groups. Additional validity should be aquired by a comparison with plasma levels of polymorphonuclear neutrophil (PMN) elastase an established general trauma marker. A series of 52 patients with MHT were included in the prospective study. At admission the patients underwent a routine CCT scan to detect intracerebral lesions, and blood samples were drawn to investigate circulating levels of S-100b and PMN elastase. For comparison, data for a positive control group of 10 severe head trauma patients (initial Glasgow Coma Scale score < 8) and for a negative control group with 20 healthy volunteers were obtained. The interval between MHT and admission to our hospital was 73.4 +/- 47.0 minutes. The initial S-100b serum levels of MHT patients were 0.470 +/- 0.099 ng/ml, those of the positive control group were 7.16 +/- 3.77 ng/ml, and those of the negative control group were 0.05 +/- 0.01 ng/ml. Relevant pathologic CCT scans were detected in 28.8% of MHT patients; one patient of that group was subjected to immediate surgical intervention (1.9%). At a cut-off point of 0.1 ng/ml, the sensitivity of positive S-100b levels reached 100% and the specificity 40.5%. Plasma levels of PMN elastase reached 60.52 +/- 10.75 ng/ml in the MHT group, 66.4 +/- 14.92 ng/ml in the severely head-injured group, and 23.26 +/- 1.53 ng/ml in the negative control group. Serum levels of S-100b seem to be a highly sensitive but not very specific marker for isolated neurotrauma. Measurement of this parameter may be helpful as an additional screening tool to identify high risk groups in the cohort of MHT patients.

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