136 patients older than 70 years, admitted to our neurosurgical ward directly after head trauma, were analysed. 40% of them were admitted with low GCS, below 9 points, and showed a mortality of 85%. 45 patients had intracranial mass lesions--the commonest was subdural haematoma, with a low incidence of epidural haematomas. In patients admitted with GCS above 12, mortality was 20%, mainly due to pneumonia. Satisfactory results were achieved in 30% of trauma victims. From patients with intracranial space occupying lesions and GCS below 9 points on admission practically all died, despite aggressive surgical treatment and intensive care. Thus, especially in departments with limited resources, therapy can be limited, or even no therapy may be introduced in this group. Surgical treatment can be limited only to patients who are conscious on admission. In patients with non-surgical lesions, low GCS--below 9 points--leads to mortality of 80%, and in this group we propose aggressive intensive care for 24 hours and the limitation of further "maximal" therapy only to those, who significantly improve within this period of time. If the patient has a non-surgical lesion and is conscious after trauma, aggressive treatment of extracranial complication is the most important, because brain injury can usually be well tolerated by these patients. If pneumonia or heart complications do not occur this group of old patients often have a good prognosis.
The authors analysed a series of 111 adult patients admitted to the Department of Neurosurgery, Medical University of Lódź directly after trauma with initial GCS of 3 points. 74% of them had intracranial haematoma, mainly subdural, and were treated surgically within the first 3 hours after trauma. 8 patients had no abnormalities on CT scans. 99 (89%) patients died 2 to 30 days after injury, 8 (7%) survived in a vegetative state, and only in 4 (4%) was a satisfactory result noted, but 2 of them had a stable neurological deficit. 3 of these 4 patients had epidural haematomas and 1 had not abnormalities on repeated CT examinations. We conclude, that among patients with GCS of 3 on admission, only those without major CT abnormalities or with epidural haematoma have a chance of survival. Cases with cerebral lesions on the initial CT examination have an invariably bad prognosis. They could be taken into account as a potential organ donor from the very moment of admission, but only after cerebral circulatory arrest occurred and brain death has been proved according to internationally accepted standards.
This paper discusses 6 trepanned skulls from central Poland, dating from the late Neolithic (3,000-2,800 BC) to early modern times (18th century AD). Four of them come from a small area in and around the town of Brześć Kujawski in Kujawy, a region of long-lasting and intense human settlement in Poland. The analysed skulls provide striking evidence for the long history of trepanation in this part of Europe. Three surgical techniques were used: sawing, scraping, and drilling, either on their own or in combination with one another. Regardless of the method, all the trepanations were fully healed, which proves long-term survival of the patients. All skulls belonged to adult males, who were generally at a higher risk of trauma in the populations from which 4 of the specimens derive. The studied skulls demonstrate a marked evolution in trepanation practices over time. Trepanations from the late medieval and early modern times tend to be smaller, less life threatening, and clearly made for therapeutic purposes to remedy cranial injuries. The remarkable skills of the surgeons who performed them could be linked to the influence of the renowned Danzig Anatomical School in Gdańsk, which was one of the leading centres of medical and anatomical research in northern and central Europe in the 17th and 18th centuries.
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