The objective: to determine the frequency of insomniac disorders in patients with traumatic brain injury (TBI) complicated with subdural hematoma, for early detection and prevention of sleep disorders in recovery periods. Materials and methods. A survey was conducted in 102 patients with TBI complicated with acute subdural hematoma who were operated on in the Neurosurgical Department of the M.A. Tverye State medical center in Perm in the period from 2018 to 2019. The study included patients with the most frequent localization of subdural hematoma. Group I consisted of 31 patients (30%) with a hematoma localized in the frontotemporal region, group II - 28 patients (27%) with a hematoma localized in the parietal - temporal region, group III - 18 patients (18%) with a hematoma localized in the frontotemporal - occipital region, group IV - 25 patients (25%) with a hematoma localized in the parietal-occipital region. On day 13-14 after surgical intervention to remove the subdural hematoma, the patients were interviewed using the ISI scale to determine the presence and severity of insomnia. Results. The severity of condition on admission was assessed as 13-12 points on the Glasgow scale in the largest number of patients. The most severe general condition on admission was noted in patients with subdural hematoma localized in the frontal-parietal-occipital area. Out of 102 patients, only one patient was found to have moderate sleep disturbances when assessing the insomnia severity index and 13 patients were found to have mild sleep disturbances. The most common complaints of the patients when interviewed were a feeling of heaviness in the head after sleep, intermittent, shallow sleep. Conclusion. Interrupted sleep and heaviness in the head afterwards, as well as the need for daytime sleep, are the most frequent complaints about the sleep process in patients with a traumatic brain injury complicated with a subdural hematoma on the 13th-14th day after injury.
A fairly common trauma in the population of developed and developing countries is traumatic brain injury, with a significant proportion of patients of the elderly and senile age due to objective reasons. However, anatomical and morphological features of the dura mater (DM) are extremely poorly covered in the scientific medical literature. The aim of the study was to investigate the age-related features of the structure and thickness of the dura mater of a person in the elderly and senile age.Material and methods. The work was based on the analysis of the results of a comprehensive morphological examination of the DM of 127 deceased (65 men and 62 women) of adolescent, elderly and senile age. Autopsy material was taken from the parietal bones in the projection of the sagittal suture. Hematoxylin and eosin and van Gieson staining was used. The thickness of the DM was determined.Results. The age morphometric features of DM consist in its statistically significant increase in its thickness in both sexes (p < 0.01). The most pronounced changes are in senile age compared to adolescent: men have 60.7 % more thickness (p < 0.01) and women 63.5 % (p < 0.01). There are no statistically significant differences in the thickness of the DM between men and women in each age period studied (p > 0.05).Conclusions. The results of the study can serve as a foundation for the future study of age-related changes in the human DM, as well as for use by physicians of such clinical specialties as forensic medicine, neurosurgery, trauma and rehabilitation, gerontology.
The aim of the study was to determine the relationship between the effectiveness of treatment of patients with traumatic brain injury complicated by subdural hematoma and the localization of the hematoma. Materials and methods. The medical documentation of 52 patients with traumatic brain injury (TBI) complicated by acute subdural hematoma with a volume of 60-100 cm3 was retrospectively analyzed. Patients were divided into 3 groups depending on the location of the hematoma: group I consisted of 21 patients (40%) with hematoma localization in the frontotemporal region, group II - 18 patients (35%) with hematoma localization in the parietal - temporal region, group III - 13 patients (25%) with hematoma localization in the frontotemporal - occipital region. When patients are discharged from the hospital, their condition indicators are calculated according to the Rankin scale. Results. More often subdural hematomas were localized in the frontotemporal and parietal-temporal regions, less often in the frontotemporal-occipital region. The severity of the victims' condition, estimated at less than 10 points according to the Glasgow scale, prevailed in patients with TBI complicated by subdural hematoma localized in the frontal-parietal-occipital region. The volume of hematoma localized in the frontal-parietal-occipital region prevailed in comparison with the frontal-temporal and parietal-temporal regions (p<0.01). After completing treatment in a specialized department, the degree of independence and disability, less than 2 points according to the Rankin scale, was established in 31 (60%) of the 52 victims; of these, in 18 (35%) patients, the hematoma was localized in the frontotemporal region. Conclusion. The results of surgical treatment of patients with TBI complicated by subdural hematoma with a volume of 60-100 cm3 are interrelated with its localization. The best indicators of treatment effectiveness were found in patients with subdural hematoma localized in the frontotemporal region. The least effective treatment was observed when the hematoma was localized in the frontal-parietal-occipital region.
Aim to conduct a comparative analysis of the structure and thickness of the dura mater between men and women in the first period of adulthood and in old age. Material and methods. We analysed the results of the complex morphological study of the dura mater in 91 deceased (49 male and 42 female) aged of 22 to 32 and 75 to 88 years. The deceased were divided into two groups according to their age. Group I included 49 cases of the first period of adulthood: 26 men and 23 women who died at the age of 22 to 32. Group II consisted of 42 cases of senile age: 23 men and 19 women who died at the age of 75 to 88. The autopsy material was collected around the parietal bones, in the projection of the sagittal suture. Results. The dura mater was represented by dense unformed connective tissue. The collagen fibers in the first period of adulthood are compactly organized, have a clear direction and structure. In the old age there is a pronounced disorder of the fibers. The walls of blood vessels in senile patients are usually thickened. The dura mater thickens with age by 29.2% in men and by 28.2% in women.
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