We investigated the time course of neuron specific enolase (NSE) and S-100 protein after severe head injury in correlation to outcome. We included 30 patients (GCS < 9), who had been admitted within 5 hours after injury, in a prospective study. Blood samples were taken on admission, 6, 12, and 24 hours and every 24 hours up to the fifth day after injury. The outcome was estimated on discharge using the Glasgow Outcome Scale. 70% reached a good outcome. All concentrations of NSE and 83% of the S-100 samples were elevated concerning the first probe (30.2 micrograms/l NSE mean and 2.6 micrograms/l S-100 mean). Patients with bad outcome had an NSE concentration of 38 micrograms/l (mean) compared with 26.9 micrograms/l (mean) in patients with good outcome. Patients with bad outcome had an S-100 concentration of 4.9 micrograms/l (mean) compared with 1.7 micrograms/l (mean) in patients with good outcome (p < 0.05). The mean values of NSE and S-100 decreased during the first 5 days. Four patients with increasing intracranial pressure showed a quick increasing concentration of NSE, in two patients the S-100 level showed a slower rise. The NSE serum levels did not correlate with intracranial pressure values. Our results show that the first serum concentration of S-100 seems to be predictive for outcome after severe head injury.

Despite the fact that some patients remain in a poor neurological condition, quality of life after decompressive surgery for ischemic stroke seems to be acceptable to the patients.

It has become practically impossible to survey the literature on cells derived from adipose tissue for regenerative medicine. The aim of this paper is to provide a comprehensive and translational understanding of the potential of UA-ADRCs (uncultured, unmodified, fresh, autologous adipose derived regenerative cells isolated at the point of care) and its application in regenerative medicine. We provide profound basic and clinical evidence demonstrating that tissue regeneration with UA-ADRCs is safe and effective. ADRCs are neither ‘fat stem cells’ nor could they exclusively be isolated from adipose tissue. ADRCs contain the same adult stem cells ubiquitously present in the walls of blood vessels that are able to differentiate into cells of all three germ layers. Of note, the specific isolation procedure used has a significant impact on the number and viability of cells and hence on safety and efficacy of UA-ADRCs. Furthermore, there is no need to specifically isolate and separate stem cells from the initial mixture of progenitor and stem cells found in ADRCs. Most importantly, UA-ADRCs have the physiological capacity to adequately regenerate tissue without need for more than minimally manipulating, stimulating and/or (genetically) reprogramming the cells for a broad range of clinical applications. Tissue regeneration with UA-ADRCs fulfills the criteria of homologous use as defined by the regulatory authorities.

The serum level of S-100B calculated within 1 to 6 hours of a severe head injury is a useful additional outcome predictor.

Different authors recommend different time spans for conservative treatment before considering surgery in patients suffering from lumbar disc herniation. We analyzed the time of onset of symptoms such as pain, sensory deficit, and motor deficit in a surgically treated group in comparison to outcome after surgery in order to define a time threshold when surgical results deteriorate and operation should therefore be considered. General data, symptoms, signs, and neurological findings of 219 patients were preoperatively recorded. The outcome was evaluated according to the Prolo scale after a mean of 9.9 months. In the statistical workup, we calculated the duration of symptoms, sensory deficits, and motor deficit as continuous variables. Additionally, the population was divided into three groups of duration of symptoms, sensory deficit, or motor deficit for < or = 30 days, 30-60 days, and >60 days. Statistically significant predictors for unfavourable outcome were, for example, a longer duration of preoperative pain and motor and sensory deficit. Patients suffering for more than 60 days from disc herniation were found to have statistically worse outcome than patients suffering for 60 days or less. Findings were similar for the different time groups concerning the duration of sensory deficit but not for duration of motor deficit. The overall outcome seems to be better when patients are operated on for lumbar disc herniations within 2 months after onset of symptoms and sensory deficits. Due to these findings, we recommend conservative treatment up to 2 months and, if conservative management does not succeed, consideration of surgery.

Object Pyogenic vertebral infections are rare. In most papers investigators have focused on risk factors, clinical characteristics, and diagnostic findings, and discussed different management strategies. The optimal strategy for dealing with spinal infections, however, remains controversial. Additionally, outcome data regarding quality of life (QOL) after pyogenic spinal infections are sparse. The aim of this study was to provide further data in this field. Methods The authors retrospectively investigated 62 patients suffering from pyogenic spinal infections. In 37 patients (59%), lumbar lesions were observed; thoracic and thoracolumbar infections were documented in 19 (31%) and a cervical infection was demonstrated in six patients (10%). Overall 28 patients (45%) underwent conservative treatment, and 34 (55%) underwent surgery with or without the placement of instrumentation. At follow-up examination the authors recorded each patient’s satisfaction as well as QOL according to the 36-Item Short Form Health Survey. Quality of life after treatment of pyogenic spine infections did not reach the level of the normative sample. Most patients continued to suffer some sort of pain. Despite different indications, the surgically treated patients experienced a slightly better QOL and self-reported satisfaction levels, as well as a statistically significant better outcome, than patients treated conservatively. Conclusions The results obtained in the present study suggest that surgery, especially in conjunction with the placement of instrumentation, may be more beneficial than conservative treatment in patients with a spinal infection.

S-100 appears to be a promising marker for the severity of head injury and neuronal damage.

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