A Clinical Consideration Upon the Cephalic Trauma (Especially Investigation of the Cause of Death)
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概要
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The authors inquired and considered 196 cases of cephalic trauma patients since 1959. Most of these cases were caused by the traffic accidents, and of the mortality cases, and the causes were quite similar except only one, Considering that 13.9% of the wounded were intoxicated when they were injured, the influence of liquor are serious.As to the age of the wounded, in accordance with the accepted reports, the number the twenties was largest and that of the infants and little children came next. As to the time of the occurence of the accidents, most of the accidents occured in the afternoon. The degree of unconsciousness and the length of its elapsed time are considered to have serious influence on the prognosis, but the case in which the wounded had been unconscious for six days, was happily cured and the patient progressed favourably after leaving the hospital.The existence of the shock-symptoms and the recovery from such symptoms have been said to have serious influence on the prognosis too, and this was proved to be true through the following facts:(1) Eight of the 13 wounded whose temperature had been lower than 35°C died.(2) Seven of the 14 wounded whose pulse had beaten less than 50 died.(3) Eight of the 44 wounded whose blood pressure had remarkably fallen died. So in the existence of the shock symptoms the treatment, of the wounded should not be delayed aid the long transportation of the patient in such a case must be prohibitted.Too high temperature has a great influence on the prognosis too and considering that within four days after the attack of the high fever all of the wounded died, the positive application of the low temperature treatment shoud be taken in future. Moreover considering the necessity of the judgement of the prognosis by using the puncture in lumbar vertebra we have lately used an early puncture in lumbar vertebra and no trouble was noticed.The increasing of leucocyte should be refered too, and in the case of the encephalic contusions, 5 of the 23 wounded whose leucocyte number had been larger than 10, 000, died. As the local symptoms of the brain, the abnormality of the tenotomy reflexion often appeared but this was not always in accordance with the symptoms and the fact that the death of 12 of the 27 cases in which the abnormality of the pupil appeared, is considered to be one of the most important factors for the judgement of the prognosis.Headache, vomiting and nausea often appeared in the slight illness, so these cannot be refered so much for the judgement of the prognosis. But these were complained when the patients were about to leave the hospital and so close attention should be paid in treatment.As to the plan of the treatment, very few operations were performed, but considering that in the 8 cases of autopsy, there was only one case in which the operation had been applicable, therefore careful consideration shoud be given for deciding the operation Mortality rate through our treatment was 3.5% and this is not so high as the percentage compared with other reports, so it can be said that the application of the operation must be decided very cautiously.
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
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