A distinction between primary and secondary brain damage of vari ous origin, particularly in acute lesions, such as head injury and ische mia is not entirely new. The concept is of practical significance, be cause it is the foremost intention of all clinical efforts to prevent, or at least attenuate the development of secondary sequelae. Primary dam age to nervous elements usually cannot be influenced by treatment. Its prevention is the objective of prophylactic measures. The current volume gathered prominent scientists and clinicians from various fields to pro vide a competent introduction and survey of the various aspects involved in secondary brain damage. It was attempted to provide criteria for the distinction between the primary and secondary phenomena on a morpho logical and functional level, on the basis of the kinetics involved and, most importantly, regarding the different specific manifestations, such as disturbances of microcirculation, aspects of the blood-brain barrier, and of cellular structure and function at a molecular level. Although it was not expected that a grand unifying hypothesis will be reached recon cilable with the many, occasionally opposing views on such a complex subject, nevertheless, the present volume attains an appropriate result. It can best be described as a mosaic of many different pieces which only as an ensemble reflect the current state of the art.

Top level clinical and laboratory scientists present their most recent clinical and experimental findings and concepts. The well balanced contributions illustrate the enormous significance of the dialogue between both laboratory and clinic, ultimately for the benefit of the patients, and contribute to a better understanding of secondary brain damage from trauma and ischemia as basis to develop more effective treatment including drugs.

The publication of the Vth International Symposium 1995 on "Mechanisms of Secondary Brain Damage" in Mauls/ltaly is a collection of focused reviews reaching from novel molecular- and cell biological findings to aspects of clinical management in head injury and cerebral ischemia. A specific purpose of these series of meetings introduced in 1984 is for an exchange on problems of mutual interest by international high ranking experts from the basic sciences and related clinical disciplines, such as intensive care medicine, neurology, or neurosurgery. The present volume covers three major areas: (a) Molecular and cell biological mechanisms including inflammation (b) Novel findings on mechanisms and treatment in cerebral ischemia (c) Secondary processes in head injury, regeneration and treatment Molecular-and cell biology is currently attracting attention towards activation of genomic processes associated with the demise of cells referred to as "programmed cell death" and "apoptosis" which, actually, might be distinguished from each other. Thus, the phenomenon of delayed neuronal death in selectively vulnerable brain areas following brief interruption of blood flow is scrutinized as to the contribution of the activation of suicide genes. The physiological role of such a response, among others, is removal of surplus neurons during ontogenesis of the brain. Yet, evidence is accumulating that similar mechanisms playa role in cerebral ischemia, probably also trauma, where nerve-and other cells demonstrate features of apoptosis. Observations on protection of neurons by administration of protein synthesis inhibitors in cerebral ischemia provide more direct support.

Information is provided from the basic and clinical sciences on the mechanisms damaging the brain from trauma or ischemia. New aspects involve the endoplasmic reticulum, mitochondrial failure, pathobiology of axonal injury, molecular signals activating glial elements, or the emerging therapeutical role of neurotrophins. Experimental issues involve a better analysis of the ischemic penumbra, the salvagable tissue. Therapeutic contributions reach from the environmental influence to gene expression, including neuroprotection, such as hibernation – mother nature’s experiment – or hypothermia which is reported to induce cell swelling. Treatment issues deal also with thrombolysis and combination therapies, or with the clearance of adverse blood components – LDL/fibrinogen – by a novel procedure using heparin. Other highlights are discussing the specificities of pediatric vs. adult brain trauma, or the evolving role of the Apolipoprotein-E e4 gene in severe head injury. An update is also provided on an online assessment of the patient management during the pre- and early hospital phase in Southern Bavaria. The empirical observation of neuroworsening is analyzed in further details, whether this is a specificity autonomously driving the posttraumatic course. Finally, the unsolved question why drug trials in severe head injury have failed so far in view of the promising evidence from the laboratory is subjected to an expert analysis.

This book demonstrates clearly how to perform a clinical examination in the infant or child with a surgical condition. While most textbooks of pediatric surgery focus on the pathological classification and overall management of disease, in clinical practice physicians and surgeons usually use a problem-oriented approach to clinical diagnosis. Surprisingly, this is rarely taught to students. The authors attempt to redress this imbalance by providing a clinical approach to the patient which can be learned with a minimum of factual information. The book should therefore remain useful to the practitioner throughout his or her medical career. It includes detailed coverage of the usual presentations of common diseases, but does not attempt to cover all aspects of the presentations of uncommon diseases unless their recognition is important for the well-being or survival of the child. Generously illustrated, this is a book for all who are learning the art of pediatric surgical diagnosis.

Brain Injury Medicine - which includes free ebook access with every print purchase - is a clear and comprehensive guide to all aspects of the management of traumatic brain injury-from early diagnosis and evaluation through the post-acute period and rehabilitation. An essential reference for physicians and other health care professionals who work with patients with brain injury, the book focuses on assessment and treatment of the wider variety of clinical problems these patients face and addresses many associated concerns such as epidemiology, ethical issues, legal issues, and life-care planning. Written by over 190 acknowledged leaders, the text covers the full spectrum of the practice of brain injury medicine including principles of neural recovery, neuroimaging and neurodiagnostic testing, prognosis and outcome, acute care, rehabilitation, treatment of specific populations, neurologic and other medical problems following injury, cognitive and behavioral problems, post-trauma pain disorders, pharmacologic and alternative treatments, and community reentry and productivity. Brain Injury Medicine, 2nd Edition Features: The acknowledged gold standard reference-brings together knowledge, experience, and evidence-based medicine Comprehensive and current-completely revised, updated, and expanded to include emerging topics and the latest clinical and research advances Multi-disciplinary focus-expert authorship from a wide range of specialties promotes a holistic team approach to a complex, many-faceted condition Covers the entire continuum of care from early diagnosis and assessment through acute management, rehabilitation, associated medical and quality of life issues, and functional outcomes New to the Second Edition: Three new Associate Editors from related disciplines provide added expertise Five new sections: acute rehabilitative care, pediatric TBI, special senses, autonomic and other organ system problems, post-trauma pain disorders 25 new chapters running the gamut from health policy to biomechanics, to military TBI to pediatric issues and more Print + Digital Access: Purchase price includes enhanced e-book containing the complete and fully searchable text plus additional digital-only content

Neuroprotection is becoming an increasingly recognized and important part of critical care and perioperative medicine. As human beings survive increasingly severe life-threatening injuries and complex surgical interventions, it has become clear that neurologic injury and dysfunction is a primary driver of long-term outcome and disability. Neuroprotection is currently under-recognized as the primary objective in promoting recovery from life-threatening injuries, illnesses, and procedures. To address this knowledge gap, Neuroprotection in Critical Care and Perioperative Medicine provides a concise review of the current state of the art of clinical care and research. Within the context of critical care, the specific topics covered will include the primary forms of brain injury on which neuroprotection research and intervention has traditionally focused, such as traumatic brain injury, cardiac arrest, acute ischemic stroke, and intracranial hemorrhage, as well as CNS injuries related to sepsis and acute respiratory distress syndrome, mechanical circulatory support, and premature birth. Within the context of perioperative care, the specific topics covered will include anesthetic and perioperative strategies to reduce brain injury from cardiac surgery, aortic surgery and endovascular repair, carotid endarterectomy, vascular and endovascular neurosurgery, and other major surgical procedures.

This two-volume book offers a comprehensive guide to anesthetic management and critical care management in neurosurgical and neurological patients. This second volume focuses on neurocritical care. The book begins with basic information on the principles of neurocritical care. Management of various neurological problems such as myasthenia gravis, Guillain-Barré syndrome, epilepsy, stroke and many more are discussed in detail. Subsequent sections address nursing care, physiotherapy and psychological care, issues related to brain death and organ donation, and common complications observed in neurological patients during their ICS stays. Each complication is discussed in detail, guiding readers in their clinical practice. In turn, the book’s closing chapters cover e.g. the role of hypothermia and evidence-based practice. The book offers a valuable resource for all residents, fellows and trainees in the fields of neurointensive care and critical care; it will also benefit intensivists and neurocritical care experts.