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* No. Fr. of skull Gunshot Wounds Penetrating brain injuries (72 hours or older).................... 23 23 Non-penetrating (dura intact):  Treated with penicillin.......................................... 17 11  Treated with sulphonamides alone.............................. 10 3 Head Wounds due to Blunt Injury  Treated with penicillin.......................................... 16 —  Treated with sulphonamides alone.............................. 7 2   Total

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Philip R. Dodge and Arnold M. Meirowsky

A s a result of clinical experience during World Wars I and II, the literature contains many excellent monographs and papers on the subject of craniocerebral trauma from missile-inflicted wounds. The majority of articles have been devoted to the problems of penetrating brain injuries and much less has been written about tangential or glancing wounds of the scalp and skull where the missiles have not penetrated bone and dura. Although seemingly less dramatic than penetrating injuries, tangential wounds present distinct clinical problems; often an apparently

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Michael L. J. Apuzzo, Khalid M. A. Sheikh, James S. Heiden, Martin H. Weiss and Theodore Kurze

(LAI) assay. This assay has been developed and used extensively by investigators in tumor immunology. 7, 8, 15 It is a specific, reliable, and reproducible method for assessment of cellular immune responses. Clinical Material and Methods Seventy-three patients admitted to the Neurosurgical Service with significant brain injury served as a test population for this study. Selection of patients was based on the presence of: 1) severe closed-head injury, 2) penetrating brain injury, 3) depressed skull fracture, and 4) acute traumatic epidural, subdural, or

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Ricardo E. Jorge, Robert G. Robinson, Sergio E. Starkstein and Stephan V. Arndt

-entry into the community. 26, 30 Thus, social functioning represents a sensitive measure of long-term outcome. Lishman 20 studied a group of 144 individuals included in the Oxford collection of head-injury records and found that affective and behavioral disorders occurred more commonly after damage to the right hemisphere. Grafman, et al. , 8 studied a group of Vietnam war veterans with penetrating brain injuries and also found an association between damage to the right hemisphere and neurobehavioral disturbance. Patients with damage to the right hemisphere may have

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Jason A. Brodkey, Eric D. Laywell, Thomas F. O'Brien, Andreas Faissner, Kari Stefansson, H. Ulrich Dörries, Melitta Schachner and Dennis A. Steindler

an enhanced astrocytic expression of tenascin following penetrating brain injuries involving the human cerebral cortex. The upregulation of a developmentally regulated ECM molecule may have important implications for the sequelae of wound healing and regeneration following traumatic brain injury. Materials and Methods Several cases of traumatic brain injury were analyzed in this study. Included was a sample of cortex and neostriatum from a penetrating stab injury (12-hour survival), as well as two cases of gunshot wound to the brain with 21- and 96-hour

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Abbass Amirjamshidi, Hamid Rahmat and Kazem Abbassioun

be considered significant and we suggest that this period is the proper interval in which angiography should be performed in patients with penetrating head wounds and a high risk for development of TAs. Discussion The body of experience dealing with war injuries, especially brain injuries, has expanded because of the recent turmoil in the Middle East. One fatal consequence of penetrating brain injuries has been DTICH or apoplexy. 9, 10, 14, 21, 34, 36, 42, 47, 69, 73 Local infection, physical or physiological changes in blood vessels, and softening of

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Staffan Holmin, Martin Schalling, Bo Höjeberg, Ann-Christin Sandberg Nordqvist, Ann-Katrin Skeftruna and Tiit Mathiesen

dominated by mononuclear phagocytes and astrocytes. Interestingly, TNFα was produced almost exclusively by astrocytes, whereas the main source of IL-1β was mononuclear phagocytes. The data from experimental paradigms of ischemia, penetrating brain injury, fluid-percussion injury, intact skull acceleration models, in vitro cellular manipulation, and the weight-drop contusional model used in this study are very different. These differences indicate that different pathogenic mechanisms and dynamics are relevant in different kinds of brain injuries. Acknowledgments

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Theodore G. Sarphie, Michael E. Carey, June F. Davidson and Joseph S. Soblosky

after either blunt or penetrating brain injury, both clinically and experimentally. 2, 4, 6, 8, 14, 16, 17, 19, 25–27 Experimental missile wounding of the right cerebral hemisphere in anesthetized cats revealed that in animals receiving between 0.9 and 2.4 j of missile energy deposit, the probability of an immediate fatal apnea was proportional to the missile energy deposit within the brain. 6, 7 Various brainstem lesions that could account for postinjury apnea have been documented, including punctate vascular lesions about the floor of the fourth ventricle 11 as

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Alan M. Haltiner, David W. Newell, Nancy R. Temkin, Sureyya S. Dikmen and H. Richard Winn

had early seizures with those of patients who were seizure free in the 1 st week, after statistically controlling for the effects of the patients' ages and the severity of their head injuries . 4 The head injury severity variables were chosen by stepwise regression, from among the initial GCS scores on hospital admission, the presence of acute intracranial hematoma, cortical contusion, depressed skull fracture, penetrating brain injuries, abnormal pupillary light reflex, and the Abbreviated Injury Scale (AIS) 9 score for the head documented within 24 hours of

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Nancy R. Temkin, Sureyya S. Dikmen, Gail D. Anderson, Alan J. Wilensky, Mark D. Holmes, Wendy Cohen, David W. Newell, Pamela Nelson, Asaad Awan and H. Richard Winn

) level below twice the upper limit of normal. A qualifying injury had at least one of the following characteristics: immediate posttraumatic seizures, depressed skull fracture, penetrating brain injury, or computerized tomography (CT) evidence of a cortical contusion or subdural, epidural, or intracerebral hematoma. The study required drug loading within 24 hours after injury. Most patients were too impaired neurologically to be able to provide informed consent before randomization. Usually, the legal next of kin or a family member provided this consent. In some cases