Archivos de la categoría Neurotraumatología

The SYNAPSE Trial has failed

Progesterone is an endogenous steroid hormone involved in the menstrual cycle, pregnancy, and embryogenesis of humans and other species.

It belongs to a group of steroid hormones called the progestogens, and is the major progestogen in the body. Progesterone is also a crucial metabolic intermediate in the production other endogenous steroids, including the sex hormones and the corticosteroids, and plays an important role in brain function as a neurosteroid.

Progesterone has been associated with robust positive effects in animal models of traumatic brain injury (TBI) and with clinical benefits in twophase 2 randomized controlled trials. Skolnick et al, investigated the efficacy and safety of progesterone in a large, prospective, phase 3 randomized controlled trial.

A multinational placebo controlled study, in which 1195 patients, 16 to 70 years of age, with severe traumatic brain injury TBI (Glasgow Coma Scale score, ≤8 (on a scale of 3 to 15, with lower scores indicating a reduced level of consciousness and at least one reactive pupil) wererandomly assigned to receive progesterone or placebo. Dosing began within 8 hours after injury and continued for 120 hours. The primary efficacy end point was the Glasgow Outcome Scale score at 6 months after the injury.

Proportional-odds analysis with covariate adjustment showed no treatment effect of progesterone as compared with placebo (odds ratio, 0.96;confidence interval, 0.77 to 1.18). The proportion of patients with a favorable outcome on the Glasgow Outcome Scale (good recovery or moderate disability) was 50.4% with progesterone, as compared with 50.5% with placebo. Mortality was similar in the two groups. No relevantsafety differences were noted between progesterone and placebo.

Primary and secondary efficacy analyses showed no clinical benefit of progesterone in patients with severe TBI. These data stand in contrast to the robust preclinical data and results of early single-center trials that provided the impetus to initiate phase 3 trials. (Funded by BHR Pharma; SYNAPSE ClinicalTrials.gov number, NCT01143064 .) 1).

1) Skolnick BE, Maas AI, Narayan RK, van der Hoop RG, MacAllister T, Ward JD, Nelson NR, Stocchetti N; the SYNAPSE Trial Investigators. A Clinical Trial of Progesterone for Severe Traumatic Brain Injury. N Engl J Med. 2014 Dec 10. [Epub ahead of print] PubMed PMID: 25493978.

Moderate elevations in international normalized ratio should not lead to delays in neurosurgical intervention in patients with traumatic brain injury

Intracranial procedures are often deferred until an international normalized ratio (INR) of less than 1.4 is achieved. There is no evidence that a moderately elevated INR is associated with increased risk of bleeding in neurosurgical intervention (NI). Thromboelastography (TEG) provides a functional assessment of clotting and has been shown to better predict clinically relevant coagulopathy compared with INR.

Traumatic brain injury (TBI) patients with an admission INR of greater than 1.4 had a longer time to NI. The use of plasma transfusion to decrease the INR may have contributed to this delay. A moderately elevated INR was not associated with coagulopathy based on TEG. Routine plasma transfusion to correct a moderately elevated INR before NI should be reexamined

Rowell SE, Barbosa RR, Lennox TC, Fair KA, Rao AJ, Underwood SJ, Schreiber MA. Moderate elevations in international normalized ratio should not lead to delays in neurosurgical intervention in patients with traumatic brain injury. J Trauma Acute Care Surg. 2014 Dec;77(6):846-851. PubMed PMID: 25423533.

XVI Simposium Internacional de Neuromonitorización y Tratamiento del Paciente Neurocrítico

XVI Simposium Internacional de Neuromonitorización y Tratamiento del Paciente Neurocrítico

Barcelona, 18 – 22 de noviembre de 2014

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Hoy cursos precongreso:

ACTUALIZACIONES EN LA FISIOPATOLOGÍA Y TRATAMIENTO DEL TRAUMATISMO CRANEOENCEFÁLICO
MONITORIZACIÓN DE LA AUTORREGULACIÓN CEREBRAL. FUNDAMENTOS FISIOLÓGICOS DE IMPORTANCIA CLÍNICA
HEMORRAGIA SUBARACNOIDEA ANEURISMÁTICA. ACTUALIZACIÓN EN LA FISIOPATOLOGÍA, MONITORIZACIÓN Y TRATAMIENTO 
MONITORIZACIÓN DE LA OXIGENACIÓN CEREBRAL EN EL PACIENTE NEUROCRÍTICO. FUNDAMENTOS, MONITORIZACIÓN Y APLICACIONES PRÁCTICAS
CONTROVERSIAS EN LA FISIOPATOLOGÍA, NEUROMONITORIZACIÓN Y TRATAMIENTO DEL PACIENTE NEUROCRÍTICO

Today: Controversies in Neurotrauma

controvnov7This course is designed to provide participants with a unique opportunity to advance their knowledge and surgical skills in brain trauma and spinal cord trauma through didactic lectures and case-based discussions with renowned neurotrauma thought leaders.

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New Book:Clinical Neuroendocrinology, Volume 124 (Handbook of Clinical Neurology)

Clinical Neuroendocrinology, Volume 124 (Handbook of Clinical Neurology)

Clinical Neuroendocrinology, Volume 124 (Handbook of Clinical Neurology)

List Price:$275.00

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Clinical Neuroendocrinology, a volume in the Handbook of Clinical Neurology Series gives an overview of the current knowledge in the field of clinical neuroendocrinology. It focuses on the pathophysiology, diagnosis, and treatment of diseases of the hypothalamus and the pituitary gland. It integrates a large number of medical disciplines, including clinical endocrinology, pediatrics, neurosurgery, neuroradiology, clinical genetics, and radiotherapy. Psychological consequences of various disorders and therapies, as well as therapeutic controversies, are discussed. It is the first textbook in the field to address all these aspects by a range of international experts.

*All contributors are recognized experts in the different fields of clinical neuroendocrinology *The book provides expanded coverage on hypothalamic mechanisms in human pathophysiology *The book includes current perspectives, diagnosis and treatment of pituitary diseases


Product Details

  • Original language: English
  • Number of items: 1
  • Dimensions: 10.59″ h x 1.06″ w x 7.83″ l, 3.22 pounds
  • Binding: Hardcover
  • 456 pages

Editorial Reviews

From the Back Cover

The book gives an overview of the current knowledge in the field of clinical neuroendocrinology. It focuses on the pathophysiology, diagnosis and treatment of diseases of the hypothalamus and the pituitary gland. It integrates a large number of medical disciplines including clinical endocrinology, pediatrics, neurosurgery, neuroradiology, clinical genetics, and radiotherapy. Psychological consequences of various disorders and therapies, as well as therapeutic controversies are discussed. It is the first textbook in the field to address all these aspects by a range of international experts.

About the Author
Eric Fliers is Professor of Endocrinology at the University of Amsterdam, serving as head of the Department of Endocrinology and Metabolism at the Academic Medical Center in Amsterdam since 2007. He received a PhD in Neuroscience on the functional neuroanatomy of the human hypothalamus, followed by his MD (with honors), both from the University of Amsterdam. He was subsequently trained as an internist-endocrinologist. Fliers was one of the founders of the Netherlands Brain Bank. His current research interests include the hypothalamus-pituitary-thyroid axis, and the neuro-endocrine response to illness. Eric Fliers is the current chair of the Dutch Endocrine Society.

Prof. Márta Korbonits is a clinical academic endocrinologist with special interest in pituitary tumorigenesis and as well as metabolic effects of hormones. She graduated in medicine at Semmelweis Medical School in Budapest and works in the Department of Endocrinology at Barts and the London School of Medicine at St. Bartholomew’s Hospital in London since 1991, where currently she is Co-Centre Head. She received an MD and a PhD from the University of London and was a recipient of a Medical Research Council Clinician Scientist Fellowship to study ghrelin physiology and genetics. Her current interests include hormonal regulation of the metabolic enzyme AMP-activated protein kinase, the physiology and pathophysiology of ghrelin and endocannabinoids and pituitary tumours including familial cases. She has a large collection of familial isolated pituitary adenoma families and works on both the clinical characterization as well as molecular aspects of this disease.
She has published over 160 papers, numerous book chapters, and edited two books in the field of Endocrinology and has been an invited speaker on medical conferences all over the world. She serves on the editorial board of several prestigious endocrine journals and serves as referee for numerous high-impact journals and grant-giving bodies. She was heading the Program Organizing Committee of the Society for Endocrinology for three years, served on the Executive Committee of the Pituitary Society and ENEA and currently the European Society of Clinical Investigation and is an elected member of the Association of Physicians of Great Britain and Ireland. She has received numerous awards including the Nicholas Zervas Lectureship at Massachusetts General Hospital, Harvard Medical School and the prestigious Society for Endocrinology Medal.
She shares her time between clinical patient care, clinical research and laboratory based research as well as teaching at undergraduate and postgraduate level.

Johannes A. (Hans) Romijn was trained in internal medicine in the Academic Medical Center, University of Amsterdam, followed by fellowships in intensive care and clinical endocrinology. He was professor and chairman of Medicine and of Endocrinology at the Leiden University Medical Center, The Netherlands between 1998 and 2010. Since 2010 he serves as professor and chairman of the Division and Department of Medicine, Academic Medical Center, University of Amsterdam in The Netherlands. He is currently the Editor-in-Chief of the European Journal of Endocrinology, the leading journal of the European Society of Endocrinology. His research focuses on the pathophysiology of endocrine and metabolic regulation, with a special focus on clinical neuroendocrinolog

New Book: Neurocritical Care Monitoring

Neurocritical Care Monitoring

By Chad Miller, Michel Torbey

Neurocritical Care Monitoring

List Price:$95.00
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I commend the editors for their careful perspective on the current state of neuromonitoring. The individual chapters provide excellent overviews of specific neuromonitoring tools and paradigms.”

From the Foreword by J. Claude Hemphill III, MD, MAS, FNCS

While damage resulting from a primary injury to the brain or spine may be unavoidable, harm from secondary processes that cause further deterioration is not. This practical, clinical resource describes the latest strategies for monitoring the brain after acute injury. With a focus on individualization of treatment, the book examines the role of various monitoring techniques in limiting disability and potentiating patient recovery during the acute phase of brain injury. International experts in diagnosis and treatment of secondary injury explain in detail the current utilization, benefits, nuances, and risks for each commercially available monitoring device as well as approaches vital to the care of brain and spine injured patients. They cover foundational strategies for neuromonitoring implementation and analysis, including proper catheter placement, duration of monitoring, and treatment thresholds that indicate the need for clinical intervention. The book also addresses multimodality monitoring and common programmatic challenges, and offers guidance on how to set up a successful multimodal monitoring protocol in the ICU. Also included is a chapter on the key role of nurses in neuromonitoring and effective bedside training for troubleshooting and proper execution of treatment protocols. Numerous illustrations provide further illumination.

Key Features:

Presents state-of-the-art neuromonitoring techniques and clinical protocols for assessment and treatment

Emphasizes practical implementation for successful patient outcomes

Written by international experts at the forefront of neurocritical care monitoring

Provides a framework for practitioners who wish to individualize patient care with an emphasis upon the needs of the critically ill brain

Discusses the key role of nurses in neuromonitoring and effective bedside training for management and troubleshooting of devices


Product Details

  • Published on: 2014-10-10
  • Original language: English
  • 184 pages

Editorial Reviews

Review
“I commend the editors for their careful perspective on the current state of neuromonitoring. The individual chapters provide excellent overviews of specific neuromonitoring tools and paradigms.” – From the Foreword by J. Claude Hemphill III, MD, MAS, FNCS (2014-05-08) –Hemphill III, MD, MAS, FNCS

About the Author

Chad M. Miller, MD, is Associate Professor of Neurology and Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, OH

Michel T. Torbey, MD, MPH, FAHA, FCCM, Professor of Neurology and Neurosurgery and Director, Division of Cerebrovascular Diseases and Neurocritical Care, Wexner Medical Center, Ohio State University, Columbus, OH