The meaning and application of 'lesion corporelle' in the context of a variety of mental or psychic injuries is less clear, while there is very little disagreement about its literal translation. U.S. Court decisions since Floyd allow recovery for a range of claims involving emotional injury under Article 17; in some cases there is no recovery, while in others there is full recovery, depending on the allegations and the nexus between the alleged injury and any related or accompanying physical injury. Courts are in agreement that pure emotional injury is not compensable under the Convention. Most courts agree that emotional injury is not compensable in those cases where it has resulted only in physical manifestations such as weight loss or sleeplessness. At the same time, most courts generally agree that emotional injury is compensable if it proximately flows from a physical injury. The issue as to whether the courts would associate PTSD with bodily injury as envisioned in the present Warsaw structure or even the new regime reflected in the Convention proposed by ICAO would largely depend on the extent to which courts would be ready to embrace the compelling scientific findings with regard to mental distress and its application within the term 'bodily injury'. Taken together, these points when the current under Article 17 of the Warsaw Convention, 'physical injury' notion of 'mental injury' is to be extended. Of course, the current terms of the Warsaw Convention have been maintaining a precedent for many countries appear to have a statue of the original purpose of the treaty does not contribute to the diffusion. Therefore, in future treaties 'bodily injury', the term 'injury', the term 'personal injury' or 'health undermined' the term should be replaced or revised.
The purpose of this study was to evaluate the general characteristics, complications and level of social adaptation of spinal cord injured patients. The subjects were one hundred forty five members who were inpatients or outpatients from October 1, 2004 to April 30, 2005 in general hospitals and municipal welfare centers for the handicapped located in the metropolitan city of Gwangju. The following results were obtained using Modified Barthel Index (MBI). 1) Gender distribution was 77.9% male and 22.1% female. The mean age at the time of injury was 35.4 and the mean age during the study was 44.2. 2) The degree of paralysis among the subjects was as follows: 49.0% had complete paralysis and 51.0% suffered incomplete paralysis. The most frequently injured lesion among the subjects was cervical (49.0%), followed by thoracic (35.9%), and lumbar (15.2%). 3) The mean MBI score was 63.5. There was statistically significant difference in the MBI score in the relation between complete and incomplete paralysis, the relation between cervical, thoracic, and lumbar injury, and the relation between a recovery period of less than three years and more than three years according to the characteristics of injury (p<.05). 4) There was statistically significant difference in the MBI score of subjects who had complications concerning spasticity, deformity, urinary tract infection, and sexual dysfunction (p<.05). 5) The most serious emotional pain after spinal cord injury resulted from economic issues, which affected 35.2% of the subjects. The group having a shorter recovery period after spinal cord injury complained of psychological matters, the group having a longer recovery period complained about the surrounding environment (lack of convenient facilities), suggesting statistically significant difference (p<.05). 6) The most common activities of the group with injuries more than ten years old included meeting schoolmates and working, while most common activities of the group with injuries less than three years old included attending religious functions and miscellaneous others (watching TV, spending time with family), suggesting statistically significant difference (p<.05).
Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.
Choi, Young-Chan;Cho, Eunae S.;Merrill, Robert L.;Kim, Seong Taek;Ahn, Hyung Joon
Journal of Oral Medicine and Pain
/
v.39
no.4
/
pp.133-139
/
2014
Purpose: There have been reports regarding the various factors associated with the level of discomfort and recovery from neurosensory symptoms in patients with trigeminal nerve injury. However, the contributing factors remain uncertain and poorly understood. The purpose of this paper was to investigate the possible association between various factors expected to affect neurosensory discomfort and recovery in patients with mandibular nerve injury after dental implant surgery. Methods: Eighty-nine post-dental implant surgery patients with mandibular nerve injury were enrolled in this retrospective analysis. A medical records review of the patients was done to determine if the patients' improvement was related to pain intensity, the length of time between the injury and removal of the implant or the depth of penetration of the implant into the mandibular canal as determined by cone-beam computed tomography. Results: There was no significant linear relationship between pain intensity and symptomatic improvement (p=0.319). There was no significant linear relationship between the level of mandibular canal penetration and either pain intensity (p=0.588) or symptomatic improvement (p=0.760). There was a statistically significant linear relationship between length of time before the injury was treated, both with pain intensity (p=0.004), and symptomatic improvement (p=0.024). Conclusions: Our findings indicate that the length of time between nerve injury and initiation of conservative treatment is more closely related to the pain intensity and symptomatic improvement than other factors, including the level of mandibular canal invasion. Additionally, increased pain intensity and decreased symptomatic improvement can be expected over time, because of this linear trend. Therefore, although direct injury to the nerve is the most important factor contributing to a neurosensory disturbances, early neurosensory assessment and initiation of conservative treatment should be done to optimize recovery.
Objective : Following central nervous system(CNS) injury, inhibitory influences at the site of axonal damage occur. Glial cells become reactive and form a glial scar, gliosis. Also myelin debris such as MAG inhibits axonal regeneration. Astrocyte-rich gliosis relates with up-regulation of GFAP and CD81, and eventually becomes physical and mechanical barrier to axonal regeneration. MAG is one of several endogenous axon regeneration inhibitors that limit recovery from CNS injury and disease. It was reported that molecules that block such inhibitors enhanced axon regeneration and functional recovery. Recently it was reported that treatment with anti-CD81 antibodies enhanced functional recovery in the rat with spinal cord injury. So in this current study, the author investigated the effect of the water extract of Uncariae Ramulus et Uncus on the regulation of CD81, GFAP and MAG that increase when gliosis occurs. Methods : MTT assay was performed to examine cell viability, and cell-based ELISA, western blot and PCR were used to detect the expression of CD81, GFAP and MAG. Then also immunohistochemistry was performed to confirm in vivo. Results : Water extract of Uncariae Ramulus et Uncus showed relatively high cell viability at the concentration of 0.05%, 0.1% and 0.5%. The expression of CD81, GFAP and MAG in astrocytes was decreased after the administration of Uncariae Ramulus et Uncus water extract. These results was confirmed in the brain sections following cortical stab injury by immunohistochemistry. Conclusion : The authors observed that Uncariae Ramulus et Uncus significantly down-regulates the expression of CD81, GFAP and MAG. These results suggest that Uncariae Ramulus et Uncus can be a candidate to regenerate CNS injury.
Kim, Tae-Kyung;Kim, Sang-Hoon;Jun, Hyung-Kyou;Yoon, Hyo-In;Cho, Sung-Whan;Kim, Duck-Hwan
Journal of Veterinary Clinics
/
v.24
no.2
/
pp.164-168
/
2007
This study was performed to establish the recovery effect of So Si Ho Tang on hepatic injury in dogs. Clinically healthy eight dogs (1-3 yrs old, 3-5 kg) were divided into control group (n=3) and experimental group (50 mg/kg, n=5). Hepatic injury was induced by administration of $CCl_4$ in all groups. Control group was received no treatment after hepatic injury and experimental group was orally administered with So Si Ho Tang at a dose of 50 mg/kg. The change of serum ALT and AST activities was examined before hepatic injury and on day 0, day 5 and day 12 after administration of So Si Ho Tang. Histopathologic examinations were performed on day 12. As a result, significant changes in serum ALT were found on day 5(p<0.05) and day 12(p<0.05), compared with those of control group, respectively. In addition, significant change in serum AST was found on day 1 (p<0.05) and day 5 (p<0.05), compared with those of control group, respectively. In histopathologic examination, mild hemorrhage and fatty degeneration and vacuolization were observed in experimental group in contrast to those of control group. Accordingly, it was suggested that administration of So Si Ho Tang was effective for hepatic injury induced by $CCl_4$ in dogs.
Peripheral nerve injuries are a commonly encountered clinical problem and often result in a chronic pain and severe functional deficits. The expression of c-Fos is sometimes used as a marker of increased neuronal activity. We have prepared the aqueous extract of amygdalin from Armeniacae semen for pain control. In the present study, we investigated the effects of amygdalin on the recovery rate of the locomotor function and on the expression of c-Fos in the ventrolateral periaqueductal gray (vlPAG) region following sciatic crushed nerve injury in rats. Walking track analysis for the evaluation of functional recovery and immunohistochemistry for the c-Fos expression were used in this study. In the present results, characteristic gait change with dropping of the sciatic function index (SFI) was observed and c-Fos expression in the vlPAG was suppressed following sciatic crushed nerve injury in rats. Amygdalin enhanced SFI value and restored c-Fos expression in the vlPAG to the control value. The present our study indicated that amygdalin activates neurons in the vlPAG, and it facilitates functional recovery following peripheral nerve injury.
Park, Sung-Jun;Hur, Jin-Woo;Kwon, Ki-Young;Rhee, Jong-Joo;Lee, Jong-Won;Lee, Hyun-Koo
Journal of Korean Neurosurgical Society
/
v.46
no.3
/
pp.205-209
/
2009
Objective : This study was conducted to investigate the correlation between the degrees of injury on brain magnetic resonance imaging (MRI) and the time interval to recovery of consciousness in patients with diffuse axonal injury. Methods : From January 2004 to December 2008, 25 patients with diffuse axonal injury were treated at our hospital. We retrospectively investigated the patients' medical records and radiological findings. We divided the patients into three groups according to the grade of MRI finding : grade I, small scattered lesions on the white matter of the cerebral hemisphere; grade II, focal lesions on the corpus callosum; and grade III, additional focal lesions on the brain stem. Result : Seven patients belonged to the grade I group; 10 to the grade II group; and 8 to the grade III group. The mean Glasgow Coma Scale (GCS) score of all patients at the time of admission was 7.28. Recovery of consciousness was observed in 23 of the 25 patients; the remaining two patients never regained consciousness. The time interval to recovery of consciousness (awake status) ranged from 1 day to 125 days (mean 22.1 days) : grade I group patients, within approximately 1 week (mean 3.7 days); grade II group patients, within approximately 2 weeks (mean 12.5 days); and grade III group patients, within approximately 2 months (mean 59.5 days). Conclusion : Our study results suggest a correlation between the mean time interval to recovery of consciousness in patients with diffuse axonal injuries and the degrees of brain injuries seen on MRI. Patients with grade I and II diffuse axonal injuries recovered consciousness within 2 weeks, while patients with grade III injuries required approximately 2 months.
Journal of Physiology & Pathology in Korean Medicine
/
v.25
no.2
/
pp.257-263
/
2011
This study was designed to investigate the effects of Hominis placenta pharmacopuncture treatment and electroacupuncture therapy on the functional recovery and histological change, protein expression in spinal cord injury(SCI) rats. Experimental groups were divided into the Group I(normal control rat), Group II(Non-treatment after spinal cord injury induction), Group III(Hominis placenta pharmacopuncture treatment after SCI induction), Group IV (Electroacupuncture therapy after SCI induction), Group V(Hominis placenta pharmacopuncture treatment and electroacupuncture therapy after SCI induction). After operation, rats were tested at modified Tarlov test at 1 to 3 days with divided into 4 groups, and motor behavior test(BBB locomotor rating scale, Grid walk test) was examined at 3, 7, 14, and 21 days. For the observation of damage change and size of the organized surface in muscle and spinal cord, histopathological studies were performed at 21 days by H & E stain, and BDNF & NT-3 protein expression studies were performed at 21 days. Acco rding to the results, Hominis placenta pharmacopuncture treatment and electroacupuncture therapy can play a role in facilitating recovery of locomotion following spinal cord injury. Specially, Hominis placenta pharmacopuncture treatment and electroacupuncture combimed therapy after SCI induction was most improvement in functional recovery, BDNF, and NT-3 protein synthesis.
Objective : Minocycline, a second-generation tetracycline-class antibiotic, has been well established to exert a neuroprotective effect in animal models and neurodegenerative disease through the inhibition of microglia. Here, we investigated the effects of minocycline on motor recovery and neuropathic pain in a rat model of spinal cord injury. Methods : To simulate spinal cord injury, the rats' spinal cords were hemisected at the 10th thoracic level (T10). Minocycline was injected intraperitoneally, and was administered 30 minutes prior surgery and every second postoperative day until sacrifice 28 days after surgery. Motor recovery was assessed via the Basso-Beattie-Bresnahan test Mechanical hyperalgesia was measured throughout the 28-day post -operative course via the von Frey test Microglial and astrocyte activation was assessed by immunohistochemical staining for ionized calcium binding adaptor molecule 1 (lba1) and glial fibrillary acidic protein (GFAP) at two sites: at the level of hemisection and at the 5th lumbar level (L5). Results : In rats, spinal cord hemisection reduced locomotor function and induced a mechanical hyperalgesia of the ipsilateral hind limb. The expression of lba1 and GFAP was also increased in the dorsal and ventral horns of the spinal cord at the site of hemisection and at the L5 level. Intraperitoneal injection of minocycline facilitated overall motor recovery and attenuated mechanical hyperalgesia. The expression of lba1 and GFAP in the spinal cord was also reduced in rats treated with minocycline. Conclusion : By inhibiting microglia and astrocyte activation, minocycline may facilitate motor recovery and attenuate mechanical hyperalgesia in individuals with spinal cord injuries.
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