Pediatric cerebellar hemorrhages

Cerebellar hemorrhage is a devastating condition with morbidity and mortality related not only to the etiology of the hemorrhage, but also to the timing of the intervention. Sixteen consecutive pediatric patients with acute cerebellar hemorrhages are presented: 6 had vascular abnormalities, 3 had tumors, and 2 had hemorrhages of unknown etiology. Thirteen of the 16 patients survived with only 1 of the 13 having persistent vegetative state as a neurologic outcome. Six of 8 patients presenting in a moribund condition had good outcomes, and 3 of 4 patients presenting with fixed and dilated pupils also had good outcomes. Thus, in contrast to adults, rapid evaluation by CT scanning, followed by the judicious use of ventricular drainage and prompt surgical treatment, have resulted in favorable outcomes in pediatric patients despite their poor clinical presentations. None of the neonates having cerebellar hemorrhages required surgical intervention; their courses could be followed clinically and with transfontanel ultrasound.Presented as a poster at the 14th Congress of the European Society for Paediatric Neurosurgery, Lyon, France, 21–23 September 1994, and the XXII Annual Meeting of the International Society for Pediatric Neurosurgery, Birmingham, UK, 25–28 September 1994     

An analysis of paramagnetic centers in irradiated dentin using electron spin resonance

Summary The ESR spectra produced in irradiated dentin have been studied over a range of incident radiation energies from 50 kVp to 25 MVp. The behavior of the dentin ESR signal strength is similar to that of enamel as a function of the energy of the incident radiation. The magnitude of the dentin ESR signals are, however, up to 10 times smaller than the signals of dental enamel for a given radiation energy. The possible contributions of radiation interaction coefficients, chemical structure, and crystallite size to the differences in ESR spectra are discussed.     

Uninformed Decisionmaking The Case of Surrogate Research Consent

A New York court recently struck down state Office of Mental Health regulations governing research involving subjects with impaired decisionmaking capacity. The court held that neither incapacitated adults nor minors could participate in any research protocol that contained a nontherapeutic element, irrespective of possible benefits to the subject or the importance of the knowledge to be gained. Although the decision rested on a technical point of law and dealt only with psychiatric research, the court's holding has significantly broader implications.     

Relocation mortality in dementia: The effects of a new hospital

Relocation mortality has been cited as an important factor when considering the placement of elderly patients. This study describes the fate of dementia patients relocated to facilitate the move to a new hospital. Some wards were moved as intact units—that is, the patients were kept together and there was little change in the nursing or medical staff. Two other wards were closed, and these patients were dispersed to several existing and new wards and experienced changes of nursing and medical staff. All patients underwent prerelocation and postrelocation orientation programmes. The mortality figures for the total patient group before and after the relocation do not show any statistically significant increase in mortality postrelocation. However, for wards that were closed and where the patients suffered maximum disruption to patient group and nursing staff, there was a significant increase in mortality rates.