Does the mendosal suture exist in the adult?

There is a paucity of information in the literature regarding the mendosal suture. Furthermore, reports of the closure of this presumed suture of childhood are variable. This study seeks to establish the presence or absence of this structure in the adult. Fifty adult skulls were evaluated for the presence or absence of the mendosal suture. Sixteen percent of specimens were found to have a mendosal suture. Six specimens were found to have these sutures bilaterally, and two had sutures on the right side only. Most sutures were linear in nature. The mendosal suture approximated the superior nuchal line in all specimens and more or less traveled medial and perpendicular to the lambdoidal suture. The length of these sutures ranged from 0.8 to 1.4 cm (1.1 cm). Our hopes are that these data will prove useful to both the anatomist and clinicians, so that, when present, misinterpretation of the mendosal suture will be avoided.     

Emergency department fall-related presentations do not trigger fall risk assessment: a gap in care of high-risk outpatient fallers

We wanted to determine whether women aged 70 years and older, who presented to the emergency department (ED) with a fall and injury, received guideline care within 18 months of presentation. Women aged 70 years and older who presented to the ED with a fall were recorded prospectively from August 1, 2001 to May 1, 2002 (n=226). Structured telephone interviews were performed 18 months after the ED fall to obtain details of patient management (n=63). The most frequently reported referral was to the family physician (32%) and to physiotherapy (24%). We concluded that most older women who presented to the ED with a fall did not appear to be receiving current guideline care. We propose that future research use a prospective study design to assess whether or not guideline care is being delivered by a variety of health care providers after the patients leave the ED.     

Neuro-ophthalmic complications in giant cell arteritis

Giant cell arteritis (GCA) is a medical emergency characterized by systemic inflammation and critical ischemia. Neuro-ophthalmic complications occur early, with permanent vision loss in up to one fifth of patients. This mainly results from failure of prompt recognition and treatment. Diagnosis of GCA is often preceded by unrecognized symptoms, including constitutional upset and jaw claudication. Features predictive of permanent visual loss include jaw claudication and temporal artery abnormalities on physical examination. These patients often do not mount high inflammatory responses. Modern imaging techniques show diagnostic promise, and have led to an increased recognition of major artery involvement in GCA. However, temporal artery biopsy remains the gold standard for investigation. Intimal hyperplasia on histologic examination is associated with neuro-ophthalmic complications. The mainstay of therapy remains corticosteroids. Experience using conventional disease-modifying drugs has been mixed, and biologic therapies require further evaluation for their steroid-sparing potential.     

Duplication of the occipital condyles

This article describes an extremely rare case, encountered in the anatomy laboratory, of a skull base found to have duplication of both occipital condyles. In addition, this specimen was noted to have a large bony excrescence near the basion, a small third occipital condyle, a left paracondylar process, elongation of the right styloid process, and a bony septation of both hypoglossal canals. The embryology and clinical implications are discussed.     

The measurement of limb blood flow using technetium-labelled red blood cells

A method for measuring blood flow below the knee during reactive hyperaemia induced by 3 min of arterial occlusion has been developed. Subjects are positioned with lower limbs within the field of view of a gamma camera and pneumatic cuffs are placed below the knees to isolate the blood and induce a hyperaemic response. The remaining blood pool is labelled with 99Tcm-labelled red cells. Blood flows have been derived from the initial gradients of time-activity curves and from equilibrium blood sampling. The technique has been validated using a tissue-equivalent leg phantom and peristaltic pump. The method has been applied to a small group of patients with peripheral vascular disease and to normal controls. The mean value (+/- SD) of limb perfusion for normal controls was found to be 16.4 +/- 3.0 ml/100 ml/min and for patients with intermittent claudication was 5.1 +/- 2.6 ml/100 ml/min. Flow measurements are found to correlate with clinical findings and with symptoms. Reproducibility (established by repeated measurements) is high. The method is well tolerated even by patients suffering from rest pain.