Bilateral brain abscesses complicating the use of crutchfield tongs

The case of a 4-year-old girl who developed bilateral brain abscesses complicating skull traction is reported. Crutchfield tongs were used to reduce a fracture dislocation at C2–3. Presenting symptoms consisted of headaches and focal seizures. Surgical treatment and antibiotics using serial CT led to a satisfactory outcome. This is the first reported case of this complication in a child. The current literature is reviewed.To whom offprint requests should be addressed at Avda. Pio Baroja 4, 30011 Murcia, Spain     

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning

Summary This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with negative angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.Our series amounts to a data bank of cases both contemporary to and in good agreement with that collected by Jennett and his associates in their 1977 multinational study; and it affords a useful reference in the assessment of epidemiological variations and alternative management in relation to outcome.     

Sensitivity to light and sound following minor head injury

9 consecutively referred closed head injury (CHI) patients were assessed for sensitivity to light and sound stimuli, within 7-19 days of injury, on both objective and subjective measures. Patients were matched with controls on age, sex, race, socio-economic status and order of test administration. The mean luminance (1366 lux) tolerated by CHI patients was significantly lower (0.01 level by Student's t-test for related samples) than that tolerated by controls (1783 lux). The mean sound intensity tolerated by CHI patients was also lower (82 db) than for controls (94 db), though this difference was not statistically significant. Subjective ratings of sensitivity made by CHI patients after exposure to intense sound and light stimuli, showed no relationship to objective ratings of tolerance. The results demonstrate an objective basis for complaints of increased sensitivity, at least to light, following CHI. These findings do not support earlier "psychogenic" explanations of post-concussion syndrome (PCS) etiology.     

多发伤的骨折内固定

目的：认识多发伤中骨折的主要特点,探讨内固定在救治中的意义。方法：回顾1994－08～1999－08间手术救治多发伤66例,对其161处骨折中的98处进行了“仿AO技术”有关方法内固定。结果：骨折均满意愈合;涉及骨折关节51个,功能恢复满意率为96．08％。结论：在多发伤中,骨折、合并伤与并发症远较“一般骨折”复杂、严重;有效固定骨折是一种重要的救命措施;内固定手术应争取在伤后24h进行,但如受条件制约,伤后1－3wk内手术也可获得满意效果;仿AO技术中的某些方法,如拉力螺钉、张力带钢丝及自动加压钢板等,用于内固定可使骨折获得卓有成效的稳定性。     

电磁辐射对小鼠神经系统超微结构影向的分析

目的探讨移动电话的电磁辐射对生物体的影响.方法用大众常用移动电话作为辐射源,工作频率为900MHz,功率密度为1190μW/cm2,在一定范围对小鼠辐射2h/d,30d后把小鼠断颈处死,取出大脑皮层、海马和小脑进行电镜观察分析.结果电镜所见,处理组与对照组小鼠的神经系统的细胞超微结构未见明显异常.结论一定时间内,移动电话的电磁辐射,对小鼠神经系统的细胞超微结构并没有明显影响.     

家兔急性实验性面神经损伤的组织病理观察

目的　观察家兔面神经急性损伤后髓鞘和轴索的组织病理变化。方法　用丝线结扎茎乳孔以外的面神经总干 ,观察结扎后 1天、3天及 5天面神经的组织病理改变。结果　家兔面神经受损后 ,先后在髓鞘和轴索出现轻重不等、程度不同的形态学改变。结论　结扎家兔面神经后 ,其髓鞘及轴索会出现相应的病理改变 ,且随着结扎天数的增加 ,面神经损伤亦呈加重的趋势     

Comparison of multiple oncotype DX® from the same patient

For women with breast cancer in whom multiple Oncotype DX^® Recurrence Scores (RS) are obtained, RS concordance utilizing current NCCN recommendations has not been evaluated. Patients with two or more RS were identified. RS were stratified by NCCN guidelines and compared for concordance. Twenty-four patients were evaluated. RS concordance varied by tumor type: 100% in the same tumor, 91.7% in multiple ipsilateral tumors, 71.4% in contralateral tumors, and 66.7% in in-breast recurrent tumors. RS concordance for multiple assays in the same patient is not high enough to omit Oncotype DX^® testing for each tumor.     

积分加权法评价磷化学烧伤实验病理的意义与应用

目的：积分加权法在病理组织学检查中的应用，方法：在常规病理描述基础上，采用积分加权法将病理结果予以定量，综合评价致伤后实验动物的主要脏器，结果：实验动物同等面积的磷酸烧伤各脏器积分降低，钙治疗后则显著改善，均与其它方面报道的资料一致，结论：积分加以数值使各脏器损伤程度一目了然，对不同脏器间的损伤情况有可比性，从而有助于了解主要受损脏器与总体的关系以及药物的治疗效果。