Infantile Subdural Haematoma and its Relationship to Whiplash Injuries

Subdural haematoma is one of the commonest features of the battered child syndrome, yet by no means all the patients so affected have external marks of injury on the head. This suggests that in some cases repeated acceleration/deceleration rather than direct violence is the cause of the haemorrhage, the infant having been shaken rather than struck by its parent. Such an hypothesis might also explain the remarkable frequency of the finding of subdural haemorrhage in battered children as compared with its incidence in head injuries of other origin, and the fact that it is so often bilateral.     

Central Nervous System Manifestations of Chickenpox

A study of 57 cases of affection of the central nervous system associated with chickenpox diagnosed and treated at The Hospital for Sick Children in Toronto between 1956 and 1967, inclusive, is presented. The commonest type, the cerebellar variety (50%), had an excellent prognosis. In the next commonest, the cerebral type (40%), the mortality rate was 35% but there was a low incidence of permanent sequelae in the surviving patients. A small group classed as aseptic meningitis was defined and one case of myelitis was reviewed.     

Pancreatic calcification: A report of 45 cases

Forty-five cases of pancreatic calcification are reported, and it is shown that in Western Nigeria this malady afflicts younger people than in Europe and the United States of America. Males and females seem about equally affected in Western Nigeria, whereas it predominantly affects males in France, Britain, and North America. Diabetes mellitus was the commonest complication in this series, and brought many patients to the doctor. In this series chronic relapsing pancreatitis was a rare cause; there was no history of alcoholism; and protein malnutrition was thought to be responsible for pancreatic calcification in over 90% of the patients.     

A two-year study of the distribution of ''thermophilic'' campylobacters in human, environmental and food samples from the Reading area with particular reference to toxin production and heat-stable serotype

The incidence of 'thermophilic' campylobacters in foods and environmental samples has been studied over a two-year period. Of 781 environmental samples, 529 (67%) were found to contain campylobacters, and campylobacters were isolated from 835 (39%) of 2116 food samples. Sewage was almost always contaminated with campylobacters (96·6% of samples) and of the food samples both poultry (55·5%) and offal (47·0%) were commonly contaminated. Determination of the heat-stable serotypes of all strains isolated from these sources and of 921 strains isolated from human faeces showed that there was a wide distribution of serotypes in most types of sample. Serotype Pen 2 was the commonest type found in human faeces (18·9%) and it was also commonest in offal (21·3%), beef (40·0%), sewage (17·7%) and was the third commonest type in poultry. A comparison of culture media and conditions for optimal production of both cytotoxic and cytotonic enterotoxins showed that Brucella Broth incubated under microaerobic conditions for 24 h at 42°C was suitable for both toxins. Detection of cytotoxic activity was most sensitive using HeLa cells. The sensitivities of two ELISA systems and a Chinese Hamster Ovary tissue culture assay for detection of cytotonic enterotoxin were comparable. Not all strains isolated from cases of enteritis in human beings produced toxin; 23·1% produced cytotonic enterotoxin and 17·5% produced cytotoxin. There was no correlation between serotype and toxin production. The wide distribution of campylobacters, indistinguishable from those isolated from cases of enteritis in human beings, leads us to conclude that simplistic statements suggesting that one particular type of food is primarily responsible for cases of human disease should not be made.     

A two-year study of the distribution of 'thermophilic' campylobacters in human, environmental and food samples from the Reading area with particular reference to toxin production and heat-stable serotype

The incidence of 'thermophilic' campylobacters in foods and environmental samples has been studied over a two-year period. Of 781 environmental samples, 529 (67%) were found to contain campylobacters, and campylobacters were isolated from 835 (39%) of 2116 food samples. Sewage was almost always contaminated with campylobacters (96.6% of samples) and of the food samples both poultry (55.5%) and offal (47.0%) were commonly contaminated. Determination of the heat-stable serotypes of all strains isolated from these sources and of 921 strains isolated from human faeces showed that there was a wide distribution of serotypes in most types of sample. Serotype Pen 2 was the commonest type found in human faeces (18.9%) and it was also commonest in offal (21.3%), beef (40.0%), sewage (17.7%) and was the third commonest type in poultry. A comparison of culture media and conditions for optimal production of both cytotoxic and cytotonic enterotoxins showed that Brucella Broth incubated under microaerobic conditions for 24 h at 42 degrees C was suitable for both toxins. Detection of cytotoxic activity was most sensitive using HeLa cells. The sensitivities of two ELISA systems and a Chinese Hamster Ovary tissue culture assay for detection of cytotonic enterotoxin were comparable. Not all strains isolated from cases of enteritis in human beings produced toxin; 23.1% produced cytotonic enterotoxin and 17.5% produced cytotoxin. There was no correlation between serotype and toxin production. The wide distribution of campylobacters, indistinguishable from those isolated from cases of enteritis in human beings, leads us to conclude that simplistic statements suggesting that one particular type of food is primarily responsible for cases of human disease should not be made.     

Recurrence of Subdural Haematoma in a Population-Based Cohort – Risks and Predictive Factors

Objectives

To estimate the risks of and identify predictors for recurrent subdural haematoma in surgically and conservatively treated patients.

Methods

The cohort comprised all individuals diagnosed with a first-time subdural hematoma in Denmark 1996–2011. Information on potential predictors was retrieved from the Danish health registers. Cumulative recurrence risks were estimated using the Aalen-Johansen estimator. Rate ratios (RR) were estimated using Poisson regression.

Results

Among 10,158 individuals with a subdural hematoma, 1,555 had a recurrent event. The cumulative risk of recurrent subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.43–1.80), older age (>70 years compared to 20–49 years; RR 1.41, 95% CI: 1.21–1.65), alcohol addiction (RR 1.20, 95% CI:1.04–1.37), surgical treatment (RR 1.76, 95% CI:1.58–1.96), trauma diagnoses (RR 1.14, 95% CI:1.03–1.27), and diabetes mellitus (RR 1.40, 95% CI:1.11–1.74). Out of a selected combination of risk factors, the highest cumulative 1-year recurrence risks for subdural hematoma of 25% (compared to 14% for all patients) was found in surgically treated males with diabetes mellitus.

Conclusions

The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed.     

Brain-stem auditory evoked potentials (BAEPs) from basal surface of temporal lobe recorded from chronic subdural electrodes

BAEPs were recorded from the basal surface of the temporal lobe by subdural electrodes chronically implanted in 6 patients who were evaluated for surgical management of intractable partial seizures. Near-field recordings were obtained by recording between the subdural electrode closet and most distant to the brain-stem. Far-field recordings were obtained by recording between the subdural electrodes and an indifferent electrode over the spinal process of the seventh cervical vertebrae. The recordings were compared with standard ear-vertex recordings.After ipsilateral ear stimulation, the subdural electrode closet to the brain-stem recorded large amplitude waves I and II, followed by less well-defined waves of longer latencies. Recordings to contralateral stimulation showed no clearly defined waves I and II and a large amplitude wave Vn. Waves III, IV, V, Vn and VI were of opposite polarity after ipsi- and contralateral stimulation. These findings indicate that waves I and II are generated ipsilaterally to the stimulation side, whereas wave Vn has a contralateral origin. Wave Vn may be generated in the brachium of the inferior colliculus, as suggested from latency and from dipole configuration studies. This conclusion is consistent with the classical anatomical observations that the supracollicular auditory pathways are predominantly crossed.     

Female circumcision in Somalia: anthropological traits

In 1981, 2497 subjects (comprising women and girls) were interviewed in Somalia, mostly in Mogadish, about female circumcision. In this study there are presented the principle cultural trends which are connected with the custom and which have arisen from the research. Even today, the practice of female circumcision is universal in Somalia; the percentage of circumcised women was 99.3%. Infibulation is the commonest type of circumcision used (75.7%). The age of circumcision varies from birth to 15; the average being 7.5. The type of circumcision does not seem to be influenced by some environmental variables (e.g. birth place of parents or place of circumcision), it is primarily determined by the population of the individual region. Infibulation is accepted to the greatest extent by the pastoral populations of the middle/northern regions, principally in Ogaden and in the 4 Somalian regions on which it borders: Togdheer, Nugal, Muddug, Galgadud. In the southern regions (Upper, Middle, Lower Giuba) amongst rural populations or populations with a cattle/cultivation economy, there are also attenuated types of circumcision: sunna and clitoridectomia (20 to 30%). The evolution of the practice was studied by data of the subjects, of their mothers and of their daughters. From this analysis there was no indication toward non-circumcision. There is, however, a movement towards the attenuated forms of circumcision. The fundamental key to such an attenuated operation for a child seems to be the presence of the same attenuation in previous generations.     

Identification of 7 alpha-hydroxy-3-oxo-4-cholestenoic acid in chronic subdural hematoma.

We detected a novel kind of bile acid in the content of chronic subdural hematoma. This substance was specifically found in chronic subdural hematoma, and not in subdural hygroma, which is pathologically similar except for the lack of capsular membrane. The compound was identified as 7 alpha-hydroxy-3-oxo-4-cholestenoic acid by high performance liquid chromatography, gas chromatography-mass spectrometry, and nuclear magnetic resonance spectrometry. The structure was confirmed by the comparison with the chemically synthesized compound. The average contents in chronic subdural hematoma were 658.09 +/- 137.53 ng/ml, while those in normal human plasma were 126.27 +/- 17.73 ng/ml. It was not detected in normal cerebrospinal fluid. The higher level in chronic subdural hematoma than human plasma strongly suggests the local, extrahepatic production of this type of C27 bile acids.     

Phylogenetic relationships of Argentinean Creole horses and other South American and Spanish breeds inferred from mitochondrial DNA sequences

South American horses constitute a direct remnant of the Iberian horses brought to the New World by the Spanish conquerors. The source of the original horses was Spain, and it is generally assumed that the animals belonged to the Andalusian, Spanish Celtic, Barb or Arabian breeds. In order to establish the relationship between Argentinean and Spanish horses, a portion of the mitochondrial D-loop of 104 animals belonging to nine South American and Spanish breeds was analysed using SSCP and DNA sequencing. The variability found both within and between breeds was very high. There were 61 polymorphic positions, representing 16% of the total sequence obtained. The mean divergence between a pair of sequences was 2.8%. Argentinean Creole horses shared two haplotypes with the Peruvian Paso from Argentina, and the commonest haplotype of the Creole horses is identical to one of the Andalusian horses. Even when there was substantial subdivision between breeds with highly significant Wright's Fixation Index (FST), the parsimony and distance-based phylogenetic analyses failed to show monophyletic groups and there was no clear relationship in the trees between the South American and any of the other horses analysed. Although this result could be interpreted as mixed ancestry of the South American breeds with respect to the Spanish breeds, it is probably indicating the retention of very ancient maternal lineages in the breeds analysed.     

Response of pulmonary veins to increased intracranial pressure and pulmonary air embolization

Brain compression with subdural air causes pulmonary hypertension and noncardiogenic pulmonary edema (A. B. Malik, J. Appl. Physiol.: Respirat. Environ. Exercise Physiol. 42: 335-343, 1977). To see whether air emboli to the lungs rather than brain compression caused these findings, anesthetized dogs received intravenous air infusions, subdural air infusions, or brain compression from balloons inflated in the subdural space. Subdural air and intravenous air resulted in similar vascular responses. Pulmonary artery pressure (Ppa) increased 160% (P less than 0.01) and pulmonary venous pressure transiently rose 13 +/- 5 Torr (P less than 0.05) without an increase in left atrial pressure or cardiac output (Q). The end-tidal PCO2 fell 55% (P less than 0.01) and the postmortem weight of the lungs increased 55% (P less than 0.05). Brain compression with a subdural balloon instead of air only caused a 20% rise in Ppa and Q without pulmonary edema. Thus, pulmonary air emboli rather than brain compression accounts for the edema and pulmonary hypertension caused by subdural air. Catheters in pulmonary veins and the left atrium showed that air emboli cause transient pulmonary venous hypertension as well as a reproducible form of noncardiogenic pulmonary endema.     

119例髁突骨折远期疗效的调查研究

目的：髁突骨折是临床常见病和多发病,其治疗方法目前尚存在着一定争议。本研究拟总结髁突骨折治疗方法选择的原则和适应征,旨在为髁突骨折的治疗提供更多的参考依据。方法：对四川大学华西口腔医院收治的119例治疗后6个月以上的髁突骨折患者进行远期疗效调查,以电话随访的方式作问卷调查,询问患者的张口度、语言、吞咽功能、咬合、面部容貌、并发症、对疗效的满意程度等,按照治疗方法对患者进行分类,根据患者的情况评价该组病例的治疗效果及满意度,并评价髁突骨折治疗方法的选择是否合理。结果：参与随访的119例患者中,107例对疗效满意,满意率为89．92％,50例出现明显并发症,并发症发生率为42．02％。按照治疗方法将患者分为保守治疗、内固定、髁突摘除等6类,每种治疗方法的满意率比较无统计学差异（P〉0．05）,而并发症的发生率比较有统计学差异（P〈0．05）。结论：在正确选择治疗方法的前提下,保守治疗和手术治疗髁突骨折均可取得较令人满意的疗效,但应尽量避免采用髁突摘除术。     

M components-a review of 1242 cases.

Among 1242 patients referred for immunologic investigation 1255 M components were detected in the serum. Of these patients 50.9% had multiple myeloma, 18.1% had nonmyelomatous malignant diseases such as macroglobulinemia, lymphoma, leukemia or cancer, 4.3% had connective tissue diseases, 2.5% had primary generalized amyloidosis (PGA) and the rest had various "benign" conditions. Whereas IgG was the commonest M component in multiple myeloma, connective tissue diseases and the other benign conditions, IgM was the commonest M component in lymphoma and leukemia; Bence Jones proteinemia was most frequently observed in PGA. The ratio of kappa to lambda light chains varied from 1.7:1 in IgG myeloma to 1:9 in IgD myeloma, and was 1:2.1 in PGA. Bence Jones protein was detected in 422 (66%) of 640 urine samples tested, the prevalence ranging from more than 70% in multiple myeloma and PGA to as low as 36% in various benign conditions. It is evident that the class and type of M components and the presence of Bence Jones proteinuria have no definite significance with regard to the diagnosis. Therefore, thorough investigation and follow-up at regular intervals are required when M components are detected.     

Molecular screening of FRAXA and FRAXE in Indian patients with unexplained mental retardation

Fragile-X mental retardation is the commonest form of inherited mental retardation. We have studied 146 Indian patients (174 X chromosomes) with unexplained mental retardation by molecular methods. All study subjects were unrelated. Three of the 118 males were found to have the FMR1 full mutation. None of the patients tested were positive for the FMR2 full mutation. The Fragile X prevalence was 2.5% among males, which is lower than previously reported in Indian mentally retarded patients. Screening for Fragile X among patients with nonspecific mental retardation is important, even if there is no family history of mental retardation or typical behavioral or physical features associated with the Fragile-X phenotype. Identification of positive cases is also very important for the families, because of the high recurrence risk of the disease. Large multicenter screening programs with uniform criteria would be worthwhile to determine the prevalence of Fragile-X mental retardation in the Indian population.     

Diagnostic utility of fine needle aspiration (FNA) cytology in HIV-infected patients with lymphadenopathy

reid a. j. c., miller r. f. and kocjan g. i. (1998) Cytopathology 9, 230–239
Diagnostic utility of fine needle aspiration (FNA) cytology in HIV-infected patients with lymphadenopathy
Sixty-five FNA cytology procedures were performed on lymph nodes in 52 HIV⁺ patients. Cervical lymph nodes were the commonest site of FNA cytology investigation (54%). The diagnoses were persistent generalized lymphadenopathy (38%), infection (17%), and malignancy (11%). Diagnosis could not be rendered in 25% of FNA cytology due to inadequate sampling. Of those with infection, mycobacterial disease was the commonest cause (91%), the diagnosis of which was enhanced by concurrent microbiological examination. Non-Hodgkin's lymphoma was the commonest malignancy. Sixteen lymph node FNA cytologies had subsequent tissue biopsy. There were two false-positive and four false-negative FNA cytologies. FNA cytology in HIV⁺ patients is most useful in the diagnosis of infection, obviating the need for tissue biopsy and allowing prompt initiation of treatment.     

Current Treatment for Venom-Induced Consumption Coagulopathy Resulting from Snakebite

Venomous snakebite is considered the single most important cause of human injury from venomous animals worldwide. Coagulopathy is one of the commonest important systemic clinical syndromes and can be complicated by serious and life-threatening haemorrhage. Venom-induced consumption coagulopathy (VICC) is the commonest coagulopathy resulting from snakebite and occurs in envenoming by Viperid snakes, certain elapids, including Australian elapids, and a few Colubrid (rear fang) snakes. Procoagulant toxins activate the clotting pathway, causing a broad range of factor deficiencies depending on the particular procoagulant toxin in the snake venom. Diagnosis and monitoring of coagulopathy is problematic, particularly in resource-poor countries where further research is required to develop more reliable, cheap clotting tests. MEDLINE and EMBASE up to September 2013 were searched to identify clinical studies of snake envenoming with VICC. The UniPort database was searched for coagulant snake toxins. Despite preclinical studies demonstrating antivenom binding toxins (efficacy), there was less evidence to support clinical effectiveness of antivenom for VICC. There were no placebo-controlled trials of antivenom for VICC. There were 25 randomised comparative trials of antivenom for VICC, which compared two different antivenoms (ten studies), three different antivenoms (four), two or three different doses or repeat doses of antivenom (five), heparin treatment and antivenom (five), and intravenous immunoglobulin treatment and antivenom (one). There were 13 studies that compared two groups in which there was no randomisation, including studies with historical controls. There have been numerous observational studies of antivenom in VICC but with no comparison group. Most of the controlled trials were small, did not use the same method for assessing coagulopathy, varied the dose of antivenom, and did not provide complete details of the study design (primary outcomes, randomisation, and allocation concealment). Non-randomised trials including comparison groups without antivenom showed that antivenom was effective for some snakes (e.g., Echis), but not others (e.g., Australasian elapids). Antivenom is the major treatment for VICC, but there is currently little high-quality evidence to support effectiveness. Antivenom is not risk free, and adverse reactions can be quite common and potentially severe. Studies of heparin did not demonstrate it improved outcomes in VICC. Fresh frozen plasma appeared to speed the recovery of coagulopathy and should be considered in bleeding patients.     

Density-dependent and frequency-dependent selection by bumblebees Bombus terrestris (L.) (Hymenoptera: Apidae)

The behaviour of bumblebee workers foraging on arrays of artificial flowers of two colour morphs was observed. Experiments were conducted on arrays of varying morph frequencies and at three different total flower densities. Bumblebees consistently showed a preference for the commonest colour morph, and this behaviour was not significantly affected by changing density. In contrast, frequency-independent preferences changed significantly with density. At low densities, there was a strong bias towards the more conspicuous colour, whereas at higher densities there was no overall colour bias. Flight distances between flowers decreased significantly at high density. Bumblebees also visited flowers of similar colours sequentially, but this behaviour was not density-dependent. It is suggested that as densities increase, there is an increased probability that bumblebees detect yellow flowers, which were probably less conspicuous compared with blue flowers, and that this might be caused by changes in flight speed with flight distance. Where there is a positive relationship between pollinator visitation and the relative fitness of a floral morph, the observed behaviour would induce positive frequency-dependent selection on a plant population with two corolla colour morphs on which the bumblebees were foraging, which would result in stabilizing selection for a single corolla colour, irrespective of density. There was no indication that rare colour morphs would be preferred at high density. The probability of different corolla colour morphs going to fixation would, however, be affected by density.     

Laparotomy during Pregnancy: An Assessment of Diagnostic Accuracy and Fetal Wastage

In a series of 48,482 pregnancies laparotomy was undertaken 74 times for conditions not associated with pregnancy (1 in 655 pregnancies). It showed no abnormality in 26 cases; ovarian cysts and acute appendicitis were the commonest pathological findings. The preoperative diagnosis was proved correct in 53% of cases, and in 66·2% laparotomy proved to be necessary for an alternative diagnosis.The fetal loss rate after surgery was 23%. Spontaneous abortion was more likely in the presence of peritonitis, with fluid in the peritoneal cavity, or when operative procedures involving the ovary were performed within the first trimester. The risk of precipitating labour following diagnostic laparotomy is negligible, provided no unnecessary surgical manœuvres are undertaken.     

宫颈癌患者阴道分泌物非厌氧菌菌群分布及常见菌药敏分析

目的：探讨宫颈癌患者阴道分泌物非厌氧菌菌群分布和常见菌的药敏情况。方法：对87例住院患者的阴道分泌物进行常规培养(不包括厌氧菌、淋病奈瑟菌及支原体培养)和常见菌的药敏测定。结果：87分标本中细菌培养阳性者共86分．阳性率98．8％;共检出菌株161株,革兰阴性菌125株(77．6％),其中嗜麦芽窄食单胞菌和鲁氏不动杆菌分别有49株(39．2％)和43株(34．4％);革兰阳性菌36株(22．4％)．以葡萄球菌和肠球菌为主,分别有18株(50．0％)和9株(25．0％)。药敏结果显示,常见革兰阴性杆菌对氨苄西林的敏感性最差,对亚胺培南、头孢三代的敏感性差别较大．革兰阳性球菌对青霉素的耐药率最高,万古霉素的敏感性最高。结论：宫颈癌患者的阴道分泌物需氧菌群以革兰阴性菌为主,尤以嗜麦芽窄食单胞菌和鲁氏不动杆菌最为常见,临床上根据阴道分泌物菌群分布和药敏情况,在术前采用合适的冲洗液可有效地减少术后感染的发生。     

Histopathologic Findings of Autoimmunity in Thyroid,Pituitary, and Adrenal Diseases in Chronic Hepatitis C Postmortem Cases

ObjectiveTo assess the histologic prevalence of immune-mediated thyroid, pituitary, and adrenal diseases in postmortem cases with hepatitis C.MethodsWe reviewed 108 consecutive cases of chronic hepatitis C in patients in whom a complete postmortem examination was performed. All microscopic and histologic slides of the thyroid, pituitary, and adrenal reports were reviewed and assessed for evidence of autoimmune diseases. These were compared with a control group of 100 postmortem cases without hepatitis C.ResultsIn chronic hepatitis C infection, there is a heightened immune response resulting in many autoimmune diseases. The commonest endocrinopathy in association with this chronic infection is thyroid disease, a finding confirmed in our current study. Among the 108 postmortem cases of hepatitis C, there were 14 cases (13%) with evidence of thyroiditis. No cases of pituitary or adrenal disease were found. The mean age of the patients was 52 years (range, 29 to 68). This frequency compared with 7 cases of thyroid disease (7%) in the control group (no significant difference between the 2 groups).ConclusionOn the basis of our postmortem data, thyroid disease was the only major endocrinopathy associated with hepatitis C infection, with a prevalence of 13%. This was comparable with other serologic and nonhistologic antemortem findings. There was no evidence of pituitary or adrenal involvement. (Endocr Pract. 2010;16:566-569)