British journal of neurosurgery
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Progressive Systemic Scleroderma (PSS) is a generalized disease of connective tissue involving the skin, as well as other internal organs. The cutaneous signs are characterized by a progressive sclerosis and loss of function or dexterity in the hands. ⋯ The study confirms that SCS is an effective therapy in patients with PSS and Raynaud's phenomenon because of its beneficial effects on the Raynaud episodes, ulcers, pain, vascular sclerosis and hand function. This method may have a primary role in the treatment of this chronic disorder because of the high probability of failure of other medical or surgical therapy.
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Comparative Study
Racial differences between Maori and European New Zealanders in aneurysmal subarachnoid haemorrhage.
Racial differences in the incidence and rate of rupture of intracranial aneurysms are well recognized. A retrospective study of racial differences between Maori and European New Zealanders presenting to the Auckland Regional Neurosurgical Unit between 1985 and 1990 was conducted. ⋯ A strong association between aneurysmal subarachnoid haemorrhage and cigarette smoking was found in both groups not only for single, but also for multiple aneurysms. Maoris were also found to have an abnormally high incidence of middle cerebral artery aneurysms and a low incidence of vertebrobasilar ones compared with Europeans.
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A retrospective study was carried out of 202 patients with traumatic intracerebral haematomas (TICH) noted on CT, to determine which factors most affected outcome. There were 151 (75%) males and 51 (25%) females, whose ages ranged from 1 to 84 years. One-hundred-and-two (51%) had a good outcome (Glasgow Outcome Score 1 and 2). ⋯ No patient with three or more haematomas had a good outcome. Single factor logistic regression analysis identified Glasgow Coma Score (GCS), haematoma volume and difficulty with airway maintenance or poor arterial oxygenation as important factors in determining outcome. A four-factor logistic regression analysis model was developed which revealed that, when all other factors had been taken into consideration, craniotomy significantly improved the probability of a good outcome.
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A prospective study of 315 consecutive patients with a severe head injury was undertaken to study factors contributing to mortality and morbidity, both in the pre-hospital and hospital phases. Entry criteria were a Glasgow Coma Scale (GCS) score of 8 or less after non-surgical resuscitation within 6 h of the injury, or a deterioration to that level within 48 h. Patients with gunshot wounds or who were dead on arrival were excluded. ⋯ When analysed using logistic regression, the most accurate model (accuracy 84.4%) included increasing age, abnormal motor responses and the three CT indicators. Analysis of the data for 'good' (Glasgow Outcome Score (GOS) 1 and 2) vs 'poor' (GOS 3 and 4) survival at 6 months was also performed using logistic regression. The model which provided the most accurate prediction of poor outcome included age, hypotension and three different CT characteristics, subarachnoid blood, intracerebral haematoma or intracerebral contusion (accuracy 72.5%).
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Hiccup or singultus is a repeated involuntary, spasmodic contraction of the diaphragm accompanied by a sudden closure of the glottis mediated by sensory branches of the phrenic and vagus nerves as well as dorsal sympathetic afferents. The principle efferent limb and diaphragmatic spasms are mediated by motor fibers of the phrenic nerve. Hiccup has been classified as a respiratory reflex and the central connection probably consists an interaction among the brainstem respiratory centers, phrenic nerve nuclei, medullary reticular formation and the hypothalamus. Chronic intractable hiccup may be due to brainstem seizures, and baclofen may be the long-awaited remedy for intractable hiccup as demonstrated in three illustrative cases.