British journal of neurosurgery
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The purpose of this study was to determine the sensitivity and specificity of the Spurling's test in predicting the diagnosis of a soft lateral cervical disc prolapse. A prospective study was performed involving 50 patients with neck and arm pain; of these, 25 patients were managed surgically (Group 1) and the other 25 patients were managed conservatively (Group 2). A Spurling's test was performed in all patients and scored as positive or negative. ⋯ The results of the Spurling's test were compared with the surgical or MR findings, which were considered as the gold standard. Spurling's test had a sensitivity of 92% and specificity of 95% with positive predictive value (PPV) of 96.4% and negative predictive value (NPV) of 90.9% in predicting a diagnosis of a soft lateral cervical disc prolapse. The high positive predictive value of the test can be utilized to improve the yield of positive MR examinations in patients with cervical radiculopathy.
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The objective of the study was to test the hypothesis that dynamic cerebral pressure-autoregulation is associated with the outcome of patients with severe head injury and to derive optimal criteria for future studies on the predictive value of autoregulation indices. Repeated measurements were performed on 32 patients with severe head injury. Arterial blood pressure (ABP) was measured continuously with an intravascular catheter, intracranial pressure (ICP) was recorded with a subdural semiconductor transducer and cerebral blood flow velocity (CBFV) was measured with Doppler ultrasound in the middle cerebral artery. ⋯ A logistic regression analysis confirmed that apart from the ARI, no other variables had a significant contribution to predict outcome. In this group of patients, death following severe head injury could not be explained by traditional indices of risk, but was strongly correlated to indices of dynamic cerebral pressure-autoregulation extracted by means of transfer function analysis. Future studies using a prospective design are needed to validate the predictive value of the ARI index, as estimated by transfer function analysis, in relation to death and other unfavourable outcomes.
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Utilization of operating theatre time is an important issue in neurosurgery, in a National Health Service Hospital. NHS Trusts are under ever increasing pressure to meet specified 'targets' in relation to admissions and operations. We performed a retrospective audit on the utilization of neurosurgical operating theatres at Royal Preston Hospital, analysed the times required for various common neurosurgical operations, and broke them down into clinical (operating and anaesthetic) and non-clinical times. ⋯ The mean time duration between the end of one surgical procedure and the beginning of the next was 101 minutes. It was found that actual operating time was surprisingly only 56% of the time available. These data could be used to schedule operating theatre sessions for neurosurgery in the UK, as we believe our practice to be representative of a majority of units in the country.
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Review Case Reports
Isolated intracranial Rosai-Dorfman disease mimicking meningioma in a child.
A 9-year-old boy presented with a 12-month history of headaches and recent grand mal seizures. Computed tomography and magnetic resonance imaging of the brain revealed an enhancing right frontal convexity lesion. ⋯ Rosai-Dorfman disease confined to the intracranial compartment is very rare, of 34 reported cases only one presented in the first decade. Optimal treatment has not been established, but complete surgical resection alone seems effective and allows histological distinction from meningioma.
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The objective of this study was to report the pattern of unusual accidental missile head injuries from the use of the locally-manufactured Dane gun, which presented at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Six illustrative patients are presented, each with a peculiar injury. All the patients except one, who died prior to surgery, had wound debridement and elevation of associated fractures with removal of the metallic foreign body. ⋯ Missile injury to the head is increasing. Firearm-related death is also on the increase and our environment is not exempted. Accidental injuries from stray bullets are fairly common; however, self-inflicted injuries are usually due to the improper handling of firearms, particularly by novices, suicide attempts and faulty technology of locally made firearms.