Avulsion fracture of the anterior half of the foramen magnum involving the bilateral occipital condyles and the inferior clivus--case report.
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A 38-year-old male presented with an avulsion fracture of the anterior half of the foramen magnum due to a traffic accident. He had palsy of the bilateral VI, left IX, and left X cranial nerves, weakness of his left upper extremity, and crossed sensory loss. He was treated conservatively and placed in a halo brace for 16 weeks. After immobilization, swallowing, hoarseness, and left upper extremity weakness improved. Hyperextension with a rotatory component probably resulted in strain in the tectorial membrane and alar ligaments, resulting in avulsion fracture at the sites of attachment, the bilateral occipital condyles and the inferior portion of the clivus. Conservative treatment is probably optimum even for this unusual and severe type of occipital condyle fracture. (+info)
A comparative study on mortality patterns among Koreans, Korean-Chinese and Chinese.
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In order to understand the causal mechanism of disease aggregates peculiar to place and ethnicity, mortality data of Yanji city, China (1993) were collected, examined for validity and analyzed. Age standardized, age specific mortality rates and ten leading causes of death were compared with 1993 Korean mortality statistics. Age standardized mortality rates for both sexes were highest in Korean-Chinese followed by Koreans and Chinese (the lowest). Out of ten leading causes of death (54%-70% of the total deaths), seven for male and six causes of death for female were common in all groups. Korean-Chinese females had more similar patterns to Chinese females than males did. Differences in mortality rates by causes of death among groups suggested that hypertensive diseases and respiratory tuberculosis were associated with ethnicity, homicide/injuries inflicted by others, diabetes mellitus and chronic renal disease with environment, and others with both ethnicity and environment. These results suggest that a few causes of death were attributed to either ethnicity or environment whereas most of the ten leading causes of deaths were attributed to mixed impacts of both ethnicity and environment. (+info)
Non-coronary sinus of Valsalva aneurysm diagnosed after a road traffic accident.
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A 38 year old man with a huge unruptured sinus of Valsalva aneurysm, complicated with severe valvar aortic regurgitation, is described. The aneurysm was detected by echocardiography in the asymptomatic patient who presented with an intense precordial diastolic rumble after a road traffic accident. The patient had successful surgery for the aneurysm and aortic valve replacement. Possible aetiologies for the aneurysm and a brief revision of clinical aspects and treatment are discussed. (+info)
A case of traumatic high thoracic myelopathy presenting dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk.
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A 3 year-old boy developed flaccid paraplegia, anesthesia below T3 and impaired vesical control immediately after a car accident. Three months later, the pupils and their pharmacological reactions were normal. Thermal sweating was markedly reduced on the right side of the face, neck, and shoulder and on the bilateral upper limbs, and was absent below T3 except for band like faint sweating on T7 sensory dermatome. The left side of the face, neck and shoulder showed compensatory hyperhidrosis. Facial skin temperature was higher on the sweating left side. Cervico-thoracic MRI suggested almost complete transection of the cord at the levels of T2 and T3 segments. We discussed the pathophysiology of the dissociated impairment of rostral sympathetic innervations and isolated segmental sweating on otherwise anhidrotic trunk. (+info)
Attention without awareness in blindsight.
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The act of attending has frequently been equated with visual awareness. We examined this relationship in 'blindsight'--a condition in which the latter is absent or diminished as a result of damage to the primary visual cortex. Spatially selective visual attention is demonstrated when information that stimuli are likely to appear at a specific location enhances the speed or accuracy of detection of stimuli subsequently presented at that location. In a blindsight subject, we showed that attention can confer an advantage in processing stimuli presented at an attended location, without those stimuli entering consciousness. Attention could be directed both by symbolic cues in the subject's spared field of vision or cues presented in his blind field. Cues in his blind field were even effective in directing his attention to a second location remote from that at which the cue was presented. These indirect cues were effective whether or not they themselves elicited non-visual awareness. We concluded that the spatial selection of information by an attentional mechanism and its entry into conscious experience cannot be one and the same process. (+info)
Transcranial doppler detection of fat emboli.
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BACKGROUND AND PURPOSE: The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. METHODS: Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. RESULTS: Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an increase in MESs during intramedullary nail insertion. The characteristics of MESs after injury varied among patients, with large signals being more frequent in the only patient with a patent foramen ovale. CONCLUSIONS: Cerebral microembolism after long-bone fractures can be detected in vivo and monitored over time. These findings may have potential diagnostic and therapeutic implications. (+info)
Prevention of youth injuries.
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There are four categories of causes responsible for the majority of injuries in youth 10-19 years of age: 1) motor vehicle traffic; 2) violence (intra-familial, extra-familial, self, pregnancy-related); 3) recreational; and 4) occupational. This article presents data from the National Center for Health Statistics mortality data and the National Pediatric Trauma Registry morbidity data. Nationwide, the pediatric injury death rate is highest among adolescents 15-19 years of age. Motor vehicle-related deaths account for 41% and firearm-related deaths account for 36% of injury deaths in this age group. For youths aged 10-14 years, motor vehicle-related deaths account for 38% and; firearm-related deaths account for 26% of injury deaths. For both age groups, occupant motor vehicle-related deaths account for the majority of deaths and underscore the need for seat belt use. Using theoretical principles based on the Haddon matrix and a knowledge of adolescent development, proposed interventions to decrease injuries and deaths related to motor vehicles and firearms include graduated licensing, occupant restraint, speed limits, conflict resolution, and gun control. Occupational injuries, particularly injury associated with agricultural production, account for an estimated 100,000 injuries per year. Preventive strategies include OSHA regulations imposing standards for protective devices and further study for guidelines for adolescent work in agriculture. Injuries related to recreation include drowning and sports injuries. Preventive strategies may include proper supervision and risk reduction with respect to use of alcohol/drugs. The data presented support the use of primary prevention to achieve the most effective, safe community interventions targeting adolescents. (+info)
Older drivers--a complex public health issue.
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OBJECTIVES: This article provides estimates of the percentage of seniors who are licensed to operate a motor vehicle. It describes the health characteristics of these license holders and reviews research relating to older drivers. DATA SOURCES: The data are from the cross-sectional file of Statistics Canada's 1996/97 National Population Health Survey. The sample size of respondents aged 65 or older was 13,363, weighted to represent 3.4 million individuals. Supplementary data are from the 1991 Survey of Ageing and Independence, also conducted by Statistics Canada, and from Transport Canada. ANALYTICAL TECHNIQUES: The percentages of seniors with a license were calculated by age and sex. Percentages by presence of chronic conditions, disabilities and medication use were age-standardized to control for the increasing prevalence of illness at older ages. MAIN RESULTS: The percentage of seniors who had a driver's license declined with advancing age. The negative association between disability and license holding was pronounced. The percentage of seniors with a driver's license was also relatively low among those with heart disease, arthritis, stroke or cataracts, and among those who reported taking selected medications in the last month. (+info)