Evaluation of USDA approved antimicrobials on the reduction of Salmonella and Campylobacter in ground chicken frames and their effect on meat quality.

The main objective of this study was to examine the efficacy of USDA approved antimicrobials in reducing Salmonella Heidelberg (S. H.) and Campylobacter jejuni (C. j.) in ground chicken frames and to determine the treatment effects on total aerobic counts and meat color. Six antimicrobials (0.1% peracetic acid [PAA], 0.6% cetylpyridinium chloride [CPC], 0.005% sodium hypochlorite, 1.5% acidified lactic acid [ALA], 0.3% propionic acid, and 0.1% lauric arginate [LAE]) applied as dip treatments were evaluated in their efficacy in reducing S. Heidelberg and C. jejuni. Fresh chicken frames were spot inoculated with nalidixic acid resistant S. H. and C. j. (ATCC 33291) to achieve a recovery level of ca. 3 log CFU/g in the ground product. Frames were dipped for 10 s in each antimicrobial solution and each treatment was replicated on 3 frames. Three separate replications were conducted for this experiment. Frames were blended, and ground samples similar to mechanically separated chicken (MSC) were obtained and stored at 4°C for 24 hours. Samples were analyzed after grinding on d zero (2 h) and d one (24 h) to determine reduction in S. H. and C. j. counts in MSC. PAA and LAE treatments had the highest reductions on Salmonella counts (P ≤ 0.05), both treatments resulting in 0.9 log CFU/g reduction as compared to control on d zero. PAA and CPC reduced Salmonella counts by 1.4 and 0.9 log CFU/g, respectively, on d one; PAA, propionic acid, ALA, and LAE resulted in one log CFU/g reductions of C. j. as compared to control on d one. There was no significant difference among the treatments in their ability to reduce C. j. on d one. The treatments had no effect on total aerobic counts. The findings from the study indicate that PAA, CPC, and LAE can reduce S. H. in ground chicken frames, whereas all the antimicrobials tested in the study, except chlorine, have the ability to reduce C. j. in ground chicken frames, a product similar to commercial MSC.

Effect of X-ray treatments on Escherichia coli O157:H7, Listeria monocytogenes, Shigella flexneri, Salmonella enterica and inherent microbiota on whole mangoes.

UNLABELLED: The aims of this investigation were to; (i) study the effect of X-ray treatments in reducing Escherichia coli O157:H7, Listeria monocytogenes, Salmonella enterica and Shigella flexneri on whole mangoes, and (ii) study the effect of X-ray treatments on microflora counts (mesophilic counts, psychrotrophic counts and yeast and mould counts) of whole mangoes during storage at ambient temperature (22°C) for 30 days. A mixture of three strains of each test organism was spot inoculated (100 µl; approx. 8-9 log CFU ml(-1) ), separately, onto the surface (5 cm(2) ) of whole mangoes, air-dried (30 min), and then treated with different doses of X-ray (0, 0·1, 0·5, 1·0, and 1·5 kGy). Approximately 2·9, 1·8, 2·1 and 5·2 log CFU cm(-2) reduction of E. coli O157:H7, L. monocytogenes, Sh. flexneri and Salm. enterica were achieved by treatment with 0·5 kGy X-ray respectively. Furthermore, the populations of E. coli O157:H7, L. monocytogenes, Sh. flexneri and Salm. enterica were reduced to less than the detectable limit (2·0 log CFU cm(-2) ) by treatment with 1·5 kGy X-ray. Treatment with 1·5 kGy X-ray significantly reduced the initial inherent microflora on skin of whole mangoes and inherent levels were significantly (P < 0·05) lower than the control sample throughout storage at 22°C for 30 days. SIGNIFICANCE AND IMPACT OF THE STUDY: Fresh produce was associated with 770 outbreaks between 1990 and 2005, resulting in 35 060 cases of illness that costs the US $39 billion annually. The food industry is looking for new preservation methods. This investigation indicated that X-ray treatment was very effective against Escherichia coli O157:H7, Listeria monocytogenes, Shigella flexneri and Salmonella enterica and inherent microflora on whole mangoes which could offer an applicable approach to control pathogens and spoilage bacteria for the mango industry.

Efficacy of Lytic Bacteriophage Preparation in Reducing Salmonella In Vitro, on Turkey Breast Cutlets, and on Ground Turkey.

The efficacy of the recently approved Salmonella lytic bacteriophage preparation (SalmoFresh) in reducing Salmonella enterica serotype Heidelberg on turkey breast cutlets and ground turkey was evaluated. In a broth model assay, the phage preparation completely inhibited the growth of four S. enterica serotypes (Salmonella Enteritidis, Salmonella Heidelberg, Salmonella Kentucky, and Salmonella Typhimurium) at 37°C at a multiplicity of infection of 10,000 PFU/CFU. At 4°C in 0.1% peptone water (PW), phage treatment at a multiplicity of infection of 10,000 resulted in ca. 4.0-log CFU/ml reductions of Salmonella Enteritidis, Salmonella Heidelberg, and Salmonella Typhimurium. When raw turkey breast cutlets inoculated with Salmonella Heidelberg (∼10(3) CFU/g) were treated with phage preparation (10(7) PFU/g) and stored at 4°C, the phage treatment caused reductions of 0.8, 0.6, and 1.3 log CFU/g (P ≤ 0.05) of Salmonella Heidelberg on day 0, 1, and 7, respectively, compared with the counts in the control. However, no significant reduction of Salmonella Heidelberg (P > 0.05) was observed in ground turkey when turkey meat pieces inoculated with Salmonella Heidelberg were surface treated with phage preparation (10(7) PFU/g) before grinding. These findings indicate that the bacteriophage preparation was effective in reducing Salmonella on turkey breast cutlets as a surface treatment but did not cause any reduction of Salmonella Heidelberg in ground turkey.

Reduction of Salmonella in skinless chicken breast fillets by lauric arginate surface application.

Lauric arginate (LAE) has been found to be effective against various foodborne pathogens. In this study, the antimicrobial efficacy of LAE against Salmonella and mesophilic organisms was evaluated in fresh, skinless, boneless, uncooked chicken breast fillets. The effect of LAE treatments on pH and color of breast fillets was also assessed. Chicken breast fillets were inoculated with a 4-strain Salmonella cocktail (Salmonella Enteritidis ATCC 4931, Salmonella Heidelberg ATCC 8326, Salmonella Kentucky ATCC 9263, and Salmonella Typhimurium ATCC 14028) and then treated with sterile dionized water (positive control) and 200 ppm and 400 ppm of LAE. The chicken breast fillets were stored at 4 ± 1°C and analyzed on d 0, 1, 3, 5, and 7 for Salmonella, total aerobes, color, and pH. The fillets destined for color analysis were not inoculated with Salmonella cocktail and stored under conditions simulating the retail display. The fillets treated with 400 ppm LAE had lower (P < 0.05) Salmonella counts compared with the positive control from d 0 through d 7 of storage except on d 3, when no effect of LAE was observed. Treating fillets with 200 ppm of LAE caused a significant reduction in Salmonella counts (P < 0.1) on d 0, 1, and 7. Reductions in Salmonella spp. were 0.7 log cfu/g and 0.7 to 1.0 log cfu/g for 200 and 400 ppm treatments, respectively. Lauric arginate did not exhibit any treatment effect on the growth of mesophilic microorganisms, pH, and color of chicken breast fillets (P > 0.05) when applied at 200 and 400 ppm concentrations. These results indicate that surface application of LAE in chicken breast fillets significantly reduces Salmonella during refrigerated aerobic storage without negatively affecting the color of chicken breast fillets.

Bactericidal activity of lauric arginate in milk and Queso Fresco cheese against Listeria monocytogenes cold growth.

Lauric arginate (LAE) at concentrations of 200 ppm and 800 ppm was evaluated for its effectiveness in reducing cold growth of Listeria monocytogenes in whole milk, skim milk, and Queso Fresco cheese (QFC) at 4°C for 15 to 28 d. Use of 200 ppm of LAE reduced 4 log cfu/mL of L. monocytogenes to a nondetectable level within 30 min at 4°C in tryptic soy broth. In contrast, when 4 log cfu/mL of L. monocytogenes was inoculated in whole milk or skim milk, the reduction of L. monocytogenes was approximately 1 log cfu/mL after 24 h with 200 ppm of LAE. When 800 ppm of LAE was added to whole or skim milk, the initial 4 log cfu/mL of L. monocytogenes was nondetectable following 24 h, and no growth of L. monocytogenes was observed for 15 d at 4°C. With surface treatment of 200 or 800 ppm of LAE on vacuum-packaged QFC, the reductions of L. monocytogenes within 24 h at 4°C were 1.2 and 3.0 log cfu/g, respectively. In addition, the overall growth of L. monocytogenes in QFC was decreased by 0.3 to 2.6 and by 2.3 to 5.0 log cfu/g with 200 and 800 ppm of LAE, respectively, compared with untreated controls over 28 d at 4°C. Sensory tests revealed that consumers could not determine a difference between QFC samples that were treated with 0 and 200 ppm of LAE, the FDA-approved level of LAE use in foods. In addition, no differences existed between treatments with respect to flavor, texture, and overall acceptability of the QFC. Lauric arginate shows promise for potential use in QFC because it exerts initial bactericidal activity against L. monocytogenes at 4°C without affecting sensory quality.

Effects of carbon dioxide and ozone treatments on the volatile composition and sensory quality of dry-cured ham.

Randomized complete block designs with 3 replications were utilized to evaluate the effects of carbon dioxide (CO(2)) (0% at 96 h, 60% at 48 h, and 60% at 96 h) and ozone (O(3)) (0 and 175 ppm for 48 h) on the volatile flavor compound concentrations in dry-cured ham. Minimal differences existed in the presence and concentration of aroma active compounds in both CO(2) and O(3) fumigated hams but phenols were slightly more prevalent (P < 0.05) in the CO(2) treatments and oxidation compounds were slightly elevated (P < 0.05) in the ozone treated samples when compared to the control. Triangle tests (n = 54 and 56) indicated that consumers could not discern (P > 0.75) between the control hams and the hams that were fumigated with CO(2) and O(3), respectively. This study revealed that there were minimal aroma/flavor differences among the ham treatments between 0 and 60% CO(2) for 96 h; and also between 0 and 175 ppm O(3).

Is the routine placement of a CSF reservoir following endoscopic third ventriculostomy justified?

Endoscopic third ventriculostomy (ETV) is a well established treatment for selected cases of obstructive hydrocephalus. However, it does carry a significant rate of failure, which can be abrupt and life threatening. The present study analyses the benefits versus the risks of routine CSF reservoir insertion during ETV. Clinical data obtained from the medical records of patients from a single neurosurgical centre who underwent ETV between August 2002 and February 2007 were analysed retrospectively. A total of 34 records were available with follow-up ranging from 3-56 months (Median 26 months) and with patient age range between 6 months - 75 yrs (median 19 years). During this period, one neurosurgeon routinely placed reservoirs in all patients undergoing ETV (n = 34). In all instances of reservoir insertion, Ommaya reservoirs were used. The number of patients in which the reservoir was tapped for diagnostic and/or therapeutic reasons was quantified, and all complications resulting from reservoir placement recorded. ETV success was defined by a lack of subsequent need for cerebrospinal fluid diversion. In total 13 of 34 (38%) reservoirs inserted were tapped at a later date and there were no complications associated with their insertion. Tapping of reservoirs helped determine which patients required subsequent ventriculoperitoneal (VP) shunting. In at least one case reservoir tapping was carried out as an emergency and was a crucial intermediate intervention prior to further surgery. The overall success rate of ETV was 65% (95% CI, 49-81%) with four complications associated with ETV: short-term memory loss, psychosis, and two cases of post-operative seizures. These complications were not attributed to CSF reservoir insertion but the ETV procedure itself. The routine placement of CSF reservoir following ETV thus seems justified with respect to the observed benefits and lack of complications associated with its placement.

Production and characterization of a monoclonal antibody to Campylobacter jejuni.

Campylobacter species are a group of spiral-shaped bacteria that can cause disease in humans and animals. We developed a high-affinity monoclonal antibody (MAb) probe that recognizes Campylobacter jejuni cells. Cell suspensions grown under microaerobic conditions at 42 degrees C for 20 h on Bolton agar plates with lysed horse blood were used as live and heat-killed preparations, centrifuged at 8,000 x g for 20 min, and resuspended in carbonate buffer (pH 9.6) for coating on the enzyme-linked immunosorbent assay plates. BALB/c mice were immunized with C. jejuni sonicated cells at 10(7) CFU/ml to generate MAb-producing hybridoma clones. Of about 500 initial hybridoma clones, MAb 33D2, which reacted with C. jejuni and Campylobacter coli, was selected for further evaluation. MAb 33D2 is in the immunoglobulin subclass G2a and had relatively weaker reactivity with the C. coli strains tested. MAb 33D2 did not show any cross-reactions with the nine non-Campylobacter bacteria tested in the enzyme-linked immunosorbent assay and had a stronger affinity for C. jejuni as live versus heat-killed cells. In Western blot assays, MAb 33D2 recognized two major antigens of 62 and 43 kDa in extracts from C. jejuni cells but only one antigen of 62 kDa in extracts from C. coli cells.

Co-infection of market-age turkeys with Escherichia coli and Listeria monocytogenes in two stress models.

We have hypothesized that stress-induced subclinical infection of turkeys with Listeria monocytogenes may be an overlooked source of processing plant contamination, and we have shown that concurrent Escherichia coli challenge can increase L. monocytogenes colonization. The objective of this study was to determine the effects of dexamethasone (Dex) immunosuppressive treatment and transport stress on the isolation of L. monocytogenes in an E. coli-L. monocytogenes challenge model. Thirteen-week-old male turkeys housed in floor pens were either nonchallenged (NCH) or challenged (CH) by environmental exposure to E. coli and L. monocytogenes Scott A, using both a coarse spray and feed inclusion. One group of both NCH and CH birds was not stressed (NCH-Con and CH-Con, respectively), a second group was treated with Dex during challenge (NCH-Dex and CH-Dex, respectively), and a third group was subjected to a 12-hour transport (Trans) stress protocol at 15 wk of age (NCH-Trans and CH-Trans, respectively). All birds were bled and necropsied the morning after transport. Dexamethasone treatment increased mortality and disease incidence. The CH-Con, CH-Trans, and CH-Dex birds, as well as the NCH-Dex birds, had lowered body weights compared to the NCH-Con. The relative liver and heart weights were increased, and the relative bursal weights were decreased by both NCH-Dex and CH-Dex treatments. The heterophil:lymphocyte ratio, a measure of the stress response, was increased by CH-Trans, NCH-Dex, and CH-Dex. Total erythrocyte counts and hematocrit were decreased by NCH-Trans, CH-Trans, NCH-Dex and CH-Dex. The challenge strain of E. coli was isolated from the organs of a significant number of CH-Dex birds using direct plating and occasionally from CH-Trans birds. Listeria monocytogenes was not isolated from significant numbers of birds using direct plating, but was isolated from the knee or hip synovial tissues of a significant percentage of CH-Dex birds using pre-enrichment cultural methods, and from CH-Trans and CH-Dex birds using real-time PCR detection. These data suggest that L. monocytogenes colonization of processing-age turkeys can be increased by stress, and the organism may be harbored within inapparent infections of turkey synovial tissue.

Ciprofloxacin-sensitive and ciprofloxacin-resistant Campylobacter jejuni are equally susceptible to natural orange oil-based antimicrobials.

A total of 10 ciprofloxacin-sensitive (ciprofloxacin minimum inhibitory concentration, MIC < 0.5 micro g/ml) and 10 ciprofloxacin-resistant (MIC 16 to 32 micro g/ml) presumptive C. jejuni were further characterized and evaluated for their inhibition by natural orange oil fractions. Partial species identification was performed by using a hippuricase gene-based polymerase chain reaction (PCR) assay. One of the isolates appeared to be atypical and failed to hydrolyze hippurate. Of the ciprofloxacin-resistant C. jejuni isolates tested, six were found to have their quinolone resistance determined by a C --> T mutation in codon 86 of gyrA. Both groups of ciprofloxacin-sensitive and -resistant C. jejuni isolates were most susceptible to cold-pressed terpeneless Valencia orange oil (C4) which yielded inhibition zones from 44.0 +/- 1.4 to 80 +/- 0.0 mm. Less inhibitory responses were recorded for 5-fold concentrated Valencia orange oil (C3) and distilled d-limonene (C7) which exerted similar effects on both ciprofloxacin-sensitive and -resistant C. jejuni isolates. In general, ciprofloxacin-resistant and -sensitive C. jejuni isolates were equally susceptible to the respective orange oil fractions.

Pathogenicity of Listeria monocytogenes Scott A after oral and oculonasal challenges of day-old turkey poults.

Listeria monocytogenes is a ubiquitous, environmental pathogen that has contaminated poultry ready-to-eat products resulting in large-scale recalls. Research is needed to determine the source of product and processing plant contamination with L. monocytogenes. The purpose of this study was to compare the oral and oculonasal routes of infection on the pathogenicity of L. monocytogenes in turkey poults under different housing conditions. One-day-old turkey poults were challenged by either route with the Scott A strain of L. monocytogenes and placed either in paper-lined battery-brooder cages for 1 wk or in floor pens on fresh pine-shaving litter. On day 7, birds challenged in battery cages were transferred to floor pens. Challenge by the oculonasal route resulted in higher mortality (P = 0.05) and lower body weights (P < 0.0001) compared with both nonchallenged controls and those challenged by the oral route. Birds contained in battery cages for 1 wk had higher mortality (P = 0.002) and higher body weights (P < 0.0001) compared with floor-pen-reared birds. Using direct plating, the challenge strain was isolated from the gall bladder, brain, and knee joint of only one dead poult challenged by the oculonasal route. These results suggest that day-old turkey poults may be more susceptible to an oculonasal challenge with L. monocytogenes than to an oral challenge and that containment in battery cages for the first week increased contact exposure to the challenge.

The effects of stress on respiratory disease and transient colonization of turkeys with Listeria monocytogenes Scott A.

Listeria monocytogenes contaminates poultry processing plants due to its ubiquitous nature and high resistance to disinfection. The sources of the persistent, biofilm-forming strains that colonize processing plants are unknown. The purpose of this study is to determine if intrinsic colonization of turkeys is a possible source of contamination. Male poults were subjected to cold stress from 4-12 days of age; poults were unchallenged or were exposed to an aerosol and oral challenge of either an avian pathogenic strain of Escherichia coli (Ec), the Scott A strain of L. monocytogenes (Lm), or to a combination (Ec-Lm). At 7 wk, all cold-stressed poults were treated with an immunosuppressive dose of dexamethasone (Dex) and exposed to the same bacterial challenges. Birds were necropsied at 1 wk and 2 wk post-Dex treatment. Percent mortality, body and organ weights, and airsacculitis scores were determined. Liver and knee synovial tissues were sampled, using transport swabs, and cultured by direct plating, pre-enrichment, and Taqman real-time PCR. There were no significant differences in cumulative mortality, and airsacculitis scores were variable but tended to be decreased by cold stress. Relative weights of liver and heart were increased, whereas body weights, and spleen and bursa relative weights, were decreased following all challenges. Listeria monocytogenes was isolated from up to 50% of liver or knee synovial tissues, using pre-enrichment followed by culturing methods, and from up to 67% of knee synovial tissues using pre-enrichment followed by real-time PCR at 1 wk post-challenge. The higher percentages of positive birds, detected by real-time PCR rather than by culture, and the negative results at 2 wk post-challenge suggest that the birds experienced a transient infection that was cleared by the immune system. These results suggest that environmentally acquired L. monocytogenes can transiently colonize the liver and synovial tissues of stressed turkeys and may be a sporadic source of contamination of processing plants.

Temporary alopecia after subarachnoid haemorrhage.

Primary endovascular intervention is increasingly the first choice of treatment for cerebral aneurysms, particularly for those with complex anatomy in the posterior circulation. However, their clinical management and follow-up continue to be predominantly in the hands of neurosurgeons. In this report, the development of alopecia following the coiling of posterior circulation aneurysms is described. The alopecia was transient and lasted for approximately 6 months, and occurred in the occipital and suboccipital regions of the scalp. This report aims to highlight this condition, which has not been previously reported in the neurosurgical literature. The potential hazards of irradiation should be borne in mind while carrying out complex endovascular procedures. The patient should be counselled and all necessary steps undertaken to limit radiation exposure.

Lintene granuloma following microvascular decompression mimicking a cerebellopontine angle tumour.

We describe a case of foreign body granuloma caused by lintene (cotton gauze), placed during microvascular decompression of the fifth nerve for trigeminal neuralgia. At presentation, the clinical and radiological findings were suggestive of a tumor. This is only the second case in the literature of a foreign body granuloma occurring owing to the placement of a lintene pledget during microvascular decompression.

Proximal migration of a lumboperitoneal unishunt system.

Proximal migration of a lumboperitoneal (LP) shunt is a rare complication associated with unishunt systems. We report three cases with a hypothesis that raised intra-abdominal pressure may be a factor responsible for the proximal migration of a LP unishunt. A rare case of proximal migration of LP shunt into the quadrigeminal cistern is also reported.

Respiratory infection of turkeys with Listeria monocytogenes Scott A.

The pathogenesis of L. monocytogenes strain Scott A was studied by challenging day-old male turkey poults by air sac inoculation with tryptose phosphate broth containing 10(0) cfu (control), 10(4), 10(5), and 10(6) cfu (low challenge), or 10(7) and 10(8) cfu (high challenge) of the Scott A (serotype 4b) strain of L. monocytogenes. Mortality at 2 wk postinfection (PI) ranged from 25% for low challenge to 100% for high challenge (P= 0.0001). Gross and histopathological lesions were observed in heart, liver, spleen, lung, and bursa of Fabricius of mortalities at 4 days PI. Listeria monocytogenes challenge resulted in significantly decreased relative weight of the bursa of Fabricius and increased relative weight of the spleen, and L. monocytogenes was isolated by direct plating of liver, pericardium, brain, and both left and right stifle joint synovium (knee) cultures, as well as gall bladder, yolk sac, and cecal tonsil from transfer swabs onto Listeria-selective agar. Isolates were confirmed as positive using Gram stain, biochemical tests, and the Biolog system. High challenge resulted in confirmed L. monocytogenes isolation from 48% of left knee and 59% of right knee cultures. Low challenge resulted in isolation of L. monocytogenes from 11% of both left and right knee cultures. These results suggest that L. monocytogenes Scott A colonization of turkey knee synovial tissue can initiate in day-of-age poults and that L. monocytogenes Scott A can be invasive through air sac infection.

Intraosseous schwannoma of the cervical spine.

The authors report a rare case of a cervical intraosseous schwannoma, which was diagnosed following an incidental history of trauma. This is the first case of an intraosseous schwannoma of the cervical vertebra that was diagnosed using magnetic resonance imaging. The authors discuss the radiological imaging, surgical procedure and review the relevant literature.

Radiation resistance and virulence of Listeria monocytogenes Scott A following starvation in physiological saline.

The influence of starvation on the resistance of Listeria monocytogenes Scott A to electron beam irradiation in 0.85% (wt/vol) NaCl (saline) and in ground pork was investigated. Exponential- or stationary-phase cells (control) were grown at 35 degrees C in tryptic soy broth supplemented with 0.6% yeast extract. Washed cells were starved for 12 days in saline, and virulence of the pathogen was evaluated at 0, 8, and 12 days during starvation. Samples of saline and irradiation-sterilized ground pork, inoculated with control or starved cells, were irradiated at doses ranging from 0.0 to 2.5 kGy. L. monocytogenes survivors were determined by plating diluted samples of saline or pork on tryptic soy agar supplemented with 0.6% yeast extract and counting bacterial colonies following incubation (35 degrees C, 48 h). Virulence of starved cells and control was not significantly different (P > 0.05). Cells exhibited the highest radiation resistance at 8 days of starvation. Irradiation (0.5 kGy) in saline resulted in approximately 7.14, 5.55, and 2.38 log reduction in exponential, stationary, and starved cells, respectively. Irradiation of ground pork at 2.5 kGy reduced controls by approximately 6.0 log, whereas starved cells were reduced by only 3.8 log. Starved cells consistently exhibited higher irradiation D10-values than controls (P < 0.05). D10-values for exponential, stationary, and starved cells were 0.07, 0.09, and 0.21 kGy and 0.35, 0.42, and 0.66 kGy in saline and ground pork, respectively. These results indicate that starvation cross-protects L. monocytogenes Scott A against radiation inactivation and should be considered when determining this pathogen's irradiation D-value.

Posterolateral thoracic disc disease: clinical presentation and surgical experience with a modified approach.

Posterolateral thoracic disc disease is often misdiagnosed and labelled as demyelination. A high index of suspicion and awareness of this disease entity is the key to diagnosis and treatment. Our experience with a modified posterolateral facetal-sparing pedicle-sparing approach is highlighted.

Elderly patients with severe head injury in coma from the outset--has anything changed?

Advancing age is known to be a determinant of outcome in head injury. We have sought to discover whether there has been any change in the outcome of elderly patients with severe head injury in Newcastle, where these patients have continued to be treated with maximum intervention. A review of prospectively collected data from the Newcastle Head Injury Database for the period 1990 to 2000 was carried out. All patients aged 70 years and above who had sustained a severe head injury (Glasgow Coma Score of 8 or less from the outset) were included. The Glasgow Outcome Score (GOS) was determined at 6 months. Seventy-one patients were identified. Fifty-seven (80%) died and 2 (3%) were in a vegetative state, 11 (16%) had severe disability, 1 (1%) had moderate disability and no patients made a good recovery. The natural history of this condition remains unchanged and due consideration should be given to this when evaluating interventions for elderly patients with a severe head injury.