Symptomatic lumbar spinal arachnoiditis: fact or fallacy?

It is generally accepted that chronic adhesive lumbar arachnoiditis is a cause of symptoms, notably back pain and/or pain (of almost any type, not necessarily 'anatomical') in the lower limbs, although there is no clearly defined clinical pattern which is clearly associated with this syndrome. There is no doubt that arachnoiditis occurs as a pathological and radiological entity due to a number of causes. In the view of the present authors, the nexus between the pathology and radiology on the one hand, and the patients' symptoms on the other hand, has not been demonstrated with any degree of scientific rigor.

Consciousness.

A brief review of some current views of consciousness is provided. Edelman's view of there being both 'primary consciousness' and 'higher order consciousness' is supported. The basis for the clinical view that primary consciousness is the result of the dynamic interaction between the cerebral cortex and the brainstem reticular activating system is presented. It is suggested that an audacious theoretical breakthrough is needed in order to advance our understanding of this complex and fascinating problem.

International neurosurgery: neurosurgical training and practice in India, Korea, Japan, and Australasia.

During the 1985 annual meeting of the Congress of Neurological Surgeons in Honolulu, neurosurgical training and practice in India, Korea, Japan, and Australasia were discussed at the International Committee symposium. This article summarizes the information presented. India has about 300 neurosurgeons for a population of 650 million, while Japan has about 4,000 neurosurgeons and trainees for a population of 120 million. Korea has 424 neurosurgeons for a population of 41.5 million, and Australasia has 92 neurosurgeons and 19 trainees for 17.5 million people. Various other demographic, institutional, organizational, and economic aspects of neurological health care and delivery, education, and quality control are described. While financing and availability of adequate neurosurgical care remains a major problem in India, it appears that reducing the number of neurosurgical trainees remains, as it is in North America, a major issue in Japan and, to a lesser extent, in Korea. This problem, as well as certification of the quality of training, is being managed effectively in Australasia.

Electrical injury to the central nervous system.

A case of delayed spinal cord damage due to high voltage electric shock is presented. The literature on the subject is reviewed and discussed.

How useful is the skull x-ray examination in trauma?

Abnormalities were detected only in 24 (2.3%) of 1053 skull X-ray examinations performed in cases of suspected head trauma, at a cost of $1461 per positive finding. Only in six cases (0.6%) was treatment influenced by the radiological findings. Skull X-ray examination is indicated if a depressed fracture, compound fracture, or radio-opaque foreign body is suspected, and these patients are reliably selected by certain clinical criteria. The skull X-ray film is not a reliable guide to the presence or extent of intracranial injury, nor is it a substitute for careful clinical evaluation, observation and re-evaluation. The medicolegal implications of this restrictive policy are discussed.

Vascular compression: cause of trigeminal neuralgia.

Fifty patients with trigeminal neuralgia have been operated upon, and the site of origin of the fifth nerve from the pons has been explored. Forty-four of these patients were demonstrated to have vascular compression at this point, and relief of the vascular compression resulted in pain relief in all of these patients, although two patients experienced some recurrence of pain. The maximum follow-up period is now six years. It is considered that the most common cause of trigeminal neuralgia is vascular compression of the fifth nerve at the nerve root entry zone.

Vascular compression of lower cranial nerves: observations using microsurgery, with particular reference to trigeminal neuralgia.

A new finding made possible by the use of the operating microscope in neurosurgery is discussed. Nineteen patients with trigeminal neuralgia have been explored, and in 14 of these vascular compression of the fifth nerve at its entry zone to the pons has been found. Relief of this vascular compression has caused cessation of pain in all these patients. In addition, one patient with hemifacial spasm, and one patient with glosso pharyngeal neuralgia, are reported; each of these also had vascular compression of the appropriate nerve causing the symptoms.

The influence of seat belt wearing on the incidence of severe head injury.

A retrospective follow-up of patients admitted to hospital with a diagnosis of head injury in two sample years, before and after the introduction of legislation requiring the use of seat belts, has been undertaken. This shows a marked reduction in the incidence of severe head injury following the introduction of this legislation.

A Solid State Pulsed Coagulating Diathermy Instrument:1 Preliminary Report.

A solid state pulsed coagulating diathermy instrument is described. The operating parameters of this instrument have been investigated for bipolar coagulation. The advantages of this instrument over spark-gap instruments are lower power requirement, smaller physical size, lessend fire danger and elimination of E. C. G. interference (when used with bipolar configuration).