Diffuse Calvarial Hyperostosis and Spontaneous Intracranial Hypotension: A Case-Control Study.

BACKGROUND AND PURPOSE: Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further evaluation. This retrospective study evaluated whether there was a difference in the prevalence of calvarial hyperostosis in a cohort of patients with spontaneous intracranial hypotension compared with an age- and sex-matched control population. MATERIALS AND METHODS: Cross-sectional imaging (CT of the head or brain MR imaging examinations) for 166 patients with spontaneous intracranial hypotension and 321 matched controls was assessed by neuroradiologists blinded to the patient's clinical status. The readers qualitatively evaluated the presence of diffuse or layered calvarial hyperostosis and measured calvarial thickness in the axial and coronal planes. RESULTS: A significant difference in the frequency of layered hyperostosis (31.9%, 53/166 subjects versus 5.0%, 16/321 controls, P < .001, OR = 11.58) as well as the frequency of overall (layered and diffuse) hyperostosis (38.6%, 64/166 subjects versus 13.2%, 42/321 controls, P < .001, OR = 4.66) was observed between groups. There was no significant difference in the frequency of diffuse hyperostosis between groups (6.6%, 11/166 subjects versus 8.2%, 26/321 controls, P = .465). A significant difference was also found between groups for calvarial thickness measured in the axial (P < .001) and coronal (P < .001) planes. CONCLUSIONS: Layered calvarial hyperostosis is more prevalent in spontaneous intracranial hypotension compared with the general population and can be used as an additional noninvasive brain imaging marker of spontaneous intracranial hypotension and an underlying spinal CSF leak.

Testing a typology of batterers.

A. Holtzworth-Munroe and G. L. Stuart (1994) proposed a tripartite typology of men who batter their female partners based on the severity of violence, extent of violence, and personality disorder characteristics. The current study attempts to empirically validate this typology using data from 75 domestically violent (DV) men and their partners, and 32 maritally distressed, nonviolent (DNV) comparison couples. Mixture analysis results generally supported the model, although 2 types were not distinguishable on personality disorder characteristics as predicted. Generally violent batterers were significantly more violent within and outside the relationship. The pathological group was moderately violent within and outside the relationship and endorsed numerous psychological symptoms. Family-only batterers endorsed fewer symptoms and were less violent. Violence in the family of origin, attachment, and communication skills also differentiated the 3 types and DNV men.

Critical care in the emergency department: a time-based study.

OBJECTIVES: Emergency departments serve many functions in the current U.S. healthcare system, including initial management of patients with critical illnesses and primary care for a growing proportion of the population. Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. To date, the effect of the critically ill patients on the emergency department has not been fully described. It was the purpose of this study to examine the incidence of critical illness in the emergency department and its total burden as reflected in emergency department length of stay. DESIGN: Prospective, cohort study in 17,900 emergency department patients. SETTING: Single, not-for-profit teaching hospital. PATIENTS: All patients admitted to the emergency department during the period of April 1, 1991 to March 31, 1992. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Date and time of arrival in the emergency department and time of discharge, death, or admission to an inpatient unit were recorded. Patients admitted to intensive care units/special care units from the emergency department were defined as critically ill. All other patients were classified as noncritically ill. Emergency department length of stay was calculated as the time from arrival in the emergency department until discharge, death, or admission to an inpatient unit. Differences in length of stay were determined using Kruskal-Wallis analysis by ranks. The study population totaled 17,900 patients: 8.5% (n = 1,527) critically ill patients, 61.1% (n = 10,930) discharged patients, and 30.4% (n = 5,443) noncritically ill admitted patients. Mean emergency department length of stay for the critically ill patients was 145.3 +/- 89.6 mins (maximum length of stay, 655 mins), and for the noncritically ill patients, mean stay was 153.1 +/- 91.9 mins (maximum length of stay, 781 mins) (p < .0003). During the study period, 154 patient-days of emergency department critical care were provided. CONCLUSIONS: Critically ill patients constitute an important proportion of emergency department practice and may remain in the emergency department for significant periods of time. Solutions to emergency department overcrowding may include alternatives for continuing management of critically ill patients. Given the realities of emergency department practice, emergency medicine practitioners should receive training in the continuing management of critically ill patients.

Power and violence: the relation between communication patterns, power discrepancies, and domestic violence.

This study hypothesized that power discrepancies in the marital relationship, where the husband is subordinate, serve as risk factors for husband-to-wife violence. The construct of marital power was assessed from 3 power domains operationalized by discrepancies in economic status, decision-making power, communication patterns, and communication skill. Three groups of married couples (N = 95) were compared: domestically violent (DV), maritally distressed/nonviolent (DNV), and maritally happy/nonviolent (HNV). DV couples were more likely than the 2 nonviolent groups to engage in husband demand/wife withdraw interactions. Within the DV group, husbands who had less power were more physically abusive toward their wives. Thus, violence may be compensatory behavior to make up for husbands' lack of power in other arenas of marriage. Difficulties in assessing marital power and future direction for the study of power and violence are discussed.