Computed tomographic angiography as a screening modality for blunt cervical arterial injuries: preliminary results.

BACKGROUND: The diagnosis of blunt cervical arterial injury (CAI) is made difficult by its infrequent occurrence and delayed presentation. Beginning in January of 1995, we used computed tomographic angiography (CTA) of the neck to screen for CAI. We hypothesized that CTA could be incorporated into the workup of patients sustaining blunt neck injury as a screening modality for CAI and that CTA would increase the early detection of CAI. METHODS: Retrospective review of all CAI for the years January of 1988 to June of 1997 at a Level I trauma center. CAI diagnosed before introduction of CTA (pre-CTA; January of 1988 to December of 1994) were compared with those after (post-CTA; January of 1995 to June of 1997). RESULTS: The overall incidence of CAI for the entire time period was 0.11%. Motor vehicle crash (53%) was the most common mechanism, with focal neurologic deficit (23%) or seizures (17.6%) the most common presenting clinical symptoms. CTA added only a few additional minutes to the time required for the workup of patients sustaining blunt neck injury in whom CAI was suspected. The incidence of CAI increased from 0.06% pre-CTA to 0.19% post-CTA (p = 0.02; Fisher exact test). CTA was associated with a decrease in mean time to make the diagnosis of CAI (156 hours pre-CTA vs. 5.9 hours post-CTA). In addition, CTA was associated with a decrease in the incidence of permanent neurologic sequelae from CAI (50% pre-CTA vs. 0% post-CTA; p = 0.07; Fisher exact test). CONCLUSION: We conclude that CTA does not significantly increase the time of the diagnostic workup of the patient with injuries caused by blunt trauma. The introduction of CTA at our institution was associated with an increase in the detection rate of CAI. Earlier detection of CAI may allow for more timely therapeutic intervention and potentially prevent permanent neurologic sequelae.

Venezuelan equine encephalomyelitis vaccine (strain TC-83): a field study.

In 1971, more than 370 horses in south Texas were studied with respect to their clinical, virologic, and neutralizing antibody responses to vaccination with Venezuelan equine encephalomyelitis (VEE) strain TC-83. This study confirms reported findings that the vaccine used in the 1971 epizootic in the lower Rio Grande Valley of Texas was safe and efficacious. Vaccinal virus viremia titers were generally below the postulated infection threshold of epizootic vectors. In general, reactions to the vaccine were minimal and transient, with no observed abortions or deaths attributable to use of the vaccine. Eleven months after vaccination, VEE antibody titers were demonstrable in most horses that had VEE antibodies within 30 days after vaccination. Presence of western equine encephalomyelitis antibody titers of greater than or equal to 1:50 at time of VEE vaccination appears to modify or to interfere with VEE antibody production.

Agglutinins to Coxiella burnetii and Brucella spp, with particular reference to Brucella canis, in wild animals of southern Texas.

The prevalence of agglutinins to Coxiella burnetii and Brucella spp, particularly Brucella canis, was determined in 269 wild animals (14 species) in southern Texas. Serologic evidence of coxiellosis and brucellosis, including B canis infection, was shown for coyotes, raccoons, opossums, badgers, jackrabbits, and feral hogs. Using the microagglutination test, the seroprevalence of C burnetii, phases I and II (titer greater than or equal to 4) was 4.1 and 27.9%, respectively. For brucella agglutinins, prevalence rates were 7.1, 8.9, and 6.7%, as determined by the brucellosis card test, the rapid slide agglutination test, and the salt 2-mercaptoethanol tube agglutination (titer greater than or equal to 50) test, respectively.

A new look at bimedial prefrontal leukotomy.

Forty-four selected patients with "hard core" functional psychiatric illness were treated by bimedial prefrontal leukotomy, in which only the medial half of the prefrontal white matter of both frontal lobes was divided. This operation differs from the conventional or "standard" leukotomy which divides the entire prefrontal white matter. There were six patients with personality disorders, 25 psychoneurotics, 12 schizophrenics, and one with involutional melancholia. Forty-two of the 44 patients had thorough psychiatric follow-up, ranging from one to seven years postoperatively. They were assessed clinically and also on a point-rating scale of assessment.Seventy-six per cent of these patients had excellent or satisfactory outcomes. The most striking benefit was decrease in anxiety and tension.Modified leukotomy is a safe and effective method of reducing the symptoms of excessive tension, anxiety, fear or depression in patients with a variety of illnesses, including anxiety neurosis, phobic psychoneurosis, obsessional neurosis, neurotic or psychotic depressive reactions and schizophrenia. The operation should be considered in such neurotic, personality and psychotic illnesses when medical treatment has failed.