The "incompleat" physicians: community physicians' lack of knowledge of medical socioeconomics and politics.

The suspicion that physicians in this community know little about current events in American medical socioeconomics and politics led to a survey of the local medical society membership. The results showed a discouraging lack of knowledge about information that is readily available to physicians. We concluded that current methods for educating physicians in these subjects are largely ineffective. Live, as opposed to printed, presentations at local, state, and specialty medical society meetings may be more effective in educating, and thereby involving, physicians in the critical political and economic issues presently facing them.

The effect of hyperbaric oxygen on glucose utilization in a freeze-traumatized rat brain.

Local cerebral glucose utilization was measured with the autoradiographic 2-deoxyglucose technique in rats injured by a focal parietal cortical freeze lesion then treated with hyperbaric oxygen (HBO). The cold lesion depressed glucose utilization in the contralateral as well as in the ipsilateral hemisphere. The largest decreases were observed in ipsilateral cortical areas. Treatment of lesioned animals with HBO at 2 atm for 90 minutes on each of 4 consecutive days tended to increase the overall cerebral glucose utilization measured 5 days after injury when compared to animals exposed to normobaric air. This improvement reached statistical significance in five of the 21 structures studied: the auditory cortex, medial geniculate body, superior olivary nucleus, and lateral geniculate body ipsilateral to the lesion, and the mammillary body. The data indicate that changes in lesioned rats exposed to HBO are not restricted to the period of time that the animals are in the hyperbaric chamber but are persistent.

Brain stem abscess managed with computed tomography-guided stereotactic aspiration.

The importance of stereotactic aspiration to the successful management of three cases of brain stem abscess is discussed with special reference to the advantages offered over medical treatment alone. Stereotactic aspiration allows evacuation of pus, accurate bacteriological diagnosis, selection of an optimal antibiotic regimen, and instillation of antibiotics directly into the abscess cavity. In two of the three cases described here, the abscess reaccumulated after initial aspiration despite appropriate maximal medical therapy. A repeat aspiration was required before resolution occurred. We conclude that medical management alone is not adequate for some cases of brain stem abscess. There was no morbidity that could be attributed to the procedure, suggesting that the risk of stereotactic aspiration is probably quite low and is likely to be less than the risk of incorrect diagnosis, suboptimal choice of antibiotics, or progression of the lesion despite appropriate maximal medical therapy.

Auditory brain stem evoked responses in comatose head-injured patients.

Brain stem evoked responses (BSERs) were obtained within the first 72 hours after hospital admission from 38 patients with closed head injuries whose Glasgow coma scale scores were 8 or less. Peak V latency differentiated patients with unfavorable outcomes (vegetative or dead) from patients with more favorable outcomes, but no features of the response could further discriminate good, moderate, and severe outcomes as assessed by the Glasgow outcome scale. These data provide further support that BSERs are generally resistant to central nervous system trauma but, when impaired, are prognostic of unfavorable outcome.