Compression plating of acute femoral shaft fractures.

Although intramedullary fixation has standardized the management of femoral shaft fractures, compression plating may offer a viable alternative. A retrospective review of acute femoral shaft fractures managed by open reduction and compression plating between 1980 and 1987 revealed 71 fractures in 69 patients. There were 58 closed fractures, and six grade I and seven grade II open fractures. All patients received prophylactic antibiotics. Sixty-nine percent of patients were bone grafted. Sixty-six of 71 fractures (93%) healed uneventfully. The average time until union was 16 weeks (range: 23 to 72). Complications included two nonunions, two refractures, and one broken implant (7%). Careful adherence to the principles of prophylactic antibiotics, medial cancellous bone grafting, and meticulous soft tissue technique can significantly reduce the complication rate of compression plating.

A study of inter-reviewer reliability of attacks recorded on ambulatory EEG.

Eleven ambulatory EEG (A/EEG) cassette tapes were sent to 5 reviewers from different EEG laboratories in the U.K. Each tape included one attack recorded from a different patient. Attacks were chosen to include various possible EEG changes that can occur during attacks on A/EEG. Reviewers were asked to give details of EEG changes seen during attacks and to state whether they thought attacks were epileptic. Total agreement about the presence of abnormality was found on 2 tapes. Four out of 5 reviewers agreed on 4 tapes and on the remaining 5 tapes only 2 or 3 reviewers were in agreement. It was concluded that the amount of agreement amongst reviewers was poor but reasonable in view of the degree of difficulty of the tapes which were not a random sample. Compared to the final clinical opinion of referring consultants, these findings would have resulted in 16% false negatives, 7% false positives and 13% of cases in which no decision was made.

Twenty-four hour ambulatory EEG monitoring: development and applications.

Since 1975 four-channel ambulatory monitoring has been available as a technique for prolonged EEG recording in an unrestricted environment. This increases EEG sampling time so that attacks can be recorded and enables the differentiation of epileptic and non-epileptic attacks. In recent years an eight-channel system has become available which provides greater scalp coverage and allows better localization of attacks and EEG abnormalities. Four-channel recording has been widely used to assess the efficacy of anticonvulsant medication in patients with absence seizures. It has also been used to investigate the effect of the environment on discharges, as well as any circadian variations in discharges. Ambulatory monitoring provides a useful alternative to sleep recording in the laboratory, both for the detection of abnormalities during sleep and for experimental sleep studies. Automated analysis techniques have so far been confined to the analysis of spike and wave activity and to the scoring of sleep stages.

The effect of sodium valproate on sleep, reaction times, and visual evoked potential in normal subjects.

The effect of enteric-coated sodium valproate on 10 normal volunteer subjects was evaluated using simple reaction times, the visual evoked potential (VEP), and EEG sleep recording. Placebo, low-drug (500 mg), high-drug (1,000 mg), and withdrawal conditions were investigated. No significant treatment effect was found for simple reaction time nor was there any significant effect on either the latency or the amplitude of the VEP. Sleep recordings were analysed visually and also using an automated technique consisting of simple period analysis. The automated sleep results suggested that there was a decrease in rapid eye movement activity and an increase in delta activity under the high-drug condition. The visually analysed data did not reach significance, although they followed the same trends as those analysed automatically. It is possible that the automated results reflect an EEG frequency change rather than a change in the sleep cycle itself caused by treatment with sodium valproate.