Standardisation of radiographic views of the fractured tibia.

Serial radiographs are difficult to compare when the position of the shin is not accurately controlled in rotation. We have designed a device which can be used easily by the radiographer to produce accurately standardised radiographs of the tibia.

Reduction of post-traumatic osteoporosis after external fixation of tibial fractures.

Disuse osteoporosis following tibial fractures is associated with pain and prolonged rehabilitation. In a prospective study, 22 patients with stable tibial fractures treated in plaster of Paris were compared with 15 patients in whom unstable tibial fractures were treated by external fixation. All patients were allowed to bear full weight from the day after the injury. The patients treated with plaster of Paris had the less severe fractures but still had a greater number of the higher grades of osteoporosis. We found a significantly lower degree of osteoporosis in the external fixator group. A comparison of the median percentage bearing weight in the two groups of patients showed greater percentage bearing weight in the external fixator group at four and eight weeks after the injury. We suggest that the reduction of post-traumatic osteoporosis is due to improved early function and weight bearing in patients treated by external fixation.

Irradiated polyglactin 910: a new synthetic absorbable suture.

Two hundred and thirty-six patients had a variety of skin and mucosal wounds sutured with a new rapidly absorbed suture material (irradiated polyglactin 910). No wound complications could be attributed to the material. These included 62 patients with scalp wounds, taking part in a comparative trial with traditional interrupted, monofilament, non-absorbable suturing. No difference in the cosmetic result could be detected three months later. The irradiated polyglactin disappeared from the wound surface spontaneously and suture removal was not normally required. Irradiated polyglactin 910 is suitable for closure of wounds where rapid suture absorption is desirable, particularly for wounds in the scalp, scrotum, and perineum and is an ideal material for mucocutaneous anastomosis at stoma surgery. Loss of suture strength is so rapid that suture removal is unnecessary, eliminating the need for further medical or paramedical care. As absorption is by hydrolysis rather than enzymatic digestion, stitch abscesses are not seen.

Judgment of facial expression of emotion in unilateral brain-damaged patients.

Patients with unilateral brain damage and normal controls were asked to give (1) inter-emotion judgment within the photographs of six facial emotions in terms of mutual similarities, and (2) intra-emotion judgment within the hemifacial composite photographs of an emotion in terms of intensity of expression. Right brain-damaged patients could differentiate between the emotion of happiness and all other emotions. Left brain-damaged patients differentiated between aroused-nonaroused emotions. Normal controls differentiated between positive-negative as well as aroused-nonaroused emotions. Left-left facial composites were judged to have expressed more intensely than right-right facial composites or normal/mirror-reversed facial orientations of emotions (except fear) by any group (p >.05).

Role of cerebral hemispheres and regions in processing hemifacial expression of emotion: evidence from brain-damage.

Patients with focal brain-damage, right or left hemisphere-damage (RHD/LHD) and anterior or posterior region-damage (ARD/PRD), and normal controls (NC) were asked to match the photographs of (left-right) hemifacial expressions of emotions, positive (happy-surprise), negative-aroused (fear-anger), negative-nonaroused (sad-disgust). Findings indicated that (a) NC subjects were significantly superior to brain-damaged patients; the difference between RHD and LHD patients was nonsignificant, and (b) ARD patients were significantly inferior to PRD patients who, in turn, were significantly inferior to NC subjects, in the perceptual matching task with hemifacial affective stimuli.

Bilateral traumatic extradural haematomas: report of 12 cases with a review of the literature.

We are reporting 12 cases of traumatic bilateral extradural haematomas. The incidence was 4.8% of all cases of extradural haematomas. The most common site was the frontal region. CT scan examination was necessary for early diagnosis. Ten patients were operated upon while one patient was treated conservatively. Two patients died. The relevant literature is reviewed.

Case report: multiple intracranial hydatid cysts with post-operative dissemination.

A case of primary multiple intracranial hydatid cysts is reported. The cysts were both supratentorial and infratentorial. One showed rim enhancement and perifocal oedema. Post-operatively, the number and size of cysts increased, possibly because of intraoperative rupture.

Right brain damage impairs recognition of negative emotions.

Patients with right or left hemisphere-damage and normal control groups were asked to judge facial emotions from photographs presented in two orientations--upright, inverted. Responses were elicited with a matching and a verbal labelling task. Normal controls were significantly superior in the judgment of facial emotions than left hemisphere-damaged patients, who in turn were significantly superior than right hemisphere-damaged patients. Negative-aroused (fear, anger) and negative-nonaroused (sadness, disgust) facial expressions were recognized with significantly greater accuracy by left hemisphere-damaged patients compared to right hemisphere-damaged patients; the group difference in performance was nonsignificant for positive (happiness, surprise) emotions.

Matching Top-Bottom Parts of Facial Expressions by Brain-damaged Patients.

Patients with focal brain-damage, right/left hemisphere-damage (RHD/LHD) and anterior/posterior region-damage (ARD/PRD), and normal controls (NC) were asked to match photographs of top-bottom facial parts expressing different emotions, positive (happy, surprise), negative-aroused (fear, anger), negative-nonaroused (sad, disgust). The LHD patients performed significantly worse than the RHD patients, and the ARD patients were significantly worse than the PRD patients, in the perceptual-matching task with affective stimuli. NC subjects performed significantly better than any of the brain damaged sub-groups.

Radiation therapy for symptomatic vertebral haemangioma.

Vertebral haemangiomas are slowly growing benign tumours and are usually asymptomatic. They rarely cause symptoms and signs related to cord compression. Larger lesions create significant problems during surgery because of haemorrhage and vascular supply crucial to spinal cord function. In such severely symptomatic vertebral haemangiomas, radiation therapy has been tried and good results obtained, especially in terms of good functional recovery. We have treated 17 patients (including nine paraplegic patients) with radiotherapy (Co-60). Treatment was given by single posterior field, encompassing the involved area with a dose of 35-40 Gy in 3 to 4 weeks (five fractions per week). All patients with pain and tenderness were relieved completely (87.5%) or partially (12.5%). Similarly patients with numbness and paresis showed either complete (66.7%) or partial response (33.3%) from symptoms on follow-up. Out of nine paraplegic patients six (66.6%) had recovered completely, one (11.2%) partially and two (22.2%) had no response. The two patients who did not show any marked relief, had paraplegia of longer duration (more than 6 months). Our study indicates that severely symptomatic vertebral haemangioma can be successfully treated by radiation therapy and it can be chosen as first line of treatment with an optimum dose of 35-40 Gy in 3 to 4 weeks.

Brain abscess: with special reference to infection by pseudomonas.

Eighty cases of brain abscess treated in the University Hospital, BHU, Varanasi, India have been reviewed. Chronic suppurative otitis media was the commonest cause, followed by compound injuries. The overall mortality was 15%. In seven cases the causative organism was pseudomonas, resistant to most antibiotics. Prior to the availability of CT the mortality was 23.3%; after the routine use of CT for diagnosis the mortality fell to 10%. A high mortality (57%) was observed in patients who had pseudomonas. The best results were in patients who had been managed by excision of the abscess capsule.

Intramedullary neurofibroma of the cervical spinal cord: case report with review of the literature.

A case of cervical intramedullary neurofibroma diagnosed and surgically treated is reported. This patient, a 27-year-old man, had no evidence of von Recklinghausen's disease. The case is discussed, and a review of literature is presented.