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Head injuries due to falls caused by seizures: A group at high risk for traumatic intracranial hematomas
1034
CURRENT
controls. The patients were examined clinically and radiographically at 1,3, and 6 months and every 6 months thereafter. The glass plates retained their original size. Resorption and remodeling occurred in two-thirds of the glass granule sites and three-fourths of the bone graft sites. Bioactive glass granules and corticocancellous bone grafts may cause unfavorable results when used for facial bony reconstruction, whereas bioactive glass, in solid form, has shown stability for bony reconstruction. Reprint requests to Dr Suominen: Department of Plastic Surgery, Too10 Hospital, Helsinki University Central Hospital, Topeliukseukat 5, Sf-00260, Helsinki, Finland.
Head Injuries Due to Falls Causedby Seizures:A Group At High Risk for Traumatic Intracranial Hematomas. Zwimpfer 1997
TJ, Brown J, Sullivan I, et al. J Neurosurg
86:433,
In this review article, the author discusses therapeutic objectives, choice of insulin, indications for insulin, glucose toxicity, temporary insulin therapy, discontinuance of insulin, basal insulin therapy, classification by disease severity, latent autoimmune diabetes, considerations in elderly patients, combination therapy with oral agents, insulin pump use, and insulin resistance. He points out that initially high doses of insulin may be required initially to gain control and in some cases the need for insulin therapy may be ongoing, to achieve satisfactory glucose control.-R.E. ALEXANDER Reprint requests to Dr Skyler: University of Miami School of Medicine, Jackson Medical Towers (D-110), 1500 NW 12th Ave, Suite 1012E, Miami, FL 33136.
Descriptive Epidemiology of Oral Cancer in JapanTrends and Predictions of Mortality and Incidence (Authors’ translation). Kirita T, Zheng Y, Kurumatani N, et al. Jpn J Oral Maxillofac
Approximately 0.5% to 2% of the population is estimated to have seizure disorders. In a review of 298 epileptics, 28,000 seizures were documented in a l-year period, and 45% of them resulted in falls causing 766 head injuries. In another study, 11% of the seizures resulted in an injury of the head or scalp. This prospective review of 1,760 adult patients examines the incidence of head injuries owing to falls caused by witnessed seizures, between 1986 and 1993. In that population, 5.82 head injuries (33.1%) were caused by falls and 22 (3.8%) of those were caused by seizures. Projected across the general population, these data suggest that epileptics are several times more like to suffer a head injury because of a fall. Mass lesions were found in 90.9% (20) of the 22 patients and the other 2 patients suffered mild diffuse head injuries. Seventeen of the intracranial injuries (85%) were etiher epidural or acute subdural hematomas. The higher incidence were not explained by differences in age, severity of head injury, or alcohol intake. The authors conclude that patients with head injuries caused by a seizureinduced fall, should undergo computed tomography scanning early in their management, to rule out a mass lesion. Any decrease in level of consciousness or focal neurologic deficits should not be attributed to the seizure itself, but to possible intracranial injuries.-R.E. ALEXANDER Reprint requests to Dr Moulton: St. Michael’s Hospital, 38 Shuter St, Toronto, Ontario, M5B IA6, Canada.
Insulin Therapy in Type II Diabetes: Who Needsit, How Much of It, and for How Long? Skyler JS. Postgrad Med 101:85, 1997 Type II, maturity-onset diabetes usually begins after the age of 40 years, particularly in patients who are overweight or sedentary. Insulin resistance is induced by adiposity and inactivity and hyperglycemia can impair beta cell function and insulin action, thus creating a vicious circle that aggravates hyperglycemia. Although type II is heterogeneous, both pathogenetic mechanisms (impaired insulin secretion and decreased insulin sensitivity) are operative in varying degrees in most patients. Type II diabetics are not usually dependent on insulin for prevention of ketosis or maintainance of life, but often benefit from insulin therapy to control symptoms or correct disordered metabolism. Currently it is felt that separate genetic defects are responsible for the predominance of one mechanism over another and environmental factors may create further insulin resistance.
LITERATURE
Surg 43:140, 1997
Global epidemiological studies have shown that oral cancer is one of the most commonly encountered malignancies in terms of incidence and mortality. However, the incidence varies from area to area in the world and also among different locations of the oral cavity. In Japan, deaths resulting from oral cancer account for only 1% to 2% of the total cancer deaths, but the number of deaths and the mortality rate caused by oral cancer are increasing in recent years. In this paper, “oral cancer” which included cancers of the lip, oral cavity, oropharynx, and salivary glands in Japan was analyzed using data of the Japanese population statistics from 1950 to 1993 published from the Ministry of Health and Welfare. The number of annual deaths from “oral cancer” in 1993 was 3,155, which increased 4.5 times (5.2 times in males and 3.4 times in females) during the past 44 years. The male to female ratio also increased 1.6: 1 to 2.5: 1 during this period. The most common cancer was tongue cancer and tongue cancer death accounted for approximately 40% to 60% of the population. The crude death rate and the age-adjusted death rate for men increased approximately 3.5 times and 1.5 times, respectively, during the period from 1950 to 1991. For women, the crude death rate showed approximately a two-fold increase, whereas the age-adjusted rate remained unchanged. In men, the age-adjusted death rates for cancers of the oropharynx, floor of the mouth, gingiva, and salivary glands showed a tendency to increase, whereas the values for cancers of the lip and tongue tended to decrease. Though not so prominent as in men, similar tendencies were also observed in women. The overall agespecific mortality rate for the group of 40 to 49 years remained virtually unchanged, but the values for the age groups of over 50 years increased, and the tendency was more prominent in the groups over 65 years. From the predictive analysis of morbidity and mortality patterns, the incidence of “oral cancer” as well as the crude and age-adjusted death rates were expected to increase in both sexes, in particular in men.-T. NAKAJIMA Reprint requests to Dr Kirita: Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijocho, Kashiwabara City, 634, Japan.
Facial Recontouring With Lipostructure. Coleman
SR.
Clin Plast Surg 24:347, 1997 Augmentation
as a means of enhancing
facial contours
CURRENT
controls. The patients were examined clinically and radiographically at 1,3, and 6 months and every 6 months thereafter. The glass plates retained their original size. Resorption and remodeling occurred in two-thirds of the glass granule sites and three-fourths of the bone graft sites. Bioactive glass granules and corticocancellous bone grafts may cause unfavorable results when used for facial bony reconstruction, whereas bioactive glass, in solid form, has shown stability for bony reconstruction. Reprint requests to Dr Suominen: Department of Plastic Surgery, Too10 Hospital, Helsinki University Central Hospital, Topeliukseukat 5, Sf-00260, Helsinki, Finland.
Head Injuries Due to Falls Causedby Seizures:A Group At High Risk for Traumatic Intracranial Hematomas. Zwimpfer 1997
TJ, Brown J, Sullivan I, et al. J Neurosurg
86:433,
In this review article, the author discusses therapeutic objectives, choice of insulin, indications for insulin, glucose toxicity, temporary insulin therapy, discontinuance of insulin, basal insulin therapy, classification by disease severity, latent autoimmune diabetes, considerations in elderly patients, combination therapy with oral agents, insulin pump use, and insulin resistance. He points out that initially high doses of insulin may be required initially to gain control and in some cases the need for insulin therapy may be ongoing, to achieve satisfactory glucose control.-R.E. ALEXANDER Reprint requests to Dr Skyler: University of Miami School of Medicine, Jackson Medical Towers (D-110), 1500 NW 12th Ave, Suite 1012E, Miami, FL 33136.
Descriptive Epidemiology of Oral Cancer in JapanTrends and Predictions of Mortality and Incidence (Authors’ translation). Kirita T, Zheng Y, Kurumatani N, et al. Jpn J Oral Maxillofac
Approximately 0.5% to 2% of the population is estimated to have seizure disorders. In a review of 298 epileptics, 28,000 seizures were documented in a l-year period, and 45% of them resulted in falls causing 766 head injuries. In another study, 11% of the seizures resulted in an injury of the head or scalp. This prospective review of 1,760 adult patients examines the incidence of head injuries owing to falls caused by witnessed seizures, between 1986 and 1993. In that population, 5.82 head injuries (33.1%) were caused by falls and 22 (3.8%) of those were caused by seizures. Projected across the general population, these data suggest that epileptics are several times more like to suffer a head injury because of a fall. Mass lesions were found in 90.9% (20) of the 22 patients and the other 2 patients suffered mild diffuse head injuries. Seventeen of the intracranial injuries (85%) were etiher epidural or acute subdural hematomas. The higher incidence were not explained by differences in age, severity of head injury, or alcohol intake. The authors conclude that patients with head injuries caused by a seizureinduced fall, should undergo computed tomography scanning early in their management, to rule out a mass lesion. Any decrease in level of consciousness or focal neurologic deficits should not be attributed to the seizure itself, but to possible intracranial injuries.-R.E. ALEXANDER Reprint requests to Dr Moulton: St. Michael’s Hospital, 38 Shuter St, Toronto, Ontario, M5B IA6, Canada.
Insulin Therapy in Type II Diabetes: Who Needsit, How Much of It, and for How Long? Skyler JS. Postgrad Med 101:85, 1997 Type II, maturity-onset diabetes usually begins after the age of 40 years, particularly in patients who are overweight or sedentary. Insulin resistance is induced by adiposity and inactivity and hyperglycemia can impair beta cell function and insulin action, thus creating a vicious circle that aggravates hyperglycemia. Although type II is heterogeneous, both pathogenetic mechanisms (impaired insulin secretion and decreased insulin sensitivity) are operative in varying degrees in most patients. Type II diabetics are not usually dependent on insulin for prevention of ketosis or maintainance of life, but often benefit from insulin therapy to control symptoms or correct disordered metabolism. Currently it is felt that separate genetic defects are responsible for the predominance of one mechanism over another and environmental factors may create further insulin resistance.
LITERATURE
Surg 43:140, 1997
Global epidemiological studies have shown that oral cancer is one of the most commonly encountered malignancies in terms of incidence and mortality. However, the incidence varies from area to area in the world and also among different locations of the oral cavity. In Japan, deaths resulting from oral cancer account for only 1% to 2% of the total cancer deaths, but the number of deaths and the mortality rate caused by oral cancer are increasing in recent years. In this paper, “oral cancer” which included cancers of the lip, oral cavity, oropharynx, and salivary glands in Japan was analyzed using data of the Japanese population statistics from 1950 to 1993 published from the Ministry of Health and Welfare. The number of annual deaths from “oral cancer” in 1993 was 3,155, which increased 4.5 times (5.2 times in males and 3.4 times in females) during the past 44 years. The male to female ratio also increased 1.6: 1 to 2.5: 1 during this period. The most common cancer was tongue cancer and tongue cancer death accounted for approximately 40% to 60% of the population. The crude death rate and the age-adjusted death rate for men increased approximately 3.5 times and 1.5 times, respectively, during the period from 1950 to 1991. For women, the crude death rate showed approximately a two-fold increase, whereas the age-adjusted rate remained unchanged. In men, the age-adjusted death rates for cancers of the oropharynx, floor of the mouth, gingiva, and salivary glands showed a tendency to increase, whereas the values for cancers of the lip and tongue tended to decrease. Though not so prominent as in men, similar tendencies were also observed in women. The overall agespecific mortality rate for the group of 40 to 49 years remained virtually unchanged, but the values for the age groups of over 50 years increased, and the tendency was more prominent in the groups over 65 years. From the predictive analysis of morbidity and mortality patterns, the incidence of “oral cancer” as well as the crude and age-adjusted death rates were expected to increase in both sexes, in particular in men.-T. NAKAJIMA Reprint requests to Dr Kirita: Department of Oral and Maxillofacial Surgery, Nara Medical University, 840, Shijocho, Kashiwabara City, 634, Japan.
Facial Recontouring With Lipostructure. Coleman
SR.
Clin Plast Surg 24:347, 1997 Augmentation
as a means of enhancing
facial contours