- Email: [email protected]
PROGNOSIS AFTER RUPTURE OF ANTERIOR CEREBRAL ANEURYSM
735 In some countries that have already made the sales of expensive items have lessened; and this is attributed to unwillingness to pay$1000 for a E500 car. Fortunately the pound is unchanged in the British system, so we do not face the problem at least in this form. Nevertheless, in a trial decimal-currency shop 12 " special offers " were initially less effective in the new currency. The new penny tended to be regarded as having the same value as an old penny. It may take considerable practice to break this habit, and the use of the term " penny " in both new and old currencies is unlikely to help. But the experience of other countries suggests that most people, armed with a conversion-table and forwarned by effective publicity, will probably make the transition without too much effort.
culty. change
phasia affected some patients, but it was not a prominent feature, except for minor degrees demonstrable only by psychometric testing. Perhaps the most startling finding was that in 9 instances both the patient and his or her relatives agreed that there had been an overall personality change for the better, though a price was usually paid for this in the form of a mild memory defect or an increase in irritability and outspokenness. These patients were presumably psychiatrically representative of the general population before the illness and the changes after operation were in some respects parallel to those of prefrontal leucotomy. On the other hand, leucotomy, while elevating mood and reducing anxiety, usually has only trivial effects on intellect; and many of the patients in this series did show definite, though often slight, intellectual
impairment. PROGNOSIS AFTER RUPTURE OF ANTERIOR CEREBRAL ANEURYSM
As Logue and his colleagues 13 point out in an important paper, many reports have been concerned with the mortality of ruptured aneurysms on the anterior cerebral and anterior communicating arteries, but the actual quality of survival in those who recover has been little studied. Logue et al.’s results are based on exhaustive clinical analysis and careful psychometric testing in 79 such patients (13 treated conservatively and 66 by intracranial clipping, proximal to the aneurysm, of the anterior cerebral artery mainly responsible for its bloodsupply). There were 39 men and 40 women in the series. The average age at the onset of subarachnoid hxmorrhage was 43-6 years (range 18-70) and the average interval between the attack and follow-up interview was 40 months (range 7-101 months). 52 patients were neurologically unimpaired at follow-up and 44 had returned to their former work. 17 patients were working in somewhat inferior occupations or were working less effectively, 7 were still out of work but with prospects of returning to some form of gainful employment, 5 were disabled at home, and 6 were disabled in hospital. The severity of the patient’s neurological disability before operation was a significant prognostic factor: results were consistently better in patients who were more or less unimpaired neurologically before operation. In 7 patients occasional epileptic attacks, easily controlled by anticonvulsants, arose after discharge from hospital. Of 13 patients treated conservatively, 6 had died at the time of follow-up (4 from recurrent hxmorrhage); and of the 66 patients treated surgically, 10 had died, but in only 4 had death been due to recurrent bleeding. The technique of components analysis was used to assess four independent aspects of the patients’ condition, corresponding to intellectual impairment, elation and/or depression, affective release or flattening of affect, and language impairment. Logue et al. showed that the chief change after rupture of an interior cerebral aneurysm is intellectual deterioration. The most prominent seems to be loss of initiative, conpersonality damage scientiousness, and interest. Among changes in mood and affect, many patients showed some general elevation of mood and a lessened tendency to anxiety, and others had variable degrees of emotional incontinence with a tendency to laugh or cry more readily and with behaviour slightly less inhibited than before the operation. Dys12. 13.
Thompson, J. Walter. Decimal Currency Experiment. London, 1967. Logue, V., Durward, M., Pratt, R. T. C., Piercy, M., Nixon, W. L. B. Br. J. Psychiat. 1968, 114, 137.
Little information has been collected about minor in intellect, memory, and personality after cerebral disorders. This careful study has provided valuable data for neurologists and neurosurgeons who are concerned about the effects of frontal-lobe infarction, which is known so often to complicate operations on aneurysms of the anterior cerebral and anterior communicating arteries. The hazards of the particular operation used in these patients may have been overestimated. This investigation should point the way to more such studies of the quality of survival after various intracranial lesions, including head injury and stereotaxic surgery.
degrees of change
AFTER THE TORREY CANYON
ON March 18 last year the tanker Torrey Canyon ran aground 7 miles north-east of the Scilly Isles, her ruptured tanks spilling her cargo of 117,000 tons of crude oil into the sea. As the huge masses of thick black oil floated nearer the English coast, so concern for the safety of the beaches of the Bristol and English Channels grew. The oil had to be dispersed quickly, and, despite protests from crab and lobster fishermen and warnings from marine biologists, enormous quantities of detergents, known to be seriously harmful to marine life, were poured on to the beaches to fight the incoming oil. Within a few days of the disaster the staff of the Plymouth laboratory of the Marine Biological Association began a 10-week survey of the biological effects of the oil and detergents on the plants and animals of the shores and sea. Their results/ supported by laboratory toxicity tests, confirm their fears. Apart from the unfortunate destruction of a large number of sea birds, the oil scarcely affected marine life. The detergent, by contrast, was extremely toxic to the plankton of the surface waters, and the littoral fauna was virtually wiped out in some areas. On rocky shores, where formerly limpets and other gastropods had grazed, green seaweed soon grew unchecked ; just off shore, the sea bed was littered with dead crustaceans and sea-urchins; and many birds that had escaped oiling died from eating poisoned animals. It will be some years before the normal ecology of the south-west coast is restored. The oil spillage from the Torrey Canyon was unprecedented, and it had to be treated as an emergency. The preservation of coastal amenities was of first importance the biologists would concede that. But if detergent had 1.’Torrey Canyon ’ Pollution and Marine Life. Edited F.R.S. London: Cambridge University Press. 1968.
by J. E. SMITH,
Pp. 196.
55s.
culty. change
phasia affected some patients, but it was not a prominent feature, except for minor degrees demonstrable only by psychometric testing. Perhaps the most startling finding was that in 9 instances both the patient and his or her relatives agreed that there had been an overall personality change for the better, though a price was usually paid for this in the form of a mild memory defect or an increase in irritability and outspokenness. These patients were presumably psychiatrically representative of the general population before the illness and the changes after operation were in some respects parallel to those of prefrontal leucotomy. On the other hand, leucotomy, while elevating mood and reducing anxiety, usually has only trivial effects on intellect; and many of the patients in this series did show definite, though often slight, intellectual
impairment. PROGNOSIS AFTER RUPTURE OF ANTERIOR CEREBRAL ANEURYSM
As Logue and his colleagues 13 point out in an important paper, many reports have been concerned with the mortality of ruptured aneurysms on the anterior cerebral and anterior communicating arteries, but the actual quality of survival in those who recover has been little studied. Logue et al.’s results are based on exhaustive clinical analysis and careful psychometric testing in 79 such patients (13 treated conservatively and 66 by intracranial clipping, proximal to the aneurysm, of the anterior cerebral artery mainly responsible for its bloodsupply). There were 39 men and 40 women in the series. The average age at the onset of subarachnoid hxmorrhage was 43-6 years (range 18-70) and the average interval between the attack and follow-up interview was 40 months (range 7-101 months). 52 patients were neurologically unimpaired at follow-up and 44 had returned to their former work. 17 patients were working in somewhat inferior occupations or were working less effectively, 7 were still out of work but with prospects of returning to some form of gainful employment, 5 were disabled at home, and 6 were disabled in hospital. The severity of the patient’s neurological disability before operation was a significant prognostic factor: results were consistently better in patients who were more or less unimpaired neurologically before operation. In 7 patients occasional epileptic attacks, easily controlled by anticonvulsants, arose after discharge from hospital. Of 13 patients treated conservatively, 6 had died at the time of follow-up (4 from recurrent hxmorrhage); and of the 66 patients treated surgically, 10 had died, but in only 4 had death been due to recurrent bleeding. The technique of components analysis was used to assess four independent aspects of the patients’ condition, corresponding to intellectual impairment, elation and/or depression, affective release or flattening of affect, and language impairment. Logue et al. showed that the chief change after rupture of an interior cerebral aneurysm is intellectual deterioration. The most prominent seems to be loss of initiative, conpersonality damage scientiousness, and interest. Among changes in mood and affect, many patients showed some general elevation of mood and a lessened tendency to anxiety, and others had variable degrees of emotional incontinence with a tendency to laugh or cry more readily and with behaviour slightly less inhibited than before the operation. Dys12. 13.
Thompson, J. Walter. Decimal Currency Experiment. London, 1967. Logue, V., Durward, M., Pratt, R. T. C., Piercy, M., Nixon, W. L. B. Br. J. Psychiat. 1968, 114, 137.
Little information has been collected about minor in intellect, memory, and personality after cerebral disorders. This careful study has provided valuable data for neurologists and neurosurgeons who are concerned about the effects of frontal-lobe infarction, which is known so often to complicate operations on aneurysms of the anterior cerebral and anterior communicating arteries. The hazards of the particular operation used in these patients may have been overestimated. This investigation should point the way to more such studies of the quality of survival after various intracranial lesions, including head injury and stereotaxic surgery.
degrees of change
AFTER THE TORREY CANYON
ON March 18 last year the tanker Torrey Canyon ran aground 7 miles north-east of the Scilly Isles, her ruptured tanks spilling her cargo of 117,000 tons of crude oil into the sea. As the huge masses of thick black oil floated nearer the English coast, so concern for the safety of the beaches of the Bristol and English Channels grew. The oil had to be dispersed quickly, and, despite protests from crab and lobster fishermen and warnings from marine biologists, enormous quantities of detergents, known to be seriously harmful to marine life, were poured on to the beaches to fight the incoming oil. Within a few days of the disaster the staff of the Plymouth laboratory of the Marine Biological Association began a 10-week survey of the biological effects of the oil and detergents on the plants and animals of the shores and sea. Their results/ supported by laboratory toxicity tests, confirm their fears. Apart from the unfortunate destruction of a large number of sea birds, the oil scarcely affected marine life. The detergent, by contrast, was extremely toxic to the plankton of the surface waters, and the littoral fauna was virtually wiped out in some areas. On rocky shores, where formerly limpets and other gastropods had grazed, green seaweed soon grew unchecked ; just off shore, the sea bed was littered with dead crustaceans and sea-urchins; and many birds that had escaped oiling died from eating poisoned animals. It will be some years before the normal ecology of the south-west coast is restored. The oil spillage from the Torrey Canyon was unprecedented, and it had to be treated as an emergency. The preservation of coastal amenities was of first importance the biologists would concede that. But if detergent had 1.’Torrey Canyon ’ Pollution and Marine Life. Edited F.R.S. London: Cambridge University Press. 1968.
by J. E. SMITH,
Pp. 196.
55s.