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Sequelae of concussion
Abstracts
171
a rise in frequency of 10 deflections a second was accompanied by an improvement in the neurological condition. Conversely, a fall of 10 was accompanied by a deterioration. Anoxic cerebral damage was associated with a flat ECG tracing and ocular microtremor of 40-50/s. Complete absence of this microtremor was found only in the presence of the recognized manifestations of a dead brain but microtremor can occur with a flat ECG tracing and in the absence of oculovestibular reflexes. Coakley D. and Thomas J. G. (1977). The ocular microtremor recorded and the prognosis of the unconscious patient. Lancer 1,512. Sequelae
Tomography
of intracranial
haematoma
neurosurgeons were asked to interpret the tomograms produced by transverse axial and computerized scanning of 50 patients with, and 47 without intracranial haematomas and they were given no clinical information to guide them. In only two cases was one of them uncertain, otherwise both agreed and were correct in their interpretation. There was no falsepositive or false-negative tomogram. Ten of 13 intradural, 28 of 34 intradural and all 11 intracerebral haematomas were correctly located but location was correct in only 1 of 3 patients with both extra- and intradural haematomas. In all, 78 per cent of the haematomas were correctly distinguished as being within or without the dura mater. Displacement of the ventricles was recognized in all 49 cases in which it occurred and in some cases it enabled a haematoma to be identified even though it did not cause the usual area of increased density. Tomography of patients with neurological abnormalities but no deterioration showed an unexpected incidence of haematomas that later disappeared and required no surgical treatment. General anaesthesia is advised in order to prevent which may otherwise disturb the movement, examination. Galbraith S., Teasdale G. and Blaiklock C. (1976) Computerized tomography of acute traumatic intracranial haematoma. Br. Med. J. 2, 1371.
and ligaments
immediate
mobilization
following
repair
The technique, which is fully described, has been carried out in 30 patients-2 tendon grafts and 28 primary repairs in the critical area. One patient failed to achieve a satisfactory result because of an excessively scarred tendon bed. The technique appears to offer the patient with a divided flexor tendon a satisfactory and predictable result with few complications. Emery F. E. (1977) Immediate mobilization following flexor tendon repair: a preliminary report. Trauma 17, 1. Rupture
of concussion
One hundred and forty-five patients admitted to hospital following concussion were examined at intervals of up to 6 weeks. Concussion is defined as a period of amnesia caused by a blow on the head. At 6 weeks 49 per cent of the patients, who were all over 12 years of age, had no symptoms, 39 per cent had from 1 to 6 symptoms and 2 per cent had more than 6. Symptoms were more likely to be recorded at 6 weeks when the patient was female, in later life, injured by a fall or in circumstances for which others could be held responsible and when there had been neurological abnormalities within the first 24 hours. There was no significant correlation in this series between the length of post-traumatic amnesia and the presence of symptoms-at 6 weeks. Rutherford W. H.. Merrett J. D. and McDonald J. R. (1977) Sequelae’of concussion caused by minor head injuries. Lancer 1, 1. Two
Tendons
of Achilles
tendon
This is a useful report on the subject recording basic information about how, why and where the tendon ruptures. The author presents clear evidence in favour of partial rupture as an, admittedly, rare occurrence and gives the credit due to Simmonds for describing the fact that squeezing the calf causes the ankle to flex when the tendon is intact but not when it has been ruptured. It is clear from his discussion that the argument between treatment with and without operation is not always to be settled by a simple yes or no, but the thoughtful surgeon should have no difficulty in deciding which method of treatment to adopt in any given case. Cargill A. G’R. (1976) Closed rupture of the Achilles tendon. Br. J. Hosp. Med. 16, 524. Ligamentous
injuries
around
the knee
This is a general account of the subject that serves equally as a good introduction or a reminder of the main features. Trickey E. L. (1976) Ligamentous injuries around the knee. Br. Med. J. 2, 1492.
Miscellaneous Scoop
stretcher
The scoop stretcher is now in routine use on many ambulances in the UK. Sometimes it is necessary to transport patients with suspected spinal injury in the prone position and the turning into the supine position at hospital can be hazardous. The authors describe a method of applying a second scoop stretcher above the patient before the turning process, bandages or straps being used to bind the stretchers between which the patient is contained. The method has been used on several occasions by the GP/ambulance rescue teams and has proved popular. It is recommended that a second stretcher should be standard equipment in an accident and emergency department. Herbert R. L., Hines K., Winch R. et al. (1977) Scoop-stretcher ‘sandwich’ method of turning patients with spinal injuries. Br. Med. J. 1, 358. Back pain
The whole of the August 1975 edition of Rheumatology and Rehabilitation is devoted to back pain. Benn and Wood discuss the size of the problem epidemiologically, Nachemson summarizes his studies of
171
a rise in frequency of 10 deflections a second was accompanied by an improvement in the neurological condition. Conversely, a fall of 10 was accompanied by a deterioration. Anoxic cerebral damage was associated with a flat ECG tracing and ocular microtremor of 40-50/s. Complete absence of this microtremor was found only in the presence of the recognized manifestations of a dead brain but microtremor can occur with a flat ECG tracing and in the absence of oculovestibular reflexes. Coakley D. and Thomas J. G. (1977). The ocular microtremor recorded and the prognosis of the unconscious patient. Lancer 1,512. Sequelae
Tomography
of intracranial
haematoma
neurosurgeons were asked to interpret the tomograms produced by transverse axial and computerized scanning of 50 patients with, and 47 without intracranial haematomas and they were given no clinical information to guide them. In only two cases was one of them uncertain, otherwise both agreed and were correct in their interpretation. There was no falsepositive or false-negative tomogram. Ten of 13 intradural, 28 of 34 intradural and all 11 intracerebral haematomas were correctly located but location was correct in only 1 of 3 patients with both extra- and intradural haematomas. In all, 78 per cent of the haematomas were correctly distinguished as being within or without the dura mater. Displacement of the ventricles was recognized in all 49 cases in which it occurred and in some cases it enabled a haematoma to be identified even though it did not cause the usual area of increased density. Tomography of patients with neurological abnormalities but no deterioration showed an unexpected incidence of haematomas that later disappeared and required no surgical treatment. General anaesthesia is advised in order to prevent which may otherwise disturb the movement, examination. Galbraith S., Teasdale G. and Blaiklock C. (1976) Computerized tomography of acute traumatic intracranial haematoma. Br. Med. J. 2, 1371.
and ligaments
immediate
mobilization
following
repair
The technique, which is fully described, has been carried out in 30 patients-2 tendon grafts and 28 primary repairs in the critical area. One patient failed to achieve a satisfactory result because of an excessively scarred tendon bed. The technique appears to offer the patient with a divided flexor tendon a satisfactory and predictable result with few complications. Emery F. E. (1977) Immediate mobilization following flexor tendon repair: a preliminary report. Trauma 17, 1. Rupture
of concussion
One hundred and forty-five patients admitted to hospital following concussion were examined at intervals of up to 6 weeks. Concussion is defined as a period of amnesia caused by a blow on the head. At 6 weeks 49 per cent of the patients, who were all over 12 years of age, had no symptoms, 39 per cent had from 1 to 6 symptoms and 2 per cent had more than 6. Symptoms were more likely to be recorded at 6 weeks when the patient was female, in later life, injured by a fall or in circumstances for which others could be held responsible and when there had been neurological abnormalities within the first 24 hours. There was no significant correlation in this series between the length of post-traumatic amnesia and the presence of symptoms-at 6 weeks. Rutherford W. H.. Merrett J. D. and McDonald J. R. (1977) Sequelae’of concussion caused by minor head injuries. Lancer 1, 1. Two
Tendons
of Achilles
tendon
This is a useful report on the subject recording basic information about how, why and where the tendon ruptures. The author presents clear evidence in favour of partial rupture as an, admittedly, rare occurrence and gives the credit due to Simmonds for describing the fact that squeezing the calf causes the ankle to flex when the tendon is intact but not when it has been ruptured. It is clear from his discussion that the argument between treatment with and without operation is not always to be settled by a simple yes or no, but the thoughtful surgeon should have no difficulty in deciding which method of treatment to adopt in any given case. Cargill A. G’R. (1976) Closed rupture of the Achilles tendon. Br. J. Hosp. Med. 16, 524. Ligamentous
injuries
around
the knee
This is a general account of the subject that serves equally as a good introduction or a reminder of the main features. Trickey E. L. (1976) Ligamentous injuries around the knee. Br. Med. J. 2, 1492.
Miscellaneous Scoop
stretcher
The scoop stretcher is now in routine use on many ambulances in the UK. Sometimes it is necessary to transport patients with suspected spinal injury in the prone position and the turning into the supine position at hospital can be hazardous. The authors describe a method of applying a second scoop stretcher above the patient before the turning process, bandages or straps being used to bind the stretchers between which the patient is contained. The method has been used on several occasions by the GP/ambulance rescue teams and has proved popular. It is recommended that a second stretcher should be standard equipment in an accident and emergency department. Herbert R. L., Hines K., Winch R. et al. (1977) Scoop-stretcher ‘sandwich’ method of turning patients with spinal injuries. Br. Med. J. 1, 358. Back pain
The whole of the August 1975 edition of Rheumatology and Rehabilitation is devoted to back pain. Benn and Wood discuss the size of the problem epidemiologically, Nachemson summarizes his studies of