Testicular degeneration in a male goat. A case report

Semen samples from an 18-month-old infertile Lamancha buck contained less than 10% motile spermatozoa and a high incidence of morphological abnormalities. Degenerate detached heads, tightly coiled tails, and thickened midpieces were the prominent morphological defects, affecting 46%, 30%, and 15% of ejaculated spermatozoa, respectively. At necropsy, the diagnosis of testicular degeneration was made, characterized by focal, noninflammatory seminiferous tubule occlusion and mineralization, with a more generalized sloughing of tubular germinal epithelium. When examining spermatozoa morphology from various sites of the excurrent ducts, detached heads were readily seen in efferent duct fluid (> 30% incidence) and the coiled tails and other midpiece defects became prominent with passage through the caput epididymis.

An unusual presentation of a mesenteric cyst of the sigmoid colon

A case of sigmoid mesenteric cyst presenting as an acute abdominal emergency is reported. The variable presentation and uncommon occurrence of these cysts are the main difficulties in pre-operative diagnosis.

Trauma to the central and peripheral nervous systems. Part II: A statistical profile of surgical treatment New South Wales 1977

The epidemiological aspects of the mortality, morbidity and the costs of neurotrauma in New South Wales 1977 were outlined in Part I of this report. Part II outlines the profile of surgical work in this field in New South Wales in 1977. In all, 21,973 patients were admitted to New South Wales Hospitals in 1977 for neurotraumatic conditions (85% with head, 13% with spinal and 2% with peripheral nerve injuries); and 1,513 patients required surgery (49% with head, 22% with spinal and 29% with peripheral nerve injuries). The profile of surgery for disc disease is outlined. The participation of neurosurgeons in the management of neurotrauma is assessed.

Trauma to the central and peripheral nervous systems: Part I: an overview of mortality, morbidity and costs; N.S.W. 1977

An epidemiological study of neurotrauma in New South Wales, South Australia and the Australian Capital Territory, 1977, was initiated and sponsored by the Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee in collaboration with the Division of Health Services Research, Health Commission of New South Wales, funded by the Australian Brain Foundation and the Commonwealth Department of Health and supported by the Health Commissions of New South Wales and South Australia. The following communication is structured so as to present the essential findings on mortality, morbidity and costs in New South Wales in 1977 in the first part and the more specific statistical profile of surgical treatment in New South Wales, 1977, in a separate, second part. The most revealing data found by this research is that cranio-cerebral and spinal injury was the leading cause of death up to the age of 44 in New South Wales (and South Australia) and up to the age of 49 in the male population and in the country regions. It accounted for 45% of all deaths to those aged 15 to 24. Cranio-cerebral and spinal injury caused 71% of all deaths on the roads. Sixty-four per cent of those dying in road accidents never reached hospital. The figures for mortality and morbidity in the country regions were significantly worse than those in the metropolitan regions. The most important causes were identified and recommendations aimed at reducing this record were formulated.

The surgical treatment of intractable childhood and adolescent epilepsy

The approach to the surgical management of intractable epilepsy of the Adelaide Children's Hospital, and a method of anaesthesia allowing intraoperative electrocorticographic recordings, are described. Using this approach, the outcome of ablative neurosurgery in a heterogenous group of sixteen childhood and adolescent epileptics is presented. This group was characterized by poorly controlled seizure disorders and interictal behavioural abnormalities. Investigations suggested that all patients had focal epileptogenic lesions. Postoperative seizure control and psychosocial adjustment were improved in 13 (81%) and 12 (75%) patients respectively. The place for, and limitations of, antiepileptogenic surgery are discussed.

Homozygous deficiency of the second component of complement presenting with recurrent bacterial meningitis

A girl presented with purulent meningitis at ages 6, 8, and 11 years. She was in good health between these three episodes. When aged 16 one of her brothers also experienced an attack of pneumococcal meningitis. Complement studies showed lack of C2 in the patient and the brother, and intermediate values in the mother and a sister. No other member of the family was available for study.

Cranioplasty in children

In children, acquired skull defects often close spontaneously. This is most likely to take place when the dura mater and the pericranium are intact. Congenital skull defects rarely close spontaneously. Cranioplasty will be needed when a bone defect has failed to close or when it is unlikely to do so. Various methods are available: autogenous bone, acrylic resin, and metal prostheses have been widely used. A series of 68 operations performed on children under the age of 15 years is reviewed. It is concluded that shaped titanium plates are usually preferable. These can be formed by hand, or in a pressure chamber; simple defects can be closed with ready-made titanium strips. Fixation by screws is recommended. Titanium plates have been used successfully even in very young children.

Functional consequences of the transcallosal removal of intraventricular tumours

Colloid cysts and other benign tumours of the third and lateral ventricles may be exposed through a small incision in the body of the corpus callosum. This approach is practicable even when ventricular dilatation is slight, and is theoretically less likely to cause epilepsy than the more usual transcortical approach. Disturbances of memory have been noted soon after such operations, but do not cause serious long-term disability. Three patients who underwent transcallosal removal of cysts or tumours some years earlier have been tested by procedures designed to demonstrate interhemispheric transfer of information: they were all found to have defects in transfer of tactile data, but not of information obtained visually. They were not aware of this inability, and do not appear to be inconvenienced by it. The transcallosal route is convenient. The operation sacrifices a functionally significant part of the corpus callosum, but the neurological sequelae have seemed acceptable. However, especially in the elderly, stereoventriculoscopic aspiration may be considered as the initial method of treatment.

Planning for better standards in the care of the neurological sequelae of trauma

Injuries of the nervous system are common, and cause many deaths and much permanent disability. They inflict an enormous financial burden on the national economy; in Australia, adequate data are at present lacking, but a simple extrapolation from Canadian statistic suggests an estimate of more than $500,000,000 annually for the injuries resulting from road traffic accidents alone; if other causes of injury are included, the figure may reach one billion dollars. The neurosurgeon is specifically trained to undertake the management of all forms of neurological trauma; however, in Australia, and in many other countries, only a small minority of such injuries receive neurosurgical care. This is chiefly because the number of neurosurgeons at present available is small in relation to the tasks. Many cases must therefore be in the care of general or orthopaedic surgeons, especially in country centres, and it is important that these surgeons should have some basic neurosurgical training. The Neurosurgical Society of Australasia wishes to formulate a programme to ensure that opportunities for such training are available throughout Australia. This programme should also embody a national plan for research into the treatment and prevention of neurological trauma.

Orthopaedic aspects of spinal tumors in children

A retrospective survey has been made of forty children with spinal tumours. Difficulties in establishing the correct diagnosis are mentioned and the value of radiological and cerebrospinal fluid investigations discussed. The major orthopaedic disabilities are spinal deformity or instability, and paraplegia. The main factor in the development of the former is the site of laminectomy: the higher the level the greater is the likelihood of deformity or instability developing. Measures to prevent this distressing complication are discussed. The role of the orthopaedic surgeon in the management of these children is emphasised.

Premature craniosynostosis-a complication of thyroid replacement therapy

Three hypothyroid children with premature craniosynostosis are presented, who have been treated intensively with 1-thyroxine from early infancy. It is postulated that the craniosynostosis is the result of iatrogenic hyperthyroidism during a critical period of skull growth. Various regimens of treatment for hypothyroidism are discussed with recommendations for avoiding this potentially hazardous complication of therapy.

Spinal neuroblastomas. Diagnosis, treatment, and prognosis

✓ Nine cases of neuroblastoma and one of ganglioneuroma are discussed, and the value of gas myelography emphasized. The authors point out that neuroblastomas may make themselves known by cord compression, and are especially likely to do so in infancy. In patients under 1 year old, recognition of cord compression may be extremely difficult, but appropriate treatment is often curative, and early diagnosis is therefore imperative. In older children the prognosis is much worse.

Traumatic cerebrospinal fluid fistulas in children

✓ The postnatal development of the skull base was studied by dissection and radiography in 15 subjects, and the findings were correlated with the occurrence of traumatic cranionasal and crainioaural cerebrospinal fluid fistulas in seven children. The authors conclude that indications for operative repair of these fistulas are as strong in the child as in the adult, although diagnosis is sometimes more difficult.

Two cases of localized hypertrophic neurofibrosis

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