Posterior cervical fusion in chidren

Six cases of posterior cervical fusion with rib grafts in children are reported. Four of the children had sustained cervical spine injuries in accidents, and two had congenital absence of the odontoid. Three-level fusions (C1-3) were done in four children, and four-level fusions (C1-4) in two. One child died of unrelated causes 3 months after the operation. The other five children have been followed for 5 to 13 years. All are doing well and each has a remarkably supple, stable neck and no neurological deficit.

An interaction between diet and blood group upon serum alkaline phosphatase activity in lambs

Serum alkaline phosphatase activity was studied in groups of lambs fed diets containing different amounts of wheat grain and lucerne hay with different levels of supplementation with formaldehyde treated casein-sunflower seed. Total serum alkaline phosphatase activity increased more in groups fed 100 per cent wheat or 67 per cent wheat 33 per cent lucerne than in those fed 33 per cent wheat 67 per cent lucerne or 100 per cent lucerne. Supplementation of the diets with the casein-sunflower seed preparation resulted in an increase in the heat resistant proportion of serum alkaline phosphatase activity. This effect was more apparent in lambs of the r blood group (R-r-i blood group system) than in R lambs. These finds are discussed in relation to the relative heat resistance of tissue isoenzymes of alkaline phosphatase.

Intracerebral schwannoma

A case is reported in which the authors describe a rare example of an intracerebral schwannoma in a 63-year-old woman having a clinical history suggesting the presence of the tumor for 40 years. Such an unusually prolonged course is ascribed to extensive regressive changes in the tumor. The occurrence of intracerebral schwannoma indicates the existence of schwann cells deep within the brain substance, although the precise source of these cells remains obscure.

Recurrent and multiple suture closures after craniectomy for craniosynostosis

✓ Six cases of craniosynostosis are reported in which recurrent and multiple closure of cranial sutures occurred after craniectomy and insertion of polyethylene film. In all patients there was closure of a second and sometimes a third suture as well as reclosure of the treated suture. In four children the second operations were done before the age of 18 months; none had increased intracranial pressure preoperatively and three who are living have normal intelligence. In two children, the second operations were not done until after the age of 3 years; both had increased intracranial pressure preoperatively, and both are now mentally retarded.

Production feeding of lambs with diets based on grain. 1. Whole wheat plus sodium buffers or sodium chloride

Lambs fattened on wheat diets were given supplements of sodium buffers and sodium chloride, and feed intake, body weight changes, and plasma mineral levels were measured. During the 84-day feeding period, daily feed intakes were 42 per cent higher and body weigh: increased by 36 per cent when wheat was supplemented with sodium bicarbonate, sodium bicarbonate and disodium hydrogen phosphate, or sodium chloride. When the diet was supplemented with disodium hydrogen phosphate body weight gains and feed intakes were lower than with the other supplements. This supplement also produced a high incidence of urinary calculi and this was not overcome by increasing the calcium level in the diet. The importance of these results in relation to grain feeding and buffer supplementation is discussed.

Crouzon's disease (craniofacial dysostosis). Modern diagnosis and treatment

✓ This article discusses the nature and treatment of Crouzon's disease and reproduces a translation of part of Crouzon's original description. Six typical patients with this disease are presented, and the reasons for surgical treatment emphasized.

Acrylic fixation of atlanto-axial dislocations. Technical note

✓ An operative technique using methyl methacrylate (acrylic) and wiring for the treatment of atlanto-axial dislocations is described. Long-term evaluation of a series of patients indicates that this is a safe and effective method of obtaining cervical fixation.

Kyphoscoliosis following lumbar subarachnoid shunts

✓ In a follow-up of 80 lumbar subarachnoid shunts for hydrocephalus, scoliosis with limitation of back flexion was found to have developed in approximately 50% of the surviving children, some of whom showed a disparity in the length and size of their legs. There was no correlation between the direction of the convexity of the scoliosis and the side of the shortened leg, or between the number of shunt revisions and the ultimate development of kyphoscoliosis, or between removal of laminae and the subsequent development of scoliosis. Three case histories are presented to illustrate the still unproven but possible relationship between arachnoiditis due to polyethylene tubes and the ensuing scoliosis. Removal of the lumbar shunts, decompression, and laminectomy seemed to have no beneficial effect in the reversal of the scoliosis in any of the cases reviewed.

Surgical treatment of brain stem gliomas

✓ A long-term study has been made of a consecutive series of 37 patients with brain stem gliomas, 22 of whom were children and 15 adults. Surgical exploration was carried out in 34 of the 37 cases and only very rarely was a diagnosis made on clinical grounds or air study alone. In 10 cases a histological diagnosis was made at operation. In five patients a significantly large neoplastic cyst was found and evacuated, and four of these have had long-term useful survivals. There were nine postoperative deaths, most of them in the pre-Decadron era; 17 cases died during follow-up, with a mean survival of 33 months; and eight patients are living, with a mean survival of 3 months to 9 years. A plea is made for surgical exploration of these lesions in the hope of finding a surgically approachable cyst, and for the use of radiation therapy at a later time.