Predictors of long-term neurological outcomes in non-accidental head injury.

BackgroundNon-accidental head injury (NAI) is an inflicted injury usually on a child, often resulting in long-term neurological impairment and occasionally death. This study aimed to investigate the predictive values of acute findings, especially ocular, for long-term neurological outcomes.MethodsMedical records including retinal images of all children who attended the local Children's hospital with a diagnosis of NAI from over a period of 5 years were reviewed and data collected via the electronic patient record system. Patient demographics, injuries sustained, wide-field digital retinal images, visual acuity and sequalae, neurological function, and global function was noted. IBM SPSS software program was used for statistical analysis.ResultsOf the 38 patients (24 males, 14 females), 12 children died acutely from the head injury with the remaining 26 children available for long-term follow-up. A younger age of injury (P=0.004) was the only statistically significant predictor of good neurological outcome as compared with absence of macular retinoschisis, unilateral retinal haemorrhage, and unilateral subdural haemorrhage. Of the 38 children, 17 children had retinoschisis; 9 children with macular retinoschisis died acutely while 4 suffered a degree of developmental delay and only 4 were developmentally normal at the last follow-up. Long-term visual acuity data was available for 18 of the 26 survivors (range: NPL to Snellen 6/5). A statistical significance was noted between retinoschisis and worsened visual acuity (P<0.05).ConclusionsBilateral macular retinoschisis on acute presentation of NAI is associated with a seven-fold and unilateral with a four-fold increase in the development of a poor neurological outcome and eventual death. Conflicting to other studies, younger children presented better neurological outcomes.

Uterine perforation following medical termination of pregnancy by vacuum aspiration.

Out of 9344 first trimester elective abortions performed by vacuum aspiration, 37 uterine perforation cases occurred. The suction cannula was responsible for more than 50% of perforations. All cases were multiparous. In 56.8%, the duration of gestation was 6 weeks or less. One third of the cases had a history of child birth within the previous 6 months. Fundal and anterior wall perforations were most common. Cases with a retroverted uterus had a higher incidence of perforation (59.4%) than those with an anteverted uterus (32.4%). Exact pelvic assessment and proper technique and case management are important for preventing perforation.

PIP: This study analyzed the 37 cases of uterine perforation that occurred in a series of 9344 1st-trimester vacuum aspiration abortions performed at a hospital in New Delhi, in 1972-81. The overall incidence of perforation was 0.4%. All the uterine perforation cases were multiparous, and 21.6% had more than 4 children. 32.4% of cases had delivered their last child within 6 months of the abortion procedure. The perforation rate was higher when a womsn was lactating. Fundal or cornual and anterior wall perforations were most common; in 59.4% of these cases, the uterus was retroverted. The suction cannula was responsible for 51.3% of the perforations; the dilator was the instrument responsible in 24.3% and the curette in 16.2%. Most perforations were suspected at the end of suction evacuation (43.2%) or at the time of check curettae (21.6%). Surgical repair was carried out in 83.7% fo cases, and combined with tubal sterilization in 70.2% of cases. Associated bowel injury was present in 3 (8.1%) cases. The policy recommended for cases of suspected perforation is to perform a diagnostic laparoscopy and plan further case management on the basis of the site and size of perforation, the extent of damage, the amount of bleeding, completeness of the procedure, and the parity of the patient. When the sucttion cannula is the instrument responsible, the bowel should be explored for possible injury. Occasionally hysterectomy may be required for severe damage or excessive bleeding.

Ketamine abreaction : a new approach to narcoanalysis.

Ketamine is a parenterally administered non barbiturate anaesthetic agent, in use for more than a decade. It is a safer than Na Pentothal. Administered intramuscularly, in dose of 6 to 15 mgm/Kg body wt. it produces dissociative anaesthesia. But, in smaller sub anaesthetic doses it may act as an abreactant. We report in this study the abreaction effect of Ketamine in dose of .5 to 1.5 mgm/kg body wt. given intramuscularly in 30 selected psychiatric cases requiring narcoanalysis for diagnostic or therapeutic purpose. The results are compared with another ten cases subjected to pentothal interview and five cases subjected to narcoanalysis with intravenous Na Amytal and methidrine. Our findings suggest that Ketamine has property of an efficacious abreactant in doses of 1 to 1.5 mgm/kg body wt. administered intramuscularly and can successfully be used for narcoanalysis in properly selected cases as a good substitute for intravenous pentothal or sodium amytal with methidrine. The relative cardio respiratory safety and ease of administration are its two added advantages.