Event-related brain potential modulation in patients with severe brain damage.

OBJECTIVE: The limited evidence and inconsistency of purposeful behaviors in patients in a minimally conscious state (MCS) asks for objective electrophysiological marker of the level of consciousness. Here, a comparison between event-related potentials (ERPs) was investigated using different level of stimulus complexity. METHODS: The patients in vegetative state were 11 and the MCS patients were 6 [corrected]. Three oddball paradigms with different level of complexity were applied: sine tones, the subject's own name versus sine tones and other first names. Latencies and amplitudes of N1 and P3 waves were compared. RESULTS: Cortical responses were found in all MCS patients, and in 6 of 11 patients in VS. Healthy controls and MCS patients showed a progressive increase of P3 latency in relation to the level of stimulus complexity. No modulation of P3 latency was observed in the vegetative patients. CONCLUSIONS: These results suggest that the modulation of P3 latency related to stimulus complexity may represent an objective index of higher-order processing integration that predicts the recovery of consciousness from VS to MCS when clinical manifestations are inconsistent. SIGNIFICANCE: Modulation of P3 latency related to stimulus complexity could provide valuable information about the cognitive capabilities of unresponsive patients.

[Intra-articular finger fractures in children]. / Intraartikuläre Fingerfrakturen im Kindesalter.

From 1982 to 1984 140 patients with fractures of the fingers were admitted to the department of surgery of the University Children's Hospital. Only 28 patients (21.5%) suffered from intraarticular fractures. Three 3/12 years later, 10 patients (35.7%) presented functional trouble or suffered from pain. Only 2 of the 15 conservatively treated patients had trouble. On the other hand, 8 children out of the 13 operatively treated patients presented an unsatisfactory result. Localisation, type of fracture and kind of treatment are analysed. We prefer as a rule conservative treatment excepting fractures of type Salter III and IV, osseous ruptures of the ulnar collateral ligament of the thumb and dislocated fractures. We suggest splinting with 0.6 mm K-wires.