La maladie de Grisel treated by combined C1-2 transarticular and C1 lateral mass screw fixation.

The authors describe a novel posterior approach to atlantoaxial stabilization combining C1-2 transarticular and C1 lateral mass screws with vertical connecting rods to create a strong construct with four-point fixation. They present here a case of atlanto-axial instability secondary to infection, Grisel's syndrome, necessitating instrumented stabilization after a period of close clinical and radiological observation following the initial cervical decompression and evacuation of retropharyngeal and epidural abscesses.

Brain sag as a cause of postoperative neurological deterioration following anterior cranial fossa floor repair for post traumatic cerebrospinal fluid rhinorrhoea.

A patient with posttraumatic CSF rhinorrhoea underwent a transcranial anterior skull base repair, with a lumbar drain being inserted at induction of anaesthesia. Postoperative neurological deterioration occurred due to brain sag. Following treatment, there was significant recovery albeit in a slow and steady fashion. Patients with brain sag as a result of lumbar drain insertion can make a good recovery, despite an initial presentation with signs of severe brainstem compression, which could easily be misinterpreted as having a poor prognosis. Absence of an initial dramatic response to treatment does not necessarily imply poor outcome in the long term.

Painful third nerve palsy in a patient with perimesencephalic subarachnoid haemorrhage.

A patient with perimesencephalic subarachnoid haemorrhage (PMSAH) developed a delayed third nerve palsy. Three formal cerebral angiograms, a computed tomography cerebral angiogram and a magnetic resonance angiogram all failed to reveal a vascular abnormality. Further investigations did not show any medical cause for the palsy. This appears to be the first case report of a patient with PMSAH presenting with a painful third nerve palsy.

Wound infection in gynecologic surgery.

OBJECTIVE: We sought to determine the wound infection rate among patients undergoing elective gynecologic surgery at a single tertiary care center and to determine the predictive value of various factors that contribute to infection. We further investigated the adequacy of hospital records in documenting infection rates as well as the timing of presentation of wound infections. METHODS: The records of 115 patients undergoing elective gynecologic surgery at our institution were reviewed. Patients were further subdivided based on route of surgery. We analyzed the importance of antibiotic prophylaxis, route of surgery, smoking, diabetes, and body mass index (BMI). RESULTS: The overall wound infection rate was 12.17% with no significant difference in the subgroups by route of surgery. Overall, antibiotic prophylaxis significantly decreased infection rates (P = 0.0118), but the route of surgery, BMI, smoking, and diabetes were not significant predictors of infection. Only one case of infection was detected during the initial hospital stay (6.1%). Fifty percent of the patients with infection required readmission, and of these 35.7% required an additional surgical procedure. The average length of hospital stay was 2.4 days longer in patients with infection. CONCLUSIONS: Antibiotic prophylaxis has a role in the management of patients undergoing abdominal gynecologic surgery. In today's environment of cost containment, an increased hospital stay and the added likelihood of additional surgical intervention associated with wound infection are important targets for prevention. Most patients with wound infection were diagnosed after discharge from the hospital. In our population, among whom transportation problems and remote residence are prevalent, strategies for infection surveillance should be integral to discharge planning.