Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 3: comparative study.

The suprascapular ligament seems to serve no defined function in the human. A comparative study was undertaken to elucidate its function. The suprascapular region was dissected in species representing seven existing primate families and six subprimate families. A striking dichotomy of pattern was observed. In the New World primates, the suprascapular ligament appeared to be continuous with the coracoclavicular ligament; the former merely served to increase the area of bony attachment of the coracoclavicular ligament. In the Old World monkeys and subprimate mammals, the suprascapular ligament was entirely absent. The human anatomy was comparable to that found in the New World primates. This dichotomy of pattern seems to be related to the function of the upper extremity in the different classes of mammals.

A prospective study of tracheobronchial bacterial flora in acutely brain-injured patients with and without antibiotic prophylaxis.

The authors observed prospectively 28 brain-injured patients, who required respiratory tract intubation, to determine the effect of antibiotic prophylaxis on bacterial flora, the rate of flora change, and the appearance of infection. Antibiotics not only failed to alter the rate of abnormal colonization but were associated with an earlier appearance of Gram-negative bacilli, the organisms that produced the most severe infections. Although more infections occurred in patients initially untreated with antibiotics, these infections were usually mild and caused by organisms susceptible to highly effective and relatively safe drugs. Although highly reproducible as a laboratory determination, the nitroblue tetrazolium dye test score showed no consistent relationship with the presence or absence of bacterial infection. Regular and extensive clinical and laboratory observations, including cultures of the respiratory tract helped to make the antibiotic administration in these patients specific, appropriate, and reasonable. Broad spectrum antibiotic prophylaxis does not prevent and may enhance the development of severe pulmonary infection in these patients.

Pathogenesis of intracranial arachnoid cysts.

The pathogenesis of intracranial arachnoid cysts is reviewed. Light and electron microscopic features of arachnoid cysts are presented in support of the hypothesis of Starkman et al, that these cysts are truly intraarachnoid in location and are formed by splitting or duplication of the arachnoid membrane. Documentary evidence is provided to prove that Richard Bright's original description in 1831 contains these concepts, which have passed unnoticed for nearly a century and a half. A brief description of the meninges and the subarachnoid spaces is given.

Facial nerve schwannoma in a 16-year-old girl.

A 16-year-old girl with unilateral facial nerve schwannoma in the cerebellopontine angle is presented in this report. The characteristic computerized tomography (CT) findings described in schwannomas and the patient's clinical findings established the preoperative diagnosis of a rare but benign tumor in the pediatric age group. The value of early diagnosis of potentially resectable benign tumors is emphasized.

Gliomas (astrocytomas) of the brain-stem with spinal intra- and extradural metastases: report of three cases.

Astrocytomas of the pons and medulla oblongata ('brain-stem gliomas') while often invasive locally, do not as a rule seed and metastasize along the spinal meninges. Three cases are here reported (two adults, one child) in whom astrocytoma of the brain-stem metastasized along the spinal cord. The dura mater itself and the spinal epidural space were invaded in two cases. The child and one adult had a pontine astrocytoma, the other adult's tumour originated in the medulla oblongata. In the two cases that came to necropsy the tumour of the brain-stem was much better differentiated than the meningeal deposits. These three cases suggest that the possibility of spinal spread of brain-stem gliomas should be considered when dealing with diagnostic and therapeutic problems of such patients.

Hypothermic total body washout and intracranial pressure monitoring in Stage IV Reye syndrome.

The number of children in this report treated with either TBW or exchange transfusions is small. Case mortality rates among children with Reye syndrome in Stage IV coma tends to be exceedingly high, varying from 50 to 100%. Intracranial pressure monitoring with the subarachnoid screw may have been an additional factor in increasing our survival data in three patients in the TBW group, since it provided continuous monitoring of ICP and allowed judicious administration of mannitol intravenously. Survival of five of six patients without neurologic sequelae in the present series has encouraged us to coninue utilization of TBW in children with Stage IV Reye syndrome.