Evaluation of the bony landmarks in transcondylar approach.

BACKGROUND: The aim of this study is to define the anatomic landmarks which are necessary for transcondylar approach and to determine the importance of these structures during surgical resection. METHODS: 56 dry skulls were included in this study. Landmarks were detected. Some distances and angles, which were determined before, were measured and the anatomical structures were observed. 21 parameters were examined and analysed in totally 56 dry skulls using 56 foramen magnum, 112 hypoglossal canal and 112 occipital condyles. The landmarks which were used were the anterior and posterior borders of the occipital condyle, the medial and lateral margin of the occipital condyle, basion, opisthion, hypoglossal canal and posterior condylar canal. The measurements were made separately for the right and left sides. RESULTS: The mean length of the occipital condyle was found as 23.1 mm. The distance between the intracranial edge of the hypoglossal canal and anterior margin of the occipital condyle was measured as 11.2 mm in both sides. The distance between the intracranial edge of the hypoglossal canal and posterior margin of the occipital condyle was measured as 12.5 mm at the right side and 12.6 mm at the left one. The mean length of the hypoglossal canal was measured as 10.5 mm at the right side and 10.6 mm at the left one. 14 hypoglossal canals were divided into two compartments by a septum. CONCLUSIONS: In transcondylar approach, the anatomical landmarks should be well known in order to make a safe occipital condyle resection. The distance between the intracranial edge of the hypoglossal canal and posterior margin of the occipital condyle is important for a safe occipital condyle resection, and it was found to be 12.55 +/-0.05 mm in our study. Approximately 12 mm occipital condyle resection can be made without giving damage to the neural tissue. This value is appropriate to the (1/2) of the occipital condyle.

Evaluation of mild head injury in a pediatric population.

Approximately 5 million children present to emergency departments, seeking care for head injuries, each year, and 80% of these children are classified as cases of mild head injury. Due to the huge number of patients and low frequency of intracranial lesions in this group, obtaining a computed tomography scan for each and every patient is a significant economic problem. This study was conducted to identify the clinical parameters and the radiographic findings that may be associated with intracranial lesions in children with mild head injury. 421 patients, with a Glasgow Coma Scale score of 15 and without any focal neurological deficit, were studied. Intracranial lesion was noted in 37 cases (8.8%). Sensitivity of a plain radiogram was 43.2%, and specificity was 93%. An intracranial pathology was demonstrated in 28.9% of the patients with a linear skull fracture. The only clinical parameters associated with an increase in the frequency of detection of intracranial lesions were posttraumatic seizures and loss of consciousness. Age, sex, headache, vomiting and scalp lacerations were not associated with a higher frequency. Even when patients with a history of loss of consciousness or posttraumatic seizure were subtracted from the study group, intracranial lesions were noted in 4.1% of the cases, and in 1.8% neurosurgical intervention was required. Computed tomography is the gold standard in the evaluation of pediatric patients with mild head trauma, and every child who has experienced a head injury should undergo a cranial computed tomography evaluation, even if he or she appears in perfect health.

[Indications for computed tomography in patients with mild head injuries]. / Hafif kafa travmali olgularda bilgisayarli tomografi endikasyonlari.

BACKGROUND: To identify clinical parameters that may be associated with intracranial lesions in patients with mild head injuries, Glasgow Coma Scale (GCS) scores of 15 but without any focal neurological deficit. METHODS: All head trauma patients admitted to the emergency room within 3 months with GCS scores of 15 (n = 371) were evaluated. Patients with focal neurological deficits, penetrating or multiple traumas, gun shot wounds were not evaluated. RESULTS: Mean age of 222 male and 149 female patients was 22.4 years. Frequency of intracranial lesions detected in CT was higher in patients older than 60 years of age. A significant difference was not found between both genders. Detection rate of abnormalities was higher after motorway accidents. Loss of consciousness and post-traumatic fits were associated with higher rates of pathological sequelae. A significant difference was not found between patients with or without headache, nausea, and vomiting. Sensitivity and specificity of cranial x-ray were estimated to be 38.2% and 93.2% when compared with cranial CT respectively. CONCLUSION: The incidence of intracranial lesions in patients with mild head injuries, GCS scores of 15, younger than 60 years of age, and without any focal neurological deficits, loss of consciousness, post-traumatic fits, gun shot wound, and penetrating injury is 0.6%.

Fatal occupational injuries among workers in Kocaeli, Turkey, 1990-1999.

The authors evaluated occupational accidents in Kocaeli, Turkey, using epidemiologic criteria. Data were derived from the registries of the service on Occupational Injuries and Diseases of the Social Insurance Institution's District Authority in Kocaeli. The analysis was based on data from 387 deaths. The rates of occupational injuries and mortality and fatalities from them were 5.1%, 30.6 per 100,000 workers, and 6.0%, respectively, compared with 2.8%, 35.2 per 100.000 workers, and 12.7% in Turkey. Sectors with the highest rates of fatal occupational injuries were construction (30.2%), transportation (13.2%), basic metal industry (9.0%), manufacturing of metal products (5.9%), and heating with electricity, gas, and steam (5.9%). 38.2% of these workers were 25-34 years old. Nearly all were male, most were married, and three fourths had children. Of all deaths due to occupational injuries, 121 (31.3%) were caused by traffic injuries, 93 (24.1%) by falling from high places, and 43 (11.1%) by electrocution; 89% occurred at workplaces, 42% of the workplaces were small, and 45.9% of the deceased workers had been working there for less than three months. Although the situation was better than that in the rest of Turkey in terms of epidemiologic criteria, the death rates, as in other developing countries, are higher than those in the world in general.