Nail Gun Injury to the Brain: An Unusual Case of Suicide

An unusual case of fatal suicidal craniocerebral penetrating injury due to a nail gun is described. The victim, a 52 year old joiner experienced in the use of nail drivers, shot himself just above the forehead in the midline, driving the nail through his hypothalamus and midbrain. Death was delayed by nearly 24 hours. </jats:p

Vein of Galen malformation: diagnosis and management

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Management of patients aged ≫60 years with malignant glioma: good clinical status and radiotherapy determine outcome

Many clinical trials have shown that the most important prognostic variable in patients with malignant glioma is advanced age. However, can some patients aged &gt;60 years still have relatively good outcomes with conventional surgical and radiotherapeutic treatment? A previous audit of practice (1983-89) suggested that functional status was an impor tant prognostic variable in the elderly. We have reviewed a fur ther cohort (1989-96) to evaluate changes in practice and outcomes given advances in neuroimaging, neurosurger y and radiotherapy.The major findings in this series of 80 patients aged over 60 years with a histological diagnosis of supratentorial malignant glioma were: (i) There was a relationship between management undertaken and clinical status of the patients ( p &lt; 0.01), i.e. patients in good grade generally had tumour debulking and radiotherapy, whilst those in poor grade generally had only biopsy. (ii) There was a significant increase in sur vival of patients in the second period who received surgical debulking and post-operative radiotherapy (from a median of 23 to 41 weeks ( p &lt; 0.05). (iii) It is likely that case selection accounted for much of this improvement since there was a direct relationship between median survival time and good clinical grade using the WHO performance scale. (iv) A shorter radiotherapy course (30Gy in six fractions) was as efficacious as a conventional course (60Gy in 30 fractions), and those patients having radiotherapy survived significantly longer than those not having this treatment ( p = 0.001). This study has again demonstrated the importance of preoperative clinical grade and radiotherapy treatment in deter mining outcomes in patients &gt;60 years. To put these data in a societal context a recent prospective multicentre audit of patients with malignant glioma in Scotland, and another audit from our unit, showed that between 24 and 65% of patients aged &gt;60 years, with a CT diagnosis of malignant glioma do not undergo either surger y or radiotherapy. Advanced age per se should not be a bar to inter ventional treatment in patients aged &gt;60 years with suspected malignant glioma

GENERALISED GLYCOGENOSIS IN BRAHMAN CATTLE

Generalised glycogenosis was diagnosed in Brahman cattle on 4 Queensland properties on the basis of clinical observations and pathological and biochemical findings. The disease presented as a problem of ill-thrift and poor growth rate in calves which eventually showed nervous signs. Histologically there was vacuolation in the cells of the central nervous system, heart and muscular tissues. Biochemical assay of liver and blood mononuclear cells demonstrated a deficiency of α-glucosidase. Parents of affected calves had approximately half the α-glucosidase activity of that found in normal cattle