Neurosurgical Forum: Letters to the Editor To The Editor H. S. Bhatoe , M.Ch. Commend Hospital Lucknow, India 339 340 Abstract Object. It is known that thespinalcordcan sustain traumaticinjurywithout associatedinjuryof thespinalcolumn in some conditions, such as a flexiblespinalcolumn or preexisting narrowedspinalcanal. The purpose of this study was to characterize the clinical features and to understand the mechanisms in cases of acute cervicalcordinjuryin which fracture or dislocation of the

Neurosurgical Forum: Letters to the Editor To the Editor Harold A. Wilkinson , M.D., Ph.D. Newton Wellesley Hospital Newton, Massachusetts 180 181 Abstract Object. Since publication in 1990, results from the National AcuteSpinalCordInjuryStudy II (NASCIS II) trial have changed the way patients suffering an acutespinalcordinjury(SCI) are treated. More recently, recommendations from NASCIS III are being adopted by institutions around the world. The purpose of this paper is to reevaluate carefully the

I n spite of major advances in prehospital emergency medical services and in regional trauma care, the outcome fromspinalcordinjury最近系列似乎变化不大。计划投入en the fact that at present we can have only a limited effect on neurological function inspinalcord-injured patients, it becomes especially important to identify factors that are responsible for further neurological deterioration in these cases. Surprisingly, this subject has been infrequently studied. Frankel, et al. , 5 reported a 2% incidence of deterioration in their

W e have observed six instances of pancreatitis followingspinalcordinjuryin otherwise healthy individuals and have been unable to find any prior reports of this sequela ofspinalcordtrauma. The following cases are presented to alert clinicians to this complication and to emphasize the fact thatspinalinjurymay occasionally result in mild pancreatic dysfunction manifested by fever and elevated serum amylase. Rarely, a fulminating, fatal, hemorrhagic pancreatitis may ensue. Case Reports Case 1 This infantryman was rendered quadriplegic when

Neurosurgical Forum: Letters to the Editor To The Editor Michael B. Bracken , Ph.D. Yale University New Haven, Connecticut 140 141 Abstract Object. Since publication in 1990, results from the National AcuteSpinalCordInjuryStudy II (NASCIS II) trial have changed the way patients suffering an acutespinalcordinjury(SCI) are treated. More recently, recommendations from NASCIS III are being adopted by institutions around the world. The purpose of this paper is to reevaluate carefully the results and

T his is not a standard review ofspinalcordmanagement. Rather, we have tried to discuss the successes, failures, and conflicts in current research on the mechanism and treatment ofspinalcordinjury. The number of sound and provocative reports reflects the momentum of this rapidly expanding field of research. Historical Background of Research The contemporary chapter of acutespinalcordinjuryresearch and treatment actually begins in 1908, for it was then that Allen reported the first comprehensive clinicopathological study of humanspinalcord

CF , Spjut HJ : Neuropathicspinalarthropathy afterspinalcordinjury. Spine 17 : 964 – 971 , 1992 9 Harrison MJ , Sacher M , Rosenblum BR , Rothman AS :SpinalCharcot arthropathy . Neurosurgery 29 : 273 – 277 , 1991 10 Hoppenfeld S , Gross M , Giangarra C : Nonoperative treatment of neuropathicspinalarthropathy . Spine 15 : 54 – 56 , 1990 11 Kalen V , Isono SS , Cho CS , Perkash I : Charcot arthropathy of the spine in long-standing paraplegia . Spine 12 : 42 – 47 , 1987 12 Kapila A , Lines M

A nimals treated in the first few hours after experimentalspinalcordinjuriesby local cooling, 1, 5, 18 hypertonic infusion, 9 and parenteral corticosteriods 5 recover more completely than do untreated control animals. This indicates that under certain conditions damagedspinalcordtissue, which otherwise would become necrotic, survives and resumes its function. The sequence of changes that occur in an injuredspinalcordwas described by Allen 2 in 1914 on the basis of an experimental study. Others 4, 8, 15, 18 have confirmed his findings, but

S peculation in previous studies as to the effect of in vivo experimentalspinalcordinjuryimplicated ischemia as a factor contributing to the pathological process, 1, 2 and impairment of thespinalblood flow followinginjuryhas been observed using fluorescent dye techniques. 12Spinalcordtissue lactic acid has been found to accumulate following circulatory arrest in primate studies, 6 presumably due to circulatory deprivation with resultant inadequate tissue perfusion and oxygenation. It is the purpose of this study to determine lactate levels in