90 Injury, 4, 90-92

Abstracts

B A C T E R I O L O G Y A N D I N F E C T I O N

Infection and indwelling intravenous catheters The tips of 58 cannulae that had been left in veins of 32 persons for up to 9 days were examined for bacterial contamination. Thirty-two per cent were so contami- nated Four of 30 carmulae removed within 24 hours and all of 10 that were removed after more than 4 days carried bacteria, but blood-culture was sterile in all cases. The organisms were what have in the past been regarded as not pathogenic. All patients had received prophylactic antibiotics. Each day a sample of blood was taken and subjected to the nitroblue-tetrazolium test, which was found to be of use in warning that bacterial contamination had occurred.

FREEMAN, R., and KING, B. (1972), 'Infective complications of indwelling intravenous catheters and the monitoring of infections by the nitroblue- tetrazolium test ', Lancet, 1, 992.

Ventilation system for patient isolation A room containing 2 beds was ventilated by a stream of air passing horizontally parallel to the long axes of the beds. Studies were carried out on more than 100 patients in the course of 2½ years. Compared with the open part of the ward, contamination of the air between the heads of the two beds in the ventilated room was 100 times less but the rate with which the patients acquired new organisms was only slightly reduced. It seemed likely that Staph. aureus were acquired from nurses but that Gram-negative organ- isms came from a redistribution of the patients' own flora.

LIDWELL, O. M., and TOWERS, A. G. (1972), 'Unidirectional ("laminar") flow ventilation system for patient isolation ', Lancet, 1, 347.

Prolonged coma after tetanus A 72-year-old woman developed tetanus after a fall in her garden and experienced spasms sufficient to require treatment by pancuronium and large doses of diazepam. The dose of the latter drug averaged 70 mg. daily for 28 days but the patient remained rigid and unconscious for a further 12 days, although she could breathe for herself throughout this period. She made a complete mental and physical recovery and the prolonged unconsciousness may have been owing to accumulation of diazepam when given in such large doses to a fat (79 kg.) person.

KENDALL, M. J., and CLARKE, S. W. (1972), ' Pro- longed coma after tetanus ', Br. med. J., 1, 354.

I N J U R I E S OF H E A D A N D S P I N E

Paraplegia in infants caused by automobile accidents Glasauer and Cares from the neurosurgical division at Buffalo Medical School report on two infants ren- dered paraplegic in car accidents. In each case the X-rays were normal. In the first, laminectomy (the indications for operation were not given), performed several weeks after injury, revealed segmented atrophy at the level of T.2. The paraplegia was unrelieved. The second child had a paraplegia from C.7, and died 4 months later from respiratory obstruction.

The importance of this article concerns the pre- vention of such injuries. The authors support the belief that the front seat of an automobile is the most dangerous location for an unrestrained child at any age, whether in their mother's lap or not. These terrible injuries can be prevented by parental insis- tence on proper restraints. Such restraints should allow for the infant's height and weight to afford maximum protection.

GLASAUER, F. E., and CARES, H. L. (1972), ' Trau- matic paraplegia in infancy ', J. Am. med. Ass., 219, 38.

Persistent vegetative state after brain damage The authors offer the words 'persistent vegetative state ' as an accurate description of the condition in which some patients survive severe injury of the brain, having no speech and no more than primitive postural and reflex movements of the limbs. The other terms that have been used imply more detailed knowledge of either the course or the situation of a lesion than can be justified.

JENNETr, B., and PLUM, F. (1972), 'Persistent vegetative state ', Lancet, 1, 734.

Severe head injury patients with physical disabilities This is the first major article in what will become a progressively enlarging subject as the primary treat- ment of head injuries improves and leaves us with increasing numbers of ' brain cripples '. Nine cases are described in which hydrocephalus (acquired, post- traumatic) was sought for and demonstrated and then treated by a ventriculo-atrial shunt. Substantial improvement resulted, patients who appeared destined for permanent institutional care recovering suffi- ciently to be sent home.

SALMON, J. H. (1971), ' Surgical treatment of severe post-traumatic encephalopathy ', Surgery Gynec. Obstet., 133, 634.