జర్నల్ ఆఫ్ ట్రామా & ట్రీట్‌మెంట్

 In cases where carers have been convicted of Shaken Baby Syndrome the infant is twice as likely to be male as female. A similar 2:1 overrepresentation of males exists in Benign Hydrocephalus of Infancy, also known as Normal Pressure Hydrocephalus (NPH). It has previously been shown that excessive intra-abdominal pressures, occurring in paroxysmal coughing, retching or vomiting, can be communicated to intracranial veins. It is proposed that the missing pressure in NPH is this transient cerebral venous hypertension, in particular that caused by violent retching and vomiting in pyloric stenosis which also shows a 2:1 M/F ratio. Distension of intra cranial veins and capillaries would temporarily increase brain volume which would stimulate the dura to signal suture growth to the dimensions occurring during, and just after, the transient pressure surge. The pressure surge in capillaries throughout the brain would force water out through their walls into the interstitium. This water would then diffuse out through the brain surface, producing subarachnoid collections. At higher pressures the capillary endothelial cell tight junctions would separate, exposing the porous basement membrane, through which proteins could escape. At higher pressures still, some capillaries and veins would burst, producing the symptoms of Shaken Baby Syndrome.

Fifty-two percent of individuals incarcerated in state prisons and 63% of individuals in federal prisons are parents of minor children and many of them (22% of the children of state inmates and 16% of the children of federal inmates) are under the age of 5 years

Background: The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 55 patients with liver injury treated in a single institution.
Methods: A retrospective study of the patients presented with blunt liver trauma was performed from 2008-2012. The patients were categorised according to the mode of treatment received. Group I: Conservative management; Group II: Operative management. Variables analyzed included demographic data, cause of injury, grade of injury, associated injuries, vitals, haemoglobin values, mode of treatment and complications.
Results: A total of 55 patients were analyzed. 16 patients had sustained severe injuries. Mean pulse rate in conservative and operative group was 92 and 102 beats/min respectively. Mean blood pressure in conservative and operative group was 110/70 and 90/60 mmHg respectively. Conservative treatment was followed in 28 patients with surgery undertaken in 6 of the patients from this group due to failure of conservative treatment. Immediate surgery was carried out in 27 patients. Mortality occurred in 8 patients. Morbidity occurred among 5 patients in conservative group and among 8 patients in operative group. Mean duration of hospital stay in conservative and operative groups are respectively 17 and 19 days. P value is significant (0.04).
Conclusions: Conservative treatment is an adequate treatment in mild to moderate liver injury patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centres with experienced surgeons.

Dental-alveolar trauma in the primary dentition associated with intra-cranial injuries is not common. This article reports the management of a complex trauma involving cranial trauma and multiple luxations and avulsions of primary teeth in a five-year old boy as a consequence of a horse kick. The treatment, including the hospital intervention and dentistry procedures, is described. The clinical outcomes are reported at a 5-year follow-up.