This report describes a new method of custom making cranial titanium plates for the repair of skull defects. We have combined 3D CT imaging and surface modelling with rapid prototyping (RP) technology to produce physical models of our patients' skulls from which custom titanium plates were made. We have expanded the use of image processing tools applied to the CT image data to fabricate a representation of the skull defect. Medical RP models are relatively expensive and particular attention has been paid to developing image processing methods to reduce costs. Our technique used the patient as their own model and generated data from the contralateral side of the head where appropriate. We present the results of 10 patients who have had a custom made cranial titanium plate fitted and discuss the models for these cases. The benefits of our custom made titanium plates are reduced patient attendances to hospital and a more accurate titanium plate which has improved fitting and cosmesis.

This study shows that AFCs and WFCs cannot be assumed to register equal values of pressure. It has further shown that even when the p readings are compared with their value at the start of a test, a divergence of values of up to 10 cmH O remains. If AFCs are used, care must be taken to compensate for any p variations that occur during patient movement. Before AFCs are adopted, new normal values for resting pressures need to be developed to allow good quality AFC pressure readings to be made. Neurourol. Urodynam. 35:926-933, 2016. © 2015 Wiley Periodicals, Inc.

We performed a randomised prospective double blind trial to study the effect of the calcium antagonist nimodipine on the outcome of head injured patients. The subjects were not obeying commands at the time of entry to the study, within 24 hours of injury. One hundred and seventy-five patients received nimodipine IV, 2 mg per hour for up to 7 days and 176 received placebo. The two groups were well matched for important prognostic features. Six months after injury 93 (53%) of the nimodipine group and 86 (49%) of the control group had a favourable outcome (moderate/good recovery). The relative increase in favourable outcomes (8%) was not significant but is compatible (95% C.I.) with an increase in favourable outcomes in treated patients by 33% or a decrease by 12%. Nimodipine was well tolerated and there were few adverse reactions; means of systolic and diastolic blood pressures and the intracranial pressure did not differ between the groups. It is unlikely that nimodipine has a marked effect on outcome (ie an increase in favourable outcome of greater than 15%) after head injury of this severity but the study does not exclude a modest but clinically useful benefit.

SYNOPSIS Drugs which block adrenergic receptors have previously been used in the prophylactic treatment ofmigraine with varying success. We report a double blind crossover trial with the ß‐blocker acebutolol(Sectral, May & Baker Ltd) in which 43 patients took part. The number, frequency, duration and intensity of the headaches were recorded by the patients and results were analysed for the 33 patients who completed the trial. Plasma levels of acebutolol were measured during the trial. There was good patient compliance but here was no obvious correlation found between any of the parameters measured and the concentration of the drug. Although there was a general reduction in frequency with intensity of migraine during treatment when compared with a pre‐trial period, there was also a large placebo effect which made it difficult to separate the true effect of the ß‐blocking drug. 13 patients, however, said that they felt better during the period of the trial when they were receiving acebutolol and continued on this treatment when the trial finished. The value of acebutolol therefore requires further evaluation in such patients.