Although cerebellar infarction was known at the turn of the century, not until 1956 was it realized that large cerebellar infarctions could cause acute obstructive hydrocephalus. There are many more reports of cerebellar hemorrhages. The clinical differentiation between hemorrhage and infarction was difficult prior to computerized tomography (CT). Cerebellar hemorrhage is a neurosurgical emergency, as are some cerebellar infarctions. We present three patients with acute hydrocephalus resulting from these vascular syndromes; they are first cases to be successfully treated by ventricular drainage and shunting. Four other cerebellar infarcts demonstrate the efficacy of CT.

We performed magnetic resonance imaging of the lumbar spine on 66 asymptomatic subjects and found that 12 (18%) had either a disc protrusion or herniation. An additional 26 (39%) had a bulge that was associated with degenerative disc disease. We also found examples of spinal stenosis, narrowed nerve root canals, osteophytes, and vertebral body involvement with multiple myeloma. Degenerative disc disease is a common finding in asymptomatic adults that increases in frequency with age. It occurs more frequently in men and usually involves more than one level. The most common location is L5-S1.

Eleven cases of enlarged cisterna magna were found in a series of 3000 computerized tomography scans. We believe mega cisterna magna by itself is not related to any specific symptoms and may not require further study or treatment.

For several years, some sectors of the specialty of Radiology have complained about the practice of self-referral, where a nonradiologist physician provides and interprets an imaging procedure. It is argued that such practice leads to increased costs since a physician will overutilize technology because of financial incentives. Here we review the literature. The most extensive analysis to date is at odds with the conclusions drawn in the older literature in that it provides little, if any, evidence for overutilization. We performed our own investigation using a poll study and found no suggestion of overutilization in 33 self-referring neurologists when compared with 900 neurologists who referred imaging to radiologists. The main period of growth in demand for imaging was between 1999 and 2002. Since 2002 there has been a steep decline in the rate of growth, so that it is possible to predict roughly zero growth in MRI utilization by 2009 without any intervention. It is shown why the rise in demand for imaging studies cannot be explained by self-referral, and it is argued that the sudden expansion of demand 8 years ago was caused by simultaneous technological improvements in the 3 major imaging modalities. Finally, it is shown how self-referral may actually reduce costs by facilitating the transfer of care from the hospital and ER to the office.

The contemporary debate over capital punishment has been conducted principally in terms of whether it is an effective deterrent,' appropriately retributive, 2 racially discriminatory, 3 arbitrary, 4 or inevitably prone to error.' In support of their positions, the contending sides have offered statistical and anecdotal arguments on deterrence, racial discrimination, and arbitrariness, as well as value judgments concerning whether the death penalty is, on the one hand, properly retributive or, on the other, morally acceptable. But, as the debate has proceeded over the past fifteen years, courts have imposed more than 2,000 capital sentences." The resulting pattern of decisions has introduced a new means of assessing the viability of the capital sentencing process. This Article explores the implications of this pattern of capital punishment decisions. It argues that the capital convicting and sentencing process has necessarily become extraordinarily careful to avoid executing those who are innocent or who deserve some sentence other than death. The substantial number of defendants sentenced to death who have subsequently been found innocent, and the much greater number who have been convicted or sentenced in violation of law, demonstrate the need to employ such scrupulous care. Because of the large number of nullified convictions and sentences that have resulted from the exercise of such care, only one person has been executed against his will during the past fifteen years; three others have been executed because they refused to contest their convictions or sentences. Yet over 1000 death-sentenced prisoners are *The data in this article was assembled by Carol Palmer, a legal assistant at the NAACP Legal Defense and Educational Fund, who was assisted by Andrew J. Furer and Steven Rabiner, both Harvard undergraduates ('84). I also have been assisted by Amy Bard (Rutgers '82), Christine R.

No abstract

No abstract

No abstract