The incidence of late infection after cranioplasty was studied in 130 patients with 133 cranioplasties. The materials used were prefabricated resin in 62 cases, autogenic bone in 38, intraoperatively fashioned resin in 25, and vitallium in eight. Six infections were documented, for an infection rate of 4.5%. In addition to these six cases, we studied eight patients with infections who had undergone cranioplasty elsewhere but had the infected plates removed in our hospitals. Among the 14 cases of infection, the intervals between cranioplasty and plate removal were 3 to 43 months (average, 10.5 months). The eight patients referred from other hospitals had a significantly shorter average interval between external decompression and cranioplasty than did patients who did not develop infection (2.6 versus 6.7 months; p less than 0.005). Systemic signs were mild despite obvious local signs of infection. Of the 11 first infections, nine (82%) were associated with discharge of pus from a fistula; in these cases a galeal suture had become infected apparently through scratching by the patients. In contrast, in the three patients who had had a previous infection, the second infection manifested as subgaleal and epidural empyema or meningitis without a fistula or pus discharge. Nine infections (69%) were due to Staphylococcus. All but two patients required removal of the infected plates. One recovered with conservative therapy and one died of meningitis, giving a mortality rate of 0.8%. No matter how mild the systemic signs, late infection warrants surgical debridement and plate removal. The risk factors for late infection of cranioplasty are discussed.
Acute spontaneous subdural hematoma of arterial origin is very rare. We have encountered two such cases and verified the arterial origin of the bleeding at operation. Both patients had no history of head trauma and developed progressive neurological deficits, becoming comatose. The source of bleeding was identified as a cortical artery located on the temporal lobe near the Sylvian region. This type of lesion is reviewed in the literature and the etiology is discussed.
The decision rules indieriduals use to judge cvrongdoing committed inside corporations and other hierarchical organizations are not well understood.We explore this issue by asking random samples of individuals in Moscow, Tokyo, and Washington, D.C., to respond to four short vignettes describing acts of wrongdoing by people in corporations. The vignettes are expperiments that manipulate the actor's mental s w , the actor's position in the organization, and whether the actor's decision was influenced by others in the organid o n . We examine ( I ) the distribution of responsibility among people in the organization, (2) how individual responsibility affects the attribution of responsibility to the organization itself, and (3) cross-national differences in attributions. We find that both what the actors did (their deeds) and the position they occupied (their roles) signifkandy influence the responsibility attributed to them. The responsibility attributed to the organizations themselves is a function of the responsibiliey attributed to the actors inside the organization, but not a function of the independent variubles in the expm'ments. Cross-national differences emerge with respect to the responsibility Joseph Sanders is A. A. White Professor of Law at the University of Houston. V. Lee Hamilton is chair of the
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