✓ The authors have analyzed their experience with intracranial pressure (ICP) monitoring in 207 patients over a 4-year period. Patients with either high-density or low-density lesions on computerized tomography (CT) at admission had a high incidence (53% to 63%) of intracranial hypertension (ICP persistently over 20 mm Hg). In contrast, patients with normal CT scans at admission had a relatively low incidence of ICP elevation (13%). Among these patients, three features were found to be strongly associated with the development of intracranial hypertension: 1) age over 40 years; 2) systolic blood pressure under 90 mm Hg; and 3) motor posturing — unilateral or bilateral. When two or more of these features were noted at admission, the incidence of intracranial hypertension was 60%, as compared to 4% when only one, or none, of these features were present. Thus, the patients at high risk for developing intracranial hypertension after severe head injury are those with abnormal CT scans at admission, and those with normal CT scans who demonstrate two or more of the above-mentioned adverse features. Based on these criteria, only 16% of this series of patients with normal CT scans would have qualified for monitoring. In addition to the three clinical features noted above, multimodality evoked potential (MEP) studies were also found to be strong predictors of ICP elevation in the normal CT scan group, with a 75% incidence of intracranial hypertension in patients with disseminated deficits. There was no statistically significant correlation between the Glasgow Coma Scale score, eye movements, pupillary reaction, hypoxia, or anemia at admission and subsequent ICP elevation in the group with normal CT scans. In this series, an intraventricular catheter was used as the sole monitoring device in 91% of the cases. In the remaining 9%, subarachnoid screws were employed, either alone, or upon failure of the ventriculostomy. While no mortality was directly ascribed to the monitoring process, there was a 7.7% complication rate (infection 6.3% + hemorrhage 1.4%). Eighty-five percent of the infections occurred in patients who had been monitored for 5 days or more, while no infections were noted in those monitored for less than 3 days. Used judiciously, this technique can be valuable in the monitoring and treatment of the brain-injured patient.

Most phantom media in current use exhibit T1 relaxation times that are significantly dependent on both temperature and operating frequency. This can introduce undesirable variability into relaxation measurements due to temperature fluctuations, and complicates direct comparison of imagers operating at different magnetic field strengths. Our investigations of a nickel-doped agarose gel system have demonstrated near independence of the proton relaxation rates to a wide range of temperatures and frequencies. We therefore propose the adoption of Ni2+ as a relaxation modifier for phantom materials used as relaxometry standards.

Controlling the metal nanoclusters with atomic precision is highly difficult and further studies on their transformation reactions are even more challenging. Herein we report the controlled formation of a silver alloy nanocluster [AuAg19{S2P(OnPr)2}12] (1) from an Ag20 template via a galvanic exchange route. X-ray structural analysis reveals that the alloy structure comprises of a gold-centered Ag12 icosahedron, Au@Ag12, capped by seven silver atoms. Interestingly upon reacting with one equiv. of silver(i) salt, (1) can transform into a higher nuclearity nanocluster, [Au@Ag20{S2P(OnPr)2}12]+ (2). The conversion process is studied via ESI mass spectrometry and 31P NMR spectroscopy. This kind of size-structural transformation at the single atom level is quite remarkable. Furthermore, the compositions of all the doped nanoclusters (1, 2) were fully characterized with ESI-MS and EDS. The blue shift depicted in the UV-visible and emission spectra of the doped nanoclusters (1, 2) compared with the precursor, Ag20, demonstrates that the doping atoms have significant effects on the electronic structures.