Intraventricular thrombolysis with urokinase speeds the resolution of intraventricular blood clots, compared with treatment with ventricular drainage alone.

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In a double-blind study, 74 children were randomly treated with prophylactic methicillin at the time of ventriculo-peritoneal shunting. There were 7 infections in the placebo group and 2 in the methicillin-treated group. There was no statistically significant difference in infection or overall malfunction rate between the two groups. The risk of shunt malfunction in the 2nd to 6th month after surgery was significantly greater in the placebo group (7 of 26 patients) than in the methicillin-treated group (1 of 26 patients). Delayed shunt malfunction may be prevented by a short course of perioperative antibiotics.

Background:Despite the importance of case logs in evaluating residents, no studies assess their accuracy in neurological surgery. Studies from other specialties reveal variations in reporting. This study assesses the accuracy of neurological surgery resident case logs at a single institution.Methods:Data was collected from three databases: billing data and two separate resident-managed case logs [department log and Accreditation Council for Graduate Medical Education (ACGME) case logs], containing records of procedures performed by 14 neurological surgery residents at a single institution over a 1-year period. The billing data was used as a proxy for a census of procedures performed during the study period. The difference between the number of procedures logged by residents and the number of procedures billed was calculated to determine the accuracy of the resident case logs.Results:Over the study period, 2150 procedures were billed at the institution, whereas 1749 procedures were logged in the ACGME case log and 1873 in the department log, representing an error rate of −18.65% and −12.88%, respectively. The error rate varied significantly (−1150% to +50.23%) between ACGME procedure categories. In 13 of the 22 ACGME procedure categories, the procedures were under-logged by residents in both resident-managed case logs. No category demonstrated over-logging in both case log systems.Conclusion:Resident managed case logs are an incomplete representation of clinical work. The cause for inaccuracy is multifactorial. The authors suggested that further research is necessary to validate their results and to identify means by which the accuracy of case logs can be increased.

INTRODUCTION Trigeminal neuralgia is a severe, debilitating facial pain disorder that has driven some to suicide when unable to obtain relief. Afflicted patients often describe the pain as ‘shocking’, ‘lightning’, or ‘electric’. If a patient describes pain in the face with words such as these, the diagnosis of trigeminal neuralgia should be at the top of the differential diagnosis. Historically, treatment has ranged from poultices and salves to injecting boiling water into the cheek to kill the nerve. The introduction of carbamazepine brought successful medical management to many, but adverse effects, and gradual development of refractory pain, mean that some patients still require invasive procedures to achieve pain control. The goal is to identify the point at which surgical intervention should be considered, and then to guide the choice of procedure. MEDICAL MANAGEMENT First line therapy for trigeminal neuralgia is carbamazepine (Tegretol). If the patient cannot tolerate carbamazepine, other anticonvulsants

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