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Background: Primary intracerebral hemorrhage (PICH) remains the deadliest and most disabling form of stroke. The aim of our study was to determine the potential predictors for survival and neurological recovery in PICH patients by clinical-computed tomographic (CT) correlation., Materials and Methods: A prospective study conducted among PICH patients at a tertiary care hospital. The clinical and CT scan findings were correlated with the functional outcome using modified Rankin scores (mRS) of 0-5 at discharge and during six months follow-up., Results: The clinical and CT findings in 160 (93 male and 67 female) eligible adult patients with age range from 25 to 85 years (mean age 58.30 ± 11.44 years) were analyzed. The mean Glasgow Coma Scale [GCS] score was significantly higher among survivors. (12.8 ± 0.4 vs. 8.5 ± 0.5, P < 0.001) Based upon the pattern of the CT findings, the best outcome in terms of survival was for the patients with ICH in basal ganglia/internal capsule region (86.7 %), followed by lobar hemorrhage (67.1%). Good functional outcome was associated with a hematoma volume of less than 30 ml. At discharge majority of the survivors were functionally dependent 76 (70.4%) and only 32 (29.6%) achieved functional independence. The significant independent predictors of in- hospital survival were GCS score > 9 (OR 10.8; 95% CI 4.061 to 28.719), basal ganglia/internal capsule bleed (OR 9.750; 95% CI 2.122 to 45.004), hematoma volume <30 ml (OR 11.476; 95% CI 4. 810 to 27.434), no mid line shift (OR 4.901; 95% CI 2.405 to 9.987) and no intraventricular extension of hemorrhage (OR 7.040; 95% CI 3.358 to 14.458)., Conclusion: Outcome and functional status at discharge were well correlated with the initial CT scan findings and GCS score.

While intraoperative three-dimensional fluoroscopy does not possess the resolution and image quality of computed tomography (CT), it may provide adequate information about screw placement to guide intra- and postoperative decision making. We compared the accuracy of intraoperative three-dimensional fluoroscopy visualization of proper screw placement with that of postoperative CT. We retrospectively reviewed spinal instrumentation procedures done using the O-arm (Medtronic, Minneapolis, MN, USA) that also had postoperative CT. All screws were assessed for placement accuracy on O-arm and CT images on a 4-point scale. In this study, 20 cases met the inclusion criteria. Thirteen breaches (11 grade 1 and 2 grade 2) were identified on O-arm images, and 14 breaches (10 grade 1, 3 grade 2, and 1 grade 3) were identified on CT. Sensitivity, specificity, and positive and negative predictive values were 93, 99, 99, and 98%, respectively. The Kappa value (0.96) suggested a very high degree of agreement between three-dimensional fluoroscopy and CT in determining accuracy of screw placement. These findings may allow less frequent use of postoperative CT scans, improving cost effectiveness in patients who require spinal instrumentation procedures and potentially decreasing the number of patients who require replacement of an inappropriately positioned screw.

Aim: To determine the utility of computed tomography (CT) scanning in localizing colon tumors., Methods: At a single tertiary care teaching hospital, a retrospective chart review was conducted on patients who underwent surgery for colon malignancies between January 2004 and May 2006. One hundred and four charts containing all of the following data were reviewed: preoperative colonoscopy report, preoperative CT report, surgical operative report, tumor pathology report. The colon was divided into five segments from the cecum to the sigmoid and the location of the lesions was categorized into one of these areas. The tumor location was considered "erroneous" if its location determined during surgery differed from the location determined by colonoscopy or CT., Results: Over all, tumor location was accurately determined via colonoscopy in 83/104 cases (79.8%) and erroneously in 21/104 (20.2%) of cases. CT scan accurately localized colon tumors in 52/104 (50.0%) of cases, incorrectly localized tumors in 18/104 (17.3%) of cases, and did not detect known tumors in 34/104 (32.7%) of cases. Of the 21 tumors erroneously located by colonoscopy, 11 (52.4%) were accurately localized by CT scan. The average tumor size for all patients in this study was 5.72 (+/- 3.11) cm. The average size of tumors properly located by colonoscopy and CT was 5.39 (+/- 3.34) cm and 6.79 (+/- 3.48) cm, respectively. The average size of the tumors not detected by CT was 3.98 (+/- 1.75) cm., Conclusion: CT scanning may be used in concert with colonoscopy to help localize colon tumors.

Study Design: A retrospective study., Purpose: To compare outcomes of apical derotation with pedicle screws in idiopathic and neuromuscular scoliosis (NMS)., Overview of Literature: No information about apical derotation in NMS with pedicle screws is available., Methods: We performed deformity correcting surgery using pedicle screw constructs on 12 adolescent idiopathic scoliosis (AIS) patients (mean age 14.1 years) and 16 NMS patients (mean age 16.5 years). Preoperative, postoperative, and final follow-up radiographs were analyzed for Cobb's angle and pelvic obliquity, while apical rotation was measured on CT scans using the Aaro-Dahlborn method., Results: For AIS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 57.3 degrees , 2.8 degrees , and 20.4 degrees , respectively, and postoperatively they were 16.8 degrees , 1.1 degrees and 14.7 degrees , respectively, showing significant correction. For NMS, the mean preoperative Cobb's angle, pelvic obliquity, and apical rotation values were 75.6 degrees , 13.7 degrees , and 42.9 degrees , respectively, and postoperatively they were 27.1 degrees , 5.8 degrees , and 34.1 degrees , respectively, also showing significant correction. There were no significant differences between AIS and NMS patients Cobb's angle p=0.306, pelvic obliquity p=0.887 and apical derotation p=0.113 degrees . There were no differences in curve severity in the three groups (AIS, NMS >80 degrees and NMS <80 degrees ); or the correction of apical rotation (p=0.25), although less correction was achieved in the Cobb's angle in the >80 NMS group (p=0.04)., Conclusions: Apical axial derotation can be achieved with posterior only pedicle screw fixation in NMS without anterior release, with comparable results in idiopathic scoliosis.

Tuberculous meningitis is a disease associated with high morbidity and mortality. Experience with this disease at the Hospital for Sick Children in Toronto was reviewed to determine whether changes in prognosis have occurred in the past decade. All patients from whom the organism was recovered from the cerebrospinal fluid, or who had a positive Mantoux test in association with a compatible history, were included. Thirteen patients were identified from 1978 to 1989. The median age was six years (range 11 months to 17.5 years). Nine patients were born in Canada, but all except one were members of recently immigrant families. History of close contact with an adult with tuberculosis, or travel to an endemic area in the preceding six months, was present in seven cases. All patients had clinical manifestations and mild pleocytosis with elevated protein content in the cerebrospinal fluid. Patients were all diagnosed within 20 days after admission (median one day). Computed tomography scan of the head was abnormal in all patients within three weeks of admission. No patient died, although long term sequelae developed in five. The prognosis of tuberculous meningitis has improved in the past decade. Although a specific reason for this improvement cannot be definitively stated, earlier diagnosis and better chemotherapy may contribute.