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Youth murder in the USA has given further impetus to the 'gun debate' in American culture. It is argued that if the extent of violent deaths in the USA, compared with the rest of the developed world, was more widely understood, this would improve the likelihood of change. A USA/international comparison of 'youth & adult' (15-34) homicide was undertaken to demonstrate the anomaly of the US homicide situation compared with other major Western countries. All data are extrapolated from the latest WHO mortality rates. Ratios of ratios are calculated from annual US rates since 1974 to demonstrate the changing pattern of 'youth' (15-24) and 'adult' (25-34) homicide with the General Population Rate (GPR) (1974-94). The five-year average homicide rates are analysed in the 10 major countries, by gender and age, to illustrate the different patterns of homicide. The latest numbers of US homicides over 7.75 years, a matching period being the Vietnam War, are compared against the daily average US fatalities during the ...

BACKGROUND Despite increasing use of craniofacial access for complex intracranial and skull base pathology, there have been no reports detailing the impact of improved access on clinical outcome. METHODS Orbitozygomatic access was used in 32 patients with an aneurysm of the basilar bifurcation, superior cerebellar, or posterior cerebral arteries over a 9-year period. RESULTS Operative mortality was 0%, overall management mortality 9% and management morbidity was 9%. This approach was selected for these patients because of the anatomy of the aneurysm and its relationship to the terminal basilar complex and the dorsum sellae/posterior clinoid process. The flexibility achieved by the access allowed intraoperative use of multiple corridors of access. Morbidity directly attributable to the use of orbitozygomatic access was minimal. CONCLUSIONS While management outcome after aneurysmal subarachnoid hemorrhage relates directly to the severity of the initial hemorrhage, rather than the surgical approach chosen, in selected patients we recommend the use of this approach as a valuable adjunct to the armamentarium of the vascular neurosurgeon.

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Three patients with a meningioma involving the bone around the orbit are presented. The need for a complete resection and immediate reconstruction is emphasized. The principles of a 3-D orbital reconstruction are discussed.

Lymphatic malformations of the head and neck, also known as lymphangiomas or cystic hygromas, are a diverse group of lesions. They can be small and superficial or large and extensive, and management can be a challenge. Surgically they can be difficult to remove completely because of their poorly defined borders and the potential for damaging neighbouring structures. We review the dilemmas posed in diagnosis and treatment, and discuss the contemporary management of these interesting entities including sclerotherapy, which is gaining popularity.

Presents results of a two‐year trial, undertaken by the ADONIS Consortium, in which CD‐ROM containing facsimile images of pages of articles, abstracts, editorials, letters and other items from 219 biomedical journals were delivered to document supply centres. Shows sufficient potential for the members of the ADONIS Consortium to introduce a commercial service.

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Dissection deep within the orbit is a cause for concern to surgeons because of the perceived risks of injuring critical structures such as the contents of the superior orbital fissure and the optic nerve. Although "safe distances" (those distances within which it is considered safe to dissect within the orbit) have been described, these are of limited value if the orbit is severely disrupted or is congenitally shallow. In addition, traumatic defects in the orbital floor, in particular, often extend beyond these distances. Reliable landmarks based on the relations between anatomical structures within the orbit, rather than absolute distances, are described that permit safe dissection within the orbit. We present the concept of the deep orbit and describe its relevance to repair of injuries.