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Background. Child abuse is a worldwide scourge. One of its most devastating manifestations is non-accidental head injury (NAHI). Methods. This is a retrospective chart review of children presenting to the Red Cross Children’s Hospital trauma unit with a diagnosis of NAHI over a 3-year period. Results. Sixty-eight children were included in the study and 2 different groups were identified. Fifty-three per cent of the children were deliberately injured (median age 2 years), while 47% were allegedly not the intended target of the assailant (median age 9 months). The assailant was male in 65% of the intentional assaults and male in 100% of the unintentional assaults, with the intended adult victim female in 85% of the latter cases. Overall, 85% of the assaults were committed in the child’s own home. Conclusions. The high proportion of cases in which a young child was injured unintentionally suggests that these infants effectively become shields in assaults committed by adults. In this context any attempts to deal with child abuse must also address the concurrent intimate partner violence.

textabstractObjective: To evaluate the activity and participation levels of adults with spastic diplegia 17-26 years after selective dorsal rhizotomy; to investigate relationships between subjects'functioning and age, socio-economic-status, level of satisfaction and their perceptions of the post-operative outcomes. Design: Observational follow-up study.Patients: Thirty-one subjects with spastic diplegia, age range 21-44 years, who underwent selective dorsal rhizotomy between 1981 and 1991. Methods: A semi-structured interview was used to gather data on patients' characteristics and long-term experiences after the operation. The Functional Mobility Scale and Life-Habit questionnaire were completed.Results: Based on the Functional Mobility Scale 84% of subjects were reported as independent for a distance of 5 m, and 61% for 50 and 500 m. Eighty percent were independent in accomplishing all life habits, with most problems found for Mobility and Recreation. This was in agreement with the subjects' perception, with strong correlations between Life-Habit questionnaire accomplishment and satisfaction levels. No significant associations were found between functioning and age at selective dorsal rhizotomy, current age and socioeconomic status. Conclusion: More than 15 years after selective dorsal rhizotomy, adults with spastic diplegia showed high levels of functioning, and similar levels of satisfaction with life habits. The majority had positive feelings about the neurosurgical procedure, although there is a need for better follow-up after subjects leave school.

Includes abstract. Includes bibliographical references.

Includes abstract., Includes bibliographical references (p. 175-218)., Traumatic brain injury (TBI) is a highly complex clinical condition in the most complex organ of the body. The foundation of care of the patient with severe TBI is the prevention of secondary insults to the brain. This relies on conventional monitoring tools to identify patients at risk, but often these may fail to detect important secondary insults. Moreover, the therapies that are used commonly in the critical care environment all have potential adverse effects, many of which may not be evident. TBI treatment in children is further complicated by changing thresholds with age, and the much smaller evidence base compared to their adult counterparts.

Includes bibliographical references (leaves 58-72)., Although the conventional role of the operation was that of a salvage procedure when medical therapy failed in the treatment of raised intracranial pressure (ICP), two important concepts have emerged in the recent literature that appear to challenge that approach. In addition to the lack of evidence supporting benefit from current forms of treament, evidence from diverse studies that use data from magnetic resonance images, cerebral owygenation and cerebral blood flow measurements have highlighted potential adverse effects that may occur with these therapies.