Anthony D. Hockley

Management of intracerebral hemorrhage in idiopathic thrombocytopenic purpura. Report of four cases.

There has been little comment on the specific management of intracerebral bleeding occurring in patients suffering idiopathic thrombocytopenic purpura. The authors present the cases of four children with intracerebral hemorrhage due to this coagulation disturbance. A plan of management is described based on this experience; it includes immediate control of cerebral edema, emergency splenectomy, supportive care with platelet transfusions and corticosteroids, cerebral angiogtaphy, and a definitive neurosurgical procedure. If necessary, the radiological investigation and surgical therapy can be performed with a single general anesthetic. Three of the patients have survived without major neurological sequelae.

Maxillary volume growth in childhood.

&NA; Nasomaxillary abnormalities in form, position, and development in children are often prominent features of craniosynostosis, and in particular, craniofacial dysostosis. While attempting to quantitatively assess the volumetric maxillary deficiency in these patients, it became apparent that there was no “normal” reference range for maxillary volumes throughout childhood that could be used for comparison. The aim of this study was to generate a model for measuring maxillary volume and subsequent changes throughout childhood. The technique of segmentation was applied to magnetic resonance images obtained in 55 healthy children (30 boys, 25 girls), aged 1 month to 184 months (15.33 years). Maxillary volumes were plotted against age for boys and girls to create a model for normal maxillary growth during the first 15 years of life. Maxillary volumes were larger in boys at all ages. However, the pattern of maxillary growth in boys and girls was similar and could be divided into three periods, each lasting approximately 5 years. During the first 5 years of life, there is a steady increase in maxillary volume, at the end of which the maxilla has reached 53 percent of the volume recorded at 15 years. There is an accelerated rate of growth between 5 and 11 years, which corresponds to the development and eruption of the permanent dentition. Thereafter, until the age of 15 years, the rate of growth of the maxilla plateaus. Maxillary volume in the first 12 months of life is, on average, 29 cm3 in boys and 25 cm3 in girls. By 15 years of age, it has increased to an average of 73.0 cm3 in boys and 59.4 cm3 in girls (an increase by a factor of 2.5 in boys and 2.4 in girls). The difference between the two sexes is statistically significant for the entire series (boys: mean maxillary volume = 56.55 cm3, SD = 24.61; girls: mean maxillary volume = 40.68, SD = 17.69, p = 0.009, one‐way analysis of variance). (Plast. Reconstr. Surg. 111: 1591, 2003.)