This review of pediatric neck injuries includes patients admitted to Children's Hospital of Columbus, Ohio, during the period 1969 to 1979. The 122 patients with neck injuries constituted 1.4% of the total neurosurgical admissions during this time. Forty-eight patients had cervical strains; 74 had involvement of the spinal column; and 27 had neurological deficits. The injuries reached their peak incidence during the summer months, with motor-vehicle accidents accounting for 31%, diving injuries and falls from a height 20% each, football injuries 8%, other sports 11%, and miscellaneous 10%. There is a clear division of patients into a group aged 8 years or less with exclusively upper cervical injuries, and an older group with pancervical injuries. In the younger children, the injuries involved soft tissue (subluxation was seen more frequently than fracture), and tended to occur through subchondral growth plates, with a more reliable union than similar bone injuries. In the older children, the pattern and etiology of injury are the same as in adults. The entire cervical axis is at risk, and there is a tendency to fracture bone rather than cartilaginous structures.

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Continuous monitoring of v i t a l s i g n s , e . g . temperature, blood pressure, heart and r e s p i r a t i o n r a t e s , and E C G , f o r the care of c r i t i c a l l y s i c k infants has become an established hospital routine. W e have compared various non-invasive and invasive continuous Pa02 monitors with a r t e r i a l blood Pa02 levels and find t h a t there i s a considerable c o r r e l a t i o n between the values obtained by d i f f e r e n t procedures. Continuous monitoring procedures permit b e t t e r evaluation of the p a t i e n t than skin c o l o r , ECG monitoring o r c l i n i c a l observation.I t s immediate a v a i l a b i l i t y a t bedside and the capacity t o detect i r r e g u l a r i t y in oxygen supply i s of major c l i n i c a l advantage. These devices help in preventing t h e e f f e c t s of hyperoxemia and hypoxemia. S t a b i l i z a t i o n of s i c k infants can be achieved rapidly without repeated a r t e r i a l blood sampling f o r Pa02 determinations. The r e s u l t s suggest t h a t these continuous Pa02 monitors (invasive o r non-invasive) may be a b l e t o eliminate or minimize conditions l i k e bronchopulmonary dysplasia, r e t r o l e n t a l f i b r o p l a s i a and brain damage due t o lack of oxygen during neonatal development. INTRAUTERINE FETAL RESUSCITATION WITH TERBUTALINENer esh A. Te a n i , Uma L. Verma, S amali Chatter ee.1451 Spo:. by P l a t i n J. Collipp. NassavlCty Med C t r , i l t h S c i C t r , SUNY a t Stony Brook, Dept. of Ob/Gyn, East Meadow, NY Cases of i n t r a p a r t a l f e t a l d i s t r e s s from any cause s u s t a i n f u r t h e r hypoxia during u t e r i n e contractions due t o t h e concomit a n t reduction i n u t e r i n e blood flow during u t e r i n e a c t i v i t y . Therapeutic reduction of u t e r i n e a c t i v i t y should, t h e r e f o r e , res u l t i n recovery of f e t a l h e a r t r a t e (FHR) and f e t a l a c i d o s i s , and t h e b i r t h of a neonate i n a b e t t e r s t a t e of owgenation and acid-base balance. Towards t h i s , t e r b u t a l i n e 250 Ug subcutaneously was i n j e c t e d i n p a t i e n t s with evidence of f e t a l d i s t r e s s . A l l 1 1 p a t i e n t s showed ominous FHR changes. I n 2 of t h e s e , f e t a l s c a l p blood pH (FSB-pH) was not t e c h n i c a l l y possible. I n 2 , t h e FSB-pH was b 7.25. The remaining 7 p a t i e n t s showed FSB-pH 4 7.25.Results: Where adequate FHR t r a c e was a v a i l a b l e , 9/10 pat i e n t s showed marked reduction t o cessation of u t e r i n e a c t i v i t y , and complete o r p a r t i a l recovery of ominous FHR changes. FSB-pH was compared t o t h e mid-point of t h e umbilical vein and a r t e r y pH's. I n t h e 2 cases where t h e o r i g i n a l FSB-pH was b 7.25, no change was seen. However, i n cases with FSB-pH 5 7.25, a s i gn i f i c a n t improvement from a mean of 7.180 + .038 t o 7.270 2 .066 (P = 4 .005) was seen. No major s i d e e f f e d s were noted. ST of AP l i p . e x t . meas...

The authors described a lumbar spine fracture that is characterized on anteroposterior x-ray views by separation of the pedicular shadows. It is almost invariably associated with posterior interlaminar herniation of the cauda equina through a dorsal dural split, and anterolateral entrapment or amputation of the nerve root. The fracture is unstable and requires internal fixation and fusion at the time of neurolysis. Fractures meeting these criteria should be explored as soon as the patients' condition permits. Myelography is usually unnecessary and may be contraindicated in some cases. The postulated mechanism of injury is hyperextension with vertical impaction and rupture of the ring made up of the lamina, pedicle, and vertebral body. The ring is fractured in several places in a manner similar to that seen in "Jefferson fracture" of C-1. The special anatomical relationships of the thoracolumbar junction and the plane of the lumbar facets are also discussed.