Study design: Retrospective analysis of a prospectively collected trauma database of a Level 1 (tertiary) trauma center. Objective: To de®ne the features of the cervical spinal injuries in polytrauma population admitted to the regional trauma unit. Setting: Canada, Ontario Province, Toronto, Sunnybrook Health Sciences Center. Methods: All trauma admissions between 1987 and 1996 entered prospectively into a trauma registry database were studied for incidence, demographic and epidemiological details of cervical spine (cord and column) injuries. Results: A total of 468 patients (66% male) with cervical spinal injury (CSI) from 1198 spinal injuries admitted to the regional trauma center were identi®ed. Seventy-®ve per cent of the CSI involved were aged less than 50 years; nearly 30% were in the third decade alone. Overall, the commonest spinal level injured was C2 (27%) followed by C5 (22%). Older population (above 60 years of age) had C1+2 involved more often than the young (P=0.02). Motor vehicular crashes (MVC) accounted for 71%, followed by pedestrian trauma (10%), sport injuries (7%). Spinal cord injury (SCI) was noted in 27%; complete in 16% and incomplete in 11% and more frequently at C4 or C5 level compared with C1, C2 (P50.00001); the former level had more often a complete SCI (P=0.06). Though MVC produced 74% of SCI, only 27% had neurological de®cits. Recreational trauma produced SCI in 45%, motor cycle crashes (MCC) in 37% and a rear passenger in MVC in 34% that was complete in 78%, 71% and 73% respectively. Front seat passenger and driver in MVC had a C5 level injury while a rear seat passenger had at C4 (P50.001). The C1 level injury had high association with severe and life threatening head and neck and facial injuries compared with the more frequently injured spinal levels; either C2 (P=0.03) or C5 (P=0.004). Similarly C1 injuries had higher ISS compared with C2 (P50.0001) and C5 (P50.008). Conclusions: C2 was the commonest fractured spine while SCI was more frequent at C5. Older and pedestrian population had higher incidences of injuries at C1 and C2. Sport and MCC resulted in severe SCI. The level of spine injured was dierent between a front and a rear seat occupant in MVC.

Forty patients with advanced head and neck cancer were treated with combined Cis-platinum-Bleomycin chemotherapy. Cis-diammine dichloroplatinum (DDP) 120 mg/mz iv was given after prehydration, with mannitol diuresis on Day 1. On Day 3, an initial loading dose of Bleomycin 15 mg/m2 was given by rapid iv push followed by continuous 24 hour intravenous infusion of Bleomycin 15 mg/m2 Day 3 through Day 10. DDP 120 mg/mZ iv was administered again on Day 22. The patients were evaluated for tumor response and resectability between Day 29 to Day 35. Of 39 patients who were evaluable, there were 8 complete responses or CR (20%) and 22 partial responses or PR (56%), for a major response rate of 76%. Nineteen patients had surgery (14 patients whose lesions were initially inoperable and 5 patients who were initially operable), Chemotherapy toxicity in 40 patients included alopecia (40), vomiting (39), mucositis (1 l), skin rash (lo), fever (17), weight loss of more than 5 lbs. (25), WBC less than 3,000 (2), platelets less than 100,000 (l), peak serum creatinine of 2 mg% (3), severe-hearing loss (l), hypersensitivity reaction (2). Surgical complication in 19 patients were pharyngocutaneous fistulae (2), wound dehiscence (l), meningitis and brain abscess (1). There was one death secondary to nephrotoxicity. This particular combination chemotherapy when given as initial treatment, appears very effective in reduction of tumor bulk. Long-term follow-up and randomization is necessary to determine effect upon survival.

A case of primary extragonadal yolk sac tumor occurring in the retroperitoneum of a young adult male was studied. The chemotherapy of this tumor has not previously been described for cases of extragonadal origin. A combination of cyclophosphamide, vinblastine, bleomycin, cis-diamminedichloroplatinum, actinomycin-D, and chlorambucil was used. A partial response and dramatic prolongation of survival was achieved, compared with previously reported cases.

A family with histopathologically proven intraocular malignant melanoma involving two generations is reported. A member of third generation was likely involved by history. Intraocular malignant melanoma, its familial occurrence, its occurrence with multiple malignancies, and its relationship to multiple malignancies occurring in a family are discussed.

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