To determine the incidence of delayed intracranial haemorrhage and the indication for repeat computed tomography (CT), a one and a half year retrospective study was made. A total of 289 patients had CT scan for head injury of which 78 (26.9%) had multiple scans. Out of these, 5 patients developed delayed haemorrhages (one extradural, one subdural, and three intracerebral haematoma). The incidence of delayed intracranial haemorrhage in our series is small when compared with others. The main predisposing factors are decompressive surgery, hyperventilation and cerebral dehydration therapy. It is important to know when to repeat the CT scan. A review of the literature regarding this aspect is presented and compared with our protocol. Intracranial pressure monitoring plays an increasingly important role in the management of head injury and should be used to decide the patient requiring repeat CT. Follow-up CT without other indication is not necessary.
A comparative study of five periodic human strains of Brugia malayi, originating from India, China, Korea, Malaysia and Indonesia, is given. This morphological analysis is based on males; the "standard" characters (oesophagus, papillae, spicules...) appear identical. On the contrary, the cuticular ornamentation of the posterior region--which is composed of the area rugosa and of a system of bosses and constitutes a secondary non-skid copulatory apparatus--differs following the geographical origin of the strain. A key is given, based on this character. 1(2) At 800-1,200 micron from the tip of tail, numerous cuticular bosses present on the right side of the body (fig. 2 and 8 B). 2(1) At 800-1,200 micron from the tip of tail, cuticular bosses absent or scarce on the right side of the body (fig. 8 D). 3(4) At 1,800-1,200 micron from the tip of tail (fig. 4), scarce and slightly projecting cuticular bosses on the dorsal side of the body contrasting with well projecting lateral cuticular bosses (fig. 9 E and F). Anterior extremity of the area rugosa made by a few stripes of tiny bosses linked transversally (fig. 9 A). 4(3) At 1,800-2,200 micron, numerous cuticular bosses on the dorsal side of the body (figs. 5, 6 and 7). Anterior extremity of the area rugosa made by the stripes of longitudinal rods (fig. 9C). 5(6) Oblong transversally stretched cuticular bosses on the dorsal and left sides of the body, anteriorly to the area rugosa (fig. 5); big oblong bosses on the left side (fig. 9 B). Transversal wrinkles and stripes of rods absent on the dorsal side of the body. 6(5) Round cuticular bosses on the dorsal and left sides of the body anteriorly to the area rugosa (figs. 6 and 7): no big oblong bosses on the left side. Transversal wrinkles or stripes of rods present on the dorsal side of the body (fig. 9 D). Nomenclaturally, such differences could be used in defining different taxa, but it could be useful to perform "blind determination" (material without labelling), to study conveniently the morphology of microfilariae (often an excellent indication for speciation in that group of Nematodes) and, evenly, to proceed to parallel studies on isoenzymes. However, whatever could be the taxonomical conclusion, the differences observed in Brugia malayi originating from different regions appear to the sufficient to consider the existence of four distinct diseases.