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Two young males with a high degree of consanguinity presented with similar brainstem gliomas. As the patients were raised separately, their presentation with similar tumors suggests a genetic basis for the occurrence of these gliomas.

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Increased frequency of reoperation in neurosurgery has made the microscopic examination of tissue from previously operated sites more common. Various synthetic materials are in common use in neurosurgery, and these can cause clinical complications as well as presenting a diagnostic dilemma for the pathologist. The microscopic appearance of synthetic materials used by neurosurgeons to aid hemostasis, prevent aneurysm rupture, serve as dural prosthesis and suture wounds is reviewed. The importance of the polarizing microscope in differentiating synthetic materials is emphasized.

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Research has consistently documented a discrepancy between experiencing offensive sex-related behaviors and labeling these situations as sexual harassment, leading to several attempts to understand this phenomenon. The authors propose that the issue of why it is that women who report such experiences generally do not indicate that they have been sexually harassed is an important psychological question, and may provide a path through the nested meanings of workplace harassment. The authors argue for the value of moving beyond a descriptive approach to this issue by examining the effects of self-labeling on the psychological, health, and work-related outcomes of unwelcome, sex-related experiences. They present data from female employees working in 3 separate organizations, demonstrating that women exposed to such behaviors report very similar consequences, whether they label their experiences as harassment or not.

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Research on sexual harassment has recently expanded to include examination of men's experiences. Such research, however, has ignored the power dynamics involved in sexual harassment and typically assumed exclusively heterosexual situations. We examine legal cases illustrating the many forms that male-male harassment may take and the complex array of situations in which such harassment occurs. We then report the frequencies of experiences of harassment in three large samples of working men as well as the sex of the perpetrators of the harassment. Finally, we examine men's evaluations of these situations to determine the degree to which they found them to be harassing in a psychological sense. Our results indicate that men experience potentially sexually harassing behaviors from other men at least as often as they do from women; however, men in all samples reported relatively few negative reactions to these experiences. Future research should examine the predictors and outcomes of such situations to clarify the meaning of such behavior for male targets.

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Sexual harassment of women in organizational settings has recently become a topic of interest to researchers and the general public alike. Although numerous studies document its frequency, the development of conceptual models identifying antecedents and consequences of harassment has proceeded at a slower pace. In this article, an empirical test of a recently proposed conceptual model is described. According to the model, organizational climate for sexual harassment and job gender context are critical antecedents of sexual harassment; harassment, in turn, influences work-related variables (e.g., job satisfaction); psychological states (e.g., anxiety and depression); and physical health. On the basis of a sample of women employed at a large, regulated utility company, the model's predictions were generally supported.

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Previous evidence regarding the outcomes of sexual harassment in the workplace has come mainly from self-selected samples or analogue studies or those using inadequate measures. The sexual harassment experiences, coping responses, and job-related and psychological outcomes of 447 female private-sector employees and 300 female university employees were examined. Discriminant function analyses indicated that women who had not been harassed and women who had experienced low, moderate, and high frequencies of harassment could be distinguished on the basis of both job-related and psychological outcomes. These outcomes could not be attributed to negative affective disposition, attitudes toward harassment, or general job stress. Results suggest that relatively low-level but frequent types of sexual harassment can have significant negative consequences for working women.

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A patient sustained a cervical spine gunshot wound resulting in immediate quadriplegia and obstruction of both vertebral arteries. After an 8-hour delay, basilar artery thrombosis occurred and resulted in locked-in syndrome. Bilateral occlusion of the vertebral arteries after penetrating cervical trauma has not been reported previously. The incidence and treatment of traumatic basilar thrombosis and locked-in syndrome is reviewed. Rapid diagnosis of ascending thrombosis and prompt treatment with hyperdynamics and anticoagulation may improve outcome.

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Paraganglioma arising in the thoracic extradural space is an uncommon tumor, with only four cases previously reported. The authors review the clinical and pathological features of thoracic paraganglioma and compare them to the more common paraganglioma of the cauda equina.

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A series of 168 civilian cases of tangential gunshot wounds to the head is presented. Neurologic deficits on presentation were generally minimal. Computed tomographic (CT) scans were performed in 51% of patients, and abnormal CT findings were noted in 35% (18% of all patients). Major operative procedures were required in 9% of the patients. Serious sequelae of tangential injuries are described even with patients who initially have no neurologic abnormality. We suggest that a CT scan is warranted in all cases of tangential gunshot wounds to the head.

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An aggressive surgical strategy was applied to cranial gunshot wound victims at Cook County Hospital in Chicago from 1983 to 1992. A series of 480 patients with an overall mortality rate of 34% is presented. A total of 150 patients underwent craniotomy with an operative mortality rate of 21%. Criteria for operation were Glasgow Coma Scale scores of 3 through 7 without hypotension or fixed and dilated pupils or Glasgow Coma Scale scores of 8 through 15 with intracranial bone fragments or significant clot. This study supports previous reports that even patients with severe neurological deficits and massive cerebral damage can benefit from aggressive treatment and make satisfactory recoveries.

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Even this information is only partial. To study fully the effects of treatment would require optimal care at all points from time of injury, including rapid prehospital resuscitation, rapid transport to an optimally equipped and staffed hospital, immediate evaluation and treatment of the initial injury and all complications, rapid and comprehensive rehabilitation, and supportive and flexible home and work settings for the patient on discharge. Patients would need to be stratified for premorbid characteristics, including intelligence, personal traits, and training. Prolonged follow-up, possibly for several years, would be required to determine true outcome. No current study contains sufficient numbers of patients treated optimally and studied for prolonged periods, but this should be done. One way of looking at such patients is to decide that many should be treated to salvage a few. The other way of looking at them is that so many must receive care, at great emotional and economic cost to themselves and others, that such treatment is inappropriate for any of them. Treating all such patients would be a major undertaking. If most of these patients were treated vigorously, a great proportion of them would still die but probably not for a number of days. During this period, their families would be under extreme stress. Once stabilized and receiving ongoing care, some patients would enter a permanent vegetative state and survive for prolonged periods until their prognosis was clear and care was withdrawn, again causing family stress as well as high cost. Some would likely survive although impaired. The charges and real costs of care for all these patients would be tremendous. The question therefore arises as to how to decide what to do about caring for a large group of patients whose maximal care would be costly in emotional and financial terms, particularly at a time when it is recognized that resources for medical care are going to be limited. When discussing such patients as a group with a view toward developing practice guidelines, many considerations must be brought to bear. One consideration is the certainty of the prognosis in both a quantitative and a qualitative sense in an individual case. It is not clear that one can be certain in patients except when there are overwhelmingly unfavorable features. As has been noted, even patients who have been shot through the geographic center of the brain and are posturing can make excellent recoveries. This would push toward aggressive treatment for many patients. Decision making must therefore be considered in terms of bioethics. The major principle-based systems of bioethics are deontologic, arising from accepted principles, and utilitarian, arising from effect on outcome. A virtue-based ethic for physicians arising from "the caring bond and the public trust" is being revived as a balance to analytical ethics. A similar orientation from the point of view of patients is communitarian ethics, that is asking for only what is reasonable and not so much as might harm others. Some of the issues to be considered include the sanctity of life while taking into account the criteria for life--vegetative function versus some level of mental function. One must also review each decision from the viewpoints of all the parties involved--patients, family and friends, physicians, and society--in the context of a heterogeneous society in which individual rights and tolerance enforced by law are primary features. In the patients' terms, there is a desire and right to medical care to maintain a healthy productive life. Even if impaired to some extent, patients may still have an interest in living. Balancing benefits and burdens of life is a complex problem. There is also the right, based on patients' values, to refuse care if there is the wish not to take a chance of having a significantly compromised existence. Such declaration before injury should be honored...

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The demographics and outcome of patients with gunshot wounds to the head over the past 10 years at Chicago's Cook County Hospital was examined. The study group consisted of 476 consecutive patients admitted to this urban level I trauma center with a diagnosis of penetrating craniocerebral missile injury. All patients followed a protocol that included aggressive surgical management when indicated. The Glasgow Outcome Score was used to assess outcome. There is an alarming rise in firearm violence in general and craniocerebral injury in particular. Some patients with severe neurologic deficits and massive cerebral damage can benefit from aggressive treatment and make a good recovery. A large proportion of this violence is most likely attributable to gang activity. Factors correlating with poor outcome included hypotension, apnea, bihemispheric injuries, or ventricular penetration. Although aggressive surgical and medical management improves the outcome of these patients, much more stringent preventative measures are required to control this violent epidemic.

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This Psychology in the Public Forum section, authored by the American Psychological Association's Committee on Women in Psychology's Task Force on Male Violence Against Women and by Senator Joseph Biden, examines the prevalence, impact, and public policy dimensions of physical assault, sexual assault, and sexual harassment of women. This introduction reviews common themes that emerge from the articles that follow. It concludes by emphasizing that the problem of violence against women cannot be fully understood, let alone solved, by focusing exclusively on individual psychology. Only by changing the social and cultural institutions that have given rise to the problem can a lasting solution be achieved.

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Sexual harassment has been a fixture of the workplace since women first began to work outside the home. Although true epidemiological studies do not exist, large-scale surveys of working women suggest that approximately 1 of every 2 women will be harassed at some point during their academic or working lives. The data indicate that harassment is degrading, frightening, and sometimes physically violent; frequently extends over a considerable period of time; and can result in profound job-related, psychological; and health-related consequences. This article provides a brief review of the prevalence and consequences of sexual harassment and outlines social policy implications for research, legislation, and primary prevention.

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Electroencephalographic and clinical findings are reported for 100 patients with the Lennox-Gastaut (LGS) triad of slow bilateral spike and wave (BSW), retardation and multiple seizures. Neurological and mental deficits were frequently observed, especially in patients who developed seizures before age 1 yr. More than half of the patients had focal epileptiform discharges that peaked in occurrence at age 4-6 yrs. EEG follow-up showed that background frequency slowed when patients developed the LGS pattern, and increased after recovery. Only 2 patients developed normal EEGs on follow-up, although 22 patients no longer showed the LGS pattern after an average of 3 yrs 3 mos follow-up.

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