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Pneumocephalus, air in the cranial cavity, is a common occurrence following cranial surgery. However, tension pneumocephalus, accumulation of air trapped in the cranial cavity causing a mass effect and abnormal neurological signs, is uncommon. Knowledge about conditions that contribute to tension pneumocephalus, a potentially fatal complication, including the related signs and symptoms, is imperative. Immediate collaboration with a physician allows for timely treatment and patient recovery. Treatment measures include preoperative teaching, immediate removal of intracranial air, supine positioning, administration of 100% oxygen, repair of the bony and dural defect, and, if indicated drain placement into the air cavity, temporary tracheotomy, and antibiotics.

The rigid cervical collar has been a great addition to the successful management of cervical spine injuries. But the collar has been known to offer a false sense of security in terms of totally preventing additional and further spinal cord compromise and damage. Also, with increased length of collar wear, there is development of skin pressure points and ulcer formation, possible delay in weaning from a ventilator, potential for exposure to transmission of blood-borne diseases. Photographs are used to demonstrate examples of related skin breakdown, show proper collar fit, present the result of ineffective cervical immobilization, and show how to stabilize the head and neck during a collar change. These problem areas are addressed with the dos and don'ts for nursing management.

Four hundred fifty volunteers participated in a placebo-controlled, double-blind, randomized trial of the prophylactic effects of rimantadine and amantadine during an outbreak of influenza A. The subjects received drugs orally at a dose of 100 mg twice a day for six weeks. Influenza-like illness occurred in 41 per cent of the subjects receiving placebo but in only 14 per cent of those receiving rimantadine and 9 per cent of those receiving amantadine (P<0.001 for either drug vs. placebo). Laboratory-documented influenza occurred in 21 per cent of placebo recipients, 3 per cent of rimantadine recipients, and 2 per cent of amantadine recipients (P<0.001). These findings represent efficacy rates of 85 per cent for rimantadine and 91 per cent for amantadine, as compared with placebo. More recipients of amantadine (13 per cent) than recipients of rimantadine (6 per cent; P<0.05) or placebo (4 per cent; P<0.01) withdrew from the study because of Central-nervous-system side effects. On the basis of this study, rimantadine appears to be the drug of choice for the prophylaxis of influenza A. (N Engl J Med. 1982; 307: 580–4.) AMANTADINE hydrochloride (1-adamantanamine hydrochloride) was licensed in 1966 for the prophylaxis of infections with influenza A viruses of the H2N2 subtype, and it has subsequently been approved for the prophylaxis of infections with all influenza A subtypes. Despite accumulated evidence of the efficacy of amantadine in the prophylaxis of influenza in human beings, 1 2 3 4 5 6 the drug has received relatively little use for this purpose. In part, this has been a result of continued challenges to the evidence of its efficacy by some workers, 7 as well as concern over its reported side effects, which have varied considerably in frequency from study to . . .

Impacted cerumen is the most common ear problem in patients over the age of 65 after otitis media and often leads to complaints of increasing deafness. The medical problem is discussed.