Open Cisterns Research Articles

Ancient cisterns in the Negev Highlands: Types and spatial correlation with Bronze and Iron Age sites

Extensive archaeological surveys have been conducted in recent years in the Negev desert region. The present research focusses on the central Negev Highlands north of the Makhtesh Ramon erosion cirque. The density of settlement sites in this area during the Bronze and Iron Ages is surprising in view of the absence of permanent water sources. Water is of course the primary and critical precondition for settlement and survival. The lack of springs necessitated water-harvesting of local rainfall for drinking water, by means of ingenious runoff capture in cisterns. Four types of cisterns occur in the region: (a) open cisterns dug in soft clayey marl, (b) bell-shaped cisterns (c) small bowl shaped cisterns and (d) roofed cisterns. The latter three types were hewn in hard limestone or chalk. This article deals in particular with the so-called open cisterns and the problem of their archaeological association and age. The time of construction of these cisterns has often been presumed to relate to the Iron Age. However, such a suggested association ignores the large number of Bronze Age sites in the area and the question of their water supply. The latter sites belong to the Early Bronze Age and/or the Middle Bronze Age I. This investigation evaluates for the first time by means of spatial analyses the distribution of cistern types and their association with settlements of various archaeological periods. Nine archaeological survey maps, each covering an area of 10 × 10 km, were included in this spatial analysis. Hence the total study area comprises 900 km2. The results show that open cisterns are not common at elevations below 600 m in the Negev Highlands. Many open cisterns are concentrated along a linear axis north of the Makhtesh Ramon erosion cirque, which is not the case for other cistern types. The average distances of all Bronze and Iron Age sites around the cisterns were evaluated. The open cisterns show a clear spatial correlation with Bronze Age sites, in particular with sites inhabited during both the Early Bronze Age and Middle Bronze Age I.

Traumatic tentorial hematoma in two-wheeler riders: Correlation with helmet use.

Background:Tentorial hematoma is frequently seen in traumatic brain injury (TBI) patients, especially in motorized two-wheeler riders following head injury. However its relevance and prognostic significance are not known.Objective:To evaluate patients of TBI with tentorial hematoma using a simple grading system and attempt to correlate this grading with factors like helmet use and neurological outcome.Materials and Methods:This prospective study over a 1-year period included patients with TBI who had tentorial hematoma in the initial plain head. Patients were divided into three grades based on the initial CT findings: Grade I: Isolated tentorial hematoma, grade II: tentorial hematoma with midline shift but open cisterns and grade III: Tentorial hematoma with effaced cisterns. Clinical and radiological records of patients including admission GCS and GOS at discharge were assessed in all cases.Observations:A total of 1786 patients of TBI were admitted during the study period. Of these, 106 (5.9%) patients had tentorial hematoma. 84.9% (n = 90) were male and 15.1% (n = 16) were female with the mean age being 36.5 years (range 2-66 years). The mean admission GCS was 13, 11 and 8 in patients with grade I, II and III tentorial hematoma respectively. 43.4% (n = 46) of the patients had grade I, 32.1% (n = 34) had grade II and 24.5% (n = 26) patients had grade III tentorial hematoma. Seventy-one patients (84.5%) were riding motorized two wheelers with 63 (89%) wearing helmets. The majority of the patients wearing helmets (58.8%) had grade I hematoma with 35% (n = 22) having grade II hematoma and only 6.3% (n = 4) having grade III hematoma. Overall, there were 20 deaths. 50% (n = 10) of the deaths were in patients with grade III hematoma and 40% (n = 8) of the deaths were in patients with grade II hematoma. There were two (10%) deaths in patients with grade I hematoma (both unrelated to head injury). The mean GOS at the time of discharge was 5, 4.1 and 2.2 in patients with grade I, II and III tentorial hematoma, respectively.Conclusions:Tentorial hematomas are very common in two-wheeler riders with TBI and could be a marker for indirect forces such as rotational forces experienced while wearing helmets.

Chapter 10. Cerebrospinal fluid drainage

Chapter 10. Cerebrospinal fluid drainage

The relationship between basal cisterns on CT and time-linked intracranial pressure in paediatric head injury

Although intracranial pressure (ICP) monitoring is a cornerstone of care for severe traumatic brain injury (TBI), the indications for ICP monitoring in children are unclear. Often, decisions are based on head computed tomography (CT) scan characteristics. Arguably, the patency of the basal cisterns is the most commonly used of these signs. Although raised ICP is more likely with obliterated basal cisterns, the implications of open cisterns are less clear. We examined the association between the status of perimesencephalic cisterns and time-linked ICP values in paediatric severe TBI. ICP data linked to individual head CT scans were reviewed. Basal cisterns were classified as open or closed by blinded reviewers. For the initial CT scan, we examined ICP values for the first 6 h after monitor insertion. For follow-up scans, we examined ICP values 3 h before and after scanning. Mean ICP and any episode of ICP ≥ 20 mmHg during this period were recorded. Data from 104 patients were examined. Basal cisterns were patent in 51.72% of scans, effaced in 34.48% and obliterated in 13.79%. Even when cisterns were open, more than 40% of scans had at least one episode of ICP ≥ 20 mmHg, and 14% of scans had a mean ICP ≥ 20 mmHg. The specificity of open cisterns in predicting ICP < 20 mmHg was poor (57.9%). Age-related data were worse. Children with severe TBI frequently may have open basal cisterns on head CT despite increased ICP. Open cisterns should not discourage ICP monitoring.

Anatomic Study of the Quadrigeminal Cistern in Patients With 3-Dimensional Magnetic Resonance Cisternography

The aim of this study was to demonstrate the anatomy of the quadrigeminal cistern, define the anatomic landmarks, and measure the extension of the cistern in the living by using magnetic resonance (MR) cisternography with 3-dimensional reconstruction. The quadrigeminal cistern was examined in 38 patients. We focused on measurements of the superior, posterior, and lateral limits; the anterior and posterior maximal rostrocaudal diameter; the distance between the right and left superior colliculus and the right and left inferior colliculus; and the angle between the quadrigeminal plate and pineal gland. The highest variability was observed for the posterior rostrocaudal diameter with a standard deviation of 3.1 and a range from 8 to 21.1 mm followed by the anterior-posterior diameter with a standard deviation of 2.8 and a range from 6.4 to 16.5 mm. In all cases the distance between the right and left superior colliculus (13.3 +/- 1.8 mm; mean +/- SD) was longer than the distance between the right and left inferior colliculus (11.4 +/- 1.3 mm; mean +/- SD). We classified 2 types of cisterns: closed cisterns with angles between the quadrigeminal plate and the pineal gland ranging from 39 degrees to 63 degrees and open cisterns with angles ranging from 63 degrees to 76 degrees . The analysis of variability by age and sex showed no significant differences. The MR cisternography with 3-dimensional reconstruction was a simple and noninvasive tool providing detailed anatomic information in the living. It allowed measurement of the high variability of morphology of the quadrigeminal cistern. We defined the lateral landmarks and identified the lateral limit of the cistern. We classified the different shapes of the quadrigeminal cistern as open or closed cisterns. This can be helpful in the choice of the surgical approach to the lesions arising in this area.

Water and Sign Magic in al-Jabin, Yemen

The preserved heritage of al-Jabin, a town located in Yemen’s western highlands, offers a unique opportunity to document traditional water engineering principles. There are no springs in the immediate vicinity, because the town is perched at the edge of the mountain escarpment. Even today, water is provided by open cisterns that collect surface run-off following a rain. But as the rains needed to feed the system are highly unpredictable, the water supply is never secure. The perimeter wall of one of the cisterns bears a group of seven signs, a detailed description of which is given in Kitab Shams al-Ma`arif wa-Lata’if al-`Awarif, a work attributed to Ahmad ibn `Ali al-Buni (d. 1225), a well-known prolific writer on magic. Al-Buni explains that the signs symbolize God’s supreme name and thus display great magical power of a protective and well-wishing nature. Generally speaking, magical practices attempt to influence the course of natural events by calling upon a superhuman force. In the case of the cistern, God’s supreme name was inscribed in the hopes that this would lead to a guaranteed water supply. While it is easy to dismiss al-Buni’s text and the observed practice in al-Jabin as superstitious frailty, one needs to bear in mind that under life-threatening circumstances, even people in the modern West easily resort to magical procedures.

Water and Sign Magic in al-Jabin, Yemen

The preserved heritage of al-Jabin, a town located in Yemen’s western highlands, offers a unique opportunity to document traditional water engineering principles. There are no springs in the immediate vicinity, because the town is perched at the edge of the mountain escarpment. Even today, water is provided by open cisterns that collect surface run-off following a rain. But as the rains needed to feed the system are highly unpredictable, the water supply is never secure. The perimeter wall of one of the cisterns bears a group of seven signs, a detailed description of which is given in Kitab Shams al-Ma`arif wa-Lata’if al-`Awarif, a work attributed to Ahmad ibn `Ali al-Buni (d. 1225), a well-known prolific writer on magic. Al-Buni explains that the signs symbolize God’s supreme name and thus display great magical power of a protective and well-wishing nature. Generally speaking, magical practices attempt to influence the course of natural events by calling upon a superhuman force. In the case of the cistern, God’s supreme name was inscribed in the hopes that this would lead to a guaranteed water supply. While it is easy to dismiss al-Buni’s text and the observed practice in al-Jabin as superstitious frailty, one needs to bear in mind that under life-threatening circumstances, even people in the modern West easily resort to magical procedures.

Chapter 10. The role of cerebrospinal fluid drainage in the treatment of severe pediatric traumatic brain injury

Ventricular cerebrospinal fluid drainage in severe pediatric traumatic brain injury is supported as a treatment option in the setting of refractory intracranial hypertension; the addition of lumbar drainage in patients showing open cisterns on imaging and without major mass lesions or shift also is supported as a treatment option.

External lumbar drainage in uncontrollable intracranial pressure in adults with severe head injury: a report of 7 cases.

The retrospective results of external lumbar drainage in 7 adult patients with severe closed head injury and intracranial pressure (ICP) refractory to aggressive management strategies are presented. All patients had Glasgow Coma Scale (GCS) scores of 8 or less within 24 hours after admission and were treated by a staircase protocol including sedation, ventricular drainage, hyperventilation and mannitol. In three cases barbiturate drugs and an artificially induced hypothermia were used. Four patients required surgical evacuation of mass lesions. Three patients made a good functional recovery, 2 were severely disabled and 2 patients died. In none of the patients clinical signs of cerebral herniation occurred. We recommend additional external lumbar drainage in adults with severe head injury unresponsive to aggressive ICP control with open basilar cisterns and absent focal mass lesions on computerized-tomography scan before drainage.

ACUTE SUBDURAL HEMATOMA

There is a current trend toward nonsurgical therapy for small, minimally symptomatic acute subdural hematomas (ASDH), but data supporting such a scheme have been lacking. We evaluated 83 patients with minimally symptomatic ASDH (Glasgow Coma Scale scores of 11-15) and found 58 managed nonsurgically (70%) and 25 managed with craniotomy (30%). Patients managed without surgery had a lower incidence of focal neurologic deficits (12% vs. 40%; p < .01), open cisterns (90% vs. 28%; p < .001), and small (< or = 1 cm) ASDHs (92% vs. 62%; p < .001). Ninety-three percent of patients managed nonsurgically had functional recovery compared with 84% of patients with craniotomy. Age and injury Severity Score were significantly associated with patient outcome. Timing of surgery had no association with outcome. Six percent of patients managed nonsurgically developed chronic SDH requiring craniotomy. We conclude that unless the hematoma is causing clinical evidence of intracranial hypertension or significant neurologic dysfunction, there appears to be no advantage in evacuating the clot. Selected patients with ASDH and GCS scores of 11-15 can safely be managed without craniotomy.

Traumatic interhemispheric subdural haematomas

According to reports in the literature traumatic interhemispheric subdural haematomas (I.S.H.) are supposed to present acutely or subacutely with contralateral monoparesis of a lower extremity or hemiparesis or in bilateral haematomas even with paraparesis, and to need early operative evacuation. In our series of 5 cases none of them followed this "classical" clinical picture, and three of them recovered without operation. We conclude that the indication for operative evacuation depends on the clinical course and that in patients with spontaneously improving symptomatology non-surgical management under close supervision may be the better solution. Also the C.T. finding of open convexity cisterns may be possible indication for conservative management.