摘要:

WE ARE REPORTING the functional outcome of 69 of 86 patients affected by intramedullary spinal cord tumors who underwent surgery at our department during the period of 1984 to 1992. The results on 17 patients affected by hemangioblastomas and cavernomas were excluded from this study and will be published separately. Twenty-eight patients had astrocytic processes; 34 had ependymoma; 4 had lipoma; 2 had neurofibroma; and 1 had oligodendroglioma. The overall rate of “radically” resected tumors was 55.1%, as opposed to 17.4% “quasiradically,” and 27.5% of “partially” resected processes. There was one postoperative death. Five other patients, affected by anaplastic astrocytomas, died because of tumor progress within 16 months from the operation. A postoperative functional assessment showed that the function of the upper and lower extremities had deteriorated in 65.4 and 55.1% of the patients; a respective functional deterioration by 1 degree of the scale of Cooper and Epstein was registered in 88.8 and 86.8% of the patients. The patients who recovered improved within a period of 6 to 18 months, whereas the function of the dorsal columns was impaired the longest. At follow-up (mean, 54 mo; range, 8–107 mo), the functional recovery (as compared with the preoperative status) was as follows: upper extremity, 17.1% of the patients were improved, 55.5% were unchanged, and 31.5% were worse (89.4% by 1 degree); lower extremity, 22.4% of the patients were improved, 51.5% were unchanged, and 29.4% were worse (most by 1 degree). Surgery on tumors of the cervicothoracic and upper thoracic region carried a relatively higher morbidity in this series. Radical and quasiradical resections were not affected by a higher morbidity than the partial ones. Tumors with large solid components had more pronounced postoperative sensory disturbances; their recovery, although satisfactory, was delayed.En blocplastic laminotomies seem helpful in preventing postoperative spinal deformities.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

IN AN ATTEMPT to evaluate the response of patients who have low admission Glasgow Coma Scale scores (GCS) after a penetrating craniocerebral injury to aggressive management, we evaluated a series of 190 patients with penetrating injuries who presented with a GCS score of 3, 4, or 5 during a 6-year period. Entrance criteria required replicable neurological examinations that were not altered by the presence of hypotension, drugs/toxins, or systemic injury. The surgical patients included 21 patients with an admission GCS score of 3, 24 with an admission GCS score of 4, and 15 with an admission GCS score of 5. All patients underwent surgical intervention and aggressive perioperative management in the neurosurgical intensive care, including resuscitative protocols. Five of the patients with a GCS score of 3 survived, all with poor outcomes. Seven of the patients with a GCS score of 4 survived, although only one had a good outcome. Eleven of the patients with a GCS score of 5 survived. Five had a Glasgow Outcome Score of 2, five had a Glasgow Outcome Score of 3, and one had a Glasgow Outcome Score of 4. We have devised a prospective model of outcome based on our series in an attempt to predict nonsurvivors at admission (while overpredicting for survivors). The variables most predictive of mortality include admission GCS score and subarachnoid hemorrhage in one model and admission GCS score and pupillary changes in a second, when pupillary response was definitive at admission (P≤ 0.00005). Important variables most predictive of morbidity include admission GCS score, bihemispheric injury when associated with intraventricular hemorrhage, and diffuse fragmentation (P< 0.001). It should be noted that disseminated intravascular coagulation was not included in our model. Disseminated intravascular coagulation was always associated with poor outcome when present in any traumatic injury. In considering outcome, we conclude that patients with admission GCS scores of 3, 4, or 5 are not likely to benefit (have a good outcome) from surgical intervention. Patients presenting with admission GCS scores of 3, 4, or 5 without radiological evidence of subarachnoid hemorrhage, ventricular involvement, or fragmentation in the presence of reactive pupils potentially should be followed more closely. We will continue to expand our series to define those prognostic variables that suggest good outcome in patients with GCS scores of 5 or higher.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A PROTOCOL FOR the treatment of selected intracavernous and proximal internal carotid artery aneurysms is described. Intraoperative angiography is used together with intraoperative balloon occlusion of the internal carotid artery and electroencephalography to optimize the timing of an extracranial-intracranial bypass before occlusion of the carotid artery and to provide intraoperative documentation of graft patency. This protocol has been used successfully in seven patients with complex aneurysms that were unsuitable for other endovascular methods or a direct microsurgical approach. Six aneurysms were located in the cavernous sinus, and one was located on the supraclinoid portion of the internal carotid artery. There were no permanent complications; one patient had a brief episode of dysphasia, which resolved without sequelae.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

INTIMAL PROLIFERATION IS thought to be initiated by the migration and proliferation of smooth muscle cells after endothelial damage. These changes may be induced, in part, by mitogenic growth factors such as insulin-like growth factor-1 (IGF-1). This study was designed to investigate the role of locally synthesized IGF-1 and its receptor in the arterial wall in response to the exposure to periarterial blood. Rat femoral arteries were exposed to periarterial blood for various time periods (control, 1, 3, 7, 14, and 21 d). Total ribonucleic acid was extracted from the arteries of 10 to 15 animals, and the expression of IGF-1 messenger ribonucleic acid in treated and untreated arteries was analyzed using dot blot analysis. To identify and localize IGF-1 receptors on the arterial walls, an in situ ligand binding of IGF-1 to the arterial sections was utilized using [125I]IGF-1 as a tracer. Our results revealed that luminal narrowing was maximum at 7 days posttreatment. Intimal proliferation occurred at 14 and 21 days. The results of dot blot analysis showed that the expression of IGF-1 messenger ribonucleic acid was increased four-fold by Day 3 and remained elevated up to 7 days, then gradually decreased. In situ [125I]IGF-1 binding to the normal rat femoral artery localized IGF-1 receptors to the arterial wall. There was a marked increase in the number of receptors at 3 and 7 days after treatment with periarterial blood. These results suggest that locally synthesized IGF-1 and its receptor may function in an autocrine and/or paracrine loop as part of the response of the arterial wall to periarterial blood, resulting in intimal proliferation.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

GLUTAMATE ANTAGONISTS ARE the most powerful neuroprotective drugs in laboratory studies of focal cerebral ischemia. Because the majority of clinical conditions in which focal brain ischemia occurs are associated with high intracranial pressure (ICP), we have used the rat acute subdural hematoma model to evaluate the effects of three glutamateN-methyl-D-aspartate antagonists, MK-801, CGS 19755 (SELFOTEL), D-CPP-ene, and mannitol, upon ICP and also upon the volume of ischemic brain damage. Only mannitol produced a significant reduction in ICP and improved cerebral perfusion pressure. The three glutamate antagonists did not significantly affect ICP or cerebral perfusion pressure, but they were associated with a significantly smaller zone of focal brain damage, when compared to the mannitol and saline groups.N-methyl-D-aspartate antagonists do not increase ICP or jeopardize cerebral perfusion pressure when administered under anesthesia with a controlled PaCO2level. Further studies in humans are indicated.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

WE STUDIED THE effect that treating two types of glioblastoma cell lines, U-87 MG and U-251 MG, with interferon (IFN)-γ had on their susceptibility to lysis by lymphokine-activated killer (LAK) cells. We also examined the participation of cell-adhesion molecules and major histocompatibility complex (MHC) class I and II antigens present on the target cells in lysis by LAK cells. Treatment with IFN-γ (1000 U/ml) for 48 hours resulted in the increased expression of both intercellular-adhesion molecule 1 and MHC class I antigens on tumor cells. In addition, untreated tumor cells expressed neural-cell-adhesion molecules and MHC class II antigens highly, but their expression was not affected by IFN-γ treatment. These changes in expression were accompanied by a decreased susceptibility to lysis by LAK cells. Treatment with antisense-intercellular-adhesion molecule-1 oligonucleotide further inhibited LAK lysis of target cells, following treatment with IFN-γ. In contrast, acid treatment of tumor cells after treatment with IFN-γ increased their susceptibility to lysis by LAK cells. These findings suggest that treatment of glioblastoma cells with IFN-γ decreased their susceptibility to lysis by LAK cells, and that this decrease in susceptibility is attributable principally to the increased expression of MHC class I antigen on target cells.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

FLOW CYTOMETRY WAS used to determine the deoxyribonucleic acid ploidy and proliferative activity of 230 astrocytomas. The relationships among survival, ploidy, proliferation, histological features, and clinical variables were analyzed. Multivariate analysis confirmed the independent prognostic significance of the S-phase fraction (P< 0.01), ploidy (P= 0.04), age at diagnosis (P< 0.001), extent of surgery (P< 0.01), and sex (P= 0.03). Three groups with significantly different survival were defined based on S-phase fraction ranges of < 3%, 3%-5.9%, and ≥ 6%. The strong correlation between the S-phase fraction and survival confirmed the importance of quantitative proliferation assays in predicting tumor behavior and demonstrated that specific reference ranges can be defined for clinical application. The weaker association between ploidy and survival leaves the usefulness of the determination of ploidy with flow cytometry in doubt.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

THE AUTHORS REPORT a case of lipofibromatous hamartoma of the median nerve in a patient who presented with symptoms of carpal tunnel syndrome. The diagnosis was made by magnetic resonance imaging and confirmed by intraoperative findings and histological diagnosis; distinctive magnetic resonance imaging features of this entity are described. In this patient, surgery was limited to biopsy to confirm the diagnosis and external neural decompression, which helped to stop the progression of the symptoms. In their review of the literature, the authors found four types of lipomatous masses in the extremities affecting the function of peripheral nerves, commonly the median nerve. Treatment and the extent of surgery differ for each patient, based on the anatomical findings and extent of neurological deficit. The etiology, pathogenesis, differential diagnosis, and surgical management of lipofibromatous hamartoma are described.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

THE NUMBER OF case reports concerning anterior atlantoaxial osteomyelitis has increased in the past decade. Although previously considered rare, this particular disease has become more prevalent for several reasons, including the increase in the elderly population, which is generally more susceptible to infectious problems. It is, therefore, imperative for physicians in general and neurosurgeons in particular to become aware of the existence of this problem and of the therapeutic options available.

ISSN:0148-396X    

出版商:OVID    

年代:1994

数据来源: OVID