摘要:

&NA;In a review of 417 intracranial astrocytomas treated radiotherapeutically at the Mayo Clinic from 1960 through 1969, the well‐known correlation of tumor grade with survival was verified. Totally unexpected was the finding that age was fully as important a discriminant as tumor grade. Another unexpected finding was that patients treated with biopsy only followed by radiation therapy did as well as or slightly better than those subjected to resection followed by postoperative radiotherapy. We could not verify the importance to survival of either large dose or large volume radiotherapy, which has been emphasized by some. Patients receiving less than 1400 rets did just as well as or slightly better than those receiving more than 1400 rets. With low grade astrocytomas, survival beyond 4 years was significantly worse (higher death rates) in the group receiving more than 1400 rets. This suggested the possibility of radiation damage with delayed manifestations. We also could not verify an increased effectiveness for the generally accepted use of total brain irradiation for high grade gliomas.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;During a 34‐month period, 12 cases of delayed traumatic intracerebral hematoma (DTICH) were diagnosed among 162 consecutive prospectively studied patients admitted to the Medical College of Virginia with severe closed head injuries. All patients were unresponsive to command and unable to utter formed words at the time of admission. The interval from injury to diagnosis of DTICH by computerized tomography (CT) was within 48 hours in 11 of the 12 cases. Six patients had no decompressive surgery before the development of the lesion. Four patients had undergone decompressive surgery and then developed DTICH on the contralateral side. Two patients developed lesions in the vicinity of the operative site that were thought not to be the result of operation. The development of DTICH was not heralded by neurological deterioration nor by elevation of intracranial pressure. Eleven of the 12 patients had suffered a secondary hypoxic insult soon after the head injury. We suggest that the CT appearance of DTICH is likely to represent hemorrhage into an existing traumatized area and is an epiphenomenon rather than a cause of severe primary and secondary brain damage.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Ten new cases of intracranial aneurysms that ruptured during cerebral angiography, obtained from four local hospitals and the practices of eight angiographers, are detailed. A review of the literature reveals 28 other well‐documented cases. An analysis of this clinical material shows that internal carotid injections are not necessarily more dangerous than common carotid injections. Although critically ill patients are at higher risk and must be treated with caution, there is not enough evidence to warrant a delay in angiography to avoid rupture. The recent trend toward early angiography in cases of subarachnoid hemorrhage is reflected in the statistical analysis. A plea for meticulous angiographic technique is advanced.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The surgical therapy and results in 17 cases of basilar aneurysm are reported, extending a series of 15 reported previously. Three surgical approaches were used: subtemporal, pterional, and suboccipital. The subtemporal route was satisfactory for most lesions, although the pterional approach has advantages for upper basilar aneurysms projecting either more than I cm above the dorsum sellae or directly anteriorly. A low lateral‐suboccipital approach is described and recommended for aneurysms of the proximal basilar trunk and vertebrobasilar junction. The recent literature regarding surgical results, classification, pathogenesis, and technical developments for management of these lesions is reviewed. Most of the morbidity resulting from surgery in the midbrain and pontine region is due to direct or indirect injury to perforating vessels. Superiorly directed bifurcation aneurysms carry the highest risk because of their association with perforating vessels. General precepts regarding size, location, patient condition, and timing of operation with respect to aneurysms of the anterior circulation hold true for aneurysms of the posterior circulation.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Selective treatment of infants with myelomeningocele is said to be beneficial to the infants, their parents, and to society. One group of arguments intended to support this point of view is analyzed. Recent data do not support the factual basis on which these arguments rest; moreover, the moral assumptions that lie behind them should be emphasized. The values held by participants in a discussion of allowing infants to die are as important as facts about treatment options.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;For the past 5 years at Mount Sinai Hospital, an intraoperative prophylactic antibiotic regime consisting of intramuscular gentamicin or tobramycin, intravenous vancomycin, and streptomycin irrigating solution, with no preoperative or postoperative antibiotics, has provided complete protection against operative infections in neurological surgery. There have been 1732 major clean operative cases with no instance of operative infection and no complication due to the antibiotics.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Spinal epidural neurostimulation, which evolved from dorsal column stimulation, has been found to be effective in the treatment of acute and chronic intractable pain. Urban and Nashold have shown that it is a safe, simplified alternative to dorsal column stimulation, especially because laminectomy is not required if the electrodes are inserted percutaneously. Percutaneous epidural neurostimulation is also advantageous because there can be a diagnostic trial period before permanent internalization and implantation. This diagnostic and therapeutic modality has been used in 36 patients during the past 3 years at Northwestern Memorial Hospital. Eleven of these patients had acute intractable pain, which was defined as pain of less than 1 year in duration. Initial postimplantation results from the 36 patients indicate that spinal epidural neurostimulation is most effective in treating the intractable pain of diabetes, arachnoiditis, and post‐traumatic and postamputation neuroma. Long term follow‐up, varying from 1 year to 3 years postimplantation in the 20 initially responding patients, indicates that the neurostimulation continues to provide significant pain relief (50% or greater) in a majority of the patients who experienced initial significant pain relief.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;In this study the difference between cerebrospinal fluid (CSF) absorption and formation (A ‐ F) was measured as a function of CSF pressure in the living and dead dog. We determined this relationship between A ‐ F and CSF pressure during both increasing and decreasing CSF pressures. A hysteresis effect was identified in 78% of living animals, but was not seen in the dead animals. This suggests that the mechanism of CSF absorption in the living dog is nonpassive and pressure‐sensitive.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The irrigation‐suction technique was used to treat a patient who developed a deep infection after removal of a herniated lumbar disc. The patient made an excellent recovery. The advantages of this modality of treatment over the standard approach to this problem are emphasized.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Three cases of rare primary intracranial yolk sac tumor are reported. Two cases had a pineal location, whereas the third presented as a suprasellar mass. After the placement of ventriculoperitoneal shunts for relief of hydrocephalus, all of the patients developed metastases restricted to the peritoneum, as demonstrated by autopsy in one patient (Case 1) and clinical and radiographic evidence in two patients (Cases 2 and 3). The peritoneal metastases were directly associated with the death of one patient, but were successfully treated with chemotherapy in another patient, who is still alive more than 2.5 years after initial presentation. The value of ascitic fluid cytology and alpha‐fetoprotein determination in the diagnosis of this complication was demonstrated in one patient. These cases emphasize the need for awareness of this mode of metastasis and its potentially lethal effect.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID