摘要:

&NA;The relationship between clinical features of brain dysfunction in the first week after severe head injury and outcome 6 months later has been analyzed for 1000 patients. Depth of coma, pupil reaction, eye movements, and motor response pattern, and patient age prove to be the most reliable predictors. The degree of brain dysfunction changes markedly soon after injury, and more reliable predictions of outcome result when assessment is based on the best level of functioning recorded in each early epoch. Predictions based on very early assessment are, therefore, often unduly pessimistic. Individual predictions of outcome, based on a large data bank, provide a powerful tool for assessing the relative efficacy of alternative treatments.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Primary wire mesh cranioplasty was performed in five patients at the time of removal of an infected frontal or frontotemporal bone flap or cranioplasty plate. No recurrent infections have occurred, with follow‐up extending to 46 months. The pre‐ and postoperative management and rationale for this procedure are discussed in light of available data regarding bacterial interactions with alloplastic materials.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Serum values of alpha‐fetoprotein (AFP) and human chorionic gonadotrophin (HCG) have been used to monitor disseminated testicular carcinoma. Serial measurements of these markers have been used to monitor the response to therapy, to follow the progress of disease, and to detect subclinical recurrences. With increasingly effective chemotherapy for systemic disease, central nervous system (CNS) metastases in testicular carcinoma are becoming increasingly important as a cause of treatment failure. Cerebrospinal fluid (CSF) values of AFP and HCG seem to be important ancillary aids in the neurosurgical management of CNS metastases from testicular cancer. Our preliminary experience with three cases suggests that these CSF markers (plus computerized tomographic scanning) should be evaluated in patients with this disease.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Decompressive craniectomy has been advocated as a treatment for the cerebral edema associated with massive head injury. Although craniectomy has been successful in lowering intracranial pressure after head injury, a comparison of computerized tomographic scans of comparable patients with traumatic brain edema treated by medical means or decompressive craniectomy showed that bony decompression resulted in apparent exacerbation of edema. To investigate the possibility of enhancement of brain edema by craniectomy, we produced standardized cold lesions in the brains of 10 dogs. Five animals served as controls. In the other 5 animals we performed large decompressive craniectomies after lesioning. Physiological parameters were comparable in both groups. The dogs were killed 8 hours after lesioning. After fixation, their brains were cut into 1‐mm‐thick slices. We used an image analysis facility built around a PDP 11/05 computer to measure the volume of edema as outlined by Evans blue staining. The mean volume of the brain edema in the control animals was 0.27 ± 0.19 ml. Mean edema volume was over 7 times greater in craniectomized animals (1.96 ± 1.89 ml). This difference is statistically significant (p< 0.05). The driving force for the formation of edema fluid is the difference between intravascular and interstitial pressure. Decompression of the brain by bone removal probably results in a reduction of interstitial fluid pressure and edema enhancement. The clinical literature contains no evidence that craniectomy decreases the morbidity or mortality of human head injury. In view of our experimental findings, this is not surprising. Indeed, pathological evidence indicates that severe edema (such as that accentuated by craniectomy) may produce permanent changes in the neuropil.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Ultrasonic echoarteriography is a noninvasive method of visualizing extracranial arteries in health and disease. The realtime echoscanning device developed at the University of Cincinnati utilizes a 5‐MHz (center frequency) pulse‐echo imaging system. B‐mode pictures of the tissues studied are obtained and displayed on a video screen, real‐time operation being provided by the scanning mechanism operating at 30 frames per second. In our experiments internal arterial damage produced by surgically scraping the intima induced experimental thrombosis in nine carotid and three femoral arteries in dogs. Where pathologically demonstrated, the thrombi were demonstrated by ultrasonic echoarteriography in every instance. Echoarteriography seemed more sensitive than contrast arteriography in the detection of a partially occlusive thrombus.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Surgical biopsies from 2 human craniopharyngiomas were transplanted subcutaneously into 6 athymic “nude” mice. Morphologically characteristic craniopharyngiomas grew in 5 of these animals. In 4 animals growth was sufficient to allow transplantation into a second generation of animals. In all, 11 craniopharyngiomas were present at autopsy in the 14 animals into which the tumors had been transplanted. The tumors that grew in the animals had the same adamantinomatous architecture, epithelial nests, and keratinized nodules that were present in the original surgical sample and that are characteristic of human craniopharyngiomas. It may be possible to study growth characteristics and therapeutic sensitivities of human craniopharyngiomas growing in “nude” mice.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;We present a case of multiple brain lesions in which the preoperative computerized tomographic (CT) scan suggested the presence of brain abscesses rather than metastatic tumors. The patient presented with symptoms of left frontal and right cerebellar mass lesions, confirmed by carotid and vertebral arteriography and a radionuclide brain scan. A CT scan revealed multiple contiguous ring‐enhancing lesions of various sizes at both sites. With the exception of a prior mild pulmonary infection, no findings suggested underlying malignancy, immunosuppression, or medical illness. We based our decision to administer antibiotics preoperatively on the presumed presence of abscesses. We found and totally removed two multiloculated abscesses during one operation and initiated sulfa drug therapy (sulfisoxazole) immediately after identification of theNocardiaorganism. The patient experienced no postoperative complications and at 6‐months follow‐up is clinically free of disease.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;We present a patient with a recurrent intracerebral blastomycotic granuloma. The computerized tomographic scan appearance of this lesion is illustrated. Of the 81 reported cases of intracranial blastomycosis, only 35 have represented solid intracerebral lesions; the other patients have had spinal lesions or meningitis. This patient represents the first reported recurrence of an intracerebral blastomycotic granuloma. The treatment utilized, surgical resection combined with intravenous and intraventricular amphotericin B, represents a unique approach to this problem. The diagnosis and currently advocated treatment of intracranial blastomycosis is reviewed, particularly in regard to the potential for recurrence of blastomycosis.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A 16‐year‐old girl with systemic lupus erythematosus and diabetes mellitus who was receiving prednisone, azathioprine, and insulin developed headaches, fever, irritability, and seizures. Studies revealed a large proximal basilar artery aneurysm with subarachnoid hemorrhage. Despite intubation and a ventriculopleural shunt, she became decerebrate and died. Postmortem studies revealed that this patient had an intracranial mycotic aneurysm due toCandida albicans.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Two patients with xanthogranuloma of the 3rd ventricle are described. In each instance the tumor obstructed the interventricular foramina and caused dilatation of the lateral ventricles and signs of increased intracranial pressure; computerized tomography demonstrated the dense, nonenhancing lesion in the anterior 3rd ventricle. The pathogenesis of these rare tumors is discussed. These cases affirm the need to consider xanthogranuloma in the differential diagnosis of anterior 3rd ventricle tumors in adults.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID