摘要:

&NA;Three unusual cases of large, peritumoral cystic lesions associated with intracranial meningiomas are reported. In each case, the cyst caused difficulty in the interpretation of the computed tomogram when the latter was considered as a diagnostic test by itself, but the composite information obtained from the clinical history, cerebral angiography, and a radionuclide brain scan led to the correct preoperative diagnosis. The cyst was extrinsic to the tumor and contained xanthochromic fluid with a high protein content. The cyst wall consisted of brain parenchyma that showed glial cell proliferation (confirmed by the presence of glial fibrillary acidic protein by immunoperoxidase staining).

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The computerized tomographic (CT) scan has revolutionized the management of cerebral trauma. Nevertheless, visualization of traumatically induced lesions of the brain stem by the CT scanner remains difficult. Seven patients with autopsy or CT evidence of brain stem hemorrhage were identified over a 1‐year period. In six of these patients, brain stem hemorrhage could be defined by CT scan. As part of a prospective study of CT changes after head injury, we performed serial CT scans on six of the seven patients. Clinical experience shows that timing is important for identification of these lesions and that inability to visualize brain stem hematomas may occur because of the development of hematomas after CT scanning, evolution of hemorrhagic lesions that makes them isodense with the surrounding brain stem, patient movement, and technical factors such as the partial volume effect. Experimental injection of fresh blood into the pons and midbrain of cadavers shows that lesions as small as 0.1 ml in volume may be visualized by ex vivo thin section CT scanning techniques. However, the character and anatomical configuration of the hemorrhage may be as important in determining CT visualization as is the volume of the hemorrhage. For example, a hematoma displacing the brain parenchyma was visualized, but a similar‐sized small hemorrhage that had diffused through the brain stem tissues was not. Although many of the experimentally placed lesions extended over a rostral‐caudal length of 15 mm or more in the brain stem, no lesion was seen on more than three thin section scans. This is explained by the presence of lesions that, although extensive in a rostral‐caudal direction, had relatively small cross sectional areas available for identification by the CT scanner. The small size of traumatic lesions of the brain stem and their proximity to bony structures at the base of the skull are not insurmountable obstacles to visualization of brain stem hemorrhages. Serial scanning and the application of thin section computed tomography will lead to identification of most of these lesions.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The authors report their recent experience in treating 80 patients with intracranial aneurysms. A total of 83 surgical procedures were performed with a surgical mortality of 4.8%. Fifty‐six patients had suffered a subarachnoid hemorrhage. Total mortality for this group was 14.2% regardless of clinical grade. Early surgical intervention, meticulous preoperative monitoring, and control of circulatory dynamics were used to improve the perioperative morbidity and mortality rates. We believe that any major improvements in the outcome of patients with aneurysms will come from advances in perioperative management.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A consecutive series of 50 diagnostic cerebral biopsies carried out over a 12‐year period (1960 to 1972) at The Neurological Institute of New York is reported. The goal of the biopsy was to acquire a definitive diagnosis to aid the patient, counsel the family, and advance scientific knowledge. General indications for biopsy were either chronic bilateral cerebral findings associated with progressive dementia or profound retardation or acute unilateral cerebral findings, usually associated with signs of meningoencephalitis. Four patients were not suitable for analysis, leaving 46 patients to be surveyed. Diagnostic neuropathological features were judged to be present in 17 specimens (37%). Abnormal but not diagnostic pathological changes were found in 22 specimens (48%). Thus, 39 specimens (85%) displayed some abnormality. No apparent neuropathological changes were present in 7 specimens (15%). These findings correspond favorably with the results of others and suggest that a certain “irreducible minimum” of normal biopsies occurs with the techniques utilized. Fourteen (30%) of the patients were known to be alive at the conclusion of the study. Twenty‐two patients (48%) had died, but necropsy findings were available for only 10 of these. Except in 2 cases in which biopsies had been normal, no discrepancy was noted between the basic neuropathological changes found at necropsy and those of the biopsy specimen. One death could be directly attributed to the procedure, and total morbidity and mortality was approximately 13%. The authors recommend that any biopsy program should be organized at an institutional level to take into account the patient's special illness and the capabilities of that institution. In addition, suitable material must be forwarded to appropriate experts who have the knowledge and facility to make full use of biopsy material.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;The application of microsurgical technique to lumbar discectomy may be of dual value: minimal disruption of the integrity of normal anatomy and meticulous hemostasis may help to speed the process of convalescence, and the retention of epidural fat around the nerve root may help to prevent adhesions, a common cause of the late, “failed disc” syndrome. The authors report their experience with 83 consecutive microdiscectomies for lumbar disc protrusions. The results must be considered as tentative because the follow‐up period has been short and the authors found it difficult to quantify the quality of health during the convalescent phase, although this seemed to be excellent. Their short term results are similar to those of the larger series reported by Williams, whose experience with microsurgical lumbar discectomies began 6 years ago. No other series have been reported. The authors describe their technique and compare it to that of Williams.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Patients undergoing surgery for herniated lumbar discs were evaluated prospectively with a battery of psychological tests. Personality factors in patients having a good outcome were compared to those in patients having a bad outcome. Both groups had similar surgical findings. Patients with a good outcome were more stable, cautious, efficiently defensive, selfconfident, realistically concerned with their illness, mildly depressed, generally optimistic regarding outcome, and able to withstand setbacks without resorting to emergency reactions. Patients with a bad outcome were less stable, were unpredictable, had inefficient defenses, were more obviously depressed, and were less able to withstand stress and breakdown. However, even the degree of psychological testing used in this study does not definitely predict outcome.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Experimental researchers have shown that, because of normal inhibitory processes, repetitive orthodromic stimulation of the dorsal spinal roots induces a depression of the reflex discharge in the spinal motoneurons that is a function of the stimulation rate. Because a lack of inhibitory processes is considered to be the basic mechanism of spasticity, intraoperative stimulation of dorsal spinal roots from L‐1 to S‐1 bilaterally was performed in 80 patients affected by cerebral palsy. In these patients spasticity (exaggerated stretch reflexes, marked increase of proprioceptive reflexes, and clonus) was the main symptom. We stimulated the dorsal roots adjacent to the spinal cord and recorded motor responses by electromyogram (EMG) in the corresponding muscle groups. The most important findings were that: (a) variable inhibition (diminished, increased, or normal) was encountered in the spinal circuits of the spastic patient; and (b) the individual roots and rootlets can have different effects upon segmentary output. The absence of normal inhibitory processes was the most common finding; surgical sectioning of the corresponding roots resulted in immediate reduction in muscle tone in the related muscles. Selecting the dorsal roots for section results in a remarkable reduction of negative side effects that may follow total or random rhizotomy (marked hypotonia, ataxia, sensory defects) and of the percentage of late recurrences. This procedure results in additional positive effects at segmentary and suprasegmentary levels. These results confirm the idea that the basic mechanism of spasticity is a central defect in the traffic regulation of peripheral afferents as they are transmitted to the spinal cord. This defect causes segmentary and suprasegmentary adaptive reactions that extend the negative outcome of the local increase of muscle tone.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;Twelve female mongrel dogs were made paraplegic by midthoracic spinal cord transection. Beginning at 9 weeks posttransection, either glycine (50 mg/kg) or saline was injected intramuscularly each day and the signs of spinal spasticity were assessed clinically. After treating the dogs for 3 weeks, we removed the lumbar enlargement of each dog and microdissected it into gray and white areas which we assayed for glycine, glutamate, and aspartate content. Some of the clinical signs of spasticity improved in the animals injected with glycine compared to the saline‐injected controls. The content of glycine was significantly elevated in the central gray matter and ventral medial white matter of the glycinetreated dogs. The levels of glutamate were also significantly elevated in the central, lateral ventral, and medial ventral gray matter and in the dorsal lateral and ventral medial white matter of the glycine‐treated dogs. The possible role of these segmental putative neurotransmitters in spinal spasticity is discussed.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;One hundred eighty‐two rats were divided into groups to test the effect of three different total body temperature levels on the toxic effect of three different dose levels of 1.3‐bis(2‐chlorethyl)‐1‐nitrosourea (BCNU) and to assess the effect of delayed total body temperature elevation on BCNU breakdown products. Results were tabulated on the basis of life survival figures. At depressed total body temperatures (28° C), normally expected toxicity was avoided. Elevated body temperatures, on the other hand, enhanced the toxic effect of BCNU. Delayed total body temperature elevation (3 and 6 days after BCNU administration) created similar toxicity. This finding was not observed when total body temperature elevation was delayed 10 days. The results point toward an interesting interaction between BCNU and heat (immediate and delayed) on the basis of an elevated metabolic rate of tissue, a synergistic effect of two therapeutic modalities, interference with normal reparative processes by the combination, or an enhancement of retained serum protein‐bound breakdown products of BCNU.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

&NA;A patient with traumatic bilateral carotid‐cavernous fistulae was successfully treated by an entirely extracranial approach. The larger fistula on the left was exposed via a transethmoidal, trans‐sphenoidal route and was directly opened and packed while the cavernous carotid artery was stented open by an intraluminal balloon catheter. The balloon catheter provided temporary hemostasis and was removed after the fistula had been packed. The left carotid artery remained patent, and the smaller fistula on the right was subsequently obliterated by a balloon catheter. The fistulae have remained cured, and the left internal carotid artery supplies the cerebral circulation.

ISSN:0148-396X    

出版商:OVID    

年代:1979

数据来源: OVID