摘要:

&NA;Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty‐five patients had permanent injury to the vertebral colum n and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty‐five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients:Type1 athletic injuries to the cervical spine are those that cause neurological injury; patients withType1 injuries are not allowed to participate in contact, competitive sporting events.Type2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group. The athlete with fractures involving a significant structural portion of the vertebral column, ligament instability, spinal cord contusion, or congenital cervical stenosis, is advised not to return to contact sports. Other radiological abnormalities, such as compromise of the ligaments, congenital fusion, degenerative disease, and herniated cervical disc require individual consideration. The rationale for treatment and advising for participation in sports are discussed. We believe that this classification of sports injuries offers clinicians a framework within which to make rational judgments and recommendations in the management of athletes with cervical spine injuries. (Neurosurgery 29:491‐497, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Vertebral body replacement after spondylectomy, combined with microsurgical decompression and anterior plating, was performed in 22 patients as an aggressive therapeutic approach to multisegmental cervical spondylosis. The patients were 13 men and 9 women, ranging in age from 32 to 74 years. In 19 patients, the typical signs of cervical myelopathy were present. In three patients, pain was the major symptom, accompanied by moderate spastic paresis and hyperreflexia. Apart from cervical myelography and computed tomographic scanning, which was performed in 10 patients, magnetic resonance imaging was the radiological procedure of choice in 12 patients. During spondylectomy, one vertebra was removed in 14 patients, two vertebrae in seven patients, and three vertebrae in one patient. The time of postoperative follow‐up ranged from 8 to 46 months, with an average interval of 21 months. In all 22 patients, satisfactory bony fusion was achieved as demonstrated by radiological control examinations. Seventeen patients (77%) were symptom free or had only minor residual symptoms. Three (14%) patients had intermittent nuchal or cervicobrachial pain, which responded well to analgesic medication or the application of a soft collar. Two (9%) patients still had myelopathic but not incapacitating symptoms. Of 15 patients who were employed before surgery, 13 returned to a full‐time job. The only severe complication of surgery was a prevertebral abscess that healed without sequelae. It is concluded that aggressive surgical therapy of multisegmental cervical spondylosis by a combination of vertebrectomy, decompression (using the surgical microscope), bone grafting, and osteosynthesis is a straightforward and promising procedure for the treatment of this debilitating disease. (Neurosurgery29:498‐503, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Medical treatment of chronic cluster headaches (cluster headaches that occur frequently without remission) can be very difficult. In many patients, the pain remains severe despite all medication trials. For these patients, previous reports recommend radiofrequency trigeminal rhizotomy, which risks corneal anesthesia and subsequent corneal decompensation. As a safer, yet effective, treatment, retro‐Gasserian injections of glycerol were given to eight patients having intractable chronic cluster headaches. Needle penetration into the trigeminal cistern, glycerol amount (0.55 ml), and length of patient elevation after the procedure (80‐90 degrees upright for 10 h) were modified for maximal exposure of the V 1 division. Three patients required one additional injection, and one patient required two additional injections. Verbal pain scales (means ± 1 standard error of the mean) were: 9.1 ± 0.30 (preoperative), 2.6 ± 1.10(1 mo postoperative), and 2.1 ± 0.64 (1 yr postoperative). Daily headache frequency decreased from 6.0 ± 2.0 (preoperative) to 0.2 ± 0.09 (i.e., one headache every 5 days) (1 yr postoperative). Three of the eight patients had no headaches after 1 year. There were no instances of corneal or facial anesthesia. One year postoperatively, five patients required no medication, and three remained on low doses of medication for headache treatment. In contrast to previous limited reports of glycerol injections for cluster headaches, results with these patients having chronic cluster headaches support the use of glycerol injections as a viable treatment alternative, with significant pain relief and corneal safety. (Neurosurgery29:504‐508, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;This retrospective review of pediatric patients with pituitary tumors causing onset of symptoms by 17 years of age was done to define their pathological distribution, clinical presentation, treatment, and prognosis. Eighteen patients were evaluated and treated from 1979 to 1989. Five had Cushing's disease and 13 had prolactin‐secreting tumors. The mean age at the onset of symptoms was 14.7 years, with a range of 7 to 17 years. The mean follow‐up period was 4.6 years, and the series consisted of 15 girls and 3 boys. Four of the 5 patients with tumors secreting adrenocorticotropic hormone were girls. The five patients exhibited obesity, hypertension, and growth retardation. The mean age of this group of patients at diagnosis was 12.2 years, and all had intrasellar lesions removed by the transsphenoidal approach. Adenoma was documented in 4 cases by histopathology. There was complete resolution of the endocrinological and clinical abnormalities in each case. The group of patients with prolactinomas comprised 11 girls and 2 boys, and their mean age at diagnosis was 15.7 years. The girls exhibited either primary or secondary amenorrhea. Seven had macroadenomas and 4 had microadenomas. Nine of the 11 girls underwent transsphenoidal resection, and surgery failed in 6, based on hormonal or radiological data. The two boys had suprasellar tumor extension and required multiple surgical procedures plus radiation therapy for control of the tumor mass. (Neurosurgery29:509‐514, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;We report the long‐term outcome of surgery for cerebral hydatid cyst in 12 children. In only one child, who had been operated on for cardiac hydatidosis a year earlier, was the brain cyst known to be secondary. Of the 12 children. 10 had a single cyst and 2 had multiple cysts. Five single cysts were removed intact by “hydatid birth,” two cysts—one single and one multiple—were removed after puncture and aspiration of the cyst fluid, and the other five—four single and one multiple—were accidentally ruptured in the course of the operation. One patient died of infection of the residual space. 2 died of intracranial recurrence of the parasite (7 and 22 months later, respectively), and one. the child with secondary cerebral echinococcosis, died 6 years later of systemic echinococcosis. Eight patients who had a mean follow‐up of 28 years are still living and enjoy very good health, both general and neurological. This long‐term follow‐up with such good results confirms the usually primary character of cerebral hydatid disease, at least in children. The combination of patent ductus arteriosus and ingestion of unboiled animals' milk might well explain how primarv cerebral hvdatid disease develops in children. (Neurosurgery29:515‐518. 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;The effects on shunt flow from the position of an antisiphon device (ASD) and from changes in posture in hydrocephalic patients were examined. Fifty patients with hydrocephalus (including 36 with normal pressure hydrocephalus) were investigated, using quantitative radionuclide shuntography (99mtechnetium‐pertcchnetate) in the supine, sitting, and standing positions. The types of shunt valve used were as follows: Mishler dual chamber low pressure without ASD (16 cases), with ASD 40 cm below the level of the foramen of Monro (three cases), and with ASD 10 cm below the level of the foramen of Monro (12 cases); low pressure with integral ASD (14 cases); and medium pressure with integral ASD (five cases). In patients with a low pressure valve without ASD, shunt flow was least in the supine position (0.0011 ml/min) but increased significantly in the sitting position (0.4381 ml/min,P< 0.001) because of the siphon effect. Conversely, in patients with a low pressure valve with integral ASD, shunt flow was maximal in the supine position (0.1056 ml/min) and decreased significantly in the sitting position (0.0017 ml/min,P< 0.001), indicating overfunction of the ASD. Intracranial pressure (ICP) in the supine position increased significantly compared with patients with a low pressure valve without ASD (93.6 and 20.7 mm H2O. respectively,P< 0.01). Intermediate values for shunt flow in the supine and sitting positions (0.0279 and 0.0896 ml/min, respectively) and for ICP (55.8 mm H2O) were obtained with patients with a low pressure valve with the ASD 10 cm below the level of the foramen of MonroP< 0.05). Shunt flow in the supine position correlated negatively with the log of the shunt flow in the sitting position (P< 0.025). Shunt flow in the sitting position correlated positively with the distance between the ASD and the level of the foramen of Monro (P< 0.01). ICP in the supine position correlated negatively with the distance between the ASD and the level of the foramen of Monro (P< 0.025). Shunt flow and ICP are significantly affected by the position of the ASD and the patient's posture. The optimum position for the ASD appears to be 10 cm downstream; the resulting hydrostatic column helps initiate flow when the patient assumes the sitting and standing positions. (Neurosurgery29:519‐525, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Little is known about the sensitivity of human glioblastoma cells to hyperthermia alone and in combination with other therapies. We carried out in vitro cell survival studies on the human glioblastoma cell line U‐87MG and our model canine glioma canine brain tumor (CBT) cells after multimodality treatment. Ionizing radiation was administered to flasks of cells in logarithmic growth at 500 rads (5 Gy) with consecutive treatment by hyperthermia, l,3‐bis‐(2‐cholorethyl)‐1‐nitrosourea (BCNU). or cisplatin. Cells were treated with single doses of BCNU at 5 &mgr;M with sequentially added radiation or hyperthermia and at 1 to 2 &mgr;g/ml of cisplatin with hyperthermia. Hyperthermia was administered in a precision controlled water bath at 44°C for 30 minutes in combination with chemotherapy or radiation. In general, the sensitivity of U‐87MG and CBT cells was similar for all test regimens. For example, colony formation efficiency decreased by 64% in CBT cells and by 64.4% in U‐87MG cells after hyperthermia alone at 44°C for 60 minutes. All combinations of BCNU, hyperthermia, and radiation administered in vitro produced enhanced cell killing, but the effects of multiple modalities were generally additive in both cell lines. When the effects of cisplatin and hyperthermia were studied, the combination produced additive cell killing in U‐87MG cells and a synergistic killing response in CBT cells. We conclude that: 1) the sensitivity of human glioblastoma cells to heat is similar to that of other cancers; 2) that the in vitro sensitivity of the canine brain tumor to combinations of hyperthermia, ionizing radiation, and BCNU is similar to human glioblastoma and supports its use as an in vitro and in vivo test system: and 3) that hyperthermia is an effective potentiator of both ionizing radiation and chemotherapy for human and canine glioma cells. (Neurosurgery29:526‐531, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Scanning electron microscopic studies revealed that the cell bodies of cultured C6 cells were densely covered with villi and that membrane blebs were rare. Exposure to a hydroxyl radical generating system resulted in rapid ultrastructural changes. Within 2.5 minutes. 98% of the cells lost their villi. The number of blebbed cells increased during the first 7.5 minutes of exposure, until virtually all cells were blebbed. After 20 and 30 minutes of exposure, the plasma membrane of the blebs ruptured, resulting in the escape of cell contents and cell necrosis. Trypan blue exclusion, a measure of cell viability, decreased between 1 and 7.5 minutes of exposure. No further significant decline in viability was observed for the remainder of the experiment. The hydroxyl radical generating system also initiated a rapid onset of membrane lipid peroxidation, as measured by accumulation of thiobarbiturate reactive material. After a short lag period, thiobarbiturate reactive material increased rapidly, with maximum lipid peroxidation occurring by 20 minutes. Increasing the concentration of the radical generati ng system components shortened the time course but not the level of maximal thiobarbiturate reactive material production. These data suggest that plasmalemmal lipid peroxidation plays a role in rapid morphological changes and necrosis that occur after free radical insult. (Neurosurgery29:532‐537, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;1H Magnetic resonance imaging (MRI) was used to study the effects of photodynamic therapy (PDT) on normal rat brain (n = 5) using T1‐, T2‐, diffusion‐, and proton density (p)‐weightcd images. Rats received intraperitoneal injections of 12.5 mg/kg of Photofrin II, and 48 hours later the dural area over the frontal cortex was treated with 35 J/cm2of light (632 ± 1 nm). The T1 ‐, T2‐, and diffusion‐weighted images revealed an evolving high contrast region of brain that corresponded to the PDT‐treated area. Lesioned brain exhibited significant increases in Tl and T2 relaxation times at 1 day (P< 0.01) and 3 days (Tl.P= 0.018: T2,P< 0.01) after treatment, compared with the contralateral equivalent volume of nonlesioned brain. Water proton diffusion coefficient (Dw) in the lesioned area decreased at 1 day (P= 0.026) and increased at 3 days (P= 0.012) compared with nonlesioned brain. An increase in the proton density ratio (pD/po) from PDT (pD) versus nonlesioned side (po) was found 3 days after PDT treatment (P= 0.03). The data indicate that the biophysical parameters obtained from magnetic resonance imaging scans. Tl, T2, Dw, and proton density, can be used to monitor changes in an evolving photochemically induced lesion. (Neurosurgery29:538‐543, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

&NA;Normal cytoarchitecture of smooth muscle cells of monkey cerebral arteries was studied using scanning electron microscopy after removal of adventitial connective tissue by hydrolysis with HCI. Cerebral arteries were also examined after contraction in vitro with prostaglandin F2a(PGF2a). Anterior cerebral arteries were studied after exposure for 6 days in vivo to whole blood, oxyhemoglobin, melhemoglobin. bilirubin, mock cerebrospinal fluid, or supernatant fluid from an incubated mixture of autologous blood and mock cerebrospinal fluid. Normal smooth muscle cells were spindle‐shaped and oriented circumferentially around the vessel. They were often grouped into bundles of 5 to 10 cells: bundles were recognizable because cells within them were joined by multiple intercellular contacts. Groups of smooth muscle cells oriented longitudinally were present outside the circular layers of cells. The adventitial surface of muscle cells was smooth apart from fine longitudinal striations in some areas. Arteries contracted with PGF2ahad markedly convoluted and folded cell membranes. Muscle cells of vasospastic arteries and of arteries exposed to oxyhemoglobin and supernatant fluid appeared identical to cells contracted with PGF2aThe outer surface of cells of arteries exposed to bilirubin, methemoglobin, and mock cerebrospinal fluid were normal. Marked similarity between vasospastic smooth muscle cells and smooth muscle cells from arteries contracted with PGF2asuggest that smooth muscle contraction occurs during “vasospasm” due to whole blood and to intrathecal injection of oxyhemoglobin. (Neurosurgery29:544‐550, 1991)

ISSN:0148-396X    

出版商:OVID    

年代:1991

数据来源: OVID