ISSN:0268-8697    

DOI:10.3109/02688699109005182

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

During a 6-year period (1984–89), 31 patients were treated at Rambam Medical Center with penetrating craniocerebral injuries (PCCI) not associated with military action. Eighteen (58%) patients died during their initial hospitalization; only two of them had admission Glasgow Coma Scale (GCS) above five. The admission GCS coupled with the mode of injury (type of missile and motivation of shooting) were valuable for early accurate prognosis assessment. Patients with admission GCS of 3 and 4 invariably died despite rapid treatment and attempted haematoma evacuation. The neurological status, CT appearance, as well as the motivation of shooting should be considered in order to assess accurately the possible outcome. Compared with our military series of 113 patients with PCCI, there were more extensive injuries, although the mean period until neurosurgical treatment was the same. Long-term complications connected to dural tears remote from the entrance wound occurred in three of the survivors.

ISSN:0268-8697    

DOI:10.3109/02688699109005183

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

The authors report their experience in the treatment of cervical spondylotic myelopathy by multiple subtotal vertebrectomy and fusion. There were 27 cases with a mean age of 66.9 years. The clinical assessment was carried out using both the Nurick and the Japanese Orthopaedic Association (JOA) grading pre- and post-operatively at 6 months. The post-operative radiological assessment was done at 3 and 6 months. Two cases died from unrelated medical problems. There were three cases of graft dislodgement. Clinical improvement was detected in 80% of cases using the Nurick grading and in 88% of cases using the JOA scoring. No cases deteriorated neurologically after operation. Bony fusion was achieved in 96% of the surviving cases by 6 months. Multiple subtotal vertebrectomy and fusion is therefore an effective method for the treatment of cervical spondylotic myelopathy.

ISSN:0268-8697    

DOI:10.3109/02688699109005184

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

In the 13-year period from 1975 to 1988, 91 carotid endarterectomies were performed on 83 patients in a neurosurgical unit. Sixty-seven of these patients had continued to have symptoms after the best medical treatment. Seventy-one presented with transient ischaemic attacks (TIAs), nine with TIA and minor completed stroke (MCS), and three with MCS alone. Follow-up ranged from 8 months to 12 years with a mean of 5.5 years. Within the follow-up period, including operative complications, four deaths of cerebral origin (4.8%) and three major cerebral events (3.6%) occurred—an annual stroke morbidity and mortality rate of less than 1.5%, which compares favourably with a minimum stroke risk of 5% per annum for the first 3 years following a TIA and 3% for subsequent years. The annual stroke and/or vascular death rate including myocardial infarction was 3.5% compared to an expected stroke and/or vascular death rate of 7.4%. It appears that carotid endarterectomy is a useful adjunct to medical therapy. Myocardial ischaemia is the major cause of death in the follow-up period in this group of patients. It is suggested that patients with TIAs and MCS should be investigated, and those who do not respond to medical therapy should be identified for carotid endarterectomy.

ISSN:0268-8697    

DOI:10.3109/02688699109005185

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

A retrospective review of the clincial and histopathological features of 31 patients with brain stem gliomas treated between 1965 and 1990 at Kyushu University Hospital was performed to determine the role of biopsy on these lesions. These 16 male and 15 female patients ranged in age from 3 to 50 years at diagnosis (average: 18.1 years). The primary site of the tumour was the pons in 20 patients, followed by the medulla oblongata and midbrain, and the final histological diagnoses of the lesions based on either the biopsy or autopsy materials were grade I astrocytomas in five patiaents, grade II in nine, grade III in 10, grade IV in five, and ependymoma in two patients. No consistent correlation could be obtained between the CT findings and histological diagnoses. Open surgical posterior fossa exploration was performed on 17 patients (diagnostic biopsy: 10, volume reduction by tumour removal with or without cyst evacuation: 7) and stereotaxic biopsy on three patients, without any mortality related to these procedures. In our biopsy series, half of the patients with grade II astrocytoma died within 12 months after diagnosis, whereas three out of four patients with grade I astrocytoma survived more than 10 years after diagnosis. Because of the relative safety of the tissue sampling technique, and the importance of an accurate diagnosis in order to select appropriate treatment modalities, histological verification of the lesion should be considered for all patients harbouring a brain stem mass lesion.

ISSN:0268-8697    

DOI:10.3109/02688699109005186

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Non-traumatic 'spontaneous' CSF fistulae are uncommon. The clinical features of 23 patients treated for non-traumatic CSF fistulae are presented. Twenty of these patients had normal CSF pressure and six developed meningitis. Surgical repair of these fistulae is recommended in order to reduce the risk of meningitis. For this their localization is essential.

ISSN:0268-8697    

DOI:10.3109/02688699109005187

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

We report a baby born with three fully developed normally functioning legs. The third leg was attached to the baby's sacrum via an iliac bone at the site of a spina bifida. A primitive perineum was present. Innervation of the limb was via a sacral hiatus with a myelomeningocele. A rudimentary peritoneal sac was found at operation containing a blind loop of bowel suspended by a mesentery. The additional leg was found to have no cortical representation using somatic evoked potentials although lumbar responses were normal. Magnetic resonance imaging demonstrated a bifid spinal cord in the lumbo-sacral region. Associated abnormalities were a haemangioma of the L orbit and a vascular mass in the cerebellum.

ISSN:0268-8697    

DOI:10.3109/02688699109005188

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Cell proliferation was assessed in brain tumours using the monoclonal antibody Ki67 which recognizes a nuclear antigen expressed by proliferating cells. Using a novel stereotactic biopsy procedure, serial 1 cm biopsies were taken along a trajectory through six malignant brain turnours. Specimens were also obtained from 10 other brain tumours during conventional surgery. The percentage of Ki67 positive cells was determined as a fraction of the total number of tumour cells present. The Ki67 index for anaplastic astrocytomas and glioblastomas was significantly higher (Ki67 index range 11–18%) than that for benign or low grade turnours. Significant variation in proliferation was measured along the biopsy track through individual turnours (e.g. 0–12.3%) which correlated well with histological appearance. The Ki67 indices of normal brain were very low. In general the Ki67 indices increased with increasing histological grade and also appear to be a useful indicator of the active tumour volume and margin. This method provides spatial information about tumour proliferation which may be used to decide between different treatments and relate to prognosis.

ISSN:0268-8697    

DOI:10.3109/02688699109005189

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Two cases of gross post-operative cerebrospinal fluid (CSF) leakage along an indwelling ventricular catheter are reported. The CSF appeared to leak through the perforations of the ventricular catheter, as well as at the site of penetration of the ventricular wall. A small or slit ventricle with high intraventricular pressure may thus be a predisposing factor for this localized CSF collection.

ISSN:0268-8697    

DOI:10.3109/02688699109005190

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor

摘要:

Development of a squamous cell carcinoma in an epidermoid cyst is rare. A case is presented in which such malignant change arose in the capsule remnants of an intracranial epidermoid removed 31 years previously. The limited literature dealing with this late sequela is summarized.

ISSN:0268-8697    

DOI:10.3109/02688699109005191

出版商:Taylor&Francis    

年代:1991

数据来源: Taylor