摘要:

Summary:The historical development and status of percutaneous discectomy through 1990 is initially reviewed. Literature since 1990 is reviewed with attention to experimental data, refinements in diagnosis, additional indications for the procedure, results, complications, and technical innovations, including laser discectomy. Despite almost 20 years of experience, no study meeting acceptable standards of comparative clinical science exists comparing percutaneous discectomy with either nonsurgical management or conventional open lumbar discectomy. Based on comparisons with similarly scientifically flawed studies of conventional discectomy, the procedure appears to have a lower success rate. The potential advantages of decreased cost and morbidity have not been subjected to a scientifically sound economic analysis. As expected, significant complications with the procedure are beginning to appear in the literature. In an evidence based health care system, percutaneous discectomy will have difficulty justifying its role without careful comparative clinical studies of high scientific caliber.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Brain metastases are the most common neurological complication of systemic cancer, a serious cause of morbidity and mortality, and a significant challenge for neurosurgeons and neurooncologists. They outnumber all other intracranial tumors combined and, with advances in technology and treatment of systemic cancer, are on the increase as cancer patients live longer. This review discusses the factors that influence their occurrence in the central nervous system, namely primary cancer, age, and sex; clinical aspects of presentation; and the basic diagnostic modalities, computed tomography and magnetic resonance imaging. These aspects are presented along with an emphasis on the efficacy of different treatment options, including recent information that broadens the scope of surgical implications. Although radiation therapy remains the main therapeutic modality, surgical excision has increasingly shown advantages in certain settings, as has stereotactic radiosurgery. Chemotherapy is less effective, but its advantages are reviewed, as are the implications of recurrent metastases. This review concludes with a separate section on the special concerns of leptomeningeal metastases.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Optimal management of cervical myelopathy, radiculopathy, or both remains controversial. Recent reviews of the literature have stated that surgical and nonsurgical management of cervical myelopathy is equal in outcome. Cervical spondylosis causing myelopathy/radiculopathy can be difficult to diagnose, and the incidence of misdiagnosis remains high. We believe that conservative care is important but that nonsurgical and surgical care are not equal in outcome and outline a systematic approach to both myelopathy and radiculopathy. The importance of correlating radiological studies with the clinical presentation is stressed, as well as their use to determine the extent of decompression, because the high rate of surgical failures appears to be related to inadequate decompression in the majority of the cases.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:Gliomas that arise from the brain stem typically have a poor prognosis. With improvement in neuroimaging and surgical technique, subclassification of brain stem glioma (BSG) is possible and provides prognostic significance. Those with a favorable prognosis account for a minority of BSGs. The majority of BSGs carry a poor prognosis, and survival has not dramatically changed with radiation therapy or chemotherapy. This review of BSGs will cover epidemiology, clinical presentation, prognostic factors, and treatment.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:A 60-year-old man was seen in the King Faisal Specialist Hospital and Research Centre, Saudi Arabia, with 6 months' history of progressive dysphagia with the sensation of the presence of a foreign body, hoarseness of voice, limitation of neck flexion, and breathing difficulty on attempting neck flexion. A plain cervical radiograph, barium swallow, and computed tomography confirmed the presence of large cervical osteophytes, which were the cause of his symptoms.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Summary:This article presents the concepts of theduty to settledoctrine and its application to medical malpractice litigation. Discussed here are the conflicting objectives of the physician, the physician's interaction with the insurance company, and the interaction and potential liability the attorney faces when confronting these issues. Medical malpractice litigation carries with it conflicting goals for the attorney who represents the physician and who interacts with the insurance company as they try to resolve a conflict with a plaintiff. Theduty to settledoctrine requires the insurance carrier to solve the claim in the least expensive and most expedient manner possible. Theduty to settlemay interfere with the desire of the physician to pursue a different course of action when he or she believes other interests are more important than the monetary settlement desired by the plaintiff and by the insurance company. The insurance company is intent on minimizing the expense and the financial exposure available to the plaintiff. The physician tries to minimize self-expense and financial exposure, but is also concerned with other issues including the absence of negligence in his or her actions, the effect a settlement will have on premiums, and the effect the settlement may have on his or her medical reputation in the community. A physician often prefers to litigate a case he or she believes was handled appropriately, whereas the insurance company prefers to settle the case in the least expensive way. The attorney has to negotiate between these parties with similar needs but different objectives.

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:1994

数据来源: OVID