bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical outcome after repeated transsphenoidal surgery in acromegaly
Authors: Long Hélène , Beauregard Hugues , Somma Maurice , Comtois Ronald , Serri Omar , Hardy Jules 
Published: June 2009

✓ Transsphenoidal selective adenomectomy is the most efficient primary treatment for acromegaly. However, management of persistent or recurrent disease remains controversial. The objective of the present study was to evaluate the early and long-term efficacy and safety of a second transsphenoidal surgery performed in those cases. The results of a retrospective study of 16 patients undergoing reoperation by the senior author (J.H.) between 1970 and 1991 are reported. Reoperation was performed for persistent or progressive acromegaly in 11 patients, visual impairment in four, and disease recurrence in one. Normalization of growth hormone (GH) was defined as a basal GH level of less than 5µg/L and suppression to less than 2 µg/L during the oral glucose tolerance test. Long-term follow-up data were available in 15 patients.
The second transsphenoidal surgery induced a greater than 50% decrease of GH level in 11 patients. Three (19%) of 16 patients were cured according to the authors' criteria and remained so after 2, 7, and 20 years. Two more patients had a postoperative basal GH level of less than 5 µg/L but incomplete suppression during the oral glucose tolerance test. Thus, a total of five patients (31%) achieved a basal GH of less than 5 µg/L. One other patient who had no initial improvement after the second transsphenoidal surgery had spontaneous normalization of his GH level after 13 years. The following complications of the second surgery occurred in three patients: one subarachnoid hemorrhage, two new visual field defects, one cranial nerve palsy, and one meningitis. Moreover, 10 patients (62.5%) developed one or more new pituitary hormone deficiencies. In conclusion, reoperation for persistent or recurrent acromegaly has low success and high complication rates. According to the authors' experience, this procedure should be reserved for patients unresponsive to other forms of therapy or with progressive visual impairment despite medical therapy.
Application of magnetic resonance neurography in the evaluation of patients with peripheral nerve pathology
Authors: Filler Aaron G. , Kliot Michel , Howe Franklyn A. , Hayes Cecil E. , Saunders Dawn E. , Goodkin Robert , Bell B. Anthony , Winn H. Richard , Griffiths John R. , Tsuruda Jay S. 
Published: June 2009

✓ Currently, diagnosis and management of disorders involving nerves are generally undertaken without images of the nerves themselves. The authors evaluated whether direct nerve images obtained using the new technique of magnetic resonance (MR) neurography could be used to make clinically important diagnostic distinctions that cannot be readily accomplished using existing methods.The authors obtained T2-weighted fast spin—echo fat-suppressed (chemical shift selection or inversion recovery) and T1-weighted images with planes parallel or transverse to the long axis of nerves using standard or phased-array coils in healthy volunteers and referred patients in 242 sessions.Longitudinal and cross-sectional fascicular images readily distinguished perineural from intraneural masses, thus predicting both resectability and requirement for intraoperative electrophysiological monitoring. Fascicle pattern and longitudinal anatomy firmly identified nerves and thus improved the safety of image-guided procedures. In severe trauma, MR neurography identified nerve discontinuity at the fascicular level preoperatively, thus verifying the need for surgical repair. Direct images readily demonstrated increased diameter in injured nerves and showed the linear extent and time course of image hyperintensity associated with nerve injury. These findings confirm and precisely localize focal nerve compressions, thus avoiding some exploratory surgery and allowing for smaller targeted exposures when surgery is indicated.Direct nerve imaging can demonstrate nerve continuity, distinguish intraneural from perineural masses, and localize nerve compressions prior to surgical exploration. Magnetic resonance neurography can add clinically useful diagnostic information in many situations in which physical examinations, electrodiagnostic tests, and existing image techniques are inconclusive.
Neural connection between the ventral portion of the lumbar intervertebral disc and the groin skin
Authors: Takahashi Yuzuru , Morinaga Tatsuo , Nakamura Shin-Ichiro , Suseki Kaoru , Takahashi Kazuhisa , Nakajima Yoshio 
Published: June 2009

✓ This study was designed to investigate neural mechanisms of referred pain in lumbar intervertebral disc lesions. Patients with a degenerative disc in lower lumbar segments occasionally complain of groin pain, which cannot be explained anatomically as having a radicular origin.
In rats pretreated with intravenous application of Evans blue dye, the dye extravasation appeared in the groin skin after application of capsaicin to the ventral portion of the L5–6 intervertebral disc. This response occurred even in rats with a sectioned L-5 spinal nerve and sympathetic trunks, but did not occur in rats with a sectioned genitofemoral nerve. Capsaicin topically applied to the sciatic nerve did not cause dye extravasation in the hindpaw. Therefore, groin dye extravasation was not due to a direct effect of capsaicin but, rather, presumably was caused by an “antidromic axon reflex” of dichotomizing C fibers or to a segmental sympathetic reflex causing vascular permeability.
The present results indicate that the ventral portion of the lumbar discs is neurally connected to the groin skin via the upper (L-2) lumbar spinal nerves in rats. Groin pain coincident with low-back pain may be explained as referred pain, indicating that a lesion is present in the ventral portion of the lumbar intervertebral disc space.
Superselective intraarterial papaverine administration: effect on regional cerebral blood flow in patients with arteriovenous malformations
Authors: Fogarty-Mack Patricia , Pile-Spellman John , Hacein-Bey Lotfi , Ostapkovich Noeleen , Joshi Shailendra , Vulliemoz Yvonne , Young William L. 
Published: June 2009

✓ In this study the authors determined the effect of papaverine on regional cerebral blood flow (rCBF) in the angiographically normal arteriolar beds of patients with arteriovenous malformations (AVMs) who underwent transfemoral superselective angiography.Middle cerebral artery (MCA) branch vessels were catheterized during 10 procedures performed in nine patients. The mean (± standard deviation) largest AVM diameter was 4.4 ± 1 cm. Regional CBF was measured by recording the washout of a bolus of xenon-133 injected through the microcatheter. In a dose-ranging study, rCBF and MCA pressure in two patients were repeatedly measured after 3-minute infusions of papaverine at 0.07, 0.7, and 7 mg/minute. In a single-dose study, an additional eight patients received only the highest dose of papaverine administered over a 3-minute period. In the dose-ranging study, CBF increased from baseline in a dose-dependent fashion. In the single-dose study, papaverine increased rCBF 103%, from 48 ± 11 to 95 ± 23 ml/100 g/minute at an MCA pressure of 55 ± 23 mm Hg. Increase in rCBF was linearly related (y = 2.2x − 17, r2= 0.84; p = 0.001) to baseline MCA pressure (range 22–84 mm Hg).Papaverine increases rCBF in a direct proportion to baseline MCA pressure, even at low baseline pressures. Selective infusion of vasodilators should be investigated in acute cerebral hypotension to facilitate either primary or collateral recruitment of CBF by aiding spontaneous autoregulatory vasodilation. In addition, rCBF monitoring may be useful in determining the most effective intraarterial dose of papaverine while minimizing complications due to hyperemia.
Chronic intrathecal delivery of baclofen by a programmable pump for the treatment of severe spasticity
Authors: Ordia Joe I. , Fischer Edward , Adamski Ellen , Spatz Edward L. 
Published: June 2009

✓ The aim of this study was to determine the efficacy, safety, and cost-effectiveness of intrathecal baclofen delivered by a programmable pump for the chronic treatment of severe spasticity. Sixty-six patients with severe spasticity of spinal cord origin that was refractory to oral baclofen or who experienced intolerable side effects with this form of the drug were screened. The first nine participated in a double-blinded, randomized, placebo (normal saline)-controlled trial to determine response to a bolus dose of intrathecal baclofen. Subsequent patients were enrolled in an open-label treatment protocol without a placebo trial. All passed the screening, and the pump was implanted in 59 patients. Spasticity scores and medical costs before and after surgery were analyzed.In all patients, the mean Ashworth score for rigidity decreased from 4.3 preoperatively to 1.4 (p < 0.0005) with use of intrathecal baclofen. The spasm frequency score decreased from a mean of 3.6 to 0.5 (p < 0.0005). Activities of daily living, sleep, and skin integrity improved, and pain was eradicated in some. Constipation occurred in six patients. A reduction in dosage was necessitated by muscular hypotonia in three ambulatory patients, areflexic bladder and urinary retention in three others, and nausea, dizziness, and drowsiness in one. Catheter-related problems occurred 19 times in 15 patients. One pump was explanted because of infection in the pump pocket, and one was removed after it eroded through the skin. There were no pump failures. The use of intrathecal baclofen resulted in a decrease in the average length of subsequent hospitalizations. It is concluded that intrathecal baclofen delivered by an implanted programmable pump is a safe, effective, and cost-efficient method for treatment of severe intractable spinal spasticity.
Activation of the complement cascade and increase of clusterin in the brain following a cortical contusion in the adult rat
Authors: Bellander Bo-Michael , Holst Hans von , Fredman Pam , Svensson Mikael 
Published: June 2009

✓ The aim of the present study was to examine the glial cell response and the possible involvement of the complement cascade following a cerebral cortical contusion. The lesion was produced using a standardized weight-drop technique in adult rats. The blood-brain barrier was damaged, as demonstrated by a decrease of immunoreactivity for a tight junction protein normally expressed by endothelial cells of small vessels in the central nervous system. Increased immunoreactivity for microglial (OX42) and astroglial cells (glial fibrillary acidic protein), as well as macrophages expressing ED1-immunoreactivity (IR) were found in the vicinity of the lesion at all postoperative survival times (2–14 days).
In the present study complement factor C3d- and C9-IR was found around the lesion, indicating that activation of the complement cascade had taken place. Furthermore, immunoreactivity for the putative complement inhibitor clusterin (sulfated glycoprotein-2) was found in some of the injured neurons. The contralateral hemisphere showed no evidence of the reaction found in the ipsilateral hemisphere. The balance between complement activation and complement inhibitors may have an impact on the degenerative components in the brain following traumatic injury and in particular on the events leading to nerve cell death.
Treatment of traumatic spondylolisthesis of the axis with nonrigid immobilization: a review of 64 cases
Authors: Coric Domagoj , Wilson John A. , Kelly David L. 
Published: June 2009

✓ Current treatment regimens for hangman's fracture, or traumatic spondylolisthesis of the axis, emphasize rigid immobilization using a halo orthosis. A retrospective study was undertaken to assess the safety and efficacy of nonrigid immobilization in the treatment of these fractures.Records of 64 patients with hangman's fracture treated over a 19-year period (1975–1994) at one institution were reviewed. Thirty-nine of these patients presented with a displacement of C-2 onto C-3 measuring less than 6 mm and no contiguous cervical fractures. All these patients were treated with nonrigid immobilization, consisting primarily of a Philadelphia hard collar worn for 10 to 14 weeks; all showed stable fracture healing on follow-up flexion—extension radiographs. None of the patients experienced neurological sequelae or significant disability at follow-up review.The results of this series indicate that the majority of patients with hangman's fractures, including all patients with displacement measuring less than 6 mm and no contiguous fractures, may be treated successfully with nonrigid immobilization. This management regimen avoids the increased morbidity and cost associated with rigid immobilization using a halo orthosis.
Somatosensory evoked potential monitoring in cervical surgery: identification of pre- and intraoperative risk factors associated with neurological deterioration
Authors: May Daniel M. , Jones Stephen J. , Crockard H. Alan 
Published: June 2009

✓ Cortical and subcortical somatosensory evoked potentials (SSEPs) were noninvasively monitored in 191 surgical procedures involving the cervical spine. In nine patients in the poorest neurological condition, SSEPs could not be monitored. Lower limb SSEPs were often too degraded to be useful.
Upper limb responses were reliably recorded in 182 procedures, with a sensitivity of 99% and a specificity of 27% in 10 patients who developed neurological signs postsurgery. The aim of monitoring was to detect changes in spinal cord function at a time when neurological deterioration could be prevented or reversed, and these studies alerted the authors to certain clinical and SSEP risk factors associated with deterioration. Clinical and operative risk factors were: 1) poor preoperative neurological function (one-third of Ranawat Class IIIb patients deteriorated); 2) use of instrumentation (the risk doubled in preoperatively unimpaired patients); 3) upper cervical and clival surgery (the risk tripled); and 4) and multi-segmental surgery (increased risk with each additional level).
There were SSEP changes in 33 patients. Fifty percent of patients with a complete loss had neurological damage, unlike those who had incomplete loss or whose electrical changes had recovered by the end of surgery. In the authors' view these “false positives” may represent real physiological changes, the effects of which might have been minimized by an alteration in the surgeon's response as a result of the warning. Although these initial studies have made this surgical team more alert to potential problems, the role of intraoperative SSEP monitoring is still being debated.
Predictors of outcome in the quadriparetic nonambulatory myelopathic patient with rheumatoid arthritis: a prospective study of 55 surgically treated Ranawat Class IIIb patients
Authors: Casey Adrian T. H. , Crockard H. Alan , Bland J. Martin , Stevens John , Moskovich Ronald , Ransford Andrew 
Published: June 2009

✓ The functional results of surgery in patients with myelopathic nonambulatory rheumatoid arthritis (Ranawat Class IIIb) are often disappointing, with high rates of postoperative morbidity and mortality. The authors therefore undertook a detailed investigation of a cohort of 55 Ranawat Class IIIb patients (11 men and 44 women) with a mean age of 64.7 years who were recruited prospectively over a 10-year period (1983–1993), to determine what factors may accurately predict a good surgical outcome. Only 14 patients (25.5%) were judged to have had a favorable outcome as determined by an improvement to Ranawat Class I or II or an improvement of at least 0.5 points in the Stanford Health Assessment Questionnaire disability index. The early postoperative mortality rate was high (12.7%) in this group and almost one-quarter of the patients were dead within 6 months. These poor results mirror those already published in the existing literature.Univariate analysis revealed that age (p = 0.02), degree of vertical translocation (p = 0.05), and, more importantly, spinal cord area (p = 0.006) were significant predictors of outcome. Multiple logistic regression analysis showed that spinal cord area (p = 0.026) was, in fact, the major determinant of outcome and, indeed, of long-term survival (p = 0.001). The mean spinal cord area of those patients not achieving a good outcome was 44 mm2. The atlantodens interval (ADI) was not shown to be a significant outcome determinant, which may be explained by the correlation between an increasing vertical translocation and a decreasing ADI (r = 0.4, p = 0.01). Furthermore, as the degree of vertical translocation increased, the space available for the cord was observed to decrease (p = 0.003) commensurate with a reduction in spinal cord area (p = 0.02). Together, these findings strongly argue for earlier surgical intervention, before the development of vertical translocation, permanent neurological damage, and spinal cord atrophy can occur.
Cholesterol granulomas of the petrous apex: combined neurosurgical and otological management
Authors: Brodkey Jason A. , Robertson Jon H. , Shea John J. , Gardner Gale 
Published: June 2009

✓ Cholesterol granulomas of the head are relatively rare. Isolated lesions of the cerebellopontine angle are even more uncommon. In this report, 17 cases of petrous apex cholesterol granulomas are presented and management is discussed.
Symptoms at presentation included dizziness (14 patients), pressure (nine patients), tinnitus (eight patients), hearing loss (eight patients), otalgia (six patients), headache (six patients), nausea (three patients), drainage from ear (two patients), facial pain (two patients), seizure (two patients), lightheadedness (one patient), hemifacial spasm (one patient), and facial numbness (one patient). Six cases were managed without surgery and 11 patients underwent operative procedures. The approaches used included the infralabyrinthine (eight patients), transcanal—infracochlear (two patients), and translabyrinthine (one patient). The mean follow-up period for all cases was 29.5 months. Of those patients managed without surgery, symptoms improved in all except one, whose tinnitus was slightly worse. Of surgically treated patients, symptoms improved or remained the same except in one with worsened dizziness. There were nine patients with hearing present presurgery and seven whose hearing was preserved postsurgery. The authors present a case that was managed at another center where an attempt at surgical resection through a subtemporal middle fossa approach was unsuccessful. This lesion was successfully treated using an infralabyrinthine approach with drainage into the mastoid cavity.
Cholesterol granulomas of the petrous apex can be managed without surgery when symptoms are stable or improve. Otherwise, a transmastoid extradural approach with simple drainage into the mastoid sinus or middle ear produces symptomatic improvement with low morbidity. Resection of petrous apex cholesterol granulomas is not necessary.
Glioblastoma-associated circulating monocytes and the release of epidermal growth factor
Authors: Fries Georg , Perneczky Axel , Kempski Oliver 
Published: June 2009

✓ Monocytes/macrophages frequently infiltrate malignant gliomas and play a central role in the tumor-associated immune response as they process tumor antigen and present it to T-lymphocytes. Findings have accumulated that peripheral blood monocytes leaving the cerebral circulation become microglial cells andvice versaand that monocytes/macrophages may stimulate malignant tumor growth by some unknown mechanism. Most malignant gliomas express growth factor receptors, for example epidermal growth factor receptor (EGFR). The aim of this study was to determine whether peripheral blood monocytes of glioma patients release EGF, the appropriate ligand of gliomacell membrane-bound EGFR.Long-term cultured peripheral blood monocytes from 14 patients with malignant gliomas were compared to those from 12 controls (seven with nontumorous disease and five healthy individuals). Using an enzyme-linked immunosorbent assay for EGF, the EGF content of cell culture supernatants was determined at Days 7, 21, and 100 of culture. The EGF content (mean ± standard error) of supernatants was 5.9 ± 0.2 pg/ml/103glioma monocytes versus 1.3 ± 0.1 pg/ml/103control monocytes at Day 7 of culture, 22.9 ± 0.8 pg/ml/103glioma monocytes versus 1.8 ± 0.9 pg/ml/103control monocytes at Day 21 of culture, and 23.4 ± 0.7 pg/ml/103glioma monocytes, and below detection levels for control monocytes at Day 100 of culture. Steroid treatment of glioma patients did not influence the EGF release of cultured monocytes. These data indicate that glioblastoma-associated peripheral blood monocytes may be distinct from those of healthy individuals. Moreover, this study indicates that subtypes of glioma-associated peripheral blood monocytes may support immunosuppression and promote growth of malignant glioma by releasing unusually high amounts of EGF.
Deformation of the cervicomedullary junction and spinal cord in a surgically treated adult Chiari I hindbrain hernia associated with syringomyelia: a magnetic resonance microscopic and neuropathological study
Authors: Beuls Emile A. M. , Vandersteen Marie-Anne M. , Vanormelingen Linda M. , Adriaensens Peter J. , Freling Gerard , Herpers Marcel J. H. M. , Gelan Jan M. 
Published: June 2009

✓ The lower brainstem and cervical spinal cord from an ordinarily treated case of Chiari Type I hindbrain hernia associated with syringomyelia was examined using high-resolution magnetic resonance microscopy and standard neuropathological techniques. Magnetic resonance microscopy allows total screening and visualizes the disturbed internal and external microanatomy in the three orthogonal planes with the resolution of low-power optical microscopy. An additional advantage is the in situ visualization of the shunts. Afterwards the intact specimen is still available for microscopic examination.
Part of the deformation of the medulla is caused by chronic tonsillar compression and molding inside the foramen magnum. Other anomalies, such as atrophy caused by demyelination, elongation, and unusual disturbances at the level of the trigeminal and solitary nuclear complexes contribute to the deformation.
At the level of the syrinx-free upper part of the cervical cord, anomalies of the dorsal root and the dorsal horn are demonstrated.