bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bacterial intracranial aneurysm
Authors: Bohmfalk George L. , Story Jim L. , Wissinger John P. , Brown Willis E. 
Published: May 2009

✓ The authors tabulate and analyze cases of bacterial intracranial aneurysm documented since 1954, and add four of their own. In 85 cases the overall mortality was 46%. Elimination of patients dying before reaching the hospital makes this figure spuriously low. Figures for patients hospitalized for endocarditis before neurological symptoms occurred suggest a true mortality of 80% from aneurysms that rupture and 30% if the aneurysm remains intact. Multiple reports of spontaneously resolving, enlarging, diminishing, multiple, and sequentially appearing aneurysms, all of which occurred in our fourth case, clarify the need for complete and sequential angiography. Computerized tomographic (CT) scanning in this disease has not been reported, but our experience with these scans demonstrates considerable potential value.
A protocol of complete cerebral angiography and CT scanning of these neurologically asymptomatic patients is proposed, in order to assess the true incidence of bacterial intracranial aneurysm, to learn more of its natural history, and to prevent some neurological catastrophes.
Preliminary evaluation of cerebellar stimulation by double-blind stimulation and biological criteria in the treatment of epilepsy
Authors: Van Buren John M. , Wood James H. , Oakley John , Hambrecht Frederick 
Published: May 2009

✓ This series included five patients who had suffered 8 to 23 years of severe, medically intractable seizures without remission, severe socioeconomic handicaps, and an average of over one seizure a day on hospital observation and by history. All had combinations of partial and general seizures with focal and/or bilaterally synchronous epileptiform activity consistently on multiple electroencephalograms (EEG's). One patient had nearly continuous myoclonic activity. Serum levels of phenytoin, primidone, and phenobarbital were adjusted to therapeutic ranges. Three patients had additional medication (diazepam, ethosuximide). Cerebellar biopsy in three patients showed reduction in Purkinje cells.
After implantation of cerebellar stimulators, seizure frequency was evaluated in hospital during three or four admissions for 4- to 6-week periods over the ensuing 15 to 21 months. No slow trends toward improvement or deterioration were noted. No significant differences in seizure frequency were found when comparing intervals of about 7 days of on-and-off stimulation both in the double-blind and unblinded conditions. No changes in EEG or Intelligence or Memory Quotients occurred unaccounted for by variations in serum levels of antiepileptic drugs. Despite the lack of objective improvement, patient and family acceptance of cerebellar stimulation was positive to enthusiastic. A rise in CSF norepinephrine and a fall in gamma aminobutyric acid (GABA) accompanied cerebellar stimulation and may be related to the results.
Metallurgical analysis of aneurysm and microvascular clips
Authors: DeLong W. Bradford , Ray Robert L. 
Published: May 2009

✓ The design of an aneurysm clip and the choice of its component materials require complex considerations of corrosion resistance, biocompatibility, desired performance, and manufacturing practicalities. This study analyzed 10 different types of aneurysm and microvascular clips for chemical composition and metallurgical characteristics. The opening force of each clip was determined with a spring gauge.
All components of four multicomponent clips (three aneurysm clips and one microvascular clip) were manufactured from 17-7PH stainless steel, a strong precipitation-hardening grade of good general corrosion resistance. Two multicomponent clips (one aneurysm clip and one microvascular clip) each contained three components manufactured from different alloys. In an implanted clip, an increased rate of corrosion may result from electrolytic reaction between components composed of different alloys.
This study demonstrated that 17-7PH stainless steel is a popular alloy for use in vascular clips, but it has several drawbacks. The authors suggest that manufacturers explore the use of PH15-7Mo instead. PH15-7Mo is another precipitation-hardening stainless steel, but contains molybdenum, which renders it potentially more resistant to corrosion than 17-7PH.
Holoprosencephaly in neurosurgical practice
Authors: Osaka Kunihiko , Matsumoto Satoshi 
Published: May 2009

✓ The clinical, angiographic, and pneumoencephalographic features of seven cases with holoprosencephaly are reported. Three of the alobar type in this series revealed the facial dysmorphia characteristic of the anomaly. In the other four cases (one alobar, one semilobar, and two lobar), such facial anomaly was absent, and the diagnosis was achieved only after contrast studies.
An azygous anterior cerebral artery running over the cerebral surface due to a defective interhemispheric fissure is pathognomonic for alobar and semilobar holoprosencephaly. Dysgenesis of the deep venous system was found in alobar, semilobar, and lobar holoprosencephaly, a finding helpful in diagnosis, especially of the lobar type. Air study and computerized tomography scan revealed incomplete separation of the ventricular system. The basic nature of holoprosencephalization and its differentiation from non-holoprosencephalic malformation are discussed. Six of the seven patients reported had hydrocephalus.
Functional treatment of acromegaly by transsphenoidal microsurgery
Authors: García-Uría José , del Pozo Jose M. , Bravo Gonzalo 
Published: May 2009

✓ The authors have analyzed the results from 41 acromegalic patients who underwent transsphenoidal surgery. In 31 patients, postoperative growth hormone (GH) levels fell and remained below 10 ng/ml. This represents an endocrinological “cure” of 78%. In the remaining 10 cases, postoperative GH values have not stabilized below 10 ng/ml, although seven show some clinical improvement. The results were particularly good in those cases of localized adenomas, which allowed a selective removal while maintaining pituitary function within normal limits in 65.5% of cases. The postoperative GH level in this group fell and remained below 10 ng/ml in more than 90% of cases.
Four patients required reoperation to normalize the GH levels which had not been sufficiently modified after the first operation; only one of them remained with plasma GH levels above normal limits. There were no deaths in this series. Rhinorrhea occurred as a postsurgical complication in four cases. In three this disappeared with bed rest and lumbar drainage; in the other, surgical repair was necessary. The occurrence of surgical complications has decreased as our experience has increased, and the need for reoperation has been unusual after the first year of our study.
Cerebral vasospasm and ultrastructural changes in cerebral arterial wall
Authors: Tanabe Yusuke , Sakata Kazuki , Yamada Hiromu , Ito Takao , Takada Mitsuaki 
Published: May 2009

✓ Subarachnoid hemorrhage (SAH) was produced experimentally by injecting normal dog's blood as well as reserpinized dog's blood into the chiasmal cistern of the dog. The following observations were made: 1) After SAH with normal dog's blood, the intima of the basal truncal arterial wall showed some or all of such ultrastructural changes as appearance of vacuoles and dense bodies in endothelial cells, detachment of endothelial cells, appearance of intimal cells, and intimal thickening. The changes first appeared 2 hours after SAH, culminated at 3 to 7 days after SAH, and persisted up to 1 month after SAH. 2) After SAH with normal dog's blood, the media of the basal truncal arterial wall showed some or all of such ultrastructural changes as moth-eaten contour of muscle cells, appearance of intracytoplasmic vacuoles and dense bodies, appearance of cell debris, enlargement of interstitial space, and appearance therein of dense particles. These findings, which, in short, are to be expressed as myonecrosis and its repairing process, first appeared 2 hours after SAH, culminated at 1 to 4 months after SAH, and persisted up to 1 year after SAH. 3) Three and 5 days following SAH with reserpinized dog's blood, ultrastructural findings of the intima and media of the basal truncal arterial wall were entirely normal.
On the basis of the above findings, it was concluded that the ultrastructural changes in the cerebral arterial wall observed after SAH with normal dog's blood occurred as a consequence of vasospasm. The possibility that late spasm, in turn, might be facilitated by myonecrosis, could not be denied.
The effect of amphotericin B on the survival of brain-tumor-bearing mice treated with CCNU
Authors: Muller Paul J. , Tator Charles H. 
Published: May 2009

✓ The membrane-active polyene, amphotericin B (AMB) has been shown to enhance or potentiate the effects of various chemotherapeutic agents against tumor cells in tissue culture. Because of the need to increase the efficacy of the nitrosoureas in brain-tumor chemotherapy, we have studied the effect of the nitrosourea, 1-(2-chloroethyl)-3-cyclohexyl-l-nitrosourea (CCNU), with or without AMB pretreatment.
The intraperitoneal administration of 25 mg/kg of AMB 24 hours before 5, 10, 20, or 30 mg/kg of intraperitoneal CCNU did not result in a significant improvement in survival. The failure of intraperitoneal AMB to potentiate the effect of CCNU was likely a failure in drug delivery, since AMB crosses the blood-brain barrier very poorly. To circumvent the drug-delivery problem, AMB was administered intracerebrally directly into the tumor-bearing hemisphere. With 0.5 mg/kg of intracerebral AMB administered 24 hours before 10 mg/kg CCNU was given intraperitoneally, the life-span was significantly increased over the control group. The same dose of CCNU alone did not significantly increase survival. When 0.2, 0.5, or 1.0 mg/kg AMB was administered intracerebrally 24 hours before 20 mg/kg of intraperitoneal CCNU, survival was significantly increased over those groups receiving the same dose of CCNU alone. It is concluded that direct intracerebral administration of AMB enhances or potentiates the therapeutic effect of CCNU in this brain-tumor model.
The outcome with aggressive treatment in severe head injuries
Authors: Marshall Lawrence F. , Smith Randall W. , Shapiro Harvey M. 
Published: May 2009

✓ In a series of 100 consecutive patients with severe head injuries, uncontrolled intracranial hypertension, which was defined as occurring when intracranial pressure (ICP) exceeded 40 mm Hg for 15 minutes or more, occurred in 25 patients. This was despite high-dose dexamethasone, hyperventilation, mannitol, normothermia, appropriate surgical evacuation, and cerebrospinal fluid drainage when possible. Persistently elevated ICP occurred in 19 patients with diffuse brain injury, and in six patients uncontrolled intracranial hypertension followed evacuation of a surgical mass. All of these patients received intravenous barbiturates to control the ICP. At the time of initial barbiturate administration, 11 of the 25 had bilaterally unreactive pupils and 12 were decerebrate. The initial pentobarbital loading dose (3 to 5 mg/kg) effectively reduced the ICP in 76% of the patients. Prolonged pentobarbital treatment with blood barbiturate levels from 2.5 to 3.5 mg% was associated with normalization of the ICP (ICP less than 15 mm Hg) in 13 patients. In those patients responding to barbiturates, the daily mannitol requirement was reduced from 4.5 to 0.5 gm/kg/day (p < 0.01). In six nonresponders to barbiturates, mannitol requirements increased to 5.9 gm/kg/day; five of these died and one remains vegetative.
Ten of the 19 barbiturate responders have returned to a productive life, two remain moderately disabled, two are severely disabled, one is vegetative, and four are dead. The high rate of good quality survival in this series of severely brain-injured patients indicates that barbiturates are useful in the treatment of uncontrolled intracranial hypertension and that a broader investigation of the clinical application of barbiturates is indicated.
Transsphenoidal hypophysectomy for disseminated carcinoma of the prostate gland
Authors: Tindall George T. , Payne Nettleton S. , Nixon Daniel W. 
Published: May 2009

✓ Transsphenoidal microsurgical hypophysectomy was performed in 53 men with disseminated carcinoma (Stage IV) of the prostate gland. The mean age was 64.8 years. Forty-three of the 53 men had severe pain due to their disease. Significant pain relief was obtained following hypophysectomy, usually within 24 hours, in 39 (91%) of these 43 patients. Objective remission occurred in 16 (36%) of 45 patients in whom the follow-up review was adequate to make this decision. Although dramatic, pain relief was not permanent in every patient. Four patients died in the early postoperative period, and in one, death was directly related to the operative procedure. Significant complications included partial diabetes insipidus in 40 cases (75.5%), and cerebrospinal fluid leaks in six (11.3%).
The authors conclude that hypophysectomy is an appropriate operation in patients with disseminated carcinoma of the prostate gland, particularly when pain is a significant feature of the illness. Further, the transsphenoidal microsurgical approach appears to be the operative procedure of choice for performing hypophysectomy.
Physiological study of presumed ventralis intermedius neurons in the human thalamus
Authors: Ohye Chihiro , Narabayashi Hirotaro 
Published: May 2009

✓ Unitary or a group of unitary responses recorded extracellularly in the rostral part of the thalamic sensory nucleus during the course of thalamotomy for parkinsonian and other kinds of tremor were studied. They were the first sensory neurons encountered in the frontocaudal approach of the stereotaxic needle to the therapeutic target at the lower border of the ventralis intermedius nucleus. The spike discharges, isolated from high neural noise background, responded to passive and/or active movement of joint or muscle on the contralateral extremity but never to light tactile stimuli. In five cases, electrical stimulation of the corresponding peripheral nerves elicited the same spike discharge at short and fixed latency of about 12 msec. Weak electrical stimulation given to each thalamic point produced paresthetic or electric sensation around the receptive field, and stronger stimulation induced tremor-like movement in the area involving the receptive field. Finally, a small coagulation lesion in this thalamic point resulted in immediate relief of tremor without any sensory deficit.
From these findings, the possibility is considered that in the human, this particular thalamic zone could be the ventralis intermedius nucleus, which is separable from the surrounding nuclei and is related to tremor mechanism.
Studies of experimental cervical spinal cord transection
Authors: Tibbs Phillip A. , Young Byron , McAllister R. G. , Todd Edward P. 
Published: May 2009

✓ Regional cerebral blood flow (CBF) was measured by the microsphere technique in anesthetized, mechanically ventilated dogs before and after cervical laminectomy in four (control group), or cervical laminectomy followed by cervical cord transection (CCT) at the C-6 level in six (experimental group). No significant differences in arterial pH, pO2 or pCO2 were observed between control and experimental dogs. Baseline values for mean arterial pressure (MAP) were also similar in the two groups, but MAP fell in all experimental dogs after CCT (p < 0.025). At 120 minutes after CCT, three of the six dogs had an MAP > 60 torr (66 ± 4 torr), and in three the MAP was < 50 torr (45 ± 3 torr). Regional CBF in cortical gray matter, white matter, and medulla did not change significantly after CCT in dogs with MAP > 60 torr. The CBF fell significantly at 120 minutes after CCT in all regions sampled in the dogs with MAP < 50 torr (p < 0.025). At 30 and 120 minutes after CCT, cerebellar blood flow fell significantly in all experimental animals (p < 0.05).
These findings indicate that, despite hypotension and sympathetic denervation of cerebral vessels, CBF in cortical gray matter, white matter, and medulla is maintained at normal levels after CCT by autoregulation as long as MAP exceeds 60 torr. Decreased cerebellar blood flow in the experimental group suggests redistribution of CBF after CCT with relative preservation of flow to gray matter, white matter, and medulla. Reduced CBF in the acutely cord-injured patient with significant hypotension (MAP < 60 torr) may simulate or complicate coexistent head injury.
Nonvolumetric methods of detecting impaired intracranial compliance or reactivity
Authors: Wilkinson Harold A. , Schuman Nancy , Ruggiero John 
Published: May 2009

✓ The authors have attempted to find a clinically reliable method of measuring intracranial pressure (ICP) compliance or reactivity that does not require volumetric manipulation. An analysis was undertaken of ICP, pulse widths and of the presence or absence of B waves, both experimentally in dogs and clinically in postoperative human patients. In both dogs and humans, ICP pulse width generally increased with increasing ICP and with increasing intracranial mass, and definitely increased with systolic arterial blood pressure. Nonetheless, ICP pulse width commonly failed to increase with increasing cerebral reactivity, and low ICP pulse width measurements were at times recorded in distinctly pathological situations.
From the clinical study it was found that B waves were encountered more commonly in patients with increased ICP or increased ICP pulse width. However, the correlation between B waves alone or in combination with increased ICP or ICP pulse width and quantitative measurements of ICP reactivity was not significant. Mean reactivity and the range of reactivity measurements were almost identical in patient groups with and without B waves. For the time being the “ICP reserve test” remains the most accurate, the safest, and the most clinically useful method of quantitating ICP reserve.
Recurrent subarachnoid hemorrhage associated with aminocaproic acid therapy and acute renal artery thrombosis
Authors: Tubbs Raymond R. , Benjamin Sanford P. , Dohn Donald E. 
Published: May 2009

✓ Epsilon aminocaproic acid (EACA) has been used to prevent rebleeding in patients with subarachnoid hemorrhage (SAH). Although this agent does decrease the frequency of rebleeding, several reports have described thrombotic complications of EACA therapy. These complications have included clinical deterioration and intracranial vascular thrombosis in patients with SAH, arteriolar and capillary fibrin thrombi in patients with fibrinolytic syndromes treated with EACA, or other thromboembolic phenomena. Since intravascular fibrin thrombi are often observed in patients with fibrinolytic disorders, EACA should not be implicated in the pathogenesis of fibrin thrombi in patients with disseminated intravascular coagulation or other “consumption coagulopathies.”
This report describes subtotal infarction of the kidney due to thrombosis of a normal renal artery. This occlusion occurred after EACA therapy in a patient with SAH and histopathological documentation of recurrent SAH. The corresponding clinical event was characterized by marked hypertension and abrupt neurological deterioration.
Experimental interfascicular nerve grafting
Authors: Bratton Bert R. , Kline David G. , Coleman William , Hudson Alan R. 
Published: May 2009

✓ Twenty-nine adult rhesus monkeys underwent complete laceration of both tibial nerves at mid-thigh level and repair by different methods to study the relative efficacy of autogenous interfascicular nerve grafts. Sixteen animals in Group I had an interfascicular graft repair using short sural nerve autografts on one limb and fascicular repair without grafts on the other limb. Thirteen animals in Group II, after having a 1-cm segment of tibial nerve resected, had an interfascicular graft repair without tension in one limb and an epineurial repair under moderate tension in the other limb. Evoked nerve and muscle action potentials and muscle strength in response to repetitive and tetanic stimulation were recorded as baseline values prelaceration and then on re-exploration at 4, 6, 9, or 12 months. All nerves were examined by light and electron microscopy.
Electrophysiological data, particularly muscle strength response, showed non-graft repairs to be superior at 4 and 6 months of regeneration. However, by 9 and 12 months the graft repairs had caught up and were equal to the non-graft repairs. Histologically, it was observed that many axons missed the graft segments and were present in extrafascicular connective tissues. Nonetheless, enough axons regenerated to the distal nerve to explain the success of these relatively short grafts. From the results of these experiments, it is concluded that use of autogenous interfascicular grafts offers no advantage over end-to-end non-graft repair. When an end-to-end repair cannot be achieved, use of short interfascicular nerve grafts is feasible and will work.
Primary cerebellar nocardiosis
Authors: Tyson George W. , Welsh Joseph E. , Butler Albert B. , Jane John A. , Winn H. Richard 
Published: May 2009

✓ The authors describe two cases of primary cerebellar nocardiosis. Confinement of Nocardia abscesses to a localized, accessible portion of the central nervous system should favor surgical cure of this aggressive and often fatal disease. In our two cases multilocularity, tenuous encapsulation, and proximity to the brain stem prevented complete primary excision. Nevertheless, the infections were effectively treated by intensive postoperative antibiotic therapy and, in one case, a second operation to excise the residual abscess. The need for the latter was suggested by the results of sequential computerized tomographic brain scans that were used to monitor the response to antibiotic therapy.
In the absence of any apparent extracranial focus of infection and any overt condition that might impair immunological competence, nocardiosis is likely to be omitted from the preoperative differential diagnosis of a posterior fossa space-occupying lesion.
Superficial temporal-middle cerebral artery bypass
Authors: Latchaw Richard E. , Ausman James I. , Lee Myoung C. 
Published: May 2009

✓ Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced.
The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation, with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.