bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preservation of ejaculatory function by reconstruction of the canine hypogastric nerve
Authors: Kihara Kazunori , Sato Kenji , Ishizaka Kazuhiro , Oshima Hiroyuki 
Published: June 2009

Object. The hypogastric nerve (HGN) plays a crucial role in the primary functions of ejaculation: sperm transport through the vas deferens, secretion of prostatic fluid, and bladder neck closure. This study was undertaken to explore the possibility of restoring HGN function to the seminal tract and preserving its cross-innervation mechanism to the seminal tract after HGN—HGN reattachment.
Methods. Responses of the vas deferens/epididymis, prostate, and bladder neck to electrical stimulation of the lumbar splanchnic nerve (LSN) or the HGN and occurrence of antegrade ejaculation as a result of manual penile stimulation were examined in dogs that had undergone HGN—HGN reattachment. Eighteen months after the procedure had been performed bilaterally, 23 LSNs were electrically stimulated. In 17 LSNs this stimulation elicited elevation of vasal pressure (12 nerves bilaterally); in 18 LNs, bladder neck pressure; and in 15 LSNs, prostate contraction. After retransection of the right HGN in the dogs that had undergone HGN—HGN reattachment, 11 right-sided LSNs were stimulated; in seven LSNs, the stimulation elicited elevation of vasal pressure (five bilaterally), in seven bladder neck pressure, and in six prostate contraction. Twelve left-sided LSNs were stimulated; in seven LSNs, the stimulation elicited elevation of vasal pressure (four bilaterally), in six bladder neck pressure, and in six prostate contracton. Each of the 12 HGN stimulations made proximal to the site that had been sutured in dogs that had HGN-HGN reattachment caused responses of the three organs specified above that were comparable to those in control dogs. Manual penile stimulation elicited antegrade ejaculation in all three dogs examined.
Conclusions. The results of this study show that the function of the HGN in the seminal tract can be preserved after HGN—HGN reattachment and that restoration of its cross-innervation mechanism is possible.
Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography
Authors: Czosnyka Marek , Matta Basil F. , Smielewski Piotr , Kirkpatrick Peter J. , Pickard John D. 
Published: June 2009

Object. The authors studied the reliability of a new method for noninvasive assessment of cerebral perfusion pressure (CPP) in head-injured patients in which mean arterial blood pressure (ABP) and transcranial Doppler middle cerebral artery mean and diastolic flow velocities are measured.
Methods. Cerebral perfusion pressure was estimated (eCPP) over periods of continuous monitoring (20 minutes—2 hours, 421 daily examinations) in 96 head-injured patients (Glasgow Coma Scale score < 13) who were admitted to the intensive care unit. All patients were sedated, paralyzed, and ventilated. The eCPP and the measured CPP (ABP minus intracranial pressure, measured using an intraparenchymal microsensor) were compared.
The correlation between eCPP and measured CPP was r = 0.73; p < 10−6. In 71% of the examinations, the estimation error was less than 10 mm Hg and in 84% of the examinations, the error was less than 15 mm Hg. The method had a high positive predictive power (94%) for detecting low CPP (< 60 mm Hg). The eCPP also accurately reflected changes in measured CPP over time (r > 0.8; p < 0.001) in situations such as plateau and B waves of intracranial pressure, arterial hypotension, and refractory intracranial hypertension. A good correlation was found between the average measured CPP and eCPP when day-by-day variability was assessed in a group of 41 patients (r = 0.71).
Conclusions. Noninvasive estimation of CPP by using transcranial Doppler ultrasonography may be of value in situations in which monitoring relative changes in CPP is required without invasive measurement of intracranial pressure.
Endoscopic treatment of carpal tunnel syndrome: a critical review
Authors: Jimenez David F. , Gibbs Scott R. , Clapper Adam T. 
Published: June 2009

Object. The goal of this paper is to present a critical review of the endoscopic procedures currently in use for the treatment of carpal tunnel syndrome. Endoscopic techniques and outcomes are discussed.
Methods. An extensive review of published articles on the subject of endoscopic carpal tunnel release surgery is presented, encompassing six endoscopic techniques used to treat carpal tunnel syndrome. Since the first report in 1987, 7091 patients have undergone 8068 operations. The overall success rate has been 96.52%, with a complication rate of 2.67% and a failure rate of 2.61%. The mean time to return to work in patients not receiving Workers' Compensation was 17.8 days, ranging between 10.8 and 22.3 days. The most common complications were transient paresthesias of the ulnar and median nerves. Other complications included superficial palmar arch injuries, reflex sympathetic dystrophy, flexor tendon lacerations, and incomplete transverse carpal ligament division. In many studies in which open and endoscopic techniques were compared, it was reported that patients in the the latter group experienced significantly less pain and returned to work and activities of daily living earlier.
Conclusions. Success and complication rates of endoscopic carpal tunnel release surgery are similar to those for standard open procedures.
Factors associated with survival in patients with meningioma
Authors: McCarthy Bridget J. , Davis Faith G. , Freels Sally , Surawicz Tanya S. , Damek Denise M. , Grutsch James , Menck Herman R. , Laws Edward R. 
Published: June 2009

Object. To explore factors affecting the survival rate in patients with meningiomas, the authors used the National Cancer Data Base (NCDB), which includes tumors from approximately 1000 hospitals participating in the American College of Surgeons tumor registry program.
Methods. Analysis included over 9000 cases diagnosed from 1985 to 1988 and 1990 to 1992. Survival estimates were computed and prognostic factors were identified using a proportional hazards model. The overall 5-year survival rate was 69% and it declined with patient age. This rate was 81% in patients aged 21 to 64 years and 56% for patients 65 years of age or older. When patients were grouped by the histological type of their tumors, those with benign tumors had an overall 5-year survival rate of 70%, whereas the overall 5-year survival rates in patients with atypical and malignant meningiomas were 75% and 55%, respectively. Prognostic factors for benign tumors included age at diagnosis, tumor size, whether treated surgically, hospital type, and radiation therapy; for malignant tumors, the prognostic factors included: age at diagnosis, whether treated surgically, and radiation therapy. These factors were statistically significant. The 5-year rate for recurrence of symptoms (regardless of the method of treatment) was 19.2% for those with benign tumors and 32.4% for those with malignant tumors. In patients whose benign tumor had been completely removed, the 5-year rate of tumor recurrence was 20.5%.
Conclusions. Although not population-based, the NCDB has the potential for providing pertinent information regarding patient characteristics and methods of treatment for benign, as well as malignant, brain tumors.
Does the size of intracranial aneurysms change with intracranial pressure? Observations based on color “power” transcranial Doppler ultrasound
Authors: Wardlaw Joanna M. , Cannon James , Statham Patrick F. X. , Price Rupert 
Published: June 2009

Object. The authors sought to determine whether the increased pulsatility of aneurysms, compared with normal intracranial arteries, on color “power” transcranial Doppler (TCD) ultrasound was due to a true change in aneurysm size and whether aneurysm dimensions change with intracranial pressure (ICP).
Methods. The authors studied nine patients who had suffered recent subarachnoid hemorrhages complicated by hydrocephalus requiring intraventricular cerebrospinal fluid drainage, in whom the presence of an aneurysm was confirmed on angiographic examination. Color “power” TCD studies of the intracranial arteries and aneurysm were obtained through the temporal bone window before and after insertion of the ventricular drain and then at different known ICPs.
Of the nine patients studied, four were examined both before and after insertion of a ventricular drain. At high ICPs, aneurysms appeared very “pulsatile” and the maximum cross-sectional area was small, whereas at low ICPs, aneurysms appeared larger and were much less pulsatile. The normal arteries did not change significantly in terms of pulsatility or maximum cross-sectional area at different levels of ICP.
Conclusions. The change in aneurysm size visualized with the aid of color power TCD is likely to be real. Aneurysm dimensions vary with ICP levels; the lesions are larger and less pulsatile at low ICPs and smaller but more pulsatile at high ICPs.
Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure
Authors: Medele Ralph J. , Stummer Walter , Mueller Arthur J. , Steiger Hans-Jakob , Reulen Hans-Jürgen 
Published: June 2009

Object. The syndrome of retinal or vitreous hemorrhage in association with subarachnoid hemorrhage (SAH) is known as Terson's syndrome. The authors' purpose was to determine whether intraocular hemorrhage occurs with similar incidence when caused by severe brain injury accompanied by acutely raised intracranial pressure (ICP).
Methods. Prospective ophthalmological examination was performed in 22 consecutive patients with SAH or severe brain injury and elevated ICP. Thirteen patients were admitted for SAH (World Federation of Neurological Surgeons Grades II–IV) and nine for severe brain injury (Glasgow Coma Scale scores 3–10). Monitoring of ICP was performed at the time of admission via a ventricular catheter. Initial ICP exceeded 20 mm Hg in all patients. Indirect ophthalmoscopy without induced mydriasis was performed within the 1st week after the acute event. Retinal or vitreous hemorrhage was seen in six (46%) of 13 patients with SAH and in four (44%) of nine patients with severe brain injury. Ocular bleeding was found bilaterally in three patients with SAH and in one patient with severe brain injury (18%). Six of the 10 patients with Terson's syndrome died as a result of their acute event.
Conclusions. The present results indicate that Terson's syndrome may be related to acute elevation of ICP, independent of its causes, and may occur with similar incidence in patients with severe brain injury and those with SAH. Because recognition and treatment of Terson's syndrome may prevent visual impairment and associated secondary damage to the eye, increased awareness of this entity in all patients with acute raised intracranial hypertension is recommended.
The presence of 4-hydroxynonenal/protein complex as an indicator of oxidative stress after experimental spinal cord contusion in a rat model
Authors: Baldwin Stanley A. , Broderick Richard , Osbourne David , Waeg Georg , Blades Deborah A. , Scheff Stephen W. 
Published: June 2009

Object. The authors tested the hypothesis that breach of the blood—spinal cord barrier (BSCB) will produce evidence of oxidative stress and that a similar staining pattern will be seen between 4-hydroxynonenal (HNE)/protein complexes and extravasated immunoglobulin G (IgG).
Methods. Adult female Fischer 344 rats, each weighing 200 to 225 g, were subjected to a spinal cord contusion at T-10 by means of a weight-drop device. Spinal cord tissue was assessed for oxidative stress by localizing extravasated plasma contents with a monoclonal antibody for rat IgG and protein conjugation with HNE, which is an aldehyde byproduct of lipid peroxidation. The animals were killed at 1 and 6 hours, and 1, 2, and 7 days after surgery. Maximum HNE/protein staining was observed at 2 days postinjury, and HNE/protein and IgG manifested similar staining patterns. Analysis revealed a graduated but asymmetrical rostral—caudal response relative to the T-10 injury site. Both HNE/protein complex and IgG staining revealed that the caudal levels T-11 and T-12 stained significantly more intensely than the rostral levels T-9 and T-8, respectively. A higher percentage of neurons positive for HNE/protein immunostaining was observed in spinal cord levels caudal to the injury site compared with equidistant rostral regions. Protein dot-blot assays also revealed a similar asymmetrical rostral—caudal HNE/protein content.
To analyze the timing of the BSCB breach, another group of animals received identical contusions, and horseradish peroxidase (HRP) was injected 10 minutes before or at various times after injury (1, 3, and 6 hours, and 1, 2, and 7 days). Maximum HRP permeability was seen immediately after injury, with a significant decrease occurring by 1 hour and a return to control levels by 2 days posttrauma.
Conclusions. Data from this study indicate possible compromise of neuronal, axonal, glial, and synaptic function after trauma, which may be a factor in motor deficits seen in animals after spinal cord contusion. The colocalization of the IgG stain with the HNE/protein stain is consistent with the hypothesis of a mutual cause—effect relationship between BSCB and oxidative stress in central nervous system trauma.
Surgical experience with an implanted artificial cervical joint
Authors: Cummins Brian H. , Robertson James T. , Gill Steven S. 
Published: June 2009

Object. To assess the effectiveness of Cummins' artificial cervical joint, the authors reviewed the cases of 20 patients in whom the joint had been placed.
Methods. A review of patients' medical records and reexamination of 18 patients were performed. The review of the surgical experience with the implantation of movable stainless-steel joints in 20 patients treated for cervical myelopathy (16 patients), cervical radiculopathy (three patients), and severe pain (one patient) indicated that the procedure is safe and well tolerated and does preserve cervical joint motion in most patients over an extended period of observation. To date, adjacent segmental symptomatic degenerative changes leading to further surgical treatment have been avoided. The joint has been placed in patients with advanced congenital and acquired cervical fusion and has been demonstrated to be stable, mobile, and biomechanically and biochemically compatible; it has shown no subsidence into adjacent bone. Wear debris has not occurred.
Conclusions. The use of stainless steel in the cervical spine appears to be suitable for this joint replacement design.
Long-term evaluation of reconstruction of the sellar floor with a silicone plate in transsphenoidal surgery
Authors: Kabuto Masanori , Kubota Toshihiko , Kobayashi Hidenori , Takeuchi Hiroaki , Nakagawa Takao , Kitai Ryuhei , Kodera Toshiaki , Kawai Hideya , Arishima Hidetaka 
Published: June 2009

Object. The authors have used a silicone plate for reconstruction of the sellar floor during rhinoseptoplastic transsphenoidal surgery because it has greater elasticity and is easier to carve than nasal septal cartilage and sphenoid sinus bone. This study was designed to evaluate the usefulness of this technique based on the authors' experience during the past 7.6 years.
Methods. A silicone plate was used to reconstruct the sellar floor in 69 consecutive patients with sellar tumors that included 60 pituitary adenomas and nine Rathke's cleft cysts. The patients ranged in age from 16 to 82 years (mean 52 years). The postoperative position of the silicone plate could be clearly identified on sagittal or coronal magnetic resonance (MR) imaging as a very low intensity plate (void signal). No displacement or migration of the implanted silicone plate was observed on follow-up MR imaging in any patient. Infections of the lesion such as a pituitary abscess were not observed clinically or radiologically in any patient. Of the 16 patients with intraoperative cerebrospinal fluid (CSF) leakage, only one patient who had a ghost sella developed postoperative CSF rhinorrhea. In all seven patients who underwent repeated surgery for residual or recurrent tumor, the silicone plate that had been placed at the initial procedure was covered with a relatively thin fibrous capsule and the plate was well preserved. The silicone plate was easily removed at reoperation and was useful for detection of the sellar floor window made previously.
Conclusions. These results indicate that a silicone plate can be useful for reconstruction of the sellar floor in rhinoseptoplastic transsphenoidal surgery.
Congenital tethered spinal cord syndrome in adults
Authors: Iskandar Bermans J. , Fulmer Benjamin B. , Hadley Mark N. , Oakes W. Jerry 
Published: June 2009

Object.The management of tethered spinal cord syndrome with onset of symptomatology occurring in adulthood remains controversial, although the necessity of early surgery in the pediatric tethered cord syndrome population is well established. To ascertain the results of surgery in adult patients with this anomaly, the authors undertook a retrospective review of 34 cases.Methods.The authors studied the hospital records of 34 consecutive patients who presented in adulthood with tethered cord syndrome and conducted follow-up phone interviews with 28 of them. The population consisted of 12 men and 22 women, ranging in age from 18 to 70 years (mean 34 years). The most common presenting feature was pain, followed by weakness and incontinence. All patients underwent surgery. The most common operative findings were tight filum terminale, split cord malformation, and lipomyelomeningocele, paralleling those observed in pediatric studies.Long-term surgical results and patient outcome ratings were encouraging. After a mean clinical follow-up period of 4 years, significant improvement occurred in 22 of 27 patients presenting with pain, 13 of 27 patients with motor or sensory dysfunction, and 11 of 18 patients with bowel and bladder disturbance. In addition, telephone interviews were obtained after a period of 8.6 years. Twenty-two (79%) of 28 patients called the operation a long-term success; 21 (75%) of 28 patients believed that they had significant postoperative improvement (and not just stabilization) in pain and/or neurological function. Surgical complications were generally minor.Nineteen (86%) of 22 employed patients returned to work after surgery. Two (33%) of six patients who were not employed before surgery worked full time postoperatively. Only two of the 28 patients interviewed had received Workers' Compensation benefits; both of these had good outcomes and returned to work.Conclusions.Tethered spinal cord syndrome in adults is an uncommon entity that can become symptomatic. Although surgery in adults involves greater risk of neurological injury than in children, it is a low-risk procedure with encouraging results. Because neurological deficits are generally irreversible, early surgery is recommended.
Basilar invagination: a study based on 190 surgically treated patients
Authors: Goel Atul , Bhatjiwale Mohinish , Desai Ketan 
Published: June 2009

Object. The authors analyzed the cases of 190 patients with basilar invagination that was diagnosed on the basis of criteria laid down in 1939 by Chamberlain to assess the appropriate surgical procedure.
Methods. Depending on the association with Chiari malformation, the anomaly of basilar invagination was classified into two groups. Eighty-eight patients who had basilar invagination but no associated Chiari malformation were assigned to Group I; the remainder of the patients, who had both basilar invagination and Chiari malformation, were assigned to Group II. The principal pathological characteristic was observed to be direct brainstem compression due to odontoid process indentation in Group I and a reduction in posterior cranial fossa volume in Group II.
Conclusions. Despite the anterior concavity of the brainstem in both groups, transoral surgery was the most suitable procedure for those patients in Group I and decompression of the foramen magnum was found to be appropriate for patients in Group II. After surgical decompression, a fixation procedure was found to be necessary in most Group I cases, but only in a small minority of Group II cases.
Mechanical dysfunction of ventriculoperitoneal shunts caused by calcification of the silicone rubber catheter
Authors: Boch Anne-Laure , Hermelin Éric , Sainte-Rose Christian , Sgouros Spiros 
Published: June 2009

Object. The authors studied new and calcified shunt catheters to identify the prevalence of failures caused by aging materials in the shunt. Complications associated with these devices have various origins. Among late complications, fracture or migration of the system is related to the subcutaneous adhesion of the distal tubing in a growing child. A review of a cohort of 64 children who underwent shunt placement in 1980 with barium-impregnated distal catheters showed that 10 of these patients underwent reoperation for complications related to aging of the shunt material. This group represents 15% of the whole series and 30% of those children who were followed for more than 3 years. The true impact of aging of materials on shunt function is probably underestimated.
Methods. The authors performed physical, chemical, and mechanical analyses of the retrieved aged catheters and also of new catheters, resulting in the following findings: 1) calcifications were observed only on the external surface of the catheter, predominantly in its subcutaneous segment at the level of the neck and anterior chest wall; 2) calcifications contained particles of free silicon and barium sulfate, signifying fragmentation of the polymer; 3) the microstructure of the silicone polymer was modified: microfractures and alteration of the polymeric network were observed; 4) silanol groups were observed on the external surface of the catheter; and 5) the mechanical properties of the silicone rubber were degraded, and the aged catheters were more brittle than the new ones, with ruptures at elongations and fracture energy much lower than that seen in new catheters.
Furthermore, in vitro testing with a metastable solution of simulated body fluid demonstrated the critical impact of pH variations in liquid media and surface degradation of the catheters on the precipitation of hydroxylapatite crystals.
Conclusions. Although most shunt complications can be addressed by better patient management and surgical technique, late complications appear to be partly related to aging of the material. Distal tubing calcifications have been observed in barium-impregnated catheters. The industry recently responded to these observations by introducing plain silicone-coated shunt tubing; further evaluation will show what improvement can be expected.