bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of malignant glioma patients during the postirradiation period
Authors: Hoffman William F. , Levin Victor A. , Wilson Charles B. 
Published: May 2009

✓ The syndrome of increased focal or generalized central nervous system (CNS) dysfunction in the early postirradiation period in patients treated with radiation therapy (RT) for malignant gliomas has not been well documented. The authors have undertaken retrospective study of 51 patients with supratentorial malignant gliomas who survived longer than 26 weeks from the time of diagnosis. All patients received irradiation and chemotherapy and were evaluated at 8-week intervals. Each evaluation consisted of a neurological examination, computerized tomography (CT) and radionuclide scans, Karnofsky rating, and an evaluation of glucocorticoid levels needed to maintain neurological function. In all, 263 evaluable periods, consisting of 1290 individual evaluable tests (parameters), were analyzed. In the first 18 weeks after RT, 26 of the 51 patients studied (51%) showed deterioration in one or more tests; 14 of the 26 (53%) did not improve. These 14 patients had a median time to tumor progression (MTP) of 31 weeks. The remaining 12 patients in this group (47%) improved and had an MTP of 73 weeks. Of the 51 patients, 25 (49%) showed deterioration significant enough to presume tumor progression (two of the following three tests were unequivocally worse: neurological examination, CT scan, and radionuclide scan), seven improved with no change in therapy and had an MTP of 66 weeks, while the other 18 had an MTP of 32 weeks. Excluding the Karnofsky rating, any individual test that showed worsening during the first 18-week period had a 33% probability of significant improvement at a subsequent evaluation period. After 18 weeks the probability of the test improving was only 4%.
The authors conclude that CNS decompensation up to 18 weeks after RT, as ascertained from clinical examination, scans, or glucocorticoid dosage, does not invariably predict tumor progression, because in 28% (7/25) of such cases there will be subsequent improvement.
The physiopathology of respiration in neurosurgical patients
Authors: Frost Elizabeth A. M. 
Published: May 2009

✓ Regulation of respiration is summarized as to peripheral and central chemoreceptors, controllers of voluntary and automatic respiration, and stimulators (CO2, O2, and pH). The information that may be obtained from blood-gas analysis is reviewed and basic problems in acid-base imbalance described. Commonly employed respiratory patterns are discussed.
Preoperative pulmonary assessment necessary in elective intracranial situations, spinal cord injuries, and pediatric neurosurgery is outlined. Some of the special problems of the patient with multiple trauma, including injury to the central nervous system are reviewed. Central and peripheral factors that cause respiratory difficulty in head-injured patients are tabulated, and an outline is given of diagnosis and therapy. There are many possible causes of intraoperative hypoxia and hypercarbia, and these complications with their prevention or treatment are examined. Criteria for extubation are established. Finally, postoperative pulmonary care in elective, emergency, and cord injury situations is discussed. The key to successful perioperative pulmonary care of the neurosurgical patient requires close cooperation between the neurosurgeon and anesthesiologist.
Pulmonary shunt as a prognostic indicator in head injury
Authors: Frost Elizabeth A. M. , Arancibia Carlos U. , Shulman Kenneth 
Published: May 2009

✓ Severe head injury may cause momentary respiratory arrest. Resultant hypoxia would increase cerebral edema and adversely affect the quality of survival. This study examines the effect of hypoxemia on outcome. Pulmonary shunt was calculated as a convenient measurement of respiratory insufficiency in 86 severely head-injured patients who underwent surgery. All samples were taken shortly after induction into anesthesia when controlled ventilation with high inspired-oxygen concentration had been established. In 39 patients who improved, mean pulmonary shunt was 8.9%. Twelve patients who survived with deficit showed a mean shunt of 13.6%, and in 35 patients who died, the mean initial shunt was 15.6%. No significant correlation was found between abnormal chest x-ray findings or the occurrence of hypertension and shunt percentage. The American Society of Anesthesiologists at-risk classification correlated grossly with the outcome.
Early pulmonary shunt is a prognostic indicator in severe head injury and should be used in conjunction with the Glasgow Coma Scale in assessing outcome. Despite an apparently adequate respiratory pattern, all patients with severe head injury must be assumed to be hypoxic until proven otherwise. While hypoxemia may prove to be refractory in overwhelming injury, patients who score low on the Glasgow Coma Scale but who have relatively normal oxygen exchange may still survive with little deficit.
Intracranial aneurysms
Authors: Andrews Russell J. , Spiegel Peter K. 
Published: May 2009

✓ All cases of intracranial aneurysm, arteriovenous malformation, and subarachnoid hemorrhage of undetermined etiology seen at one hospital over a 13-year period were reviewed to assess relationships between age, sex, systolic and diastolic blood pressure, and number of aneurysms. There were 350 patients, of whom 212 had aneurysms. The major findings were as follows: 1) Hypertension was not significantly more prevalent in the aneurysm population than in the age-matched general population, except for females aged 18 to 54 years (systolic pressure elevation of 10 to 15 mm Hg). 2) Under 55 years of age, both male and female hypertensive patients were twice as likely to have multiple aneurysms as normotensive patients. 3) Females were more likely than males to have multiple aneurysms. 4) For females but not males, increasing age, higher systolic pressure, and higher diastolic pressure all correlated with an increasing number of aneurysms.
Hypertension appears to be more prevalent in certain subgroups of the total aneurysm population, although the individual relationships between hypertension, atherosclerosis, and aneurysms cannot be determined from either the present or previous studies. The possible role of familial factors, as well as implications for both diagnosis and further research, are briefly noted.
Surgical hemostasis
Authors: Owen Charles A. , Bowie E. J. Walter 
Published: May 2009

✓ Every surgical procedure taxes the hemostatic defenses of the patient. If his hemostatic mechanism is sound, he is unlikely to have a bleeding problem during or after an operation, unless, of course, a suture or clip slips off. Two classes of patients do present bleeding problems to the surgeon. One group has a pre-existing bleeding tendency, the other acquires it during or after the operation.
The recognition of patients with severe hemostatic disabilities, such as hemophilia, presents no problem since the patient is aware of the disease. The mild bleeder is less likely to be detected by screening tests than by adroit questioning. The major hemostatic defect that may develop during an operation, or shortly thereafter, is disseminated intravascular coagulation. This syndrome, always secondary, may accompany shock, mismatched blood transfusion, septicemia, or extensive malignancy. Its prevention or early recognition is much easier than treatment after circulating platelets and some coagulation factors have been consumed and fibrinolysis is destroying fibrin and fibrinogen.
Protective effects of steroids on the cortico-microcirculation injured by cold
Authors: Soejima Tohru , Yamamoto Y. Lucas , Meyer Ernst , Feindel William , Hodge Charles P. 
Published: May 2009

✓ Early microcirculatory changes after focal cold injury of the cerebral cortex were examined in dogs with and without steroids by serial fluorescein angiography of the brain (FAB), by measurement of the diameter of epicerebral vessels, and by measurement of cerebral blood flow with the clearance method using krypton-85 and xenon-133. Changes in the transcerebral vessels were examined by x-ray projection microangiography.
Within 30 minutes of the injury, the cortical area injured by a temperature of −65° C showed a reduction in blood flow of 60%. When treated with steroids and while still at the same temperature, blood flow was reduced by only 35%. Serial FAB revealed slowing and arrest of flow in the epicerebral microcirculation which could be noted first in the small veins, then in the medium-sized veins and small arteries. Fluorescein dye leaked from the epicerebral vessels, around the small veins, then around larger veins and small arteries. Some leakage of dye from medium-sized arteries was noted 2 hours after injury. This sequence of slowing and arrest of the microcirculation, with exit of dye from intact arterial vessels, identified here for the first time in relation to a cortical freezing lesion, may help to explain the development of later brain edema which spreads widely in the subcortical white matter. After steroids, improvement of the microcirculation was present as defined by cortical blood flow, fluorescein angiography, and x-ray projection microangiography.
Relation of cerebral blood flow to neurological status and outcome in head-injured patients
Authors: Obrist Walter D. , Gennarelli Thomas A. , Segawa Hiromu , Dolinskas Carol A. , Langfitt Thomas W. 
Published: May 2009

✓ Noninvasive studies of regional cerebral blood flow (CBF) were performed on 36 head-injured patients in varying degrees of coma, using the intravenous xenon-133 method. Serial examinations, averaging four per patient, were begun during the acute phase of illness and continued until death or recovery of normal consciousness. Comparison of the initial and final studies revealed that CBF declined to very low levels in all nine patients who died, and remained subnormal in a patient with persistent vegetative state. In contrast, 25 of 26 patients who recovered consciousness showed increases in blood flow.
Because of the presence of both reduced and elevated blood flows on the initial study, CBF was not predictive of outcome. Absolute or relative hyperemia, observed in nine acute cases, was associated with either diffuse cerebral swelling (observed on computerized tomography) or recovery from systemic shock. Cerebral metabolic studies in hyperemic patients yielded a very low oxygen uptake and arteriovenous oxygen difference, indicating that the high blood flow was a true “luxury perfusion.” When instances of presumed luxury perfusion were excluded, CBF was positively correlated with level of consciousness, assessed on a four-point coma scale.
Intraspinal tumors in children
Authors: DeSousa Alonso L. , Kalsbeck John E. , Mealey John , Campbell Robert L. , Hockey Arthur 
Published: May 2009

✓ The authors have presented 81 children with intraspinal tumors, all less than 16 years of age. The clinical features indicated that gait disturbance, pain, and sphincter disturbance are the most prominent complaints. Reflex changes, paralysis, and sensory impairment are the most frequent physical findings. Cerebrospinal fluid protein was recorded in 47 patients and was abnormal in 34. Spine radiography was abnormal in 58% of the patients. Seventy of the patients had myelography, and it was diagnostic in 67. Surgery was performed on 79 patients, with a 2.5% operative mortality (30 days postsurgery). Of the 49 patients who are alive, 91.5% are able to walk. Mean follow-up period was 8.5 years.
The authors document the benign course of the intramedullary astrocytomas and suggest an approach to their treatment. They encourage an aggressive approach to metastatic intraspinal tumors. The iatrogenic origin of some epidermoid tumors is noted. The importance of early diagnosis and treatment of the intraspinal tumors in children is emphasized.
Direct surgical treatment of giant intracranial aneurysms
Authors: Hosobuchi Yoshio 
Published: May 2009

✓ The author has operated on 40 patients with giant intracranial aneurysms, using various surgical approaches. Giant aneurysms predominated in females (3:1) and were most common in the age group 30 to 60 years. Patients presented with subarachnoid hemorrhage (17), visual disturbance (18), chronic headache (14), transient or progressive hemispheric deficit (6), seizure (2), dementia (2), and cerebrospinal fluid rhinorrhea (1). Giant aneurysms were located at the carotid artery (25), the basovertebral artery (8), the anterior communicating artery (5), and the middle cerebral artery (2). Eight of 40 patients had one or more other aneurysms and/or associated arteriovenous malformations. Aneurysms were treated with intramural thrombosis (21), neck occlusion (7), trapping (10), proximal parent artery ligation (1), and aneurysmorrhaphy (1). After as much as 8 years of follow-up, 32 patients (80%) showed complete or marked improvement in signs and symptoms; two patients (5%) had a poor recovery. There were six surgical mortalities (15%).
Giant aneurysms can be treated with respectable results if the surgeon selects the technique best suited to the particular aneurysm. In general, neck occlusion, trapping, and aneurysmorrhaphy are best for giant aneurysms of the anterior circulation, and intramural thrombosis is best for those of the posterior circulation. Extra- and intracranial vascular anastomotic techniques are also of value. For success, a flexible approach is essential.
Ineffectiveness of enzyme therapy on regeneration in the transected spinal cord of the rat
Authors: Guth Lloyd , Albuquerque Edson X. , Deshpande Sharad S. , Barrett Charles P. , Donati Edward J. , Warnick Jordan E. 
Published: May 2009

✓ The potential clinical significance of the experiments of Matinian and Andreasian prompted repetition of their experiments. A laminectomy was made at T-5 or T-8 in 92 young female rats, and a fine wire probe was passed beneath the intact cord. The cord was then transected and the probe lifted through the incision so as to ensure the completeness of the transection. Rats were injected with various enzymes of American or Russian manufacture, including trypsin, hyaluronidase, elastase, elastase plus trypsin, or vehicle. At autopsy 4 to 6 months later, all rats were paraplegic. The stumps of the spinal cord were separated by cysts and a fibroglial scar. Nerve fibers did not cross the lesion site, nor was there conduction of nerve impulses across the site of injury. There were no significant behavioral, histological, or electrophysiological differences between any of the treatment groups.
Transection of the spinal cord was then performed in additional animals using Matinian and Andreasian's original surgical method (without passing a probe beneath the intact cord). Most of these rats began walking within 2 to 3 weeks, without enzyme therapy. Histological analysis revealed intact nerve fibers in the ventrolateral region of the spinal cord, indicating that the spinal cord had not been completely transected. It is concluded that: 1) enzyme treatment neither facilitates nerve regeneration nor permits functional restitution in rats with spinal cord transection; and 2) previously reported findings were apparently the result of incomplete spinal transection.
Studies of experimental cervical spinal cord transection
Authors: Tibbs Phillip A. , Young Byron , Todd Edward P. , McAllister R. G. , Hubbard Steve 
Published: May 2009

✓ Effects of cervical cord transection on total and regional myocardial blood flow and coronary vascular resistance were studied in anesthetized dogs using 15-µm microspheres. Left atrial catheters were inserted by thoracotomy in 10 dogs and iodine-125-labeled microspheres were injected to measure baseline tissue blood flows by means of the reference flow technique. Four dogs then underwent laminectomy of the C-6 vertebra (control group), and six underwent laminectomy and cord transection (experimental group). Microspheres labeled with cerium-141, strontium-85, and scandium-46 were injected at 15, 30, and 120 minutes, respectively, after surgical intervention. The dogs were sacrificed, and the radioisotope content of specimens of epicardial, mid-myocardial, and endocardial tissues was determined by differential spectrometry, and tissue blood flow was calculated in relation to arterial reference specimens.
No significant differences in baseline endocardial, epicardial, or mid-myocardial blood flow were detected between the control and experimental groups. Tissue blood flows fell significantly in all regions (p < 0.05 or less) at 15, 30, and 120 minutes after transection. No major alteration of the endocardial/epicardial flow ratio occurred, and no electrocardiographic or pathological evidence of ischemia was seen. When corrected for variations in systemic arterial pressure, no differences in coronary vascular resistance between control and cord-transected dogs were observed. These findings suggest that the decreased coronary blood flow following cervical cord transection is secondary to decreased mean arterial pressure rather than to altered coronary vascular resistance. Pharmacological augmentation of perfusion pressure may therefore be necessary to maintain adequate coronary blood flow in patients with acute cord injury who have pre-existent cardiac disease.
The effect of phenobarbital on the toxicity and tumoricidal activity of CCNU in a murine brain tumor model
Authors: Muller Paul J. , Tator Charles H. , Bloom Martin 
Published: May 2009

✓ The nitrosoureas are known to be substrates for hepatic microsomal enzymes. Since phenobarbital (PB) is a potent inducer of hepatic microsomal enzymes, and since PB and other enzyme-inducing drugs are commonly used in patients with brain tumors, the authors have assessed the effect of PB pretreatment on the toxic and tumoricidal activity of CCNU in a murine model.
In C57B1/6J mice, PB pretreatment markedly reduced the lethal toxicity of high doses of CCNU. The LD99 dose of CCNU was found to be 80 mg/kg given intraperitoneally. Pretreatment with PB reduced the toxic death rate of CCNU at 40, 60, 90, or 120 mg/kg to less than 10% (p < 0.01). Pretreatment with PB also reduced the tumoricidal activity of CCNU. In an intracerebral murine ependymoblastoma, intraperitoneal CCNU alone, at 30 mg/kg given on the 5th day after tumor transplantation, produced a percent increased life span (%ILS) of > 300, and 18 of 25 were long-term survivors (LTS). In contrast, after four daily doses of PB prior to the same dose of CCNU, the %ILS was reduced to 85 with no LTS among 25 mice (p < 0.01). When CCNU was given alone at 30 mg/kg intraperitoneally on Day 10, a %ILS of > 300 with 22 of 25 LTS resulted; whereas, PB pretreatment reduced the %ILS to 15, with two of 25 LTS (p < 0.01). When CCNU was administered directly into the tumors intracerebrally at 30 mg/kg on Day 10, the %ILS was > 300, with 16 of 20 LTS; whereas, PB pretreatment reduced the %ILS to 50 with five of 20 LTS (p < 0.01). Furthermore, PB pretreatment significantly reduced the ability of CCNU to retard tumor growth in a subcutaneous murine ependymoblastoma.
Thus, PB pretreatment significantly altered the activity of CCNU. Since enzyme-inducing drugs are so commonly used in patients with brain tumors, it is possible that the clinical failure of nitrosoureas in some cases may be due to an unsuspected drug antagonism.
Idiopathic normal-pressure hydrocephalus
Authors: Black Peter McL. 
Published: May 2009

✓ Of 62 patients given shunts for normal-pressure hydrocephalus of idiopathic type, 46.8% showed some improvement and 27.4% enjoyed virtually complete recovery. The best clinical predictor of good response was the complete triad of memory difficulty, gait disorder, and urine incontinence; 61.2% of patients with this combination of symptoms improved. Gait disturbance alone was also accompanied by improvement in two of three patients. An “obstructive” cisternographic radioisotope pattern was not significantly different from a “normal” pattern in predicting a response to shunting. Computerized tomography (CT) showing large ventricles and little atrophy predicted improvement in 11 out of 13 patients. There were five deaths within 3 months of shunting. The complication rate was 35.4%; subdural collections, shunt malfunction, and postoperative seizures constituted the most frequent complications.
These data suggest that continued investigation for better predictions of shunt response is important, but that in the meantime the clinical pattern and cranial CT pattern are the most satisfactory guides to improvement after shunting.
Spinal neurological complications of achondroplasia
Authors: Morgan David F. , Young Ronald F. 
Published: May 2009

✓ Spinal neurological complications caused the admission of 17 patients with achondroplasia to the UCLA affiliated hospitals between 1955 and 1979. These patients constituted 41% of all achondroplastic patients admitted during that period. The spinal stenotic syndromes could be divided into three groups: Group I: thoracolumbar stenosis (10 patients); Group II: foramen magnum and upper cervical stenosis (five patients); and Group III: generalized spinal stenosis (two patients). Eleven patients underwent a total of 18 decompressive operative procedures for treatment of paraparesis, quadriparesis, sensory deficits, and sphincter dysfunction. Excellent results were obtained with patients in Group I and II, 77% of whom were ambulatory and continent postoperatively. Two patients in Group III fared less well, showing steady neurological deterioration despite multiple operative procedures.
The spectrum of spinal neurological manifestations secondary to achondroplasia is reviewed. Problems with conventional radiological studies and the potential role of computerized tomographic analysis of such patients are discussed. Recommendations for surgical technique are made. Early recognition, prompt clinical evaluation, and safe and accurate radiological analysis of spinal neurological complications of achondroplasia will allow appropriate decompressive surgical procedures to be performed. Excellent results may be anticipated in the reversal and prevention of neurological deficit secondary to achondroplasia with such an approach.
Homovanillic acid and 5-hydroxyindoleacetic acid in the ventricular CSF of comatose patients with obstructive hydrocephalus
Authors: Inagawa Tetsuji , Ishikawa Susumu , Uozumi Tohru 
Published: May 2009

✓ Ventricular cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) were determined every 2 to 4 hours over a period of 1 to 4 days in 12 patients, consisting of seven cases of brain tumor, two cases of cerebrovascular disease, and three cases of head injury. The concentrations of HVA and 5-HIAA varied with time in all cases, and significant correlations were found between the two values in eight cases. However, the relationship between variations of HVA and 5-HIAA levels and rhythms of sleep and waking could not be clarified. Both HVA and 5-HIAA concentrations varied at high levels in two patients whose CSF flow was completely blocked by tumor at the site of the fourth ventricle and aqueduct, respectively. On the contrary, in a case with craniopharyngioma in the third ventricle which blocked the bilateral foramina of Monro, although the HVA values were high, the 5-HIAA values varied at low levels. Of five comatose patients, two had cerebrovascular lesions and three had sustained head injury, and, in four of the five, the values of either one or both of HVA and 5-HIAA were low, but in the fifth case the 5-HIAA value was high.
Estimation of HVA and 5-HIAA concentrations in ventricular CSF may be a valuable tool in the investigation of brain monoamine metabolism. However, many factors must be considered in the interpretation of results of clinical studies.