bluuebunny/crossref_metadata_2025_split huggingface dataset:
Missile Injuries to the Brain Treated by Simple Wound Closure: Results of a Protocol during the Lebanese Conflict
Authors: Taha Jamal M. , Saba Maurice I. , Brown Jeffrey A. 
Published: April 2011

Abstract
This is a prospective study of the treatment of penetrating missile injuries to the brain without intracranial surgery carried out at the American University of Beirut Medical Center between 1981 and 1988. Of 600 patients treated for missile injuries to the head. 32 satisfied the study criteria. There were 27 shrapnel and 5 bullet injuries. The mean patient age was 23 years (range, 3-51 years). Twenty patients had intracranial indriven bone fragments. Six patients had exposed brain tissue. The mean follow-up was 3.5 years (range, 1-7.5 years). The superficial entry wound was debrided and closed without drainage in the Emergency Room within a mean of 3 hours (range, 0.5-6 hours), and the patient received methicillin for 14 days. All patients survived and had no or improved neurological deficits. No leakage of the cerebrospinal fluid, infection, or seizures occurred in 31 patients. One patient with indriven bone fragments had leakage of the cerebrospinal fluid and developed seizures and a brain abscess 20 days after the injury. The management of penetrating missile injuries to the brain without intracranial surgery in a select patient population is a reasonable option. This treatment becomes important for a surgeon facing large numbers of casualties, or when operative personnel or resources are limited or unavailable.
The Relationship between Survival and the Extent of the Resection in Patients with Supratentorial Malignant Gliomas
Authors: Quigley Matthew R. , Maroon Joseph C. 
Published: April 2011

Abstract
Current neurosurgical opinion favors the radical surgical removal of supratentorial gliomas, when feasible, in the belief that this optimizes patient survival. Although bolstered by the results of some early investigators, the efficacy of this approach remains debatable. Therefore, we undertook a review of the English language literature of the past 30 years for a series of surgically treated malignant gliomas. Twenty reports comprising 5691 patients were identified. Only 4 found the extent of the surgical resection related to survival. In 2 of these, it followed age, histological findings, and performance status in importance. The 2 other studies did not rank the prognostic variables at all. On closer inspection, however, there does appear to be a subgroup of young patients with favorable histological findings and good performance status for whom surgery is beneficial. Future reporting of surgical results of patients with gliomas will require stratification by the known prognostic variables of age. histological findings, and performance status to characterize better this subgroup for whom surgery is beneficial.
Percutaneous Drainage and Serial Magnetic Resonance Imaging in the Diagnosis of Symptomatic Posttraumatic Syringomyelia: Case Report and Review of the Literature
Authors: Levy Robert , Rosenblatt Szymon , Russell Eric 
Published: April 2011

Abstract
A patient with high cervical tetraplegia with new-onset headaches and posttraumatic syringomyelia is presented. Percutaneous drainage of the syrinx resulted in a resolution of the headaches and collapse of the syrinx on follow-up magnetic resonance imaging (MRI). The return of the symptoms correlated with the re-expansion of the syrinx on MRI. The patient underwent syringopleural shunting with persistent resolution of the symptoms and collapse of the syrinx on MRI. The value of percutaneous drainage and serial MRI to determine the clinical significance of posttraumatic syringomyelia is discussed.
Screening for Unruptured Familial Intracranial Aneurysms: Subarachnoid Hemorrhage 2 Years after Angiography Negative for Aneurysms
Authors: Schievink Wouter I. , Limburg Martien , Dreissen Rob J. J. , Peeters Frans L. M. , ter Berg Hans W. M. 
Published: April 2011

Abstract
The screening of asymptomatic individuals in families with intracranial aneurysms has been advocated to detect unruptured aneurysms before a major hemorrhage occurs. We report a 39-year-old male member of a large Dutch family, with a documented history of intracranial aneurysms, who suffered a subarachnoid hemorrhage 2 years after cerebral digital subtraction angiography using intravenously administered contrast medium showed no abnormalities. Conventional arteriography demonstrated three intracranial aneurysms measuring 3 × 3 mm. Potential alternative screening procedures are discussed.
Traumatic Aneurysm of the Posterior Inferior Cerebellar Artery: Case Report
Authors: Morard M. , de Tribolet N. 
Published: April 2011

Abstract
We report a case of a traumatic aneurysm of the posterior inferior cerebellar artery caused by an occipital fracture. The necessity to suspect a vascular traumatic lesion when an unusual subarachnoid hemorrhage is seen on the computed tomographic scan in a case of trauma is stressed.
Malignant Carcinoid Tumor Metastatic to the Dura Mater Simulating a Meningioma
Authors: Huang Peter S. , Oz Mustafa 
Published: April 2011

Abstract
A 50-year-old man, transferred from another hospital, was admitted because of adult onset seizures. Nine months earlier, he had undergone an esophagogastrectomy; the lesion was confirmed to be a carcinoid tumor. Laboratory tests, chest x-rays, and electrocardiogram were normal. A second liver and spleen scan was performed. A computed tomographic scan revealed a well-circumscribed homogeneous enhancement of a lesion in the left frontal superficial area. On the 10th day. the patient underwent a left frontal parietal craniotomy. Postoperatively, he manifested no residual neurological deficits and was discharged on the 6th postoperative day. A week later, he was readmitted for treatment of aphasia and right hemiparesis; he was treated and discharged. The patient survived 16 more months. The occurrence of central nervous system metastasis from carcinoid tumor is rare. This tumor resembled, in many respects, a parasagittal meningioma. Radiological findings on the computed tomographic scan were typical of these tumors. This patient was diagnosed as having metastatic disease just 9 months after the diagnosis of the primary tumor and 13 months from the onset of any symptoms. This is a short period of time compared with that reported in other cases.
Management of Athletic Injuries of the Cervical Spine and Spinal Cord
Authors: Bailes Julian E. , Hadley Mark N. , Quigley Matthew R. , Sonntag Volker K.H. , Cerullo Leonard J. 
Published: April 2011

Abstract
Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral colum n and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty-five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group. The athlete with fractures involving a significant structural portion of the vertebral column, ligament instability, spinal cord contusion, or congenital cervical stenosis, is advised not to return to contact sports. Other radiological abnormalities, such as compromise of the ligaments, congenital fusion, degenerative disease, and herniated cervical disc require individual consideration. The rationale for treatment and advising for participation in sports are discussed. We believe that this classification of sports injuries offers clinicians a framework within which to make rational judgments and recommendations in the management of athletes with cervical spine injuries.
Pediatric Pituitary Tumors
Authors: Haddad Souheil F. , VanGilder John C. , Menezes Arnold H. 
Published: April 2011

Abstract
This retrospective review of pediatric patients with pituitary tumors causing onset of symptoms by 17 years of age was done to define their pathological distribution, clinical presentation, treatment, and prognosis. Eighteen patients were evaluated and treated from 1979 to 1989. Five had Cushing's disease and 13 had prolactin-secreting tumors. The mean age at the onset of symptoms was 14.7 years, with a range of 7 to 17 years. The mean follow-up period was 4.6 years, and the series consisted of 15 girls and 3 boys. Four of the 5 patients with tumors secreting adrenocorticotropic hormone were girls. The five patients exhibited obesity, hypertension, and growth retardation. The mean age of this group of patients at diagnosis was 12.2 years, and all had intrasellar lesions removed by the transsphenoidal approach. Adenoma was documented in 4 cases by histopathology. There was complete resolution of the endocrinological and clinical abnormalities in each case. The group of patients with prolactinomas comprised 11 girls and 2 boys, and their mean age at diagnosis was 15.7 years. The girls exhibited either primary or secondary amenorrhea. Seven had macroadenomas and 4 had microadenomas. Nine of the 11 girls underwent transsphenoidal resection, and surgery failed in 6, based on hormonal or radiological data. The two boys had suprasellar tumor extension and required multiple surgical procedures plus radiation therapy for control of the tumor mass.
Noninvasive Intraoperative Monitoring of Motor Evoked Potentials under Propofol Anesthesia: Effects of Spinal Surgery on the Amplitude and Latency of Motor Evoked Potentials
Authors: Jellinek David , Jewkes Doreen , Symon Lindsay 
Published: April 2011

Abstract
We present the results of intraoperative monitoring of motor evoked potentials from 34 patients undergoing spinal surgery under total anesthesia with intravenously administered propofol. intraoperative recording was performed with transcranial electrical stimulation. Two groups of patients were studied: 1) a control population of 26 patients undergoing lumbar discectomy for prolapsed intervertebral disc, all of whom had normal preoperative motor conduction; and 2) a population of 8 patients undergoing neurosurgical procedures for spinal tumor (5 patients) and spinal arteriovenous malformation (3 patients), all of whom had abnormal preoperative neurological signs and abnormal preoperative motor conduction. In the first group, electromyographic responses were recorded intraoperatively either from the 2nd dorsal interosseous muscle of the hand (5 patients) or from the 1st dorsal interosseous muscle of the foot (21 patients). In the second group, responses were recorded intraoperatively either from the 1st dorsal interosseous muscle of the foot (7 patients) or from the anterior tibial muscle (1 patient). Intraoperative monitoring of motor function was successful in 88.5% of the patients in the control group. Propofol anesthesia caused a reduction in response amplitude to 7% of baseline values obtained from conscious relaxed subjects. Intraoperative monitoring was successful in 87% of the patients in the pathological group. We observed significant changes in both amplitude (&gt;50%) and/or onset latency (&gt;3 ms) from the intraoperative baseline that indicated cither improvement (3 patients) or deterioration (2 patients) in motor conduction within minutes of surgical maneuvers anticipated to alter spinal cord function. Only permanent complete loss of intraoperative motor conduction (1 patient) correlated with a significant change in the postoperative neurological state. We conclude 1) that changes in latency as well as amplitude are useful evaluation criteria of intraoperative motor evoked potentials, and 2) that even in the presence of significant intraoperative deterioration in motor conduction, subsequent recovery of motor conduction toward baseline values during anesthesia is a favorable prognostic sign.
“One-and-a-Half” Syndrome after a Resection of a Midline Cerebellar Astrocytoma: Case Report and Discussion of the Literature
Authors: Newton Herbert B. , Miner Michael E. 
Published: April 2011

Abstract
This report describes a rare complication after the resection of a tumor of the posterior fossa, the “one-and-a-half” syndrome. The one-and-a-half syndrome is a disturbance of horizontal eye movements in which patients have lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other direction. The patient was a 54-year-old woman who developed headaches, diplopia, and blurred vision over 6 months. Computed tomographic scans and magnetic resonance imaging demonstrated an enhancing, mixed density, midline mass of the cerebellum. After a resection of the mass, an anaplastic astrocytoma, the patient complained of more severe diplopia and facial weakness. An examination disclosed a left one-and-a-half syndrome, left peripheral facial paralysis, dysarthria, dysphagia, mild left hemiparesis, dysmetria of the left upper limb, and truncal ataxia. The brain stem showed no abnormalities on postoperative computed tomographic scans. After 4 months of follow-up, the one-and-a-half syndrome had not improved, even though other signs had improved or resolved. This syndrome is caused by damage to structures within the pontine tegmentum: the medial longitudinal fasciculus, the ipsilateral paramedian pontine reticular formation, or the ipsilateral abducens nucleus. Multiple sclerosis and brain stem infarctionn are the most common causes of the one-and-a-half syndrome. Less frequently, it is caused by primary and metastatic tumors of the brain stem and cerebellum. Rarely, the one-and-a-half syndrome can develop postoperatively after the removal of tumors of the posterior fossa. The mechanism of pontine tegmental injury remains unknown.
An Adjustable Ventriculoscope Guide for Use with Stereotactic Frames
Authors: Frank Edmund 
Published: April 2011

Abstract
A ventriculoscope guide intended for use with stereotactic frames is described. This guide allows the ventriculoscope to be moved freely and then fixed rigidly into position without readjustment of the stereotactic frame. This design address requirements for extremely strong fixation of the ventriculoscope, adaptability to most stereotactic systems, and minimal damage to the brain tissue traversed by the ventriculoscope.
Intracranial Infection after Missile Injuries to the Brain: Report of 30 Cases from the Lebanese Conflict
Authors: Taha Jamal M. , Haddad Fuad S. , Brown Jeffrey A. 
Published: April 2011

Abstract
This study reviews the features of 30 intracranial infections complicating 600 penetrating head injuries from missiles in patients treated at the American University of Beirut Medical Center between 1981 and 1988. The follow-up period ranged from 1 month to 7 years (mean, 2.5 years). Sixteen patients had a brain abscess, 9 had cerebritis, 2 had an infected intracerebral hematoma, and 5 had meningitis. Infection developed 4 days to 7 years after the initial debridement. The infecting organisms were Gram positive in 11 patients (36%), Gram negative in 12 (40%), and a combination of Gram positive and Gram negative in 2 (7%). Twenty-four patients (80%) had wound dehiscence or cerebrospinal fluid leakage at the time the infection appeared. There was a 76% correlation between the organisms cultured from the dehisced scalp wound and the brain. Twenty-three patients had intracranial retention of bone. Infection developed in 16 of the 30 patients (70%) around bone fragments, in 4 around a metallic fragment, in 2 around absorbable gelatin sponge, and in 3 along the missile tract; 2 had an infected intracerebral hematoma, and 3 had meningitis. At least one of the following risk factors was present in each patient: extensive brain injury, coma, trajectory through an air sinus, cerebrospinal fluid fistula, inadequate initial debridement, or incomplete dural closure. The incidence of intracranial infection in patients with postoperative retention of bone was 4% in the absence of scalp wound dehiscence, compared with 84.6% when wound dehiscence was present. Ten patients (43%) still retained a bone fragment measuring less than 1 cm after excision of a brain abscess or treatment of cerebritis or meningitis. None developed a recurrent infection. The authors conclude that a bone fragment measuring less than 1 cm that is retained after treatment of intracranial infection caused by a missile injury to the brain does not have to be removed when there is not wound dehiscence or leakage of cerebrospinal fluid.
Special article
Authors: Ray Charles D. 
Published: April 2011

Abstract
Neurosurgeons may derive as much as 62% of their professional income from and perform proportionately as large a number of procedures on the lumbar spine. Publications in neurosurgical journals, presentations at national and international neurosurgical meetings, and participation in organized neurosurgical symposia are, however, relatively sparse in this area of activity. It appears, therefore, that the lumbar spine must have minimal academic interest to neurosurgeons, as compared with the surgical areas where they have clinical domain, i.e., the brain and spinal cord. In that this clear discrepancy between what they do (their source of income) and what they talk about and publish is apparently not well known to neurosurgeons or their professional society directors, this paper is presented as objective, awakening evidence. The potential impact on future patient draw, professional prowess, and income, which may result from a continuation of this wide gap, is also discussed.
Spinal Cord Stimulation Electrode Design: Prospective, Randomized, Controlled Trial Comparing Percutaneous and Laminectomy Electrodes—Part I: Technical Outcomes
Authors: North Richard B. , Kidd David H. , Olin John C. , Sieracki Jeffrey M. 
Published: April 2011

Abstract

OBJECTIVE
The clinical use of spinal cord stimulation for treatment of chronic intractable pain has been increasingly successful because of recent technical improvements, particularly the development of multiple-contact electrodes supported by programmable implanted pulse generators. Contemporary electrodes can be placed percutaneously in some cases and require a limited laminectomy in other cases.

METHODS
We performed a prospective, randomized, controlled trial comparing two prototypical electrode designs, using a computerized system that allows direct patient interaction and quantitative measurements. A series of 24 patients with chronic lumbosacral pain syndromes first underwent testing with percutaneous four-contact electrodes and then underwent implantation, at the same spinal level, of one of two different electrode configurations; 12 patients received a new percutaneous four-contact electrode of the same design and 12 received an insulated four-contact array, which was implanted via laminectomy.

RESULTS
The insulated array performed significantly (P = 0.0005–0.0047) better than the temporary percutaneous electrode for the same patients, according to all three measures tested (ratings of paresthesia coverage of pain, coverage calculated from patient drawings, and amplitudes), at the “usage” amplitude for the three standard bipoles examined. The insulated array also performed significantly (P = 0.0000–0.026) better than the permanent percutaneous electrode in terms of coverage ratings and amplitude requirements. Low back coverage ratings were significantly better for the insulated array than for the temporary percutaneous electrode, and scaled amplitudes necessary for low back coverage were significantly better for the permanent percutaneous electrode than for the temporary electrode. In comparison with the percutaneous temporary electrode, at subjectively identical stimulation intensities, the permanent insulated array required significantly lower amplitude.

CONCLUSION
We can immediately infer from these technical data that the use of an insulated array, in comparison with a percutaneous electrode, would double battery life. Extended follow-up monitoring will be required to assess the extent to which the technical advantages we observed for the insulated array might be associated with improved clinical outcomes.
Oxidative Stress Survival in a Clinical Saccharomyces cerevisiae Isolate Is Influenced by a Major Quantitative Trait Nucleotide
Authors: Diezmann Stephanie , Dietrich Fred S 
Published: April 2011

Abstract
One of the major challenges in characterizing eukaryotic genetic diversity is the mapping of phenotypes that are the cumulative effect of multiple alleles. We have investigated tolerance of oxidative stress in the yeast Saccharomyces cerevisiae, a trait showing phenotypic variation in the population. Initial crosses identified that this is a quantitative trait. Microorganisms experience oxidative stress in many environments, including during infection of higher eukaryotes. Natural variation in oxidative stress tolerance is an important aspect of response to oxidative stress exerted by the human immune system and an important trait in microbial pathogens. A clinical isolate of the usually benign yeast S. cerevisiae was found to survive oxidative stress significantly better than the laboratory strain. We investigated the genetic basis of increased peroxide survival by crossing those strains, phenotyping 1500 segregants, and genotyping of high-survival segregants by hybridization of bulk and single segregant DNA to microarrays. This effort has led to the identification of an allele of the transcription factor Rds2 as contributing to stress response. Rds2 has not previously been associated with the survival of oxidative stress. The identification of its role in the oxidative stress response here is an example of a specific trait that appears to be beneficial to Saccharomyces cerevisiae when growing as a pathogen. Understanding the role of this fungal-specific transcription factor in pathogenicity will be important in deciphering how fungi infect and colonize the human host and could eventually lead to a novel drug target.