bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications of surgery for arteriovenous malformations of the brain
Authors: Morgan Michael K. , Johnston Ian H. , Hallinan John M. , Weber Neville C. 
Published: May 2009

✓ A series of 112 patients undergoing complete surgical resection of arteriovenous malformations (AVM's) of the brain between 1974 and 1990 were analyzed for complications and 12-month outcomes. The cohort consisted of 44 patients with small AVM's (< 2 cm in diameter), 43 patients with medium-sized AVM's (2 to 4 cm in diameter), and 25 patients with large AVM's (> 4 cm in diameter). There was a 3.6% series mortality rate and an 18% morbidity rate. One of the four deaths was caused by normal perfusion pressure breakthrough. Analysis of logistic regression found that the most important factor influencing the occurrence of complications in this series was AVM size (p = 0.005) and that the occurrence of complications (p < 0.001) and the neurological grade at the time of surgery (p < 0.004) both significantly contributed to the outcome at 12 months.
This study stresses the importance of defining complications in terms of rigid criteria when analyzing AVM series in order to allow for a correct evaluation of the risk:benefit ratio of surgery. Furthermore, it emphasizes the need for a separate analysis of the importance of complications upon outcome.
Decompressive lumbar laminectomy for spinal stenosis
Authors: Silvers H. Roy , Lewis P. Jeffrey , Asch Harold L. 
Published: May 2009

✓ A total of 258 consecutive decompressive lumbar laminectomies performed on 244 individuals presenting with spinal stenosis were analyzed retrospectively. Spinal fusion was avoided in all but two patients. Outcome in terms of pain relief and return to normal activity was evaluated in two stages, one derived from patient charts and having a relatively short-term follow-up time (mean 8.4 months) and a second derived from patient responses to a questionnaire (which also scored for satisfaction with the results of surgery), which had a longer follow-up time (mean 4.7 years). More than 20 clinical and operative parameters were analyzed. Overall, a high degree of success (93% pain relief, 95% return to normal activity) was achieved in the short term, which was supported by the longer-term follow-up data (64% pain relief, 56% activity return, 75% satisfaction). The following factors were not significantly correlated with outcome: patient age; sex; worker's compensation or no-fault insurance status; employed versus not employed; a history of back surgery prior to the laminectomy studied; existence of degenerative spondylolisthesis or scoliosis; complete versus incomplete myelographic block; or the level of the lumbar spine undergoing surgery.
The major conclusions arising from these data are: 1) for all age groups through at least the eighth decade of life, decompressive lumbar laminectomy is a relatively safe operation having a high medium-to-long-term success rate; 2) lumbar instability following laminectomy is rare, even in individuals presenting prior to surgery with degenerative instability conditions; and 3) lumbar fusion in addition to the decompressive laminectomy procedure is rarely required for degenerative spinal stenosis.
Repair of facial nerve after removal of cerebellopontine angle tumors: a comparative study
Authors: King T. T. , Sparrow O. C. , Arias J. M. , O'Connor A. F. 
Published: May 2009

✓ The results of repair of 18 facial nerves were examined by means of a modified House-Brackmann grading system. Six were repaired by end-to-end anastomosis and 12 by nerve graft. The reliability of the simplified House-Brackmann grading system was also assessed, using the kappa statistic to analyze the agreement between pairs of observers who examined the function of 40 nerves in 37 patients. Facial nerves studied had been either preserved, repaired or grafted, or divided and treated by faciohypoglossal nerve anastomosis. One nerve was not treated.
The grading system proved to be somewhat unreliable, with complete agreement between observers in only 25% of cases. Facial nerve repair produced a fair return of function in just under two-thirds of the cases. The ability of an examiner ignorant of the patient's history to assess from the end result how the nerve had been managed was also estimated. Observers showed little ability to decide correctly on the previous treatment of the nerve when the patient showed moderate dysfunction postoperatively. The implications of these findings for grading systems and for management of the facial nerve in acoustic nerve tumor surgery are discussed.
Preservation of hearing in surgery for acoustic neuromas
Authors: Glasscock Michael E. , Hays James W. , Minor Lloyd B. , Haynes David S. , Carrasco Vincent N. 
Published: May 2009

✓Preservation of hearing was attempted in 161 cases of histologically confirmed acoustic neuroma removed by the senior author between January 1, 1970, and September 30, 1991. There were 136 patients with unilateral tumors: 22 patients had bilateral tumors (neurofibromatosis 2) and underwent a total of 25 procedures. Hearing was initially preserved in 35% of patients with unilateral tumors and in 44% of those with bilateral tumors. Results are reported in terms of pre- and postoperative pure tone average and speech discrimination scores.
Surgical access to the tumor was obtained via middle cranial fossa and suboccipital approaches. The latter has been used more often over the past 5 years because of a lower associated incidence of transient facial paresis. Persistent postoperative headaches have been the most common complication following the suboccipital approach.
The results of preoperative brain-stem auditory evoked response (BAER) studies were useful in predicting the outcome of hearing preservation attempts. Patients with intact BAER waveform morphology and normal or delayed latencies had a higher probability of hearing preservation in comparison to those with abnormal preoperative BAER morphology.
Attenuation of potassium cyanide-mediated neuronal cell death by adenosine
Authors: Sturm Christopher D. , Frisella William A. , Yoon Kong-Woo 
Published: May 2009

✓ Glutamate has been shown to play an important role in delayed neuronal cell death occurring due to ischemia. Attenuation of synaptically released glutamate can be accomplished by modulators such as adenosine and baclofen. This study focused on the ability of adenosine to attenuate the excitotoxicity secondary to glutamate receptor activationin vitroafter exposure to potassium cyanide (KCN) in hippocampal neuronal cell cultures.For this study, hippocampal cell cultures were obtained from 1-day-old rats and trypan blue staining was used for assessment of cell viability. It was found that the N-methyl-D-aspartate-specific antagonist MK801 (10µM) attenuated neuronal cell death resulting from exposure to 1 mM KCN for 60 minutes. Adenosine (10 to 1000µM) decreased neuronal cell death secondary to the same concentration of KCN in a dose-dependent manner. This same neuroprotective effect is mimicked by the adenosine A1-specific receptor agonist N6-cyclopentyladenosine (10µM). The A1-specific receptor antagonist 8-cyclopentyl-1,3-dimethylxanthine (10 to 1000 nM) blocked the neuroprotective effect of adenosine in a dose-dependent manner. Therefore, neuronal cell death produced by KCN in the experimental model described was mediated at least in part by glutamate. This neuronal cell death was attenuated by adenosine via the A1-specific mechanism.
Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation
Authors: Doran Stephen E. , Papadopoulos Stephen M. , Ducker Thomas B. , Lillehei Kevin O. 
Published: May 2009

✓ The coexistence of traumatic locked facets of the cervical spine and a herniated disc is not well described. The authors present a series of patients with traumatic locked facets who demonstrated a high incidence of associated disc herniation documented on magnetic resonance (MR) imaging. Thirteen patients with either unilateral (four cases) or bilateral (nine cases) locked facets of the cervical spine were analyzed retrospectively. Immediate closed reduction using traction and/or manipulation was attempted in the first nine cases treated and was successful in only three; however, the procedure was abandoned in three cases due to deterioration in the patient's clinical status. In the subsequent four patients, an MR image was obtained prior to attempts at closed reduction. All patients underwent MR imaging of the cervical spine. Of eight consecutive cases treated at the University of Michigan, frank disc herniation with fragmented disc in the canal was found in five while pathological disc bulging was found in the other three. All five cases contributed by other institutions had concurrent disc herniation.This series illustrates the importance of using MR imaging to document the presence of a herniated disc during the initial evaluation of a patient with traumatic locked facets of the cervical spine and prior to attempted reduction of the locked facets. Experience indicates that closed reduction of facet dislocation associated with disc rupture may result in increased spinal cord compression and neurological deficit. If a herniated disc is discovered. anterior discectomy and fusion would be favored as the initial therapy over attempts at closed reduction or operative posterior reduction.
A clinical study of the relationship of timing to outcome of surgery for ruptured cerebral aneurysms
Authors: Miyaoka Makoto , Sato Kiyoshi , Ishii Shozo 
Published: May 2009

✓ Between 1980 and 1987, 1622 patients with angiographically verified ruptured cerebral aneurysms were admitted within 7 days after subarachnoid hemorrhage. A retrospective analysis evaluated both the timing of surgery in operative patients and the status of nonsurgical patients. The patients' clinical grade according to the Hunt and Hess classification was assessed at admission, and a comparative analysis of outcome was carried out for each grade in relation to time of surgery: those operated on from Day 0 to 3 and those undergoing surgery on Day 4 or later.
Among nonsurgical cases, fatal rebleeding occurred in 105 cases and fatal vasospasm in 69 cases. These nonsurgical cases were divided into one of two groups, either an early- or a late-management group, and the outcome of each group was analyzed by clinical grade. The mortality rates in the early-surgery groups were higher than in the late-surgery groups, especially in Grade V, in which the rate was significantly different. However, with the 174 nonsurgical patients included in these management results, marked differences in mortality rates disappeared except in Grade V, which failed to show statistical significance. A higher rate of good recovery among Grade III patients receiving early surgery shifted significantly in the early-management group.
The results suggest that the timing of surgery in clinical Grade I or II patients is not a major factor; however, early surgery appears to be beneficial in Grade III and IV patients. The incidence of rebleeding in the early-and late-management groups was 2.7% and 9.5%, respectively.
A comparison of the protective effect of dexamethasone to other potential prophylactic agents in a neonatal rat model of cerebral hypoxia-ischemia
Authors: Chumas Paul D. , Del Bigio Marc R. , Drake James M. , Tuor Ursula I. 
Published: May 2009

✓ It has recently been reported that pretreatment with a single dose of dexamethasone (0.1 mg/kg) 24 hours before hypoxia in 7-day-old rat pups is protective against an hypoxic-ischemic insult (unilateral carotid artery occlusion followed by 3 hours of hypoxia in 8% O2). The authors now examine whether pretreatment 6 hours before insult is equally effective and compare other agents potentially suitable for prophylaxis in neonatal hypoxia-ischemia, including the calcium antagonists flunarizine (30 mg/kg pretreatment), nimodipine (0.5 mg/kg pretreatment), and the 21-aminosteroid U-74389F (10 mg/kg pre- and posttreatment). For each active agent, there was also a vehicle-treated control group.Comparison of the mean area of ipsilateral infarction on brain coronal sections showed that there was no statistically significant difference between the various control groups (mean area of infarction 66% ± 4%). Pretreatment with dexamethasone 6 hours prior to hypoxia offered complete protection with no infarction. A beneficial effect was seen following pretreatment with flunarizine (mean area of infarction 33.6% ± 7.8%), although this degree of damage was still significantly different from that seen with dexamethasone pretreatment. Pretreatment with nimodipine or U-74389F offered no protection (mean area of infarction 77.5% ± 4% and 59% ± 10%, respectively). Unlike findings in adult animals and clinical studies, the current studies show that dexamethasone may have a role in the treatment of neonatal hypoxia-ischemia and deserves reappraisal.
Traumatic brain injury, hemorrhagic shock, and fluid resuscitation: effects on intracranial pressure and brain compliance
Authors: Hariri Robert J. , Firlick Andrew D. , Shepard Scott R. , Cohen Douglas S. , Barie Philip S. , Emery John M. , Ghajar Jamshid B. G. 
Published: May 2009

✓ Intracranial hypertension following traumatic brain injury is associated with considerable morbidity and mortality. Hemorrhagic hypovolemia commonly coexists with head injury in this population of patients. Therapy directed at correcting hypovolemic shock includes vigorous volume expansion with crystalloid solutions. It is hypothesized that, following traumatic brain injury, cerebrovascular dysfunction results in rapid loss of brain compliance, resulting in increased sensitivity to cerebrovascular venous pressure. Increased central venous pressure (CVP) occurring with vigorous crystalloid resuscitation may therefore contribute to the loss of brain compliance and the development of intracranial hypertension.The authors tested this hypothesis in miniature swine subjected to traumatic brain injury, hemorrhage, and resuscitation. Elevated CVP following resuscitation from hemorrhage to a high CVP significantly worsened intracranial hypertension in animals with concurrent traumatic brain injury, as compared to animals subjected to traumatic brain injury alone (mean ± standard error of the mean: 33.0 ± 2.0 vs. 20.0 ± 2.0 mm Hg, p < 0.05) or to animals subjected to the combination of traumatic brain injury, hemorrhage, and resuscitation to a low CVP (33.0 ± 2.0 vs. 24.0 ± 2.0 mm Hg, p < 0.05). These data support the hypothesis that reduction in brain compliance can occur secondary to elevation of CVP following resuscitation from hemorrhagic shock. This may worsen intracranial hypertension in patients with traumatic brain injury and hemorrhagic shock.
Experimental chronic compressive cervical myelopathy
Authors: Al-Mefty Ossama , Harkey H. Louis , Marawi Isam , Haines Duane E. , Peeler Dudley F. , Wilner Harvey I. , Smith Robert R. , Holaday Howard R. , Haining Joseph L. , Russell William F. , Harrison Brent , Middleton Troy H. 
Published: May 2009

✓ A canine model simulating both cervical spondylosis and its results in delayed progressive myelopathy is presented. This model allowed control of compression, an ongoing assessment of neurological deficits, and evaluation using diagnostic images, frequent electrophysiological tests, local blood flow measurements, and postmortem histological examinations. Subclinical cervical cord compression was achieved in 14 dogs by placing a Teflon washer posteriorly and a Teflon screw anteriorly, producing an average of 29% stenosis of the spinal canal. Four dogs undergoing sham operations were designated as controls. Twelve of the animals undergoing compression developed delayed and progressive clinical signs of myelopathy, with a mean latent period to onset of myelopathy of 7 months.
Spinal cord blood flow studies using the hydrogen clearance method showed a significant transient increase in blood flow immediately after compression and a decrease before sacrifice. Somatosensory evoked potential studies indicated progressive deterioration during the period of compression. Magnetic resonance images revealed intramedullary changes. Histological studies showed abnormalities overwhelmingly within the gray matter, including changes in vascular morphology, loss of large motor neurons, necrosis, and cavitation. Axonal degeneration and obvious demyelination were rarely seen. The most profound morphological changes occurred at the site of greatest compression. It is proposed that a momentary arrest of microcirculation occurs during extension of the neck because of loss of the reserve space in the compromised spinal canal. This microcirculatory disturbance is predominant in the watershed area of the cord and mainly affects the highly vulnerable anterior horn cells, leading to neuronal death, necrosis, and eventual cavitation at the junction of the dorsal and anterior horns. Additional supportive evidence of this hypothesis was derived from the literature.
Corpus callosotomy: a quantitative study of the extent of resection, seizure control, and neuropsychological outcome
Authors: Mamelak Adam N. , Barbaro Nicholas M. , Walker John A. , Laxer Kenneth D. 
Published: May 2009

✓ Corpus callosotomy is valuable for controlling medically intractable generalized seizures in appropriate patients, but postoperative development of language disorders, neuropsychological impairment, and motor dysfunction have all been noted. The extent of callosum resection has been implicated as a possible determinant of outcome, but this hypothesis has not been formally tested. Analysis of the records of all patients who underwent corpus callosotomy at the University of California, San Francisco, from 1986 to 1991 showed that, of 15 patients who underwent anterior or complete callosotomy, seven were entirely or nearly seizure-free, four had at least a 50% reduction in seizure frequency, and four had no change.
To determine callosal size and extent of callosotomy, preoperative and postoperative magnetic resonance images were measured with computer-based planimetry. Seizure outcome was not significantly associated with preoperative callosal size or extent of callosotomy. Intelligence quotient scores did not change significantly after callosotomy. No severe neuropsychological deficits developed after anterior or complete callosotomy, even in patients with mixed cerebral dominance or bilateral language representation. These results indicate that division of the anterior one-half to two-thirds of the corpus callosum is nearly as effective as more extensive anterior sectioning or complete callosotomy in reducing drop-attack and generalized tonic-clonic seizures in appropriate patients, and that the extent of callosotomy is not an important factor on outcome when at least 50% to 65% of the callosum is divided. Mixed cerebral dominance and other unusual patterns of language and memory organization do not appear to increase the postoperative risk for neuropsychological deficits, regardless of the extent of anterior section.
Survey of Pharmacist Activities and Attitudes in Diabetes Management
Authors: Simpson Scot H. , Haggarty Susan , Johnson Jeffrey A. , Schindel Theresa J. , Tsuyuki Ross T. , Lewanczuk Richard 
Published: May 2009

Background: With the epidemic of diabetes in our population, pharmacists must become more actively involved in the management of this chronic illness. This study was designed to examine the relationship between diabetes-specific training and pharmacists' activities in and attitudes toward diabetes management. Methods: This was a cross-sectional survey of licensed pharmacists in Alberta. Respondents were grouped according to diabetes-specific training: Certified Diabetes Educator, completion of one or more diabetes-specific continuing education courses or no diabetes-specific training. A list of 67 activities related to diabetes management was generated through a review of the literature describing activities related to pharmacist involvement in diabetes management, national guideline recommendations, indicators for best practice and discussions with pharmacists specializing in diabetes management. Survey respondents were asked how frequently they provided each of these activities. Attitudes were measured using the Diabetes Attitude Scale. Results: Certified Diabetes Educators reported conducting significantly more activities related to diabetes management, especially in the areas of patient education in self-monitoring of blood glucose, hypoglycemia management, sick-day management, diabetes drug therapy and management of comorbid diseases. Pharmacists who had completed diabetes-specific continuing education courses and pharmacists with no diabetes-specific training reported similar levels of activities. There was a significant and graded relationship between attitudes and diabetes-specific training. Conclusion: Pharmacists with more advanced, experiential-based training and national certification consistently reported providing more activities related to diabetes practice and generally held more positive attitudes toward the disease and its management, compared to other pharmacists.
Resource Pharmacist at Kinburn Pharmasave
Authors: Beresford Susan 
Published: May 2009

Objective: To provide and measure the effects of having a resource pharmacist committed to the front store for his or her work shift. Clients could use this service to access individualized, timely, professionally provided information to guide them in their health choices. Methods: A resource pharmacist was scheduled to be located in the front of the store for his or her whole shift. An immediate record of interventions was kept in a pocket notebook, with more in-depth recording done later on a standardized form. Clients were greeted by the pharmacist and counted, with a goal of showcasing pharmacists' accessibility. Clients who required counselling were counted separately and categorized. Our highest number day had 82 clients greeted and 32 counselled — a total of 114 clients; our lowest had 15 greeted and 10 counselled — a total of 25 clients. Promotion, signage and mailout were done to increase awareness of the new service. The key message promoted was of the benefits of a one-on-one consult with the resource pharmacist on the client's health concerns and counselling for over-the-counter medication. Results: This has proven to be a successful professional service that can be easily implemented into any community pharmacy. Professional satisfaction with the process was high. The dispensing pharmacist could focus on prescriptions, while the resource pharmacist was able to provide a patient-centred and individualized service. The clients had ready access to information that clarified their choices; gave them immediate, individualized health information; and sometimes ended with a referral to other health care providers. An example of some of the health issues addressed were cancer, suicide, depression and various chronic illnesses. The resource pharmacist was able to provide a service that will increase the efficiency of the health care system by empowering clients to take charge of their health and making professionally advised decisions.