bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the outcome of severe head injury with the oxygen radical scavenger polyethylene glycol-conjugated superoxide dismutase: a Phase II trial
Authors: Muizelaar J. Paul , Marmarou Anthony , Young Harold F. , Choi Sung C. , Wolf Aizik , Schneider Roberta L. , Kontos Hermes A. 
Published: May 2009

✓ Formation of the oxygen radical superoxide anion is one of the final events of several metabolic pathways in the cascade that leads to delayed neuronal death after traumatic or ischemic brain injury. In the laboratory, scavenging of the superoxide anion with native superoxide dismutase (SOD) or polyethylene glycol (PEG)-conjugated SOD (PEG-SOD) has been shown to be beneficial in several types of traumatic and ischemic injury. Accordingly, PEG-SOD was utilized in a randomized controlled Phase II trial to evaluate its safety and efficacy in severely head-injured patients with a Glasgow Coma Scale score of 8 or less. At two institutions, 104 patients were randomly assigned to receive either placebo or PEG-SOD (2000, 5000, or 10,000 U/kg) intravenously as a bolus, an average of 4 hours after injury. Prognostic factors were evenly distributed in the four groups, except for mean age which was significantly higher in the group receiving 10,000 U/kg than in the placebo group (mean age 34 years vs. 25 years).
No complications attributed to the study medication were noted. The average intracranial pressure (ICP) was similar in the four groups, but the percentage of time during which ICP was above 20 mm Hg was less in the groups receiving 5000 or 10,000 U/kg of PEG-SOD. Patients in the group receiving 10,000 U/kg also required less mannitol for ICP control than the placebo group. Outcome was assessed using the Glasgow Outcome Scale at 3 and 6 months postinjury in 91 and 93 patients, respectively, by blinded observers not involved in the clinical management of the patients. At 3 months, 44% of patients in the placebo group were vegetative or had died, while only 20% of patients in the group receiving 10,000 U/kg of PEG-SOD were in these outcome categories (p < 0.03, multiple logistic regression test); at 6 months, these figures were 36% and 21%, respectively (p = 0.04). Differences in outcome between the placebo group and either of the other two dosage groups were not statistically significant. It is concluded that PEG-SOD was generally well tolerated and appears promising in improving outcome after severe head injury. A larger, multicenter, Phase III trial, using a higher dose (20,000 U/kg) compared to placebo and to 10,000 U/kg of PEG-SOD is planned.
A randomized trial of nicardipine in subarachnoid hemorrhage: angiographic and transcranial Doppler ultrasound results
Authors: Haley E. Clarke , Kassell Neal F. , Torner James C. , _ _ 
Published: May 2009

✓ Calcium antagonist drugs were proposed for use in patients with recent aneurysmal subarachnoid hemorrhage (SAH) because of their ability to block the effects of a wide variety of vasoconstrictor substances on cerebral arteries in vitro. It was suggested that these agents might, therefore, be useful in ameliorating cerebral vasospasm and its ischemic consequences which frequently complicate SAH. This hypothesis was tested in an arm of a randomized double-blind placebo-controlled trial of high-dose intravenous nicardipine in patients with recently ruptured aneurysms. Participating investigators were required to send selected copies of all admission and follow-up angiograms obtained between Days 7 and 11 following hemorrhage (the peak period of risk for vasospasm) to the Central Registry of the Cooperative Aneurysm Study for blinded interpretation and review for the presence and severity of angiographic vasospasm. In centers with transcranial Doppler ultrasound (TCD) capabilities, middle cerebral artery (MCA) mean flow velocities were measured and recorded.
Angiograms obtained between Days 7 and 11 were available for 103 (23%) of 449 patients receiving nicardipine and 121 (26%) of 457 receiving placebo. There was a balance of prognostic factors for vasospasm between the groups. Fifty-one percent of placebo-treated patients had moderate or severe vasospasm on “Day 7–11 angiograms” compared to 33% of nicardipine-treated patients. This difference is statistically significant (p < 0.01). Sixty-seven (49%) of 137 placebo-treated patients examined with TCD between Days 7 and 11 had mean MCA flow velocities exceeding 120 cm/sec compared to 26 (23%) of 112 nicardipine-treated patients (significant difference, p < 0.001). These data suggest that high-dose intravenous nicardipine reduces the incidence and severity of delayed cerebral arterial narrowing in patients following aneurysmal SAH.
The expression of deafferentation dysesthesias reduced by dorsal root entry zone lesions in the rat
Authors: Rossitch Eugene , Abdulhak M. , Ovelmen-Levitt Janice , Levitt M. , Nashold Blaine S. 
Published: May 2009

✓ Extensive longitudinal lesions of the dorsal root entry zone (DREZ) are effective in relieving some chronic deafferentation pain in humans. A deafferentation syndrome follows C5—T2 dorsal root ganglionectomies in rats. The syndrome consists of biting and scratching the completely and partially denervated limb areas, respectively.
This study examines the effect of DREZ lesions on the deafferentation syndrome in the rat. Of 37 rats, 24 underwent C5—T2 ganglionectomies only, five received C4—T3 micromechanical DREZ lesions only, and eight underwent ganglionectomies plus simultaneous DREZ lesions. The animals were observed for 45 days postoperatively. Histological analysis of the spinal cord lesions was performed.
All rats with ganglionectomies alone exhibited the deafferentation syndrome; however, no rats with DREZ lesions alone showed this feature. Only 25% of rats with combined ganglionectomies and DREZ lesions exhibited the deafferentation syndrome in the first 30 days, whereas 80% of the animals with ganglionectomies only did so. Although 75% of the animals with combined lesions eventually bit the insensitive forepaw, this behavior was significantly attenuated: the day of onset was delayed and the extent of self-mutilation was reduced. Postmortem histological examination of the DREZ lesions indicated a close association between the completeness of the dorsal horn destruction and the reduction or prevention of self-mutilation.
These data support the validity of the animal model and also the hypothesis stating that the deafferentation syndrome results from abnormal spontaneous neural activity in the dorsal horn. Moreover, the variability of the histological findings in these experiments stresses the importance of making contiguous and complete dorsal horn lesions in human DREZ surgery.
Comparative study of transcranial color duplex sonography and transcranial Doppler sonography in adults
Authors: Schöoning Martin , Buchholz Reiner , Walter Jochen 
Published: May 2009

✓ To determine whether the frequency shift recorded in basal cerebral arteries corresponds to “true” flow velocities, a prospective comparative study of transcranial color duplex sonography (TCCD) and transcranial Doppler sonography (TCD) was performed. A 2.0-MHz transducer of a computerized TCCD system and a TCD device were used. The middle cerebral artery (MCA) and anterior cerebral artery (ACA) were examined by TCCD in 49 healthy volunteers (mean age 35 ± 12 years). In 45 of the same volunteers a comparative TCD examination was possible. The studies were carried out blindly by different examiners at separate appointments. Peak systolic flow velocity, end-diastolic maximum flow velocity, time-averaged maximum flow velocity, and the pulsatility index were measured by both techniques. Additionally, for TCCD, time-averaged flow velocity was assessed, the resistance index and a spectral broadening index were calculated, and the energy output required for reliable measurement was analyzed.
The TCCD signals were recorded in 98% of both MCA's and ACA's; with TCD, signals were recorded in 98% of MCA's and 87% of ACA's. Although in both vessels the angle-corrected peak systolic and time-averaged maximum velocities were approximately 10% to 15% higher in TCCD than in TCD measurements, correlation of flow velocities between both techniques was significant (p < 0.0001); differences between sides and age-dependency of flow velocities corresponded as well. In a reproducibility study, TCCD was repeated in 27 subjects by a third examiner with significant correlation (p < 0.0001) of both TCCD examinations.
It is concluded that the advantage of TCCD is associated more with a qualitative aspect than a quantitative one. The additional visual dimension of TCCD can open new diagnostic possibilities in cerebrovascular disorders.
Intractable hiccups: treatment by microvascular decompression of the vagus nerve
Authors: Johnson Dennis L. 
Published: May 2009

✓ Idiopathic hiccups are usually managed with pharyngeal stimulation or a plethora of pharmacological agents. Hiccups that persist and prove intractable to these medical measures are treated by crush or ablation of the phrenic nerve, which denervates the major respiratory muscle. This is the first reported case of nondestructive microvascular decompression of the vagus nerve for the treatment of intractable idiopathic hiccups. The success of microvascular decompression has been documented with other conditions, such as trigeminal neuralgia and hemifacial spasm, that are characterized by hyperactive dysfunctional neurovascular contact.
The vagus nerve was separated from the posterior inferior cerebellar artery by inserting a Teflon pledget between the nerve and vessel which eliminated the neurovascular contact. One year after the initial surgery, the hiccups recurred. The Teflon pledget had fallen out of place and the nerve was once again in contact with the artery. Once the contact was eliminated by wrapping the artery with a tuft of Teflon, the hiccups stopped. The patient has remained free of hiccups for 3 years.
It is concluded that patients with intractable idiopathic hiccups who fail medical therapy should be considered for microvascular decompression of the vagus nerve.
Endovascular treatment of vertebral artery dissections and pseudoaneurysms
Authors: Halbach Van V. , Higashida Randall T. , Dowd Christopher F. , Fraser Kenneth W. , Smith Tony P. , Teitelbaum George P. , Wilson Charles B. , Hieshima Grant B. 
Published: May 2009

✓ Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography.In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second).Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.
Epidural perfusion cooling protection against protracted spinal cord ischemia in rabbits
Authors: Vanický Ivo , Maršala Martin , Gálik Ján , MarŠala Jozef 
Published: May 2009

✓ The protective effect of a modified epidural cooling technique was assessed in a rabbit spinal cord ischemia model. The epidural space around the lumbar segments with induced ischemia was continually perfused with cold (5°C) isotonic saline via two communicating spinal canal openings. This procedure allowed the spinal cord to be kept deeply hypothermic (< 15°C within central gray matter) during the ischemic period.
The animals were subjected to either normothermic ischemia (Group A) or hypothermic ischemia (Group B). Each group contained three subgroups of animals undergoing 20, 40, or 60 minutes of aortic ligation. Their neurological outcomes were evaluated up to 48 hours postischemia, and the intergroup differences were compared. Two days postischemia, all of the animals were sacrificed by transcardial perfusion-fixation and their lumbar segments were processed for histopathological examination. In addition, in animals with 60-minute ischemia, spinal somatosensory evoked potentials were recorded during surgical intervention and again after 48 hours.
In the normothermic animals, a high incidence of paraplegia was detected: in 40% after 20 minutes of ischemia, in 75% after 40 minutes, and in 100% after 60 minutes. In contrast, all of the hypothermic animals exhibited full neurological recovery even after 60 minutes of ischemia. Both electrophysiological and histological observations clearly correlated with the neurological findings. The results suggest that deep spinal cord hypothermia produced by epidural perfusion cooling provides effective protection against protracted spinal cord ischemia in rabbits.
Localization of the face area of human sensorimotor cortex by intracranial recording of somatosensory evoked potentials
Authors: McCarthy Gregory , Allison Truett , Spencer Dennis D. 
Published: May 2009

✓ The authors describe a method of localizing the sensory and motor peri-rolandic cortex representing the face and intraoral structures. Somatosensory evoked potentials (SEP's) to stimulation of the chin, lips, tongue, and palate were recorded in 37 patients studied intraoperatively under general anesthesia or following chronic implantation of cortical surface electrodes. Localization by trigeminal SEP recording was validated by SEP localization of the hand area with median nerve stimulation, and by cortical stimulation of the hand and face areas.
The following conclusions were drawn regarding the implementation of face area localization: 1) in general agreement with the results of cortical stimulation in humans and single-unit recordings in monkeys, there is a medial-to-lateral representation in somatosensory cortex of the hand, chin, upper lip, lower lip, tongue, and palate; 2) the chin and lip representations overlap, are adjacent to the hand area, and provide little additional localizing information if the hand area has been identified; 3) stimulation of the tongue and palate evokes reliable, large-amplitude SEP's useful for localization; 4) palatal SEP's allow localization near the sylvian sulcus; 5) for any type of trigeminal stimulation, the largest SEP's are recorded from the somatosensory cortex and provide the most consistent criterion for its identification; and 6) polarity inversion of potentials across the sulcus (a reliable localizing criterion for median nerve SEP's) is a less reliable criterion for trigeminal SEP's.
Cognitive functioning in long-term survivors of high-grade glioma
Authors: Archibald Yvonne M. , Lunn Diane , Ruttan Lesley A. , Macdonald David R. , Del Maestro Rolando F. , Barr Hugh W. K. , Pexman J. H. Warwick , Fisher Barbara J. , Gaspar Laurie E. , Cairncross J. Gregory 
Published: May 2009

✓ In a pilot study, two groups of patients with malignant glioma underwent sequential neuropsychological evaluations after successful tumor treatment. Group 1 included nine patients treated from 1981 to 1985; all patients received irradiation and eight underwent chemotherapy. The baseline neuropsychological assessment was performed 1 to 63 months after tumor diagnosis, with follow-up evaluations at irregular intervals over the next 3 to 7 years. Six patients in Group 1 exhibited impairment on most measures at baseline; subsequently, two patients developed profound cognitive impairment. Initially, three patients functioned in the average range on most tasks; thereafter, two deteriorated on one measure each. Group 2 was ascertained prospectively and included 16 patients treated from 1985 to 1987, all of whom received irradiation and chemotherapy. The first evaluation was performed 18 months after diagnosis, then every 6 months for 2 years, and then yearly. Compared to a control group, those in Group 2 had significant cognitive impairment at baseline. Cognitive performance did not change over the next 12 months in 10 patients who remained free of tumor, but within 2 years of baseline testing, deterioration on specific tasks was evident in two of seven disease-free survivors. When last tested, five of six disease-free survivors had deteriorated on one or more measures. Unlike Group 1, severe global cognitive impairment was not seen, perhaps because Group 2 was followed for a shorter time. Verbal and nonverbal composite scores derived from intelligence quotient (IQ) tests showed less impairment at baseline than did other measures and were more likely to remain stable subsequently. Verbal memory and sustained attention were the most impaired at baseline, and verbal learning and flexibility in thinking showed the greatest tendency to decline over time.
Cognitive functioning in survivors of high-grade glioma is best measured and monitored by tests that probe a broader spectrum of abilities than IQ. Neuropsychological measures used in this analysis lacked sensitivity at the lower end of the impaired range. Future studies should use tests better able to discern cognitive differences at low performance levels. Based on this experience, the authors conclude that most long-term survivors of high-grade glioma will have significant cognitive difficulties, usually evident by the first assessment; some patients will develop profound impairment years later, and few are capable of fully independent living.
Review of Duloxetine and Venlafaxine in Depression
Authors: Zerjav Sylvia , Tse Gordon , Scott Michael J.W. 
Published: May 2009

Objectives: To compare the efficacy and pharmacologic, pharmacokinetic, drug interaction and adverse effect profiles of duloxetine and venlafaxine. Methods: A systematic review of the literature pertaining to duloxetine and venlafaxine was conducted using a computer-aided search of MEDLINE and EMBASE for the period January 1988 to May 2008 with the following search terms: venlafaxine and duloxetine and depression, clinical studies, pharmacology, drug interactions, pharmacokinetics, adverse effects, safety, case reports and review articles. Results: Duloxetine and venlafaxine have comparable efficacy and share similar pharmacologic profiles but differ somewhat in their pharmacokinetic profiles, drug interactions and adverse effects. Both agents block the reuptake of serotonin and norepinephrine and both are substrates for the cytochrome P450 2D6 isoenzyme; however, duloxetine inhibits these enzymes to a moderate extent, whereas venlafaxine is only a weak inhibitor. Furthermore, duloxetine is more extensively bound to protein than venlafaxine. Venlafaxine is more likely to elevate blood pressure in a dose-related manner. Both duloxetine and venlafaxine have the potential to cause hepatic injury. Conclusions: Although venlafaxine and duloxetine have similar efficacy in the treatment of depression, differences in their adverse effects and pharmacokinetic profiles suggest that one agent may be preferred over the other in certain patient groups.
Effectiveness of Specific Neck Stabilization Exercises or a General Neck Exercise Program for Chronic Neck Disorders: A Randomized Controlled Trial
Authors: GRIFFITHS CATHRIN , DZIEDZIC KRYSIA , WATERFIELD JACKIE , SIM JULIUS 
Published: May 2009

Objective.In a cohort of primary care patients with chronic neck pain, to determine whether specific neck stabilization exercises, in addition to general neck advice and exercise, provide better clinical outcome at 6 weeks than general neck advice and exercise alone.Methods.This was a multicenter randomized controlled trial in 4 physical therapy departments. Seventy-four participants (mean age 51.3 yrs) were randomized to specific neck stabilization exercises with a general neck advice and exercise program (n = 37) or a general neck advice and exercise program alone (n = 37). They attended a 1-hour clinical examination, followed by a maximum of 4 treatment sessions. Assessments were undertaken at baseline, 6 weeks, and 6 months. The primary outcome was the Neck Pain and Disability Scale (NPDS). Analysis was by intention to treat.Results.Seventy-one (96%) participants received their allocated intervention. There was 91% followup at 6 weeks and 92% followup at 6 months. The mean (SD) 6-week improvement (reduction) in NPDS score was 10.6 (20.2) for the specific exercise program and 9.3 (15.7) for the general exercise program. There were no significant between-group differences in the NPDS at either 6 weeks or 6 months. For secondary outcomes, participants in the specific exercise group were less likely to be taking pain medication at 6-week followup (p = 0.02). There were no other significant between-group differences.Conclusion.Adding specific neck stabilization exercises to a general neck advice and exercise program did not provide better clinical outcome overall in the physical therapy treatment of chronic neck pain.