bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survey of client satisfaction with methadone maintenance programmes
Authors: Kumar M. Raj , Rajwal Madhuri 
Published: December 2005

Aims and MethodThe aim of the study was to elicit clients' satisfaction with the methadone maintenance service and their views regarding opiate users not in the service. A self-completion questionnaire with 40 questions covering various aspects of service delivery was given to clients on this programme.ResultsOf a total of 52 questionnaires, 31 (60%) were returned. There was a high level of overall satisfaction (93%) with the service and staff, but there were significant problems related to prolonged waiting times and access to ancillary services. There were also practical difficulties related to prescriptions. Over half of the clients (54%) used additional illicit opiates.Clinical ImplicationsIt is likely that addressing identified problem areas may influence treatment outcome in this challenging group. Staff should maintain optimism in helping the clients who, as seen by this survey, value their advice.
Higher specialist training in child and adolescent psychiatry: a survey of academic programmes
Authors: Hawkins Tim , Lee Alison , Stephens Helen , Matthies Gisa , Bailey Alison 
Published: December 2005

Aims and MethodAcademic programmes are mandatory in child psychiatry specialist registrar training. A postal questionnaire survey was undertaken to explore the views of specialist registrars and academic programme coordinators identified nationally with regard to their local academic programme.ResultsSixty per cent of specialist registrars (152 out of 253) and 90% of coordinators (17 out of 19) responded. All schemes offered an academic programme with protected time. Teaching methods were diverse, and satisfaction varied within and between schemes, with trainees reporting greater satisfaction associated with active involvement of coordinators.Clinical ImplicationsThe authors provide recommendations for local planning of academic programmes. The authors request the assistance of CAPSAC in standardising the appointment and training of coordinators and facilitating their release from clinical commitments.
Beginning therapy: clinical outcomes in brief treatments by psychiatric trainees
Authors: Mace Chris , Beeken Sally , Embleton Joan 
Published: December 2005

Aims and MethodPsychotherapy provided by inexperienced psychiatric trainees was assessed through comparison of post-treatment outcomes with a brief psychodynamic therapy and a brief integrative psychotherapy. A retrospective case–control design was applied to all patients seen by nine senior house officers (SHOs) during 6-month placements who provided follow-up data. Matching linked each patient offered simple cognitive–analytic therapy to one who had received brief psychodynamic therapy from the same SHO. Post-treatment changes were analysed by treatment received and differences between trainees were explored.ResultsSeventeen cases in each group met entry criteria. Patients receiving the integrative treatment had more severe pathology and outcomes were more variable when this model was used. Eight of the nine SHO therapists performed better with the psychodynamic intervention.Clinical ImplicationsSignificant clinical improvements can be achieved by inexperienced psychiatric trainees providing brief psychotherapy under supervision. Patient selection is undoubtedly important. Fundamental psychotherapy competencies need to be mastered before structured hybrid models are attempted.
Prospective Staged Volume Radiosurgery for Large Arteriovenous Malformations: Indications and Outcomes in Otherwise Untreatable Patients
Authors: Sirin Sait , Kondziolka Douglas , Niranjan Ajay , Flickinger John C. , Maitz Ann H. , Lunsford L. Dade 
Published: December 2005

Abstract

OBJECTIVE:
The obliteration response of an arteriovenous malformation (AVM) to radiosurgery is strongly dependent on dose and volume. For larger volumes, the dose must be reduced for safety, but this compromises obliteration. In 1992, we prospectively began to stage anatomic components in order to deliver higher single doses to symptomatic AVMs &gt;15 ml in volume.

METHODS:
During a 17-year interval at the University of Pittsburgh, 1040 patients underwent radiosurgery for a brain AVM. Out of 135 patients who had multiple procedures, 37 patients underwent prospectively staged volume radiosurgery for symptomatic otherwise unmanageable larger malformations. Twenty-eight patients who were managed before 2002 were included in this study to achieve sufficient follow-up in assessing the outcomes. The median age was 37 years (range, 13–57 yr). Thirteen patients had previous hemorrhages and 13 patients had attempted embolization. Separate anatomic volumes were irradiated at 3 to 8 months (median, 5 mo) intervals. The median initial AVM volume was 24.9 ml (range, 10.2–57.7 ml). Twenty-six patients had two stages and two had three-stage radiosurgery. Seven patients had repeat radiosurgery after a median interval of 63 months. The median target volume was 12.3 ml. (range, 4.2–20.8 ml.) at Stage I and 11.5 ml. (range, 2.8–22 ml.) at Stage II. The median margin dose was 16 Gy at both stages. Median follow-up after the last stage of radiosurgery was 50 months (range, 3–159 mo).

RESULTS:
Four patients (14%) sustained a hemorrhage after radiosurgery; two died and two patients recovered with mild permanent neurological deficits. Worsened neurological deficits developed in one patient. Seizure control was improved in three patients, was stable in eight patients and worsened in two. Magnetic resonance imaging showed T2 prolongation in four patients (14%). Out of 28 patients, 21 had follow-up more than 36 months. Out of 21 patients, seven underwent repeat radiosurgery and none of them had enough follow- up. Of 14 patients followed for more than 36 months, seven (50%) had total, four (29%) near total, and three (21%) had moderate AVM obliteration.

CONCLUSIONS:
Prospective staged volume radiosurgery provided imaging defined volumetric reduction or closure in a series of large AVMs unsuitable for any other therapy. After 5 years, this early experience suggests that AVM related symptoms can be stabilized and anticipated bleed rates can be reduced.
Gamma-Knife Radiosurgery for Cranial Base Meningiomas: Experience of Tumor Control, Clinical Course, and Morbidity in a Follow-Up of More than 8 Years
Authors: Zachenhofer Iris , Wolfsberger Stefan , Aichholzer Martin , Bertalanffy Alexander , Roessler Karl , Kitz Klaus , Knosp Engelbert 
Published: December 2005

Abstract

OBJECTIVE:
Surgical resection of cranial base meningiomas is often limited owing to involvement of crucial neural structures. Within the last 2 decades Gamma Knife radiosurgery (GKRS) has gained increasing importance as an adjunct treatment after incomplete resection and as an alternative treatment to open surgery. However, reports of long-term results are still sparse. We therefore performed this study to analyze the long-term results of GKRS treatment of cranial base meningiomas, following our previously published early follow-up experience.

METHODS:
A retrospective analysis of the medical files for Gamma Knife and surgical treatments, clinicoradiological findings, and outcome was carried out focusing on tumor control, clinical course, and morbidity.

RESULTS:
Between 1992 and 1995, we treated 36 patients with cranial base meningiomas using GKRS (male:female ratio, 1:5; mean age, 59 yr; range, 44–89 yr). Twenty-five patients were treated with GKRS after open surgery, and 11 patients received GKRS alone. Tumor control, neurological outcomes, and adverse effects were analyzed after a long-term follow-up period (mean, 103 mo; range, 70–133 mo) and compared with our previous results after an early follow-up period (mean, 48 mo; range, 36–76 mo). Control of tumor growth was achieved in 94% of patients. Compared with the early follow-up period, the late neuroradiological effects of GKRS on cranial base meningiomas were continuing tumor shrinkage in 11 patients (33%), stable tumor size in 20 patients (64%) and tumor progression in two meningiomas (6%). The neurological status improved in 16 patients (44%), remained stable in 19 patients (52%), and deteriorated in one patient (4%). Adverse side effects of GKRS were found only during the early follow-up period.

CONCLUSION:
Our data confirm that GKRS is not only a safe and effective treatment modality for cranial base meningiomas in short-term observation, but also in a mean long-term follow-up period of more than 8 years. Tumor shrinkage and clinical improvement also continued during the longer follow-up period.
Brainstem Metastases: Management Using Gamma Knife Radiosurgery
Authors: Fuentes Stéphane , Delsanti Christine , Metellus Philippe , Peragut Jean Claude , Grisoli François , Regis Jean 
Published: December 2005

Abstract

OBJECTIVE:
Brainstem metastasis is an uncommon complication of systemic cancer, generally considered to have a highly unfavorable prognosis. Surgical risks are high and standard radiation or chemotherapy have little effect. The purpose of this study is to evaluate our experience using Gamma Knife radiosurgery (GKRS) for the management of brainstem metastasis.

METHODS:
Between July 1992 and March 2001, we treated 28 patients with brainstem metastasis using GKRS. Lesions were located in the pons in 17 patients, midbrain in nine, and medulla oblongata in two. At time of the radiosurgery, eight patients presented with another supratentorial metastasis. The most frequent primary tumor site was the lung (13 cases) followed by the melanoma in four cases, the kidney in two, and other locations in six. Only six patients underwent fractionated whole-brain radiation therapy. Mean marginal radiation dose for GKRS was 19.6 Gy (range, 11–30). Mean maximum diameter was 17.2 mm (range, 10–30).

RESULTS:
No GKRS-related morbidity was observed. Local tumor control was achieved in 92% of patients. Twenty-six patients have died. Death was related to the progression of the brainstem lesion in two cases. Mean and median survival after GKRS were 10.2 and 12 months, respectively. Follow-up periods in the two surviving patients were 12 and 13 months.

CONCLUSION:
The results of this small series demonstrate that GKRS can be a valuable modality for safe and effective management of brain stem metastasis. Owing to the high risk of surgical resection and low efficacy of medical treatment, radiosurgery can be proposed upfront.
Revascularization and Parent Artery Occlusion for Giant Internal Carotid Artery Aneurysms in the Intracavernous Portion Using Intraoperative Monitoring of Cerebral Hemodynamics
Authors: Kubo Yoshitaka , Ogasawara Kuniaki , Tomitsuka Nobuhiko , Otawara Yasunari , Kakino Shunsuke , Ogawa Akira 
Published: December 2005

Abstract

OBJECTIVE:
Therapeutic parent artery occlusion with or without revascularization is a useful surgical technique for the management of a giant aneurysm located in the intracavernous portion of the internal carotid artery (ICA). The purpose of the present study was to determine whether intraoperative cortical blood flow (CoBF) monitoring during surgical parent artery occlusion could identify patients who required bypass with a saphenous vein graft (high flow bypass).

METHODS:
Eleven patients with a giant aneurysm located in the intracavernous portion of the ICA underwent superficial temporal artery-middle cerebral artery bypass. CoBF was monitored intraoperatively in all patients using a thermal diffusion flow probe. The lowest CoBF during test occlusion of the ICA under functioning superficial temporal artery-middle cerebral artery bypass was determined, and the ratio of the value to the CoBF immediately before test occlusion of the ICA was calculated in the frontal and temporal lobes. When the CoBF ratio in the frontal or temporal lobe was less than 0.9, high flow bypass grafting was elected.

RESULTS:
Of the eleven patients undergoing superficial temporal artery-middle cerebral artery bypass, five patients underwent concomitant high flow bypass grafting. Postoperative cerebral ischemic events did not occur in any patient over a follow-up period ranging from 3 to 60 months. Postoperative cerebral angiography showed resolution of the aneurysm and patency of the bypass in all patients.

CONCLUSION:
Intraoperative CoBF monitoring using a thermal diffusion flow probe during surgical parent artery occlusion for giant intracavernous carotid artery aneurysms can identify patients who require concomitant high flow bypass grafting.
High Dose Magnesium Infusions Are Not Associated with Increased Pressor Requirements after Carotid Endarterectomy
Authors: Chiu Camay , Heyer Eric J. , Rampersad Anita D. , Zurica Joseph , Ornstein Eugene , Sahlein Daniel H. , Sciacca Robert R. , Connolly E Sander 
Published: December 2005

Abstract

INTRODUCTION:
Although magnesium provides cerebral protection in animal stroke models, magnesium therapy has significant side effects in humans. Therefore, we sought to examine the incidence of α-agonist treated hypotension in our ongoing, prospective, randomized, double-blind, placebo-controlled Phase I/IIa dose escalation study of magnesium therapy in patients undergoing carotid endarterectomy.

METHODS:
Eighty patients undergoing elective carotid endarterectomy were randomly assigned to a placebo control group (n = 38) or to one of the three intravenous magnesium groups. Magnesium levels were obtained before induction, and then 15 minutes, 1 hour, 2 hours, 6 hours, 12 hours, and 24 hours after a loading dose and infusion. After surgery, a target systolic blood pressure range was chosen, and the amount and duration of phenylephrine needed to maintain that pressure was compared across treatment groups.

RESULTS:
All treatment groups achieved levels significantly different from baseline at 12 and 24 hours (P&lt;0.01). Magnesium treatment did not significantly increase the proportion of patients requiring pressure support. For those requiring pressure support, the amount and average duration of phenylephrine required was not different between control patients and those receiving magnesium, even when the individual minimum systolic blood pressures required were subdivided on the basis of dose of magnesium administered.

CONCLUSION:
There were no significant differences detected in the 1) percentage of patients requiring pressor support, 2) the duration of postoperative pressor support, or 3) the amount of phenylephrine support needed between controls and magnesium treated patients. The percentage of patients requiring pressure support depended on the minimum systolic blood pressure ordered after surgery.
Spinal Neurenteric Cysts in the Magnetic Resonance Imaging Era
Authors: Menezes Arnold H. , Traynelis Vincent C. 
Published: December 2005

AbstractOBJECTIVE:Neurenteric cysts are derived from displaced entodermal tissue. They are infrequently found in the ventral spinal canal with varying degrees of success in their removal. Experience with 10 such individuals is critically analyzed to aid in the diagnosis and management.METHODS:Ten patients, ages 4 through 55 years, with neurenteric cysts were encountered in the last 20 years. This series included three females and seven males; seven children and three adults. The follow-up periods ranged from 3 to 18 years. Three cysts were located at the ventral cervicomedullary junction, five in the midventral cervical spine, and one thoracic and one lumbosacral. The symptoms reflected the location.RESULTS:Six of the 10 patients had associated bony abnormalities such as bifid clivus, hemivertebrae, segmentation failures at the site of the lesion, and blocked vertebra. The patient with the thoracic spinal lesion (age, 55 yr) had symptoms from early childhood. A diplomyelia at the site of the lesion was seen in one individual and tethered spinal cord in the same adult and in a young child. Two patients had undergone laminectomy for aspiration and partial resection before referral to our institution at the time of recurrence. Cervicomedullary junction lesions were approached via the far lateral transcondylar approach; two of the cervical intramedullary lesions were resected via a ventral corpectomy with radical resection and interbody fusion. The goal in each case was complete resection to avoid recurrences.CONCLUSION:Spinal neurenteric cysts are ventrally located, usually intradural and extramedullary, but may insinuate into the spinal cord. They are isointense on T1 images and hyperintense on T2-weighted images on magnetic resonance imaging without true enhancement. These lesions may be associated with block and hemivertebrae with a predisposition to the craniocervical region. Partial resections have led to recurrence and arachnoiditis.
Analysis of Pain Resolution after Surgical Resection of Intramedullary Spinal Cord Cavernous Malformations
Authors: Kim Louis J. , Klopfenstein Jeffrey D. , Zabramski Joseph M. , Sonntag Volker K.H. , Spetzler Robert F. 
Published: December 2005

Abstract

OBJECTIVE:
To determine the short- and long-term effects of surgical resection of intramedullary spinal cavernous malformations on preoperative pain.

METHODS:
Between 1988 and 2003, 53 intramedullary spinal cavernous malformations were surgically managed. A retrospective analysis of this cohort revealed 23 (43%) patients who presented with pain as a clinically relevant feature. Long-term evaluation of pain outcomes was available in 21 patients. Pain outcomes were characterized as improved, unchanged, or worse compared with preoperative and immediate postoperative status.

RESULTS:
Seven patients presented with radiculopathy, 12 with central pain, and four with both. Immediately after surgery, pain symptoms improved in 18 (78%) patients, were unchanged in 5 (22%), and were worse in none compared with the patients' preoperative status (n = 23). During the follow-up period, 11 (52%) patients improved, nine (43%) remained at their preoperative baseline, and one (5%) was worse compared with their preoperative levels of pain. The difference in postoperative and long-term pain status was statistically significant (P = 0.031).

CONCLUSION:
The surgical efficacy for improving pain related to intramedullary spinal cavernous malformations may be worse than implied in the literature. Although pain relief immediately after surgery is good, we found that recurrence is common and that only approximately 50% of patients report long-term benefit. Despite the significant limitations of this retrospective study, these data may serve as a guide when counseling patients preoperatively to help them to maintain realistic expectations about outcomes.
Peripheral Neurostimulation for Treatment of Intractable Occipital Neuralgia
Authors: Slavin Konstantin V. , Nersesyan Hrachya , Wess Christian 
Published: December 2005

Abstract

OBJECTIVE:
Medically intractable pain caused by occipital neuralgia (ON) can be very difficult to control with traditional pain management. Peripheral nerve stimulation (PNS) may serve as a good alternative to destructive surgical manipulations used currently for the treatment of severe ON.

METHODS:
We analyzed records of 14 consecutive patients (9 women and 5 men; mean age, 43.3 yr) with intractable ON treated with PNS during the period from April 2002 to November 2004. Five patients had unilateral and nine had bilateral PNS electrodes inserted for trial, which was considered successful if patient reported at least 50% decrease of pain on the visual analogue scale. Ten patients proceeded with system internalization, and their long-term results were analyzed.

RESULTS:
At the time of the last follow-up examination (5–32 mo, mean 22 mo), seven patients (70%) with implanted PNS systems continue to experience beneficial effects of stimulation, including adequate pain control, continuous employment, and decrease in oral pain medications intake. Two patients had their systems explanted because of loss of stimulation effect or significant improvement of pain, and one patient had part of his hardware removed because of infection.

CONCLUSION:
Overall, the beneficial effect from chronic stimulation in our series persisted in more than half of the patients for whom procedure was considered and in 80% of those who significantly improved during the trial and proceeded with internalization. Thus, chronic PNS may be a safe and relatively effective method for long-term treatment of chronic pain syndrome in patients with medically intractable ON.
Radiographic Characteristics Fail to Predict Clinical Course after Subdural Electrode Placement
Authors: Mocco J , Komotar Ricardo J. , Ladouceur Amos K. , Zacharia Brad E. , Goodman Robert R. , McKhann Guy M. 
Published: December 2005

Abstract

OBJECTIVE:
Subdural arrays of grid and strip electrodes are frequently used in epilepsy patients to localize the seizure focus and determine the location of critical brain functions via stimulation mapping. Postoperatively, the majority of patients with implanted subdural electrodes develop subacute extra-axial collections (EACs). Although conservative management is appropriate in most of these cases, occasionally patients manifest neurological symptoms that may necessitate reoperation for collection evacuation. Currently, there is little information available regarding the range of EAC size and the potential correlation between EAC size and symptom development. To facilitate treatment decision-making in postoperative subdural electrode patients, we reviewed and compared the computed tomographic (CT) features of postelectrode placement EACs in asymptomatic and symptomatic patients.

METHODS:
We retrospectively reviewed the medical records and CT scans of 22 consecutive patients who underwent craniotomy for placement of subdural grid and strip electrodes at Columbia University Medical Center. Medical records were reviewed for neurological complications from the time of grid placement until its removal. Each EAC was measured on CT for volume (% of total cranial volume), maximal thickness, and midline shift. One patient was excluded secondary to the development of an intracerebral hemorrhage.

RESULTS:
Thirteen of 21 patients remained asymptomatic or minimally symptomatic during their hospitalization, with only mild to moderate, intermittent, postoperative headaches. The remaining eight developed symptoms such as persistent and severe headache, transient motor deficit, or speech impairment. Two of these patients underwent reoperation for hematoma evacuation. EACs in asymptomatic patients had a mean volume, maximal thickness, and midline shift of 5.7%, 1.25 cm, and 0.33 cm, respectively. EACs in symptomatic patients had a mean volume, maximal thickness, and midline shift of 7.7%, 1.46 cm, and 0.5 cm, respectively. Differences between maximal thickness and midline shift did not approach statistical significance. Despite this, the difference between the mean volume of symptomatic and asymptomatic EACs was statistically significant (P = 0.04).

CONCLUSION:
The conventional methods of midline shift and maximal thickness for assessing EAC size did not adequately differentiate symptomatic and asymptomatic subdural electrode patients with EACs. Although total volume calculation using digital planimetric analysis demonstrated a statistically significant difference, we found no clear threshold volume that correlated with clinical course. Therefore, the appearance of EACs on CT scans is of limited use in predicting the development of symptoms and possible postoperative complications after subdural grid placement. Clinical judgment must guide management and determine the potential need for reoperation.