Journal of neurosurgery
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Journal of neurosurgery · Dec 1993
The yin and yang of neurological surgery. The 1993 AANS presidential address.
The President of the American Association of Neurological Surgeons (AANS) discusses the present socioeconomic milieu, which has created anxiety in the neurosurgical community. The underlying factors are technological advances, hospital-physician relationships, medical liability, quality assurance reviews, and physician reimbursement. It is proposed that neurosurgeons be proactive in the development of health-care reform.
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Journal of neurosurgery · Dec 1993
Release of beta-endorphin and methionine-enkephalin into cerebrospinal fluid during deep brain stimulation for chronic pain. Effects of stimulation locus and site of sampling.
The authors systematically studied the release of the endogenous opioid peptides beta-endorphin and methionine (met)-enkephalin into the cerebrospinal fluid (CSF) during deep brain stimulation in patients suffering from otherwise intractable chronic pain. Nine patients were included in the study; six had stimulation electrodes placed in both the periventricular gray matter (PVG) and the thalamic nucleus ventralis posterolateralis (VLP) and three in the PVG only. Immunoreactivity of beta-endorphin and met-enkephalin (beta-EPir and MEir, respectively) was measured by radioimmunoassays in ventricular and lumbar CSF samples obtained before, during, and after stimulation. ⋯ The beta-EPir and MEir concentration during:before stimulation ratios were positively correlated, whereas no correlation was present in prestimulation samples from ventricular or lumbar CSF. High-performance liquid chromatography of ventricular CSF pools obtained during PVG stimulation revealed that major portions of beta-EPir and MEir eluted as synthetic beta-endorphin and met-enkephalin, respectively, thus documenting the release of beta-endorphin and met-enkephalin into ventricular CSF during PVG stimulation. The finding of a direct relationship between beta-EPir release and pain alleviation may suggest a role for beta-endorphin in the analgesic mechanism of PVG stimulation.
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Journal of neurosurgery · Oct 1993
Cytotoxicity and antitumor effects of growth factor-toxin fusion proteins on human glioblastoma multiforme cells.
The prognosis of glioblastoma multiforme remains poor despite advances in treatment by surgery, irradiation, and chemotherapy. Many malignant gliomas overexpress growth factor receptors. The possibility of targeting these receptors with selective cytotoxic molecules constructed by fusing deoxyribonucleic acid (DNA)-encoding mutant forms of Pseudomonas exotoxin A (PE) with complementary DNA-encoding growth factors was investigated. ⋯ The animals were treated for 7 days via a continuous infusion pump placed in the peritoneal cavity. A constant serum level of TGF-alpha-PE40 was achieved that was nontoxic to the mice yet caused a reduction in tumor volume and retarded growth beyond the treatment period. The overexpression of the epidermal growth factor receptor in glioblastomas multiforme and the potency and specificity of the TGF-alpha-PE40 construct designed to target this receptor suggests that TGF-alpha-PE40 has the potential to be an effective antitumor agent for the adjuvant therapy of these carcinomas.
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Journal of neurosurgery · Sep 1993
Randomized Controlled Trial Clinical TrialEffect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury.
Recent experimental studies have demonstrated that mild hypothermia at about 34 degrees C can be effective in the control of intracranial hypertension. A randomized controlled study of mild hypothermia was carried out in 33 severely head-injured patients. All patients fulfilled the following criteria: 1) persistent intracranial pressure (ICP) greater than 20 mm Hg despite fluid restriction, hyperventilation, and high-dose barbiturate therapy; 2) an ICP lower than the mean arterial blood pressure; and 3) a Glasgow Coma Scale score of 8 or less. ⋯ In five patients in the hypothermia group, cerebral blood flow was measured by the hydrogen clearance method and arteriojugular venous oxygen difference was evaluated before and during mild hypothermia. Mild hypothermia significantly decreased the cerebral blood flow, arteriojugular venous oxygen difference, and cerebral metabolic rate of oxygen (p < 0.01). The results of this preliminary investigation suggest that mild hypothermia is a safe and effective method to control traumatic intracranial hypertension and to improve mortality and morbidity rates.
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Journal of neurosurgery · Sep 1993
Case ReportsSupraclinoid internal carotid artery fenestration with an associated aneurysm. Case report.
The case of an aneurysm occurring at the site of fenestration of the supraclinoid portion of the left internal carotid artery (ICA) is reported. A 37-year-old woman presenting with subarachnoid hemorrhage was found to have bilateral ICA aneurysms at the level of the posterior communicating arteries (PCoA's). ⋯ This represents the third reported case of fenestration of the intracranial ICA associated with an aneurysm. Intracranial artery fenestrations and their embryological origins are also reviewed.