Neurosurgery
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Long-term intraventricular infusion of morphine for intractable pain in cancer of the head and neck.
The authors' experience with seven patients with intractable pain that was treated by continuous intraventricular infusion of morphine through an implanted Infusaid pump is reported. The pain was caused by head and neck cancer in six patients and was associated with postpolio syndrome in one. The average follow-up was 7 months. ⋯ The morphine dose required to maintain analgesia increased over time in all patients treated. This is a safe and effective method of pain management in patients with head and neck cancer. It is useful as well in patients who have intractable pain that cannot be managed through an intrathecal route because of a contraindication to lumbar puncture or an inaccessible subarachnoid space.
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Complex partial seizures are associated with alterations in regional cerebral blood flow in abnormally spiking foci, as shown by positron emission tomography and single photon emission computed tomography, with an increase in flow ictally and a decrease interictally. Alterations of vasoregulation during ictal periods have also been described in animal seizure models. An electron microscopic study on human brain tissue from seven patients undergoing resections for the treatment of intractable complex partial seizures was performed to examine ultrastructural changes of the microvasculature and their locations within the microvessel wall. ⋯ No statistically significant difference was noted in pericyte coverage or pericyte or endothelial mitochondrial densities between microvessels in spiking and control regions. This study shows degeneration of pericytes, cells thought to play an essential role in microvascular hemodynamics, and thickening of microvessel walls in abnormally spiking brain regions in patients with intractable complex partial seizures. The pericyte degeneration and basement membrane thickening in abnormally spiking areas may explain alterations in vasoregulation, by a decrease in the microvascular compliance and in cross-capillary diffusion.
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Over the past 3 years, during a time when seat belt use has increased, we have managed nine midlumbar spine fractures in children caused by standard rear seat lap belts. Children with a lap belt injury typically complained of abdominal and back pain, and the nature of their injuries was evident by the presence of a belt-shaped abrasion across the lower abdomen. ⋯ This study shows that the rear seat belts installed as standard equipment do not meet the special needs of children. Rear seat lap belts are better than no restraints, but the addition of a shoulder restraint is strongly advocated to reduce lumbar spine injury.
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Creative research thought, embodying original ideas that are adaptable and lasting, changes the scholarship and course of neurosurgery, and will be recognized by high citation frequency. Thirty-nine of 50 of the first American neurosurgeons were the first authors of 411 research papers, which were studied by analysis of citations between 1965 and 1979. Of all papers written by these authors between 1896 and 1976, 11% concerned research; this category received 22% of the aggregate of citations. ⋯ They included Bailey (441), Cushing (431), Penfield (423), Dandy (246), and Davis (158). Among the 50 authors, the percentage of published research papers did not separate the neurosurgeon with laboratory experience from his clinically oriented counterpart with regard to productivity and creativity. The data suggest that neurosurgeons are generally not basic scientists but clinical investigators.
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Review Case Reports
Ruptured aneurysm at the origin of the accessory middle cerebral artery: case report.
The accessory middle cerebral artery is a rare vascular anomaly of the brain. We describe a case of a ruptured aneurysm at the junction of the accessory middle cerebral artery and the horizontal portion of the anterior cerebral artery. ⋯ There have been only four previous reports of aneurysms located at the origin of the accessory middle cerebral artery. The relevant literature is briefly reviewed.