Neurosurgery
-
Harvey Cushing was born, raised, wedded, and buried in Cleveland, OH. Many of his family members lived in Cleveland. Cushing frequently visited the city and maintained close personal and professional relationships with Clevelanders throughout his life. Presented are artifacts, photographs, and excerpts from his and others' works that document Cushing's connection with his home town.
-
An aggressive surgical strategy was applied to cranial gunshot wound victims at Cook County Hospital in Chicago from 1983 to 1992. A series of 480 patients with an overall mortality rate of 34% is presented. ⋯ Criteria for operation were Glasgow Coma Scale scores of 3 through 7 without hypotension or fixed and dilated pupils or Glasgow Coma Scale scores of 8 through 15 with intracranial bone fragments or significant clot. This study supports previous reports that even patients with severe neurological deficits and massive cerebral damage can benefit from aggressive treatment and make satisfactory recoveries.
-
Currently, no ideal method exists for monitoring the injured brain. Recently, a single, compact, fiberoptic sensor has become available for measuring oxygen, CO2, pH and temperature in blood. We have adapted this instrument for continuous use in brain tissue to measure oxygen tension, carbon dioxide tension (pCO2), pH, and temperature. ⋯ The brain temperature in the focally ischemic tissue decreased from 36.7 +/- 0.7 to 35.5 +/- 1.6 degrees C by the end of the experiment. The in vitro experiment demonstrated good linear correlation between the sensor readings and the blood gas analysis. Continuous monitoring of oxygen, CO2, pH, and temperature in damaged or at-risk brain tissue using a single sensor is now feasible and will, thus, allow improved continuous monitoring of neurosurgical patients who are at risk of significant secondary brain damage.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Central dysesthesia pain after traumatic spinal cord injury is dependent on N-methyl-D-aspartate receptor activation.
The role of central N-methyl-D-aspartate (NMDA) receptors in the pathogenesis of central pain was examined in nine patients with central dysesthesia pain after spinal cord injury. The central pain syndrome included spontaneous continuous and intermittent pain as well as evoked pain. Pain was evoked by non-noxious stimulation of the skin (allodynia) and by repeated pricking of the skin (wind-up-like pain). ⋯ The reduction of pain was not associated with severe side effects; the most severe side effect of ketamine was bothersome dizziness in one patient, and only modest side effects were caused by alfentanil. The present data provide clinical evidence that the development of central dysesthesia pain after traumatic spinal cord injury is dependent on the activation of central NMDA receptors. The results further indicate that mu-opioid receptors are involved in the control of this type of pain.
-
Meta Analysis Comparative Study
Spinal cord stimulation for chronic low back pain: a systematic literature synthesis.
A systematic literature synthesis was performed to analyze the long-term risks and benefits of spinal cord stimulation for patients with failed back surgery syndrome. Relevant articles were identified through a MEDLINE search (January 1966-June 1994), bibliography reviews, searches of personal files, and literature supplied by a stimulator manufacturer. Two investigators independently reviewed each article to determine whether it met the following study inclusion criteria: 1) original data on return to work, pain, medication use, reoperations, functional disability, or stimulator use after permanent implantation of spinal cord stimulators in patients with chronic low back or leg pain despite previous back surgery; and 2) follow-up > or = 30 days for all patients. ⋯ At follow-up (mean, 16 mo; range, 1-45 mo), an average of 59% of patients had > or = 50% pain relief (range, 15-100% of patients). Complications occurred in 42% of patients but were generally minor. It seems that approximately 50 to 60% of patients with failed back surgery syndrome report > 50% pain relief with the use of spinal cord stimulation at follow-up; the lack of randomized trials precludes conclusions concerning the effectiveness of spinal cord stimulation relative to other treatments, placebo, or no treatment.