Neurosurgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Use of factor IX complex in warfarin-related intracranial hemorrhage.
Anticoagulation-treated patients presenting with intracranial hemorrhage, including subdural hematoma, epidural hematoma, subarachnoid hemorrhage, and intracerebral hemorrhage, require urgent correction of their coagulopathy to prevent worsening hemorrhage and to facilitate surgical intervention when necessary. In this study, we compared the use of fresh frozen plasma (FFP) with that of Factor IX complex concentrate (FIXCC) to achieve rapid correction of warfarin anticoagulation. ⋯ The use of FIXCC accelerated correction of warfarin-related anticoagulation in the presence of intracranial hemorrhage.
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Biography Historical Article
A legacy of microneurosurgery: memoirs, lessons, and axioms.
This article is written at the request of the editor. It contains my autobiographical sketch, professional memories, lessons, axioms, and reflections on the present problems in neurodiagnosis and neurotherapy. The combination of microsurgical techniques, the bipolar coagulation technique, the concept of arachnoidal exploration, and the concept of segmental and compartmental occurrence of vascular and neoplastic lesions of the central nervous system, with their predilection sites, allowed microneurosurgery to gradually unfold and proceed within the last 30 years as a continuation of conventional neurosurgical principles established by the founder generation. ⋯ The current hypothesis of infiltrative growth of gliomas is opposed. The microsurgical technique for the treatment of various types of lesions is summarized. The principal microsurgical instruments and apparatus are presented with some remarks relating to their conception and manufacture.
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Harvey Cushing began surgical training with William Halsted at Johns Hopkins in 1896. Cushing joined the Johns Hopkins faculty in 1900 and spent 1 year in Europe in the laboratory of Theodore Kocher. He returned to Johns Hopkins, where he founded neurosurgery as an independent specialty, established the concept of the clinician scientist, discovered the hormonal properties of the pituitary gland and founded endocrinology, introduced intraoperative x-rays into surgical practice, introduced blood pressure monitoring into the operating room, and wrote the first definitive text on neurosurgery. Although there have been many pioneers in our field, Cushing, more than anyone else, developed neurosurgery as a specialty and left a legacy of talented neurosurgeons to develop and expand the field.
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Biography Historical Article
Harvey Cushing at the Peter Bent Brigham Hospital.
Harvey Cushing's years at the Peter Bent Brigham Hospital in Boston were marked by the establishment of neurosurgery as a surgical subspecialty. As a clinical neurosurgeon, he performed more than 2000 brain tumor operations in that time and reduced neurosurgical mortality from 50% to only 8%. As a teacher, he trained a whole generation of neurosurgical leaders, created the Society of Neurosurgeons, and indirectly led to the founding of the American Association of Neurological Surgeons. ⋯ As an investigator, he described Cushing's disease, the Cushing reflex, Cushing's ulcer, the "third circulation" of cerebrospinal fluid, and a variety of other phenomena. And as a book collector, he developed perhaps the most significant collection of antiquarian medical and surgical texts extant. In these Brigham years, he clearly became the Neurosurgeon of the Century.
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Cushing's New Haven years were limited professionally to the completion of projects that had been previously started. These were the description of basophilism and the completion of the meningioma monograph and A Surgeon's Journal. His early years as a student at Yale led him to subsequent intense involvement in events in the developing Yale University. One little-appreciated aspect was Cushing's involvement in the early history of national health care.