Neurosurgery
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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.
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Intracerebral microdialysis has been demonstrated to be a useful method for detection of brain ischemia in experimental models and in patients. We have applied new mobile microdialysate analysis equipment that allows a bedside comparison of changes in neurochemistry with the neurological status of the patient. Ten patients with severe aneurysmal subarachnoid hemorrhage (that is, with a high risk of vasospasm and a high risk of subsequent ischemic deficits) were selected. ⋯ Bedside intracerebral microdialysis monitoring of patients with subarachnoid hemorrhage and signs of delayed ischemia revealed dramatic changes in extracellular concentrations of glucose, lactate, and glycerol that could be directly correlated to the clinical status of the patients. These findings emphasize the potential of microdialysis in neurosurgical intensive care patients.
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Biography Historical Article
M. Gazi Yaşargil: Neurosurgery's man of the century.
Dissatisfied with the available macrosurgical techniques and encouraged by colleagues such as Donaghy and Krayenbühl, M. Gazi Yaşargil possessed the ingenuity to take advantage of and further improve emerging technologies such as angiography to develop microsurgery. To enable the advancement of microsurgical techniques, Yaşargil created innovative instrumentation, such as the floating microscope, the self-retaining adjustable retractor, microsurgical instruments, and ergonomic aneurysm clips and appliers. His genius in developing microsurgical techniques for use in cerebrovascular neurosurgery has transformed the outcomes of patients with conditions that were previously inoperable.
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This article reviews the 1681 edition of The Anatomy of the Brain, by Thomas Willis (1621-1675), which was first published in Latin in 1664. Although description of the circulation at the base of the brain is part of this text, the majority of the book is devoted to functional anatomic features of the brain. ⋯ Extensive comparisons are made between "lower" animals and human subjects, emphasizing the differences in their intellects. This unique document ushered in the era of modern neuroanatomy and laid the groundwork for future neuroanatomic and neurophysiological investigations.
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The rationale and current evidence for using p53 gene replacement as a potential treatment for human gliomas are reviewed. The possible benefits of and obstacles to this approach are delineated. ⋯ Preclinical data strongly support the use of p53 gene transfer as a potential treatment for human gliomas.