Neurosurgery
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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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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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Microneurosurgery is Professor Yaşargil's legacy. Its impact on patient outcomes, surgeons' abilities, the field of neurosurgery in particular, and the art of surgery in general is great, profound, and everlasting. Professor Yaşargil led a revolution that has transformed neurosurgery into the fine art we practice today. ⋯ It has been an honor, a great opportunity, and a phenomenal experience to spend the last 5 years with him at the University of Arkansas for Medical Sciences in Little Rock. There, he represents the very best in knowledge, expertise, dexterity, and, above all, devotion to advancing the field of neurosurgery. Most enjoyable have been his stimulating intellect and inspiring vision.
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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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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.