Neurosurgery
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Case Reports Randomized Controlled Trial Clinical Trial
Intrathecal octreotide for relief of intractable nonmalignant pain: 5-year experience with two cases.
Somatostatin is distributed in the substantia gelatinosa in the dorsal horn of the spinal cord, and its application has been found to produce an inhibitory effect on nociceptive neurons. Although intraspinal administration of somatostatin-14 produces pain relief in patients with cancer and in postoperative patients, its short half-life limits its clinical usefulness. ⋯ This article describes the 5-year clinical course of two patients receiving intrathecal octreotide for severe, intractable nonmalignant pain. Included in this description are the results of blinded, randomized "N of 1" trials conducted in each of these patients.
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We described a new ventricular catheter that is the combination of a "classic" ventricular catheter with a piezo-resistive transducer at its tip. The device allows parallel recordings of intraventricular fluid pressure via a chip and a fluid-filled external transducer, drainage of cerebrospinal fluid from the ventricle or injection of fluid into the ventricle with simultaneous monitoring of intracranial pressure, and recording of brain tissue pressure in cases of misplacement or dislocation of the ventricular catheter or in cases of progressively narrowing ventricles caused by brain edema. Clinical tests in various situations at different pressure ranges (total recording time, 1356 h in 13 patients) gave excellent correlations of both pressures. Application of the device is especially indicated in clinical situations in which pressure-controlled drainage is desirable, occlusion of ventricular bolts is likely, or pressure-volume tests are needed.
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Organized neurosurgery at Yale began in 1918 with Dr. Sam Harvey. In 1928, Dr. ⋯ This tradition has continued under the guidance of Dr. Dennis Spencer since 1987. This article provides a brief overview of the history of neurosurgery at Yale, its current practice, and plans for the future.
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Ischemia is one of the major factors causing secondary brain damage after severe head injury. We have investigated the value of continuous partial pressure of brain tissue oxygen (PbrO2) monitoring as a parameter for cerebral oxygenation in 22 patients with severe head injury (Glasgow Coma Scale score, < or = 8). Jugular bulb oxygenation, intracranial pressure, and cerebral perfusion pressure were simultaneously recorded. ⋯ The early occurrence of ischemia after head injury can be monitored on a continuous basis. Deficiency of oxygen autoregulatory mechanisms can be demonstrated, and their occurrence is inversely related to outcome. For practical clinical use, the method seemed to be superior to jugular oximetry.