Neurosurgery
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The possibility that the female sex steroid progesterone plays a role in meningioma proliferation has been suggested by a number of investigators, and it has been shown that many meningiomas have high-affinity progesterone binding sites. There has been a long-standing debate in the literature as to whether the progesterone receptors that are present in meningiomas are functional. We recently showed, by the use of immunohistochemistry, that the progesterone receptor in meningiomas is localized to the nucleus, suggesting that the receptor is in a location to be activated. ⋯ In all meningioma cell cultures, an increase in the transcription of the progesterone response element construct was observed in the presence of dexamethasone, suggesting that the glucocorticoid receptor in meningiomas is functional. An increase in transcription was observed with the addition of promegestone (R5020), a progesterone agonist, only in meningioma cell cultures that were expressing the progesterone receptor. These data show that both the progesterone and the glucocorticoid receptor in meningiomas are functional and support the concept that progestins and glucocorticoids may play an important role in meningioma growth.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm.
A multicenter, randomized, blinded, placebo-controlled trial was conducted to study the possible role of intracisternally administered fibrinolytic agent recombinant tissue plasminogen activator (rt-PA) in preventing delayed onset cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). The target population was patients with ruptured saccular aneurysms causing severe SAH, placing them at high risk for vasospasm. Treatment consisted of a single 10 ml intraoperative injection of either vehicle buffer solution or rt-PA (1 mg/ml) into the opened basal subarachnoid cisterns immediately following aneurysm clipping. ⋯ However, there was a trend toward lesser degrees of vasospasm in the rt-PA treated group. The rates for no or mild, moderate, and severe vasospasm were 69%, 16% and 15% in the rt-PA treated group, versus 42%, 35% and 23% in the placebo group (P = 0.07). When only those patients with thick subarachnoid clots were considered at the treating centers, there was a 56% relative risk reduction of severe vasospasm in the rt-PA treated group, which was significant (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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Neurosurgery at the University of Michigan was established as a specialty three-quarters of a century ago by Max Minor Peet. It developed under the successive leadership of Edgar Allan Kahn, Richard Coy Schneider, and Julian T. ⋯ Each has made unique contributions to the program, which has a strong tradition of teaching, research, and patient care. This article traces the development of the training program in neurosurgery at Michigan, focusing on its historical background, past accomplishments, present structure, and future directions.
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Infantile myofibromatosis is a rare clinical entity characterized by multiple mesenchymal tumors in the neonatal period. We describe a 15-month-old girl with multicentric cranial lesions involving the parietal and occipital bones associated with a single small subcutaneous lesion in the back. ⋯ This is the first description of magnetic resonance features of multicentric infantile myofibromatosis in the cranium, and gadolinium-enhanced magnetic resonance images were useful in showing dural involvement. The importance of recognizing this disorder is emphasized because of its special clinical behavior.
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Comparative Study
Clinical evaluation of a miniature strain-gauge transducer for monitoring intracranial pressure.
In 25 patients, we evaluated the accuracy of a new miniature strain-gauge transducer developed for the measurement of intracranial pressure (ICP). The ICP in each patient was measured with the intraventricular, miniature strain-gauge transducer, and that value was compared with the ICP measured with a ventriculostomy catheter coupled to an external strain-gauge transducer. From the two monitors, 2218 simultaneous measurements of ICP were obtained. ⋯ The two values for the ICP were within 2 mm Hg of each other on 63% of the measurements and within 4 mm Hg of each other on 89% of the measurements. The average zero drift of the miniature strain-gauge transducer, measured at ambient pressure after removal of the catheter, was 0.2 +/- 0.5 mm Hg. The results indicate that this miniature strain-gauge transducer is highly accurate and stable and that it is a reliable alternative to a ventriculostomy for monitoring the ICP.