British journal of neurosurgery
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Paraffin sections of 305 meningeal tumours were analysed for the presence of nucleolar organizer region (Ag-NOR) in the neoplastic cells, using a one step silver-colloidal staining method. The mean (+/- SEM) Ag-NOR counts were 2.73 +/- 0.21 for atypical and 2.91 +/- 0.18 for papillary variants of meningioma. ⋯ Differences in the mean Ag-NOR numbers between meningothelial and transitional variants in their primary and recurrent tumours were not significantly different (p > 0.05). The results of this study indicates that estimation of Ag-NORs can be applied in predicting the aggressive clinical behaviour of primary meningeal tumours.
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Case Reports
Pyomyelia: an intramedullary spinal abscess complicating lumbar lipoma with spina bifida.
We report a case of spinal dysraphism, complicated by an intramedullary spinal abscess (IMSA). The magnetic resonance images of this case are shown and the pathophysiology of this condition is discussed.
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Hiccup or singultus is a repeated involuntary, spasmodic contraction of the diaphragm accompanied by a sudden closure of the glottis mediated by sensory branches of the phrenic and vagus nerves as well as dorsal sympathetic afferents. The principle efferent limb and diaphragmatic spasms are mediated by motor fibers of the phrenic nerve. Hiccup has been classified as a respiratory reflex and the central connection probably consists an interaction among the brainstem respiratory centers, phrenic nerve nuclei, medullary reticular formation and the hypothalamus. Chronic intractable hiccup may be due to brainstem seizures, and baclofen may be the long-awaited remedy for intractable hiccup as demonstrated in three illustrative cases.
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We have reviewed 35 years experience of extradural haemorrhage (EDH) in a large neurosurgical unit, based in two university hospitals, one dealing exclusively with children and the other a general hospital. A steady reduction in the mortality rate from 29 to 8.5% occurred during that period. ⋯ However, no single feature could be identified as the major contributor to falling mortality results. Clinical awareness and early diagnosis are the keys to successful management of EDH.
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A retrospective study was carried out of 202 patients with traumatic intracerebral haematomas (TICH) noted on CT, to determine which factors most affected outcome. There were 151 (75%) males and 51 (25%) females, whose ages ranged from 1 to 84 years. One-hundred-and-two (51%) had a good outcome (Glasgow Outcome Score 1 and 2). ⋯ No patient with three or more haematomas had a good outcome. Single factor logistic regression analysis identified Glasgow Coma Score (GCS), haematoma volume and difficulty with airway maintenance or poor arterial oxygenation as important factors in determining outcome. A four-factor logistic regression analysis model was developed which revealed that, when all other factors had been taken into consideration, craniotomy significantly improved the probability of a good outcome.