British journal of neurosurgery
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Randomized Controlled Trial Comparative Study
Post-operative day two versus day seven mobilization after burr-hole drainage of subacute and chronic subdural haematoma in Nigerians.
The traditional care of patients with subacute/chronic subdural haematoma (S/CSDH) often involves delayed mobilization after burr-hole drainage. It is thought that delayed mobilization aids brain re-expansion thereby reducing the risk of recurrence. However, there is paucity of information regarding its efficacy and safety over early mobilization. We evaluated the efficacy and complications of each type of mobilization following burr-hole drainage of S/CSDH. ⋯ It appears that both EM and LM are equally beneficial in the post-operative care of patients following burr-hole drainage of S/CSDH. There is no significant complication referable to the specific type of mobilization. The authors, therefore, advocate EM of patients to reduce the length of hospital stay.
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Randomized Controlled Trial Comparative Study
A prospective study of two methods of closing surgical scalp wounds.
Scalp wounds are commonly closed in two layers, although single layer closure is feasible. This study prospectively compared the two methods of closing scalp wounds. ⋯ The study shows that closing the scalp in one layer is much faster and more cost effective compared to the multilayer closure method. We did not observe significant difference in the complication rates in the two methods of closure. Long-term outcome, especially cosmetic outcome, remains to be determined in this preliminary study.
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Randomized Controlled Trial Comparative Study
Comparison of unilateral pallidotomy and subthalamotomy findings in advanced idiopathic Parkinson's disease.
A prospective, randomized, double-blind pilot study to compare the results of stereotactic unilateral pallidotomy and subthalamotomy in advanced idiopathic Parkinson's disease (PD) refractory to medical treatment was designed. Ten consecutive patients (mean age, 58.4 +/- 6.8 years; 7 men, 3 women) with similar characteristics at the duration of disease (mean disease time, 8.4 +/- 3.5 years), disabling motor fluctuations (Hoehn & Yahr stage 3-5 in off-drug phases) and levodopa-induced dyskinesias were selected. All patients had bilateral symptoms and their levodopa equivalent dosing were analysed. ⋯ Cognitive functions were unchanged in both groups. Complications were observed in two patients: one had a left homonymous hemianopsia after pallidotomy and another one developed left hemiballistic movements 3 days after subthalamotomy which partly improved within 1 month with Valproate 1000 mg/day. The findings of this study suggest that lesions of the unilateral STN and GPi are equally effective treatment for patients with advanced PD refractory to medical treatment.
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Randomized Controlled Trial
Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study.
Blood transfusions and intravenous fluids are commonly employed as rescue therapy for delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (aSAH). We sought to determine effects of various fluid supplements on clinical outcome in patients following aSAH. Clinical events and laboratory data of 160 aSAH patients were prospectively collected as part of 2 randomised controlled trials. ⋯ Colloid fluids (OR 2.53/L/day, p = 0.025) promoted unfavourable outcome at 6 months (OR 4.45, p = 0.035), while crystalloids decreased unfavourable outcome (OR 0.27/L/day, p = 0.005). Associations between synthetic colloids and crystalloids with GOS at 6 months were dose-related. Intravenous fluid therapy using synthetic colloids or blood transfusions may be associated with increased unfavourable outcome following aSAH.
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Randomized Controlled Trial Clinical Trial
Hydrocortisone dose and postoperative diabetes insipidus in patients undergoing transsphenoidal pituitary surgery: a prospective randomized controlled study.
We report the results of a prospective randomized controlled trial, which looked at the incidence of postoperative diabetes insipidus (DI) following the use of three different hydrocortisone protocols, and the results of a study, on the incidence of DI and cortisol response in patients not given hydrocortisone. In study 1, 114 patients with pituitary macroadenoma were randomized into three groups: conventional dose (inj. hydrocortisone 100 mg IV 6-hourly for 3 days); intermediate dose (inj. hydrocortisone 100 mg IV 6-hourly on day 1, 100 mg IV 8-hourly on day 2, and 100 mg IV 12-hourly on day 3); low dose protocol (inj. hydrocortisone 25 mg IV 6-hourly on day 1, 25 mg IV 8-hourly on day 2 and 25 mg IV 12-hourly on day 3). Radical excision was achieved in 92 patients. ⋯ Patients in Group II demonstrated normal cortisol response intraoperatively and no patient developed features of hypocortisolism; the incidence of DI in this group was 14%. The low dose hydrocortisone protocol reduced the incidence of DI by 46% when compared with the conventional dose hydrocortisone protocol. In patients with grade A and B tumour with normal preoperative cortisol levels, the use of perioperative hydrocortisone can be avoided.