Neurosurgery clinics of North America
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If return to work is part of the expected outcome, more and more data indicate that medical care alone does not hold the key to providing success. Our modern physical treatments may seem a humane alternative to no treatment, but they have not been proven to significantly alter the natural course of back problems. Even the results of strongly indicated surgical treatment differ little from doing nothing at all after a 4-year period. ⋯ This humane approach to care has evolved from common frustrations of dealing with patients with back problems, observations in the third world, and information gained from scientific studies. Medical pain, and physical models alone are unsuccessful. To be humane and successful, we can no longer ignore the nonphysical factors that can, and do, influence patients' responses to physical treatment, especially when return to work is part of the expected outcome.
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewManagement of head injury. Intracranial pressure monitoring.
The role of intracranial pressure monitoring as an adjunct to the clinical examination, CT scanning, and other diagnostic modalities has become increasingly recognized. This article presents a brief overview of the present status of this technique and touches on prospects for further developments.
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewNeurophysiologic monitoring of patients with head injuries.
Despite new technologic developments designed to analyze the brain's electrical activity, monitoring the electroencephalogram or evoked potentials has not yet provided important information with regard to acute management of patients with head injury. Measurement of cerebral blood flow as well as jugular oxygen saturation is of more practical importance. Particularly when monitored continuously, these measures can provide useful information about the use of hyperventilation and control of elevated systemic arterial pressure.
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Neurosurg. Clin. N. Am. · Apr 1991
ReviewManagement of head injury. Treatment of abnormal intracranial pressure.
Intracranial hypertension is recognized as a fundamental pathophysiologic process in brain injury. Although the exact pressure level defining intracranial hypertension remains to be firmly established, the majority of evidence available currently suggests that ICP should generally be treated when it exceeds 20 mm Hg. We suggest that lesions in the temporal lobe be treated at 15 mm Hg owing to the special relationship of this region to the brain stem. ⋯ The basic mechanisms of raised ICP are slowly becoming elucidated. Clinical clues with which to subdivide patients with intracranial hypertension are being defined. New agents with efficacy in lowering raised ICP are appearing, and determination of their mechanisms of action may provide insight into the underlying disorder.