Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Patients with sickle cell disease (SCD) who have deformities and vertebral fractures due to osteoporosis may require surgery. Spinal surgeons must become familiar with the vertebral morphometry of patients with SCD and to that aim we have examined the morphometry of the thoracolumbar spine in these patients. A cohort of 100 patients with SCD was examined using plain thoraco lumbar anteroposterior/lateral radiographs and dual energy X-ray absorptiometry (DEXA). ⋯ Our data highlight the differences in vertebral bone mineral density, anatomy and deformities in patients with SCD compared to healthy individuals. When considering surgical intervention for patients with SCD, it is important that pre-operative radiography and planning is undertaken, and that the surgeon is familiar with the geometry of the pedicles of the thoracolumbar vertebrae necessary for the safe insertion of pedicle screws. Osteoporosis must be considered when planning surgical interventions in these patients.
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Phrenic nerve stimulation is a technique whereby a nerve stimulator provides electrical stimulation of the phrenic nerve to cause diaphragmatic contraction. The most common indications for this procedure are central alveolar hypoventilation and high quadriplegia. This paper reviews the available data on the 19 patients treated with phrenic nerve stimulation in Australia to date. ⋯ Three patients had revisions due to mechanical failure. The remaining patients' notes were incomplete. These data suggest that phrenic nerve stimulation can be used instead of mechanical ventilators for long-term ongoing respiratory support.
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Seeding metastases of a benign intraventricular meningioma along the surgical track is rare. We report a patient with a benign fibroblastic intraventricular meningioma that had spread along the path of previous surgery; the recurrences as well as the primary tumor were benign.
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Biography Historical Article
Harvey Cushing and some Australian connections: part 1 - early life and work.
Before World War 1 both the United States of America and Australia had rather rudimentary medical systems. Enterprising practitioners in both countries tended to look to continental Europe (especially Germany) and the United Kingdom as places of medical renown. The outbreak of World War 1 changed this but also enabled doctors from both the United States and Australia to work in military hospitals in Europe. ⋯ Examples of these were the experiences of Harvey Cushing, a burgeoning American neurosurgeon, which he recounted in his diary. His commentary merits close inspection and analysis. An account of some of Cushing's Australian connections post World War 1 is given in Part 2 (in press).
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Randomized Controlled Trial Comparative Study
Cerebral oxygen metabolism and neuroelectrophysiology in a clinical study of severe brain injury and mild hypothermia.
Mild hypothermia has an important role in the treatment of severe brain injury and there are therapeutic windows for this technique for patients with severe brain injury. We used a randomized, controlled, clinical study to investigate indexes of cerebral oxygen metabolism and neuroelectrophysiology to evaluate the efficacy of mild hypothermia treatment in severe brain injury. A total of 148 patients (106 males and 42 females), aged 18 to 64 years with acute severe brain injury were selected from June 1998 to June 2004 from the Department of Neurosurgery at The First Affiliated Hospital of Chongqing Medical University. ⋯ For patients with GCS 3-4, there was no difference between the hypothermia and normothermia subgroups. We conclude that hypothermia had a significant therapeutic effect on severe brain injury of patients with GCS 7-8, had no effect on patients with GCS 3-4, and an uncertain effect on patients with GCS 5-6. The indexes of cerebral oxygen metabolism and neuroelectrophysiology indicated primary and secondary brain injury, respectively, and provided an effective way to evaluate brain injury.