Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 1998
Randomized Controlled Trial Clinical TrialTreatment of elevated intracranial pressure by infusions of 10% saline in severely head injured patients.
The management of intracranial pressure (ICP) is a factor in outcome of patients with head trauma. However, recent studies have revealed that the current strategies, which have been applied to control ICP for adequate cerebral perfusion, are unsatisfactory. Against this background, the efficacy of short-term infusions of hypertonic saline on ICP was investigated. ⋯ In the individual cases the temporal course of the parameters amplitude and decline interval depict a tendency toward lower and higher values, respectively, under conditions of a generally increasing ICP. As expected, the infusion of hypertonic saline reduces ICP in patients suffering from SHI. The pressure drop, duration and dynamic behaviour are suspected to depend both on the pressure level to reduce and concomitant medications.
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Acta Neurochir. Suppl. · Jan 1998
Randomized Controlled Trial Comparative Study Clinical TrialICP during anaesthesia with sevoflurane: a dose-response study. Effect of hypocapnia.
In patients with a supratentorial cerebral tumor, an increase in sevoflurane concentration from 1.5% (0.7 MAC) to 2.5% (1.3 MAC) did not change the intracranial pressure (ICP) significantly (12 to 14 mm Hg (medians)). However, a significant increase in cerebral blood flow (CBF) from 29 to 39 ml/100 g/min (medians) was disclosed. During administration of sevoflurane 1.5% and 2.5%, a significant decrease in ICP (3.5 and 3.0 mm Hg (median) respectively) was found when PaCO2 was decreased by 0.8 kPa.
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Acta Neurochir. Suppl. · Jan 1995
Randomized Controlled Trial Comparative Study Clinical TrialSpinal cord stimulation versus reoperation for failed back surgery syndrome: a prospective, randomized study design.
Retrospectively reported results of spinal cord stimulation compare favorably with those of neurosurgical treatment alternatives for the treatment of failed back surgery syndrome, including reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. Therefore, we have designed a prospective, randomized comparison of spinal cord stimulation and reoperation in patients with persistent radicular pain, with and without low back pain, after lumbosacral spine surgery. ⋯ The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for spinal cord stimulation over reoperation. Many other potentially important outcome measures will now be followed long-term as a larger overall study population accumulates.