Journal of neurosurgery
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Journal of neurosurgery · Oct 1989
Review Historical ArticleTrends in neurosurgery. The 1989 AANS presidential address.
This overview of neurosurgical practice examines patterns of case management, using several areas such as head injury, brain tumors, and the delivery of health care to illustrate the changes that have taken place over the past 40 years and the changes that might be expected in the next 40 years. The rapid pace of progress has indicated further exciting growth of this specialty into the 21st century; however, what remains constant is the dynamic character of the neurosurgeon. This view of the past and the possibilities for future innovation enables neurosurgeons of all generations to have a sense of pride in the achievements generated by their peers.
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To analyze the phenotypic profile of lymphoid cells freshly isolated from surgically resected human gliomas, a double-immunostaining technique was developed which permitted the investigators simultaneously to distinguish between hematogenous and tumor cell populations and to detect expression of lymphocyte-monocyte subset-specific antigens on hematogenous cells. With this technique, the profiles of tumor-infiltrating lymphocytes (TIL's) derived from high- and low-grade gliomas were compared with phenotypes of lymphocytes concurrently isolated from peripheral blood. ⋯ The proportion of natural killer HNK-positive cells, some of which bear the CD8 antigen (although not necessarily the pan T cell antigens CD2 and CD3), was also increased in the TIL's (41.9% +/- 4.2%) compared to that found in PBL's (32.1 +/- 5.6%, p less than 0.05) of high-grade glioma cases. The observed phenotypic pattern of high-grade glioma TIL's is similar to that reported based on immunohistochemical analysis of tumor tissue sections, suggesting that the techniques described here resulted in isolation of lymphoid cells representative of TIL's.
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Journal of neurosurgery · Oct 1989
Comparative StudySupratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma.
A retrospective analysis is presented of factors affecting the length of survival of 285 consecutive adults with newly diagnosed biopsy-proven supratentorial anaplastic glioma (188 cases of glioblastoma multiforme, 76 of anaplastic astrocytoma, 11 of anaplastic mixed glioma, and 10 of anaplastic oligodendroglioma) treated at a regional cancer center from July, 1982, through December, 1987. The approach to initial therapy included maximum feasible resection and radiotherapy. The median survival time for all patients was 35 weeks. ⋯ First, patients with anaplastic oligodendroglioma had the longest median survival time (278 weeks). Second, corrected for accessibility and all other variables, patients with gross total resection lived longer than those with partial resection, and patients with any degree of resection lived longer than those who underwent only a biopsy procedure. Third, patients with anaplastic glioma in whom there was a prior history of low-grade glioma lived significantly longer after the diagnosis of anaplastic glioma than did patients in whom the anaplastic glioma apparently arose de novo.