Journal of neurosurgery
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Journal of neurosurgery · Dec 1983
Effect of mannitol and furosemide on blood-brain osmotic gradient and intracranial pressure.
The effect of mannitol (1.0 gm/kg) and furosemide (0.7 mg/kg), alone and in combination, on the blood-brain extracellular fluid and cerebrospinal fluid (CSF) osmotic gradient, elevated intracranial pressure (ICP), CSF and serum osmolality, and urine output was studied in 26 mongrel dogs. Mannitol and furosemide, when used together, produced a greater (62.4% versus 56.6%) and more sustained (5 hours versus 2 hours) fall in ICP than mannitol alone. ⋯ The results from this present study suggest that the distal loop diuretics in a dose of less than 1.0 mg/kg act synergistically with mannitol by causing preferential excretion of water over solute in the renal distal tubule, and thereby sustaining the osmotic gradient initially established by the mannitol infusion. It is possible, but unlikely in the doses used, that the additive effect of furosemide on reducing ICP in the presence of mannitol is due to interference with CSF formation or Na+ and H2O movement across the blood-brain barrier.
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Journal of neurosurgery · Nov 1983
Spinal cord compression due to prolapse of cervical intervertebral disc (herniation of nucleus pulposus). Treatment in 26 cases by discectomy without interbody bone graft.
Twenty-six patients who presented with spinal cord compression due to cervical disc prolapse (herniation of the nucleus pulposus) were treated by anterior discectomy. There was a high incidence of disc prolapse at the C3-4 level. The most severe degrees of preoperative disability were associated with prolapse at that level. ⋯ Preexisting fusion of vertebral bodies in the cervical spine and a history of cervical spinal trauma appear to be predisposing factors. Discectomy is an effective treatment of this condition. Spinal cord compression due to cervical disc prolapse should be distinguished from spondylotic myelopathy.
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Journal of neurosurgery · Nov 1983
Outcome from severe head injury related to the type of intracranial lesion. A computerized tomography study.
The influence of the type of intracranial lesion on the final outcome in a consecutive series of 277 severely head-injured patients was analyzed. Patients were studied with computerized tomography (CT) and underwent continuous measurement of intracranial pressure. ⋯ Patients with pure extracerebral hematoma (19 cases), single brain contusion (45 cases), general brain swelling (41 cases), and normal CT scans (28 cases) had a significantly better outcome than patients developing acute hemispheric swelling after operation for a large extracerebral hematoma (27 cases), patients with multiple brain contusion, either unilateral or bilateral (74 cases), and patients with diffuse axonal injury (43 cases). These anatomical patterns are interesting because, in addition to having clinical and physiopathological significance, they provide useful prognostic information and facilitate improved therapeutic decision-making in severely head-injured patients.
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Journal of neurosurgery · Oct 1983
"The common devotion"--Cushing's legacy and medical ethics today. The 1983 Harvey Cushing oration.
The author examines the principles that have been specific to the profession of medicine. He iterates Harvey Cushing's exhortation to reaffirm adherence to traditional medical ethics which are at times strained in dealing with major congenital defects, maintenance of ancillary support, technological possibilities, and terminal illness. Moral considerations must be examined and respected, and remain the personal responsibility of the profession. The best decisions involve the patient's interests and the freedom to choose.
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Journal of neurosurgery · Oct 1983
Differential diagnosis between ventriculitis and fourth ventricle cyst in neurocysticercosis.
The fourth ventricle is frequently affected in patients with cysticercosis of the central nervous system, due either to a large cyst occluding the cavity or to granular ependymitis (ventriculitis) as a consequence of diffuse inflammation within the intraventricular and subarachnoid spaces. In some cases, the differential diagnosis between these two forms of neurocysticercosis is difficult to make, even after special radiological procedures. It is important to establish the correct diagnosis, since a surgical approach is beneficial only when the fourth ventricle is obstructed by a large cyst. ⋯ Patients with a large cyst occluding the fourth ventricle had a short evolution of signs and symptoms, Bruns' syndrome, and discrete or no inflammatory reaction in the cerebrospinal fluid (CSF). Patients with ventriculitis generally had a longer duration of signs and symptoms, Parinaud's syndrome, a consistently positive complement fixation test to cysticerci, and more cells and proteins in the CSF. The clinical picture and ancillary studies can give the precise diagnosis in most patients before surgical exploration is performed.