Journal of neurosurgery
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Journal of neurosurgery · Sep 1981
Traditions, transition, and the torch. The 1981 AANS presidential address.
The President of the American Association of Neurological Surgeons (AANS) emphasizes the need to participate actively in the burgeoning field of neuroscience, and the unique opportunity of neurological surgeons to apply the new knowledge to the treatment of their patients. Clinician-investigators need to be trained in their formative years in the methodology and techniques of modern neurobiology. ⋯ To meet a critical need, the formation of a Research Foundation is announced as a function of the AANS. As Science is expanded and applied, the Art of neurosurgery will continue to be refined, along with the high tradition of Ethics which has been handed down over the years as part of the heritage of neurological surgeons.
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Journal of neurosurgery · Aug 1981
Case ReportsHydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment.
One may consider that the child with hydrocephalus complicating a primary brain tumor has two distinctly different diseases: 1) a neoplasm, and 2) hydrocephalus. The hydrocephalus may be obstructive, communicating, or (in the case of choroid plexus papilloma) hypersecretory. This paper presents the incidence, symptomatology, and management of hydrocephalus associated with infratentorial brain tumors in 156 children and with pineal tumors in 21 children, all treated by the first author during the period 1967 to 1979. ⋯ Eighteen of these children required shunt revisions after craniotomy; 36 of 80 patients followed for 6 months or more had their shunts permanently removed, but it was necessary to reinsert the shunt from 5 days to 13 months later in 30% of these patients. Only 25 patients remained permanently shunt-free. It is considered that the placement of shunts before craniotomy is justified by the extraordinarily high incidence of papilledema and visual impairment associated with hydrocephalus. "Upward herniation" and dissemination of neoplastic cells through the shunting system are theoretical contraindications to precraniotomy shunt insertion, although the former is rare (3%), and there is no statistical evidence to support the latter.
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Journal of neurosurgery · Jun 1981
Case ReportsPharmacokinetics of epsilon-aminocaproic acid during peritoneal dialysis.
Two patients requiring peritoneal dialysis were treated with epsilon-aminocaproic acid (EACA), an antifibrinolytic agent. Samples of serum and dialysate were assayed for EACA concentrations. ⋯ Our results suggest that patients undergoing peritoneal dialysis should receive 25% of the usual recommended dose of EACA. Dialysis clearance accounted for only 58% of total body clearance, suggesting an alternative route of elimination of EACA.