Neurosurgery
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The value of removing hair in preparation for neurosurgery is addressed in detail. One neurosurgeon's series, accrued over 40 consecutive months, of 638 prospectively examined, consecutive cases is the basis of this report. The overall surgical wound infection rate was 1.1%. ⋯ These data are discussed in the context of extensive nonneurosurgical and microbiological literature. It is concluded that the removal of hair by shaving does not lower the risk of surgical wound infection and may increase the risk. A technique for preparing skin and hair for neurosurgery and for the management of hair during neurosurgical procedures is discussed.
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A high degree of variability in energy expenditure has characterized the metabolic response to traumatic brain injury. A goal of parenteral or enteral repletion in this population is the precise estimation of caloric requirement to avoid complications associated with overfeeding and underfeeding. The first aim of this study was to evaluate three predictive formulas for comparison to measured energy expenditure (MEE) derived from indirect calorimetry in patients with traumatic brain injury. ⋯ The second aim of this study was to evaluate the ability of additional nutritional markers to improve predictive ability. Regression analyses were performed on nutritional markers including indices of severity of injury, concurrent drug therapy, vital signs, neurological status, gluconeogenesis, protein synthesis/excretion, and immune response. The statistical results of the analysis on these multiple nutritional markers showed only heart rate, temperature, and number of days elapsed after injury to be significant predictors of MEE by indirect calorimetry in multiple regression analyses (R = 0.32; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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In a series of 35 patients with intracranial meningiomas, factors influencing the development of peritumoral brain edema (PTBE) were analyzed. We used numbers of the Edema Index as the extent of PTBE, which was obtained from the size of the meningioma and associated PTBE on a T2-weighted image of magnetic resonance imaging. We evaluated a relationship between the Edema Index and some factors that may play a role in the development of PTBE. ⋯ The meningiomas that had a vascular supply from the intrinsic cerebral arteries on angiography significantly correlated with severe PTBE compared with those supplied only from the meningeal side (P less than 0.01). We concluded that location, histology, and vascular supply from intrinsic cerebral arteries were the factors influencing PTBE. It is stressed that the vascular supply from the intrinsic cerebral arteries may have an influence on the extensive PTBE of meningioma.