Neurosurgery
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Oxygent, a second-generation perfluorocarbon (Perflubron) emulsion (Alliance Pharmaceutical Corporation, San Diego, CA) with superior oxygen delivery characteristics and greater stability than previous perfluorocarbon emulsions, was evaluated as a cerebroprotective agent in a dog model of partial brain stem ischemia. Six dogs were exposed to 20 minutes of isolated brain stem ischemia after receiving an intravenous bolus of Oxygent at a dose of 1.5 ml/kg. Brain stem auditory evoked potentials (BAEP) and regional cerebral blood flow were measured before and during the ischemia and for 5 hours after reperfusion. ⋯ The continued improvement in the BAEP in the Oxygent-treated group compared with the control groups suggests that Oxygent may be of some value as a protective agent to the brain stem during ischemia. This effect may be the result of improved oxygen delivery to the brain stem or may be related to other effects of Oxygent, such as reduction of reperfusion injury. Results suggest that Oxygent may be useful as a cerebroprotectant during cerebrovascular surgeries that require temporarily reducing blood flow to the brain stem.
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Comparative Study
Comparison of stereotactic radiosurgery and brachytherapy in the treatment of recurrent glioblastoma multiforme.
The purpose of this study was to compare the efficacy of stereotactic radiosurgery (SRS) and brachytherapy in the treatment of recurrent glioblastoma multiforme (GBM). The patients had either progressive GBM or pathologically proven GBM at recurrence after previous treatment for a lower grade astrocytoma. Thirty-two patients were treated with interstitial brachytherapy, and 86 received treatment with stereotactic radiosurgery (SRS). ⋯ Five patients (16%) treated with brachytherapy were alive, with a median follow-up of 43.3 months. The median actuarial survival for all patients treated with brachytherapy was 11.5 months. Survivals of 12 and 24 months were 44 and 17%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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To clarify the efficacy and limitations of the intra-arterial local infusion of a high-dose fibrinolytic agent for acute embolic stroke, we analyzed the results of 44 patients and compared them with those of 51 patients treated with intracarotid (18 patients) or intravenous (33 patients) infusion therapy. Ten megaunits of recombinant tissue plasminogen activator or 24 x 10(4) IU of urokinase were administered through a microcatheter placed into or proximal to an embolus for 20 minutes. When arterial recanalization was not achieved, a second or third infusion was performed. ⋯ The incidence of hemorrhagic infarction was 28%. The outcome in this group and the intravenous infusion group (18 x 10(4) IU of urokinase a day for 1 wk) was poor compared with that in the local infusion group showing complete recanalization. This preliminary study appears to suggest that intra-arterial local fibrinolytic therapy could be a new strategy for acute embolic stroke.
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Clinical Trial
Stereotactic puncture and lysis of spontaneous intracerebral hemorrhage using recombinant tissue-plasminogen activator.
We have tested a treatment protocol for intracerebral hemorrhage (ICH), consisting of stereotactic insertion of a catheter into the clot, hematoma lysis by the injection of a fibrinolytic agent, recombinant tissue-plasminogen activator (rt-PA), and closed system drainage of the liquefied clot. Fourteen patients underwent computed tomographically guided stereotactic hematoma puncture and silicone tube insertion within 72 hours of intracerebral hemorrhage. The majority (nine patients) suffered from ganglionic ICH, and the size of the hematoma ranged between 3 x 3 x 4 cm and 7 x 7 x 4 cm (mean, 5.2 x 4 x 3.6 cm). ⋯ The number of rt-PA injections was four in one patient, three in eight patients, two in four patients, and one in one patient, and the total dose of rt-PA required ranged from 5 to 16 mg (mean, 9.9 mg). After rt-PA injection, the tubing was clamped for 2 hours and then opened to drain spontaneously through a closed system against 0 cm of pressure. At follow-up 6.6 months (mean) after treatment (ranging from 3 to 13 months) and according to the Glasgow outcome score, one patient was Grade V, four were Grade IV, five were Grade III, two were Grade II, and two had died.(ABSTRACT TRUNCATED AT 250 WORDS)