Neurosurgery
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Neurosurgery at the University of Michigan was established as a specialty three-quarters of a century ago by Max Minor Peet. It developed under the successive leadership of Edgar Allan Kahn, Richard Coy Schneider, and Julian T. ⋯ Each has made unique contributions to the program, which has a strong tradition of teaching, research, and patient care. This article traces the development of the training program in neurosurgery at Michigan, focusing on its historical background, past accomplishments, present structure, and future directions.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A randomized trial of intraoperative, intracisternal tissue plasminogen activator for the prevention of vasospasm.
A multicenter, randomized, blinded, placebo-controlled trial was conducted to study the possible role of intracisternally administered fibrinolytic agent recombinant tissue plasminogen activator (rt-PA) in preventing delayed onset cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH). The target population was patients with ruptured saccular aneurysms causing severe SAH, placing them at high risk for vasospasm. Treatment consisted of a single 10 ml intraoperative injection of either vehicle buffer solution or rt-PA (1 mg/ml) into the opened basal subarachnoid cisterns immediately following aneurysm clipping. ⋯ However, there was a trend toward lesser degrees of vasospasm in the rt-PA treated group. The rates for no or mild, moderate, and severe vasospasm were 69%, 16% and 15% in the rt-PA treated group, versus 42%, 35% and 23% in the placebo group (P = 0.07). When only those patients with thick subarachnoid clots were considered at the treating centers, there was a 56% relative risk reduction of severe vasospasm in the rt-PA treated group, which was significant (P = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Reduction of post-traumatic intracranial hypertension by hypertonic/hyperoncotic saline/dextran and hypertonic mannitol.
Cerebral injury is seen in one of three patients with multiple traumas; thus efficient shock treatment is a most important measure against the development of secondary brain damage. Small-volume resuscitation in severe hemorrhagic shock by hypertonic/hyperoncotic saline/dextran has been shown to instantaneously normalize cardiac output and to raise systemic blood pressure. In this study, the fluid regimen was compared with hypertonic mannitol to investigate their therapeutic efficacy in intracranial hypertension. ⋯ The increase of the cerebral water content of the traumatized hemisphere was associated with a respective increase of the cerebral Na+ content and a (nonsignificant) decrease of the K+ content. The present findings demonstrate that the hypertonic/hyperoncotic saline/dextran was as efficient as the mannitol in reducing ICP that had been increased by a cerebral lesion and a space-occupying mass; the underlying mechanisms responsible for the reduction might differ. Because of the powerful hemodynamic properties of the saline/dextran in circulatory shock, administration of the solution in patients with multiple traumas and head injury might be particularly advantageous for the prevention of secondary ischemic brain damage.
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The possibility that the female sex steroid progesterone plays a role in meningioma proliferation has been suggested by a number of investigators, and it has been shown that many meningiomas have high-affinity progesterone binding sites. There has been a long-standing debate in the literature as to whether the progesterone receptors that are present in meningiomas are functional. We recently showed, by the use of immunohistochemistry, that the progesterone receptor in meningiomas is localized to the nucleus, suggesting that the receptor is in a location to be activated. ⋯ In all meningioma cell cultures, an increase in the transcription of the progesterone response element construct was observed in the presence of dexamethasone, suggesting that the glucocorticoid receptor in meningiomas is functional. An increase in transcription was observed with the addition of promegestone (R5020), a progesterone agonist, only in meningioma cell cultures that were expressing the progesterone receptor. These data show that both the progesterone and the glucocorticoid receptor in meningiomas are functional and support the concept that progestins and glucocorticoids may play an important role in meningioma growth.