Neurosurgery
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Patients with brain metastases were analyzed retrospectively to assess the risks and benefits of surgery with modern neurosurgical techniques, including image guidance coupled as indicated with corticography. ⋯ In most patients with single or multiple brain metastases, surgical resection reversed or stabilized neurological symptoms with therapeutic benefit, conveying a notable survival advantage without apparent increased risk, particularly in RPA Class I patients. In patients with Grade III single metastasis or RPA Class II multiple metastasis, surgical judgment should be exercised, and stereotactic radiosurgery boost treatment may be preferable. An algorithm for treatment of brain metastases is proposed.
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To describe the occurrence of secondary insults using a computerized monitoring data collecting system and to investigate their relationship to outcome when the neurointensive care was dedicated to avoiding secondary insults. ⋯ Overall, the secondary insults were rare, except for high CPP. The results suggest that patients with traumatic brain injury might benefit from a CPP slightly less than 60 mm Hg.
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Argatroban is a synthetic direct thrombin inhibitor. We applied argatroban locally during carotid endarterectomy to prevent local mural thrombus formation. Although local delivery of argatroban is expected to be effective for inhibition of mural clot formation, there is no report of the evaluation of its clinical effectiveness or local drug concentration in humans. ⋯ The results suggest that direct local application of argatroban during carotid endarterectomy for at least 3 minutes may deliver high local tissue levels. Argatroban may be effective for prevention of perioperative embolic cerebral complications during carotid endarterectomy.