Neurosurgery
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Randomized Controlled Trial
Randomized pilot trial of intensive management of blood pressure or volume expansion in subarachnoid hemorrhage (IMPROVES).
Volume expansion and hypertension are widely used for the hemodynamic management of patients with subarachnoid hemorrhage. ⋯ This pilot study showed adequate feasibility and excellent retention to follow-up. Given the suggestion of possible worse neurobehavioral outcome with ABP, a larger trial to determine the optimal blood pressure management in this patient population is warranted. (ClinTrials.gov NCT01414894.)
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In lower brachial plexus injury, finger flexion after brachialis motor branch transfer is relatively weak. We sought to screen potential branches of the median nerve from the upper trunk for strengthening finger flexion in addition to the brachialis motor branch. However, the spinal origin of the muscular branches of the median nerve based on electrophysiological study was unclear. ⋯ This electrophysiological study indicates that the pronator teres branch might be the most feasible alternative donor nerve to supplement the brachialis motor branch and strengthen finger flexion after lower brachial plexus injury.
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Randomized Controlled Trial
Contralateral peripheral neurotization for hemiplegic upper extremity after central neurologic injury.
Central neurological injury (CNI) is a major contributor to physical disability that affects both adults and children all over the world. The main sequelae of chronic stage CNI are spasticity, paresis of specific muscles, and poor selective motor control. Here, we apply the concept of contralateral peripheral neurotization in spasticity releasing and motor function restoration of the affected upper extremity. ⋯ This contralateral C7 neurotization approach may open a door to promote functional recovery of upper extremity paralysis after CNI.
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The pipeline embolization device (PED) has been used for treatment of unruptured aneurysms. Little is known about the use of the PED in ruptured aneurysms. ⋯ In our preliminary experience, treatment of ruptured aneurysms with the PED was associated with low complication rates, high occlusion rates, and favorable outcomes. These findings suggest that PED may be a safe and effective option for patients with favorable Hunt and Hess grades and aneurysms difficult to treat with conventional methods.
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Recent studies have highlighted the obesity paradox where patients with obesity have a greater chance of survival than patients with normal weight. ⋯ The results of our study indicate that BMI is not noticeably associated with severity of bleeding or functional outcome in patients with SAH. This finding was discovered after performing a multivariate analysis adjusting for age where older age was associated with worsened severity and outcome.