Neurosurgery
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Approximately 20 to 30% of patients undergoing carotid endarterectomy (CEA) subsequently develop cognitive impairment. The purpose of the present study is to determine whether or not malondialdehyde (MDA)-modified low-density lipoprotein (LDL), a biochemical marker of oxidative damage, concentrations in the jugular bulb during CEA correlates with development of postoperative cognitive impairment. ⋯ MDA-LDL concentration in the jugular bulb during CEA correlates with development of postoperative cognitive impairment.
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Historical Article
New World cranial deformation practices: historical implications for pathophysiology of cognitive impairment in deformational plagiocephaly.
Throughout history, prehistoric and even some contemporary civilizations have practiced various forms of intentional and unintentional cranial deformation. Plagiocephaly can be the result of craniosynostosis, infant positioning, or other unintentional or intentional deformation. ⋯ Because we can only view these cultures through the relics of time, any conclusions one might draw from the anthropological and historical record regarding the cognitive effects of head deformation can only be inferred through generalized observations and are tenuous. Nevertheless, there does not seem to be any evidence of negative effect on the societies that have practiced even very severe forms of intentional cranial deformation (e.g., the Olmec and Maya). On the other hand, the physical anthropology and the contemporary developmental literature suggest possible mechanisms for such an effect.
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Sports medicine clinicians commonly use multiple tests when evaluating patients with concussion. The specific tests vary but often include symptom inventories, posturography, and neurocognitive examinations. The sensitivity of these tests to concussion is vital in reducing the risk for additional injury by prematurely returning an athlete to play. Our study investigated the sensitivity of concussion-related symptoms, a postural control evaluation, and neurocognitive functioning in concussed collegiate athletes. ⋯ Currently recommended concussion-assessment batteries accurately identified decrements in one or more areas in most of the athletes with concussion. These findings support previous recommendations that sports-related concussion should be approached through a multifaceted assessment with components focusing on distinct aspects of the athlete's function.
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Surgical error is common and contributes to complications for patients, necessitating detailed prospective collection and analysis of error data that emphasizes prevention. ⋯ Surgical errors are common, often preventable, and frequently lead to clinical impact. In addition, the type of procedure and characteristics of the patient are important factors to consider when addressing surgical error. For individual surgeons to maintain quality control and contribute to the safety of the health care system, they must track and analyze errors to ensure that systems may be developed to prevent their occurrence.
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Treatment of patients who fail epilepsy surgery is problematic. Selected patients may be candidates for further surgery, potentially leading to a significant decrease in the frequency and severity of seizures. We present our long-term outcome series of highly investigated patients who failed resective epilepsy surgery and subsequently underwent reoperative resective procedures. ⋯ Reoperation should be considered in selected patients failing epilepsy resective surgery because approximately 50% of patients may have benefit. Patients with cortical dysplasia and mesial temporal sclerosis are less likely to improve after reoperation.