Neurosurgery
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Case Reports
Resolution of traumatic hypertrophic periodontoid cicatrix after posterior cervical fusion: case report.
The case of a 38-year-old man with delayed myelopathy 19 years after a nontreated odontoid type II fracture is reported. Magnetic resonance imaging of the craniocervical region revealed a periodontoid cicatrix. The clinical syndrome improved, and complete resolution of the retro-odontoid mass was achieved 9 months after posterior cervical fixation. The implications of this unique case for the management of myelopathy associated with nonunion of odontoid fractures are discussed.
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Although the majority of head injuries in children and adults involve dynamic loading conditions, some patients suffer static loading. Static loading occurs when forces are applied slowly to the head, and it produces a much different pattern of injuries. Crush injuries are usually described in the context of industrial accidents, but in our experience, these injuries are not rare in children. ⋯ There was one cervical spine injury but no major vascular injuries. One child had pituitary transection, four had cranial nerve palsies, and another developed a delayed cerebrospinal fluid rhinorrhea 18 months after injury. All children made good cognitive recoveries, with some having relatively mild fixed focal deficits.(ABSTRACT TRUNCATED AT 250 WORDS)
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In view of the pathophysiology and biomechanics of severe closed head injury (CHI) in children, we postulated that the frontal lobes sustain diffuse injury, even in the absence of focal brain lesions detected by magnetic resonance imaging (MRI). This study quantitated the morphological effects of CHI on the frontal lobes in children who sustained head trauma of varying severity. The MRI findings of 14 children who had sustained severe CHIs (Glasgow Coma Scale score of < or = 8) were compared with the findings in a matched group of 14 children having sustained mild head injuries (Glasgow Coma Scale score of 13-15). ⋯ Gray matter volume was also reduced in the orbitofrontal and dorsolateral regions of the brains of children with severe CHI, relative to the children who sustained mild head trauma. These volumetric findings indicate that prefrontal tissue loss occurs after severe CHI in children, even in the absence of focal brain lesions in this area. Nearly two-thirds of the children who sustained severe CHIs were moderately disabled after an average postinjury interval of 3 years or more, whereas 12 of the 14 patients with mild CHIs attained a good recovery (2 were moderately disabled) by the time of study.(ABSTRACT TRUNCATED AT 250 WORDS)
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In this study, a differential display method for messenger ribonucleic acid was successfully used to identify genes differentially expressed between normal human brain and malignant glioma tissues. A total of 60 differentially expressed sequences were initially identified, of which 21 were cloned and sequenced. Twenty of the cloned sequences represented novel genes, and one sequence represented a kinesin heavy chain (KHC) gene isoform. ⋯ Expression analysis of a variety of normal human tissues demonstrated that this KHC isoform is expressed only in brain tissues, with no detectable expression in placenta, spleen, kidney, lung, liver, or skeletal muscle. Our results confirm the rapid and sensitive nature of the differential display technique in identifying differential gene expression. This method offers a means to identify new genes of biological interest in human brain tumors such as oncogenes, tumor suppressor genes, and tumor-specific markers.
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Medical treatments and strategies are increasingly being subjected to evaluations of economic efficiency. Although the reasons for this are many, it is becoming ever more important for physicians to have an understanding of the uses and limitations of such evaluations. Cost effectiveness analysis (CEA) is a technique that measures the cost of medical technology per unit of a defined health output, usually life years saved with an adjustment for quality of survival. ⋯ Marginal and incremental CEAs are techniques that help to address the cost effectiveness of different amounts of a particular treatment and the differential costs and benefits of competing strategies, respectively. A review is presented of the theoretical basis of CEA and its component parts. Emphasis is placed on generating an understanding of the method rather than providing a step-by-step protocol for the undertaking of such studies.