Neurosurgery
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Creative research thought, embodying original ideas that are adaptable and lasting, changes the scholarship and course of neurosurgery, and will be recognized by high citation frequency. Thirty-nine of 50 of the first American neurosurgeons were the first authors of 411 research papers, which were studied by analysis of citations between 1965 and 1979. Of all papers written by these authors between 1896 and 1976, 11% concerned research; this category received 22% of the aggregate of citations. ⋯ They included Bailey (441), Cushing (431), Penfield (423), Dandy (246), and Davis (158). Among the 50 authors, the percentage of published research papers did not separate the neurosurgeon with laboratory experience from his clinically oriented counterpart with regard to productivity and creativity. The data suggest that neurosurgeons are generally not basic scientists but clinical investigators.
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Thirty-three children ranging in age from 8 months to 15 years were treated for gunshot wounds to the brain. Half of the children were less than 10 years old. Fifty-eight percent died. ⋯ Of the survivors, none was left vegetative after 6 months, 3 had severe disabilities, 9 were moderately disabled, and 2 had a good outcome. The mortality rate is strikingly similar to that of adults with similar injuries; however, the morbidity appears to be less. On the other hand, with simple preventative measures, virtually each injury would have been avoided.
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Hospitals face an increasingly competitive environment in the era of diagnostic related group (DRG) prospective pricing. Further reductions in Medicare outlays relative to hospital costs are likely, given the looming federal deficit. We analyzed the relationship of individual neurosurgical volume, hospital costs, and outcome. ⋯ Pearson correlation showed an inverse relationship between declining cost per patient and increasing neurosurgical volume for both nonemergency patients -0.340 (P less than 0.0001), and emergency patients, -0.321 (P less than 0.0001). These findings suggest that the volume of neurosurgical procedures performed by an individual neurosurgeon is related to hospital resource utilization. This study also suggests that the DRG prospective payment system could provide incentives that may affect both neurosurgical practice and the access to neurosurgical care.
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Toxic epidermal necrolysis is a rare but often fatal hypersensitivity reaction to numerous agents, including most anticonvulsants. The authors present a case of fatal phenytoin-related toxic epidermal necrolysis in a patient who was given prophylactic anticonvulsant therapy after he sustained a moderately severe closed head injury. The typical course and current management of toxic epidermal necrolysis are reviewed, as are the indications for the prophylaxis of posttraumatic epilepsy.
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During the 1985 annual meeting of the Congress of Neurological Surgeons in Honolulu, neurosurgical training and practice in India, Korea, Japan, and Australasia were discussed at the International Committee symposium. This article summarizes the information presented. India has about 300 neurosurgeons for a population of 650 million, while Japan has about 4,000 neurosurgeons and trainees for a population of 120 million. ⋯ Various other demographic, institutional, organizational, and economic aspects of neurological health care and delivery, education, and quality control are described. While financing and availability of adequate neurosurgical care remains a major problem in India, it appears that reducing the number of neurosurgical trainees remains, as it is in North America, a major issue in Japan and, to a lesser extent, in Korea. This problem, as well as certification of the quality of training, is being managed effectively in Australasia.