Neurosurgery
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Chronic pain in the perineum is a difficult neurosurgical problem. This article evaluates the effectiveness of sacrococcygeal rhizotomy in 28 patients who had cancer-related pain or coccydynia, underwent rhizotomy, and were followed for an average of 3 years. Good pain relief was obtained in 53% (10 of 19 patients) with malignant pain, as opposed to 22% (2 of 9 patients) with nonmalignant pain. Sacral rhizotomy is a reasonable treatment for cancer-related perineal pain, but it is ineffective for coccydynia and other benign perineal pain problems.
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A newborn with paraplegia and evidence of a subarachnoid hemorrhage was found to have a spinal arteriovenous malformation. The arteriovenous malformation was managed by direct surgical obliteration. This patient is the youngest ever reported to have this disorder and the youngest so treated.
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Abnormalities of coagulation and fibrinolysis in 12 head-injured patients were studied in early (within 24 hours of onset) and late (10th to 17th day after onset) stages. alpha 2 Plasmin inhibitor (alpha 2PI), antithrombin III (ATIII), and fibrinopeptide A (FPA) and B beta 15-42 (FPB beta) were measured in particular, in addition to the usual tests (platelet count (PLT), prothrombin time (PT), partial thromboplastin time, fibrinogen, and fibrin/fibrinogen degradation products (FDP)). alpha 2PI was abnormally lower, and FPA and FPB beta were much higher; fibrinogen and ATIII were moderately lower in the early stage than in the late stage in 6 head-injured patients with postoperative intracranial hemorrhage. alpha 2PI, ATIII, and fibrinogen were moderately lower and FPA was moderately higher in the early stage than in the late stage in 6 head-injured patients without postoperative intracranial hemorrhage. PLT and fibrinogen were lower, alpha 2PI was much lower, and FPA was much higher in the 6 patients with postoperative intracranial hemorrhage than in the 6 patients without postoperative intracranial hemorrhage. ⋯ This recurrent hemorrhage was due to disseminated intravascular coagulation (DIC) caused by primary brain damage and was associated with extremely high FPA and FPB beta levels and abnormally low alpha 2PI and PLT. Fresh-frozen plasma and intravenous low-dose heparin were administered after the two recurrent hemorrhages, after which FPA and FPB beta normalized immediately, although other screening tests showed only gradual improvement.(ABSTRACT TRUNCATED AT 250 WORDS)
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The cerebrospinal fluid pulse pressure (CSFPP) has found application as a measure of intracranial elastance. However, CSFPP is also dependent on the magnitude of the pulsatile variation in cerebral blood volume (delta Vb). The purpose of the present study was to assess the effect on delta Vb of changes in systemic arterial pressure (SAP) and arterial carbon dioxide tension (PaCO2) as well as elevation of intracranial pressure (ICP). ⋯ The underlying mechanisms of the pulsatile flow changes are extensively discussed. It is argued that the arterial inflow profile is largely determined by the compliance of the inflow section of the cerebral vascular bed. Vascular compliance is significantly altered by changes in SAP and ICP because they affect the transmural pressure of the vessels, whereas this is not the case during changes in PaCO2.