Neurosurgery
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Three years ago we reported our preliminary results regarding treatment of intractable spasticity with use of intrathecal morphine. This paper is a follow-up report of 12 patients who underwent implantation of a pump or reservoir for delivery of intrathecal morphine sulfate for control of spasticity. ⋯ Only one of these 12 patients has developed drug tolerance. The longest follow-up period has been 4.3 years, and this patient has maintained excellent control of his spasticity with a stable dose of 2 mg of morphine daily.
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Biography Historical Article
Donald Darrow Matson (1913-1969): a remembrance.
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The first United States 201 cobalt-60 source gamma knife for stereotactic radiosurgery of brain tumors and arteriovenous malformations became operational at the University of Pittsburgh on August 14, 1987. Four and one-half years of intensive planning, regulatory agency review, and analysis of published results preceded the first radiosurgical procedure. Installation of this 18,000-kg device and loading of the 201 cobalt-60 sources posed major challenges in engineering, architecture, and radiophysics. ⋯ Neither surgical mortality nor significant morbidity was associated with gamma knife radiosurgery. As compared with treatment by conventional intracranial surgery (craniotomy), the average length of stay for radiosurgery was reduced by 4 to 14 days, and hospital charges were reduced by as much as 65%. Based on both the previously published results of treatment of more than 2,000 patients worldwide and on our initial clinical experience, we believe that gamma knife stereotactic radiosurgery is a therapeutically effective and economically sound alternative to more conventional neurosurgical procedures, in selected cases.
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Over the past 18 months we have encountered 11 cases of symptomatic lumbar synovial cysts. This experience occurred during a period during which some 1,800 lumbar computed tomographic scans were done. ⋯ This is a report and discussion of our 11 cases with a review of the literature. There is nothing distinctive in the physical findings or in the histories of our patients, but we have found, as have others, that high-resolution computed tomographic scanning and magnetic resonance imaging significantly enhance the diagnosis of such lesions.
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A 23-year-old Hispanic woman whose mother had died of a brain hemorrhage developed signs and symptoms of a brain stem lesion. These gradually progressed over the next 30 years. Her computed tomographic and magnetic resonance imaging scans show features typical of a cavernous angioma in the brain stem. ⋯ The daughter's computed tomographic and magnetic resonance imaging scans likewise suggest cavernous angioma of the brain stem. There has been only one other report of familial cavernous angioma of the brain stem, and that also involved a Hispanic family. Hispanics have a known predisposition to familial cavernous angioma, and this diagnosis should be considered when more than one person in a family develops brain stem symptoms.