Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Carotid sinus massage, a technique involving digital pressure on the richly innervated carotid sinus, is a time-honoured method for termination of supraventricular tachycardia due to paroxysmal atrial tachycardia. Vagal nerve stimulation, a more recent technique, employs pacemaker stimulation of the vagus as a treatment for refractory epilepsy. This case report discusses the use of carotid sinus massage to abort seizure activity. The patient used manual manipulation of the carotid sinus (similar to cardiology techniques) to suppress seizures, achieving a therapeutic neurological outcome.
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The Wnt4 molecule is a secretory glycoprotein implicated in proliferation and differentiation of both normal and malignant cells. Despite extensive investigation of Wnt4 expression in various cancers, little is known about its expression pattern in different types of pituitary tumors. In this study, we examined the expression of Wnt4 and its downstream molecule β-catenin in pituitary adenoma specimens. ⋯ These results were confirmed by real-time RT-PCR and western blot analyses. The expression pattern of β-catenin was similar to that of Wnt4 and was inversely correlated to the Knosp grade of tumor invasion. These data indicate that Wnt4 signaling is deregulated in most pituitary adenomas and its excessive activation may inhibit pituitary tumor invasion.
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Cushing's disease is hypercortisolaemia secondary to an adrenocorticotrophic hormone secreting pituitary adenoma. Primary management is almost always surgical, with limited effective medical interventions available. Adjuvant therapy in the form of radiation is gaining popularity, with the bulk of the literature related to the Gamma Knife. ⋯ Serum cortisol levels improved in nine of 36 (25%) SRS patients and 24 hour urinary free cortisol levels improved in 13 of 36 patients (36.1%). Tumour volume control was excellent in the SRS group with deterioration in only one patient (3%). The patient who underwent FSRT had a highly aggressive tumour refractory to radiation.
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Perioperative vision loss following non-ocular surgery is a well-documented phenomenon. In particular, perioperative vision loss has been frequently cited following spinal surgery. Although the rate of vision compromise in spinal surgery is relatively low, the consequences can be quite severe and devastating for the patient. ⋯ Postoperatively, the patient suffered severe anemia and bilateral infarctions of the posterior cerebral arteries and occipital lobes resulting in vision compromise. Although a definitive pathogenesis remains unknown, preoperative cardiovascular issues and intraoperative hemodynamic instabilities have typically been implicated as high risk factors. High risk factors for this novel clinical presentation of visual compromise following posterior lumbar laminectomy with decompression for an intraspinal tumor are reported.
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While anterior cervical discectomy and fusion (ACDF) is the gold standard surgical treatment for cervical disc disease, concerns regarding adjacent segment degeneration lead to the development of cervical disc arthroplasty (CDA). This study compares the utilization trends of CDA versus ACDF during the period of the Food and Drug Administration Investigational Device Exemption clinical trials from 2004 to 2007. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify CDA and ACDF procedures performed in the USA between 2004 and 2007. ⋯ Significantly more CDA patients had private insurance while more ACDF patients had Medicare. The average cost was higher for ACDF than CDA. While ACDF dominated surgical intervention for cervical disc disease during the trial period, CDA utilization increased at a significantly greater rate suggesting rapid early adoption.