J Neurosurg Sci
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Percutaneous retrogasserian glycerol rhizolysis (PRGR) became a diffuse and valuable method for treatment of trigeminal neuralgia, following its introduction by Hakanson in 1981. Its main advantages are: a) mild postoperative facial sensory loss, b) simplification of the technique, c) reduction of costs. Our results in a series of 191 patients treated between September 1983 and September 1990 are reported. ⋯ The mean time of recurrence was 30.5 months. The recurrence rate in the patients of our series at the end of the follow-up period was 23%. Glycerol produces a weak neurolytic lesion, that generates minor post-operative facial deafferentation; it is the best technique, in our opinion, for treatment of tic douloreux.
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During centuries, the loss of spontaneous cardio-pulmonary function was found to predict permanent non-functioning of the "organism as a whole", therefore serving adequately as a criterion of death, but during the era of Intensive Care, there was a shift to brain-oriented definitions of death, ie, the irreversible cessation of brain functions, started to be considered as the main reason for cessation of functioning of the "organism as a whole". A concept or definition of death is related to the question: What is it "about human life, which is irreplaceable by any artifice, and that its loss is so essential, that the individual who loses it ought to be called dead?" Further work has been centered on how much of the brain needs to be dead, before a person can be declared dead on neurological grounds: "whole brain", "brainstem death" ("brain as a whole") and "higher brain" formulations of death. ⋯ I propose a concept of death that excludes those states taking in consideration the basic mechanisms of consciousness generation in human beings: "The irreversible loss of consciousness, considering both its capacity and its content". This definition of human death takes consideration as hallmarks, both components of consciousness which are essentially significant to the nature of man, to provide the functioning of the "organism as a whole".
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Penetrating cranio-cerebral trauma caused by fire-arm constitute the most frequent penetrating wounds in civilian ambit; in these cases the great extention of cerebral damage is the result of distructive forces generated by high velocity which moves this bodies. In civilian ambit cranio-cerebral wounds caused by penetrating bodies, but moved by low cinetic energy are increasing constantly, due to the development of industrial activities. ⋯ We think that for these traumatic event, we can adapt the same valutations criteria used for wounds caused by fire-arms. For what concerns surgery of such injuries, we consider the emergency operation the best solution; generally in these cases the purpose of surgery is not the removal of devitalized tissues, evacuation of hematomas or removal of bone fragments or of penetrating bodies as happen in cases of penetrating bodies moved by high cinetic energy, but for the possible complications which can result immediately or after the trauma.
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Fibrin and fibrinogen degradation products in the cerebrospinal fluid (CSF-FDP) were first studied in a group of 29 patients observed during the first and the second week after subarachnoid hemorrhage (SAH), then in a second group of 26 patients for a total of 55 patients. In the latter group only the first FDP value obtained as soon as possible after SAH was taken in consideration. In the whole series of 55 patients several noteworthy factors were found: 1) FDP determination should be performed as soon as possible after SAH; 2) CSF-FDP at or above 40, 80 micrograms/ml was found both in the patients with severe neurological deficits and in those with cerebral ischemia (statistically significant); 3) the significance of CSF-FDP in patients who rebled was also evaluated. In conclusion CSF-FDP could be considered useful in predicting cerebral ischemia.
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Among the patients with a cervical injury admitted to our clinic between 1980 and 1988, 18 cases underwent a ventral fusion operation (Cloward) and 8 of them needed additional vertebrectomy. The injury in all of these cases was due to falls and presented with major compression fractures. ⋯ During the follow-up period, cervical alignment was found to be stable in all patients. The radiological characteristics of the lesions, intraoperative surgical modifications for specific aspects of the lesion, other technical availabilities and the results are discussed.