Neurology
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Randomized Controlled Trial Comparative Study Clinical Trial
Surgical treatment for intracerebral hemorrhage (STICH): a single-center, randomized clinical trial.
To perform a single-center pilot investigation of early hematoma removal in patients with intracerebral hemorrhage (ICH). ⋯ A trial of early surgery for ICH is feasible. This study represents the largest prospective, randomized series of surgery for ICH. A modest early mortality benefit for surgery is possible, but long-term benefit for surgery was not established in this single-center pilot investigation.
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Optimal treatment of epilepsy in adults requires a tailored approach that weighs the efficacy of individual drugs in the specific diagnosis against the patient's risks for adverse events. Partial seizures, which are the most common seizure type in adults, can be effectively controlled by virtually all the standard and newer antiepileptic drugs (AEDs). For the generalized epilepsies, valproate remains the drug of choice. ⋯ Monotherapy should be the goal when AED treatment is instituted for the adult with epilepsy. Dosage modification on the basis of seizure control and toxicity should be implemented, as well as single-drug trials with alternative AEDs, before resorting to polytherapy. With the introduction of several promising newer AEDs, safe and effective seizure control may become a reality for an increasing number of adults with epilepsy.
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Patients experiencing a first seizure need a careful history and examination to confirm that the presenting seizure is truly the initial event and to identify other possible risk factors for recurrence. The decision of whether to start therapy should be made by the clinician and a fully informed patient. Status epilepticus presents in several forms, with generalized convulsive status epilepticus (GCSE) being the most dramatic. ⋯ Should seizures continue or recur despite AED administration, induction of coma with pentobarbital may be considered. This must be done with continuous EEG and other physiologic monitoring in an intensive care unit. Additional assessment of the patient who has experienced GCSE focuses on identification of the underlying cause.
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Review
The functional role of tumor suppressor genes in gliomas: clues for future therapeutic strategies.
The ability to transfer exogenous genes to cancer cells has yielded a wealth of information about the neoplastic processes that occur at molecular and cellular levels. Current research focuses on defining the biochemical factors that govern the interplay between cell growth and cell death in gliomas. The identification of tumor suppressor genes has greatly enhanced our understanding of the molecular mechanism of brain tumors. ⋯ Moreover, recent advances linking tumor suppressor genes, apoptosis, and cell-cycle control pathways in brain tumors are reviewed. The ability to detect mutations in tumor suppressor genes plays an important role in cancer diagnosis and prognosis. Perhaps of greatest significance has been the realization that tumor suppressor genes may provide novel targets for development of specific anticancer therapies for brain tumors.
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To correlate MRI and sensory changes in patients with spontaneous lesions in the cerebral "pain pathway." ⋯ Different stroke sites produce different patterns of sensory deficit. The progression from painless sensory deficit to CPSP is not purely quantitative.