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  • outcome  (49)
  • cerebral blood flow  (46)
  • 1
    Keywords: SURVIVAL ; tumor ; THERAPY ; FOLLOW-UP ; LONG-TERM ; SURGERY ; PATIENT ; IMPACT ; RESECTION ; GLIOMAS ; MANAGEMENT ; ADULT ; REGRESSION ; THERAPIES ; GLIOMA ; methods ; LONG ; LOW-GRADE GLIOMA ; multivariate analysis ; EXTENT ; surgical resection ; LOW-GRADE ; PROGRESSION-FREE SURVIVAL ; outcome ; Low grade gliomas ; A ; randomized studies
    Abstract: Purpose: The appropriate management of low-grade gliomas is still a matter of debate. So far, there are no randomized studies that analyze the impact of surgical resection on patient outcome. The value of the data obtained from the few retrospective reports available is often limited. Patients and methods: In the present study, we performed an analysis on data of 130 adult low-grade glioma patients. Extent of the resection was evaluated in correlation to the overall survival (OS) and progression-free survival (PFS) using Cox regression multivariate analysis. Results: Extended surgery was shown to prolong OS and PFS significantly. Re-surgery in the case of a tumor relapse has a significant impact on OS and PFS, too. Conclusions: In summary, we could retrospectively evaluate a large case series of well-defined low-grade gliomas patients with a long follow-up period showing that extended surgery would be the most effective therapy for low-grade glioma patients even in recurrent diseases.
    Type of Publication: Journal article published
    PubMed ID: 19730773
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  • 2
    ISSN: 0942-0940
    Keywords: Brain contusion ; contusion volume ; quantitative assessment, CT ; CSF-CKBB clearance ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In order to evaluate if it is practically possible to assess the volume of contused brain tissue from the CT pictures, a comparison has been carried out between the size of the cerebral contusion(s)-as estimated from the CT scans-and the post-traumatic CSF-CKBB activity, in a series of 29 patients with severe head injury. A clearance curve for the elimination of CKBB from the CSF was constructed. The relation between contusion volume and CSF-CKBB-activity was not statistically significant, while the relationships between contusion volume and outcome, and between CSF-CKBB, as estimated at 6 hours after trauma from the clearance curve, and outcome, were.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Keywords: Brain edema ; cerebral blood flow ; brain tissue hydraulic resistance ; somatosensory evoked potential ; intracranial pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary To evaluate the potency of putative secondary mediators of brain edema and their possible contribution to edema related brain dysfunction an infusion model of brain edema was developed in rats. 100 ul of fluid (saline, 20% nonautologous protein) was infused over one hour into the left forebrain white matter through a stereotaxically placed (+ 1.2 mm ant to bregma, 3 mm lateral and 2.9 mm depth) 25 G needle. Brain tissue hydraulic resistance (Rt), regional cerebral blood flow (rCBF), cortical somatosensory evoked potentials (SEPs) and intracranial pressure (ICP) (intraventricular needle) were monitored during the infusion and rCBF CO2 reactivity (hydrogen clearance), local brain water content (microgravimetry), BBB integrity (Evans Blue 2%) and brain histology (H & E, Solochrome-cyanin) were evaluated after the infusion. Saline infusates caused no physiological dysfunction despite ipsilateral expansion and vacuolation of the subcortical white matter, separation of axonal bundles and a significant decrease (p=3.8×10−5)in local subcortical tissue specific gravity. Cortical histology and specific gravity adjacent to the infusion locus were normal. Rt significantly decreased (p=6.5×10−4) during the infusion but there were only minor increases in ICP. Findings with 20% protein infusates were similar despite a focal 65% decrement in the rCBF CO2 reactivity adjacent to the infusion site. This study has shown that a simple and inexpensive model of infusion brain edema can be created in the rat and that it provides a useful model for assessing the physiological effects of mediator compounds in the infusate. Potential applications and methodological improvements for this model are discussed.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Acute head injury ; barbiturate coma ; cerebral blood flow ; cerebral metabolism ; hyperventilation ; indomethacin ; intracranial pressure ; intracranial hypertension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In five head-injured patients with cerebral contusion and oedema in whom it was not possible to control intracranial pressure (ICP) (ICP〉20 mmHg) by artificial hyperventilation (PaCO2 level 3.5–4.0 kPa) and barbiturate sedation, indomethacin was used as a vasoconstrictor drug. In all patients, indomethacin (a bolus injection of 30 mg, followed by 30 mg/h for seven hours) reduced ICP below 20 mmHg for several hours. Studies of cerebral circulation and metabolism during indomethacin treatment showed a decrease in CBF at 2h. After 7h, ICP remained below 20 mmHg in three patients, and these still had reduced CBF. In the other patients a return of ICP and CBF to pretreatment levels was observed. In all patients indomethacin treatment was followed by a fall in rectal temperature. These results suggest that indomethacin due to its cerebral vasoconstrictor and antipyretic effect should be considered as an alternative for treatment of ICP-hypertension in head-injured patients.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 0942-0940
    Keywords: Blood brain barrier ; cerebral blood flow ; intracranial pressure ; arachidonic acid ; brain oedema ; evoked potential
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Arachidonic acid solution (2 to 15 mg/ml) was infused into the right forebrain white matter of anaesthetised cats over three hours to evaluate its contribution to the genesis and pathophysiology of vasogenic brain oedema. The 0.6 ml infusion increased local white matter water content by a mean of 11.3 ml/100 g tissue but did not increase cortical water content. Histological studies revealed local expansion and trabeculation of the white matter with aggregations of granulocytic neutrophils in the venules and perivenular brain. The adjacent cortical cytoarchitecture was normal. The white matter around the infusion site was stained lightly and over a variable area (15–20 mm2) by intravenously administered Evans Blue dye 2%. Regional cerebral blood flow (rCBF) adjacent to the frontal infusion did not change significantly during the period of infusion and remained similar to rCBF in the contralateral hemisphere. Following the arachidonic acid infusion regional CBF CO2 reactivity was normal and three was no asymmetry of either cortical somatosensory evoked potential (SEP) or motor evoked potential (MEP) waveforms. The increase in brain water content and changes in the ICP and ICP related biodynamics (pressure-volume index, lumped craniospinal compliance and CSF outflow resistance) were similar to those seen following infusion of 0.6 ml saline. These studies suggest that free intraparenchymal arachidonic acid, at concentrations exceeding those occurring in most neuropathological conditions, can increase the normal brain parenchymal capillary permeability but does not disrupt focal cerebrovascular and electrophysiological function. The clinical implications of these findings are discussed.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 0942-0940
    Keywords: No-reflow ; global brain ischemia ; cerebral blood flow ; ATP ; magnetic resonance spectroscopy ; high energy phosphates
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Post-ischemic reperfusion impairment, (“no-reflow phenomenon”), was studied in rats subjected to 8–30 minutes of global brain ischemia. During ischemia, rapid and complete loss of cerebral blood flow, EEG and31P-high energy phosphates (ATP/PCr) was observed. Brain intravascular perfusion defects were examined by injecting carbon blackintravenously in a group of rats with stable cardiopulmonary function and in another group subjected to rapid thoracotomy andintraarterial infusion of the carbon marker. Results indicate that global brain ischemic or non-ischemic control rats givenintraarterial carbon black after thoracotomy had varying degrees of vessel filling defects in brain resulting in “pale tissue areas” suggestive of impaired perfusion (no-reflow). All rats given carbon blackintravenously whether global brain ischemic or not, showed normal cerebrovascular filling of the carbon black and absence of “pale tissue areas”. In addition, post-ischemic cerebral reperfusion following 8–30 minutes global brain ischemia can reverse neuroelectric, energy metabolite and cerebral blood flow loss in rats whose cardiopulmonary function is not compromised. These findings indicate that the “no-reflow phenomenon” is an agonal or post-mortem artifact observed in the presence of cardiopulmonary failure.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 0942-0940
    Keywords: Intracranial pressure ; subarachnoid haemorrhage ; cerebral blood flow ; Cushing response
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The relationships of intracranial pressure (ICP), systemic blood pressure (SBP) and cerebral blood flow (CBF) during experimental subarachnoid haemorrhage were investigated in cats. Continuous monitoring of regional cerebral blood flow (rCBF) was done by a thermal diffusion method using a Peltier stack. During haemorrhage ICP rose within 5.4±0.97 minutes from 10.5±4.9 to 176.1±27.8 mmHg. This strong increase of ICP resulted in a temporary arrest of cerebral circulation. The Cushing response during the haemorrhage could not improve the cerebral circulation, but in contrast caused a further increase of ICP. After the haemorrhage the cerebral blood flow normalised within minutes. It is concluded, that the Cushing response during a subarachnoid haemorrhage should be regarded as a deleterious rather than a beneficial mechanism.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 0942-0940
    Keywords: Unruptured aneurysm ; operation ; indication ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors report a series of 37 cases of unruptured aneurysms, admitted and operated upon over a 5 year period (1985–1990), which represents an incidence of 18% of the total number of aneurysm patients operated upon during this period. These unruptured aneurysms were discovered in 4 types of circumstances: 1) Associated with a ruptured aneurysm but treated in a second procedure (9 cases); 2) After a transient ischaemic attack (6 cases); 3) After a cerebral haemorrhage of a different origin (3 cases), 4) After the onset of various neurological symptoms other than SAH (19 cases). Giant aneurysms (over 2.5 cm in diameter) are excluded from this series. Overall these 37 patients harboured 52 aneurysms, and 1 patient was operated upon on both sides. 27 aneurysms (52%) were located on the right side, 15 (29%) on the left side, and 10 (19%) on the midline. In the immediate post operative period, 1 patient died (2.6%) and 8 patients (21%) presented various complications. The outcome at 6 months was: death 2.6%, moderately disabled 8%, good recovery 89%. The arguments in favour of, or against, the surgical treatment of unruptured aneurysms are discussed in view of the literature. In favour of prophylactic surgery are: 1) The rather poor overall outcome following aneurysm rupture (including deaths before admission); 2) The rather good outcome of surgery in published series of unruptured aneurysms. The data of the natural history of the unruptured aneurysm are more questionable: in this view, surgery seems to be recommended in young patients with an easily accessible aneurysm and being in a good clinical condition. Several contra indications should be strictly accepted: severe associated diseases, age (over 65 and sometimes over 60), patient's refusal or reluctance. In cases of unruptured aneurysms to be operated upon in a second procedure after a ruptured aneurysm, the authors usually wait for 2 months or more before the second operation.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Head injury ; barbiturate therapy ; outcome ; cognitive impairment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study reports on clinical outcome in 38 patients with severe head injuries (posttraumatic coma for 6 hours or more) treated with barbiturate coma because of intracranial hypertension. Eighteen patients died, 4 patients remained in a severely disabled or a chronic vegetative state, and 16 patients reached the levels good recovery/ moderate disability. Six of these patients returned to work or school full time, 4 for half time and 3 were in a rehabilitation program. Fourteen patients were subjected to a comprehensive neuropsychological assessment. All patients except one exhibited varying degrees of cognitive dysfunction and 6 patients had signs of personality change. The quality of life for the majority of surviving patients was relatively good but the positive effects of barbiturate coma therapy in the age groups over 40 years appeared to be limited.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Brain edema ; blood brain barrier ; serum protein ; evoked potential ; glioma ; cerebral blood flow ; permeability factor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The feline infusion model of brain edema was used to evaluate the pathophysiological effects of 0.6ml infusions of autologous serum protein (66%), human serum protein (66%), human glioma cyst fluid and a tissue culture medium (TCM) on the structure and function of the forebrain white matter. These infusions increased local white matter water content by between 10.8 and 12.5 ml/100 g brain and were associated with moderate increases in ICP and CSF outflow resistance and a significant decrease in lumped craniospinal compliance. Cortical somatosensory potentials, motor evoked potentials, EEG and local cerebral blood flow (rCBF) at normocapnia were generally unchanged by the various infusions. All infusates except the 66% autologous serum protein infusion impaired rCBF CO2 reactivity. Histologically all infusates caused marked extracellular edema. The autologous serum protein infusion caused no additional histological changes whereas the glioma cyst infusates caused profound endothelial and astrocytic swelling, focal endothelial necrosis, basement membrane disruption, perivascular microglial reaction and pavementation and perivascular migration of polymor-phonuclear leukocytes. Similar but less marked changes were seen after infusion of human serum protein whilst the TCM produced only minimal changes. The intensity and extent of Evans Blue extravasation into the forebrain white matter was greatest with glioma cyst infusates and with all infusions reflected the extent to microvascular changes. These studies show that products derived from gliomas cause additional damage to the blood-brain-barrier than that caused by non-autologous serum proteins. These results add further support for the existence of glioma derived permeability factors (GDPF), but suggest neither serum proteins nor glioma derived compounds in the white matter interstitium significantly influence local electrophysiological function. Some limitations of the infusion edema model when using non-autologous infusions and difficulties quantitating brain dysfunction are emphasised.
    Type of Medium: Electronic Resource
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