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  • 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: Diffuse axonal injury ; head injury ; neuropathology ; intracranial haematoma ; coma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Diffuse Axonal Injury (DAI) is a well known entity that affects many patients with severe head trauma. Classically DAI has been considered the pathological substrate of those cases rendered unconscious at the moment of impact and in which the CT scan does not show mass lesions. Diffuse axonal damage is almost always related to mechanisms of injury in which the rotational acceleration produces shear and tensile strains of high magnitude. In this paper we present a group of 24 patients with a severe head injury in whom the postmortem examination demonstrated unequivocal signs of DAI. Widespread axonal retraction balls, located preferentially in the centrum semiovale and internal capsule were the most constant histological finding. We divided the entire series into two subgroups. One group (15 cases), included all the patients in whom the CT scan did not demonstrate mass lesions. In the second group (9 patients) we considered patients with a diffuse axonal injury in whom the CT scan additionally demonstrated a mass lesion (6 acute subdural haematomas, 2 intracerebral and 1 extradural haematoma). The mean age of the entire group was 26 years. Twenty two patients were injured in a road traffic accident, the remaining two fell from a considerable height. All were rendered immediately unconscious on impact. Diffuse brain damage is a common finding in patients with a severe head injury and immediate coma in whom the CT scan does not show mass lesions. Diffuse axonal injury can also appear in connection with a wide spectrum of focal lesions (acute subdural haematoma, basal ganglia haematoma etc.). Associated shear injuries of the brain in this latter group, could justify the poor outcome that certain groups of patients had in spite of the rapid surgical treatment and aggressive control of intracranial pressure.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 0942-0940
    Keywords: Cerebral blood flow ; CO2 reactivity ; head injury ; thermal diffusion method
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary For measurement of the cerebral blood flow (CBF) the thermal diffusion method is quite convenient and allows the chronological measurement of CBF and CO2 reactivity of cerebral vessels. We investigated the CO2 reactivity of fifteen head injury patients. The results showed that in head injury cases, the disturbance of the CO2 reactivity correlates well to poor outcome. Using thermal diffusion method, investigations of CO2 reactivity are useful for further understanding of the physiological state of head injury patients.
    Type of Medium: Electronic Resource
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  • 5
    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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  • 6
    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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  • 7
    ISSN: 0942-0940
    Keywords: Aged population ; head injury ; GCS ; GOS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary 136 patients older than 70 years, admitted to our neurosurgical ward directly after head trauma, were analysed. 40% of them were admitted with low GCS, below 9 points, and showed a mortality of 85%. 45 patients had intracranial mass lesions — the commonest was subdural haematoma, with a low incidence of epidural haematomas. In patients admitted with GCS above 12, mortality was 20%, mainly due to pneumonia. Satisfactory results were achieved in 30% of trauma victims. From patients with intracranial space occupying lesions and GCS below 9 points on admission practically all died, despite aggresive surgical treatment and intensive care. Thus, especially in departments with limited resources, therapy can be limited, or even no therapy may be introduced in this group. Surgical treatment can be limited only to patients who are conscious on admission. In patients with non-surgical lesions, low GCS — below 9 points — leads to mortality of 80%, and in this group we propose aggresive intensive care for 24 hours and the limitation of further “maximal” therapy only to those, who significantly improve within this period of time. If the patient has a non-surgical lesion and is conscious after trauma, aggresive treatment of extracranial complication is the most important, because brain injury can usually be well tolerated by these patients. If pneumonia or heart complications do not occur this group of old patients often have a good prognosis.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 119 (1992), S. 97-100 
    ISSN: 0942-0940
    Keywords: Vomiting ; head injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Post-traumatic vomiting was clinically analyzed. One hundred and forty seven patients with head injury came to our hospital consecutively from April 1991 to August 1991. Of 147 patients, 26 exhibited vomiting post-traumatically. The incidence of loss of consciousness, that of fractures on plain X-ray films, and that of traumatic intracranial lesions demonstrated on CT were compared between two patient groups, i.e., a group of patients with post-traumatic vomiting and another one without it. None of them were revealed to be significantly different between the two groups, respectively. It was concluded from the results that the existence of post-traumatic vomiting implied neither severe traumatic impact nor serious intracranial damage. The plausible mechanisms of post-traumatic vomiting are discussed, taking account of the statistical data on the patients' age, sites of impact, and past histories.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 0942-0940
    Keywords: Blindness ; visual evoked potentials ; head injury ; regional cerebral blood flow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Normal regional blood flow was documented by Single Photon Emission Computed Tomograms 5 and 20 hours before the full recovery of cortical blindness in two patients, lending itself to the possibility of being a prognostic factor. Rubbing of the posterior cerebral arteries against the tentorial edges during trauma instead of traction was believed to cause blindness in one patient and embolization due to hammering bone grafts home during cervical spinal fusion, in the other. Pattern reversal visual evoked responses (PRVERs) were absent during blindness; upon recovery P 100 with full amplitude and normal latency appeared despite the presence of tunnel vision. These are consistent with the fact that the central 8–10 degrees of visual field represented in the posterior occipital poles being the main sources of P 100 in association with the x-cells in the centre of the retina.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Cerebellar haemorrhage ; computerized tomography ; obstructive hydrocephalus ; managament ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The records of 50 cerebellar haemorrhages were reviewed retrospectively. In this series the most important factor for clinical development, management and mortality was the presence of obstructive hydrocephalus (p〈0.01). Slowly progressive (type 1) and abruptly developing (type 2) deterioration of consciousness was significantly related to high mortality; this holds also true for the combination of hydrocephalus with an haematoma diameter 〉 3 cm. Larger haematomas had a higher mortality but this relation, analyzed alone, did not reach statistical significance (p〉0.05). In cases with hydrocephalus mortality could significantly be reduced by surgical evacuation of the haematoma (p〈0.01). The treatment of cerebellar haemorrhages must be directed at resolving obstructive hydrocephalus.
    Type of Medium: Electronic Resource
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