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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: Normal pressure hydrocephalus ; brain spect ; Alzheimer disease ; prognosis ; 99Tcm-HM-PAO
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary From January 1989 to September 1990 fourteen patients with the Normal Pressure Hydrocephalus (NPH) syndrome were diagnosed in our Service. All patients were studied by CT-Scan, Radionuclide Cisternography and brain Single Photon Emission Computed Tomography (SPECT). In this series, the predictive value of the brain SPECT was assesed. A statistically significant relationship between SPECT patterns and clinical outcome was found. The patients who showed a Dementia Alzheimer Type (DAT) pattern on SPECT had worse results. The results are discussed and compared with those reported by other authors.
    Type of Medium: Electronic Resource
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  • 4
    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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  • 5
    ISSN: 0942-0940
    Keywords: Arteriovenous malformations ; surgery ; grading system ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The case histories and angiograms of 93 consecutive patients who underwent surgery for arteriovenous malformations were analyzed retrospectively to find clinical and radiological prognostic factors influencing the outcome. A stepwise multiple regression was performed as follows. All radiological data such as size, location, and feeding and draining vessels as well as the clinical data such as age, sex, clinical grade on admission were introduced into the model and tested whether they contributed significantly to the prediction of the outcome which was the target variable. If so they were retained, otherwise eliminated. By this procedure the following features were indentified as significant prognostic factors which adversely influence the outcome: poor clinical grade, feeding vessels from the A 1-segment and the anterior communicating artery, feeders from the M 1-segment, feeders from the Rolandic branches of the middle cerebral artery, a shunt through the anterior communicating artery. Neither the presence of a particular draining vein nor the type of the venous drainage when devided into superfical or deep had an influence on the outcome. Nor was the size of the lesion of significant importance. The bearing of these findings on the value of established grading systems is discussed and a new grading system is proposed.
    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: 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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  • 8
    ISSN: 0942-0940
    Keywords: Lumbar disc herniation ; re-operation ; recurrent disc herniation ; scar formation ; diagnostic methods ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Out of a series of 1850 cases operated upon for lumbar disc herniation 130 underwent re-operation because of persistent or recurrent symptoms. Re-operation was successful in 62%. The prognosis of re-operation was not related to special clinical symptoms and signs but only to the operative findings. Herniations at other levels and recurrences of lumbar disc herniations had the best results (excellent in 98% respectively 54%), but scar formations alone came out much less satisfactory (only 38% excellent results). Computed tomography (CT) findings were less reliable in distinguishing between disc prolapse and fibrosis than magnet resonance imaging (MR). Therefore MR is the diagnostic method of choice in these conditions, and scar formations alone should be considered a contra-indication for re-operation.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 127 (1994), S. 21-26 
    ISSN: 0942-0940
    Keywords: Cerebral aneurysm ; nimodipine ; prognosis ; rebleed ; subarachnoid haemorrhage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The management of aneurysmal subarachnoid haemorrhage has recently changed considerably. Emergency admission to specialized centres and early surgery have become common practice. In addition, the use of nimodipine has gained widespread acceptance. Little data are available concerning the frequency and temporal profile of reruptures under the current policies. The case histories of 387 patients treated for aneurysmal subarachnoid haemorrhage between January 1984 and March 1992 were reviewed with regard to the incidence of in-hospital reruptures. All patients were managed according to the same protocol including a policy of individually timed early surgery and intravenous nimodipine. A total of 44 first in-hospital rebleeds were observed during the waiting period. Two percent of the patients admitted on the day of haemorrhage had a rebleed on the same day after admission to the hospital. No rebleeds were observed on the day after subarachnoid haemorrhage. Rebleed rates on day 2 and 3 were also low with 0.6 and 0.8% of the population with an undipped aneurysm. For the following 10 days, the daily rate of rerupture increased. A further peak was observed during the 4th week. Using life-table methods, the cumulative rate of rebleeds was calculated as 23% within 2 weeks and 42% within 4 weeks. Although patients suffering rebleeds differed in several respects from patients without rebleeds, most of the differences could be identified to be a consequence of a selection bias resulting in a longer period of exposure to the risk of rerupture for certain subgroups. Only patients suffering a loss of consciousness after the initial subarachnoid haemorrhage were definitively exposed to a higher daily risk of rerupture. Comparison with other series suggests that nimodipine treatment may add to the protective effect of bedrest, control of blood pressure and stress deprivation during the first days after subarachnoid haemorrhage. However, it cannot be excluded that withdrawal of nimodipine together with the general precautions in patients with unclipped aneurysms is responsible for the late peak of rebleeds. With regard to the timing of surgery, the low rebleed rates between days 1 and 3 justify semi-elective timing within this interval. On the other hand, in patients in whom aneurysm elimination has been deferred because of bad neurological condition or concomittant medical problems, surgery should be performed prior to the 4th week, unless the prognosis is considered hopeless at this time.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 0942-0940
    Keywords: Head injury ; cerebral perfusion pressure ; arterial hypotension ; raised intracranial pressure ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A group of 74 patients with head injury (54 severe, 17 moderate and 3 minor) had continuous monitoring of both arterial and intracranial pressure with computer-based registration of these pressures, cerebral perfusion pressure and other vairables. In 60 patients cerebral perfusion pressure CPP fell below 60 mm Hg for periods of 5 minutes or longer. The distribution over time of these reductions in CPP during up to 12 days of monitoring was studied, and each episode of reduced CPP was attributed to a fall in arterial pressure, an increase in intracranial pressure, or both. Two clusters of reduced CPP were found, one during the first 24 hours of monitoring, when reduced CPP was mainly caused by a reduction in arterial pressure, and the other at 5 or 6 days after injury, when reduced CPP was due mainly to an increase in intracranial pressure. There was a significant correlation between low CPP due to reduced arterial pressure and the Injury Severity Score (p〈0.001), suggesting that resuscitative measures may have been less than optimal in these cases. There was also significant correlation between the duration of low CPP and low arterial pressure and an adverse outcome from injury as assessed at 6, 12 and 24 months after injury (p〈0.001). It is recommended that in patients with severe and significant head injury who require monitoring, this should include both arterial and intracranial pressure, be continued for at least 6 days, that cerebral perfusion pressure should be displayed and recorded, and that particular attention is paid to detecting and correcting even small reductions in arterial pressure, especially those that reduce CPP below 60 mm Hg.
    Type of Medium: Electronic Resource
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