Search PubMed⌕ Search

Biomedical subjects

B C Walters

Publications and source records attributed to B C Walters.

At least 37 records · Page 2Linked to original sources
PubMed2002

Treatment of subaxial cervical spinal injuries.

UNLABELLED: SUBAXIAL CERVICAL FACET DISLOCATION INJURIES: STANDARDS: There is insufficient evidence to recommend treatment standards. GUIDELINES: There is insufficient evidence to recommend treatment guidelines. OPTIONS: Closed or open reduction of subaxial cervical facet dislocation injuries is recommended. Treatment of subaxial cervical facet dislocation injuries with rigid external immobilization, anterior arthrodesis with plate fixation, or posterior arthrodesis with plate or rod or interlaminar clamp fixation is recommended. Treatment of subaxial cervical facet dislocation injuries with prolonged bedrest in traction is recommended if more contemporary treatment options are not available. SUBAXIAL CERVICAL INJURIES EXCLUDING FACET DISLOCATION INJURIES: STANDARDS: There is insufficient evidence to recommend treatment standards. GUIDELINES: There is insufficient evidence to recommend treatment guidelines. OPTIONS: Closed or open reduction of subluxations or displaced subaxial cervical spinal fractures is recommended. Treatment of subaxial cervical spinal injuries with external immobilization, anterior arthrodesis with plate fixation, or posterior arthrodesis with plate or rod fixation is recommended.

Cervical Vertebrae↗
PubMed2002

Management of acute central cervical spinal cord injuries.

STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Intensive care unit (or other monitored setting) management of patients with acute central cervical spinal cord injuries, particularly patients with severe neurological deficits, is recommended. Medical management, including cardiac, hemodynamic, and respiratory monitoring, and maintenance of mean arterial blood pressure at 85 to 90 mmHg for the first week after injury to improve spinal cord perfusion is recommended. Early reduction of fracture-dislocation injuries is recommended. Surgical decompression of the compressed spinal cord, particularly if the compression is focal and anterior, is recommended.

Acute Disease↗
PubMed2002

Management of vertebral artery injuries after nonpenetrating cervical trauma.

DIAGNOSTIC STANDARDS: There is insufficient evidence to support diagnostic standards. GUIDELINES: There is insufficient evidence to support diagnostic guidelines. OPTIONS: Conventional angiography or magnetic resonance angiography is recommended for the diagnosis of vertebral artery injury after nonpenetrating cervical trauma in patients who have complete cervical spinal cord injuries, fracture through the foramen transversarium, facet dislocation, and/or vertebral subluxation. TREATMENT STANDARDS: There is insufficient evidence to support treatment standards. GUIDELINES: There is insufficient evidence to support treatment guidelines. OPTIONS: Anticoagulation with intravenous heparin is recommended for patients with vertebral artery injury who have evidence of posterior circulation stroke. Either observation or treatment with anticoagulation in patients with vertebral artery injuries and evidence of posterior circulation ischemia is recommended. Observation in patients with vertebral artery injuries and no evidence of posterior circulation ischemia is recommended.

Evidence-Based Medicine↗
PubMed2000

Management of type II dens fractures: a case-control study.

STUDY DESIGN: A case-control study of patients with isolated type II dens fractures treated with halo vest immobilization. OBJECTIVES: To evaluate age as a risk factor for failure of halo immobilization in patients with type II dens fractures. SUMMARY OF BACKGROUND DATA: The literature reports an average fusion rate of approximately 70% in patients with type II dens fractures treated by halo vest immobilization. Although many investigators have examined patient age as a risk factor for nonfusion using halo immobilization, all studies have been supported only by Class III data. These studies, consequently, carry little or no statistical significance. Therefore, a case-control study based on Class II data was designed to evaluate age as a risk factor for failure of halo vest immobilization in patients with type II dens fractures. METHODS: Thirty-three patients with isolated type II dens fractures treated with halo vest immobilization at the University of Iowa Hospitals and clinics between 1983 and 1997 were included. Type II fractures were defined with plain radiography as per the Anderson-D'Alonzo classification. Cases were defined as nonfusions after halo immobilization, whereas control subjects represented successful bony unions attained with halo immobilization. RESULTS: When the case and control groups were compared, there was no significant difference between the groups in the presence of concomitant medical conditions, sex, the amount of fracture displacement, the direction of fracture displacement, the length of hospital stay, or length of follow-up. Age more than 50 years was found to be a highly significant risk factor for failure of halo immobilization (P = 0.002; Fisher's exact test, two-tailed). The odds ratio of these data indicate that the risk of failure of halo immobilization is 21 times higher in patients aged 50 years or more. CONCLUSIONS: Surgical intervention should be considered in those patients aged 50 years or more who have a type II dens fracture, if it can be accomplished with acceptable risk of morbidity and death.

Age Factors↗
PubMed1999

Use of cerebrospinal fluid shunt for the management of elevated intracranial pressure in a patient with active AIDS-related cryptococcal meningitis.

Persistently elevated intracranial pressure (ICP) is one of the most accurate predictors of a poor prognosis in patients with AIDS-related cryptococcal meningitis. We present a severe case of persistent cryptococcal meningitis in a patient with advanced AIDS, complicated by elevation of ICP. A ventriculoperitoneal shunt was placed that successfully lowered the ICP and alleviated the associated symptoms. The elevated ICP secondary to AIDS-related cryptococcal meningitis should be treated aggressively. Despite the risk of shunt complications, cerebrospinal fluid shunts can be considered in these patients if they do not respond to other treatment.

AIDS-Related Opportunistic Infections↗
PubMed1999

Malignant glial tumor arising from the site of a previous hamartoma/ganglioglioma: coincidence or malignant transformation?

Gangliogliomas are generally considered benign tumors. Although more commonly found in the brain, spinal cord ganglioglioma is a well established, albeit infrequent, entity. We describe a 2-decade clinical course of a patient initially diagnosed with a thoracolumbar 'glial-neuronal hamartoma' at age 4. Seventeen years after his first operation, local recurrence was noted. Despite subsequent multiple gross total resections and adjuvant therapy, histologic features became increasingly ominous and ultimately proved fatal. This is an unusual report and histologic presentation of a resected spinal cord ganglioglioma recurring as an anaplastic ependymoma/astrocytoma and subsequently a glioblastoma. It is quite likely that the originally resected ganglioglioma was actually part of a primitive neuroectodermal tumor which had undergone extensive maturation.

Adult↗
PubMed1998

Diagnosis and outcome measures in trials for neoplastic meningitis: a review of the literature and clinical experience.

Innovative approaches to the treatment of neoplastic meningitis are being widely tested. Unfortunately, research on diagnostic strategies and outcome measures on which any advances in treatment ultimately depend, has not been avidly pursued. A critical review of the literature on neoplastic meningitis published since 1978 was undertaken by using MEDLINE and other English language databases. All articles addressing the issues of diagnostic or response criteria were included. Randomized clinical trials (RCTs) were emphasized. Prospectively collected data from the authors' institution correlating the results of cerebrospinal fluid (CSF) cytological examinations with Karnofsky Performance Scale (KPS) score are also discussed. Twenty-six studies (representing 1208 patients) fulfilled search criteria. Only three were RCTs. Cerebrospinal fluid cytology was the sole diagnostic criterion in two-thirds of studies. The results of CSF cytological examination alone or in combination with other clinical or laboratory endpoints constituted the primary outcome measure in 85%. Few studies attempted to address known deficiencies in the reliability and validity of these measures, and correlation between measures was poor. Quality of life was never used as a primary outcome measure. All currently available measurements, including CSF cytology, biochemistry, immunological, and molecular markers, neuroimaging studies, clinical examination, and survival, suffer from poor sensitivity and/or specificity, and often correlate poorly with each other. Although CSF cytological examination, performed according to a rigorous, research-supported protocol, may be the optimum diagnostic and outcome measure at this time, additional research is a prerequisite for any further advances in the clinical care of patients with neoplastic meningitis.

Journal Article↗
PubMed1998

Cerebrospinal fluid cytology in patients with cancer: minimizing false-negative results.

BACKGROUND: Detection of malignant cells on cytologic examination of the cerebrospinal fluid (CSF) is the diagnostic gold standard for leptomeningeal carcinomatosis. The absence of cells is a primary endpoint for most therapeutic trials. Unfortunately, false-negative results are common. Practical strategies are necessary to remedy this problem. METHODS: Four physician-dependent variables (CSF sample volume, site of CSF sampling, processing time, and frequency of CSF sampling) were identified, and their contributions to the false-negative rate of CSF cytology were evaluated prospectively in 39 patients with leptomeningeal carcinomatosis. Retrospective data were analyzed to estimate the importance of these variables in daily practice. RESULTS: False-negative CSF cytology results correlated with small CSF volume (P < 0.001), delayed processing (P < 0.001), not obtaining CSF from a site of symptomatic or radiographically demonstrated disease (P = 0.02), and sampling fewer than two times (P < 0.001). In 1 year, 97% of CSF specimens at the study institution were of inadequate volume; >25% were processed too slowly. CONCLUSIONS: False-negative CSF cytology results are common, but can be minimized by: 1) withdrawing at least 10.5 mL of CSF for cytologic analysis; 2) processing the CSF specimen immediately; 3) obtaining CSF from a site of known leptomeningeal disease; and 4) repeating this procedure once if the initial cytology is negative.

Cerebrospinal Fluid↗
PubMed1996

Observer reliability in histological grading of astrocytoma stereotactic biopsies.

This study provides an objective assessment of the reliability of histological grading of astrocytoma specimens obtained using stereotactic biopsy. Pathological diagnosis of brain tumors provides an index of disease severity and guides clinical practice in their treatment. It also functions as the gold standard in assessing the validity of diagnostic tests such as magnetic resonance imaging. Often diagnoses are made from biopsy material obtained using stereotactic technique. The current study was designed to evaluate this gold standard with regard to interobserver and intraobserver variability. Four certified neuropathologists from academic centers in the United States and Canada were asked to grade 30 brain biopsy specimens obtained stereotactically in patients with astrocytomas. Intraobserver agreement was analyzed in individual observers by comparing their first and second readings, separated by 5 to 14 weeks. Interobserver data were analyzed by comparing initial readings across all observers for individual diagnoses. Kappa analysis was used to measure agreement beyond chance. Intraobserver agreement was 74.73% for glioblastomas multiforme, 51.43% for anaplastic astrocytomas, and 65.22% for low-grade astrocytomas. The most common disagreements were between anaplastic astrocytomas and glioblastomas multiforme, followed by disagreements between anaplastic and low-grade astrocytomas. Interobserver agreement on initial readings was 62.41% (kappa 0.39) for glioblastomas, 36.04% (kappa 0.06) for anaplastic astrocytomas, and 57.14% (kappa 0.48) for low-grade astrocytomas. A significantly greater degree of reliability was seen in histopathological diagnoses of low- or high-grade astrocytomas than in those of intermediate-grade astrocytomas. Therefore, the highest variability occurs at the point of clinical decision making--namely, intermediate-grade tumors that may or may not be selected to receive adjuvant therapy. This considerable variability is an issue that needs to be recognized and further addressed by analysis of current and proposed astrocytoma grading schemes.

Astrocytoma↗
PubMed1995

What is metanalysis?

Explore the source record for details and available documents.

Meta-Analysis as Topic↗