Report from the XIII International AIDS Conference. Psychosocial issues of the HIV pandemic in Africa.
Explore the source record for details and available documents.
Adaptation, Psychological↗
Biomedical subjects
B George
Publications and source records attributed to B George.
Surgical treatment of dumbbell neurinomas of the cervical spine.
Cervical neurinomas ex-tending through the intervertebral foramen are uncommon. They raise difficult problems of surgical management. The few papers dealing with surgical technique for removal of these tumors are reviewed. The surgical approach has to be chosen from posterior, anterior, and anterolateral routes. Analysis is essentially devoted to the radicality of tumor resection, nerve root preservation, relation to the vertebral artery, and compromise of spinal stability.
Journal Article↗
Paraganglioma of the cauda equina region--report of two cases and review of the literature.
A paraganglioma of cauda equina region is extremely rare and except for secreting tumour, the pre-operative diagnosis of paraganglioma is very difficult. Two cases of non-functional paragangliomas of the cauda equina region are reported, one was attached to the filum terminale and the other to a rootlet looking very much like a vascular neurinoma. Both were successfully removed by surgery. An extensive review of the literature permits one to find 77 other cases. The clinical, radiological, pathological (ultrastructural and immunohistochemical) features and surgical findings of all theses cases are discussed. Surgery remains the treatment of choice. No effect of radiotherapy on recurrence prevention has ever been demonstrated.
Adult↗
The extent of drilling in lateral approaches to the cranio-cervical junction area from a series of 125 cases.
The trans-condylar approach to the craniocervical junction area (CCJA) requires a more or less extensive drilling of the two first cervical joints (C0-C1 and C1-C2). The extent of drilling necessary to resect a lesion at the CCJA was analyzed from a series of 125 cases including 114 tumours and 11 non-tumoural processes treated using a lateral approach (postero-lateral or antero-lateral) over a 15-year period (1980-1995). The extent of drilling was estimated on CT scanner axial views from the reduction of the joints surface and three groups were determined: A/less than one third B/between one third and one half, and C/more than one half. The extent of drilling was compared with the lesion location in relation to the bone limits of the CCJA: within these limits, outside them and into the bony structures. It was also analyzed with regard to pathology when separated into three groups non-osseous tumours, osseous tumours and chordomas, and non tumoural processes. Only 26 cases had a significant drilling, i.e., more than one third of the joint surfaces and of these, 14 were more than one half. In all these 14 cases, the bone structures were already invaded and 13 of them were, to some extent, beyond the bone limits of the CCJA. Of the 12 cases with drilling between one third and one half, 11 involved the bone structures and 1 was located inside the CCJA bone limits. Drilling of more than one third was required only in the case of bone lesions: 10 out of 23 bone tumours, all the 14 cases of chordomas, one case of rheumatoid arthritis and one case of C1-C2 joint spondylosis. In the other cases including mostly non-osseous tumours, drilling was limited to less than one third, though a high rate of complete removal was achieved (98%). Stabilization by arthrodesis with posterior grafting (N = 10) or by lateral bone grafting (N = 5) was achieved in all cases involving more than one half drilling, and in one case of tuberculosis. By adequately choosing the surgical approach, the extent of drilling can always be minimal. Extensive bone resection is only necessary when the tumour has already destroyed the joints. In that case, lateral or posterior fusion is an efficient technique.
Axis, Cervical Vertebra↗
Combined management of intracranial aneurysms by surgical and endovascular treatment. Modalities and results from a series of 395 cases.
The selective occlusion of saccular intracranial aneurysms may be achieved by two techniques: microsurgical clipping and endovascular coiling. Each of them have particular indications which need to be defined. We report on a series in which both techniques were applied. From September 1992 to June 1996, 395 consecutive patients with small or large aneurysm were treated either by surgery (N = 102) or by endovascular coiling (N = 293). Coiling was chosen each time the shape of the aneurysm seemed to be appropriate for this treatment: narrow neck and ratio neck diameter by sac diameter less than one third. Satisfactory results with complete or subtotal obliteration and no recanalization on the following controls at 1, 6, 12 and 36 months, were obtained in 92% before retreatment and in 98.8% after retreatment. Unsatisfactory results were observed after surgery in 7 cases and in 25 cases after embolization. After retreatment, it remains 3 post-surgical and 2 post-endovascular cases. In the overall series, good and excellent clinical outcome was noted in 90% for small aneurysms and in 86.5% for large ones; mortality was of 4.8%. In a series in which were applied both types of treatment, surgery in 25% and endovascular technique in 75%, good results in terms of aneurysm occlusion and clinical results were achieved. These results are as good as the best series in which surgery was the only choice. Therefore with appropriate selection, endovascular treatment is a good alternative for treatment of the majority of saccular aneurysms.
Adult↗
Intramedullary cavernous angioma. Resection by oblique corpectomy.
BACKGROUND: Intramedullary cavernomas are rare lesions usually operated on via a posterior approach and myelotomy. CASE REPORT: A 42-year-old woman progressively developed a tetraplegia with sphincter disturbances over a period of 26 years. Magnetic resonance imaging showed a cervical intramedullary cavernoma with an extramedullary anterolateral exophytic portion. To avoid myelotomy, this lesion was approached directly via its anterior exophytic portion. Through a cervical anterolateral approach, the vertebral body of C4 and the intervertebral discs were obliquely drilled out. The posterior longitudinal ligament and the dura mater were opened. The exophytic portion was coagulated and the intramedullary portion was completely excised. The dura mater was closed and a bone graft was inserted between C3 and C5 and secured with a plate. RESULTS: After transient worsening, upper limb weakness improved from its preoperative status but paraparesis persisted after a follow-up of 12 months. The sphincter disturbances disappeared. CONCLUSIONS: The anterolateral approach combined with oblique corpectomy may be an appropriate technique in case of anterior intramedullary cavernomas. It provides direct access to the lesion, avoiding additional myelotomy.
Adult↗
Treatment of unruptured cerebral aneurysms.
Explore the source record for details and available documents.
Humans↗
Economic evaluation of pharmacy services--fact or fiction?
Previous attempts to conduct economic evaluation of pharmacy services are almost exclusively from the US and the UK. Studies from the US concentrate largely on the drug cost savings realised by pharmacists. Few detail the costs of service provision and even fewer give an estimate of service benefits other than decreased drug expenditure. UK evaluation to date focuses on quantifying pharmacists' interventions, but there is no clear indication of the quality or the impact of these. This article proposes a model for economic evaluation and discusses the factors which make evaluation results useful to decision makers. The costs and outcomes, that need to be considered for economic evaluation, are discussed and the example of a pharmacist led anticoagulation clinic is used. The nature of modern health care systems demands that services are effective and, increasingly, cost-effective. If pharmacy as a profession is to develop, decision makers must decide that pharmaceutical care delivered by pharmacists is a cost-effective use of health care resources. Politics, education and cost pressures will mean that decision makers are likely to put more weight on the results of economic evaluation in future. If pharmacists do not start to provide good quality data about the costs and outcomes of pharmacy services then other evaluators will.
Clinical Trials as Topic↗
Diversion colitis--new light through old windows.
Diversion proctocolitis is an iatrogenic disorder caused by surgical diversion of the faecal stream away from the colorectal mucosa. Such surgery may be necessary in cases of tumour, trauma or inflammatory conditions of the colorectum. Histopathological change is characterized by a chronic lymphoplasmacytic inflammatory infiltrate, and the hallmark feature, lymphoid follicular hyperplasia. Histological appearances are determined by the disease state of the colonic mucosa prior to faecal diversion. Macroscopic appearances may vary considerably, but often include aphthoid ulceration. The exact pathogenesis of the condition remains unclear, but the removal of short-chain fatty acids, present in the faecal stream, is considered an important aetiological factor. Current research areas, including the microbiology and cellular kinetics of diversion colitis, are discussed along with clinical features and treatments.
Bacteria↗
Diversion colitis: new light through old windows
Explore the source record for details and available documents.
Journal Article↗
Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion.
OBJECTIVE: The description of the technique of multilevel oblique corpectomy (MOC) without fusion in the treatment of spondylotic myelopathy and radiculopathy and the analysis of the results of this technique from a series of 101 cases are presented. METHODS: MOC is performed using an anterolateral approach with control of the vertebral artery. The vertebral bodies are drilled obliquely from the lateral side toward the opposite posterolateral corner. More than half of the vertebral bodies are preserved, and no fusion procedure is required. The series of patients from 1992 through 1997 included 54 men and 47 women, with an average age of 57.9 years, who presented with myelopathy (n = 66) or radiculopathy (n = 35). MOC was realized on one to five levels from C2-C3 to C7-T1. Follow-up data were obtained by performing dynamic roentgenography, computed tomography, and magnetic resonance imaging 2 months, 1 year, and 3 years after surgery. RESULTS: The results (Japanese Orthopedic Association score) were improvement in 82% of the patients, worsening in 8%, and stabilization in 10%. Better results were observed in younger patients (<50 yr). No relation between results and duration of symptoms or number of levels could be established. One death occurred as a result of multiorgan failure. No late deterioration was observed; however, three patients with particular features showed delayed instability requiring fusion. CONCLUSION: MOC is a safe and efficient technique. It must be applied for patients with anterior compression and straight or kyphotic axis of the spine. No fusion is required regardless of the number of levels, providing there are no soft discs and there is no preoperative instability.
Bone Transplantation↗
Protective effect of clozapine against pentylenetetrazol convulsions and kindling.
The atypical antipsychotic clozapine treatment (at high doses) has been reported to be associated with tremors. However, antitremor effects of clozapine have also been reported in Parkinsonian patients. Recently, we reported the protective effects of acute clozapine against pilocarpine-induced status epilepticus (SE). With this background, this study was designed to investigate the possible protective effect of clozapine against acute chemoconvulsions and kindling seizures produced by pentylenetetrazol (PTZ) in mice. Various doses of clozapine (1.0, 2.5, 5.0 and 7.5 mg) offered different degrees of protective effects against PTZ (80 mg) challenge, and the maximum protection was observed with the 2.5 mg dose as it delayed the onset of jerks, clonus, tonic extensor phase and reduced mortality. Animals chronically pretreated with clozapine (2.5, 7.5 and 15.0 mg) for 8 days when challenged by PTZ (50 and 80 mg) on the 8th day also showed protection. Repeated administration of PTZ at a subconvulsive dose (30 mg/kg, i.p, three times a week, for 9 weeks) produced kindled seizures in over 80% of the mice. Pretreatment with clozapine (1 or 5 mg) prevented the behavioral manifestations (motor seizures) as well as the development of kindling. The effect was compared with GABA (200 mg) and diazepam (1 mg), a known anticonvulsant drug.
Animals↗
Management of intracranial aneurysms by surgical and endovascular treatment--modalities and results from a series of 395 cases.
The selective occlusion of saccular intracranial aneurysms may be achieved by two techniques: microsurgical clipping and endovascular coiling. Each of them have particular indications which need to be defined. From September 1992 to June 1996, 395 consecutive patients with small or large aneurysms were treated either by surgery (n = 102) or by endovascular coiling (n = 293). Coiling was chosen each time the shape of the aneurysm seemed to be appropriate for this treatment: narrow neck and ratio neck diameter by sac diameter less than one third. Satisfying results with complete or subtotal obliteration and no recanalization on the following controls at 1, 6, 12, and 36 months were obtained in 92% before retreatment and in 98.8% after retreatment. Unsatisfying results were observed after surgery in seven cases and in 25 cases after embolization. After retreatment, it remains three post-surgical and two post-endovascular cases. Good and excellent clinical outcome was noted in 90% for small aneurysms and in 86.5% for large ones. Mortality is of 4.8% in the overall series. In a series in which were applied both types of treatment, surgery in 25% and endovascular techniques in 75%, good results in terms of efficiency and clinical results were achieved. These results are as good as the best series in which surgery was the only choice. Therefore with appropriate selection, endovascular treatment is a good alternative for treatment of the majority of saccular aneurysms.
Adult↗
'The soul of a corporation'. Interview by Pat Jakobsen.
Explore the source record for details and available documents.
Administrative Personnel↗
Development of self-sustaining limbic status epilepticus by continuous ventral hippocampal stimulation followed by low dose pilocarpine in rats.
Sequential treatment of rats with low doses of lithium and pilocarpine, a high dose of pilocarpine, or continuous hippocampal stimulation [CHS] (9 epochs, 10 min each) is reported to result in status epilepticus (SE). We report a novel method to establish SE based on continuous ventral hippocampal stimulation (5 epochs) followed by low dose pilocarpine (40 mg/kg) challenge. Motor limbic seizures occured in all the control rats. The latency to spike activity was 15 +/- 1 min after pilocarpine administration. Ventral hippocampal [VHc] and cortical EEG recordings were used to monitor the protective effect of diazepam (5 mg/kg). Except phenobarbital, all the three drugs completely prevented all the phases of seizure activity. Initiation of spikes was significantly prolonged by phenobarbital pretreatment. Further study on the characteristics of these convulsions offers a unique possibility for the recognition of brain regions, pathways, and neurotransmitters engaged in the spread of seizures in this model.
Animals↗
Endovascular treatment of saccular intracranial aneurysm.
BACKGROUND: Since September 1992, 295 aneurysms in 217 patients have been treated by detachable coils (GDC) in the Department of Neuroradiology and Neurosurgery of Lariboisière Hospital. METHODS: They included four groups of cases: ruptured aneurysms which were treated in early period (45%), ruptured aneurysms treated after the 30th day after haemorrhage (29%), unruptured aneurysms incidentally discovered (22%); and cases without haemorrhage but with a mass effect inducing a neurological deficit. RESULTS: In the group of patients treated in early period, the frequency and date of vasospasm occurrence before or after treatment is of major interest. Complete occlusion could be obtained in 78%, subtotal (80%) in 19% and partial in 3%. The technical complication rate was 18.60% with only 3.05% permanent neurological deficit. The overall results including technical complications and others (vasospasm, hydrocephalus) show 80.2% good results, 5.81% moderate disability, 2.3% severe disability and 11.6% deaths. CONCLUSIONS: The overall results of this series of patients are excellent and may be compared to surgical series. Comparison has been made with large series of well know neurosurgeons and the rates of good and excellent anatomical and clinical results obtained by endovascular treatment of intracranial aneurysm are similar or better than those provided by surgical treatment.
Persons with Disabilities↗
Impact of the prehospital trauma life support programme in Trinidad and Tobago.
The impact of the Prehospital Trauma Life Support (PHTLS) programme, introduced in Trinidad and Tobago in 1992, was assessed by questionnaires completed by 26 medical personnel (MP); 71 ambulance personnel (AP); and 50 non ambulance paramedical personnel (NAP). Of the 23 MP, 45 AP and 38 NAP who were aware of the programme, 19 (82.6%) MP, 40 (88.9%) AP and 25 (65.8%) NAP were able to differentiate personnel that had taken the PHTLS programme based on their performance. 32 (71.1%) of the AP were PHTLS trained. 24 (53.3%) and 4 (9%) of the AP identified poor equipment and poor supervision, respectively, as reasons for difficulty in applying PHTLS principles. Improvements observed among those completing the PHTLS programme were: improved resuscitation techniques by 20 (86.9%) MP, 38 (84.4%) AP and 27 (71.1%) NAP; better vital signs recording by 8 (34.8%) MP, 27 (60%) AP and 8 (21.1%) NAP; improved immobilization by 23 (100%) MP, 40 (88.9%) AP and 33 (86.8%) NAP; better haemorrhage control by 22 (95.6%) MP, 40 (88.9%) AP and 24 (63.2%) NAP; appropriate splinting of fractures by 23 (100%) MP, 40 (88.9%) AP and 32 (84.2%) NAP; and increased utilization of oxygen by 15 (65.2%) MP, 31 (68.9%) AP and 21 (55.3%) NAP. 32 (71.1%) AP with PHTLS training indicated improvement in their ability to resuscitate and transport trauma victims, with 42 (93.3%) reporting improvement in overall prehospital care. Medical, paramedical and ambulance personnel all perceive a significant positive impact of PHTLS training on prehospital trauma care. Although improvements in supervision, documentation and equipment are still required, improved trauma resuscitative techniques after PHTLS training should improve trauma patient outcome in Trinidad and Tobago.
Education, Continuing↗
Constitutional inversion of chromosome 7 and hematologic cancers.
Nonrandom aberrations of chromosome 7 have been described in various hematopoietic disorders. We describe here two unrelated families with the same constitutional inversion of chromosome 7 [inv(7)(q11.2q22)]. The probands in both families had acute leukemia and cytogenetic analysis revealed that the inversion was the sole cytogenetic abnormality in the bone marrow at diagnosis. There is a history of hematologic diseases in one of these families that included a son who is a carrier of this constitutional inversion. The distal inversion breakpoint lies within the common region of chromosome loss identified in some myeloid diseases. These observations raise the possibility that this inherited chromosome rearrangement could result in a mutation of a tumor suppressor gene and possibly represent a predisposing event for the development of leukemia in these individuals.
Aged↗