Search PubMed⌕ Search

Biomedical subjects

R A Roski

Publications and source records attributed to R A Roski.

At least 19 recordsLinked to original sources
PubMed1998

The Current Procedural Terminology and the Medicare Resource Based Relative Value Scale in neurosurgical practice.

Changes in healthcare have made it increasingly more important for neurosurgeons to understand the economic pressures that effect their reimbursement. Two fundamental concepts that are of the greatest importance are the Current Procedural Terminology coding and the Medicare Resource Based Relative Value Scale. The impact of these two entities on neurosurgical reimbursement in analyzed in this review.

Journal Article↗
PubMed1995

The winds of change.

Redirecting physician incentives, providing universal coverage, improving access to meaningful information, and providing innovation are the key components to solving this crisis. Those changes must focus on true competition and innovative ideas, which we must provide. In the past, the innovation in health care has come from physicians, and physicians must provide it in the future. Now is the time for action. Once again, we can use the words of Theodor Geisel to inspire us: So ... Be your name Buxbaum or Bixby or Bray or Mordaci Ali Van Allen O'Shea, You're off to great places! Today is your day! Your mountain is waiting! So ... get on your way! No one could put it more clearly or succinctly than Dr. Seuss. Take his words to heart. The challenge lies before us, and the opportunities are endless. Just as Sidney Garfield revolutionized health care delivery more than 60 years ago, now is the time to introduce revolutionary changes of our own. Do not sit idly by while our health care system further deteriorates. Allow yourselves to be the innovative leaders that will give this country a new and better system of health care delivery. So remember, your mountain is waiting! Get on your way!

Delivery of Health Care↗
PubMed1984

Extradural meningeal cyst. Case report and review of the literature.

Extradural meningeal cysts are rare spinal lesions. The clinical presentation is most often characterized by a slowly progressive spastic paraparesis, frequently associated with pain. Adequate drainage of the cyst with obliteration of the neck of the cyst or complete removal of the cyst can bring about a permanent resolution of the symptoms. The use of somatosensory cortical evoked responses also has an important role in the surgical management of this problem.

Child↗
PubMed1983

Ineffectiveness of DMSO in treating experimental brain ischemia.

A beneficial effect of dimethyl sulfoxide (DMSO) in the treatment of acute focal cerebral ischemia has not been proven. In the present study, two established experimental models of acute focal cerebral ischemia were treated with DMSO. Twenty adult cats lightly anesthetized with ketamine hydrochloride underwent right middle cerebral artery (MCA) occlusion for 6 hours. Ten cats were not treated and 10 cats received DMSO (2.5 g/kg i.v.) immediately after occlusion. No improvement of EEG findings, erythrocyte transit, regional cerebral blood flow (rCBF), blood-brain barrier permeability, or morphological findings were demonstrated in the DMSO-treated cats. In a second study, 15 conscious adult baboons underwent temporary left MCA occlusion (6 or 12 hours) using an implanted occluding device. Seven baboons were not treated and 8 baboons received continuous intravenous infusions of DMSO for 10 hours beginning 30 minutes after occlusion. Four of the baboons that were treated with DMSO also were treated with pentobarbital coma for 96 hours starting 4 hours after occlusion. Analysis of the neurological scores after 1 week survival indicated that treatment with DMSO alone and DMSO and pentobarbital coma did not improve the outcome. Morphological changes were similar in the 3 groups. The findings of our investigation indicate that DMSO is ineffective in treating acute focal cerebral ischemia.

Animals↗
PubMed1982

Middle meningeal artery trauma.

We present the case of a patient who had the symptoms of a subarachnoid hemorrhage but was subsequently found to have an unusual combination of a separate traumatic pseudoaneurysm and a traumatic arteriovenous fistula of the middle meningeal artery. A review of the literature revealed a difference in the clinical course of patients with traumatic pseudoaneurysms compared to that of patients with arteriovenous fistulas. Patients who were found to have traumatic pseudoaneurysms of the middle meningeal artery frequently manifested signs of delayed hemorrhage. This mechanism may account for the prolonged lucid intervals exhibited in some patients subsequently found to have epidural hematomas.

Arteriovenous Fistula↗
PubMed1982

Cerebral revascularization during barbiturate coma in primates and humans.

Extracranial-intracranial arterial bypass was performed in five baboons to assess the effectiveness of the procedure in preventing acute cerebral ischemia following middle cerebral artery occlusion in our primate model. Thirty minutes following middle cerebral artery occlusion, the animals were placed in barbiturate coma while the extracranial-intracranial artery bypass was being completed. In the three animals with patent extracranial-intracranial arterial bypasses, infarction was prevented. In the two with occluded extracranial-intracranial arterial bypasses, a large infarction in the territory of the middle cerebral artery occurred. In a clinical correlate, postoperative ischemia was presumably prevented in three patients by barbiturate administration and revascularization for unanticipated intracranial vessel occlusion.

Animals↗
PubMed1982

Barbiturate coma in focal cerebral ischemia. Relationship of protection to timing of therapy.

The therapeutic application of barbiturate-induced coma was evaluated in a primate model of focal cerebral ischemia. A standardized regimen of pentobarbital was used, and the times of initiation of administration were varied following a 6-hour middle cerebral artery occlusion in baboons. Three groups of five animals were treated at 30, 120, and 240 minutes after occlusion, while one group of five animals received no barbiturate therapy. Complete protection from intracranial pressure (ICP) elevation and ischemic damage was seen only in the group treated at 30 minutes. Those treated at 120 minutes, while doing better than untreated animals, still had ICP elevation and a marked neuropathological deficit. Animals treated at 240 minutes suffered a detrimental effect, in that malignant ICP and marked ischemic damage occurred earlier than in the untreated animals. The safe "therapeutic window" for barbiturate-induced coma in this animal model does not extend beyond 2 hours. Delayed administration results in a deleterious response and not merely a lack of protection.

Animals↗
PubMed1982

Occipital artery to posterior inferior cerebellar artery bypass for vertebrobasilar ischemia.

Fourteen patients who underwent occipital to posterior inferior cerebellar arterial bypass are reviewed. All of the patients were treated for severe vertebrobasilar ischemia secondary to lesions of the distal vertebral artery. There was no operative death or permanent postoperative morbidity. On follow-up evaluation (averaging 13 months after operation), there has been 100% graft patency and a noticeable improvement in the neurological function in all patients. Operating with the patient in the prone position and avoiding intraoperative hypotension help to minimize the operative morbidity from this procedure.

Adult↗
PubMed1981

Barbiturate resuscitation from focal cerebral ischemia--A review.

Barbiturate therapy has been shown to be of benefit in certain instances for focal cerebral ischemia. This therapy can, however, result in a deleterious outcome. Early institution in combination with revascularization appears to be important for successful barbiturate application. Whether combinations of agents designed to act on different mechanisms in the pathophysiology of cerebral ischemia can prolong the 'therapeutic window' of barbiturate application is an area for future investigation.

Animals↗
PubMed1981

Intrachiasmatic arteriovenous malformation. Case report.

A patient presented with an abrupt monocular decrease in visual acuity and a bitemporal hemianopsia. At surgery, a totally intrachiasmatic arteriovenous malformation was removed, with subsequent resolution of the visual deficit.

Adult↗
PubMed1981

Late complications of carotid ligation in the treatment of intracranial aneurysms.

The results in 57 consecutive patients treated with carotid ligation for an intracranial aneurysm were analyzed to define the risks of late complications. The average age for the group was 46 years. Eighty percent of the aneurysms were located on the internal carotid artery (ICA). The acute morbidity and mortality of the treatment and the natural history of the disease was 29%. Twenty-four patients were discharged with a common carotid artery (CCA) ligation, and 21 patients with an ICA ligation. Three patients from each ligation group could not be located for review. The follow-up period for the 21 patients with CCA ligation ranged from 1 to 15 years, with an average of 8.4 years, and for the 18 patients with ICA ligation it ranged from 2 to 19.5 years, with an average of 12.5 years. Excluding deaths from unrelated causes, five of the 21 patients with CCA ligation developed a late complication. Two patients had a transient ischemic attack (TIA). Two patients had a subarachnoid hemorrhage (SAH), one of which was fatal and was preceded by a TIA. Two patients developed monocular blindness. None of the patients had a stroke. Excluding deaths from unrelated causes, five of the 18 patients with ICA ligation developed a late complication. One patient had a fatal SAH. Three patients had a TIA, two of which were followed by a stroke. One patient had a stroke in the cerebral hemisphere contralateral to the side of the carotid ligation.

Adult↗
PubMed1981

Clinical and pathological study of dysplastic gangliocytoma. Case report.

A case of dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease) is reported. Computerized tomography revealed a nonenhancing mass lesion surrounded by areas of calcification. Surgical excision resulted in complete resolution of the patient's symptoms. The histological findings support the concept that this tumor represents a congenital abnormality in granule-cell migration and is not a true neoplasm.

Adult↗
PubMed1981

Improved neurologic function after cerebrovascular accident with extracranial-intracranial arterial bypass.

This study, by use of direct measurement, sought to investigate the role of diminished cerebral blood flow on neurologic function after cerebrovascular accident (CVA). Twenty-seven patients had mean middle cerebral artery pressure (MCAP) measured intraoperatively prior to a superficial temporal artery to middle cerebral artery bypass. The ratio of MCAP to mean systemic blood pressure (BP) was less than 0.500 in 11 patients. Six of these 11 had preoperative neurologic deficit and four of these six had improved neurologic function after revascularization. In 16 patients the MCAP/BP was greater than 0.500, and none of the seven patients with neurologic deficit improved postoperatively. In general, the MCAP/BP correlated well with the angiographic severity of cerebrovascular disease. In 16 patients, unsuitable for conventional bypass, autogenous saphenous vein was used as a bypass from the subclavian or other extracranial artery to a cortical branch of the middle cerebral artery. One cerebral death and one CVA occurred postoperatively early in the series, but there have been no untoward events since deep barbituate anesthesia has been used. Diminished cerebral blood flow after CVA may leave a pool of viable but nonfunctional neurons. Extracranial-intracranial bypass may improve neurologic function in such patients.

Blood Pressure↗
PubMed1980

The role of EC-IC in the treatment of giant intracranial aneurysms.

Extracranial to intracranial bypass surgery was used in 27 cases of intracranial giant aneurysm to prevent ischemic complications. In 19 of 21 patients the aneurysm was considered unfit for a direct clipping or ligation, and an EC-IC bypass was done in conjunction with staged clipping of the internal carotid artery or occlusion of the middle cerebral artery. All bypass grafts have remained patent postoperatively. None of the patients have developed ischemic complications in the 6--14 month period of follow-up.

Adult↗