Communication: who is in charge?
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Biomedical subjects
Publications and source records attributed to W E Stern.
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Upon completing his sixth year as chairman of a large department of surgery in a major United States medical school, the author, a neurosurgical chief for 32 years, reflects upon the goals of departmental stewardship. The charges and challenges to any chairman of a multispecialty department are sampled from the perspective of personal experience. The general message could be interpreted as a call to service and a job description.
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The not-uncommon spinal abnormalities associated with Marfan's syndrome rarely undergird clinical problems, and neurological features accompanying such bone abnormalities are rare. In such unusual circumstances it is a widened vertebral canal that attracts attention: the substrate of such widening is dural ectasia with bone erosion, presumably due to hydraulic forces operating via the cerebrospinal fluid (CSF). When neural symptoms or findings do occur they may be related to stretching and traction mechanisms. This study of a symptomatic patient defined with reasonable clarity the abnormal anatomy, and some neurological symptom relief was achieved by attempting to alter the CSF dynamics. The relevant literature has been sampled to elucidate the condition.
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An unusual case is reported of a patient with spastic paraparesis who was found to have severe spinal arachnoiditis due to Coccidioides immitis. Despite an obstructive hydrocephalus and a spinal subarachnoid block, the patient was treated effectively with surgery (shunting) and antifungal therapy (amphotericin and ketoconazole). He remains asymptomatic 3 years after diagnosis. Aggressive surgical and medical treatment of coccidioidal infection of the central nervous system can be beneficial, even in patients with the worst prognosis.
Infestation of the central system (CNS) by the larval form of Taenia solium can be etiological for one or more of several clinicopathological manifestations. Experience gained from treating 18 patients forms the basis for a classification of this disease and for observations upon therapy. Twenty-three surgical procedures in 15 of the 18 patients provide the foundation for comment on operative treatment in management. Whereas most procedures are palliative, eradication of the CNS disease may be achieved in cases of solitary intraventricular cysts. There has been no operative mortality.
A primate model of chronic cerebral vasoconstriction is presented which closely approximates the human experience following subarachnoid hemorrhage. Treatment of the vasoconstriction with intravenous nitroglycerin produces a modest, but statistically significant, increase in the size of the most constricted vessels (11%, p less than 0.02) when compared with a control infusion of normal saline. The significance of these experiments is discussed.
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