Multifaceted interventions improve adherence to the surgical checklist.

Introduction: Adherence to surgical safety checklists remains challenging. Our institution demonstrated acceptable rates of checklist utilization but poor adherence to all checkpoints. We hypothesized that stepwise, multifaceted interventions would improve checklist adherence.

Neurophysiologic correlates of implicit face memory in intracranial visual evoked potentials.

Visual evoked potentials were recorded in the amygdala, hippocampus, mid- and inferotemporal cortex, orbitofrontal cortex, and lateral frontal cortex of seven epileptic patients while they were engaged in a difficult task requiring the discrimination between repeated and nonrepeated faces. The explicit recognition of previously seen faces was at chance levels, as measured by the accuracy of push-button responses. Nevertheless, all subjects showed clear-cut differential evoked responses to repeated versus nonrepeated faces, indicating implicit encoding of the distinction between the two types of stimuli.

Treatment of occipital neuralgia by partial posterior rhizotomy at C1-3.

To minimize the sensory loss associated with intradural posterior rhizotomy for medically refractory occipital neuralgia, partial sectioning of the upper cervical posterior rootlets was performed in 11 patients. The ventrolateral aspect of each posterior rootlet from C-1 to the upper portion of C-3 was divided at the root entry zone. In three patients with bilateral neuralgia, the procedure was performed on both sides, for a total of 14 partial rhizotomy procedures in the 11 patients.

Selectively distributed processing of visual object recognition in the temporal and frontal lobes of the human brain.

Evoked potentials to visually driven cognitive tasks were recorded through depth electrodes placed bilaterally within the amygdala, hippocampus, midtemporal and inferotemporal cortex, and lateral frontal cortex of 6 epileptic patients. Task-related differential response patterns were used to identify the recording sites engaged by specific aspects of visual encoding. In this group of 6 patients, the amygdala was most frequently engaged in encoding the familiarity of faces; midtemporal and inferotemporal cortex, in encoding perceptual identity and object categorization; and lateral frontal cortex, in holding visual object information in working memory.

Differential neural activity in the human temporal lobe evoked by faces of family members and friends.

In 6 patients, depth electrodes revealed differential evoked responses to familiar versus novel faces. These differential responses were obtained in the amygdala, hippocampus, and temporal neocortex but not in the dorsolateral frontal or cingulate cortex. The limbic and temporal structures that differentiated novel from familiar faces did not respond differentially to variations in luminance.

Abnormal pulsatile secretion of luteinizing hormone in men with epilepsy: relationship to laterality and nature of paroxysmal discharges.

We compared the pulsatile secretion of luteinizing hormone (LH) between 13 men with clinically and electrographically documented temporal lobe seizures and 8 age-matched controls. Serum for LH measurement was drawn every 15 minutes during 8 hours of EEG telemetry in both groups. The 2 groups did not differ significantly in average mean baseline LH secretion, total LH secretion, or average pulse amplitude.

Treatment of hemispheric collapse and herniation beneath the falx in a case of shunted hydrocephalus.

A successfully treated case of inversion and herniation of a cerebral hemisphere beneath the falx is reported. This condition resulted from large subdural hematomas as a complication of shunting in advanced hydrocephalus. The subdural collections were evacuated gradually while ventricular cerebrospinal fluid was replenished through the externalized ventricular catheter.

Embolization of solitary spinal metastases from renal cell carcinoma: alternative therapy for spinal cord or nerve root compression.

Four patients with a solitary vertebral metastasis from a renal cell carcinoma presented with acute spinal cord or nerve root compression. Because of the markedly hypervascular nature of the metastases it was decided to palliate the lesions by transarterial catheter embolization. The embolization reduced the venous blood pool within the tumors, resulting in progressive neurological improvement often lasting for 12 weeks or more.

Effect of dorsal-column stimulation on gelatinosa and marginal neurons of cat spinal cord.

Single neuronal units with physiological characteristics of superficial dorsal-horn neurons were recorded extracellularly in laminae 1, 2, and 3 of cat spinal cord. When focal electrical stimulation was applied to the ipsilateral dorsal column, most of the units were excited transsynaptically at various latencies consistent with an effect mediated by large myelinated axons. Units recorded in laminae 2 and 3 had earlier latencies of activation than units in lamina 1.

Craniopharyngioma in an elderly patient.

Craniopharyngioma, a tumor most commonly diagnosed in the young, may occur at any age. The oldest patient known to have histologic documentation of a craniopharyngioma, an 82.5-year-old woman, presented with visual field changes, panhypopituitarism, and mental status changes.

Descending influences on receptive fields and activity of single units recorded in laminae 1,2 and 3 of cat spinal cord.

Units (108) were isolated in laminae 1,2 and 3 in segments L7-Sl of decerebrate cat spinal cord. For each unit, the size and nature of its receptive field (RF) was delineated. Then the dorsolateral funiculus (DLF) was stimulated for 1 sec with 10 or 50 Hz, 0.

The formalin test: a quantitative study of the analgesic effects of morphine, meperidine, and brain stem stimulation in rats and cats.

A method for assessing pain and analgesia in rats and cats is described. The procedure involves subcutaneous injection of dilute formalin into the forepaw, after which the animal's responses are rated according to objective behavioral criteria. The formalin test is a statistically valid technique which has two advantages over other pain tests: (1) little or no restraint is necessary, permitting unhindered observation of the complete range of behavioral responses; and (2) the pain stimulus is continuous rather than transient, thus bearing greater resemblance to most clinical pain.