Shortfalls in published neurosurgical literature.

Expenditure related to neurosurgery has increased unevenly since the early 1990s. In this study we explored the literature by which clinical evidence is obtained to better direct neurosurgical practice. We searched different types of neurosurgery literature and four major neurosurgical procedures (excision of brain lesion, cerebral aneurysm clipping/coiling, discectomy, spine fusion) written in English on PubMed from 1996, the year of its launch, using the keyword "cost".

Shortfalls in pediatric hydrocephalus clinical outcome analysis.

Background: In this paper, we used search engine technology to study outcome analysis and cost awareness of child hydrocephalus in the literature.

Methods: The aggregate hospital charges of hydrocephalus treatment procedures for patients <18 years old was extracted from the Nationwide Inpatient Sample (NIS) data. Hydrocephalus literature was probed through the PubMed biomedical search engine.

The role of drains in lumbar spine fusion.

Objective: To study the role of drains in lumbar spine fusions.

Methods: The charts of 402 patients who underwent lumbar decompression and fusion (LDF) were retrospectively reviewed. Patients were classified per International Classification of Diseases, 9th Edition (ICD-9) procedure code as 81.

Uterine peaking--sonographic sign of vesico-uterine adhesion.

Objective: In this paper we present our observation of a specific sign on transvaginal ultrasound that may help basic minimal invasive surgeons diagnose vesico-uterine adhesions preoperatively.

Methods: The ultrasound images of the latest eleven patients who were preoperatively diagnosed with vesico-uterine adhesions using transvaginal ultrasound were compared with their intraoperative findings.

Results: Ultrasonography showed a spectrum of changes from obliterated anterior cul-de-sac to dense fibrosis between the lower uterine segment and cervix with the bladder.

The role of laparoscopic myomectomy in the management of uterine fibroids.

Purpose Of Review: Laparoscopic myomectomy has been described as comparable to open myomectomy in terms of fertility and obstetrical outcome with decreased intraoperative bleeding and postoperative disability. Despite this, laparoscopic myomectomy is not widely used reportedly due to lack of experience. This article presents our technique for laparoscopic myomectomy and assesses the current evidence-based literature for the use of this minimally invasive procedure in benign gynecological practice.

Higher comorbidity rates in unemployed patients may significantly impact the cost of spine surgery.

Chronic back pain is commonly associated with physical and mental comorbidities, which create a considerable burden on the healthcare system. We examined the differences in comorbidity rates of 619 spinal surgery patients of employment age, and the impact of comorbidity rates on length of hospital stay and cost. The charts of patients aged >25 years and <65 years were reviewed retrospectively.

The effect of age and body mass index on cost of spinal surgery.

Complex shifts in demography combined with drastic advancements in spinal surgery have led to a steep increase in often expensive spinal interventions in older and obese patients. A cost analysis, based on hospital charges, was performed retrospectively on the spinal surgery of 787 randomly selected patients who were operated at The Medical Center of Central Georgia, a large urban hospital in Central Georgia. The types of surgery included anterior cervical decompression and fusion (ACDF), lumbar decompression and fusion (LDF), and lumbar microdiscectomy (LMD).

Successful treatment with intravenous immunoglobulin of acute flaccid paralysis caused by west nile virus.

West Nile virus (WNV) is one of the leading causes of insect-borne encephalitis and acute flaccid paralysis in the US. Acute flaccid paralysis is a potentially serious illness, which manifests itself as a Guillain-Barré-like syndrome with generalized weakness and shortness of breath. We report a case involving a patient who presented with acute flaccid paralysis due to WNV infection and was successfully treated with intravenous immunoglobulin from Israeli donors.

Syringomyelia: a complication of an underlying pathology.

Unlabelled: Patients with syringomyelia may have diverse etiology and experience a variety of symptoms. This report describes two cases of syringomyelia in patients with different profiles, presentations and pathomechanisms.

Keywords: Syrigomyelia; Syrinx; Arachnoid cyst; Arnold-Chiari.

Dyspareunia: a complex problem requiring a selective approach.

Dyspareunia frequently has a multifactorial aetiology. The problem with the term is that it is not specific enough and does not allow for proper discussion of the very important problem of pain with sexual intercourse, a problem that can be very disturbing to a couple's relationship. We present two cases of patients who had multiple potential anatomic reasons for dyspareunia.

Lymphoma of the base of the tongue: an incidental finding on the preoperative workup for a spine surgery.

Unlabelled: Lymphoma of the tongue is very rare and accounts for 1% of all malignant tumors of the oral cavity. We present a patient who presented with weakness and difficulties with ambulation who was a known cervical spine spondylosis and stenosis patient. During the preoperative workup for cervical spine surgery a tumor at the base of the tongue was discovered which was confirmed by pathology to be a lymphoma.

Prevalence of urinary incontinence in female residents of american nursing homes and association with neuropsychiatric disorders.

Background: Urinary incontinence (UI) is most common in older women.

Methods: We studied the prevalence of UI among female residents of nursing homes and the influence of associated neuropsychiatric problems on the rates of UI using the results of the 2004 National Nursing Home Survey (NNHS).

Results: Analysis shows that 37% of female nursing home residents are incontinent, especially those with dementia.

Prognostic factors for long-term survival after glioblastoma.

Long-term survivors of glioblastoma (GB) are rare. Several variables besides tumor size and location determine a patient's survival chances: age at diagnosis, where younger patients often receive more aggressive treatment that is multimodal; functional status, which has a significant negative correlation with age; and histologic and genetic markers.

Early screening for IUGR: comparison of two related echographic markers.

Introduction: Can ultrasonography be performed in pregnant women as a screening test to predict IUGR? To justify its use, it must have a high enough positive predictive value.

Materials And Methods: This study addresses the concept of early prediction of IUGR using echographic measurements in the first trimester. We studied one traditional and one new marker, the crown-rump length (CRL) and the cerebro-corporal coefficient (CCC).

Neurosarcoidosis--the great mimicker.

Introduction: Neurosarcoidosis is rare and difficult to diagnose especially in the absence of systemic involvement.

Case Report: A 22-year-old African-American man presented with inability to gaze laterally. He underwent magnetic resonance imaging (MRI) the day before that revealed "a 5-mm enhancing mass with surrounding edema in the pons anterior to the fourth ventricle most likely compatible with pontine glioma.

The fifth vital sign--what does it mean?

Acute pain is reported as a presenting symptom in over 80% of physician visits. Chronic pain affects an estimated 76.2 million Americans--more than diabetes, heart disease, and cancer combined.

Brain metastasis from thymic carcinoma in association with SIADH and pituitary enlargement: a case report.

A 49-year-old white female presented to the emergency room complaining of severe headaches. A brain computed tomography (CT) showed a large right temporal mass that measured 2.9 x 5 cm.

Bilateral dermoid cysts of the ovary in a pregnant woman: case report and review of the literature.

Objective: Most nonphysiological ovarian masses discovered during pregnancy are benign dermoid cysts. The association of dermoid cysts with pregnancy has been increasingly reported since 1918. They usually present the dilemma of weighing the risks of surgery and anesthesia versus the risks of untreated adnexal mass.

Cerebellar anaplastic astrocytoma in a teenager with Ollier Disease.

Introduction: Ollier Disease is a sporadic skeletal disorder with a predisposition to oncogenesis. It is estimated at around 1/100,000. We are presenting a young patient with Ollier Disease and high-grade astrocytoma.

Cauda equina syndrome-think of cancer.

Leptomeningeal carcinomatosis (LC) is a serious complication found in approximately 1% to 8% of patients with solid cancer and carries substantial rates of morbidity and mortality. Up to 48% of patients may present with LC before the presence of systemic cancer is known. We present the case of a patient who presented with symptoms of cauda equina syndrome and for whom subsequent investigations revealed intrathecal metastases and locally advanced lung cancer without respiratory symptoms or brain or bone metastases.