Malignant psammomatous melanotic schwannoma of the spine: A component of Carney complex.

Background: Psammomatous melanotic schwannomas (PMS) of the spine may be a component of the Carney complex in 50% of cases and is inherited in an autosomal dominant manner. Most PMS are benign and frequently associated with lentiginous pigmentation; cardiac, cutaneous, or breast myxomas; endocrine overactivity; and cutaneous blue nevi. These tumors are characterized by melanin containing cells having ultrastructural characteristics of Schwann cells.

Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion.

Study Design: A retrospective review of patients who underwent an anterior cervical fusion using recombinant human bone morphogenetic protein (rhBMP)-2 with an absorbable collagen sponge (INFUSE; Medtronic Sofamor Danek, Minneapolis, MN).

Objective: To ascertain the complication rate after the use of high-dose INFUSE in anterior cervical fusions.

Summary Of Background Data: The rhBMP-2 has been primarily investigated in lumbar spine fusions, where it has significantly enhanced the fusion rate and decreased the length of surgery, blood loss, and hospital stay.

Dynamic weight-bearing cervical magnetic resonance imaging: technical review and preliminary results.

Background: Conventional magnetic resonance imaging (MRI) of complex cervical spine disorders may underestimate the magnitude of structural disease because imaging is performed in a nondynamic non-weight-bearing manner. Myelography provides additional information but requires an invasive procedure.

Methods: This was a prospective review of the first 20 upright weight-bearing cervical MRI procedures with patients in the flexed, neutral, and extended positions conducted in an open-configuration MRI unit.

Outcome following moderate traumatic brain injury.

Background: Little is known about the outcome following moderate traumatic brain injury (TBI) (GCS 9-12). Most patients regain consciousness; however, the full magnitude of long-term cognitive and functional deficits is unknown.

Methods: We conducted a prospective observational study evaluating the outcome of patients suffering moderate TBI between October 1995 and March 1998.

Development and implementation of a clinical pathway for severe traumatic brain injury.

Background: Clinical pathways (CPs) have been shown to be beneficial in optimizing patient care and resource use.

Methods: A multidisciplinary CP for the treatment of severe traumatic brain injury (Glasgow Coma Scale score of 3-7) was developed. Data from these patients (group I) were collected prospectively and compared with a retrospective database (group II).

Development and implementation of a clinical pathway for spinal cord injuries.

The authors have developed a clinical pathway for the treatment of spinal cord injuries to help improve patient care. A clinical pathway for the treatment of patients with spinal cord injury was developed through a multidisciplinary approach. The control group (group 1) consisted of patients who were treated in the 2 years before the initiation of the pathway.

Successful incorporation of the Severe Head Injury Guidelines into a phased-outcome clinical pathway.

Clinical pathways have been proven to be valuable tools in improving outcomes in patients with neurological diagnoses. However, their use with trauma populations has been limited. The unpredictable nature of trauma makes it difficult to develop a day-by-day plan of care that would be applicable to all patients with the same trauma diagnosis.

Treatment of neoplastic diseases of the sacrum.

Sacral neoplasms constitute a wide range of pathological entities including primary and metastatic as well as benign and malignant conditions. Often these lesions are large at the time of initial diagnosis and surgical cure may be difficult. Nonetheless, surgery may be indicated for a wide range of reasons including tissue diagnosis, palliation of pain, preservation of neurological function, or attempts for curative resection.

The role of directly applied hypothermia in spinal cord injury.

Study Design: The effect of intense local hypothermia was evaluated in a precision model of spinal canal narrowing and spinal cord injury in rats. The spinal cord injury was cooled with a custom cooling well used over the epidural surface. Basso, Beattie, and Bresnahan (BBB) motor scores and transcranial magnetic motor-evoked potential (tcMMEP) responses were used after injury to accurately evaluate neurologic recovery.

Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age.

Object: The purpose of this study was to evaluate the safety and efficacy of the surgical treatment of lumbar spinal stenosis in patients older than 75 years of age.

Methods: The authors reviewed the records of 65 patients with lumbar spinal stenosis who were at least 75 years of age at the time of surgery, which was performed between November 1990 and May 1996. The 65 patients (43 women, 22 men; average age 78 years) underwent a total of 71 operations (one patient underwent three, and four patients underwent two).

The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model.

Study Design: The effect of spinal canal narrowing and the timing of decompression after a spinal cord injury were evaluated using a rat model.

Objective: To evaluate whether progressive spinal canal narrowing after a spinal cord injury results in a less favorable neurologic recovery. Additionally, to evaluate the effect of the timing of decompression after spinal cord injury on neurologic recovery.

Effect of prior lumbar discectomy on outcome of lumbar fusion: a prospective analysis using the SF-36 measure.

This study prospectively measured patient-reported quality-of-life outcome in patients undergoing fusion for recurrent symptoms after prior discectomy. Analysis of SF-36 data revealed statistically significant improvement in physical function, social function, and bodily pain 1 year postoperatively. Analysis of variance revealed significant interactions based on worker's compensation, litigation status, educational level, and age.

Effect of a clinical pathway for severe traumatic brain injury on resource utilization.

Background: The usefulness of clinical pathways for the complex trauma patient is unclear. We analyzed the effect of a clinical pathway for severe traumatic brain injury (TBI) on resource utilization.

Methods: A clinical pathway for severe TBI (Glasgow Coma Scale (GCS) score < or = 8 at 24 hours) was developed by a multidisciplinary team and used for all patients with severe TBI.

Management of iatrogenic spinal stenosis complicating placement of a fusion cage. A case report.

Study Design: A case of iatrogenic spinal stenosis secondary to fusion cage retropulsion is presented.

Objectives: To highlight fusion cage retropulsion, a potential complication that may become more prevalent as the use of fusion cage instrumentation expands. The difficulty in management of this complication is emphasized.

Evaluation of minor head injury in children.

The authors' goal was to determine criteria for hospitalization for children with minor head injuries. A retrospective review was performed of the hospital records of 401 children with isolated minor head injuries who were admitted to a level I pediatric trauma center between July 1988 and December 1990. Specific information regarding each patient was documented, including demographic data, pertinent physical findings, diagnostic studies, criteria for admission, and hospitalization costs.

The two-edged sword of large-dose steroids for spinal cord trauma.

Objective: In 1990, large-dose steroid administration was advocated in spine-injured patients to lessen neurologic deficits. The authors undertook both prospective and retrospective studies to evaluate the response of such profound pharmacologic intervention.

Summary Background Data: Of all sources of nonfatal injury, spinal cord trauma remains the most devastating in both cost and impact on the quality of the patient's life.

Ritual head computed tomography may unnecessarily delay lifesaving trauma care.

Examination of 462 consecutive patients with blunt trauma suggested reassessment of the timing of head computed tomographic (CT) scanning in the critical care of the seriously injured. Even though potential brain injury was the most common reason for admission, few (5 percent) of the patients required neurosurgical intervention. It is apparent that the more common non-neurosurgical procedures that were used to squelch hemorrhage and provide hemodynamic stability and airway control should not be delayed to obtain "routine" head CT scans.

There is an answer to the shortage of organ donors.

From a retrospective review of 32,562 deaths that occurred in 1988 in the service area of Kentucky Organ Donor Affiliates, an area with a population of 3.4 million, 173 potential solid organ donors were identified for a rate of 50.8 donors per million population base.

MR imaging in acute cervical spine trauma.

Fourteen patients with cervical spine injuries, 12 with resultant neurological deficits, were scanned with magnetic resonance (MR) imaging within 7 days following injury. Useful information concerning the status of the spinal canal and disks was obtained in most cases. In addition, MR was able to suggest the nature of the pathological changes within the spinal cord, as well as hemorrhage and edema in the extraspinal soft tissues.

Cervical spine fractures with major associated trauma.

A detailed review of 88 consecutive patients placed in skeletal tong traction for cervical fractures by the University of Louisville Neurosurgical Service during a 5-year period from July 1, 1979, through June 30, 1984, was carried out. Of this group, 60% of the patients had a major associated injury consisting of major facial and skull fractures, cerebral contusions or intracerebral blood clots, cardiac or pulmonary contusions, major thoracic injuries including rib fractures and hemo- or pneumothoraces, intra-abdominal injuries, and major extremity fractures. An additional 24% of the patients had minor associated injuries, including facial or scalp lacerations, general body lacerations, or abrasions and cerebral concussions.

Effects of pure or combined inocula of Escherichia coli and Bacteroides fragilis on the liver and related metabolism.

To test for synergy between a facultative and anaerobic bacterium and the role hepatic hypoxia may have in its development, rats were subjected to intravascular infusion of 10(8) Escherichia coli, 10(9) Bacteroides fragilis, or a combination of both. Acute effects were evaluated by selected 6-hour measurements, including hepatic pO2, and longer range effects by liver cultures and histology in rats surviving 7 days. During the acute period, systemic arterial pressure and pO2 in bacteremic groups did not differ from saline-infused controls.

Changes in concentrations of taurine in murine Harderian glands and retinas during postnatal development.

Quantitative measurements of taurine in the Harderian glands of male and female CF-1 mice were made by standard methods of amino acid analysis. Values, in nmoles per mg dry weight of gland, were 60 to 70 in the first 4 postnatal days with a gradual decrease to 31.1 +/- 3.

An amino acid diet supporting superior growth in mice.

A diet containing, as a source of nitrogen, a mixture of purified L-amino acids simulating the amino acid composition of a successful diet containing vegetable and milk proteins was fed to mice in a 3% agar gel. This diet, at 17% amino acids, supported better growth of young male animals during a 21-day period than did the same assortment of amino acids at 23% of the diet, a commercial mouse food or the same basic diet containing a different assortment of amino acids from a published diet developed for rats. Cystine was removed from the diet, which contained 0.