[Time lost between stroke and carotid endarterectomy].

Objective: To establish whether measures taken to shorten the interval of time between a stroke and carotid endarterectomy (CEA) procedure at two Dutch hospitals had any effect.

Design: Retrospective and descriptive.

Method: Data were gathered on all patients with symptomatic narrowing of the carotid artery from a non-academic teaching hospital (Amphia Ziekenhuis in Breda) as well as from a university clinic dedicated to carotid abnormalities (University Medical Center Utrecht, UMCU).

The facet orientation circle. A new parameter for facet joint angulation in the lower lumbar spine.

Study Design: A descriptive quantitative evaluation was done of the transverse orientation of the lower lumbar facet joints as measured by computed tomography scanning.

Objectives: To evaluate a new parameter for facet joint angulation in the transverse plane (the "facet orientation circle") and to obtain reference values for this new parameter.

Summary Of Background Data: In other studies, both in vitro and in vivo, the angulation of the facet joints has been measured in degrees relative to the frontal or sagittal plane.

Delayed radiation myelopathy: serial MR-imaging and pathology.

Clinical data, MR-scans, time-dose fractionation schemes and neuropathologic findings of two cases of delayed radiation myelopathy (DRM), are presented. Both patients, a 72-year-old diabetic woman with cervical lymphnode metastasis from a squamous cell carcinoma and a 46-year-old woman with tonsillar carcinoma, developed paraparesis followed by quadriplegia, at 7 and at 10 months following radiation. The spinal cord received 46 and 49 Gy.

Dose-effect relationship of dexamethasone on Karnofsky performance in metastatic brain tumors: a randomized study of doses of 4, 8, and 16 mg per day.

The purpose of this study was to determine whether lower doses of dexamethasone for treatment of brain tumor edema are as effective as the conventional dose of 16 mg/d. We consecutively executed two double-blind randomized trials in patients with CT-proven brain metastasis and Karnofsky scores of 80 or less. In the first series, we compared 8 mg dexamethasone per day versus 16 mg/d; in the second series, 4 mg/d versus 16 mg/d.

Medical therapy of malignant nerve pain. A randomised double-blind explanatory trial with naproxen versus slow-release morphine.

It is uncertain whether there exists a nociceptive component in malignant nerve pain responsive to NSAIDs and opioids. 20 patients with malignant nerve pain were randomly assigned to treatment with naproxen 1500 mg versus slow-release morphine 60 mg daily during 1 week, followed by cross-over medication during the second week in a double-blind, double-dummy protocol. In the 16 evaluable patients, a significant (P < 0.

Removal of aneurysmal bone cyst in the area of C1, C2 and foramen magnum. Follow-up of surgical osteoplastic repair by means of 3 D CT studies 15 years later.

First, the author relates his memories of his first encounter with the new Editor-in-Chief of the Acta Neurochirurgica in 1957 and the reasons why it made such an unforgettable impression. Next, follows a discussion of the technical difficulties in the treatment of spinal aneurysmal bone cysts, which may produce extensive destruction of its bony elements. The relatively rare occurrence of these lesions and resulting limited experience provide insufficient grounds for developing rigid rules of surgical treatment.

Carbamyl phosphate synthetase-1 deficiency discovered after valproic acid-induced coma.

Valproic acid induced coma is presented in an adult patient without a history of metabolic disease. Liver biopsy revealed a reduction in activity of carbamyl phosphate synthetase-I, an enzyme obligated for transformation of ammonia to urea in the urea cycle. After recovery CT scan follow-up showed marked cerebral atrophy which did not exist prior to the state of coma.

The course of neuropathy after cessation of cisplatin treatment, combined with Org 2766 or placebo.

Peripheral neuropathy is an important and disabling side-effect of cisplatin treatment. A new drug, Org 2766, has been found to prevent this neuropathy up to 1 month after treatment. A group of 18 patients with ovarian cancer, who participated in an earlier randomized study with placebo or Org 2766, together with cisplatin and cyclophophamide, were thereafter prospectively followed up to 2 years after discontinuation of treatment to monitor the development of neurological signs and symptoms and vibration perception threshold (VPT).

Subacute progressive sensory ataxic neuronopathy after Rickettsia conorii infection.

A case is presented in which sensory ataxic neuronopathy developed after serologically proven infection with Rickettsia conorii and continued to be progressive after appropriate antibiotic treatment. Electrophysiological studies showed decreasing sensory nerve conduction velocities ending with the absence of sensory nerve action potentials as well as peripheral and cortical somatosensory evoked potentials. Histological studies revealed a profound loss of myelinated fibres due to primarily axonal degeneration.

Isolated spinous process deviation. A pitfall in the interpretation of AP radiographs of the lumbar spine.

A new type of spinous process deviation is described. This variant may cause confusion in the interpretation of anteroposterior (AP) radiographs of the lumbar spine. In the literature, two types of lumbar spinous process deviation (SPD) have been described: 1) SPD due to rotation of the entire vertebra (as in rotatory scoliosis and degenerative arthritis), and 2) SPD as a consequence of developmental asymmetries of the neural arch.

Morphometry of lower lumbar vertebrae as seen on CT scans: newly recognized characteristics.

Transaxial computed tomographic (CT) sections represent a new approach to vertebral morphometry, allowing certain measurements to be made in vivo for the first time. The cross-sectional morphology of the bodies and pedicles of L3, L4, and L5 was studied in a series of 213 vertebrae. This revealed that the pedicles of L5 arise more laterally from the body of L5 than from L3.

The orientation of laminae and facet joints in the lower lumbar spine.

The relationship between the angulation of the facet joints and that of the caudad parts of the corresponding laminae in the transverse plane was investigated with computed tomography (CT) at the vertebral levels L3-L4, L4-L5, and L5-S1. At the level of L3-L4, both the facet joints and the caudad portions of the laminae tend toward a sagittal orientation, while at L5-S1 this is more toward the frontal plane. At the level of L4-L5, they occupy an intermediate position.