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John H. Schneider, Martin H. Weiss and William T. Couldwell

superseding previous smaller facilities. 3 Dr. John Griffin, a wealthy landowner and physician, was appointed the first physician in charge of the county hospital. In 1860, he moved the facilities to a larger building on his own property, which now comprises much of East Los Angeles. The average hospital census in 1860 was 25 patients per day, primarily cases of chronic diseases. By the 1870's, Los Angeles had transformed from a Mexican frontier town to an American commonwealth, establishing vast citrus crops to replace rangeland. This was facilitated by the introduction

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William T. Couldwell, Thomas C. Chen, Martin H. Weiss, Takanori Fukushima and William Dougherty

-sized defects and is not intended for use in areas requiring load-bearing structural support. Specific sizes and shapes of thicker implants are available for individual applications, and may be custom-ordered on an individual basis depending upon defect shapes derived from three-dimensionally reconstructed computerized tomography (CT) images. Microscopic Appearance and Histology of the Chronic Implant The high-density polyethylene microspheres are sintered to create a porous framework ( Fig. 4 left ). With chronic implantation, this porous network enables the

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Charles B. Stillerman, Thomas C. Chen, J. Diaz Day, William T. Couldwell and Martin H. Weiss

and lateral procedures. The essence of this procedure is that a safe and effective microdiscectomy may be performed through a limited partial facetectomy, without removal of the corresponding pedicle. We have found that this keyhole bone removal does not sacrifice the exposure achieved with the transpedicular approach, and it may diminish the potential for chronic localized back pain arising from disruption of the facet, pedicle, and disc. Prior to clinical application of this technique cadaveric analysis was performed in 180 thoracic vertebral segments to evaluate

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Charles B. Stillerman, Thomas C. Chen, William T. Couldwell, Wei Zhang and Martin H. Weiss

 transient (resolved in 48 hrs) 1 (1.2)  permanent mild residual deficit 1 (1.2) superficial wound infection 3 (3.7) pneumonia 3 (3.7) seizure 1 (1.2) total 12 (14.6) Illustrative Cases Case 1 Excessive Surgery in a High-Risk Patient This 77-year-old man presented with a history of rapidly progressing lower-extremity weakness and urinary incontinence. He reported a long history of midthoracic nonradiating pain. His medical history was notable for chronic renal failure, chronic obstructive pulmonary

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Kaushik Das, Deborah L. Benzil, Richard L. Rovit, Raj Murali and William T. Couldwell

. The work, which began in 1972, continued until Cooper's death in 1985. Cooper published results of series of patients treated with chronic cerebellar stimulation and deep brain stimulation for the treatment of spasticity and intractable seizures. 52, 61 He reported that 55% of patients experienced useful improvements. 62 However, others who attempted controlled studies usually found negative or equivocal results when using these techniques. 47 It is interesting to note that recent work by Benabid and colleagues 2 and by others 3, 75 has renewed interest in the

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William T. Couldwell

The long-term consequences of adenovirus-mediated conditional cytotoxic gene therapy for gliomas remain uncharacterized. We report here detection of active brain inflammation 3 months after successful inhibition of syngeneic glioma growth. The inflammatory infiltrate consisted of activated macrophages/microglia and astrocytes, and T lymphocytes positive for leucosyalin, CD3 and CD8, and included secondary demyelination. We detected strong widespread herpes simplex virus 1 thymidine kinase immunoreactivity and vector genomes throughout large areas of the brain. Thus, patient evaluation and the design of clinical trials in ongoing and future gene therapy for brain glioblastoma must address not only tumor-killing efficiency, but also long-term active brain inflammation, loss of myelin fibers and persistent transgene expression.

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William T. Couldwell, Joseph Zuback, Eugenia Onios, Brij Singh Ahluwalia, Michael Tenner and Augustine Moscatello

into the cavernous sinus. Aneurysms of the petrous ICA are rare, with approximately 37 cases reported previously in the literature. 2, 5, 12, 13, 16–18, 27, 34, 36 Such aneurysms may have several causes. Trauma (including iatrogenic), 8, 29, 37 is a significant cause of petrous aneurysms and has been well documented. Chronic otomastoiditis also has been associated, although the association in some cases is perhaps coincidental. Tonsillar and pharyngeal infections and cholesteatomas have also been implicated in the development of these aneurysms. Chronic infection

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Marga Spiller, Michael S. Tenner and William T. Couldwell

samples approximately every 5 minutes. The 1/T 1 NMRD profiles were followed in vitro for all samples over a period of 3 weeks, the amount of time it takes in vivo for fresh blood to evolve from the acute phase through the subacute phase to the chronic phase. To evaluate the implications of the 1/T 1 , measured in vitro for postoperative MR images, we used data generated during the first 4 days. Changes in signal intensity on T 1 - and T 2 -weighted images were predicted from changes in the 1/T 1 at the highest and lowest field strengths of the relaxometer

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Tunneled lumbar drain

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Michael Hahn, Raj Murali and William T. Couldwell

T reatment to prevent a CSF fistula commonly involves the use of continuous lumbar drainage. 1–3, 6 For longer term drainage, it may be desirable to tunnel the catheter laterally to avoid kinking of or leakage around the tube at the skin exit site. We report a simple and rapid procedure for tunneling a lumbar drain subcutaneously to facilitate chronic closed CSF drainage. We have found this method to be particularly useful in some skull base and spinal surgical applications in which continuous drainage is desired. Surgical Procedure The patient is

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Neurosurgical Forum: Letters to the Editor To The Editor Satoru Shimizu , M.D. Kitasato University School of Medicine Sagamihara, Japan 442 443 Abstract The authors report a simple and rapid procedure for tunneling a lumbar drain subcutaneously to facilitate chronic cerebrospinal fluid (CSF) drainage. A standard lumbar puncture (LP) is performed with a large-bore Tuohy needle (14- to 16-gauge), the drainage catheter is advanced into the subarachnoid space, and the needle is removed. The free Tuohy needle is