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Thomas J. Rosenbaum, Collin S. MacCarty and Helmut Buettner

✓ A patient with a peculiarly refractory uveitis and vitritis was later found to have an infiltrative mass lesion of the posterior portion of the corpus callosum. The histopathological diagnosis of reticulum-cell sarcoma (large-cell lymphoma) was made after study of vitreous tissue obtained by pars plana vitrectomy of the right eye. Intraocular involvement with cerebral reticulum-cell sarcoma has been reported previously.

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Thomas J. Rosenbaum, Edward H. Soule and Burton M. Onofrio

✓ A search of the English literature revealed 46 cases of primary intraspinal teratomas, of which 22 were teratomatous cysts of the spinal cord. To clarify the confusion regarding this rare lesion, the definition, origin, presentation, and histological features of the lesion are discussed. An additional case is presented.

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Thomas J. Rosenbaum and Thoralf M. Sundt Jr.

✓ Various straight-jawed aneurysm clips were tested for occluding capabilities on a vascular tissue model. Occluding pressures varied markedly among the clip styles and were altered by changes in the lumen and tissue composition of the model. Mechanical characteristics are highly variable between clip styles, but fall within a narrow range for clips of a similar style. The complex interplay of the unique aspects of clip design and force generated by the spring in conjunction with tissue characteristics and precise clip placement upon the tissue are major variables in the apparent ability of a particular clip to occlude the neck of an aneurysm.

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Thomas J. Rosenbaum, O. Wayne Houser and Edward R. Laws

✓ The authors report a case of pituitary apoplexy occurring several hours after carotid angiography. The event was associated with stupor, focal headache, and left hemiparesis. Repeat angiography demonstrated intracranial occlusion of the right internal carotid artery. At surgery, a hemorrhagic pituitary adenoma was found to be compressing the internal carotid artery, and the removal of the tumor resulted in restoration of flow. The mechanism, presenting symptoms and signs, and treatment of pituitary apoplexy causing compression of a major vessel are discussed.

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Thomas J. Rosenbaum and Thoralf M. Sundt Jr.

✓ The sequential hematological and endothelial responses in the postoperative period after end-to-side arterial anastomosis in 1- to 1.3-mm vessels were assessed by scanning electron microscopy. Two minutes after restoration of flow, an amorphous coating covered the vessel lumen around the suture line, and oozing of blood from the suture line ceased. Within 15 minutes, a partially occluding thrombus was present, which was maximal at the anastomotic bifurcation point. The thrombus underwent partial lysis or embolization within 30 minutes, and gross intraluminal thrombi did not recur. The initial thrombi that formed within 2 minutes were composed of platelets and erythrocytes in a loose reticular fibrin network, but the intraluminal thrombi present at the branch point 15 minutes after flow restoration appeared to be composed solely of platelets. Thrombi that did not undergo complete dissolution had a loss of distinct cellular elements at later time intervals. The fibrin-platelet matrix coating the lumen remained unchanged during the initial 24 hours. When examined at 9 days, normal endothelium was present throughout the vessel with the exception of the suture line, which remained covered by a smooth coagulum. This sequence of events suggests that if surgical manipulation is to result in complete occlusion of the anastomosis, it will likely occur in the initial 30 minutes after resumption of blood flow.

Anticoagulant regimens were evaluated. Pretreatment with aspirin and intraoperative heparin irrigation of the vessel lumen were not beneficial in altering the quantity of thrombus. All systemic heparin regimes tested resulted in a quantitative decrease of thrombotic material. Five minutes of intravenous heparin therapy after resumption of blood flow was as effective as long-term heparin in decreasing the transient intraluminal thrombotic response.