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Traumatology Without Knowledge of the Trauma: Diagnosis, Scaling, and/or Scoring?

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Mannitol and Head Injury

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Experimental Cerebral Missile Injury

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Management of 136 consecutive supratentorial berry aneurysms

Sean Mullan, Kathy Hanlon, and Frederick Brown

✓ A series of 103 consecutive cases admitted to the University of Chicago Hospitals with a recently ruptured supratentorial aneurysm were medically managed by antifibrinolytic medication, and, when applicable, by hypotension, intracranial pressure control, and respiratory support. Nine patients deteriorated and died, and six rebled and died before they were judged fit for surgical treatment. Four were treated by carotid occlusion. Nine, because of refusal or medical judgment, did not have surgical treatment. Sixty-nine of these patients and a further 33, electively admitted, underwent craniotomy. In these 102 patients, there was no mortality. Seven developed postoperative hemiparesis or hemiplegia. Six recovered. One has a residual monoparesis.

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Hyperemic and ischemic problems of surgical treatment of arteriovenous malformations

Sean Mullan, Frederick D. Brown, and Nicholas J. Patronas

✓ Three patients with arteriovenous malformations are described who showed signs of massive hyperemia in the vascular territory of the normal brain proximal to arterial ligation. One additional patient had evidence of ischemia of the brain in the territory distal to ligation (steal), and in another both mechanisms were considered as operative hazards.

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Delayed traumatic intracerebral hematomas

Report of three cases

Frederick D. Brown, Sean Mullan, and Eugene E. Duda

✓ Three patients are reported who developed delayed intracerebral hematomas following closed head injuries. Two patients showed hematomas within 24 hours after a normal computerized tomogram. All three were treated surgically, and two had good results.

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Treatment of aneurysmal hemiplegia with dopamine and mannitol

Frederick D. Brown, Kathryn Hanlon, and Sean Mullan

✓ Three patients with severe postoperative hemiplegia and one with hemiplegia following a subarachnoid hemorrhage are presented. None had hematomas. All were treated with dopamine-induced hypertension, mannitol, and large quantities of intravascular fluids. All showed a remarkable degree of clinical improvement, presumably secondary to an increase in cerebral blood flow.

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Dimethyl sulfoxide in experimental brain injury, with comparison to mannitol

Frederick D. Brown, Lydia M. Johns, and Sean Mullan

✓ The effects of dimethyl sulfoxide therapy were studied in rhesus monkeys following a standardized occipitofrontal missile injury. This therapy resulted in substantially higher blood pressure, cerebral perfusion pressure, blood flow, and oxidative metabolism than those of a group of monkeys that had been treated similarly with mannitol, and than those of an untreated group.

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Cerebral blood flow evaluation of prolonged experimental vasospasm

Frederick A. Simeone, Peter J. Trepper, and Daniel J. Brown

✓ Prolonged experimental cerebral vasospasm, determined by angiography, can be produced in animals by puncture of an intracranial artery (IAP) or subarachnoid injection of blood (SAI). Following these stimuli, several patterns of blood flow evolve. The biphasic pattern, seen only with hemorrhage from mechanical trauma to the vessel, seems to resemble most closely the clinical phenomenon. Presumably because of autoregulation, only angiographic constriction of cerebral arteries to less than one-half of their control value is associated with significant reduction of cerebral blood flow. Cerebral blood flow recordings and vessel caliber measurements should complement experiments in cerebral vasospasm to ascertain whether the spasm is producing significant ischemia and to assess the efficacy of subsequent treatment techniques.

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Changes in food intake with electrical stimulation of the ventromedial hypothalamus in dogs

Frederick D. Brown, Richard G. Fessler, Jacob R. Rachlin, and Sean Mullan

✓ Six adult dogs were implanted stereotaxically with chronic indwelling Medtronic platinum-tipped electrodes in the left ventromedial hypothalamic area (VMH); two dogs with electrodes placed in the subcortical white matter served as controls. Following 24 hours of food deprivation, VMH-stimulated dogs delayed their next meal for a period ranging from 1 to 18 hours. When not stimulated, however, each dog ate immediately upon receiving its food and consumed greater than average daily intake (p < 0.005). The two control dogs ate immediately upon receiving food regardless of whether they were stimulated or not. Dogs that received 1 hour of VMH stimulation every 12 hours for 3 consecutive days maintained an average daily food intake of 35% of normal baseline levels (range 13% to 51%), and water consumption averaged 50% of baseline intake (range 29% to 67%). Both of these results were statistically significant (p < 0.01). After cessation of stimulation, food and water intake returned to normal within 6 to 9 days, with no observable “rebound hyperphagia.” The two animals that received subcortical electrodes showed no change in food or water intake with stimulation. Blood pressure, pulse, respiration, temperature, and gross behavior were not altered during or after stimulation. These results suggest that the use of electrical stimulation of the VMH may be a useful modality for regulating food intake, and deserves further examination as a potential alternative therapy for human morbid obesity.