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Ricardo Vieira Botelho, Lia Rita Azeredo Bittencourt, José Marcus Rotta and Sérgio Tufik

respiratory disorder. 8 , 26 Obesity and craniofacial abnormalities that alter the oropharyngeal airways may be responsible for the pathophysiological changes behind obstructive apnea. 29 However, neuronal involvement may be responsible for both central and obstructive apneas by altering the reflex control of airways during sleep. 11 The effect of decompressive surgery on the posterior fossa in symptomatic patients who present with adult respiratory dysfunction may play a role in the alleviation of this clinical manifestation. In this study our objective was to assess

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Shigetoshi Yano, Jun-ichi Kuratsu and the Kumamoto Brain Tumor Research Group

, but also their patients, must decide whether and how to treat these asymptomatic meningiomas. To assess the indications for surgery in patients with asymptomatic meningiomas, we posed the following questions: 1) What is the tumor growth rate? 2) How many asymptomatic tumors eventually become symptomatic? 3) If patients with asymptomatic tumors undergo surgery, is the incidence of morbidity lower than that in surgically treated symptomatic patients? To investigate these questions, we conducted a retrospective study of 1434 patients with meningiomas who had been

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Clark Watts, Gary Hutchison, Jack Stern and Kemp Clark

C hemonucleolysis is the technique whereby primary lumbar intervertebral disc disease is treated by the intradiscal injection of the enzyme chymopapain. 5 We are reporting our experiences with the use of chemonucleolysis in the treatment of lumbar disc disease and comparing it to a series treated by orthodox disc surgery. Clinical Material and Methods The patients were initially seen because of signs and symptoms suggesting intervertebral lumbar disc disease. After an unsuccessful course of conservative treatment, myelography was performed. The

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Ross C. Puffer, Ryan Planchard, Grant W. Mallory and Michelle J. Clarke

S urgery has long been an accepted treatment for symptomatic lumbar degenerative disease. Although outcomes at 2 years are similar with surgery and nonoperative measures, some recent studies have suggested that continued medical management beyond 6 weeks without improvement is not cost-effective. 11 , 17 Furthermore, although the upfront costs of operative management are higher, the overall economic impact (e.g., loss of productivity, continued medical evaluation, and treatment) may be higher in patients who are managed conservatively than in those who

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Russell R. Lonser, John D. Heiss and Edward H. Oldfield

devascularization could be accomplished by injecting ETOH directly into tumors during surgery, reducing bleeding and facilitating resection. We report our initial experience in four patients who underwent intratumoral injection of ETOH during resection of neoplasms affecting the central nervous system. Of the four patients, three had spinal epidural and one had a cerebellar neoplasm requiring resection ( Table 1 ). One patient underwent partial intraarterial embolization of the tumor vasculature before surgery. TABLE 1 Intraoperative injection of ETOH for tumor

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Sarah I. Woodrow, Mark Bernstein and M. Christopher Wallace

. Indeed, although limited in number, several studies have demonstrated no change in patient outcome after various trainee-performed procedures including carotid endarterectomy, laparoscopic cholecystectomy, and cardiac surgery. 5, 17, 39 Not surprisingly, results are not as promising for all procedures. White, et al., 44 for example, found that significantly fewer patients were able to walk successfully with the aid of a prosthetic limb following lower-limb amputation by a junior trainee than after a procedure performed by a senior trainee or consultant. Elsewhere in

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Naz B. Akbaş, Sedat Dalbayrak, Duygu G. Külcü, Mesut Yılmaz, Tevfik Yılmaz and Sait Naderi

two-thirds of patients with back pain, but the differences between men and women were not assessed. The aim of this study is to evaluate sexual problems and sexual behavior patterns before and after surgery in a group of patients with LDH. We also plan to define other causative factors that may be related to sexual problems. Methods Forty-three patients were included in this study. All of the patients had applied to the physical therapy or neurosurgery outpatient clinics with back or leg pain. In all cases, LDH was diagnosed on the basis of the history of

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Hillary A. Shurtleff, Dwight Barry, Timothy Firman, Molly H. Warner, Rafael L. Aguilar-Estrada, Russell P. Saneto, John D. Kuratani, Richard G. Ellenbogen, Edward J. Novotny and Jeffrey G. Ojemann

to resection; 30 4) wide ranges of presurgical seizure duration; 28 and 5) variable pathologies. 2 , 28 Because many pediatric studies have focused on different age ranges, some studies have attempted to narrow the developmental scope, but their methods have still varied from each other, making them difficult to compare. Age range samples include patients less than 6 or 7 years at surgery, 19 , 28 3 to 7 years, 6 8 to 159 months, 34 less than 3 years, 20 , 26 or 3 to 36 months. 3 A number of studies 7 , 21 , 22 , 29 , 32 , 37 have focused on temporal

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Alexander Muacevic, Friedrich W. Kreth, Gerhard A. Horstmann, Robert Schmid-Elsaesser, Berndt Wowra, Hans J. Steiger and Hans J. Reulen

reported treatment results from surgery plus WBRT for brain metastases that might also have been amenable to radiosurgical treatment. It remains unclear whether radiosurgery should be performed in combination with WBRT. Therefore, our two-institution study was conducted retrospectively to establish the efficacy of surgery plus WBRT compared with radiosurgery alone in a homogeneous patient population in whom small, solitary cerebral metastases were treated; all patients in the surgery group were considered to have been eligible for radiosurgical treatment as well. We

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Gregory W. Poorman, Peter G. Passias, Samantha R. Horn, Nicholas J. Frangella, Alan H. Daniels, D. Kojo Hamilton, Hanjo Kim, Daniel Sciubba, Bassel G. Diebo, Cole A. Bortz, Frank A. Segreto, Michael P. Kelly, Justin S. Smith, Brian J. Neuman, Christopher I. Shaffrey, Virginie LaFage, Renaud LaFage, Christopher P. Ames, Robert Hart, Gregory M. Mundis Jr. and Robert Eastlack

strong negative impact on postsurgery pain and outcome. 14 , 18 Specifically, patients with anxiety and depression have reported higher levels of postsurgery pain and worse long-term outcomes. 11 , 13 Currently there is no protocol for helping patients with depression and anxiety as they undergo cervical spine deformity surgery, whereas attempts at establishing protocols in the lumbar spine surgery population have been better developed. 31 Similar recommendations for the cervical spine were summarized in a review published in the Journal of Orthopedic and Sports