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Robert R. Smith and John J. Upchurch

, acts principally by competitive inhibition of the activator that converts inactive plasminogen into the active fibrinolytic enzyme plasmin. Active plasmin, normally not present in the circulating blood, is probably the most important factor in fibrin clot dissolution. While EACA has been used extensively in the treatment of patients with various fibrinolytic disorders, there is little information on proper dosage, the duration of action, and the complications related to therapy in patients with normal fibrinolytic systems. Several recent studies emphasize that even

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Robert P. Iacono, Michael L. J. Apuzzo, Richard L. Davis and Fong Y. Tsai

radiation as a cause of meningiomas. Case Report This 31-year-old black woman was admitted to our institution in September, 1979, with chief complaints of headache, nausea, difficulty in walking, and blurred vision. In 1952, at the age of 3 years, she had undergone a posterior fossa craniectomy for medulloblastoma and had subsequently received radiation therapy with a total of 5000 rads to the region of tumor. She had a history of primary amenorrhea. At the age of 22 years, she was diagnosed as having Turner's syndrome and subsequently received estrogen replacement

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Albert M. Petty, Larry E. Kun and Glenn A. Meyer

M eningiomas are benign intracranial neoplasms which constitute approximately 15% of all primary brain tumors. Surgical removal is the treatment of choice for these lesions; the role of radiation therapy, either as a primary or postoperative modality, remains to be established. Several investigators have been impressed with the relative insensitivity of meningiomas to irradiation and thus have concluded that radiation therapy has little value in the management of these tumors. 4, 8, 11, 14 In contrast, recent reports, including those of Bouchard, 2 Wara, et

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Bhargav Desai, Ying Hsu, Benjamin Schneller, Jonathan G. Hobbs, Ankit I. Mehta and Andreas Linninger

overproduction of CSF. In these forms of hydrocephalus where overproduction of CSF is implicated, inhibition of AQP4 may be therapeutically desired. It is important to understand the molecular mechanism of hydrocephalus to best design therapies to facilitate the clearance of fluid. Clearly, numerous studies have elucidated that a link exists between AQP4 channels, brain water balance, and hydrocephalus. The CSF cycle commences at AQP channels in the choroid (i.e., AQP1) and may have a terminus at the BBB interface linking capillary fluid exchange to interstitial fluid

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Henry M. Brodkin

April, 1979, with headache and a stiff neck. Computerized tomography (CT) scan of the head demonstrated blood around the basal cisterns, and arteriography showed spasm of the right internal carotid and right posterior cerebral arteries. No aneurysm was demonstrated. Therapy with EACA (Amicar) was begun at an intravenous dose of 38 gm/day. Repeat arteriography 2 weeks later was normal. The EACA was continued intravenously for 28 days, then given orally at 24 to 36 gm/day for 12 more days. The patient's blood pressure was controlled with hydralazine and methyldopa, and

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Robert H. Andres, Raphael Guzman, Angélique D. Ducray, Pasquale Mordasini, Atul Gera, Alain Barth, Hans R. Widmer and Gary K. Steinberg

survivors suffer from persistent, severe neurological deficits. It is estimated that 90% of surviving patients are dependent on a caregiver at 1 month, and 80% are dependent on a caregiver at 6 months after the insult. 7 , 8 , 19 The available therapy is mainly supportive, including maintenance of homeostasis and treatment of brain edema. Therapies that prevent hematoma expansion and continuous bleeding through the administration of hemostatic agents, such as recombinant activated factor VII, 79 are currently under investigation, but the results of a Phase III study

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Michael J. Rosner, Sheila D. Rosner and Alice H. Johnson

injury (TBI) 64 were encouraging. Importantly, we demonstrated that CPP could be iatrogenically elevated by inducing systemic hypertension without potentiating mortality from vasogenic edema and uncontrolled intracranial hypertension. Subsequently, techniques have evolved from this model ( Figs. 1 and 3 ) that form a coherent approach for managing the patient with TBI and have led to testing two closely related hypotheses: 1) management of CPP as the primary goal of therapy will yield lower mortality than that achieved with traditional, ICP-based techniques; and 2

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Haring J. W. Nauta, Joseph C. Wehman, Vassilis E. Koliatsos, Marylee A. Terrell and Kyungsoon Chung

N erve growth factor (NGF), a neurotrophic factor acting on basal forebrain cholinergic neurons, has been proposed as a possible therapy for Alzheimer's disease. 11, 16, 32 Such a consideration is based on observations that these neurons degenerate early and consistently in patients with this disease. 43 Basal forebrain cholinergic neurons are known to express NGF receptors, 10 and their survival and phenotypic maintenance have been shown to be influenced by the availability of NGF. 7, 9, 17, 18, 44 A clinical trial in which patients with Alzheimer's disease

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Monitoring of antifibrinolytic therapy following subarachnoid hemorrhage

The importance of CSF fibrin/fibrinogen degradation products

Raymond Sawaya, Victor Sonnino, Robert L. McLaurin and Gerardo Perrotta

M any controversies revolve around the management of patients with ruptured intracranial aneurysms. Of particular concern is the high incidence of rebleeding, which is probably the most important factor influencing mortality. The use of antifibrinolytic drugs in patients suffering a subarachnoid hemorrhage (SAH) from a ruptured cerebral aneurysm was introduced in the hope of improving the overall management results for these patients. 23 A recent review of the literature 28 concluded that “the data do not support the contention that antifibrinolytic therapy

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Raphael Guzman, Raymond Choi, Atul Gera, Alejandro De Los Angeles, Robert H. Andres and Gary K. Steinberg

window and limited availability. 2 However, stem cell–related treatments represent a novel and promising therapeutic avenue. Preclinical data regarding stem cell therapy for the treatment of stroke are impressive and have raised hopes that such new therapies can be used to treat the sequelae of a devastating stroke. Furthermore, stem cell transplantation therapy is already a well-established treatment modality for patients with hematopoietic and lymphoid cancers and some autoimmune disorders. Three human trials in which researchers assessed the utility of stem cell