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Humbert G. Sullivan, Jullo Martinez, Donald P. Becker, J. Douglas Miller, Richard Griffith and Abund O. Wist

, Mr. William Young, and Ms. Vickie Lovings of the Division of Neurological Surgery, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia. We also wish to thank Mr. J. A. Coates, Department of Pathology, Virginia Commonwealth University, for the histological preparations and the Department of Biophysics, Virginia Commonwealth University, for assistance in design of the fluid-percussion device. References 1. Chason JL , Fernando OU , Hodgson VR , et al : Experimental brain concussion: morphogenic

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Humbert G. Sullivan, J. Douglas Miller, Donald P. Becker, Roger E. Flora and Gilbert A. Allen

be easily measured and quickly analyzed in the clinical setting will we be in a position to understand the “meaning” of a given level of ICP in a particular patient. Acknowledgments We wish to acknowledge the technical assistance of Ms. Arletha T. Allen, Mr. William Young, and Ms. Sharon Read of the Division of Neurological Surgery, Virginia Commonwealth University, Medical College of Virginia, Richmond, Virginia. References 1. Avezaat CJJ , van Eijndhoven JHM , de Jong DA , et al : A new method of monitoring

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Italo Rinaldi, William J. Mullins Jr., William F. Delaney, Peter M. Fitzer and David N. Tornberg

. Vicki Hauser for their excellent secretarial assistance; and to Mr. Nicholas Mackovak of the Visual Education Department of the Virginia Commonwealth University. References 1. Braakman R , Penning L : Injuries of the Cervical Spine. Amsterdam : Excerpta Medica , 1971 , p 15 Braakman R, Penning L: Injuries of the Cervical Spine. Amsterdam: Excerpta Medica, 1971, p 15 2. Corner EM : Rotary dislocations of the atlas. Ann Surg 45 : 9 – 26 , 1907 Corner EM: Rotary dislocations of the atlas

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Gerrit J. Bouma and J. Paul Muizelaar

performed in the Neuroscience Intensive Care Unit in agreement with the radiation safety regulations of the Office of Environmental Health and Safety of the Virginia Commonwealth University. CBF Measurements Measurement of CBF was performed by the 133 Xe inhalation or intravenous technique as described by Obrist, et al. 21 Details of the procedures used are described elsewhere. 16, 17 With the inhalation method, patients breathed a gas mixture containing 5 to 8 mCi 133 Xe/liter for 1 minute. With the intravenous injection method, 133 Xe dissolved in saline

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Gerrit J. Bouma, J. Paul Muizelaar, Sung C. Choi, Pauline G. Newlon and Harold F. Young

was obtained from the patients' next of kin for insertion of catheters and measurement of CBF. The protocol was approved by the Committee on the Conduct of Human Research at the Medical College of Virginia. Measurement of CBF Measurement of CBF was performed in the neuroscience intensive care unit using the 133 Xe inhalation or intravenous technique. 3 All procedures involving 133 Xe were performed in accordance with the radiation safety regulations of the Office of Environmental Health and Safety of the Virginia Commonwealth University. In most patients

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Gerrit J. Bouma, J. Paul Muizelaar, Kuniaki Bandoh and Anthony Marmarou

of Human Research at the Medical College of Virginia. All procedures involving 133 Xe were performed in accordance with the radiation safety regulations of the Office of Environmental Health and Safety of the Virginia Commonwealth University. Determination of Blood Pressure, ICP, and PVI In all patients, ICP was measured with an intraventricular catheter connected to a pressure transducer. Arterial blood pressure was continuously monitored from an intra-arterial catheter and digitally displayed as mean arterial blood pressure (MABP), which equals diastolic

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: Medical Decision Making. Boston: Butterworth-Heinemann, 1988, p 111 Neurosurgical Forum: Letters to the editor Response Ross Bullock , M.D., Ph.D. Medical College of Virginia Virginia Commonwealth University Richmond, Virginia We thank Dr. King for his scholarly biostatistical comments regarding our paper. Dr. King has, however, seized upon one aspect of our data and quoted this out of context, thus distorting the overall message. Although we have pointed out that it has been difficult to formulate a critical value

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-saline/MK-801) or the protective effect of NMDA antagonism against trauma (injured rat-MK801/MK-801). Moreover, the decreased latency difference in the former group could be due to the rat's just sitting in the lighted compartment, both for training and testing. Also interesting is that injury itself demonstrates no amnesia. Neurosurgical Forum: Letters to the editor Response Robert J. Hamm , Ph.D. Virginia Commonwealth University Richmond, Virginia The consideration of motor effects on the assessment of amnesia using the

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outcome following severe head trauma: follow-up data from the Traumatic Coma Data Bank. Brain Inj 7: 101–111, 1993 6. Teasdale G , Jennett B : Assessment and prognosis of coma after head injury. Acta Neurochir 34 : 45 – 55 , 1976 Teasdale G, Jennett B: Assessment and prognosis of coma after head injury. Acta Neurochir 34: 45–55, 1976 Neurosurgical Forum: Letters to the editor Response Sung C. Choi , Ph.D. , Ross Bullock , M.D., Ph.D. Virginia Commonwealth

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Care Med 11: 290–292, 1983 Neurosurgical Forum: Letters to the Editor Response Kathryn Holloway , M.D. , Ross Bullock , M.D. , Anthony Marmarou , Ph.D. Virginia Commonwealth University, Richmond, Virginia We were honored by the kind words and attention given to our article by the distinguished Dr. Malis. His technique of subgaleal shunting is a fascinating and intriguing concept. We would be very interested in seeing a graph of intracranial pressure measured over a week