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Neurosurgery 1977: problems and attainments

The 1977 AANS presidential address

Lester A. Mount

companies, including Blue Cross and Blue Shield, are attempting to do the same. No other profession has been subjected to such harassment. Patient expectations are at an all-time high in terms of both services and results. Further, if we do not make them well we may be sued. Additional services and prolonged hospitalization are often demanded by patients when payment comes from third parties. This places the physician in the undesirable role of policeman. Utilization control should be as much a responsibility of the patient as it is of the physician, but patients are

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Charles J. Long, Katherine Pueschel and Samuel E. Hunter

factors appear worthy of comment regarding personality measures used in this study. The MMPI is an objective self-report test which is subject to the patient's expectations and reflects personality characteristics rather than personality dynamics. Thus, if patients expect and want to get better, these feelings may be reflected in their performance on the MMPI. In contrast to the test results, patients often present a clinical impression that the personality measures on the MMPI appear somewhat better than the patients actually feel. Such outcomes suggest that, in

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Dwight Parkinson

patient on his back. The anesthetist with adrenaline-filled syringe followed the patient back to the recovery room. Morphine was prescribed for the back pain and spasm that occurred in about 85% of the patients. The patient was up and about the same day, and with rare exception was dismissed from the hospital the following morning. We did not use a test dose of Discase, and have not given any preoperative cortisone or histamine blockers. Postoperative Management The postoperative management begins with the preoperative discussion, during which the patient

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Michael D. Taylor and Mark Bernstein

were seen in seven patients (3.5%). TABLE 4 Complications and adverse effects in 200 patients who underwent awake craniotomy Complication/Adverse Effect No. of Patients complication  medical   deep venous thrombosis 6   urinary tract infection 2   hyponatremia 2   arrhythmia 1   pulmonary embolus 1  wound   wound dehiscence 2 postop hematoma 3 neurological deficit  transient 17  permanent 9 Discussion Diminishing health care resources in the face of increasing patient expectations have forced the medical community to adopt more economical systems such as ambulatory

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Douglas Kondziolka, Elad I. Levy, Ajay Niranjan, John C. Flickinger and L. Dade Lunsford

-term results (> 10 years) will be necessary to substantiate the potentially curative effects of radiosurgery, we believe that the present analysis highlights several points. First, radiosurgery is a well-tolerated surgical procedure that meets most patients' expectations. Second, the rate of tumor volume reduction is significant and higher than previously believed. Early reports noted a 30 to 40% rate of tumor regression, 14 whereas 73% of the patients in this study who underwent imaging 5 or more years postradiosurgery had smaller tumors. With extended follow

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neurosurgical entities throughout the country. I still find that premise to be outrageous and counterproductive to the advancement of women in their chosen field. I also disagree with the statement of Rosseau, et al., that as our neurosurgical discipline evolves it will require less professional commitment on the part of its practitioners. It is an interesting observation that they make and says much about their professional experience, as does their comment on a patient's expectations of a neurosurgeon. They must see an entirely different group of patients than we do. Our

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Ossama Al-Mefty and Aramis Teixeira

thoughtful and thorough evaluation and counseling with clear patient expectations. We agree with the recommendations of Van Der Mey and colleagues 64 that the opposite side should be treated surgically only if the first resection did not cause essential cranial nerve palsy. Otherwise, these authors refrain from surgery and favor close follow-up review. Unfortunately, our patient who experienced a rapid growth that prompted surgery on the opposite side for a carotid body tumor had prolonged dysfunction of swallowing and pulmonary complications. For patients with multiple

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Mark Bernstein and Ross E. G. Upshur

successfully determined the difference between interventional drug and placebo and were sharing the active drug with friends who were not eligible or not enrolled in the trial. Such contamination undermines the scientific integrity of the research. Patients should be aware that they are free to leave the study at any time without compromising their care. There is evidence that many patients' expectations of treatment are unrealistic, 21, 32, 38, 64 and this aspect of human nature will always contribute to dissatisfaction on the part of some patients involved in RCTs. Was

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Jason Sheehan, Douglas Kondziolka, John Flickinger and L. Dade Lunsford

strategy include the size of the tumor, rate of tumor growth if discernible on the basis of serial neuroimaging studies, and response to any prior treatments. Ideally, a multidisciplinary team consisting of a neurosurgeon, otolaryngologist, neurointerventionalist, and radiation oncologist can evaluate the patient and clinical situation and arrive at an appropriate course of treatment. Any therapeutic strategy that is ultimately implemented must be based on the aforementioned clinical details and, hopefully, satisfy the patient's expectations. At the University of

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Richard S. Polin, Nicholas F. Marko, Matthew D. Ammerman, Mark E. Shaffrey, Wei Huang, Frederick A. Anderson Jr., Anthony J. Caputy and Edward R. Laws

validated index (the KPS), and we leave the interpretation of the index in the context of an individual patient's expectations to the physician's discretion. Patient Cohorts Definition of Cohorts In this study, we addressed the problem of the ambiguous definitions of “tumor location” and “eloquent cortex” by separating the sample based on the clearly defined criterion of location in the DH as opposed to the NDH. We believe that this distinction can be easily applied in clinical practice and will therefore allow our evidence-based data to be readily applied to