This trial failed to demonstrate that the addition of surgery to radiation therapy improved outcome of patients with a single brain metastasis. Thus, the efficacy of surgery plus radiation compared with radiation alone needs to be addressed by further clinical trials and/or a meta-analysis.
SUMMARY Three groups of patients who had suffered head injury were compared with matched control subjects on reaction time (RT) tasks. Group I consisted of outpatients previously hospitalised for head injury ofwide ranging degrees of severity, assessed at varying intervals after injury. Group II was composed of non-hospitalised mildly concussed patients. Group III was made up of head injured patients of varying degrees of severity assessed 7-10 months after initial hospitalisation for their injury. The reaction time tests were graded in difficulty, from a simple RT response to a complex choice RT test. In addition, subjects were compared in their ability to ignore redundant information during one of the choice RT tests. The findings indicate that traumatic brain injury causes slower information processing, deficits in divided attention, an impairment of focused attention, and inconsistency of performance.Reaction time (RT) tests have consistently revealed slowness ofinformation processing, a deficit in divided attention after head injury.' In this study, we addressed four specific issues concerning the effects of head injury on reaction time.The question of fatigue was examined by using the same simple RT test at the beginning and end of experimental sessions to see if head injured patients and normal control subjects changed their performance differently across the session.A second question addressed the nature of the attentional deficit. While "There can be no controversy... about the presence of DADs [divided attention deficit] in head injury",2 there has been less success in identifying a specific impairment in focused attention.< Focused attention is tested by evaluating the ability to ignore distracting stimuli. A selective involvement of frontal lobe areas has been suggested in head injury7"'1 and deficits in focused attention using
The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter.
The administration of a methylprednisolone infusion following acute spinal cord injury was widely adopted following the report of the results of the second national acute spinal cord injury study in 1990.1 Subsequent clinical studies and critical reviews of the study methodology and results have challenged the validity of the initial conclusions.2-11 Therefore, a current systematic review was conducted to provide evidence-based ABSTRACT: Background: A systematic review of the evidence pertaining to methylprednisolone infusion following acute spinal cord injury was conducted in order to address the persistent confusion about the utility of this treatment. Methods: A committee of neurosurgical and orthopedic spine specialists, emergency physicians and physiatrists engaged in active clinical practice conducted an electronic database search for articles about acute spinal cord injuries and steroids, from January 1, 1966 to April 2001, that was supplemented by a manual search of reference lists, requests for unpublished additional information, translations of foreign language references and study protocols from the author of a Cochrane systematic review and Pharmacia Inc. The evidence was graded and recommendations were developed by consensus. Results: One hundred and fifty-seven citations that specifically addressed spinal cord injuries and methylprednisolone were retrieved and 64 reviewed. Recommendations were based on one Cochrane systematic review, six Level I clinical studies and seven Level II clinical studies that addressed changes in neurological function and complications following methylprednisolone therapy. Conclusions: There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment. Methylprednisolone, prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury, followed 45 minutes later by an infusion of 5.4 mg per kilogram of bodyweight per hour for 23 hours, is only a treatment option for which there is weak clinical evidence (Level I-to II-1). There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option. RÉSUMÉ: Méthylprednisolone à haute dose dans les traumatismes aigus fermés de la moelle épinière -une option thérapeutique. Introduction:Une revue systématique des données concernant l'infusion de méthylprednisolone suite à un traumatisme aigu de la moelle épinière a été effectuée afin de clarifier la confusion qui règne sur l'utilité de ce traitement Méthodes: Un comité formé de spécialistes en neurochirurgie et en chirurgie orthopédique de la colonne vertébrale, d'urgentologues et de physiatres en pratique clinique active a procédé à une recherche électronique de bases de données pour identifier des articles sur les traumatismes aigus de la moelle épinière et l'administration de stéroïdes, du 1er janvier 1966 à...
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