Biomedical subjects

A John Popp

Publications and source records attributed to A John Popp.

9 recordsLinked to original sources

PubMed2005

Neurosurgical workforce trends in the United States.

OBJECT: The purpose of this study was to evaluate the US neurosurgery workforce by reviewing journal recruitment advertisements published during the past 10 years. METHODS: The number of available academic and private neurosurgical staff positions was determined based on recruitment advertisements in the Journal of Neurosurgery and Neurosurgery for the 10-year period from 1994 to 2003. Advertisements were evaluated for practice venue, subspecialization, and location. The numbers of active neurosurgeons and graduating residents also were reviewed. The number of advertised neurosurgical positions increased from 141.6 +/- 38.2 per year from 1994 through 1998 to 282.4 +/- 13.6 per year from 1999 through 2003 (mean +/- standard deviation, p < 0.05). The mean number of academic positions increased from 50.6 +/- 11.1 to 95 +/- 17.5 (p < 0.05), and the mean number of private positions rose from 91 +/- 30.4 to 187.4 +/- 6.8 (p < 0.05). Subspecialty positions represented a mean of only 15.6 +/- 5% per year during the first time period and 18.8 +/- 3% per year in the second period (p = 0.22), and therefore the majority of positions advertised continued to be those for generalists. The number of practicing neurosurgeons declined after 1998, and by 2002 it was less than it had been in 1991. The numbers of incoming and matriculating residents during the study period were static. CONCLUSIONS: The number of recruitment advertisements for neurosurgeons during the last 5 years has increased significantly, concomitant with a severe decline in the number of active neurosurgeons and a static supply of residents.

Advertising↗

PubMed2005

Coronary angiojet catheterization for the management of dural venous sinus thrombosis. Technical note.

In most cases of deep venous sinus thrombosis, systemic anticoagulation represents the initial treatment of choice for preventing propagation of a clot in the dural sinuses. In patients with deep or extensive venous sinus thrombosis, a combination of treatment modalities may be required including systemic anticoagulation, selective venous thrombolysis, and mechanical thrombectomy. In the current study the authors report on a patient who presented with the acute onset of headache, vomiting, a depressed level of consciousness, and a left hemiparesis and in whom a right middle cerebral artery (MCA) territory ischemic stroke with hemorrhagic conversion was initially diagnosed. Results of diagnostic cerebral angiography demonstrated a patent right MCA and a deep venous sinus thrombosis involving most of the dural sinuses. Despite adequate systemic heparinization, the patient's neurological condition deteriorated and direct administration of alteplase into the transverse sinus in conjunction with mechanical clot disruption using a coronary AngioJet was required. Venous flow was successfully reestablished in the deep and superficial venous sinuses by using a 0.014-in exchange wire routed from the right common femoral vein through the sinuses and out the left common femoral vein. Excellent angiographic results were obtained, and the patient had recovered completely by the 7-month follow up.

Adult↗

PubMed2004

Medieval management of spinal injuries: parallels between Theodoric of Bologna and contemporary spine surgeons.

In recent decades there have been revolutionary technological advances in the management of traumatic spinal column injuries. Despite these advances, the basic principles of reduction and stabilization of vertebral fractures and dislocations remain similar to those proposed by ancient and medieval physicians. Theodoric of Bologna, in his text Chiurgica de Theodoric (ca. AD 1267), described an extracorporeal approach to the management of traumatic spinal column misalignments. Surprisingly, his techniques are still used in many instances by contemporary spine surgeons, despite the availability of a more advanced technological armamentarium than that existent in medieval times.

History, 20th Century↗

PubMed2004

Preoperative stent placement for intradural vertebral artery stenosis from a rare xanthogranuloma. Case report.

In this report, the authors discuss a novel use of intradural vertebral artery (VA) stent placement to protect a tumor-encased vessel from injury during lesion resection. The tumor was a rare foramen magnum region xanthogranuloma and a component of Erdheim-Chester disease (ECD). This 64-year-old man presented with large masses encasing and compressing the intracranial segments of each VA. Preoperatively, a left VA stent was placed to protect the arterial wall during resection of the tumor. Histopathological study results on the subtotally resected mass were consistent with xanthogranuloma, a rare benign histiocytic tumor frequently occurring in patients with ECD. Further radiographic evaluation in the patient revealed an osteolytic lesion of the eleventh thoracic vertebra supporting the diagnosis of ECD disease. Based on this case study, the authors recommend the following: 1) tumor-encased vessels can be protected preoperatively by stent placement to assist with tumor debulking; and 2) patients diagnosed with a xanthogranuloma should be evaluated for multisystem involvement consistent with ECD.

Angioplasty, Balloon↗

PubMed2004

Music, musicians, and the brain: an exploration of musical genius. The 2004 presidential address.

The concept of musical genius used to frame a discussion of the "art" practiced by neurosurgeons is the focus of the 2004 Presidential Address to the American Association of Neurological Surgeons (AANS). The musical genius, in contrast to the musically talented individual, is profiled and placed in the pantheon of those who have demonstrated extraordinary creativity. Observations and speculations about the specialization and elaboration of brain structures in musicians evolve into a discussion of artificial intelligence as a foil to what constitutes the essence of humanity. Taking an inductive approach, the author juxtaposes the conclusion about "music, musicians, and the brain" with the theme of the 2004 annual meeting of the AANS, "Advancing Patient Care Through Technology and Creativity," to elaborate on the characteristics of the consummate neurosurgeon. (Note: Musical vignettes used in the address can be found in the accompanying article posted on Neurosurgical Focus http://www.aans.org/education/journal/neurosurgical).

Brain↗

PubMed2003

Revisiting the appropriateness of carotid endarterectomy.

BACKGROUND AND PURPOSE: In the 1980s, carotid endarterectomy was controversial because proof of efficacy was lacking, complication rates were high, and one third of cases were reported to be inappropriate. Since publication of several randomized controlled trials (RCTs), rates of carotid endarterectomy have doubled nationwide. This study assesses the appropriateness and use of carotid endarterectomy since publication of the RCTs. METHODS: Using the literature, we developed a list of 1557 mutually exclusive indications for carotid endarterectomy and asked a panel of national experts to rate the appropriateness of each indication using the RAND methodology. We used these ratings to assess appropriateness in a sample of 2124 patients who underwent the procedure in 1997 to 1998 in 6 hospitals. We also analyzed the reasons for the procedure and rates of death, stroke, and myocardial infarction within 30 days of surgery. RESULTS: Overall, 84.9% of operations were done for appropriate reasons, 4.5% for uncertain reasons, and 10.6% for inappropriate reasons. Among procedures considered inappropriate, the most common reasons were high comorbidity (46.6%) and minimal stenosis (27.1%). Overall, 72.5% were asymptomatic, 17.4% had a carotid transient ischemic attack, and 10.1% had a stroke. The 30-day rate of death or stroke was 5.47% for symptomatic patients and 2.26% for asymptomatic patients. Among patients having combined carotid and coronary artery bypass graft surgery, the rate was 10.32%. The complication rate in asymptomatic patients with high comorbidity was 5.56%. CONCLUSIONS: Since the RCTs, rates of overuse appear to have fallen considerably, although they are still significant. A major shift has occurred toward operating on asymptomatic patients. Although overall complication rates were low, rates among asymptomatic patients with high comorbidity exceeded recommended thresholds.

Aged↗

PubMed2002

Factors affecting profitability for craniotomy.

OBJECT: The authors studied factors influencing hospital profitability after craniotomy in patients who underwent craniotomy coded as diagnosis-related group (DRG) 1 (17 years of age with nontraumatic disease without complication) and who met their hospital's craniotomy pathway criteria and had a hospital length of stay 4 days or less during a 20-month period. METHODS: Data in all patients meeting these criteria (76 cases) were collected and collated from various hospital databases. Twenty-one cases were profitable and 55 were not. Variables traditionally influencing cost of care, such as surgeon, procedure, length of operation, and pharmacy use had no significant effect on whether a patient was profitable. The most important influence on profitability was the individual payor. Cases in which care was reimbursed under the prospective payment system based on DRGs were nearly always profitable whereas those covered by per diem plans were nearly always nonprofitable. CONCLUSIONS: 1) Hospital information systems should be customized to deliver consolidated data for timely analysis of cost of care for individual patients. This information may be useful in negotiating profitable contracts. 2) A clinical pathway was successful in reducing the difference in cost of care between profitable and nonprofitable postcraniotomy cases. 3) In today's health care environment both cost containment and revenue assume importance in determining profitability.

Adolescent↗

PubMed2002

Gorham disease of the orbit.

PURPOSE: To report a case of Gorham disease, also known as vanishing bone disease, of the orbit. DESIGN: Interventional case report. METHODS: A 43-year-old Caucasian woman developed a depression in her left temple, pulsation in her left upper eyelid and temple, and bulging of the left upper eyelid and headache. Computerized tomography revealed a lytic lesion in the roof of the left orbit. RESULTS: Intraoperative examination of the lesion revealed a bony defect in the left orbital roof. Surgical intervention resulted in improvement of her symptoms, and pathology failed to reveal evidence of malignancy or other benign neoplastic process. CONCLUSION: Gorham disease should be considered in the differential diagnosis of lytic bony lesions of the orbit.

Adult↗

PubMed1999

Intracranial endoscopy.

The authors' intention is to reduce the invasiveness of intracranial procedures while avoiding traumatization of brain tissue, to decrease the risk of neurological and mental deficits. Intracranial endoscopy is a minimally invasive technique that provides rapid access to the target via small burr holes without the need for brain retraction. Craniotomy as well as microsurgical brain splitting and dissection can often be avoided. Furthermore, because obstructed cerebrospinal fluid pathways can be physiologically restored, the need for shunt placement is eliminated. The ventricular system and subarachnoid spaces provide ideal conditions for the use of an endoscope. Therefore, a variety of disorders, such as hydrocephalus, small intraventricular lesions, and arachnoid and parenchymal cysts can be effectively treated using endoscopic techniques. With the aid of special instruments, laser fibers, and bipolar diathermy, even highly vascularized lesions such as cavernomas may be treated. Moreover, during standard microsurgical procedures, the endoscopic view may provide valuable additional information ("looking around a corner") about the individual anatomy that is not visible with the microscope. In transsphenoidal pituitary surgery, transseptal dissection can be avoided if an endonasal approach is taken. In the depth of the intrasellar space, the extent of tumor removal can be more accurately controlled, especially in larger tumors with para- and suprasellar growth. The combined use of endoscopes and computerized neuronavigation systems increases the accuracy of the approach and provides real-time control of the endoscope tip position and approach trajectory. In the future, the indications for neuroendoscopy will certainly expand with improved technical equipment.

Journal Article↗