"Decision making for severely brain-injured newborns".
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Biomedical subjects
Publications and source records attributed to J Venes.
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Authors discuss the need for increased analytical skills in the current medical environment and suggest a method which combines the use of targeted studies and Internet communication as part of graduate medical education. Advantages of such a program include involvement of the private sector in clinical outcome studies, improvements in the design of clinical studies and publications and the early development of skills in interpreting and evaluating literature. A further goal would be the development of an understanding of the principles underlying, to the extent that it is possible, unbiased assessment of one's own clinical practices.
Sinus pericranii is an anomalous extracranial vascular malformation that is in continuity with the intracranial dural venous sinuses. Five case reports, three congenital and two traumatic, are described. Clinical management, including evaluation, diagnosis, and treatment, is discussed. Awareness of this entity by plastic surgeons will allow for earlier diagnosis and appropriate surgical management, resulting in decreased risk of complications.
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Monitoring of intracranial pressure has become increasingly widespread in a variety of conditions. The information gained has allowed for the development of certain principles of management in patients with presumed or potential intracranial hypertension. These principles are applicable whether ICP monitoring is employed or not. Aggressive management of severe intracranial hypertension may improve survival; however, data from several studies are inconclusive. The author attempts to review developments in the field and assess the impact of this modality of therapy in pediatric neurosurgical practice.
Concentrations of homovanillic acid (HVA) were markedly elevated in the ventricular fluid of 15 children with Reye syndrome (median, 887 ng per milliliter) compared to 7 controls (median, 282 ng per milliliter), but 5-hydroxyindoleacetic acid (5-HIAA) values were comparable (medians of 198 and 189 ng per milliliter, respectively). The ratio of 5-HIAA to HVA was significantly lower in patients with Reye syndrome (0.26) than in controls (0.51). Serial samples demonstrated wide fluctuations in HVA concentration, but not in that of 5-HIAA. Monoamine metabolite concentrations were not correlated with serum ammonia, increased intracranial pressure, morbidity, or mortality. Increased HVA in Reye syndrome may reflect cerebral ischemia and release of vasoactive amines (particularly dopamine) into the brain and cerebrospinal fluid (CSF).
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