A series of 66 spinal cord neurofibromas was analyzed for history, signs, surgical approach, and outcome. The tumors presented primarily with sensory symptoms. Plain films were abnormal in 1/2 of cases and 1/2 had a complete block. They were primarily intradural, and primarily thoracic. A conservative exam system was used for follow-up and 85% with pain had complete relief; 50% with motor loss had normal motor function, and 88% had normal sensation who had prior sensory loss. In comparison to meningiomas, the principal differences were that neurofibromas had an even sex distribution, a lower incidence of cord signs and symptoms, more frequent findings on plain x-rays, and higher cerebrospinal fluid protein. Surgical outcome was similar. Sacrifice of the involved root during removal usually did not produce a deficit. The series is compared with a similar series of meningiomas from the same institution over the same time period.

Ninety-six patients underwent percutaneous radiofrequency coagulation (RC) of the Gasserian ganglion for relief of trigeminal neuralgia between 1973 and 1978. Fifty-two percent of patients who were followed for 5 years were free of recurrence after a single RC procedure. Factors predicting clinical results were sought from initial historical and demographic data. Age, sex, duration of illness, and previous response to medication were unrelated to outcome. Patients previously treated by open surgery appeared to receive less benefit from subsequent RC. The RC procedure seemed more effective in the treatment of patients with classical tic douloureux than in those with atypical features. The degree of sensory loss created by RC was associated with the clinical outcome. Patients acquiring dense sensory deficits demonstrated a reduced risk of recurrence (p = 0.006): 25% of patients with dense sensory loss and 55% of those with a partial deficit developed a recurrence by 5 years, whereas all patients without initial sensory loss suffered a recurrence by 5 years.

We report a case of an intraperitoneal pseudocyst as a complication of a ventriculoperitoneal shunt. The sequestration was visualized by abdominal computed tomographic scan and was heralded by an increase in hepatic enzyme levels. This complication may be related to previous abdominal surgery. A review of the literature relating to this unusual complication is presented.

SUMMARY Propranolol has been found to have a protective effect in experimental myocardial ischemia. Protection of ischemic kidneys was subsequently demonstrated following treatment with propranolol and its weaker beta blocking isomer, d-propranolol. The objective of the present investigation was to study the effects of propranolol (i.e., racemic d,l mixture) and d-propranolol upon regional cerebral blood flow (rCBF) and early ischemic changes following experimental middle cerebral artery (MCA) occlusion. Thirty adult cats, lightly anesthetized with ketamine hydrochloride, underwent 3 hours of right MCA occlusion. Ten cats were untreated. Ten cats were given a continuous infusion of propranolol (1 mg/kg/hr) for 4 hours beginning 1 hour before MCA occlusion and a 4 mg/kg bolus immediately before occlusion. Ten cats were given a continuous infusion of d-propranolol (0.5 mg/kg/hr) for 4 hours beginning 1 hour before MCA occlusion and a 2 mg/kg bolus immediately before occlusion. The therapeutic agents were injected directly into the right carotid artery. The rCBF in the right Sylvian region was not significantly different in the 3 groups. EEG changes also were similar. Carbon filling defects were found to be smallest in the d-propranolol-treated group. Light microscopic studies demonstrated a reduction in infarct size in the propranolol and d-propranolol groups. The findings of the investigation indicated that propranolol and d-propranolol do not have a deleterious effect on rCBF after MCA occlusion and suggested that these agents have a protective effect upon ischemic cerebral tissue.Stroke, Vol 13, No 3, 1982 PROPRANOLOL has been found to have a protective effect in experimental myocardial ischemia. 1-3 Protection of ischemic kidneys was subsequently demonstrated following treatment with propranolol (i.e., Inderal) and its weaker beta blocking isomer, d-propranolol. [4][5][6][7][8] The actions of these agents upon cerebral blood flow and cerebral tissue during ischemia, however, have not been evaluated.A recent experimental study by David and Sundt 9 suggested that propranolol might reduce cardiac output and regional cerebral blood flow (rCBF) in the nonischemic cerebral hemisphere despite the maintenance of arterial blood pressure. This could have serious implications in cerebral ischemia as many stroke-prone patients receive this medication. The objective of the present investigation was to study the effects of propranolol (i.e., racemic d, 1-propranolol) and its weaker beta blocking isomer, d-propranolol, upon rCBF and early ischemic changes following experimental middle cerebral artery (MCA) occlusion. Methods Right Middle Cerebral Artery ExposureThirty adult cats (mean weight 3.7 kgs) were anesthetized with ketamine hydrochloride (40 mg/kg intraperitoneally). Administration of ketamine hydrochloride took place two hours or longer before right MCA occlusion. Additional doses of ketamine hydrochloride were not given.Catheters were inserted into the right femoral artery and vein through a groin incision....