Surgical Cases, from the Records of the City Hospital, Boston

Fifteen cases of presumed cocaine intoxication were evaluated in the emergency room (ER) at a city hospital over a four-day period. This series is unique in that many of these patients were from a similar area of the city, in some cases had the same street address, were regular abusers of cocaine, and presented to the ER with similar symptoms of tachycardia, dilated pupils, marked confusion, bizarre and sometimes violent behavior, psychosis, and hallucinations. Many of these symptoms were present several hours after drug use. Samples of a white powder presumed by the patients to be cocaine were obtained from two patients and analyzed by gas-liquid chromatography. Neither sample contained cocaine, but rather revealed atropine, benzocaine, and procaine. The signs and symptoms of cocaine, amphetamine, and atropine intoxication are reviewed and the problems of drug analysis and differential diagnosis of drug intoxication are discussed.

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Surgery of Petroclival Meningiomas: Report of 24 Cases

Neurosurgery ◽

10.1227/00006123-198901000-00003 ◽

1989 ◽

Vol 24 (1) ◽

pp. 12-17 ◽

Cited By ~ 145

Author(s):

Madjid Samii ◽

Mario Ammirati ◽

Ahmed Mahran ◽

Walter Bini ◽

Abholgasse Sepehrnia

Keyword(s):

Cranial Nerve ◽

Transverse Sinus ◽

Surgical Approaches ◽

Common Symptom ◽

City Hospital ◽

Petroclival Meningiomas ◽

Number Of Patients ◽

Microsurgical Techniques ◽

Total Tumor Removal ◽

The City

Abstract Twenty-four patients with petroclival meningiomas were operated upon at the neurosurgical clinic of the City Hospital of Hannover between 1978 and 1987. Seventeen were women and seven men; the mean age was 45 years. Symptoms were usually present for more than 2 years before the diagnosis was made. The most common symptom was disturbance of gait; the most common preoperative sign was cranial nerve deficit, mainly of the 7th and 8th nerves. Preoperative neuroradiological evaluation included computed tomography and four-vessel cerebral angiography. Fifteen patients (62%) had a tumor larger than 2.5 cm in its major diameter. The surgical approaches used were the retromastoid, pterional, subtemporal, and combined retromastoid-subtemporal. We developed a modification of the retromastoid-subtemporal approach with preservation of the transverse sinus and used this in the last 2 patients. There was no postoperative death; 11 patients (46%) suffered postoperative complications, mainly in the form of cranial nerve deficits, often reversible. “Total” tumor removal was achieved in 17 patients (71%). Twenty patients (83%) were independent at the time of discharge from the hospital. With accurate neuroradiological evaluation, careful choice of the surgical approach, and sound application of microsurgical techniques, petroclival meningiomas may be “totally” and safely resected in a significant number of patients.

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