Charles H. Frazier’s craniopharyngioma treatment: the pivotal role of the transfrontal approach

2020 ◽  
Vol 133 (6) ◽  
pp. 1739-1752 ◽  
Author(s):  
Ruth Prieto ◽  
José María Pascual ◽  
Laura Barrios
Keyword(s):  
Third Ventricle ◽  
Intractable Pain ◽  
Conservative Strategy ◽  
The Us ◽  
Hypothalamic Injury ◽  
Rathke's Cleft ◽  
Subfrontal Approach ◽  
Neurovascular Structures ◽  
Complete Account

Charles H. Frazier (1870–1936), one of the pioneers of neurosurgery in the US, is known worldwide for devising surgical procedures to relieve trigeminal neuralgia and intractable pain. Less well-known are his substantial contributions to understanding and treating pituitary and parahypophyseal lesions. Along with Bernard Alpers, he defined Rathke’s cleft tumors as a different pathological entity from adenomas and hypophyseal stalk tumors (craniopharyngiomas [CPs]). The surgical challenge posed by CPs piqued Frazier’s interest in these lesions, although he never published a complete account of his CP series. An examination of the Charles Frazier papers at the College of Physicians of Philadelphia allowed the authors to identify 54 CPs that he had treated during his career. In the early 1910s, Frazier developed the subfrontal approach, which would become the primary surgical route to access these lesions, providing better control of the adjacent vital neurovascular structures than the transsphenoidal route hitherto used. Nevertheless, strong adhesions between CPs and the third ventricle floor, the major reason underlying Frazier’s disappointing results, moved him to advocate incomplete tumor removal followed by radiotherapy to reduce both the risk of hypothalamic injury and CP recurrence. This conservative strategy remains a judicious treatment for CPs to this day.

scholarly journals Harvey Cushing’s craniopharyngioma treatment: Part 2. Surgical strategies and results of his pioneering series

2019 ◽  
Vol 131 (3) ◽  
pp. 964-978 ◽  
Author(s):  
Ruth Prieto ◽  
José María Pascual ◽  
Laura Barrios
Keyword(s):  
Standard Procedure ◽  
Third Ventricle ◽  
Surgical Techniques ◽  
Early Period ◽  
Surgical Strategies ◽  
Entire Series ◽  
Cystic Component ◽  
Hypothalamic Injury ◽  
Poor Outcomes ◽  
Subfrontal Approach

OBJECTIVEHarvey Cushing (1869–1939) developed pioneering surgical techniques for craniopharyngioma (CP) removal. This study exhaustively analyzes the pathological variables and surgical strategies that influenced Cushing’s results in his entire series of CP patients.METHODSThe CP records from Cushing’s Brain Tumor Registry were carefully reviewed, as were his CP cases published in medical monographs and scientific reports.RESULTSOne hundred twenty-four tumors with characteristics typical of CP comprise Cushing’s entire series (CP124). Cushing performed 198 surgical procedures in the patients in whom these tumors were treated, with a 23% mortality rate within the first 2 months after surgery. Three periods in Cushing’s CP surgical career can be differentiated: an early period (1901–1917, 39 patients) characterized by his use of the transsphenoidal approach and limited cyst drainage procedures, an intermediate period (1919–1925, 42 patients) in which the subfrontal approach was the standard procedure and maximal removal was attempted, and a late period (1926–1932, 43 patients) characterized by the use of air ventriculography for topographical diagnosis and limited resections via a transventricular approach. Among Cushing’s CP series were 92 cases that were pathologically verified (CP92). In this subcohort, the unilateral subfrontal approach was predominantly used (72% of cases), followed by the transsphenoidal (15%) and frontal transcortical-transventricular (8%) approaches. Drainage of the CP cystic component or partial excision of the solid component was achieved in 61% of the cases, subtotal removal in 23%, and macroscopic total removal in 10%. Satisfactory outcomes were obtained in 55% of the patients in CP92, whereas poor outcomes and/or death related to hypothalamic injury was observed in 28%. Postoperative symptoms related to hypothalamic dysfunction occurred 53% of the time. The subfrontal approach yielded the highest rates of radical removal (p < 0.001) and good outcomes (p = 0.01). Partial removals were associated with the highest rates of poor outcomes, including death (p = 0.009). Cushing’s removal of CPs with a primary infundibulo-tuberal topography or showing third ventricle invasion was associated with the highest rates of hypothalamic injury (p < 0.001) and the worst outcomes (p = 0.009).CONCLUSIONSHarvey Cushing’s techniques and surgical philosophy varied substantially throughout his career. The experience he gained with this large CP series made him aware of the importance of limiting the extent of tumor removal and leaving untouched the tumor portion strongly adhered to the hypothalamus.

Scripturalizing and the Second Amendment

2018 ◽  
Author(s):  
Rosamond C. Rodman
Keyword(s):  
White Women ◽  
White Children ◽  
The Bible ◽  
Second Amendment ◽  
The Us ◽  
The Status ◽  
Us Constitution ◽  
Half Decade

Expanding beyond the text of the Bible, this chapter explores instead a piece of political scripture, namely the Second Amendment of the US Constitution. Over the last half-decade, the Second Amendment has come to enjoy the status of a kind of scripture-within-scripture. Vaulted to a much more prominent status than it had held in the first 150 years or so of its existence, and having undergone a remarkable shift in what most Americans think it means, the Second Amendment provides an opportunity to examine the linguistic, racial, and gendered modes by which these changes were effected, paying particular attention to the ways in which white children and white women were conscripted into the role of the masculine, frontier-defending US citizen.

EXPRESS: The Role of Patient Satisfaction in Hospitals’ Medicare Reimbursements

2020 ◽  
pp. 074391562098472
Author(s):  
Lu Liu ◽  
Dinesh K. Gauri ◽  
Rupinder P. Jindal
Keyword(s):  
Patient Satisfaction ◽  
Pain Management ◽  
Hospital Care ◽  
Pay For Performance ◽  
Data Sources ◽  
Satisfaction Survey ◽  
The Us ◽  
Performance System ◽  
Diverse Data

Medicare uses a pay-for-performance program to reimburse hospitals. One of the key input measures in the performance formula is patient satisfaction with their hospital care. Physicians and hospitals, however, have raised concerns especially about questions related to patient satisfaction with pain management during hospitalization. They report feeling pressured to prescribe opioids to alleviate pain and boost satisfaction survey scores for higher reimbursements. This over-prescription of opioids has been cited as a cause of current opioid crisis in the US. Due to these concerns, Medicare stopped using pain management questions as inputs in its payment formula. We collected multi-year data from six diverse data sources, employed propensity score matching to obtain comparable groups, and estimated difference-in-difference models to show that, in fact, pain management was the only measure to improve in response to pay-for-performance system. No other input measure showed significant improvement. Thus, removing pain management from the formula may weaken the effectiveness of HVBP program at improving patient satisfaction, which is one of the key goals of the program. We suggest two divergent paths for Medicare to make the program more effective.

scholarly journals The 2020 Portrait of American Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 681-681
Author(s):  
Regina Shih
Keyword(s):  
Family Member ◽  
Family Caregivers ◽  
Care Recipient ◽  
Health Conditions ◽  
Complex Care ◽  
The Past ◽  
Care Recipients ◽  
The Us ◽  
National Alliance

Abstract The prevalence of caregiving for an adult or child with special needs has increased significantly in the past five years (from 18.2% to over 21.3%), driven by an increase in the prevalence of caring for a family member or friend aged 50 and older. At the same time, care recipients have greater health and functional needs that necessitate care from others in comparison to 2015. These new 2020 data from the Caregiving in the US Survey by the National Alliance for Caregiving suggests that not only are more American adults taking on the role of caregiver, but they are doing so for increasingly complex care situations. This paper addresses the prevalence of caregiving including the demographics of family caregivers, relationship between the caregiver and the care recipient, health conditions of the care recipient, and living situations of care recipients and their caregivers.

scholarly journals Resisting racial militarism: War, policing and the Black Panther Party

2021 ◽  
pp. 096701062199722 ◽  
Author(s):  
Nivi Manchanda ◽  
Chris Rossdale
Keyword(s):  
Vietnam War ◽  
Political Violence ◽  
Black Panther Party ◽  
Racial Capitalism ◽  
The Social ◽  
The Us ◽  
Liberal Societies ◽  
Police Action ◽  
Black Panther

The past ten years have witnessed a revival in scholarship on militarism, through which scholars have used the concept to make sense of the embeddedness of warlike relations in contemporary liberal societies and to account for how the social, political and economic contours of those same societies are implicated in the legitimation and organization of political violence. However, a persistent shortcoming has been the secondary role of race and coloniality in these accounts. This article demonstrates how we might position racism and colonialism as integral to the functioning of contemporary militarism. Centring the thought and praxis of the US Black Panther Party, we argue that the particular analysis developed by Black Panther Party members, alongside their often-tense participation in the anti–Vietnam War movement, offers a strong reading of the racialized and colonial politics of militarism. In particular, we show how their analysis of the ghetto as a colonial space, their understanding of the police as an illegitimate army of occupation and, most importantly, Huey Newton’s concept of intercommunalism prefigure an understanding of militarism premised on the interconnections between racial capitalism, violent practices of un/bordering and the dissolving boundaries between war and police action.

“No more little boxes” – Poetic Positionings in the Literary Field

2021 ◽  
Vol 69 (1) ◽  
pp. 91-104
Author(s):  
Stefanie Mueller
Keyword(s):  
Literary Marketplace ◽  
Literary Field ◽  
The Us ◽  
Unites States

AbstractMy article’s title borrows a line from Thomas Sayers Ellis’s poem “Skin, Inc.” (2010), a poem which uses the metaphor of incorporation in terms of its economic and formal affordances: formally as signifying upon a container, a box, in which the poet/lyric persona finds himself trapped as he is trying to create and to write; and economically, as signifying upon the poet as entrepreneur, who has to sell a brand and a product in the literary marketplace. Based on Pierre Bourdieu’s work on the theory of the literary field, I think of the poem as a form of poetic position-taking in the literary field in the Unites States in 2010. In my reading, I explore the literary marketplace as presented in the poem, and I argue that we can use this image of the market to think about the role of race in the literary field in the US, in particular with regard to what has been called the “post-soul aesthetic.”

Public perceptions of who counts as a scientist for controversial science

2019 ◽  
Vol 28 (7) ◽  
pp. 797-811 ◽  
Author(s):  
Brianne Suldovsky ◽  
Asheley Landrum ◽  
Natalie Jomini Stroud
Keyword(s):  
Climate Change ◽  
Media Coverage ◽  
Political Ideology ◽  
Genetically Modified Organisms ◽  
The United States ◽  
Public Perceptions ◽  
The Public ◽  
The Us ◽  
Science Media

In an era where expertise is increasingly critiqued, this study draws from the research on expertise and scientist stereotyping to explore who the public considers to be a scientist in the context of media coverage about climate change and genetically modified organisms. Using survey data from the United States, we find that political ideology and science knowledge affect who the US public believes is a scientist in these domains. Our results suggest important differences in the role of science media attention and science media selection in the publics “scientist” labeling. In addition, we replicate previous work and find that compared to other people who work in science, those with PhDs in Biology and Chemistry are most commonly seen as scientists.

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