The Johns Hopkins Hospital

1991 ◽  
Vol 75 (1) ◽  
pp. 160-161 ◽  
Author(s):  
Donlin M. Long
Keyword(s):  
Medical Education ◽  
Medical School ◽  
Research University ◽  
Scientific Research ◽  
Johns Hopkins Hospital ◽  
Graduate Level ◽  
Content Type ◽  
Johns Hopkins University ◽  
Fine Print

The role of The Johns Hopkins University as an innovative school with a basic mission of scientific research is discussed. Its principle that research is best performed by faculty and students at a graduate level gave birth to the revolutionary concept of a research university. Against this background, the hospital and later the medical school were founded. The innovations that emerged from this medical education structure are touched on.

Politics and health: an emerging technology

1984 ◽  
Vol 61 (4) ◽  
pp. 625-632
Author(s):  
Robert M. Rosenzweig
Keyword(s):  
World War Ii ◽  
Research University ◽  
Central Government ◽  
Medical Profession ◽  
Political Scientist ◽  
Role Of Government ◽  
Content Type ◽  
The Government ◽  
Fine Print

✓ A political scientist examines the worlds of advanced medicine and the modern research university. Both elements are affected by the growth in the role of government. Central government had sharply limited powers early in this century, but by the middle third their powers were enlarged, particularly in the spheres of the economy and social welfare. The last third of the century will reveal what the governed want of the government. The scientific and technological aspects of World War II plunged the universities into the limelight as the main producers of vital knowledge and as objects of national policy. This power of knowledge expanded from national security to public health and welfare. Governmental patronage fostered basic medical research and revolution in biology. With advanced research there marched advanced training. America's leading research universities became stronger and flourished for a few decades, to be confronted suddenly by a shift in government priorities. Governmental fiscal support has dwindled while governmental regulation has increased. The medical profession passed from an early position of opposing the role of government to a position in which it paid inadequate attention to the adverse consequences of the systems that were adopted. Physicians who practice in a variety of settings have a variety of interests which account for the division within the profession. In a political setting it is advantageous and more important to have a clear view of central common interests. The speaker's advice to his colleagues in education is applicable to medicine, to act now in a manner to serve as a model for a vision of a “plausible future.” The measure of success in the future depends upon the ability to preserve those values, practices, and habits of mind that account for our value to society. The primacy of scholarly judgments over political judgments is not always easy to achieve in dealings with governments.

scholarly journals Direct evidence for a key role of protein kinase C in the development of vasospasm after subarachnoid hemorrhage

1992 ◽  
Vol 76 (4) ◽  
pp. 635-639 ◽  
Author(s):  
Shigeru Nishizawa ◽  
Nobukazu Nezu ◽  
Kenichi Uemura
Keyword(s):  
Signal Transduction ◽  
Protein Kinase C ◽  
Protein Kinase ◽  
Direct Evidence ◽  
Control Group ◽  
Content Type ◽  
Kinase C ◽  
Protein Kinase C Activity ◽  
Fine Print

✓ Vascular contraction is induced by the activation of intracellular contractile proteins mediated through signal transduction from the outside to the inside of cells. Protein kinase C plays a crucial role in this signal transduction. It is hypothesized that protein kinase C plays a causative part in the development of vasospasm after subarachnoid hemorrhage (SAH). To verify this directly, the authors measured protein kinase C activity in canine basilar arteries in an SAH model with (γ-32P)adenosine triphosphate and the data were compared to those in a control group. Protein kinase C is translocated to the membrane from the cytosol when it is activated, and the translocation is an index of the activation; thus, protein kinase C activity was measured both in the cytosol and in the membrane fractions. Protein kinase C activity in the membrane in the SAH model was remarkably enhanced compared to that in the control group. The percentage of membrane activity to the total was also significantly greater in the SAH vessels than in the control group, and the percentage of cytosol activity in the SAH group was decreased compared to that in the control arteries. The results indicate that protein kinase C in the vascular smooth muscle was translocated to the membrane from the cytosol and was activated when SAH occurred. It is concluded that this is direct evidence for a key role of protein kinase C in the development of vasospasm.

Incidence of silent hemorrhage and delayed deterioration after stereotactic brain biopsy

1998 ◽  
Vol 89 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
Abhijit Guha ◽  
Andres Lozano ◽  
Mark Bernstein
Keyword(s):  
Ct Scan ◽  
Neurological Deficit ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Ct Scanning ◽  
Ct Scans ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Fine Print

Object. Many neurosurgeons routinely obtain computerized tomography (CT) scans to rule out hemorrhage in patients after stereotactic procedures. In the present prospective study, the authors investigated the rate of silent hemorrhage and delayed deterioration after stereotactic biopsy sampling and the role of postbiopsy CT scanning. Methods. A subset of patients (the last 102 of approximately 800 patients) who underwent stereotactic brain biopsies at the Toronto Hospital prospectively underwent routine postoperative CT scanning within hours of the biopsy procedure. Their medical charts and CT scans were then reviewed. A postoperative CT scan was obtained in 102 patients (aged 17–87 years) who underwent stereotactic biopsy between June 1994 and September 1996. Sixty-one patients (59.8%) exhibited hemorrhages, mostly intracerebral (54.9%), on the immediate postoperative scan. Only six of these patients were clinically suspected to have suffered a hemorrhage based on immediate postoperative neurological deficit; in the remaining 55 (53.9%) of 102 patients, the hemorrhage was clinically silent and unsuspected. Among the clinically silent intracerebral hemorrhages, 22 measured less than 5 mm, 20 between 5 and 10 mm, five between 10 and 30 mm, and four between 30 and 40 mm. Of the 55 patients with clinically silent hemorrhages, only three demonstrated a delayed neurological deficit (one case of seizure and two cases of progressive loss of consciousness) and these all occurred within the first 2 postoperative days. Of the neurologically well patients in whom no hemorrhage was demonstrated on initial postoperative CT scan, none experienced delayed deterioration. Conclusions. Clinically silent hemorrhage after stereotactic biopsy is very common. However, the authors did not find that knowledge of its existence ultimately affected individual patient management or outcome. The authors, therefore, suggest that the most important role of postoperative CT scanning is to screen for those neurologically well patients with no hemorrhage. These patients could safely be discharged on the same day they underwent biopsy.

The role of craniectomy in the treatment of chronic subdural hematomas

1980 ◽  
Vol 52 (6) ◽  
pp. 776-781 ◽  
Author(s):  
George Tyson ◽  
W. Ellis Strachan ◽  
Peter Newman ◽  
H. Richard Winn ◽  
Albert Butler ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Chronic Subdural Hematoma ◽  
Neurological Deterioration ◽  
Neurological Dysfunction ◽  
Consecutive Series ◽  
Content Type ◽  
Significant Clinical Improvement ◽  
Acute Neurological Deterioration ◽  
Fine Print

✓ A consecutive series of 48 adult patients with a chronic subdural hematoma is reported. These patients were treated according to a protocol consisting of a sequence of conventional surgical procedures ranging from simple burr-hole drainage to craniotomy and subdural membranectomy. Seven patients (15%) continued to demonstrate severe neurological dysfunction, or suffered acute neurological deterioration after completion of this protocol. However, after undergoing excision of the cranial vault overlying the hematoma site, six of these seven patients demonstrated a significant clinical improvement. Based on analysis of these seven cases, the authors suggest that craniectomy be considered in those patients who suffer a symptomatic reaccumulation of subdural fluid following craniotomy and membranectomy, or who demonstrate further neurological deterioration as a result of cerebral swelling subjacent to the hematoma site. However, this procedure probably has no efficacy once extensive cerebral infarction has occurred.

Chronic tonsillar herniation in Crouzon's and Apert's syndromes: the role of premature synostosis of the lambdoid suture

1995 ◽  
Vol 83 (4) ◽  
pp. 575-582 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Dominique Renier ◽  
Guy Sebag ◽  
Christian Sainte-Rose ◽  
Eric Arnaud ◽  
...  
Keyword(s):  
Resonance Imaging ◽  
Tonsillar Herniation ◽  
Content Type ◽  
Lambdoid Suture ◽  
High Incidence ◽  
Apert's Syndrome ◽  
Suture Closure ◽  
Crouzon's Syndrome ◽  
Fine Print

✓ The incidence of chronic tonsillar herniation (CTH) was evaluated with magnetic resonance imaging in 44 patients with Crouzon's syndrome and 51 with Apert's syndrome; the incidence was 72.7% in Crouzon's syndrome and 1.9% in Apert's syndrome. All the patients with Crouzon's syndrome and progressive hydrocephalus had CTH, but of 32 individuals with Crouzon's syndrome and CTH, only 15 had progressive hydrocephalus. Five patients with Apert's syndrome were treated for progressive hydrocephalus; none had CTH. The patterns of suture closure in these two groups of patients were studied, and significant differences in coronal, sagittal, and lambdoid sutures were found between patients with Crouzon's and Apert's syndromes. In Crouzon's syndrome, significant differences in the pattern of lambdoid suture closure were found between the groups with and without CTH; in the group with CTH, the lambdoid closure appeared earlier. The authors propose that the high incidence of individuals with CTH who have Crouzon's syndrome is related to the premature synostosis of the lambdoid suture in the first 24 months of age.

Role of hydrodynamic processes in the pathogenesis of peritumoral brain edema in meningiomas

2000 ◽  
Vol 93 (4) ◽  
pp. 594-604 ◽  
Author(s):  
Michael Bitzer ◽  
Thomas Nägele ◽  
Beverly Geist-Barth ◽  
Uwe Klose ◽  
Eckardt Grönewäller ◽  
...  
Keyword(s):  
Contrast Agent ◽  
Brain Edema ◽  
Brain Tissue ◽  
Magnetic Resonance Images ◽  
Content Type ◽  
Extracellular Contrast Agent ◽  
Peritumoral Brain Edema ◽  
Hydrodynamic Processes ◽  
Fine Print

Object. In a prospective study, 28 patients with 32 intracranial meningiomas were examined to determine the role of hydrodynamic interaction between tumor and surrounding brain tissue in the pathogenesis of peritumoral brain edema.Methods. Gadolinium—diethylenetriamine pentaacetic acid (Gd-DPTA), an extracellular contrast agent used for routine clinical imaging, remains strictly extracellular without crossing an intact blood—brain barrier. Therefore, it is well suited for investigations of hydrodynamic extracellular mechanisms in the development of brain edema. Spin-echo T1-weighted magnetic resonance images were acquired before and after intravenous administration of 0.2 mmol/kg Gd-DPTA. Additional T1-weighted imaging was performed 0.6, 3.5, and 6.5 hours later. No significant Gd-DPTA diffused from tumor into peritumoral brain tissue in 12 meningiomas without surrounding brain edema. In contrast, in 17 of 20 meningiomas with surrounding edema, contrast agent in peritumoral brain tissue was detectable after 3.5 hours and 6.5 hours. In three of 20 meningiomas with minimum surrounding edema (< 5 cm3), contrast agent effusion was absent. After 3.5 hours and 6.5 hours strong correlations of edema volume and the maximum distance of contrast spread from the tumor margin into adjacent brain parenchyma (r = 0.84 and r = 0.87, respectively, p < 0.0001) indicated faster effusion in larger areas of edema.Conclusions. The results of this study show that significant contrast agent effusion from the extracellular space of the tumor into the interstitium of the peritumoral brain tissue is only found in meningiomas with surrounding edema. This supports the hypothesis that hydrodynamic processes play an essential role in the pathogenesis of peritumoral brain edema in meningiomas.

An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies

1999 ◽  
Vol 91 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Michael G. Fehlings ◽  
Charles H. Tator
Keyword(s):  
Clinical Studies ◽  
Class Ii ◽  
Decompressive Surgery ◽  
Evidence Based ◽  
Class Iii ◽  
Content Type ◽  
Cord Injury ◽  
Limited Class ◽  
Fine Print

Object. The authors conducted an evidence-based review of the literature to evaluate critically the rationale and indications for and the timing of decompressive surgery for the treatment of acute, nonpenetrating spinal cord injury (SCI). Methods. The experimental and clinical literature concerning the role of, and the biological rationale for, surgical decompression for acute SCI was reviewed. Clinical studies of nonoperative management of SCI were also examined for comparative purposes. Evidence from clinical trials was categorized as Class I (well-conducted randomized prospective trials), Class II (well-designed comparative clinical studies), or Class III (retrospective studies). Examination of studies in which animal models of SCI were used consistently demonstrated a beneficial effect of early decompressive surgery, although it is difficult to apply these data directly to the clinical setting. The clinical studies provided suggestive (Class III and limited Class II) evidence that decompressive procedures improve neurological recovery after SCI. However, no clear consensus can be inferred from the literature as to the optimum timing for decompressive surgery. Many authors have advocated delayed treatment to avoid medical complications, although good evidence from recent Class II trials indicates that early decompressive surgery can be performed safely without causing added morbidity or mortality. Conclusions. There is biological evidence from experimental studies in animals that early decompressive surgery may improve neurological recovery after SCI, although the relevant interventional timing in humans remains unclear. To date, the role of surgical decompression in patients with SCI is only supported by Class III and limited Class II evidence. Accordingly, decompressive surgery for SCI can only be considered a practice option. Furthermore, analysis of the literature does not allow definite conclusions to be drawn regarding appropriate timing of intervention. Hence, there is a need to conduct well-designed experimental and clinical studies of the timing and neurological results of decompressive surgery for the treatment of acute SCI.

Roles and functions of a non-academic medical school Facebook page: A study of usage and survey data (Preprint)

2021 ◽  
Author(s):  
Ella Catharine Sykes ◽  
Qi Zhuang Siah ◽  
Julie Browne ◽  
Caitlin Golaup
Keyword(s):  
Medical Education ◽  
Medical School ◽  
Social Networking ◽  
Student Support ◽  
Educational Resource ◽  
Student Body ◽  
Descriptive Information ◽  
Academic Medical ◽  
High Degree

BACKGROUND Facebook is a well-established social networking platform that is commonly used by medical schools as an educational resource, but there are few studies assessing the roles of a non-academic Facebook page in medical education. Cardiff University uses Facebook primarily as a student support and engagement platform through its ‘C21’ Facebook Page. OBJECTIVE To explore the role of a non-academic Facebook page in medical faculty-student communication and examine how the page is perceived by the student body. METHODS We collected and analysed C21 Facebook Page usage data to obtain descriptive information on reach, engagement and content. We also distributed an anonymised survey to evaluate and explore users’ interest in, experience of and engagement with the content. RESULTS Of the 1021 posts on the page in 2019, the highest post-engagement rate occurred in the Student or Staff News category (13.5%) and the lowest in Medical Research News (3.5%). Survey feedback on the page was overwhelmingly positive (n=89; 84.8%), and respondents reported a high degree of trust (n=95; 90.5%) in the page. Students would like to see more ‘CV-building’ Opportunities advertised on the page. CONCLUSIONS The C21 Facebook Page is an important resource in developing community within the medical school and facilitating student engagement with both the C21 course and wider medical opportunities. It is perceived as an appropriate channel of communication between the medical school and students.

Spontaneous chronic subdural hematomas in young adults with a deficiency of coagulation factor XIII

2005 ◽  
Vol 102 (6) ◽  
pp. 1130-1132 ◽  
Author(s):  
Alessio Albanese ◽  
Antonio Tuttolomondo ◽  
Carmelo Anile ◽  
Giovanni Sabatino ◽  
Angelo Pompucci ◽  
...  
Keyword(s):  
Young Adults ◽  
Factor Xiii ◽  
Coagulation Factor ◽  
Content Type ◽  
Coagulation Factor Xiii ◽  
Subdural Hematomas ◽  
History Of ◽  
Bridging Veins ◽  
Fine Print

✓ Chronic subdural hematomas (SDHs) generally occur in elderly patients. Its pathogenesis is usually related to head trauma with tearing and rupture of the bridging veins, although in some cases a history of trauma is not recognizable. There are many reports regarding the association between spontaneous chronic SDHs and an alteration in coagulative parameters. A coagulative disorder should be suspected when an unexplained hemorrhage occurs, especially in a young patient. The authors report on three young men with a deficiency in coagulation factor XIII (FXIII) who underwent surgery for chronic SDHs. The role of FXIII in the pathogenesis of chronic SDH is emphasized. In patients with unexplained chronic SDH all coagulation parameters and factors should be screened to identify an eventual coagulative disorder.

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