Collegiality: what is it?

The privileges of members of the academic medical collegium consist of the following: freedom to pursue medical knowledge, performance of therapeutic interventions, opportunity to instruct, freedom to engage in experimentation, and to share in the expression and communication of medical knowledge with colleagues. The obligations are the same as those of the purely academic collegium mentioned above. Additionally, there are the obligations specific to the medical collegium: the care and cure of the sick, fulfillment of the moral covenant to the patient, to guarantee the life cycle of medical ideas, to assure academic critique in medicine, the stewardship of medical knowledge, and adherence to a professional code. We feel that the relationship among medical colleagues adheres to a codified set of duties, one that can be objectively relied upon to protect the endangered species of American academic medicine, the collegial environment.

Metabolism of the malignant astrocytoma.

A comprehensive review of the biochemical organization of the malignant astrocytoma is presented. The review is intended for neurosurgeons. It outlines the metabolic flow of events beginning with energy and substrate utilization, followed by structural components (protein, lipids, etc.) and tumor cell secretory products, and ending with nucleic acid synthesis. Cellular pH, tumor-induced cerebral edema, tumor blood flow, and tumor necrosis are also considered.

Epidural spinal infection in intravenous drug abusers.

The incidence of spinal epidural abscess and disk space infection appears to be rising in intravenous drug-using patients. We report 18 cases seen over three years in two municipal hospitals. Staphylococcus aureus was the most common infective agent, but two patients had Mycobacterium tuberculosis infection. Computed tomography of the spine facilitates diagnosis. Early treatment improves outcome but host factors play a role in recovery.

Third ventricular primary cerebral neuroblastoma. Electron-microscopic and immunohistochemical study.

A case of third ventricular primary cerebral neuroblastoma with secondary hydrocephalus is reported. Light microscopy showed a cell pattern that resembled either ependymoma or oligodendroglioma. The tumor was confirmed to be neuroblastoma by electron microscopy and immunohistochemistry. Immunoperoxidase staining was positive for neuron-specific enolase and negative for glial fibrillary acidic protein.

Transoral removal of missile fragments from the C1-C2 area: report of four cases.

Low velocity firearm damage to the upper cervical spine without neurological deficit occurs infrequently. Four cases of gunshot fragments involving the anterior elements of C1 and C2 are presented. In all four cases, the fragments were removed via a transoral approach without neurological complications or mechanical instability.

Brainstem haematomas: review of the literature and presentation of five new cases.

Fifty-one cases of brainstem haematoma that have undergone neurosurgical intervention since Finkelnburg's first exploration in 1905, are presented, together with five new cases. The location, incidence, aetiological and pathological factors, as well as clinical syndromes are reviewed. Diagnostic criteria are presented. The distinction between brainstem "haematoma" and "haemorrhage" is stressed. A retrospective comparison of 56 surgically treated cases and 31 conservatively managed cases is made, as is an analysis of the natural history of the disease process. Based on currently available data, the conclusion is drawn that patients with brainstem haematomas fare quite well after surgical therapy.

Cocaine-related intracranial hemorrhage. Report of nine cases and review.

Nine cases of intracranial hemorrhages related to cocaine usage are presented. Another 5 cases from the literature are reviewed. The relationship between severe cocaine-induced hypertension, and the development of subarachnoid or intracerebral hemorrhages is noted, and apparently is related to sudden transient increases of blood pressure related to cocaine use.

Traumatic intraspinal pneumocele.

Traumatic intraspinal pneumocele (TIP) is a radiologic finding in which air is visualized within the spinal canal on routine cervical spine x-rays following a head injury. TIP may be the initial radiologic evidence of a severe central nervous system injury. The presence of TIP will alert a physician to the severity of the head injury, as well as the need for further radiologic investigations.

Hemangiopericytoma of the pituitary fossa: case report.

A case of hemangiopericytoma presenting as a sellar and suprasellar mass is reported. Although this is the first report of this tumor in such a location, it appears similar to hemangiopericytomas found in other locations.

Systemic Weber-Christian disease presenting as an intracranial mass lesion. Case report.

A case is reported in which systemic Weber-Christian disease presented as a dural mass causing the signs and symptoms of increased intracranial pressure. The literature and possible pathogenesis of this entity are discussed.