Craniotomy for intracranial aneurysm and subarachnoid hemorrhage. Is course, cost, or outcome affected by age?

BACKGROUND AND PURPOSE: Age may influence cost or effectiveness of treatment for subarachnoid hemorrhage (SAH). This study examined the effect of age on both. METHODS: Patients (n = 219) who underwent craniotomy for intracranial aneurysm and SAH over 6 years at one tertiary care center were divided in two ways by age: single advanced age (< 65 years and > or = 65 years) and decade of age (23 to 39, 40 to 49, 50 to 59, 60 to 69, and 70 to 81 years). Data recorded for each patient included numbers of procedures and complications in the surgical intensive care unit (SICU), number of days in the SICU and the hospital, costs for SICU and ward care, total cost (SICU plus ward costs), and the Acute Physiology and Chronic Health Evaluation (APACHE) II score at admission and discharge, the Hunt-Hess grade at admission and immediately preoperatively, and quality of life score, a measure of outcome. Mortality rates by age group were calculated. RESULTS: The only variable significantly affected by decade of age was mortality rate, which increased as decade of age increased (3% to 17%). With the 65-year comparison, mortality rate, cost, APACHE II score at admission and discharge, days before operation, and days in the SICU were significantly higher for age > or = 65 years. CONCLUSIONS: Whereas mortality is higher for the older age group, quality of life scores appear acceptable for those who survive. Even though the hospital costs of treating elderly patients for SAH may be higher than those for younger patients, this should not be used to justify withholding care from the elderly.

Myelinoclastic diffuse sclerosis presenting as a mass lesion in a child with Turner's syndrome.

A rare case of myelinoclastic diffuse sclerosis (MDS), occasionally referred to as Schilder's disease, is reported in a child with Turner's syndrome. The child originally presented with a 3-week history of nausea, vomiting and frontal headaches. Magnetic resonance imaging showed a large, contrast-enhancing, right frontal lobe mass which was ultimately resected uneventfully. Complete laboratory investigations and pathological evaluation of the resected specimen verified the case to be MDS. The clinical presentation, laboratory evaluation, imaging characteristics and diagnosis are discussed in this review of the disease. The importance of including demyelinating diseases in the differential diagnosis for newly discovered mass lesions in the pediatric population is underscored by this case.

Impaired proliferation response after PDGF induction in fibroblasts from Hutchinson-Guilford Progeria syndrome.

Fibroblasts from a Hutchinson-Guilford Progeria Syndrome (HGPS) patient were compared to normal human fibroblasts to determine if differences existed in growth factor mediated cell proliferation. Cultures of progeric fibroblasts were exposed individually to platelet-derived growth factor (PDGF), epidermal growth factor (EGF), platelet poor plasma (PPP) and fetal bovine serum (FBS). Autoradiographic studies using 3H thymidine showed that progeric fibroblasts had similar labeling indices relative to controls after exposure to FBS and EGF. In contrast, progeric cells made competent with PDGF and later treated with 5% PPP had a significantly lower labeling index. This and preliminary observations on fos RNA accumulation suggests the possible existence of a genetic defect in HGPS fibroblasts.