Intracranial repair of posttraumatic cerebrospinal fluid rhinorrhea associated with recurrent meningitis

PMID = 2546989

Two cases of neuro-Behçet's disease mimicking cerebral tumor

Two cases of neuro-Behçet's disease with isolated, solitary fronto-temporal and mesencephalic lesions respectively are reported. The cases were misdiagnosed as cerebral tumor. The postoperative outcome of the first patient was not satisfactory as he developed hemispheric edema. The second patient, with mesencephalic lesion, was treated only with corticosteroids, and the patient improved significantly. The lesion in this case resolved completely at six-month follow-up. We conclude that distinguishing the isolated solitary cerebral lesion of the Behçet's disease from a tumor may prevent surgical intervention

New classification for insular tumors and surgical results of 40 patients

The insular lobe is anatomically deep seated and located close to vital structures (middle cerebral artery, internal capsule, and corresponding opercula). Most insular tumors are of low grade and encountered in younger patients. Radical surgical intervention in this area is challenging but is superior to other treatment modalities. Because of the central location of the insula, most large paralimbic tumors involve it, and they present as insular tumors on radiologic examination. The surgical technique required for removal differs according to the size and location of the tumor. Thus, a classification system to aid in the choice of technique would be helpful. In this retrospective study, 40 patients (24 female and 16 male with mean age of 27 years) with insular tumors (62.5% were of low grade, 37.5% were of high grade) operated on between November 1996 and January 2001 were evaluated. Preoperative localization was classified according to our tentative new system based on preoperative magnetic resonance imaging (MRI): 15 of the tumors were restricted to the insula and corresponding opercula, and the others involved more mesocortical and/or allocortical areas. All the patients were operated on microsurgically by the transsylvian route. Comparing the preoperative and postoperative MRI studies, the patients were classified into three groups based on gross total (almost total) resection, nearly total resection (80%-100%), and partial resection (50%-80%) according to the reduction of tumor diameter as measured by neuroradiologists. Resection was gross total in 60% of cases, nearly total in 30%, and partial in 10%. Residual tumors were located near the internal capsule or beyond the posterior parahippocampal area. There was no perioperative mortality, and major complications were permanent hemiparesis in 2 patients and dysphasia in 1. During the follow-up period (mean of 24 months), 6 patients died as the result of uncontrollable tumor progression (4 cases of glioblastoma multiforme, 1 metastasis, and 1 grade 3 astrocytoma), and we still have I glioblastoma multiforme, 1 grade 3 oligoastrocytoma, 1 grade 2 oligoastrocytoma, and 1 grade 2 astrocytoma patients with tumor progression. To achieve more radical resection, the insular tumors originating from any parts of the paralimbic or limbic structures need a practical classification system based on the degree of extension obtained by means of preoperative MRI

Closing Routes to Retirement: How Do People Respond?

We present quasi-experimental evidence on the employment effects of an unprecedented large increase in the early retirement age (ERA). Raising the ERA has the potential to extend contribution periods and to reduce the number of pension beneficiaries at the same time, if employment exits are successfully delayed. However, workers may not be able to work longer or may choose other social support programs as exit routes from employment. We study the effects of the ERA increase on employment and potential program substitution in a regression-discontinuity framework. Germany abolished an important early retirement program for women born after 1951, effectively raising the ERA for women by three years. We analyze the effects of this huge increase on employment, unemployment, disability pensions, and inactivity rates. Our results suggest that the reform increased both employment and unemployment rates of women age 60 and over. However, we do not find evidence for active program substitution from employment into alternative social support programs. Instead employed women remained employed and unemployed women remained unemployed. The results suggest an increase in inequality within the affected cohorts