Saint Mary's Hospital Research Articles

Intracranial Stent Implantation for Drug Resistant Atherosclerotic Stenosis: Results of 52 Cases

The authors express their gratitude to Gyung Kyu Lee, M.D., Department of Radiology, Hangang Sacred Heart Hospital, Seoul, Korea, Hey Sil Jang, Department of Administration., Myungji Saint Mary's Hospital, Seoul, Korea, Shiyi Lui, M.D., Intervention treatment center, Shanghai Saint Luke’s Hospital, China, Tong Lin, M.D., Department of Emergency, Shanghai Saint Luke’s Hospital, China, Tongfu Yu, M.D., Department of Radiology, Jiangsu Province Hospital, Nanjing Medical University, China, for their data analysis.

The Chest Pain Choice trial: a pilot randomized trial of a decision aid for patients with chest pain in the emergency department.

BackgroundChest pain is a common presenting complaint in the emergency department (ED). Despite the frequency with which clinicians evaluate patients with chest pain, accurately determining the risk of acute coronary syndrome (ACS) and sharing risk information with patients is challenging. The aims of this study are (1) to develop a decision aid (CHEST PAIN CHOICE) that communicates the short-term risk of ACS and (2) to evaluate the impact of the decision aid on patient participation in decision-making and resource use.Methods/DesignThis is a protocol for a parallel, 2-arm randomized trial to compare an intervention group receiving CHEST PAIN CHOICE to a control group receiving usual ED care. Adults presenting to the Saint Mary's Hospital ED in Rochester, MN USA with a primary complaint of chest pain who are being considered for admission for prolonged ED observation in a specialized unit and urgent cardiac stress testing will be eligible for enrollment. We will measure the effect of CHEST PAIN CHOICE on six outcomes: (1) patient knowledge regarding their short-term risk for ACS and the risks of radiation exposure; (2) quality of the decision making process; (3) patient and clinician acceptability and satisfaction with the decision aid; (4) the proportion of patients who decided to undergo observation unit admission and urgent cardiac stress testing; (5) economic costs and healthcare utilization; and (6) the rate of delayed or missed ACS. To capture these outcomes, we will administer patient and clinician surveys after each visit, obtain video recordings of the clinical encounters, and conduct 30-day phone follow-up.DiscussionThis pilot randomized trial will develop and evaluate a decision aid for use in ED chest pain patients at low risk for ACS and provide a preliminary estimate of its effect on patient participation in decision-making and resource use.Trial registrationClinical Trials.gov Identifier: NCT01077037

Outcome of childhood acute promyelocytic leukemia treated using a modified AIDA protocol

BackgroundCombination treatment with all-trans-retinoic acid (ATRA) and anthracycline-based chemotherapy has led to major advances in the treatment of acute promyelocytic leukemia (APL).MethodsIn this study, we reviewed the outcome of pediatric APL patients treated using a modified AIDA protocol at our institution.ResultsBetween May 1999 and December 2007, 23 patients were diagnosed with APL at the Department of Pediatrics, Saint Mary's Hospital, The Catholic University of Korea. Eleven patients were male (48%) (median age at diagnosis, 11 (range, 2-14) years). The treatment protocol consisted of remission induction (achieved by coadministration of ATRA and idarubicin), 3 courses of consolidation treatment, and 2 years of maintenance treatment during which ATRA was also administered. Three patients died early during remission induction due to CNS hemorrhage. The remaining 20 patients achieved complete remission (CR), with an overall CR rate of 87%. Two patients relapsed and died, and another patient died of pneumonia unrelated to APL. Four patients (17%) were diagnosed with ATRA syndrome, and all patients showed resolution of symptoms. The event-free survival (EFS) and overall survival (OS) of the cohort were 78.3±8.6% and 76.3±9.5%, respectively. Initial WBC count at diagnosis was the only significant prognostic factor for the rate of CR (P=0.039) and OS (P=0.039).ConclusionA modified AIDA protocol for the treatment of childhood APL leads to improved EFS and OS, with limited ATRA syndrome-associated toxicity. Active monitoring and treatment of patients with high initial WBC counts may help in reducing mortality.

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Jun 2009Editorial Comment Gordon Hosker Gordon HoskerGordon Hosker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.01.165AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 181(6), p. 2633 References 1 : Standardisation of urethral pressure measurement: report from the Standardisation Sub-Committee of the International Continence Society. Neurourol Urodyn2002; 21: 258. Google Scholar The Warrell Unit, Saint Mary's Hospital, Manchester, United Kingdom© 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 6June 2009Page: 2633 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Gordon Hosker More articles by this author Expand All Advertisement PDF downloadLoading ...

Hyperammonemia from a Urea Cycle Disorder Presenting in Adulthood

OBJECTIVE: The aim of this report is to describe a patient with late presentation of carbamyl phosphate syn- thetase I (CPS-I, EC 6.3.4.16) deficiency, a rare urea cycle deficiency, and to facilitate recognition and treatment of pa- tients presenting with encephalopathy and hyperammonemia in a critical care setting. DESIGN: Case Report. SETTING: Intensive care unit of Saint Mary's Hospital, Mayo Clinic, Rochester, Minnesota. PATIENT: A 65-year-old woman ad- mitted with progressive encephalopathy. INTERVENTIONS: Intubation and mechanical ventilation, protein-restricted parenteral nutrition, intravenous arginine, hemodiafiltration, and intravenous antibiotic therapy. MEASUREMENTS AND MAIN RESULTS: Serum ammonia and glutamine levels were elevated, but other laboratory and imaging investigations were unremarkable. Despite the above interventions, her mental status deteriorated. She developed ventilator associated pneumonia, which worsened despite antibiotic treatment. The family decided to withdraw care and the patient expired on hospital day 10. A postmortem enzyme assay on fresh-frozen liver tissue showed severely diminished CPS-I activity. CONCLUSIONS: To our knowledge, this is the oldest reported age at presentation of CPS-I deficiency. Urea cycle disor- ders should be part of the differential diagnosis of hyperammonemia regardless of age as early treatment may ameliorate mortality and morbidity in these patients.

Systems of Care to Improve Timeliness of Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction During Off Hours: The Mayo Clinic STEMI Protocol

We implemented the Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated the timeliness of reperfusion therapy during off hours versus regular hours. Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times. The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion therapy for STEMI patients presenting to Saint Mary's Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Mary's Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing the protocol, median door-to-balloon time at Saint Mary's Hospital was 85 min during regular hours and 98 min during off hours. Among 258 patients who presented to Saint Mary's Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067). The Mayo Clinic STEMI protocol demonstrates the rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.

Treatment Outcome of Cisplatin-based Concurrent Chemoradiotherapy in the Patients with Locally Advanced Nasopharyngeal Cancer

The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. The patients had a median age of 53 years (range: 19 approximately 75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5 approximately 83.3) after CCRT and followed by adjuvant chemotherapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9 approximately 90.5) and 54.2% (95% CI: 36.7 approximately 71.7), respectively (p=0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1+/-2.9 weeks vs. 9.0+/-1.2 weeks, p=0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p=0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.

Comparable Outcomes of High-Resolution HLA-Matched Unrelated and HLA-Identical Sibling Donor Stem Cell Transplantation for Childhood Acute Myeloid Leukemia in First Remission.

Purpose: The role of allogeneic stem cell transplantation (SCT) from unrelated donor for childhood acute myeloid leukemia (AML) in first remission remains unclear because of its high transplant-related mortality. In this study, we investigated the role of SCT from high-resolution HLA-matched unrelated donor for childhood acute myeloid leukemia in first remission by comparing the outcomes of SCT from HLA-identical sibling donors and high-resolution HLA-matched unrelated donors. Patients andMethod: Between June 2002 and August 2005, 40 children who have AML in first complete remission received SCT at Saint Mary's hospital in Korea. In SCT from 17 sibling donors (M-SBMT), low-resolution typing (two-digit level) for HLA-A, -B, -C and -DRB1 was performed and all of donor-recipient pairs were 8/8 matches. Unrelated donors and recipients were typed for HLA-A, -B, and -DRB1 by high-resolution molecular typing (four-digit level). Of the 23 unrelated donor-recipients pairs, 14 were 6/6 matches (M-UBMT) and 9 were 5/6 matches (MM-UBMT). Conditioning regimen consisted of busulfan i.v. and cyclophosphamide. All patients received cyclosporin A and short-course methotrexate for GVHD prophylaxis.Results: Of the 40 patients, 27 survived event-free with a median follow-up of 38 months (range, 23–57 months). Median times for neutrophil engraftment were 12 days(range, 11–15 days), 11 days(range, 10–16 days) and 12 days(range, 11–15 days) for M-SBMT, M-UBMT and MM-UBMT, respectively. The number of Grade II-IV acute GVHD was 5 (29%), 7 (50%) and 6 (67%) in the M-SBMT, M-UBMT and MM-UBMT, respectively. One patient in MM-UBMT developed grade III acute GVHD. The number of patients who developed chronic GVHD was 2, 6 and 4 in the M-SBMT, M-UBMT and MM-UBMT,respectively. The number of relapsed patients after SCT was 3, 2 and 1 in the M-SBMT, M-UBMT and MM-UBMT and the number of non-relapse death was 2, 2 and 4, respectively. The Kaplan-Meier estimates for event-free survival at 3 years were 70 ± 11%, 71 ± 12% and 44 ± 17% for M-SBMT, M-UBMT and MM-UBMT, respectively without statistical significance (p=0.38). The Kaplan-Meier estimates for overall survival at 3 years were 76 ± 10%, 71 ± 12% and 44 ± 17% for M-SBMT, M-UBMT and MM-UBMT,respectively (p=0.25).Conclusion: In this study, we showed the outcome of SCT from high-resolpution HLA-matched unrelated donors was comparable with that of SCT from HLA-identical sibling donors in childhood AML in first remission. Therefore, high-resolution HLA-matched unrelated SCT might be recommended in patients without HLA-matched sibling donor in childhood AML in first remission.

Event-Related Potentials in Patients With Insomnia and Sleep-Related Breathing Disorders: Evening-to-Morning Changes

The relationship between event-related potentials (ERPs) and sleep alterations in patients with sleep disorders is still controversial. Whether the ERP alterations are affected by sleep loss and sleep discontinuity can be addressed by studying presleep-to-postsleep changes in ERPs. We investigated if presleep-to-postsleep ERP latencies and amplitudes differ in patients with insomnia and sleep-related breathing disorders and whether these changes are affected by the degree of subjective and objective sleep alterations. Fifteen patients with a diagnosis of insomnia, 45 patients with sleep-related breathing disorders, and 13 healthy controls were examined. Auditory ERPs were measured in the evening before sleep and in the morning after polysomnography. Subjective sleepiness and sleep quality were assessed by the Epworth Sleepiness Scale and the Saint Mary's Hospital Quality of Sleep Questionnaire. Analysis of evening-to-morning ERP variations did not reveal significant between-group differences in N100 latency and amplitude or in P200 and P300 amplitudes. Patients with sleep-related breathing disorders had a significant lengthening of P200 and P300 latencies in the morning, compared with controls and insomniacs. A trend to delayed morning P300 was present in patients with insomnia but did not reach statistical significance. The evening-to-morning ERP differences were not significantly related to subjective sleep quality, indexes of sleep fragmentation, or total sleep time. ERPs are sufficiently sensitive to assess attention dysfunction in patients with sleep disorders when presleep-to-postsleep changes are considered. The lack of relationship between indexes of sleep loss and sleep fragmentation and presleep-to-postsleep ERP changes might suggest that other factors outside sleep alterations affect ERP deterioration in patients with sleep disorders.

Advanced directives in an emergency department nonagenarian population

Study objectives: We determine how many persons close to the end of life have actual, formalized advanced directives. Methods: The records of 849 visits of patients aged 90 years and older presenting to the Saint Mary's Hospital emergency department (ED) between January 1, 2002, and December 31, 2002, were reviewed. Data on the presence and details of any advanced directives were abstracted. There is no standard screen for the presence of these on our ED record, so information was gathered by reading the entire ED record, as well as the remainder of the general medical record within the past year (current visit information form). In addition to ascertaining whether advanced directives were in place, the details of these directives were catalogued. Also, for those who did not have advanced directives, information on whether they wished to receive further information on the topic was also collected. Results: A total of 363 (43%) patient encounters had formal advanced directives. Of the 238 that specified their advanced directives, 8 (3%) encounters were do not resuscitate (DNR), 2 (1%) encounters were do not intubate (DNI), and 21 (9%) encounters were DNR and DNI. A small minority (3%) indicated interest in organ donation, whereas 5 (2%) made a request or gave permission for an autopsy. The most common ultimate diagnoses resulting from these ED visits were pneumonia or pneumonitis, acute coronary syndrome, cardiac arrhythmia, congestive heart failure, and extremity fracture. Everyone who was asked whether he or she would like to receive more information about advanced directives answered yes. Conclusion: Less than half of all patients aged 90 years and older who presented to the ED had formal advanced directives in place. In addition to these patients being toward the end of life by virtue of their age, the most common presenting complaints were all of an acute nature with real potential life threat. Furthermore, from the patients' standpoint, there appears to be a clear interest in receiving more information on advanced directives. This study highlights the need to address the issue of advanced directives with elderly patients presenting to the ED; possibly, this may best be achieved by way of a mandatory screen on the ED record.

The impact of blood pressure in the emergency department on survival in transient ischemic attack

Study objectives: The role of blood pressure in acute brain ischemia has been long been a subject of controversy. Although it is generally accepted that too high a blood pressure can harm survival, the lower end of the spectrum is seldom considered. Is there a range of blood pressure below which chances of survival are again poorer so that the survival curve is no longer a linear one? We determine how the mean arterial pressure (MAP), systolic blood pressure, or diastolic blood pressure in the emergency department (ED) correlates with mortality in transient ischemic attack (TIA). Methods: The records of all patients with a final diagnosis of TIA ( International Classification of Diseases, Ninth Revision code 435) presenting to the Saint Mary's Hospital ED in a 6-month period was performed. Data on ED blood pressure measurements and dates of death and last follow-up were abstracted. All consecutive patients in the mentioned period were captured; all but 1 patient (subsequently deceased) had blood pressure measurements recorded. Associations with survival were evaluated according to fitting univariate Cox proportional hazards models and summarized by calculating risk ratios (RR, risk/10-unit decrease) and 95% confidence intervals (CIs). This study was approved by the authors' institutional review board. Results: Among the 72 patients with TIAs, 8 deaths occurred, with mean time until death of 196.3 deaths (median, 173 days). The 8 deaths occurred at 17, 17, 61, 145, 201, 321, 377, and 431 days after the initial ED visit. Among the remaining 64 patients who were alive at last follow-up, the mean duration of follow-up was 275.6 days (median 310; range 0 to 463 days). According to univariate Cox models, patients with low systolic blood pressure were more likely to have poorer survival (RR 1.4, 95% CI 1.02 to 1.8, P =.036). Likewise, patients with low MAP were more likely have poorer survival (RR 2.0, 95% CI 1.1 to 3.5, P =.026). There was also a trend for patients with low diastolic blood pressure to have poorer survival (RR 2.1, 95% CI 0.99 to 4.7, P =.054). Conclusion: Low MAP, systolic blood pressure, or diastolic blood pressure in the ED in the setting of a TIA all appear to be associated with poorer survival. These findings argue for judicious use of antihypertensive medications to patients with TIA in the acute setting.

Evolution of mapping and anatomic imaging of cardiac arrhythmias.

Journal of Cardiovascular ElectrophysiologyVolume 15, Issue 7 p. 839-854 Evolution of Mapping and Anatomic Imaging of Cardiac Arrhythmias DOUGLAS L. PACKER M.D., DOUGLAS L. PACKER M.D. Division of Cardiology/Electrophysiology, Mayo School of Medicine, Rochester, Minnesota, USASearch for more papers by this author DOUGLAS L. PACKER M.D., DOUGLAS L. PACKER M.D. Division of Cardiology/Electrophysiology, Mayo School of Medicine, Rochester, Minnesota, USASearch for more papers by this author First published: 12 July 2004 https://doi.org/10.1046/j.1540-8167.2004.04275.xCitations: 17 Address for correspondence: Douglas L. Packer, M.D., 2-416 Alfred Building, Saint Mary's Hospital Complex, Mayo Foundation, Rochester, MN 55902. Fax: 507-255-3292; E-mail: [email protected] J Cardiovasc Electrophysiol, Vol. 15, pp. 839-854, July 2004. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume15, Issue7July 2004Pages 839-854 RelatedInformation

The umbilical metastasis. Sister Mary Joseph and her time

Although Baluff in 1854 and Nelaton in 1860 had already described umbilical metastases, the best known description of the metastasis of carcinomas to this site as "trouser button navel" was published in 1928 by William James Mayo (1861-1939), son of William Worrall Mayo (1815-1911), the founder of the Mayo Clinic in Rochester, Minnesota, This phenomenon is supposed to have been pointed out to Mayo by his long-serving head surgical nurse Sister Mary Joseph (1856-1939). The English surgeon Hamilton Bailey, in his famous textbook "Physical Signs in Clinical Surgery" in 1949, coined the term "Sister Joseph's nodule" for an umbilical metastasis. The expression has become widely accepted and used. Sister Mary Joseph, daughter of Irish immigrants, belonged to the 3rd order of the Holy Francis, was distinguished for her skills, intelligence and devotion to nursing which was also her calling. She worked for many decades at the world-famous Mayo Clinic and taught generations of young nurses. In recent years, the original surgical building at Saint Mary's Hospital has been named "Joseph Building" in her memory. Among the numerous eponyms occurring in the dermatology and the medicine, the association with the name of a nurse represents beyond doubt a special feature.

Striving toward continuous quality improvement: a case study of Saint Mary's Hospital.

This case analysis is the result of a year-long study designed to identify and assess the ingredients that led to the successful implementation of a continuous quality improvement (CQI) program at Saint Mary's Hospital in Grand Rapids, Michigan. The key ingredients of success included: (1) an organizational structure and leadership commitment for identifying and improving processes, (2) use of data-based statistical and analytical tools to study processes, (3) empowerment of teams of employees to take charge of the operations of their own work tasks in a manner that encourages continuous learning, (4) involvement of internal and external customers through the improvement process, and (5) development of effective measures for monitoring improvement. The benefits of the CQI efforts at Saint Mary's have been remarkable and hospital-wide.

Bronchiectasis and Rheumatoid Arthritis: Potential Pitfalls in Interpretation

Journal Article Bronchiectasis and Rheumatoid Arthritis: Potential Pitfalls in Interpretation Get access E. NEVILLE, E. NEVILLE Saint Mary's Hospital, Milton Road, Portsmouth PO 36AD Search for other works by this author on: Oxford Academic PubMed Google Scholar T. SOLANKI T. SOLANKI Saint Mary's Hospital, Milton Road, Portsmouth PO 36AD Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume 32, Issue 3, March 1993, Page 264, https://doi.org/10.1093/rheumatology/32.3.264-b Published: 01 March 1993 Article history Accepted: 23 November 1992 Published: 01 March 1993

Understanding age-related values in the work force.

Clinical Nurse Manager Medical/Surgical Nursing Mercer Medical Center Trenton, New Jersey Director of Administrative Nursing Services Saint Mary Hospital Langhorne, Pennsylvania Carol F. Burcin, BSN, RN, CNA Associate Senior Nurse Friends Hospital Philadelphia, Pennsylvania

The adrenaline modifiable maternofetal potential difference (PD) in the pig : B.S. Ward, J.D. Glazier, C.P. Sibley and R.D.H. Boyd, Departments of Child Health and Obstetrics and Gynaecology, University of Manchester, Saint Mary's Hospital, Manchester M13 OJH, U.K.

The adrenaline modifiable maternofetal potential difference (PD) in the pig : B.S. Ward, J.D. Glazier, C.P. Sibley and R.D.H. Boyd, Departments of Child Health and Obstetrics and Gynaecology, University of Manchester, Saint Mary's Hospital, Manchester M13 OJH, U.K.

Kidney disease and pregnancy. Experience at the nephrology unit of Saint Mary's Hospital

29 pregnancies in 27 renal patients were reviewed. The etiology of renal disease was mainly glomerular (14 patients). At the beginning of pregnancy 11 patients had renal failure and 14 patients had a high blood pressure. Only two patients had pregnancy related worsening of the renal function (the two patients had a normal renal function before pregnancy). Maternal morbidity was infrequent with no mortality. Fetal loss was 21.5% related to prematurity. There were no congenital anomalies. Renal failure at the beginning of pregnancy caused an obstetric risk factor. (greater fetal prematurity and mortality).

Nurse Exchange ??? A Creative Approach to the Nursing Shortage

JUDEANN Q. SHARP, MSN, RN, is Administrative Assistant of Nursing BRUCE FREDERICK, MN, RN, is Assistant Administrator of Nursing RUTH VOSS, MPH, RN, is Assistant Director of Nursing Resources, all in the Nursing Service Department at Saint Mary's Hospital, Rochester, Minnesota.

Dyskinesias: nursing care and surgical intervention.

The dyskinesia syndromes are a group of physically, socially and psychologically debilitating diseases. Many patients may be helped through medical management consisting of drugs, physical and speech therapy, and vocational rehabilitation. However, when medical management fails to palliate symptoms, surgical intervention may be the patient's alternative. The ultimate goal of therapy is to lead an improved quality of life. As a neurosurgical nurse, you have an important role in achieving that goal.