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tumor resection cavity. The implanted chemotherapy can be by BCNU wafers, by photodynamic means as a form of immunotherapy and as a form of genetic therapy. Current chemotherapy such as alkylating agents, depend on cells entering the cell cycle. The tumor cells can often repair the single or double stranded breaks induced by the alkylating agents. Other more specific chemotherapies look to inhibit protein kinase-C, inhibit cyclin dependent kinase, inhibitor tumor angiogenesis, inhibit growth factor inhibition, inhibit tumor invasion or stimulate cell deafferentation. These cells are currently being tried. The most promising chemotherapy appears to be gene therapy.
CONCLUSION
At this point, with all of our technology and advances in medicine we can only stretch out the survival of individuals with glioblastoma. Not only must we look for a tumor cocktail to fix the genetic alterations of p53, p16, p15, PTEN but also EGFR, MDM2, CDK4, RAS and TGF. At the same time we are treating these alternations we must keep in mind that there may be one initiating factor that affects p53, EGFR, and TGF.
LECTURE NOTES FROM MULTIPLE SOURCES, NOT ORIGINAL WORK
POST-TRAUMATIC VASOSPASM
Of the greater than 2,000,000 individuals in the United States that seek hospital attention because of a head injury about 75,000 die. The Traumatic Coma Data Bank study showed an overall mortality from severe head injury of 36%. Recently we have developed standards to treat severe head injury. We have recognized that 50% of the morbidity and mortality occurs after the initial insult. We can try developing further preventive measures. Most of us could make significant differences in treating those patients after the moment of injury. We are well aware that we can remove mass lesions, however, we can do much, much more. There are many clinical conditions that we have to watch for and prevent from occurring, such as hypotension and hypoxia. There are other conditions that we must be aware of and treat aggressively in order to preserve brain function and return our patients back to productive members of society. Ischemic brain injury is the most common secondary insult and found in up to 80% of the fatal cases. In monitoring our patients in Intensive Care Units, it has been shown that 92% of patients suffer one or more cerebral ischemic insults lasting greater than five minutes. (Andrews, et. al., "Lancet," 1990, 335:327; Chestnut, et. al., "Journal of Trauma," 1993, 34:216; Graham et. al., "Journal of Neurology, Neurosurgery and Psychiatry," 1989, 52:346; Jones et. al., "Journal of Neurosurgical Anesthesiology," 1994, 6:4).
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