Transcript Barrier is Deficient in Human Brain Tumors Moore, Peyton, French

The Introduction of Steroids into Neurosurgical
Practice
Blood- Barrier is Deficient in Human Brain Tumors
Moore, Peyton, French
Glucosteroids improve patients with
Symptomatic, Pre-Terminal Glioblastoma
Galicich,French 1958-59
Glucosteroids improve non-tumorous brain swelling
Galicich, Long 1959
Randomized, Controlled Trial Begins and Ends
Galicich, Long 1959
Prospective Trial Begins
Galicich, Long, French 1960
Laboratory Studies in Brain Edema
Don Long
Choi Kilsoo
Robert Maxwell
1960-1965
1967-1969
1970-1972
These studies proved the following:
Identified the Astrocyte-EM
Described the Human Brain Capillary-EM
Described the Ultra structural Features of Brain Edema
Demonstrated Beneficial Effects of Steroids
Described a B-B-B Effect of Steroids
Clinical Studies in Brain Edema
RC Clinical Trial Abandoned 1960
Prospective Efficacy Trial 1967-1972
FDA Approval of the Drug for Brain Edema
(First drug ever taken through FDA process by a
neurosurgeon)
Impact of Glucosteroids
In 45 years about 900,000 – 1,000,000 patients in the US
In 1959 mortality was 10-30% - 90,000-300,000 deaths
With steroids morality dropped to 3-10% - 27,000-100,000
deaths
The effect upon morbidity can not be qualified but is
substantial: XRT
Between 60,000 and 200,000 lives saved in US
Worldwide the number is well into the millions
No other neurosurgical introduction has been so important
in mortality
Nothing else illustrates the French approach so well
A fundamental clinical observation
Application in new situations
Study it in the laboratory
Trust young associates to do it
Support them in the face of criticism
Share the credit and never boast about the
accomplishment
My own career was intimately tied to this process
I learned I was accepted in the residency through a
lab assignment
I was offered a staff position through extensions of
the research
The offer at Johns Hopkins was clearly related to
this entire research project