Search PubMed⌕ Search

Biomedical subjects

A L Day

Publications and source records attributed to A L Day.

At least 37 records · Page 2Linked to original sources
PubMed1998

Surgical treatment of paraclinoid and ophthalmic aneurysms.

Paraclinoid aneurysms include those arising from the ophthalmic segment and from the distal cavernous carotid artery or clinoid segment. Three aneurysm variants originate from the ophthalmic segment: ophthalmic artery, superior hypophyseal artery, and dorsal types. Clinoidal segment aneurysms arise from the carotid artery in the interval between the carotid oculomotor membrane proximally and the dural ring distally, and include anterior-lateral and medial variants. With proper exposure and a firm understanding of the parasellar osseous, dural, and vascular anatomy, most paraclinoid aneurysms are occluded with low risk to the brain or visual apparatus.

Carotid Artery Diseases↗
PubMed1997

Estrogens may reduce mortality and ischemic damage caused by middle cerebral artery occlusion in the female rat.

The present study was undertaken to determine if estrogens protect female rats from the neurodegenerative effects of middle cerebral artery (MCA) occlusion. The rats were ovariectomized and 7 or 8 days later various estrogen preparations were administered before or after MCA occlusion. Pretreatment with 17beta-estradiol (17beta-E2) or a brain-targeted 17beta-E2 chemical delivery system (CDS) decreased mortality from 65% in ovariectomized rats to 22% in 17beta-E2-treated and 16% in 17beta-E2 CDS-treated rats. This marked reduction in mortality was accompanied by a reduction in the ischemic area of the brain from 25.6+/-5.7% in the ovariectomized rats to 9.8+/-4% and 9.1+/-4.2% in the 17beta-E2-implanted and the 17beta-E2 CDS-treated rats, respectively. Similarly, pretreatment with the presumed inactive estrogen, 17alpha-estradiol, reduced mortality from 36 to 0% and reduced the ischemic area by 55 to 81%. When administered 40 or 90 minutes after MCA occlusion, 17beta-E2 CDS reduced the area of ischemia by 45 to 90% or 31%, respectively. In summary, the present study provides the first evidence that estrogens exert neuroprotective effects in an animal model of ischemia and suggests that estrogens may be a useful therapy to protect neurons against the neurodegenerative effects of stroke.

Animals↗
PubMed1996

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.

Adult↗
PubMed1995

Assessing clinical efficacy of a hydrocolloid/alginate dressing on full-thickness pressure ulcers.

An absorbent hydrocolloid/alginate spiral dressing and a hydrocolloid secondary dressing were used in the management of 30 patients with 30 exuding State III and IV pressure ulcers. After a mean treatment time of 12.9 days (SD 6.5), all wounds had a significant increase in the amount of granulation tissue/epithelium and a decrease in the amount of devitalized tissue (p < 0.05). Wounds that underwent wide surgical debridement prior to the study were covered with 15 percent fibrin slough at study entry versus 39 percent for non-debrided wounds (p < 0.05). The dressing combination facilitated wound contraction and removal of fibrin slough in ulcers that were surgically debrided prior to the study. Ulcers which had not been surgically debrided expanded as autolytic debridement reduced the amount of fibrin slough/necrotic tissue present at the wound bed (Mean: 17.6 percent, p < 0.05). The absorbent spiral dressing helped manage exudate, was easy to use and comfortable for the patients. The average time between dressing changes in these exuding wounds was 1.56 days (SD = 0.95). Use of air-fluidized bed or mattress was found to significantly reduce wear time of the dressing (p < 0.01). Further studies are needed to confirm short-term, and evaluate long-term effects of this dressing combination on healing and debridement.

Adult↗
PubMed1992

Carotid endarterectomy complicated by vein patch rupture.

Saphenous vein patch angioplasty has been used to improve the results of carotid endarterectomy by decreasing the incidence of postoperative occlusion and recurrent stenosis. A rare but potentially lethal complication of this technique is aseptic necrosis and rupture of the vein patch during the postoperative period. We report three cases of this phenomenon and review an additional 13 cases from the literature. This event generally occurs without warning 2 to 7 days postoperatively and may result in death or stroke. At reoperation, the central portion of the vein patch is necrotic, without evidence of infection. Technical considerations in the harvesting and preparation of these grafts are reviewed, as are the physical parameters predisposing certain vein patches to rupture. Saphenous vein harvested from the ankle has been linked to every reported case. Small diameter veins in particular appear to carry a higher risk of rupture.

Aged↗
PubMed1992

Aneurysmal intracerebral hemorrhage.

Approximately 20% of all massive nontraumatic intracerebral hemorrhages are caused by ruptured intracranial aneurysms. The possibility for repeated and catastrophic rebleeds, potentially reversible increased intracranial pressure effects, and the need for cerebral vasospasm treatment make the early identification of this cause of hematoma mandatory.

Cerebral Angiography↗
PubMed1991

Monitoring of somatosensory evoked potentials during surgery for middle cerebral artery aneurysms.

Somatosensory evoked potentials (SEPs) were monitored during 53 procedures for aneurysms of the middle cerebral artery (MCA). "Significant" changes were reported to the surgeon, who took corrective action when possible. Changes in the SEPs were categorized as follows: Type I, no change; Type II, significant change with complete return to baseline; Type III, significant change with incomplete return to baseline; Type IV, complete loss with no return; and Type V, no response at baseline. Only 1 of 37 patients with a Type I SEP had a new neurological deficit, and this was a patient who could not be examined for several days after surgery because he was in a pentobarbital coma. All 4 patients with Type III and IV changes had new postoperative neurological deficits. Perhaps of greater importance, 4 of 5 patients with Type II changes had no new deficit. These patients all had changes in SEPs that were completely reversible by clip adjustment (2), prompt removal of temporary clips (1), and inducing hypertension after aneurysm trapping (1). These cases may, therefore, represent instances in which SEP monitoring allowed the clinicians to prevent a neurological deficit. The MCA supplies the area of the somatosensory cortex that controls the hand. Median nerve SEPs are, therefore, a theoretically ideal monitor during surgery for MCA aneurysms. This study suggests that the results of MCA aneurysm surgery may be accurately predicted and improved with SEP monitoring.

Adolescent↗
PubMed1991

The effect of duodenojejunal alimentation on gastric pH and hormones in intensive care unit patients.

We evaluated effects of duodenojejunal (DJ) feeding on gastric pH and selected gastrointestinal hormones in 13 randomly selected patients in an intensive care unit (ICU). To obtain baseline values for gastric pH, a nasogastric (NG) tube was placed in each patient and gastric pH was measured every 30 minutes for 2 hours. To obtain control values, a Dobbhoff tube was placed fluoroscopically and 0.45 percent saline solution (NaCl), 75 ml, was infused for 1 hour and gastric pH was measured again; the previously placed NG tube was left in position. Then, by randomization, either 0.45 percent NaCl (pH = 5) was continued (n = 6) or a high-nitrogen, isotonic, enteral feeding solution (Osmolite HN, pH = 6.4) (n = 7) was infused, both at 75 ml/h. Gastric pH was noted hourly for 96 hours; antacid (Maalox TC, 15-ml aliquots) was given by NG tube when the pH was 4 or less. After 96 hours, the infusion was stopped and gastric pH was noted for 4 additional hours. Before and during initial saline solution infusion; after 24, 48, 72, and 96 hours of continuous infusion; and 4 hours after stopping the infusion, peripheral venous blood was obtained for measurement of plasma gastric inhibitory polypeptide (GIP) and serum gastrin. Data were analyzed by ANOVA (RMD), Fishers' exact test, and the unpaired t-test. Groups did not differ demographically. Throughout the infusion, gastric pH tended to be higher with the enteral feeding solution than with saline solution, but this was significant only at 24 hours. Less antacid was required with the enteral feeding solution at 24 and 48 hours than with saline solution. Plasma GIP levels were significantly higher with the enteral feeding solution than with saline solution during most of the infusion. Serum gastrin levels did not differ between the groups. In this cohort, infusion of the enteral feeding solution tended to maintain a gastric pH of more than 4 and was associated with increased plasma GIP levels, which may inhibit gastric acid secretion. Early enteral feeding may benefit certain ICU patients.

Antacids↗
PubMed1991

A hospital-based chemotherapy education and training program.

Impatient chemotherapy administered by nurses from the outpatient setting causes fragmentation of care by impeding the primary nursing model. The inpatient oncology nursing staff, highly motivated to expand their knowledge base for cancer patient care, expressed interest in chemotherapy administration. In a collaborative effort among the oncology clinical nurse specialist, nurse educator, and nurse manager, a program was designed based on The Oncology Nursing Society Cancer Chemotherapy Guidelines and Recommendations for Nursing Education and responses from an education-needs assessment survey. The program consists of a theoretical and a practical component. This article will describe the planning, implementation, and evaluation of the Chemotherapy Certification Program at St. Elizabeth's Hospital.

Antineoplastic Agents↗
PubMed1990

Treatment of visual loss in pseudotumor cerebri associated with uremia.

Ten patients with pseudotumor cerebri associated with renal insufficiency had papilledema and elevated intracranial pressure, but neurologic examinations and CT were normal. The 40% frequency of severe visual loss, 20/100 or worse, was higher than expected for pseudotumor cerebri. While furosemide was effective in 3 patients with renal transplants, administration of corticosteroids to 2 other patients did not halt progressive loss of vision. The visual function of 2 patients deteriorated even after lumboperitoneal shunting. Five patients underwent fenestration of the optic nerve sheath. This procedure improved the visual acuity of 3 patients and stabilized vision in the others. While the pathogenesis of pseudotumor cerebri in renal insufficiency is unknown, optic nerve sheath fenestration is the surgical treatment of choice for visual loss unresponsive to medical therapy.

Adolescent↗
PubMed1990

Aneurysms of the ophthalmic segment. A clinical and anatomical analysis.

The clinical, radiographic, and anatomical features in 80 patients with ophthalmic segment aneurysms were reviewed, and were categorized according to a presumed origin related to the ophthalmic (41 cases) or superior hypophyseal (39 cases) arteries. There was a marked female predominance (7:1) and high incidence of multiple aneurysms (45%) within this population. Clinical presentations included subarachnoid hemorrhage in 23 cases (29%) and visual deficits in 24 (30%); five patients exhibited both hemorrhage and visual loss. Twenty-eight aneurysms were incidentally identified. Ophthalmic artery aneurysms arose from the internal carotid artery (ICA) just distal to the ophthalmic artery, pointed superiorly or superomedially, and (when large) deflected the carotid artery posteriorly and inferiorly, closing the siphon. Abnormalities relating to vision were not identified until the aneurysm realized giant proportions. The optic nerve was typically displaced superomedially, which restricted contralateral extension until late in the clinical course; unilateral nasal field loss was seen in 12 patients. Nine patients had bilateral ophthalmic artery aneurysms which were often clipped via a unilateral craniotomy. Superior hypophyseal artery aneurysms arose just above the dural ring from the medial bend of the ICA, at the site of perforator origin to the superior aspect of the hypophysis, and had no direct association with the ophthalmic artery. The carotid artery was usually located lateral or superolateral relative to the aneurysm. These lesions could extend medially beneath the chiasm (suprasellar variant), producing a clinical and computerized tomography picture similar to a pituitary adenoma, or they could extend ventrally to burrow beneath the anterior clinoid process (paraclinoid variant). Preoperative categorization of these lesions according to their likely branch of origin provides excellent correlation with visual deficits and operative findings, and has allowed the author to clip 52 of 54 lesions, with very low operative or visual morbidity.

Aged↗
PubMed1989

Contralateral trochlear nerve paresis and ipsilateral Horner's syndrome.

Two patients had paresis of the trochlear nerve contralateral to the site of lesions in the brainstem. Both patients had ipsilateral blepharoptosis and miosis suggesting oculosympathetic paresis from involvement of the descending sympathetic tract, adjacent to the fourth cranial nerve nucleus and its fascicles, in the caudal mesencephalon. Cerebral antiography documented an arteriovenous malformation of the brainstem in Case 1. Magnetic resonance imaging disclosed a lesion of high signal intensity on T2-weighted images involving the dorsal mesencephalon in Case 2. Involvement of the superior cerebellar peduncle produced ipsilateral dysmetria and ataxia. Lesions involving the fourth cranial nerve nucleus or its fascicles, before decussation in the superior medullary velum, and adjacent sympathetic fibers may produce an ipsilateral Horner's syndrome and contralateral superior oblique muscle paresis.

Adult↗
PubMed1989

Intracranial aneurysms with superior division paresis of the oculomotor nerve.

Five patients with intracranial aneurysms had unilateral ptosis, limitation of supraduction, and normal pupillary reactivity. The most common aneurysm location for superior division paresis of the oculomotor nerve was the superior cerebellar-posterior cerebral artery junction, where aneurysms (3) of the basilar artery compressed and flattened the interpeduncular oculomotor nerve from below. A superior cerebellar artery aneurysm and brain stem infarction affected the intra-axial course of the oculomotor nerve producing superior division paresis. Only an aneurysm of the intracavernous carotid artery resulted in superior division paresis at the expected anatomic site of bifurcation of the oculomotor nerve into its superior and inferior divisions. Because the superior division supplies innervation exclusively to the superior rectus muscle and levator palpebrae, an aneurysm involving this branch does not affect the pupillo-constrictor fibers. Consequently, cerebral angiography should be considered in the initial evaluation of this ocular motor deficit.

Adult↗
PubMed1989

Surgical treatment of progressive visual loss in traumatic optic neuropathy. Report of two cases.

In two patients with traumatic optic neuropathy progressive visual loss was reversed by surgical decompression of the optic nerve sheath. The first patient with hemorrhage beneath the optic nerve sheath had progressive loss of vision from counting fingers to no light perception within 24 hours after the injury. Surgical evacuation of the hematoma improved visual acuity to 8/30. The second patient had progressive visual loss from 20/20 to 20/400 within the 1st week after injury. Drainage of an arachnoid cyst of the optic nerve sheath improved visual acuity to 20/25. Computerized axial tomography disclosed the hemorrhage in the first case and enlargement of the optic nerve sheath in the second. While the management of traumatic optic neuropathy is controversial, surgical intervention for an arachnoid cyst and hematoma involving the optic nerve is clearly beneficial.

Adult↗