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Biomedical subjects

C D Ray

Publications and source records attributed to C D Ray.

At least 37 records · Page 2Linked to original sources
PubMed1983

Indwelling epidural morphine for control of post-lumbar spinal surgery pain.

The epidural instillation of morphine for pain control has been utilized for some time, although primarily intraoperatively or for patients with chronic severe pain, as in terminal cancer. Long term indwelling catheter or subarachnoid administration of epidural morphine are both potentially hazardous. However, in relatively brief applications, up to a few days, the epidural administration of morphine sulfate Is effective, safe, and well tolerated when used according to a carefully controlled plan. We report the use of this method as an improved means for the control of post-lumbar surgery pain in 25 cases. These patients were compared with 25 others receiving standard doses of parenteral and oral narcotics. The two groups were quite similar preoperatively. However, patients receiving epidural morphine were more comfortable, had fewer side effects such as nausea and lassitude, and exhibited no respiratory depression. Further, they ambulated sooner, showed no definitive orthostatic hypotension and less ileus, and remained much more alert and cooperative during the initial 48 hours after operation. Hospitalizations were usually shorter by 1 or 2 days. The administration of very small doses (1.0 to 2.5 mg) of morphine every 12 to 24 hours was usually adequate for good to excellent postoperative pain control. Hydroxyzine was sometimes used to potentiate the analgesia between doses. The epidural catheters were routinely removed within about 72 hours. The technique for the intraoperative placement of the epidural catheter and drug administration are detailed. Precautions for catheter placement were carefully followed to prevent dural penetration or intrathecal injection.

Adult↗
PubMed1982

New techniques for decompression of lumbar spinal stenosis.

Central and lateral stenoses of the lumbar neural canal are relatively less common causes of chronic pain in the lumbar back and the legs. However, their incidence is much higher than was previously thought. Accurate anatomical diagnosis was difficult until the advent of high resolution computed tomographic scanning. Appropriate decompressive surgery can now be designed and "guided" by the scans and the clinical syndrome. New or highly modified surgical procedures are now being used with good to excellent clinical results in as high as 80% of the cases depending upon the technique chosen. Many of these cases are failed back surgical cases and those whose diagnoses were not established by standard means, e.g., plain films, myelography, low resolution tomography, discography, etc. The good results reported here include patients with pain and disorders of long standing.

Back Pain↗
PubMed1981

Disposable ventricular catheter.

A new 1.6-mm-diameter (5 French), flexible, plastic disposable ventricular catheter is described. It has a self-attached sealing cap and fits standard Luer terminations of syringes. There are a self-contained stylette, a radiopaque stripe, and a single, smooth, lateral hole drilled through to the lumen. It has been used primarily for selective catheterization of the 3rd ventricle for the injection of contrast media and the collection of ventricular fluid for neurotransmitter analysis during the implantation of deep brain stimulators, but may be used for perfusion, drainage, or connection to pressure transducers.

Catheterization↗
PubMed1981

Burr-hole ring-cap and electrode anchoring device. Technical note.

A new burr-hole ring and cap are described. The threaded ring is C-shaped, holding itself in the burr hole by elastic recoil. A ventricular catheter or deep brain electrode may be passed through the slotted ring and anchored in place by means of a mushroom-shaped silicone rubber cap. The cap fills, sealing the plug. This simple two-part device, originally designed for use with a deep brain stimulator system, may also be used as a standard 5/8-inch. (16 mm) burr-hole plug.

Brain↗
PubMed1980

Deep brain stimulation for severe, chronic pain.

Deep brain electrodes placed in the parafascicularis-centre-median area (pf-CM) can reliably relieve severe chronic pain of long duration by simple electrical stimulation, in selected cases. Twenty-eight patients are presented here who had one or more electrodes placed for periods ranging from a few days to several months. Overall results rated good-to-excellent (having 50% or more relief of the prestimulation pain) were seen in 76% of the cases. Intraoperative test stimulation has been very useful in predicting future effectiveness. Also presented are a new disposable ventricular catheter and a burr hole plug and cap for anchoring the electrode wires in the skull.

Electric Stimulation Therapy↗
PubMed1978

Electrical stimulation: new methods for therapy and rehabilitation.

Electrical stimulation is emerging as a new therapeutic and rehabilitative agent. Reviewed are pain control, restoration of lost functions and alteration of abnormal movement and other functions using electrical stimulation. Reported for acute and chronic pain control use are transcutaneous, dorsal column, spinal cord, peripheral nerve, and direct brain stimulation methods and results. Overall success ranges up to 50% for chronic pain problems and up to 80% for acute pain; e.g., postoperative incisional pain, sports medicine, and trauma. Restoration of lost function has broad implications for the future. These include phrenic nerve pacing for respiration, foot drop control, restoration of bladder function, and grasp control in the spinal cord-injured patient. Amelioration of abnormal function includes stimulation for epilepsy and cerebral palsy, certain symptoms of multiple sclerosis and scoliosis. The effects of electrostimulation are completely reversible and nondestructive. Technical details of devices and stimulus waveforms are also briefly considered.

Acute Disease↗
PubMed1975

Electrical neurological stimulation systems: a review of contemporary methodology.

An analysis of the essentials of both external and implantable neurologic stimulation devices is presented. Specific system requirements have been extracted from clinical experience with neurologic hardware for pain inhibition. Application of these devices includes dorsal column stimulation, transcutaneous nerve stimulation and peripheral nerve stimulation. The electrode, an essential component of any neuro-stimulation system, is examined critically, with particular attention to unanswered questions regarding the electrode tissue interface.

Bioelectric Energy Sources↗