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Biomedical subjects

C G Drake

Publications and source records attributed to C G Drake.

At least 91 records · Page 5Linked to original sources
PubMed1980

Treatment of ischemic deficits from cerebral vasospasm with high dose barbiturate therapy.

In 12 patients with life-threatening neurological deficits from vasospasm refractory to other measures, high dose barbiturate therapy was used in an attempt to prevent permanent changes in the brain. In each case angiography was performed and intracranial pressure was measured. Dexamethasone, a low molecular weight dextran, and mannitol were administered. If intracranial pressure (ICP) was elevated, drainage of cerebrospinal fluid and hyperventilation were used. Arterial pressure was maintained at not less than 140/90 preoperatively and 180/100 postoperatively. Barbiturate therapy was continued until vasospasm decreased angiographically and ICP was normal. Eleven of the 12 patients perished. One had a fatal rebleed. One died of an iatrogenic hemothorax. Four died from uncontrollable intracranial hypertension. One improved slightly and then died from a cardiac arrhythmia. One died of increased ICP when her ventriculostomy malfunctioned. One improved and was responding purposefully to pain, only to die suddenly with a low ICP. Two patients became awake and responsive to verbal commands; 1 of these died from Klebsiella meningitis and the other died from an intracerebral hematoma. In the 3 patients in whom hypothermia was also used, profound alterations in acid-base and fluid electrolyte balance occurred. These discouraging results are most likely a reflection of the severity of the patients' condition at the beginning of therapy. There may be some benefit of barbiturates in the management of vasospasm, and the potential effectiveness of barbiturates may be more obvious if therapy is started at an earlier stage. However, until further evidence of the usefulness of this modality becomes manifest, it should be limited to patients with life-threatening impairments unresponsive to all other measures.

Adolescent↗
PubMed1979

The results of operating upon cerebral aneurysms and angiomas in children and adolescents. II. Cerebral angiomas.

Symptomatic angiomas of the brain, brain stem or cerebellum are uncommon in all age groups. They usually present by subarachnoid and intraparenchymatous hemorrhage, but they may act as expanding mass lesions, as causes of ingavescent neurological deficit (?'steal phenomenon'), as epilepticogenic foci, or as a source of relentless headache. We have operated upon 20 patients, 18 years of age of less, with symptomatic angiomas. There has been no surgical mortality, and no patient has been made worse by operation.

Adolescent↗
PubMed1979

Subarachnoid hemorrhage secondary to ruptured cerebral aneurysm in pregnancy.

Eight patients suffering ruptured cerebral aneurysms during pregnancy were managed at the University of Western Ontario hospitals between 1967 and 1977. Seven aneurysms were managed surgically. All of these patients survived, 1 with permanent neurologic deficit. Seven living infants were delivered, 6 by vaginal delivery and 1 by cesarean section. One pregnancy was terminated surgically. One maternal death occurred in a patient whose aneurysm was inoperable. Fetal heart rates (FHR) were monitored by Doptone monitor during the aneurysm surgery. Clipping of the aneurysms was performed under induced hypotension. The prognosis for ruptured cerebral aneurysms during pregnancy is good for both mother and fetus. A short course of conservative therapy followed by surgical management of the aneurysm is advocated. Delivery may be managed according to obstetrical indications following surgical correction of the aneurysm.

Adult↗
PubMed1978

Neurosurgery: considerations for strength and quality. The 1978 AANS presidential address.

The President of the American Association of Neurological Surgeons reviews the organization of the Association designed to represent neurosurgery and neurosurgeons. He summarizes the pertinent problems that the specialty has faced and with which it continues to deal, in persistent pursuit of its objective: to assure the highest quality of neurosurgical care for all.

American Medical Association↗
PubMed1977

Intracranial aneurysms.

The modern history of the management of intracranial aneurysm encompasses little more than a quarter century. These are seen in 5% routine autopsies and those under 2 mm exist in 17% normal adult brain vasculature. One third of strokes are SAH and aneurysms account for 70% of these. Aneurysms rupture at a rate of 12/100.000 population/year, mostly on the 5th, and 6th decades. Given the high morbidity and mortality of these (43% from first haemorrhage if untreated), surgeons can attempt to avoid rebleeding for a week or more until surgery becomes safe and expand the ability to deal safely with most of them regardless of size or position. Early surgery has still an unacceptable morbidity and operation is usually planned between the 6th and 10th day after the first bleed. Early surgery is only indicated when there is a clot and deterioration. Conservative measures are reduction of blood pressure and use of antifibrinolysins and some minor surgical means whose practicality is still unknown. The recognition of warning leaks must be one of the significant factors for future treatment. Several surgical adjuncts are of considerable value, i.e., brain shrinking agents, microsurgical technique, induced hypotension. Aneurisms are classified as: small (less than 12 mm) large or bulbous (12-25 mm) and giant (greater than 25 mm). From 326 of small vertebral-basilar aneurysms the results were excellent in 246, good in 35, poor in 26 and 19 died. From 71 basilar aneurysms only 6 died, the results being excellent in 42, good in 10 and poor in 13. The management of giant anterior circulation (Table III) and posterior circulation (Table IV) aneurysms, involved various surgical procedures including carotid, middle cerebral, vertebral and basilar artery ligation, neck occlusion, wrapping or coating, as an overall result the outcome was good in 52 out of 63 gicunt anterior circulation giant aneurysms but was bad in 48 out of 91 posterior circulation giant aneurysms. The best results were obtained with 7 carotid-cavernous aneurysms (all good) and the worse results with 17 giant aneurysms of the basilar trunk at the superior cerebellar artery (11 poor, 6 good). A technique for the percutaneous occlusion of the basilar artery with a plastic Rommel type tourniquet is described (Fig 3). This allows the occlusion under local anesthesia. It has been used in 10 cases with 2 deaths STA-MCA by-pass proved to be useful for the progressive occlusion of the MCA in 3 cases of giant middle cerebral aneurysms.

Basilar Artery↗
PubMed1975

Cerebral artery aneurysms in infancy, childhood and adolescence.

From this series of 16 cerebral artery aneurysms in the paediatric age group the following points can be made: (a) aneurysms in the paediatric age group may be found in unusual locations, more peripherally than usually seen in the adult population, (b) in seven patients, the aneurysm was of giant size; two of these produced symptoms by mass effect, (c) in two patients with subacute bacterial endocarditis the aneurysm was mycotic; the inflammatory fusiform dilatation of the entire circle of Willis in one case was associated with generalized candidiasis, (d) an antecedent head injury in a child may so prejudice the initial clinical assessment that the possibility of haemorrhage from aneurysm is overlooked, and (e) gradual vertebral artery ligation, to reduce the pressure-head in fusiform aneurysms, is well tolerated by the young patient, even when done bilaterally.

Adolescent↗
PubMed1975

Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms.

The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later. Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome. Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries. The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.

Adolescent↗