Odontoid fracture: management with early mobilization using the halo device.
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Adult↗
Biomedical subjects
C H Tator
Publications and source records attributed to C H Tator.
Hangman's fracture in ankylosing spondylitis preceded by vertical subluxation of the axis.
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Aged↗
The effect of phenobarbital on the toxicity and tumoricidal activity of CCNU in a murine brain tumor model.
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Animals↗
The effect of exogenous thyroid hormones on functional recovery of the rat after acute spinal cord compression injury.
The effect of triiodothyronine (T3) or thyroxine (T4) on functional recovery after acute spinal cord compression injury in the rat was assessed. Rats treated with T3 for 14 consecutive days after injury showed significantly improved recovery at 12 and 16 weeks, and rats treated with T4 for 4 days after injury showed significantly improved recovery at 12 weeks as compared with control animals. The possible modes of action of these two hormones on the injured spinal cord are briefly discussed.
Acute Disease↗
The value of decompression for acute experimental spinal cord compression injury.
A clip compression method was used to produce acute spinal cord compression injury in rats. The force and duration of the spinal cord compression were independently varied, and functional recovery of the cord was assessed using the inclined plane technique. Mathematical modeling produced a curve defining the relationship between force, duration, and functional recovery for each week after injury. The study clearly showed the beneficial effect of decompression and that increasing either the force or duration of compression, or both, caused a reduction in recovery.
Animals↗
The effect of spinal distraction on regional spinal cord blood flow in cats.
Distraction is considered to be a factor in many spinal cord injuries. With a specially designed distraction apparatus and the 14C-antipyrine autoradiographic technique, the effect of distraction on spinal cord blood flow (SCBF) in cats was studied. Distraction was performed at L2-3 at a rate of 0.25 cm/10 min, and the spinal evoked response (SER) was monitored by stimulating the sciatic nerve and recording at T-13. The SCBF was assessed in five control animals, four animals in whom the SER was markedly altered by distraction, and five animals after the SER had been abolished and an additional 0.5 cm distraction applied. Control cats had gray- and white-matter flows of 44.5 +/- 1.4 (SEM) and 10.5 +/- 0.4 ml/100 gm/min, respectively. Distraction to the point of marked SER alteration caused a 50% loss of SCBF at and caudal to the distraction site. An additional 0.5 cm distraction produced total abolition of SCBF at the distraction site and for a considerable distance rostral and caudal to it. Thus, it is shown that spinal distraction causes cord ischemia similar to that seen with other types of spinal cord injury. In addition, distraction severe enough to cause loss of the SER has already produced severe cord ischemia.
Animals↗
Surgical management of cerebellopontine angle tumors.
Of the 50 cerebellopontine angle tumors diagnosed during a three and one half year period, 36 were removed (all totally) using one of the three approaches to the cerebellopontine angle. Six patients, all elderly (over age 70) with obstructive hydrocephalus and complicating medical problems, had ventriculoperitoneal shunts inserted. One of these subsequently required tumor excision 10 months later. Of the 35 patients with normal functioning facial nerves pre-operatively, 34 (97 per cent) had the nerve spared surgically. Of 12 patients in whom hearing conservation was attempted, the cochlear nerve was spared in eight. However, useful hearing was preserved in one, with sound appreciated only in another.
Adult↗
The treatment of hypotension due to acute experimental spinal cord compression injury.
The therapeutic value of elevating the systemic blood pressure was studied in an acute spinal cord compression injury model in rats. In this model an acute spinal cord compression at T1 by a 180 gram clip for one minute consistently produced profound hypotension, and untreated animals served as controls. Treated animals had their mean systemic blood pressure raised for one hour after injury. Functional recovery was assessed weekly for eight weeks post-operatively by the inclined plane method. It was found that with noradrenaline mean systemic blood pressure could be maintained at normotensive (100 to 120 mmHg) or hypertensive levels (125 to 150 mmHg) for one hour after injury, but that this had no effect on the functional recovery of the animals.
Animals↗
Current concepts in the immediate management of acute spinal cord injuries.
The management of acute spinal cord injuries has changed considerably during the past 10 years owing to new information about the pathophysiology of cord trauma and new diagnostic and treatment methods. It is now known that the cord suffers not only from the immediate physical effects of trauma, but also from secondary pathologic processes, such as ischemia and edema, which are treatable in the first few hours after injury. New neuroradiologic and neurophysiological techniques, such as the recording of the somatosensory evoked potential, increase the accuracy of diagnosis and prognosis in the acute phase. Current immediate treatment includes the administration of steroids and mannitol, with careful attention to respiratory and cardiovascular homeostasis, to overcome post-traumatic ischemia and edema, and immobilization of the spine with devices such as the halo. New surgical procedures are used in selected cases to improve neurologic recovery, to provide rigid immobilization of the spine or to allow earlier mobilization of the patient. The care of spinal cord injuries in the acute phase is facilitated by multidisciplinary units.
Animals↗
Effect of vasodilators and myelotomy on recovery after acute spinal cord injury in rats.
The effect of papaverine, nitroprusside, or myelotomy on the recovery of spinal cord function was studied in rats after acute cord-compression injury. Spinal cord recovery was measured by a quantitative method of clinical assessment previously developed in our laboratory. Neither papaverine nor nitroprusside improved recovery of cord function. Dorsal midline myelotomy extending anteriorly as far as the central canal did not produce significant improvement (p greater than 0.05). However, when the myelotomy extended completely through the cord in the anteroposterior plane significant improvement (p less than 0.01) was obtained.
Animals↗
A new method for testing the force of clips for aneurysms or experimental spinal cord compression.
A new method is described for the determination of force-distance curves for aneurysm clips. A dissecting microscope with a goniometer eyepiece was used to determine the angle between the clip blades as various forces were applied to open the clip. The cosine law was then used to calculate the force-distance curves. The method allows accurate characterization of different clips and is especially useful for the early detection of clip weakening.
Aneurysm↗
Acute spinal cord injury: analysis of epidemiologic factors.
The authors studied the epidemiologic aspects of acute spinal cord injury in 358 patients admitted to the Toronto General and Sunnybrook hospitals between 1948 and 1973. The ages of the patients ranged from 14 to 89 years (median 32 years) and the male:female ratio was 4.5:1. The most frequent causes of injury were traffic accidents (34.4%), accidents at work (29.3%), sports-recreational injuries (15.4%) and falls at home (9.8%). Several epidemiologic factors were identified which are important for developing programs to reduce the frequency of cord injury. In particular young persons should be made more aware of the risks they run as automobile drivers and of the hazards of diving in shallow water, middle-aged workers in the construction industry are at risk of spinal cord injury from falls and elderly farmers are at risk of falling from lofts or being crushed by overturned tractors.
Accidents, Home↗
The effect of amphotericin B on the survival of brain-tumor-bearing mice treated with CCNU.
The membrane-active polyene, amphotericin B (AMB) has been shown to enhance or potentiate the effects of various chemotherapeutic agents against tumor cells in tissue culture. Because of the need to increase the efficacy of the nitrosoureas in brain-tumor chemotherapy, we have studied the effect of the nitrosourea, 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), with or without AMB pretreatment. The intraperitoneal administration of 25 mg/kg of AMB 24 hours before 5, 10, 20 or 30 mg/kg of intraperitoneal CCNU did not result in a significant improvement in survival. The failure of intraperitoneal AMB to potentiate the effect of CCNU was likely a failure in drug delivery, since AMB crosses the blood-brain barrier very poorly. To circumvent the drug-delivery problem, AMB was administered intracerebrally directly into the tumor-bearing hemisphere. With 0.5 mg/kg of intracerebral AMB administered 24 hours before 10 mg/kg CCNU was given intraperitoneally, the life-span was significantly increased over the control group. The same dose of CCNU alone did not significantly increase survival. When 0.2, 0.5, or 1.0 mg/kg AMB was administered intracerebrally 24 hours before 20 mg/kg of interaperitoneal CCNU, survival was significantly increased over those groups receiving the same dose of CCNU alone. It is concluded that direct intracerebral administration of AMB enhances or potentiates the therapeutic effect of CCNU in this brain-tumor model.
Amphotericin B↗
Regional spinal cord blood flow in rats after severe cord trauma.
Spinal cord blood flow (SCBF) was measured in 12 albino rats following acute cord injury produced by the extradural clip compression technique. Severe injury was produced with the clip compressing the cord with a force of 180 gm for 5 minutes, an injury previously shown to produce a severe functional deficit. Regional SCBF was measured 15 minutes, 2 hours, and 24 hours after injury by the 14C-antipyrine autoradiographic technique and a scanning microscope photometer. At 15 minutes and 2 hours, white and gray matter blood flow was severely diminished, and, at 24 hours, there was only minimal improvement. Focal decreases in blood flow were seen in white and gray matter for a considerable distance proximal and distal to the site of cord trauma. Thus, it has been confirmed in this model that severe cord compression injury produces severe posttraumatic ischemia in the cord which lasts for at least 24 hours.
Animals↗
Somatosensory evoked potentials in acute spinal cord injury: prognostic value.
The somatosensory evoked potential is absent in patients with complete motor and sensory loss below the level of spinal cord injury. When spinal cord injury is incomplete, these alterations in potential may be elicited from stimulation of a nerve entering the cord below the level of injury. The presence of such potentials soon after injury, or their early return, and progressive normalization of the wave form are sensitive early indications of favorable prognosis. Indeed, recovery of the somatosensory evoked potentials frequently precedes major clinical improvement and may occur in advance of clinical recovery or posterior column function.
Adolescent↗
Effect of duration of acute spinal cord compression in a new acute cord injury model in the rat.
The effect of duration of acute compression of the spinal cord was assessed in a new model in the rat. The spinal cord was acutely compressed for varying times by a modified aneurysm clip which produced a compression force of 180 grams. The effect of duration of compression was measured by the inclined plane method of assessing the animals' clinical performance. The results showed a linear relationship between log compression time and clinical performance. Thus, the clinical effect of acute compression of the spinal cord injury is inversely related to duration of compression time and the relationship has been precisely quantified. These results suggest that persisting compression should be relieved as soon as possible in order to improve recovery.
Acute Disease↗
Intraneoplastic injection of methotrexate for experimental brain-tumor chemotherapy.
The retention and distribution of tritiated methotrexate (MTX-3H) after direct intracerebral or intraneoplastic injection were studied in mice bearing subcutaneous or intracerebral ependymoblastomas. After intracerebral injection of MTX-3H in nontumor-bearing animals, a large amount of the drug was retained in the head, much more than could have been retained after systemic administration, and there was rpaid spreading of the drug through the ipsilateral hemisphere. Intraneoplastic injection of subcutaneous and intracerebral tumors produced rapid spreading of the drug through the tumors. Intially, the drug was mainly in the intersititial fluid of the tumors followed by earlier cellular uptake than was seen after intravenous injection. Even though the distribution of the drug in the intracerebral tumors was not uniform, and some intracranial tumor deposits contained less radioactivity than areas closer to the site of injection, intraneoplastic injection may have advantages for brain-tumor chemotherapy. However, further experimental study is necessary before clinical application can be recommended, especially evaluation of neurotoxicity after intracerebral, intraneopasltic injection of MTX or other chemotherapeutic agents.
Animals↗
Therapy of an experimental glioma with systemic or intraneoplastic methotrexate or radiation.
An intracranial mouse glioma model was used to study the effectiveness of chemotherapy with methotrexate )MTX) or radiotherapy. Maximum tolerable doses of MTX were established by toxicity studies in nontumor-bearing mice for the intraperitoneal and intracerebral routes of drug administration with and without leucovorin as an antidote. These maximum tolerable doses were then given either by the intraperitoneal route or directly into the tumor to mice bearing intracerebral tumors. The glioma model proved to be extremely useful for assessing the modalities studied, including repeated intraneoplastic injection of MTX. Dosage schedules were successfully developed for administering large amount of MTX and for preventing systemic toxicity by the administration of the antidote. Radiotherapy in single doses and 800 rads delayed the median day of death and produced several long-term survivors. Higher doses were toxic. Intraperitoneal or intraneoplastic MTX was completely ineffective as a chemotherapeutic agent for this tumor, even though very large amounts could be delivered due to the protection from systemic toxicity afforded by leucovorin. It is concluded that MTX is a poor chemotherapeutic agent for this experimental brain tumor, but that the technique of intraneoplastic administration of chemotherapeutic agents is feasible with this model system and should be studied further.
Animals↗