Search PubMed⌕ Search

Biomedical subjects

D L Kelly

Publications and source records attributed to D L Kelly.

At least 91 records · Page 5Linked to original sources
PubMed1983

Cerebral arterial spasm--a controlled trial of nimodipine in patients with subarachnoid hemorrhage.

We enrolled 125 neurologically normal patients with intracranial aneurysms in a multi-institution, prospective, double-blind, randomized, placebo-controlled trial within 96 hours of their subarachnoid hemorrhage, to determine whether treatment with the calcium blocker nimodipine would prevent or reduce the severity of ischemic neurologic deficits from arterial spasm. A deficit from cerebral arterial spasm that persisted and was severe or caused death by the end of the 21-day treatment period occurred in 8 of 60 patients given placebo and in 1 of 56 given nimodipine (P = 0.03, Fisher's exact test). Analysis of the amount of basal subarachnoid blood on pre-entry CAT scans in patients with deficits from spasm showed that an increase in subarachnoid blood was not associated with a worse neurologic outcome among patients who received nimodipine, unlike the situation in patients given a placebo. There were no side effects from nimodipine. We conclude that nimodipine should be given to patients who are neurologically normal after subarachnoid hemorrhage in order to reduce the occurrence of severe neurologic deficits due to cerebral arterial spasm.

Adolescent↗
PubMed1983

Post-traumatic acalculous cholecystitis on a neurosurgical service.

Post-traumatic acalculous cholecystitis is a potentially lethal complication that may develop in patients during hospitalization for trauma. Three case reports illustrate that obscuration of many early diagnostic symptoms and signs may make this complication particularly treacherous in the neurosurgical patient. Suspicion should be aroused by unexplained fever, leukocytosis, elevated serum bilirubin and alkaline phosphatase values, and developing intolerance to oral or tube feedings. There may be a rapid progression to signs of an acute abdominal condition. Symptoms are most likely to occur 1 week to 1 month after the episode of trauma. Patients of all ages are susceptible. Diagnosis is best confirmed by noninvasive iminodiacetic acid hepatobiliary scanning accompanied by ultrasound or abdominal computed tomographic scanning. The treatment of choice is emergency cholecystectomy. The cause is most likely multifactorial and is probably related to hypotension, sepsis, or biliary stasis with subsequent cystic duct obstruction. Although this disease is rare, its incidence is apparently increasing, and a high index of suspicion is warranted in the neurosurgeon involved in the care of the biliary tract disorder.

Adult↗
PubMed1983

A suprasellar atypical teratoma presenting as an intrasellar mass: a case report.

Intracranial atypical teratomas are midline brain tumors with both germinomatous and teratomatous elements. When they occur in the suprasellar region, they usually present with a classic triad of visual disturbances, diabetes insipidus, and hypopituitarism. We report the case of a suprasellar atypical teratoma that presented as an intrasellar lesion and caused secondary amenorrhea in a 15-year-old girl.

Adolescent↗
PubMed1982

Normal computed tomograms in acute head injury: correlation of intracranial pressure, ventricular size, and outcome.

To assess the predictive value of a normal computed tomographic (CT) scan obtained shortly after head injury, we reviewed all cases of patients with acute closed injury seen at the North Carolina Baptist Hospital over a 42-month period for whom initial CT scanning and continuous intracranial pressure (ICP) monitoring had been done. Of 160 patients meeting those criteria, the initial CT scan was interpreted as normal in 17 patients, all of whom had a Glasgow coma scale score of 9 or less. Of those 17 patients, 7 had elevated ICP (higher than 25 mm Hg) and required mannitol. Six of the 7 had a major pulmonary injury. From the 27 CT scans of the 17 patients, we calculated an inverse cella media index and compared it to previously published standards in an attempt to delineate more quantitatively the "slit ventricles" often seen in cases of head injury. Two patients died of extracranial injuries; I had severe disability and 2 had moderate disability - all related to extracranial factors. The remaining 12 made good recoveries. From these findings, we conclude that a normal initial CT scan in patients with closed head injury and pulmonary injury does not preclude increased ICP (and thus should not preclude ICP monitoring) and that patients with closed head injury and a normal initial CT scan in the absence of associated extracranial injuries should make a good recovery.

Adolescent↗
PubMed1981

Oculomotor palsy with pupillary sparing, coincidental aneurysm, and chronic lymphocytic leukemic meningeal infiltration.

A patient with oculomotor palsy with pupillary sparing was shown angiographically to have an aneurysm of the internal carotid artery, which proved at operation to arise distal to the origin of the ophthalmic artery. It did not impinge on the oculomotor nerve at any point. The oculomotor palsy persisted postoperatively, and complete intrinsic and extrinsic ophthalmoplegia developed. Cytological studies of cerebrospinal fluid were then made and were positive for malignant lymphocytic leukemic cells. Despite the fact that an aneurysm causing oculomotor palsy with pupillary sparing has been reported, we recommend that nonaneurysmal causes be considered first in patients presenting with that neurological sign.

Aged↗
PubMed1981

Conservative management of aplasia cutis congenita: case report.

A male newborn with a large scalp and skull defect and a cervical meningocele was transferred to the neonatal intensive care unit of the North Carolina Baptist Hospital. The scalp defect measured 8.5 x 9.5 cm, and the sagittal sinus was exposed. Because the defect was considered too large to be covered with a rotation skin flap, it was treated thrice daily with the topical application of bacitracin ointment and circumferential dressings. By the end of 3 months, the skull defect was covered with skin. The cervical meningocele was then removed without incident. At the 9-month follow-up examination, the scalp defect was well healed and the skull defect was closing slowly; the neurological findings were still normal for the patient's age.

Bacitracin↗
PubMed1981

Biological features of meningiomas that determine the production of cerebral edema.

Although meningiomas are known to cause varying degrees of cerebral edema, the relative importance of their location, size, histological subtype, and other histological features in the production of cerebral edema has not been studied adequately. Therefore, we undertook a retrospective analysis of 43 meningiomas excised between 1975 and 1980. The results indicate that histological subtype has no relationship to the production of cerebral edema, with one exception. Meningiomas containing partly or completely a hemangiopericytic component were the only histological subtype associated consistently with cerebral edema. The location of a meningioma per se may not determine the production of cerebral edema. A relationship between size, aggressive histological features, vascular proliferative changes, and the production of cerebral edema was seen. The need for and the nature of further studies required to explain the cerebral edema that may be associated with small meningiomas are discussed.

Brain Edema↗
PubMed1980

Traumatic dissection of the extracranial internal carotid artery.

Six cases of traumatic dissection of the extracranial carotid artery that were all treated conservatively are reported. The initial trauma was believed to be an intimal tear caused by severe stretching of the artery over the process of a cervical vertebra due to sudden hyperextension and lateral flexion of the neck to the opposite side. No clinical evidence of neck trauma was present, but one patient had roentgenographic evidence of cervical spine fracture. Four-vessel angiography was diagnostic in all six patients and was useful during follow-up in the four in whom it was done.

Accidents, Home↗
PubMed1980

Lhermitte-Duclos disease: case report with computerized tomographic scan.

Lhermitte-Duclos disease is a rare, benign cerebellar condition that mimics a posterior fossa mass and has never been diagnosed preoperatively. Grossly, the diseased cerebellar tissue is tough and poorly demarcated; microscopically, the cortex has a thick outer layer of nerve fibers, an inner layer of abnormal ganglion cells, and the absence of normal Purkinje cells. The prognosis, based on cases treated surgically since 1955, is good. A case is reported in which cranial computerized tomography performed 5 years after the partial removal of abnormal tissue showed neither enhancement nor radiolucency.

Abducens Nerve↗
PubMed1980

Thrombosed aneurysm of the vein of Galen.

Computed tomography in a 3 1/2-year-old boy with ataxia, lethargy, fever, vomiting, and increasing irritability revealed moderate hydrocephalus and a blood density mass lesion lying superior and posterior to the 3rd ventricle. On several of the sections, the blood density was greater in the dependent than in the superior portion of the mass. The average attenuation number within the mass was 40 EMI units. The infusion of contrast agent demonstrated capsular enhancement (a target sign), which was also demonstrated by angiography. The diagnosis, which was confirmed at operation, was thrombosis of an aneurysm of the vein of Galen. The massive thrombus was resected, but the aneurysm was not excised. The patient's recovery was uneventful.

Cerebral Angiography↗
PubMed1980

The vascular component in meningiomas associated with severe cerebral edema.

Cerebral edema is usually a complication of the later growth stages of intracranial neoplasms. Three patients with small meningiomas presented with unusually several cerebral edema out of proportion to the size of tumors. All three tumors exhibited benign meningothelial components, the formation of pseudopsammoma bodies, and striking vascular mural proliferation of small dark cells. In two tumors ultrastructural examination of these cells showed features of pericytes. The vascular pericytic component in these tumors may grow more actively than the meningothelial component and thus may cause the production of severe cerebral edema. The clinical, radiological, operative, and light and electron microscopic findings are presented, and the relationship to angioblastic meningiomas is discussed.

Aged↗
PubMed1980

Hyperextension injury of the cervical spine with esophageal perforation. Case report.

A case is presented of esophageal perforation following a hyperextension-flexion cervical injury. The patient recovered without complication. Hyperextension-flexion injuries of the cervical spine have proved to be a rare cause of esophageal perforation. The mechanism may be impingement of the esophagus against an exostosis or the edge of a vertebral body, or entrapment of the esophageal wall between the vertebral bodies as hyperextension changes to flexion. If not detected and treated early, the perforation may cause mediastinitis, retropharyngeal abscess, aspiration pneumonia, or death.

Cervical Vertebrae↗
PubMed1979

Gunshot wounds to the spinal cord.

A series of 59 patients with gunshot wounds to the spinal cord is presented. Seventeen injuries were cervical, 30 were thoracic, 11 were lumbar, and one was sacral. Twenty-nine patients had immediate complete sensorimotor loss of function, 18 had sensory or motor sparing below the cord lesions, and 12 had injury of the cauda equina. Thirty-nine patients were treated with decompressive laminectomy, four with local wound debridement only, three with cervical traction and subsequent anterior cervical fusion; 13 had only conservative therapy. Eleven patients had return to normal function and 20 patients had some degree of improvement. There was no significant difference in the outcome between patients operated on and those treated conservatively.

Adolescent↗
PubMed1979

The trapped temporal horn: a trap in neuroradiological diagnosis.

Although the advent of computerized cranial tomography (CT) has decreased the number of pneumoencephalograms performed for the diagnosis of hydrocephalus and lesions of the posterior fossa, brain stem, and ventricles, there are some patients in whom pneumoencephalography should still be done because it adds valuable information to that obtained with CT. When the temporal horn becomes obstructed, the choroid plexus and ependymal surface "upstream" from the obstructing mass continue to produce cerebrospinal fluid (CSF). The temporal horn can thus enlarge enough to appear as a mass on CT because of its reduced x-ray attenuation coefficient. Pneumoencephalography is effective in this situation because air will flow past a mass that obstructs CSF and because the ventricular system dilates during pneumoencephalography. When pneumoencephalography is used in a patient with a trapped temporal horn, the partially trapped horn may enlarge approximately 24 hours later. With that precaution in mind, the neurosurgeon should find pneumoencephalography to be a useful adjunct to CT in delineating the cause of a trapped temporal horn. In the three patients reported here CT had indicated a unilateral trapped temporal horn; pneumoencephalography confirmed that finding and demonstrated both the location and the nature of the lesion. One patient had a Grade II astrocytoma fungating into the atrium of the right lateral ventricle, one had a mass extending into the right ventricle from the medial and superior ventricular wall with nodular encroachment on the ventricle, and one had a meningioma in the atrium of the right lateral ventricle.

Aged↗