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Biomedical subjects

G G Ferguson

Publications and source records attributed to G G Ferguson.

71 records · Page 4Linked to original sources
PubMedDate not supplied

The natural history of asymptomatic carotid bifurcation plaques.

Seventy-three patients with an angiographically identified asymptomatic stenosis (greater than 50%) and/or ulceration of the common carotid bifurcation have been followed from 6 months to 10 years (average 4 years). All patients had previously undergone contralateral carotid endarterectomy for a transient ischemic attack (TIA) or minor stroke in that carotid territory. During follow-up, 22 patients (30%) developed new symptoms of cerebral ischemia. Twelve developed ischemia referable to the previously asymptomatic side (10 TIA's, 2 strokes). Six developed recurrent ischemic symptoms in the territory of the previously symptomatic and operated carotid artery (2 TIA's, 4 strokes). Five developed ischemia in the vertebro-basilar territory (2 TIA's, 3 strokes). Thirteen patients (17%) died during follow-up, including 6 from cardiovascular disease and 3 from stroke. In our series the incidence of stroke in the territory of a significant asymptomatic carotid plaque was low (3%). Patients were as likely to develop stroke in the territory of a previously operated carotid artery (5%) with asymptomatic carotid lesions is to keep them under review and to consider endarterectomy only if appropriate ischemic symptoms (which are most likely to be TIA's) develop.

Arteriosclerosis↗
PubMedDate not supplied

Significance of EEG changes at carotid endarterectomy.

Visually apparent EEG changes associated with clamping the internal carotid artery appeared in 55 of 176 consecutive patients (31%) undergoing carotid endarterectomy without shunt. Attenuation of higher frequency activity was the most common change. Changes were moderate in 33 patients (19%) and major in 22 (12.5%). Major changes usually commenced earlier than less severe alterations. EEG changes resolved within 10 minutes of clamp release in 36 of 55 patients (65%) after an average clamp time of 36.25 minutes. Changes occurred more commonly when pre-operative EEGs were abnormal contralateral to clamping and when the contralateral carotid artery was more than 90% stenosed. Of the inhalational anesthetics employed with nitrous oxide and oxygen, isoflurane was associated with the lowest incidence of clamp-associated EEG change. Post-operative strokes occurred in 2 of 22 patients (9%) with major clamp-associated EEG changes, none of 33 patients with moderate changes and none of 121 without changes. However, the mechanism of this relationship remains in doubt.

Anesthesia, General↗
PubMedDate not supplied

How old people tolerate intracranial surgery for aneurysm.

The purpose of this paper is to examine how well (or poorly) patients past the age of 60 tolerate intracranial surgery for aneurysms in all locations. The records of 93 consecutive good risk patients (Botterell Grades 1 and 2) have been reviewed. Co-existing chronic medical conditions, e.g., hypertension, were ignored in patient grading. The results indicate that, for treatment of aneurysms on the anterior circulation, older patients tolerate intracranial procedures as well as younger patients. This is not true for operations upon posterior circulation aneurysms. Some possible reasons for this discrepancy are suggested.

Age Factors↗
PubMedDate not supplied

Saccular aneurysms in basilar artery fenestration.

Of 59 cases of vertebrobasilar junction aneurysms diagnosed and treated from January 1977 to April 1986, 21 (35.5%) saccular aneurysms arose in a fenestration of the proximal basilar artery. Defects of the media at the junctures of the fenestrated segments, as well as the possible presence of turbulent flow at the vertebrobasilar junction, may explain the high incidence of vertebrobasilar aneurysms associated with proximal basilar artery fenestration.

Adult↗
PubMedDate not supplied

Preoperative embolization of brain AVMs with isobutyl-2 cyanoacrylate.

The role of embolization in the management of brain arteriovenous malformations remains controversial. The benefits of embolization alone are not clear and surgical removal may be technically difficult or impossible in many cases. In an attempt to facilitate surgical removal, we performed preoperative embolization in 15 cases using a mixture of isobutyl-2 cyanoacrylate and glacial acetic acid. In one case, a mixture of polyvinyl alcohol particles, microfibrillar collagen, and 30% ethanol was used. In 10 of these cases the surgeon felt that the embolization significantly aided the operative removal by decreasing blood loss, reducing the size of draining veins, and removing portions of the nidus itself. In no patient did the embolization result in an unanticipated significant neurologic deficit. The major role for embolization in the management of brain arteriovenous malformations may be as an aid to surgical removal.

Adult↗