Search PubMed⌕ Search

Biomedical subjects

L F Marshall

Publications and source records attributed to L F Marshall.

At least 73 records · Page 4Linked to original sources
PubMed1987

Continuous monitoring of intracranial pressure with a miniaturized fiberoptic device.

A No. 4 French fiberoptic catheter initially developed as an intravascular pressure sensor was incorporated into a system to be used as an intracranial pressure (ICP) monitor. Initially, a series of acute and chronic animal experiments carried out in the rabbit and pig, respectively, demonstrated the reliability and safety of the device. Subsequently, this new monitor was compared to a concurrently functioning ICP monitor in 15 adult and five pediatric patients. This clinical experience also confirmed the safety, accuracy, and reliability of the device. Since these initial studies, this monitor has been used to routinely measure ICP in a large number of adult and pediatric patients. The monitor has functioned well, and there have been no complications related to its use except for an occasional problem with breakage of the optic fiber as a result of patient movement or nursing maneuvers, which has been easily corrected by replacement of the probe. As nursing personnel and ancillary services have become familiar with this new monitor, breakage has not been a problem. This new device can be placed into the ventricular system, the brain parenchyma, or the subdural space, and appears to offer substantial advantages over other monitors presently in use.

Adult↗
PubMed1986

Impaired verbal and figural fluency after head injury.

Previous research has found that verbal fluency is reduced in head-injured patients and in patients with focal damage to the frontal lobes. The present study compares a task of verbal associative fluency with a new measure of nonverbal, or figural, fluency that focuses on speed of producing unique designs and accounting for perseverative tendencies. Using results from 35 head-injured patients and 50 normals, we found that both verbal and figural fluency are compromised following brain trauma. Consistent with previous research, patients with severe head injuries were more impaired than patients with moderate head injuries. The discussion focuses on those cognitive factors that might influence verbal or figural fluency.

Journal Article↗
PubMed1985

Confirmation of the posterolateral technique to decompress and fuse thoracolumbar spine burst fractures.

A posterolateral technique to decompress retropulsed bone from the spinal canal has been employed in nine patients, confirmed with intraoperative canal inspection and pre- and postoperative computed axial tomographic (CAT) evaluation. This technique has allowed reduction of retropulsed bony elements from the spinal canal, assessment of canal decompression and reestablishment of vertebral body alignment. The approach permits posterior fusion at the same operation. If the postoperative CAT scan continues to show spinal cord embarrassment from anterior bony elements, an anterior approach can be performed for additional decompression and fusion. The posterolateral approach does not necessarily improve neurologic function. However, when compared with posterior instrumentation alone, it does help ensure canal reduction and alignment, which may aid recovery and hasten rehabilitation.

Adolescent↗
PubMed1985

Auditory evoked potentials in coma after closed head injury: a clinical-neurophysiologic coma scale for predicting outcome.

We studied auditory evoked potentials in 45 head-injured patients. All but three were comatose or stuporous at the time of study. Preservation of brainstem auditory or long-latency auditory evoked potentials predicted good outcome. The Glasgow coma scale (GCS), the clinical subtotal of the neurophysiologic coma scale (NPCS), and the NPCS had predictive accuracies of 71%, 82%, and 82%. Although there were 22 falsely pessimistic predictions with the GCS and 9% with the clinical subtotal of the NPCS, there were no falsely pessimistic predictions with the NPCS.

Adolescent↗
PubMed1985

Cause of decline in head-injury mortality rate in San Diego County, California.

Even with an increasing population, there were 100 fewer deaths due to head injury in San Diego County, California, in 1982 compared to 1980. During the 5 years from 1976 to 1980 there was nearly a constant death rate from head injuries, followed in the next 2 years by a decline of 24%. The number of deaths at the scene of injury declined 28%, and the number of individuals listed as dead on arrival at the hospital declined 68%. Mortality rates in the emergency room increased slightly and later death rates declined slightly. Mortality rates of hospitalized patients, adjusted for severity of injury, did not vary materially by year. This decline in deaths due to head injury followed a marked improvement in the county's emergency ground and prehospital air evacuation services. The data strongly suggest that advanced prehospital emergency medical services can substantially reduce mortality rates in head-injured patients. The authors postulate that some patients who ordinarily "would die now talk" because of early airway and circulatory management by highly trained paramedical personnel and airborne trauma specialists. Despite a search for other factors that might explain these observations, no satisfactory alternatives could be identified.

Brain Injuries↗
PubMed1984

Dimethyl sulfoxide for the treatment of intracranial hypertension: a preliminary trial.

Dimethyl sulfoxide (DMSO) has shown promise as a drug for the treatment of intracranial hypertension. In this report, we describe our experience in six patients, two who received a bolus administration of 10% DMSO and four who received a 20% solution titrated against the intracranial pressure (ICP). Five of the patients in this series suffered from severe head injury, and one had a cortical venous thrombosis associated with pregnancy. The first two patients were treated with a rapid infusion of a 10% solution of DMSO. Initially, the ICP was satisfactorily controlled using this method. Over time, however, fluid overload, severe electrolyte disturbances, and an ultimate loss of ICP control occurred. In subsequent patients, a 20% solution titrated against the ICP was used. Although ICP control was better achieved using this method of administration, problems with fluid management and electrolytes occurred again despite a high level of vigilance. In addition, because of the solvent properties of DMSO and its propensity over time to dissolve most standard intravenous infusion systems, mechanical difficulties in its administration were encountered in all six patients. The mechanism of action of DMSO is not well understood. It differs from the barbiturates, but acts too rapidly to function solely as a diuretic. The drug is extremely complex to use, and difficulties with its administration may make its risks ultimately greater than its potential benefits. Until more laboratory data are available concerning its use and better delivery systems are developed, neurosurgeons are cautioned against treating intracranial hypertension with DMSO.

Adult↗
PubMed1984

Traumatic acute epidural hematoma: unrecognized high lethality in comatose patients.

A series of 51 comatose patients suffering traumatic epidural hematoma after closed head injury is reviewed. This prospective series was accumulated from the National Pilot Traumatic Coma Data Bank during a 2-year period and represents 9% of all patients entered into the Data Bank. The overall mortality was 41%, with 4% remaining in the vegetative state. Fifty per cent of these patients, all of whom were in coma, also had an associated intracerebral contusion. There was no difference in outcome with regard to sex, mode of injury, or the presence or absence of contusion or shift on the computed tomographic (CT) scan. The motor score immediately before operation was the most powerful preoperative predictor of outcome. Sixty-seven per cent or two-thirds of the patients with a motor score of 4, 5, or 6 on the Glasgow coma scale had a satisfactory outcome at last follow-up examination. In contrast, in patients with a motor score of 3 or less, two-thirds either died or remained in a vegetative state. The acute traumatic epidural hematoma is often lethal in the comatose patient. We recommend early evacuation of epidural hematomas, i.e., when they are first noted on the CT scan, rather than waiting for clinical motor deterioration.

Acute Disease↗
PubMed1984

Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury.

The relationship of outcome to the appearance of the basal cisterns as seen on initial computerized tomography (CT) scanning was assessed in 218 consecutive severely head-injured patients entered into the second phase of the National Pilot Traumatic Coma Data Bank. Outcome could be directly related to the status of the basal cisterns on the initial CT scan. The mortality rates were 77%, 39%, and 22% among those with absent, compressed, and normal basal cisterns, respectively. This association between cisterns and outcome was shown to be strong after adjusting for Glasgow Coma Scale (GCS) score (p less than 0.001). The state of the cisterns was more important for those with higher GCS scores (scores 6 to 8) than for those with lower scores (scores 3 to 5). Patients with GCS scores of 6 to 8, with cisterns absent or not visualized, suffered nearly a fourfold additional risk of poor outcome, compared to those with normal cisterns. This indicates that the status of the cisterns can be used as an early noninvasive method of identifying patients at high risk of death or severe disability, in whom the initial neurological examination would potentially suggest otherwise.

Brain Injuries↗
PubMed1984

A model for predicting delayed intracranial hypertension following severe head injury.

A graph is presented for predicting delayed intracranial hypertension (intracranial pressure (ICP) greater than 30 mm Hg) for severely head-injured patients, based on a logistic regression model. Data gathered during the first 24 hours of patient observation are used to predict patient status during the subsequent 48 hours. The best predictor out of 10 factors analyzed was the peak ICP level during the first 24 hours (p less than 0.0001). Other predictors used in the final model were the presence of hypotension (p = 0.045) and abnormal ventricles--defined as ventricles which were either absent, small, or enlarged (p = 0.086). Error rates of 24% and 20% were obtained initially and by means of a separate cross-validation group, respectively. Use of a conservative cut point (25% estimated chance of developing excess ICP) for designating high-risk patients provided a procedure with sensitivity of 86% to 89% for the two groups.

Brain Injuries↗
PubMed1983

Modification of the effect of dimethyl sulfoxide on intracranial pressure, brain water, and electrolyte content by indomethacin.

Albino rabbits with experimental brain oedema produced by a combined cryogenic left hemisphere and a metabolic 6-aminonicotinamide lesion were given indomethacin (20 mg/kg) fifteen minutes prior to dimethyl sulfoxide (DMSO) treatment (1 g/kg bolus). Intracranial pressure (ICP), systolic arterial pressure (SAP), central venous pressure (CVP), and EEG were continuously measured while the animals were being mechanically ventilated at a constant PaCO2 (38-42 torr). At the end of the run, brain H2O and electrolytes were measured. There was no significant reduction in ICP at 5 minutes and 15 minutes after DMSO. This was strikingly different to what occurred when DMSO alone was administered, when a significant reduction was noted (p less than 0.05). At 30 minutes there was a reduction in ICP in both the DMSO and the DMSO/indomethacin groups, but in the former it was 50% of the pretreatment values while in the latter it was only 24%. Because indomethacin is a proven prostaglandin inhibitor, these results suggest that these substances may play a role in the mechanism of action of DMSO.

Animals↗
PubMed1983

Fatal epistaxis in craniofacial trauma.

Facial trauma often results in minor and infrequently results in major bleeding in the structures of the face. We have recently observed two patients who suffered fatal hemorrhages which could have been controlled using relatively simple measures. Treating physicians often overlook this serious and potentially life-threatening source of hemorrhage until the patient has been in shock for long periods of time and irreversible ischemic brain damage and renal failure have occurred. With careful attention to examination of the face and oropharynx, hemorrhage from these sites can be identified early and the appropriate measures taken to control epistaxis.

Adolescent↗
PubMed1983

Treatment of massive intraoperative brain swelling.

Massive intraoperative brain swelling is an infrequent but catastrophic occurrence. In this report, we describe the use of very large doses of thiopental as a means of treating such swelling. In our initial 11 cases (5 arteriovenous malformations, 4 hematomas, and 2 penetrating injuries), this approach produced the following outcomes: 6 patients made a good recovery, 2 are moderately disabled, 1 is severely disabled, and 2 are dead. These results indicate that this condition, which once was considered unmanageable, can indeed be managed and that treatment often results in an acceptable outcome. More recent experience in an additional 6 patients suggests that the use of planned deep thiopental anesthesia, with induced cerebral silence, during intracranial surgery may even prevent the occurrence of this phenomenon.

Brain Diseases↗
PubMed1983

The National Traumatic Coma Data Bank. Part 1: Design, purpose, goals, and results.

This paper describes the pilot phase of the National Traumatic Coma Data Bank, a cooperative effort of six clinical head-injury centers in the United States. Data were collected on 581 hospitalized patients with severe non-penetrating traumatic head injury. Severe head injury was defined on the basis of a Glasgow Coma Scale (GCS) score of 8 or less following nonsurgical resuscitation or deterioration to a GCS score of 8 or less within 48 hours after head injury. A common data collection protocol, definitions, and data collection instruments were developed and put into use by all centers commencing in June, 1979. Extensive information was collected on pre-hospital, emergency room, intensive care, and recovery phases of patient care. Data were obtained on all patients from the time of injury until the end of the pilot study. The pilot phase of the Data Bank provides data germane to questions of interest to neurosurgeons and to the lay public. Questions are as diverse as: what is the prognosis of severe brain injury; what is the impact of emergency care; and what is the role of rehabilitation in the recovery of the severely head-injured patient?

Accidents↗
PubMed1983

The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment.

The records of the first 325 patients entered into the pilot phase of the National Traumatic Coma Data Bank were reviewed. Thirty-four severely head-injured patients who talked prior to deteriorating to a Glasgow Coma Scale (GCS) score of 8 or less were identified. Of those 34 patients, 18 died or were left vegetative and 16 recovered. While there were certain common factors between those who talked and died and those who talked and recovered, there were also significant differences. The common factors between the two groups were the length of time to deterioration or operative intervention (16 versus 18 hours, respectively), and the initial GCS scores (12.6 versus 12.4, respectively). The primary differences between the groups included the mean age, the degree of midline shift seen on computerized tomography (CT), and the presence of subdural hematoma. Those who talked at some point postinjury, but who subsequently died, had a mean age of 50 years. Those who talked, deteriorated, and then recovered were found to have a mean age of 32 years. Seven of the 18 patients who talked and died had a shift of greater than 15 mm on CT, while this degree of shift was demonstrated in only one of 16 patients who talked, deteriorated, and recovered. Subdural hematomas were significantly more common in the "talk and die" group, as was the overall need for operation. Since the overwhelming majority of patients with marked shift on CT have surgical lesions, early operative intervention is strongly recommended in these patients, prior to their inevitable deterioration.

Brain Injuries↗
PubMed1982

Comparison of the effects of DMSO and pentobarbitone on experimental brain oedema.

The purpose of this report is to compare the effect of acute therapy with dimethyl sulphoxide (DMSO) and pentobarbitone on experimental brain oedema produced by a cryogenic lesion over the left hemisphere in albino rabbits. A group of animals received DMSO (1 mg/kg-10% solution) by intravenous bolus, and another group received a pentobarbitone intravenous 30-minute infusion (40 mg/kg). Intracranial pressure (ICP), systolic arterial pressure (SAP), central venous pressure (CVP), and EEG were studied. Brain water and electrolyte content were analyzed at one hour following the initiation of therapy. ICP was promptly reduced with both forms of therapy. A 66% reduction from control values was reached at 50 +/- 12 minutes with pentobarbitone, and a 45% reduction from control values was reached at 30 minutes with DMSO. There was no significant reduction in the water content of the brain with either form of therapy. A significant elevation in brain potassium content was noted following DMSO when compared to untreated controls. CVP was essentially unchanged in both groups. Pentobarbitone produced a reduction of SAP with a mean value of 20.3 torr at 45 minutes from infusion. DMSO produced no reduction of SAP. It is concluded that DMSO and pentobarbitone are just as effective in reducing ICP. DMSO has the capacity to maintain SAP which pentobarbitone does not have, thus assuring a better cerebral perfusion pressure.

Animals↗