Neuropharmacology of depression, anxiety, and pain.
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Animals↗
Biomedical subjects
R B King
Publications and source records attributed to R B King.
Research, research training, and neurological surgery.
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Neurosurgery↗
Intradiploic cerebrospinal fluid fistula. Report of two cases.
Two patients with asymptomatic osteolytic skull lesions were found to have cerebrospinal fluid diploic fistulas. The radiographic and operative findings have not been reported previously.
Bone Resorption↗
Traditions, transition, and the torch. The 1981 AANS presidential address.
The President of the American Association of Neurological Surgeons (AANS) emphasizes the need to participate actively in the burgeoning field of neuroscience, and the unique opportunity of neurological surgeons to apply the new knowledge to the treatment of their patients. Clinician-investigators need to be trained in their formative years in the methodology and techniques of modern neurobiology. Diminishing governmental support for training poses a grave threat to carrying on the tradition of research in neurological surgery. To meet a critical need, the formation of a Research Foundation is announced as a function of the AANS. As Science is expanded and applied, the Art of neurosurgery will continue to be refined, along with the high tradition of Ethics which has been handed down over the years as part of the heritage of neurological surgeons.
Foundations↗
Femoropopliteal vein grafts for intermittent claudication.
Femoropopliteal vein grafts were performed for intermittent claudication in 160 patients (182 legs) over a 12-year period. The accumulative patency rate was 67 per cent at 5 years. However, patency rates improved significantly in the latter 6 years of the study, to 75 per cent at 5 years. Early postoperative occlusion and morbidity rates also markedly declined in this latter period. Patency rates were significantly better in males than in females, in patients who were able to stop smoking after operation and in legs with a three-vessel run-off compared with those with a two- or one-vessel run-off. The patients' age did not influence graft patency rates.
Adult↗
Massive haemorrhage caused by left renal vein ligation.
It is common practice to ligate the left renal vein during aortic surgery. Although this does not usually lead to complications we report 2 patients in whom left renal vein ligation caused massive venous congestion of the kidney and major retroperitoneal haemorrhage. Nephrectomy was necessary to control the haemorrhage. In 1 patient immediate autotransplantation preserved renal function.
Aged↗
Femoropopliteal bypass using polytetrafluoroethylene.
Reinforced expanded polytetrafluoroethylene (PTFE) was used as a femoropopliteal bypass graft in 31 patients (37 operations). The indications were intermittent claudication (13 operations), severe ischaemia with rest pain or gangrene (20 operations), and prophylactic treatment of popliteal aneurysms (4 operations). The one-year accumulative patency rates were 75% for patients with intermittent claudication and 20% for patients with severe ischaemia. In three patients with claudication, graft thrombosis led to amputation in spite of attempted graft thrombectomy. These results compare unfavourably with our experience using autogenous vein, in which the one-year accumulative patency rates were 80% for claudication and 70% for severe ischaemia, and in which failure of the bypass graft for claudication rarely made the patient worse.
Aged↗
Pain and tryptophan.
Tryptophan, the precursor for serotonin, was given to five patients with recurrent pain and diminished sensory deficits following rhizotomy and cordotomy. Their sensory deficits for both touch and pinprick reexpanded to the maximum extent initially recorded after their operative procedures. Their pain was again relieved. No clear understanding of the mechanisms responsible for these changes can be proposed at this time. It is speculated that a metabolic modulation of neurotransmitter functions is responsible for the clinical observations.
Adult↗
Rehabilitation of the patient with a spinal cord injury.
The goal of rehabilitation of the person with spinal cord inury is to enable the individual to live successfully in the community. This implies that persons are prepared to care for themselves (or to direct others in their care) and are independent to the greatest extent possible. They are also able to maintain a healthy and adjusted social and vocational life. Independent living centers, providing access to services such as attendant care, have allowed the most severely disabled perons to live indenpendently in the community.
Activities of Daily Living↗
RIC-Wu catheter kit: new device for an old problem.
A new catheter kit has been developed for sterile urethral catheterization. It is useful for any patient requiring catheterization but has special advantages for the spinal cord injured person with a neurogenic bladder. The RIC-Wu Catheter Kit is simply a straight rubber catheter contained in a sterile clear plastic bag with one end formed into a restricted sterile field and the other into a tear-off chamber for urine laboratory testing. In clinical trials the RIC-Wu Catheter Kit has been found to have several advantages over the conventional sterile catheter tray: staff or self-catheterization is usually easier, faster and can be carried out with the patient sitting in a wheelchair in any private place; it is pocket sized and can be less expensive; less professional staff time is expected for a catheterization program; catheterization-induced infection rates are expected to be the same or less.
Adolescent↗
Observations on the validity of using "NEN-TRAC" microspheres for measuring organ blood flow.
"NEN-TRAC" brand of radioactive microsphere, 15 micron in diameter, have recently become available and therefore organ blood flow (Q) values obtained using these have been compared with values simultaneously obtained with the well-established "TRACER" brand of microspheres. For all major tissues of the body of two conscious sheep, there was excellent agreement between Q values obtained using NEN-TRAC Ce-141 and TRACER Sr-85 in one sheep, and between Q values obtained using NEN-TRAC Ce-141 and Sn-113 and TRACER Cr-51, Sr-85 and Nb-95 in a second sheep. It is concluded that NEN-TRAC microspheres satisfy the major validation tests to which TRACER microspheres have been previously subjected, and therefore it is valid to proceed with use of the new product.
Animals↗
Regional distribution of blood flow in awake heat-stressed baboons.
Radioactive microspheres (containing six different nuclide labels) were used to measure blood flow (BF) to most major organs of eight conscious baboons during heat stress. Cardiac output (CO), arterial mean pressure, and arterial PO2, PCO2, and pH did not change, but heart rate increased and stroke volume fell as body temperature increased by as much as 2.56 degrees C. Skin BF increased in all regions sampled so that the fraction of CO distributed to skin (not including feet and hands) increased from 3% (control) to 14%. Increased skin BF was compensated for by decreases in splanchnic (intestines, stomach, pancreas, and spleen) (35%), renal (27%), and possibly muscle BF. There was no change in BF to the brain, spinal cord, coronary, or subcutaneous adipose tissue during heating. Therefore, baboons show a generalized redistribution of BF during heat stress, so that increments in skin BF are provided without increases in CO, whereas man depends on changes in both; despite this latter difference between the baboon and man, the similarity in magnitude of the splanchnic and renal vasoconstriction between the two primates may indicate that the baboon would be a suitable animal model for investigations into mechanisms of changes in regional blood flow in man during heat stress.
Adipose Tissue↗
Principles of pain management. A short review.
Information that contributes to our understanding of the processes that participate in the perception of and responses to pain has expanded rapidly in the last decade. Much of this information and many clinical observations demand new conceptual frameworks within which to modify and expand classical teachings of pain pathways and mechanisms. In this brief review, some of these new dimensions are considered. The limited references serve as an introduction to more comprehensive original and review material.
Afferent Pathways↗
The management of intermittent claudication.
Many patients with intermittent claudication improve due to development of collateral vessels. Only a small proportion worsen, and few progress to severe ischaemia with the risk of amputation. Accordingly, most patients can be reassured and treated expectantly. Those patients have a reduced life expectancy compared with the population at large. Thus, surgical treatment should be reserved for patients who are severely restricted by claudication. The early technical results of arterial reconstruction for claudication are excellent. However, the late results are much worse in patients who continue to smoke. Nowadays, the complication rate from surgery is low.
Adult↗
Peripheral arterial embolism.
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Australia↗
The effect of smoking on the late patency of arterial reconstructions in the legs.
In a retrospective study of 217 patients, smoking habits were related to the late patency rates of arterial reconstructions performed for ischaemia of the legs. Patients who had stopped smoking or who smoked no more than 5 cigarettes per day after the operation had late patency rates of approximately 90 per cent for aortofemoral reconstructions and 80 per cent for femoropopliteal vein grafts. Patients who continued to smoke more than 5 cigarettes per day were approximately three times more likely to block an aortofemoral reconstruction and four times more likely to block a femoropopliteal vein graft. The results were similar for males and females, for various age groups, for claudicants and patients with severe ischaemia and for aortofemoral endarterectomy and Dacron grafts. The late patency rate was approximately inversely proportional to the number of cigarettes smoked per day after the operation. There was no such correlation with the number smoked per day before the operation.
Aged↗
Surgical treatment of the severely ischaemic leg: I. Survival rates.
Over a 10-year period, 411 patients with atherosclerotic major artery disease causing severe ischaemia of the legs were treated by surgery. Their survival rate, assessed by the life table method, was 80 per cent at 1 year and 50 per cent at 5 years. Early and late survival rates were significantly worse in elderly patients, and in patients with extensive gangrene. Late survival rates were significantly worse in diabetics, and in patients with clinical myocardial ischaemia. Patients treated by arterial reconstruction showed a better survival rate than those treated by sympathectomy or amputation, though the latter groups contained more poor risk patients. Survival rates were not influenced by the technique of reconstruction.
Aged↗