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Biomedical subjects

R F Spetzler

Publications and source records attributed to R F Spetzler.

At least 253 records · Page 14Linked to original sources
PubMed1984

New lumboperitoneal shunt catheter.

A new catheter is described for percutaneous lumboperitoneal shunts. The method of introduction and indications for this shunt are reviewed.

Catheterization↗
PubMed1983

Phenytoin-induced agranulocytosis after treatment for a gunshot wound to the face.

A case of phenytoin-induced agranulocytosis is presented. This syndrome is characterized by a decrease in the blood neutrophil count to very low levels. Patients are generally asymptomatic, but they may become febrile and develop an infection, which is frequently fatal. Practitioners treating trauma patients or other patients in whom phenytoin treatment is initiated should be aware of the potential development of agranulocytosis.

Adult↗
PubMed1983

Ineffectiveness of DMSO in treating experimental brain ischemia.

A beneficial effect of dimethyl sulfoxide (DMSO) in the treatment of acute focal cerebral ischemia has not been proven. In the present study, two established experimental models of acute focal cerebral ischemia were treated with DMSO. Twenty adult cats lightly anesthetized with ketamine hydrochloride underwent right middle cerebral artery (MCA) occlusion for 6 hours. Ten cats were not treated and 10 cats received DMSO (2.5 g/kg i.v.) immediately after occlusion. No improvement of EEG findings, erythrocyte transit, regional cerebral blood flow (rCBF), blood-brain barrier permeability, or morphological findings were demonstrated in the DMSO-treated cats. In a second study, 15 conscious adult baboons underwent temporary left MCA occlusion (6 or 12 hours) using an implanted occluding device. Seven baboons were not treated and 8 baboons received continuous intravenous infusions of DMSO for 10 hours beginning 30 minutes after occlusion. Four of the baboons that were treated with DMSO also were treated with pentobarbital coma for 96 hours starting 4 hours after occlusion. Analysis of the neurological scores after 1 week survival indicated that treatment with DMSO alone and DMSO and pentobarbital coma did not improve the outcome. Morphological changes were similar in the 3 groups. The findings of our investigation indicate that DMSO is ineffective in treating acute focal cerebral ischemia.

Animals↗
PubMed1982

Cerebral revascularization during barbiturate coma in primates and humans.

Extracranial-intracranial arterial bypass was performed in five baboons to assess the effectiveness of the procedure in preventing acute cerebral ischemia following middle cerebral artery occlusion in our primate model. Thirty minutes following middle cerebral artery occlusion, the animals were placed in barbiturate coma while the extracranial-intracranial artery bypass was being completed. In the three animals with patent extracranial-intracranial arterial bypasses, infarction was prevented. In the two with occluded extracranial-intracranial arterial bypasses, a large infarction in the territory of the middle cerebral artery occurred. In a clinical correlate, postoperative ischemia was presumably prevented in three patients by barbiturate administration and revascularization for unanticipated intracranial vessel occlusion.

Animals↗
PubMed1982

Revascularization of the rostral brain stem.

The clinical and angiographic diagnosis of rostral brain stem vascular insufficiency is reviewed. The various possibilities for surgical revascularization of this area include anastomosis of the superficial temporal or occipital artery to the main stem of the posterior cerebral or superior cerebellar artery of their branches. A new technique for anastomosing the superficial temporal artery to the posterior cerebral artery in the tentorial incisura is presented, and other methods of rostral brain stem revascularization are considered. Indications for revascularization of the rostral brain stem are not clearly defined, but should include clinical and angiographic evidence of upper brain stem ischemia.

Angiography↗
PubMed1982

Barbiturate coma in focal cerebral ischemia. Relationship of protection to timing of therapy.

The therapeutic application of barbiturate-induced coma was evaluated in a primate model of focal cerebral ischemia. A standardized regimen of pentobarbital was used, and the times of initiation of administration were varied following a 6-hour middle cerebral artery occlusion in baboons. Three groups of five animals were treated at 30, 120, and 240 minutes after occlusion, while one group of five animals received no barbiturate therapy. Complete protection from intracranial pressure (ICP) elevation and ischemic damage was seen only in the group treated at 30 minutes. Those treated at 120 minutes, while doing better than untreated animals, still had ICP elevation and a marked neuropathological deficit. Animals treated at 240 minutes suffered a detrimental effect, in that malignant ICP and marked ischemic damage occurred earlier than in the untreated animals. The safe "therapeutic window" for barbiturate-induced coma in this animal model does not extend beyond 2 hours. Delayed administration results in a deleterious response and not merely a lack of protection.

Animals↗
PubMed1982

Occipital artery to posterior inferior cerebellar artery bypass for vertebrobasilar ischemia.

Fourteen patients who underwent occipital to posterior inferior cerebellar arterial bypass are reviewed. All of the patients were treated for severe vertebrobasilar ischemia secondary to lesions of the distal vertebral artery. There was no operative death or permanent postoperative morbidity. On follow-up evaluation (averaging 13 months after operation), there has been 100% graft patency and a noticeable improvement in the neurological function in all patients. Operating with the patient in the prone position and avoiding intraoperative hypotension help to minimize the operative morbidity from this procedure.

Adult↗
PubMed1981

Barbiturate resuscitation from focal cerebral ischemia--A review.

Barbiturate therapy has been shown to be of benefit in certain instances for focal cerebral ischemia. This therapy can, however, result in a deleterious outcome. Early institution in combination with revascularization appears to be important for successful barbiturate application. Whether combinations of agents designed to act on different mechanisms in the pathophysiology of cerebral ischemia can prolong the 'therapeutic window' of barbiturate application is an area for future investigation.

Animals↗
PubMed1981

Management of prolonged therapeutic barbiturate coma.

Barbiturate administration for protection from focal ischemia was evaluated in baboons. All animals were monitored for 96 hours in an intensive care unit during various regimens of pentobarbital administration. Intermittent bolus injections of barbiturate yielded inconsistent electroencephalographic responses and produced the most cardiovascular instability. Continuous barbiturate infusion safely allowed the greatest amount of barbiturate to be employed with the most stable electrophysiological and cardiovascular response.

Animals↗
PubMed1981

The radiographic anatomy of surgical extracranial-intracranial anastomoses.

Microvascular surgical techniques have been developed that allow anastomosis between extracranial arteries and cortical branches of intracranial arteries distal to a stenotic, occluded, or diseased arterial segment. Indications for this procedure other than cerebrovascular occlusive disease are discussed. The radiographic anatomy of the various surgical bypasses is described.

Adult↗
PubMed1981

Intrachiasmatic arteriovenous malformation. Case report.

A patient presented with an abrupt monocular decrease in visual acuity and a bitemporal hemianopsia. At surgery, a totally intrachiasmatic arteriovenous malformation was removed, with subsequent resolution of the visual deficit.

Adult↗
PubMed1981

Late complications of carotid ligation in the treatment of intracranial aneurysms.

The results in 57 consecutive patients treated with carotid ligation for an intracranial aneurysm were analyzed to define the risks of late complications. The average age for the group was 46 years. Eighty percent of the aneurysms were located on the internal carotid artery (ICA). The acute morbidity and mortality of the treatment and the natural history of the disease was 29%. Twenty-four patients were discharged with a common carotid artery (CCA) ligation, and 21 patients with an ICA ligation. Three patients from each ligation group could not be located for review. The follow-up period for the 21 patients with CCA ligation ranged from 1 to 15 years, with an average of 8.4 years, and for the 18 patients with ICA ligation it ranged from 2 to 19.5 years, with an average of 12.5 years. Excluding deaths from unrelated causes, five of the 21 patients with CCA ligation developed a late complication. Two patients had a transient ischemic attack (TIA). Two patients had a subarachnoid hemorrhage (SAH), one of which was fatal and was preceded by a TIA. Two patients developed monocular blindness. None of the patients had a stroke. Excluding deaths from unrelated causes, five of the 18 patients with ICA ligation developed a late complication. One patient had a fatal SAH. Three patients had a TIA, two of which were followed by a stroke. One patient had a stroke in the cerebral hemisphere contralateral to the side of the carotid ligation.

Adult↗