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Biomedical subjects

R Neff

Publications and source records attributed to R Neff.

14 recordsLinked to original sources

Gallstone pancreatitis: combined endoscopic and laparoscopic approaches.

Of 11 patients with gallstone pancreatitis, 10 underwent preoperative ERCP. Calculi were removed from the common duct in two patients. All patients underwent laparoscopic cholecystectomy, with normal rapid convalescence. The eleventh patient is recovering from pancreatitis with the bile duct accessed percutaneously. A combined endoscopic and laparoscopic approach to gallstone pancreatitis is safe and was associated with minimal risk in this small series.

Adult

Grand mal seizure after extradural morphine analgesia.

Following an elective Caesarean section under extradural anaesthesia, a 30-yr-old known epileptic woman (gravida 4, para 3) developed a tonic-clonic seizure, 6 h after the administration of morphine 3 mg into the extradural space. Possible aetiological factors are discussed.

Cesarean Section

Diastolic flow as a predictor of arterial stenosis.

With a pulsed Doppler imaging system, it is now possible to interrogate sites from the aorta to the popliteal trifurcation. To determine which velocity parameters could be correlated with the degree of disease as determined by angiography, 34 arterial stenoses identified by scanning were also evaluated by contrast arteriography and classified in 10% increments. The angiographic readings were blinded with respect to the scan results. Four hand-measured parameters from velocity waveforms obtained at the site of stenosis were correlated with the angiogram--peak systolic velocity, systolic rise time, diastolic reverse velocity, and diastolic reverse flow time. When diastolic reverse flow was absent, diastolic forward flow was recorded. To describe diastolic flow along a continuum, diastolic reverse velocity was ascribed a positive value and diastolic forward velocity was ascribed a negative value. A systolic velocity gradient (peak velocity/rise time) was also calculated. The relationship between the angiographic categories and the measured parameters was evaluated with the Jonkheere-Terpstra trend test. A trend was determined with diastolic flow (diastolic reverse flow or diastolic flow velocity) that was significant (p less than 0.01). The linear regression was calculated (y = 40.8 + [-5.6X]), and correlation coefficient was obtained (r = 0.76) that was statistically significant (p less than 0.01). The method enables mapping and calculation of arterial stenoses by noninvasive means. This can be expected to obviate the need for diagnostic angiograms in certain and select cases in which angioplasty can be expected to be beneficial. It also affords a convenient quantitative means of following lesions over time.

Angiography

Intracranial blood clot volume and geometric parameters determined from CT images.

A method of determining intracranial blood vlot volumes from CT images data is presented. This technique avoids dependence on regular geometric volume approximations. Studies are presented on phantoms of known volume (ranging from 3.5 to 108 cm3) but with varying size, shape, and density relative to the surrounding medium. For a wide range of differential densities across the boundary, these phantom results indicate that volumes may be calculated to an accuracy generally better than +/- 2 cm3. A series of clinical cases, principally hypertensive intracranial hemorrhages, have been studied to demonstrate the technique. Three-dimensional axes, which allow clot localization relative to cerebral anatomy, are defined using the anterior/posterior falx attachment points and the dorsum sellae. Clot volume, center of mass, vector of clot expansion, and shift of anatomical structures are determined. Correlation of these data with clinical outcome and surgery is discussed.

Cerebral Hemorrhage

Multivariate analysis of risk of perinatal telencephalic leucoencephalopathy.

The hospital and autopsy records of 40 infants who died with perinatal telencephalic leucoencephalopathy (PTL) (hypertrophic astrocytes and amphophilic globules in telencephalic white matter) were compared to those of 76 control infants who had no white matter abnormality. A linear discromination procedure, which takes into account multiple confounding factors, was used to estimate risk ratios. PTL was found more commonly in infants who (a) had bacteria isolated from blood at autopsy, (b) received intravenous glucose and water for more than one day, or (c) received kanamycin or streptomycin. Infants were at reduced risk if they received penicillin, atropine, mercurhydrin or a transfusion of whole blood. It is hypothesized that endotoxin from bacteremia adversely affects developing white matter and that the other risk factors of PTL are markers of, or contributors to, increased risk of gram negative infection. No evidence was found for antibiotic-endotoxin interaction. The factors that are associated with reduced risk of PTL may be markers of, or contributors to reduced risk of gram negative infection.

Brain Diseases

Fetal death in eclampsia: II. The effect of non-therapeutic factors.

The ability of 15 variables to predict fetal death is examined among 173 eclamptic women admitted to the only public maternity hospital in Cali, Colombia, between 1st Janurary 1964 and 31st December 1970. In addition to low gestational age and retarded fetal growth, high systolic pressure and the unmarried status carried excess risk. Primiparae appeared to be of lower risk because their eclampsia tended to occur late in gestation and was characterized by less retarded fetal growth. Older women and women with a history of abortion appeared to be of higher risk because they tended to have higher systolic pressures. A discriminant function risk formula is presented which generated groups with a nine-fold difference in fetal death rates. This formula could be used to standardize for relevant non-therapeutic factors which meant vary between patient groups who had received different therapeutic regimens.

Abortion, Spontaneous

[Iskedyl and general anesthesia. Measurement of the systolic ejection volume and peripheral resistance using the arterial pressure curves].

ISKEDYL (PF 50), which is sold as a vasoregulator of cerebral irrigation, consists of a mixture of dihydroergocristine and raubasine. This work aims at determining possible interactions between this product and certain drugs used in anesthesia from the cardiovascular point of view. ISKEDYL does not seem to be a contraindication to anesthesia of the "neuroleptic" type, when injected in pre-, per- or post-operative period. A slight temporary and spontaneously reversible fall in arterial blood pressure, affecting both maximum and minimum pressure, together with a decrease in stroke volume and peripheral resistances, estimated by the study of the arterial blood pressure curve, seem to indicate that this product has peripheral vaso-dilatory properties.

Anesthesia, General