[New concepts concerning hemodynamics of cerebral circulation].
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Biomedical subjects
Publications and source records attributed to S Hakim.
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A case of massive hepatic necrosis has been found to have intense, diffuse accumulation of Tc-99m HMDP in the liver. A review of three similar cases revealed that diffuse intense uptake of bone-scanning agents is a grave prognostic sign.
The course and complications of pregnancies in 46 patients with valvular disease and congestive heart failure with or without valve prostheses are described. In group I consisting of 33 women without valve replacement and without anticoagulant therapy one thromboembolic event was seen, emergency closed or open heart surgery was necessary five times. One still-birth happened after open heart surgery. In group II, of 13 patients with prosthetic valve replacement and anticoagulation therapy there was no thromboembolism, but 2 spontaneous abortions and 2 premature stillbirths; 2 fetuses died after delivery, 3 had congenital abnormalities. Pregnancies in patients with valvular disease and congestive heart failure can be sustained relatively safely for the mother, even if emergency heart surgery becomes necessary. Heart surgery and anticoagulation treatment carry a higher risk for the fetus. Uterine blood loss is not increased, if coumadine treatment is switched to heparin administration shortly before delivery.
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It is intended for this research, to provide some basis for the understanding of the rational mechanics of the cranial content. There are many interesting and controversial facts derived from the experimental and clinical-pathological observations of hydrocephalus and increased intracranial pressure. For instance, in some patients a moderate increase of intracranial pressure is accompanied by hydrocephalus and mental changes, while in others, with high intracranial pressure, the ventricles and mental functions remain unaltered. What then is the parameter that changes the size of the ventricles and impairs brain function? It is shown how the transmission of intraventricular pressure throughout the brain parenchyma creates a stress distribution that varies in magnitude; how during the production, maintenance, and reversal of hydrocephalus, and normal pressure hydrocephalus the stress is distributed throughout the brain; and how in the presence of a sudden increase of intracranial pressure nature has arranged additional mechanisms for protecting the brain. It is important to recognize that some aspects of intracranial physiopathology can be explained through classical concepts of physics, prior to attempting to interpret such processes solely in terms of biological or auto-regulatory phenomena.
The authors present a technique involving placement of a catheter in the third ventricle in shunt systems for hydrocephalus, in order to avoid obstruction of the proximal catheter by particles of chorioid plexus. They emphasize the simplicity of the technique, lack of morbidity, and the good results they have obtained in 30 cases with a follow-up from six to 40 months.
A new surgical technique is described for the treatment of benign cystic tumors of the third ventricle. It basically consist of: 1) introduction of a catheter to the third ventricle, therefore to the cyst; 2) suction of all the material of the cyst; 3) connection of the catheter to a ventriculoatrial shunt. A report of five patients with a possible colloid cyst in the third ventricle treated with this technique and the satisfactory results obtained in all the cases, with lack of morbidity and mortality, is presented. A comparison between the traditional surgical procedure and ours, as far as the technique itself and the results are concerned, is made. The simplicity of the technique is emphasized and it is proposed as another solution for the treatment of cystic tumors of the third ventricle.
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