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Biomedical subjects

T B Ducker

Publications and source records attributed to T B Ducker.

At least 73 records · Page 4Linked to original sources
PubMed1985

Increased susceptibility of patients with cervical cord lesions to peptic gastrointestinal complications.

The incidence and risk factors in the development of hemorrhaging and perforating gastrointestinal (GI) lesions in 408 patients with cervical column/cord injury were studied retrospectively. Most injuries were caused by blunt trauma (94.1%). Male patients predominated (83.6%); the mean patient age was 35.8 years. Of the 408 patients, 190 (46.6%) had complete cord deficits, 111 (27.2%) had incomplete deficits, and 107 (26.2%) were intact. Admission shock (systolic BP less than 100 mm Hg) was present in 31.6% and 20.7% of patients with complete and incomplete lesions, respectively, and in 4.7% of those intact. Patients with complete deficits received corticosteroids for 2 days; patients with incomplete deficits received them for 7 to 10 days. Eleven of the 107 intact patients (10.3%) received steroids. All patients received standard antacid therapy. Nine patients without previous GI disease developed peptic ulcerations: six gastric and three duodenal lesions (six were perforated) that required surgical intervention; all occurred in patients with complete deficits. Both the 4.7% incidence of the lesions in those patients compared with the other victims of cervical trauma and an estimated 0.1% incidence among more than 6,000 other seriously injured patients are significant (p less than 0.005, p less than 0.001). Steroids were not an ulcerogenic factor.

Adolescent↗
PubMed1984

Estrogen and progesterone receptors in meningiomas.

Two-thirds of all meningiomas and four-fifths of intraspinal and sphenoidal meningiomas occur in women. Meningiomas frequently enlarge or become symptomatic during pregnancy or during the luteal phase of the menstrual cycle. There is an increased incidence of meningiomas in women with breast carcinoma. In a series of 23 patients with meningiomas, the authors assayed biopsy specimens of the tumor for the presence of estrogen (ER) and progesterone (PR) receptors, using glycerol density gradient centrifugation and dextran-coated charcoal techniques. Significant levels of ER were found in only 17% of the patients, while significant PR levels were detected in 39%. Only one of the 16 tumors from female patients had significant ER levels, whereas three of the seven tumors from men had significant ER levels. Eight of the 16 tumors in women had significant PR levels, whereas only one of the seven tumors in men had a significant PR level. Thus, three out of four tumors with definite ER were from men, whereas eight of nine tumors with definite PR were from women. Of the eight women whose tumors contained PR, three were premenopausal and five postmenopausal. The single tumor with high levels of PR in the male patient was histologically atypical. The results of this series were compared with six published series of sex steroid assays in meningiomas. These seven series were divided into two groups: one group included two reports from the same laboratories in France, and the other the remaining five reports. Much higher percentages of both ER- and PR-positive tumors were reported from the French group. The authors suggest that this discrepancy may be due to the use of preoperative glucocorticoid therapy in the series from the United States. Since meningiomas are known to enlarge during periods when levels of circulating progestins are high, the presence of significant quantities of PR in a high percentage of tumors may have therapeutic implications for recurrent, malignant, or incompletely excised tumors, or for medically fragile patients. Conversely, since meningiomas are not known to enlarge during the proliferative phase of the menstrual cycle or with exogenous estrogen therapy, the small number of tumors positive for ER may indicate that ER lacks clinical significance. High levels of PR found in a small group of histologically aggressive tumors in several series may indicate that hormonal therapy may be especially useful in this difficult subset of patients.

Adult↗
PubMed1983

Recovery from spinal cord injury.

There are many classifications of spinal cord injury. The anatomic definitions help in understanding the pathophysiology but are less useful in calculating recovery. Basic classifications, such as those by Guttman and Frankel, are useful for epidemiological studies, especially if one wishes to compare patients internationally or to compare data bases but this information, except in complete lesions, is too limited to allow more refined calculations as to the effectiveness of treatment modalities, especially in partial lesions. An accurate motor index, such as we have described, or such as the Yale index (2), is needed for more specific calculations of recovery if any prediction about the efficacy of various treatments are to be made. We have described our data from the mid-1970s in detail to explain our current treatment protocols. While nothing can be done for the completely paralyzed patient, our treatment of the acute (transiently concussed) near complete lesion and partial lesion must be tailored to maximize recovery. The fact that patients with initially complete motor lesion show some motor recovery in 15% indicates that some lesions are reversible and that we should try to learn to identify these patients and treat them to maximize their recovery. Certain severe partial lesions show poor recovery; we must improve therapy for these patients. Patients with partial lesions and 25-30% motor power below the injury have an 80% (+/- 20%) recovery; we should strive to attain and improve on these good results by appropriate medical and surgical management. In sharing with you our methods and data, we have provided these preliminary conclusions which influence our behavior as neurosurgeons, but it is equally clear that much work still needs to be done. This chapter should represent a reference source with which we can continue to work.

Humans↗
PubMed1983

The diagnosis of intra-abdominal injury in patients with cervical cord trauma.

A review of the records of 288 patients sustaining blunt cervical column and/or cord injuries revealed that twelve (4.2%) had significant intra-abdominal injuries, all occult, and all detected by peritoneal lavage. Three of 58 patients in shock (BP less than 100 mm Hg) with neurologic deficits were found to have intra-abdominal injuries. Shock in another 15 was the result of major associated injuries and/or the loss of sympathetic vascular tone. Thus 40 of these 58 patients (69%) had neurogenic shock. An analysis of the mechanisms of injury and associated injuries indicated that those at risk of having significant intra-abdominal injury are those who have been injured in a vehicular crash and those who have other obvious major injuries that can cause shock. The data indicate that patients not at risk of having intra-abdominal injury can be selected for early attempts at anatomic cervical realignment in an effort to achieve return of neurologic function.

Abdominal Injuries↗
PubMed1983

Bilateral facet to spinous process fusion: a new technique for posterior spinal fusion after trauma.

A variety of options exist for the treatment of fracture/dislocation of the cervical spine, including prolonged traction immobilization, immobilization in an external device, and open surgical fusion. In cases of facet dislocation and flexion/compression injuries, the authors have found that surgical fusion is the most useful. However, in cases of facet fracture or disruption of the posterior neural arch, routine interspinous wiring techniques do not provide adequate rotational stability and may allow postsurgical redislocation before bony fusion. For these cases, a new technique using bilateral facet to spine wire loops has been developed. In the 25 cases reported here, the technique provided excellent stability against anterior horizontal displacements and rotational dislocations despite unilateral or bilateral facet fracture or disruption of the posterior neural arch.

Cervical Vertebrae↗
PubMed1982

Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma.

Before the advent of the operating microscope and the carbon dioxide laser, reoperations were performed in less than 5% of patients with malignant astrocytoma. Between 1978 and 1981, a consecutive series of 74 adult patients were prospectively treated therapy, all patients eligible for further treatment were offered reoperation with the microscope and/or laser before treatment with Phase I agents (microwave hyperthermia, dimethyl sulfoxide (DMSO)-Adriamycin, DMSO-Cytoxan, or azaridinylbenzoquinone (AZQ)). Forty-six per cent of the patients were referred from outside institutions for intensive treatment. In 36 months, 40 patients received second operations directed at their tumor and had a median calculated survival from the time of reoperation of 37 weeks. The length of survival after the second operation was independent of patient age, performance status, tumor grade, and interoperative interval. Sixty-five per cent of patients under 40 and 48% of patients over 40 underwent reoperation with minimal morbidity and no deaths. The single most important prognostic factor for survival in both reoperated and single-operated patients was age. Tumor grade had no influence on survival in the series as a whole, in patients under 40 years of age, or in reoperated patients. The calculated median survival for the entire series was 15 months, with a predicted 2-year survival rate of 0.25. These figures include all patients treated without exclusion for incomplete radiotherapy or chemotherapy. It is concluded that reoperation for malignant astrocytoma is safe, feasible, and of potential benefit in combination with other therapies. The routine use of reoperation to "set up" other treatment modalities deserves further study.

Adolescent↗
PubMed1982

Alterations in neurological function in head-injured patients experiencing major episodes of sepsis.

More than 300 head injuries per year are evaluated by the neurotrauma team at the Maryland Institute of Emergency Medicine. Although most of the injuries follow motor vehicle accidents, a significant number also follow industrial accidents or acts of personal violence. Approximately 25% of patients with serious head injuries have associated episodes of sepsis--commonly because of other bodily injuries. We have identified a syndrome characterized by encephalopathy and/or accentuation of focal neurological dysfunction in head injury patients that presents during episodes of sepsis and that occurs in the absence of meningitis. Aggressive fever management alone does not reverse the encephalopathy. Neurodiagnostic studies reveal no focal changes. The intracranial pressure often remains normal or unchanged, and no improvement is evident after the empirical administration of standard doses f steroid or osmotic agents. The patient's neurological condition returns to base line once the sepsis has been eradicated. Ongoing investigations suggest an immunological basis for this abnormality.

Adult↗
PubMed1982

Evoked potentials in the clinical neurosciences.

The use of evoked potentials for the evaluation of disorders of the nervous system has become a most valuable aid to the neurosurgeon and neurologist, often providing information of critical value without recourse to invasive techniques. In order to employ these techniques, it is helpful to understand the principles of evoked potential electrogenesis and the methodology used for analysis of evoked potential clinical data. This article is aimed at providing the clinical neurosurgeon with this type of information and with a review of current clinical applications in this rapidly developing field.

Action Potentials↗
PubMed1982

Effect of intracranial pressure monitoring and aggressive treatment on mortality in severe head injury.

During 1977-1978, 127 patients with severe head injury were admitted and underwent intracranial pressure (ICP) monitoring. All patients had Glasgow Coma Scale (GCS) scores of 7 or less. All received identical initial treatment according to a standardized protocol. The patients' average age was 29 years; 60% had multiple trauma, and 35% needed emergency intracranial operations. Treatment for elevations of ICP was begun when ICP rose to 20 to 25 mm Hg, and included mannitol therapy and drainage of cerebrospinal fluid (CSF) when possible. Forty-three patients (34%) had ICP greater than or equal to 25 mm Hg; of these, 36 (84%) died. The mortality rate of the entire group was 46%. During 1979-1980, 106 patients with severe head injury were admitted and underwent ICP monitoring. Their average ager was 29 years; 51% had multiple trauma, and 31% underwent emergency intracranial surgery. All patients received the same standardized protocol as the previous series, with the exception of the treatment of ICP. In this present series: if ICP was 15 mm Hg or less (normal ICP), patients were continued on hyperventilation, steroids, and intensive care; if ICP was 16 to 24 mm Hg, mannitol was administered and CSF was drained; if ICP was 25 mm Hg or greater, the patients were randomized into a controlled barbiturate therapy study. Twenty-six patients (25%) had ICP's of 25 mm Hg or greater, compared to 34% in the previous series (p less than 0.05), and 18 of these 26 patients (69%) died. The overall mortality for this current series was 28% compared to 46% in the previous series (p less than 0.0005). This study reconfirms the high mortality rate if ICP is 25 mm Hg or greater; however, the data also document that early aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 mm Hg or greater and reduces the overall mortality rate of severe head injury.

Adolescent↗
PubMed1982

Aggressive multimodality therapy based on a multicompartmental model of glioblastoma.

Glioblastoma multiforme is composed of multiple cellular compartments with different morphologic, kinetic, metabolic, vascular, and genetic properties. Optimal therapy may consist of a variety of therapeutic strategies designed for individual compartments, administered in close temporal relation. These concepts may turn out to be valid for other solid tumors as well. Microwave-induced hyperthermia can be used to treat metabolically quiescent, relatively hypoxic, nondividing cells (Go) otherwise resistant to radiation and chemotherapy. Similarly, polychemotherapy can treat a broad spectrum of cell types if the blood-brain barrier can be circumvented. Radical surgery, repetitively applied, can be safely used to "set up" experimental agents if the operation microscope and laser are employed. A consecutive series of 74 adult patients with malignant astrocytoma were treated with primary resection, radiation therapy, and 1,3,-bis(2 chloroethyl) 1 nitrosourea chemotherapy. At recurrence, all patients were offered reoperation with the microscope and the laser prior to administration of phase-I agents--hyperthermia via an implantable miniature microwave antenna (6 cases); aziridinylbenzoquinone chemotherapy (13 cases); and blood-brain barrier reversal with dimethyl sulfoxide (DMSO) and polychemotherapy (9 cases). It was concluded that temperatures of 45 degrees C could be safely achieved and human tumors could not efficiently dissipate heat; that DMSO plus drug therapy could be tolerated but blood-brain barrier reversal demonstrated by us in animals could not be shown in humans; and that aggressive multimodality therapy and reoperation could produce a 40% 2-year survival rate for patients younger than 40 years.

Brain Neoplasms↗
PubMed1982

Immediate mini-myelography in acute cervical cord injuries.

The use of contrast myelography in the evaluation of acute cervical spinal cord trauma is controversial. The purpose of employing such a technique is to demonstrate any persistent extradural cord compression after the spine is realigned by skeletal traction. The surgical correction of such compression may result in enhanced neurological recovery. The "mini-myelogram" is accomplished by performing a lateral C1/C2 spinal puncture and injecting a low volume of Pantopaque into the subarachnoid space. Demonstration of significant extradural compression results in emergency surgery for appropriate decompression. A small percentage of patients may enjoy enhanced recovery due to the decompression. A description of the technique and results of 90 patients undergoing mini-myelography are presented.

Adult↗
PubMed1982

Intracranial pressure monitoring in patients with severe head injury.

Increased intracranial pressure (ICP) has an adverse effect on the clinical course of patients with severe head injuries. Direct intracranial measurement is the only method of knowing the precise ICP. At the Maryland Institute for Emergency Medical Services Systems, elevations in ICP are treated according to an aggressive protocol. Our experience with this protocol has led to the following conclusions: 1) ICPs above 25 mm Hg are associated with an unacceptable mortality, 2) aggressive medical treatment of patients with an ICP of 16 mm Hg can decrease the number of patients whose ICPs reach 25 mm Hg, and 3) the overall mortality of severe head injury can be reduced with such a protocol. ICP monitoring can be a valuable parameter in the management of severe head injury. With continuous accurate reading of ICP, sound theraputic decisions can be made about the patient's care that, ultimately, can effect the patient's survival and outcome.

Brain Edema↗
PubMed1981

The clinical application of hyperbaric oxygen therapy in spinal cord injury: a preliminary report.

While reports of the beneficial effects of hyperbaric oxygen therapy in experimental use appear in the literature, there have been no reports of clinical trials with hyperbaric oxygen therapy of acute spinal cord injury. A series of treatment protocols have thus been designed for treatment of acute spinal cord injury utilizing hyperbaric oxygen. The study has been in progress for the last two years and involved more than 50 patients; results from the therapy trial in 25 patients over the last 18 months will be presented in this preliminary report. Hyperbaric oxygen therapy was generally initiated approximately 7 1/2 hours following injury. Pretreatment and posttreatment motor scores were compared with those of patients given conventional therapy for acute spinal cord injury. Under these circumstances, patients receiving hyperbaric oxygen therapy appeared to recover more quickly, although their final motor scores were about the same as those of patients receiving conventional therapy. Thus, alter the time course of recovery, perhaps without altering the final neurological outcome.

Acute Disease↗
PubMed1981

Delayed carotid-cavernous fistula and multiple cranial neuropathy following basal skull fracture.

A case of basilar skull fracture associated with palsies of the 3rd through 10th cranial nerves on the ipsilateral side is presented. Three months after the initial injury, despite return of significant ocular movement, proptosis and conjunctival congestion heralded the onset of an ipsilateral carotid-cavernous fistula. Angiography revealed the presence of a carotid-cavernous fistula; however, the ipsilateral carotid artery was occluded in the neck. A single pathophysiological mechanism is proposed to account for this unique series of events.

Adult↗