Biomedical subjects

V Zelman

Publications and source records attributed to V Zelman.

23 records · Page 2Linked to original sources

PubMed1991

Management of intraoperative rupture of aneurysm without hypotension.

A retrospective analysis was performed on all aneurysms operated on by one of us (SLG) from July 1980 to October 1988 to determine the factors that govern outcome from the intraoperative rupture of aneurysms. A total of 276 consecutive surgical procedures for 317 intracranial aneurysms produced 41 perioperative or intraoperative ruptures for analysis. Five cases were pre-exposure ruptures, 3 of which occurred during anesthetic induction. Four of these patients died, and 1 made a good recovery. Of the remaining 36 cases, outcome was analyzed in terms of the adjuncts used to deal with the intraoperative rupture. There was no statistically significant difference in outcome between those cases in which tamponade was used to control hemorrhage versus temporary clipping; however, those cases in which hypotension was used did less well than those in which it was not used. From October 1986 to October 1988, 108 operations for 132 aneurysms were performed without the use of induced hypotension. There were 16 intraoperative ruptures (14.8%). All 16 of these patients made a good recovery. In the group before 1986, of which there were 20 intraoperative ruptures (of 168 operations, 11.9%), 11 of those 20 patients suffered a permanent deficit or died. We conclude that hypotension may not be a necessary adjunct to the management of intraoperative rupture of aneurysms.

Cardiac Tamponade↗

PubMed1987

Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses.

The evolution of more sophisticated imaging techniques has initiated a renewed interest in stereotactic devices, methods, and applications. The Brown-Roberts-Wells instrument was available to us early in its prototype stage, and this report reviews the first 500 cases using the system at the University of Southern California Medical Center Hospitals. Procedures were undertaken after recognition of apparent structural alterations on imaging studies, with objectives being both diagnostic and therapeutic. Target locations were predominantly within the cerebral centrum-basal ganglia (284 cases) and diencephalic-mesencephalic regions (129 cases). Operative objectives included: histological and microbiological assay, cyst and abscess aspiration, installation of temporary or permanent drainage conduits, point source and colloid base brachytherapy, cerebroscopy and ventriculoscopy with biopsy, aspiration, and excision, and intraoperative vascular localization. Using multiple instrumentation at the target point (741 point placements), we realized procedural objectives in 95.6% of the cases. The mortality was 0.2% and the morbidity was 1%: hematoma, 2 cases; infection, 1 case; increased deficit, 1 case; intraprocedural seizure, 1 case. A specific diagnosis was not obtained in 4.4% (necrosis, 10 cases; inflammatory response, 9 cases; granuloma, 1 case; gliosis, 1 case; diagnostic error, 1 case). Individual guidelines for case selection, technique, institutional requirements, and applications of the method are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1986

Nitrous oxide withdrawal reduces intracranial pressure in the presence of pneumocephalus.

Nitrous oxide anesthesia has been implicated as contributing to the development of delayed tension pneumocephalus following surgery performed in the sitting position. The authors tested the hypothesis that withdrawal of nitrous oxide anesthesia administered during formation of an intracranial gas cavity would lead to a decrease in intracranial pressure (ICP) as N2O diffuses from the cavity back into the blood. Ten halothane-anesthetized rabbits were prepared for measurement of supracortical ICP and arterial blood pressure (BP) and for intracranial volume alterations via a cisterna magna infusion catheter. Hyperventilation (Paco2 = 28-30 mmHg) and mannitol were used to shrink the brain to accommodate intracranial infusion of either air or lactated Ringer's (LR) solution, which was used to elevate ICP to between 10-15 mmHg from a baseline ICP of 2.1 +/- 2.5 mmHg over a period of 8 to 10 min. Following stabilization at an elevated ICP, inhalation of nitrous oxide (75%) was either initiated or withdrawn (if already present during the induced ICP increase) and the subsequent changes in mean ICP and BP were recorded. Following ICP elevation with LR to 10 +/- 1 mmHg, initiation of 75% N2O administration resulted in no change in ICP and modest increases (P less than 0.05) in BP and cerebral perfusion pressure (CPP = BP - ICP) after 4 min. However, when ICP was raised (to 12 +/- 3.5 mmHg) with intracranial air infusion, subsequent initiation of 75% N2O inhalation caused an abrupt ICP increase to 22.3 +/- 9 mmHg (from control P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗

PubMed1986

Ruptured intracranial aneurysms during pregnancy. A report of four cases.

Four patients presented with ruptured intracranial aneurysms during pregnancy. Problems encountered during the management of these cases included delayed diagnosis, obstructive hydrocephalus, cerebral ischemia due to vasospasm and recurrent subarachnoid hemorrhage. Recent advances in the management of ruptured intracranial aneurysms, including early computerized tomographic scanning, intravascular volume expansion and induced hypertension for the management of cerebral vasospasm, and the timely obliteration of the aneurysm are applicable to the subarachnoid hemorrhage patient even if her condition is complicated by pregnancy.

Adolescent↗

PubMed1984

Computed tomographic guidance stereotaxis in the management of lesions of the third ventricular region.

The initial management strategies for lesions of the 3rd ventricular region are often controversial. Current techniques for computed tomographic guidance stereotaxis allow accurate access to any intracranial point. A Brown-Roberts-Wells stereotactic system was used as a technical adjunct in the initial management of 42 mass lesions of the 3rd ventricular region. Objectives included biopsy, culture, aspiration, visualization, and installment of drainage conduits. Forty-five point placements were accomplished, and 140 tissue specimens were retrieved without complication. The pathological diagnosis was substantiated in all cases and included lesions of developmental (1 case), neoplastic (31 cases), and infectious (10 cases) origins. Information based on stereotactic assessment provided a rational substrate for the initiation of management, which included craniotomy, cerebrospinal fluid diversion, radiotherapy, chemotherapy, and antibiotic or antiviral therapies. Based on this experience, it is apparent that these methods offer acceptably safe and accurate access to lesions of the entire 3rd ventricular region. Histological or microbiological diagnosis without the need for craniotomy may be readily realized and offers logical guidance for therapeutic strategies. Dependent on the pathological condition, definitive treatment may be achieved.

Adolescent↗