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  • 1
    ISSN: 0942-0940
    Keywords: Aneurysm ; subarachnoid haemorrhage ; intracerebral haematoma ; emergency operation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a randomized prospective study, 15 patients with an intracerebral haematoma caused by an intracranial aneurysm were treated concervatively and 15 operated on as an emergency. Mortality was 12/15 (80%) in the conservative group and 4/15 (27%) in the surgical group. The difference is statistically significant. The deaths in the conservative group were caused by both the primary haematoma and rebleeding. The results suggest that intracerebral haematomas caused by rupture of an intracranial aneurysm should be evacuated immediately, and that the aneurysm should be clipped at the same operation.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 17 (1967), S. 24-31 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die zerebrale Zirkulation bei Kaninchen wurde durch fortlaufende Registrierung des zerebro-venösen Sauerstoffdruckes gemessen. Der intrakranielle Druck wurde auf hydrostatische Weise durch einen in den lumbalen Subarachnoidalraum eingeführten Katheter erhöht. In den hier dargestellten Versuchen wurden sehr hohe Drucke, im allgemeinen um 140 mmHg, untersucht. Dabei wurde festgestellt, daß die meisten Versuchstiere selbst bei so hohen Drucken ihre Hirndurchblutung für einige Zeit verhältnismäßig gut aufrecht erhalten konnten und daß die Toleranz durch Infusion vasopressorisch wirkender Pharmaka verbessert werden konnte. Periodische Atmung und Schwankungen des Blutdruckes schienen anzuzeigen, daß das Tier die Grenze seiner Toleranzfähigkeit erreicht hatte. Wenn die intrakranielle Drucksteigerung beendet wurde, stieg der Sauerstoffdruck in den zerebralen Venen oft höher als vor Beginn der Drucksteigerung; unter Berücksichtigung der Arbeit vonHäggendal, Löfgren, Nilsson undZwetnow (1966) spricht dieses wahrscheinlich für eine zerebrale Hyperämie.
    Abstract: Résumé La circulation cérébrale chez les lapins fut contrôlée par un enregistrement continu de la tension de l'oxygène dans les veines cérébrales (PcvO2). La tension intracranienne fut augmentée en appliquant une pression hydro-statique au moyen d'un cathéter introduit dans l'espace sous-arachnoidien. Dans les expériences rapportées des tensions très hautes, en général 140 mmHg, ont été réalisées. Dans la plupart des cas les animaux d'expérience pouvaient maintenir leur circulation cérébrale relativement bien pendant quelque temps, même avec une si haute pression et leur tolérance pouvait être élevée par la perfusion de «vasopresseurs». La respiration périodique et les oscillations de la pression sanguine semblaient indiquer que l'animal avait atteint sa limite de tolérance. Quand l'hypertension intracranienne fut supprimée le PcvO2 montait souvent plus haut qu'avant. D'après l'étude deHäggendal, Löfgren, Nilsson etZwetnow (1966), ceci indique vraisemblablement une hyperémie·cérébrale.
    Notes: Summary The cerebral circulation in rabbits was monitored by continuous recording of the cerebral venous oxygen tension (Pcvo2). The intracranial pressure was raised by applying hydrostatic pressure through a catheter introduced into the lumbar subarachnoid space. In the experiments reported here, very high pressures, generally 140 mmHg, were investigated. It was found that in most cases the experimental animals could maintain their cerebral circulation reasonably well for some time, even with such high pressures, and that their tolerance could be raised by infusion of vasopressors. Periodic breathing and oscillations in blood pressure seemed to indicate that the animal had reached its limit of tolerance. When the application of high intracranial pressure was stopped, the Pcvo2 often rose higher than before the application of pressure; considering the report ofHäggendal, Löfgren, Nilsson, andZwetnow (1966) this presumably indicated cerebral hyperaemia.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Acta neurochirurgica 48 (1979), S. 231-236 
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Twenty-nine patients with chronic bilateral subdural haematomas were surgically treated during 1966 to 1977. Twenty-four of them (83%) had a history of head injury, which caused unconsciousness in eight cases. The mean interval from trauma to operation was eleven weeks. The mean age of the patients was 60 years. The prevalence of the most commonly encountered symptoms and signs was: headache 72%, mental symptoms 48%, papilloedema 41%, vertigo 31%, nausea 28%, reduced consciousness 28%, walking difficulties 24%, hemiparesis 24%, and paraparesis 14%. The aggregate thickness of haematomas was 34 mm, 36 mm, and 40 mm in age groups of 20–39, 40–59, and over 60 years, respectively. All patients were operated on, four of them only unilaterally. Three patients in the whole series died. Two of them had been operated upon only on one side in the first session, the haematoma of the other side being evacuated 81/2 hours and four days later, respectively. Unilateral operation is likely to cause sever e distortion of the midline structures and the brain stem and thus aggravates the cerebral situation. Therefore the necessity of simultaneous evacuation of the haematomas on both sides is stressed. The reason for the death of the third patient was delay in diagnosis. All three patients who died belonged to the group of eight patients with a reduced level of consciousness before surgery. Twenty-three of the survivors were fully independent in their daily lives, and three needed some help after operative treatment.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 21 (1981), S. 215-220 
    ISSN: 1432-1041
    Keywords: phenytoin ; cimetidine ; antipyrine test ; drug interaction ; drug metabolism ; kinetics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In a prospective study in nine patients the effects of phenytoin and of cimetidine (1000mg/day) + phenytoin on the antipyrine test and serum phenytoin concentrations were studied. Serum phenytoin increased from the steady state level of 5.7±1.3 mg/l to 9.1±1.4mg/l after three weeks on cimetidine (p〈0.01), and fell to 5.8±1.2 mg/l within two weeks after withdrawal of cimetidine. The protein binding of phenytoin was not changed by cimetidine. After use of phenytoin for 2–4 months, antipyrine clearance increased from 0.67±0.06ml/min/kg to 1.61±0.22 ml/ min/kg, and antipyrine half-live fell from 10.9±1.3h to 4.5±0.6h as compared to the values before phenytoin treatment (p〈0.01). After three weeks combined use of cimetidine and phenytoin, antipyrine clearance was decreased to 1.01±0.07 ml/min/kg and antipyrine half-life was prolonged to 6.1±0.5h, (p〈0.01) compared to the values on phenytoin alone. The distribution volume of antipyrine was not affected by phenytoin nor by cimetidine + phenytoin. The half-life of cimetidine was 2.8±0.3h in the patients on longterm phenytoin treatment. There was a significant positive correlation (p〈0.001) between the increase in serum phenytoin concentration and the prolongation of antipyrine half-life caused by cimetidine. Thus, cimetidine increases serum phenytoin concentration, very probably by inhibiting its metabolism. Care should be taken in the concomitant use of cimetidine and phenytoin, and the dose of phenytoin should be modified according to the clinical symptoms and serum phenytoin concentrations.
    Type of Medium: Electronic Resource
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