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  • 1
    ISSN: 0942-0940
    Keywords: Head injury ; intracranial pressure ; metabolism ; nitrogen balance ; oxygen consumption
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Both metabolic rate and protein catabolism are known to increase following severe head trauma, but the etiology of this hypermetabolism is unknown. To further investigate the problem, we studied the metabolism of 17 patients with indirect calorimetry who had severe craniocerebral trauma only and who required ICP monitoring for management. Patients were studied daily and immediately after ICP spikes greater than 20 mmHg, prior to treatment with hyperventilation, osmotic diuretics, or barbiturates. Oxygen consumption (VO2) was correlated with ICP. Two groups of patients were identified. Group I patients were treated with hyperventilation and osmotic diuretics while Group II patients additionally received cerebral metabolic depressants. Group I had a significant correlation coefficent between VO2 and ICP. Significant hypercatabolism early in the post trauma period was demonstrated by increased urine urea nitrogen. Our observations suggest that in patients with craniocerebral trauma, elevated ICP is associated with increased oxygen consumption, protein catabolism and systemic hypermetabolism. Cerebral metabolic depressants blunted increases in VO2 which were seen with elevated ICP.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 0942-0940
    Keywords: Cerebral blood flow ; subarachnoid haemorrhage ; 133Xenon ; cerebrograph
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Assessment of cerebral perfusion on patients with subarachnoid haemorrhage (SAH) in the Neurologic Intensive Care Unit is difficult since nuclear medicine imaging modalities capable of measuring cerebral blood flow (CBF) are not generally available. We performed 101 quantitative (ml/100g-min) bedside CBF measurements on 40 individual patients to correlate SAH grade with CBF and to assess the effect of surgical intervention on CBF. Global CBF (G-CBF) and bihemispheric CBF (B-CBF) asymmetry were correlated with the grade of SAH pre- and post-operatively. Data analysis showed that pre-operative patients with low grade SAH (Hunt and Hess grades 0 to 2) had higher mean G-CBF values [44.2±.71] than those with high grade SAH (Hunt and Hess grades 3 to 4): [mean G-CBF=34.1±1.7]. Post-surgery there was a significant improvement in G-CBF; CBF increased [5.3±1.07] in the group of patients with low grade SAH. Patients with high grade SAH showed no significant improvement in their G-CBF during the first week post-operatively compared to pre-operative values. We conclude that portable units capable of measuring bedside CBF values are useful in monitoring CBF changes in patients with SAH. Patients with low grade SAH have G-CBF within normal limits both pre-operatively and post-operatively, with a statistically significant increase in CBF during two weeks post-operatively. Patients with high grade SAH show no significant increase in CBF one week post-operatively compared to their pre-operative measures.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 0942-0940
    Keywords: Cervical osteophytes ; dysphagia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary An uncommon cause of progressive dysphagia may be large cervical osteophytes impinging upon the cervical esophagus. Dysphagia may be due to the mechanical mass effect of a large anterior osteophyte, trapping the esophagus opposite a fixed point such as the cricoid cartilage, or a local inflammatory reaction resulting in cricopharyngeal spasm. We report three patients with progressive dysphagia due to large anterior cervical osteophytes. All three patients were treated with anterior cervical approach with removal of the osteophytes without fusion. A review of the literature in addition to the specific case histories, video fluoroscopic and radiographic findings are presented.
    Type of Medium: Electronic Resource
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