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  • 1
    Electronic Resource
    Electronic Resource
    Dose escalation trial of a novel calcium antagonist, AT877, in patients with aneurysmal subarachnoid haemorrhage (1990)
    Springer
    Acta neurochirurgica 107 (1990), S. 11-15 
    Details
    ISSN: 0942-0940
    Keywords: Subarachnoid haemorrhage ; chronic cerebral vasospasm ; calcium antagonist ; AT877 ; HA 1077
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The initial dose-escalating clinical trial of a novel calcium antagonist, AT877, in patients with aneurysmal subarachnoid haemorrhage is reported. AT877 is characterized by its strong spasmolytic activity, its inhibition of intracellular calcium ion activity, and the inhibiton of several protein kinases. A total of 113 patients (Hunt and Hess grades I to IV) who had undergone surgery within 3 days of aneurysmal rupture entered the study. Patients were divided into 5 groups according to the total daily dose of AT877: I: 20 mg; II: 40 mg; III: 60 mg; IV: 90 mg; and V: 120–180 mg. AT877 was given by intravenous infusion over 30 min two or three times a day for 14 days after surgery. Although AT877 did not completely abolish angiographic vasospasm, severe vasospasm was seen less frequently in patients given higher doses. Vasospasm was the cause of a poor clinical outcome (Glasgow outcome scale rating 3 or greater) in 19%, 7%, 9%, 8%, and 6% of the patients in groups I to V, respectively. The results indicated a favourable clinical effect of AT877 at doses above 40 mg per day. Only mild hypotension was seen, even when 60 mg of AT877 was infused over 30 min. AT877 appears to be effective in patients with subarachnoid haemorrhage. Part of its effect may be attributable to protection of the brain from ischaemic insults due to chronic cerebral vasospasm. However, the drug still needs to be evaluated in a placebo-controlled double-blind trial (which is currently being carried out).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402606
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  • 2
    Electronic Resource
    Electronic Resource
    Development of the operating computerized tomographic scanner system for neurosurgery (1991)
    Springer
    Acta neurochirurgica 111 (1991), S. 61-63 
    Details
    ISSN: 0942-0940
    Keywords: Computerized tomography ; neurosurgery ; clinical imaging ; operating room
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A computerized tomographic (CT) scanner system for intraoperative imaging is presented. The system consists of the following: 1) CT scanner with a mobile gantry, 2) digitally controlled operating table with central processing unit (CPU) and encoder unit; the table can be controlled by the scanner computer as accurately as the scanner bed, and 3) exclusively designed head fixation devices. It allows us to scan the patient on the operating table in the operating room pre-operatively, intra-operatively and immediately after surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01402515
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Subdural fluid collections following transcortical approach to intra- or paraventricular tumours (1989)
    Springer
    Acta neurochirurgica 99 (1989), S. 20-25 
    Details
    ISSN: 0942-0940
    Keywords: Hydrocephalus ; intraventricular tumour ; postoperative complication ; subdural fluid collection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Subdural fluid collections appeared in 15 cases (39%) after removal of 38 intra- and paraventricular tumours in the third or lateral ventricle through 18 frontal and 20 parietal transcortical approaches. Transient fluid collections which disappeared within 2 weeks occurred in 6 cases (16%) and persistent ones in 9 cases (24%). Four of the 9 cases (11%) of collections required surgical treatment because of positive clinical signs and symptoms. Two cases had expansive fluid collections and the other two contained subdural haematomas at surgery. The risk factors likely to contribute to a persistent collection were preoperative ventriculomegaly (frontal horn index 〉 0.38) and a frontal transcortical approach. A symptomatic collection should be considered as a potential complication of the transcortical approach to intraventricular tumours and some methods should be devised to prevent it when intra- or paraventricular tumours with ventriculomegaly are removed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01407772
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  • 4
    Electronic Resource
    Electronic Resource
    Mortality study of patients with subarachnoid haemorrhage at University hospitals and their affiliated hospitals in Japan (1982)
    Springer
    Acta neurochirurgica 63 (1982), S. 175-183 
    Details
    ISSN: 0942-0940
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary This study was undertaken to examine the differences in aneurysm statistics between University hospitals where subacute or chronic patients are primarily treated and University-affiliated hospitals where both acute and chronic cases are also admitted. In each hospital group, the transition of the statistics in the last decade was studied. The purpose of this study was also to see if any conclusion could be drawn regarding the surgical treatment of acute cases. The death rate for all aneurysm cases admitted is 8% at University hospitals, whilst that at affiliated hospitals is roughly 30% during the 1970s. The operative death rate at the University hospitals is 3%, whilst that at affiliated hospitals is 16% which improved at one affiliated hospital to 8% in the 1980–1981 period. Morbidity also improved in the latest series in the affiliated hospital. These improvements are considered to be due to the change of operative and postoperative policies for acute cases to : limited surgical indications for grade IV patients, extensive cisternal clot removal at the time of surgery, and oral administration of Ticlopidine, a new antiplatelet agent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01728870
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Normovolaemic induced hypertension therapy for cerebral vasospasm after subarachnoid haemorrhage (1990)
    Springer
    Acta neurochirurgica 103 (1990), S. 18-26 
    Details
    ISSN: 0942-0940
    Keywords: Cerebral vasospasm ; haemorrhagic infarction ; intracranial aneurysm ; normovolaemic induced hypertension therapy ; subarachnoid haemorrhage ; Swan-Ganz catheter
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We showed that normovolaemic induced hypertension therapy was effective in reducing ischaemic symptoms attributed to cerebral vasospasm in 41 patients after subarachnoid haemorrhage. By inducing hypertension to 25% to 50% above normal systolic arterial blood pressure, we observed that in 17 of 24 cases (71%) neurological deficits improved. In four cases of haemorrhagic infarction, the blood pressure rose to over 50% of systolic arterial pressure, and a low density area was confirmed on computerized tomography (CT) scan prior to vasospasm. Induced hypertension was therefore not considered when a low density area was revealed on CT scan. Restriction of fluid input is usually a factor in producing hypovolaemia after a neurosurgical operation. Intravascular volume expansion has been reported effective in reversing ischaemic deficits. However, according to Poiseuille's equation, increasing blood volume to a state of hypervolaemia can not enhance flow. The cerebral blood flow (CBF) was raised by increasing perfusion pressure, reducing viscosity, or increasing blood vessel diameter. Intravascular volume expansion elevates not only systemic arterial pressure, but also pulmonary artery wedge pressure over 18 mmHg and cardiac index over 2.2. Since pulmonary oedema and congestive heart failure may develop, one should monitor haemodynamic parameters with the Swan-Ganz catheter as a preventive measure. We emphasize that normovolaemic induced hypertension, maintaining haemodynamics subset 1 of the comparable haemodynamic subsets, is effective in raising perfusion pressure of CBF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01420187
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    Paper (German National Licenses)
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