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Biomedical subjects

A L Sahs

Publications and source records attributed to A L Sahs.

At least 19 recordsLinked to original sources
PubMed1984

Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. II. Ruptured intracranial aneurysms managed conservatively.

The late natural history of ruptured intracranial aneurysms was studied in 568 cases reported to the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage from 1958 to 1965. The patients had been selected for conservative management of their aneurysms at the time of diagnosis. A follow-up search in 1981 and 1982 revealed 378 known deaths; 40% had occurred within six months of hemorrhage. During the next two decades, the patients' survival probabilities were significantly worse than those of a matched US population. Multiple aneurysms did not differ prognostically from single aneurysms, but posterior circle aneurysms carried a better prognosis after ten-year survival. The rate of probable recurrent bleeding after six months was 2.2% per year for the first 9 1/2 years and 0.86% per year for the second decade. Reported rebleeding episodes were fatal in 78%.

Adolescent↗
PubMed1984

Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: a long-term prognostic study. III. Subarachnoid hemorrhage of undetermined etiology.

Among 6,638 cases reported to the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage were 477 cases in which the cause of hemorrhage could not be determined after carotid and vertebral angiography. These patients were followed up for up to 24 years after hemorrhage. Twenty patients were subsequently found to have an aneurysm or arteriovenous malformation missed by the first angiographic survey. After six-month survival, the rate of recurrent hemorrhage was a maximum 0.86% per year. Survival was significantly better than that of patients with verified ruptured aneurysms managed conservatively in this cooperative study. For normotensive patients who survived the first six months, the life expectancy for the next 20 years equaled that of an age- and sex-matched US population. Hypertensive patients had a higher mortality than normotensive patients.

Adult↗
PubMed1983

Carpal tunnel syndrome. Complication of toxic shock syndrome.

Peripheral nerve complications occurred in four patients with toxic shock syndrome. Each patient had an acute carpal tunnel syndrome develop that was verified by nerve conduction studies. Recovery was rapid in two cases, but delayed in two others. Decompressive procedures were required in only one patient, with eventual recovery. Another condition, the toxic shock syndrome, must now be added to the long list of possible causes of compression of the median nerve in the wrist.

Adult↗
PubMed1983

CT and clinical correlations in recent aneurysmal subarachnoid hemorrhage: a preliminary report of the Cooperative Aneurysm Study.

Computed tomography was performed on 1,378 patients admitted within 3 days of subarachnoid hemorrhage (SAH) at 71 centers in a cooperative study. CT on the day of SAH (day 0) was abnormal in 95.8%. Intracranial blood was detected in 95.3% of patients on day 0, 90.5% on the first day after SAH (day 1), and 73.8% on day 3. CT was normal in only 1 of 284 patients in stupor or coma but was normal in 14.6% of 638 alert patients. In the first few days after SAH, CT is highly accurate, often obviating the need of CSF examinations. The interval from SAH until CT and the seriousness of the patient's condition are two factors that influence the results of CT.

Coma↗
PubMed1981

Antifibrinolytic therapy in patients with aneurysmal subarachnoid hemorrhage. A report of the cooperative aneurysm study.

Antifibrinolytic therapy was used in 1,114 patients who had aneurysmal subarachnoid hemorrhage (SAH) and who were treated by the 13 institutions of the Cooperative Aneurysm Study. Patients were started on treatment within one week after SAH was diagnosed, and therapy was discontinued 14 days after the ictus. Rebleeding occurred in 10% of the treated patients. Overall mortality among the treated patients during the two weeks following hemorrhage was 10.7%. Though some minor and a few major side effects occurred, serious complications of therapy were infrequent.

Adolescent↗
PubMed1981

Overall management of ruptured aneurysm: comparison of early and late operation.

The overall management results with 61 consecutive patients admitted within 3 days of subarachnoid hemorrhage from a ruptured intracranial aneurysm were analyzed. During the course of this study, the preferred method of management shifted from late surgery (planned at least 7 days after the last hemorrhage) to early surgery (within 4 days of the last hemorrhage). Ten moribund patients were excluded from analysis, leaving 24 in the late group and 27 in the early group. Both groups had comparable patient demographic characteristics and neurological conditions, and their care was supervised by one neurosurgeon (N.F.K.). A microsurgical intracranial operation was performed on all patients who survived long enough to have surgery. The intraoperative conditions and complications were similar for the two groups. The average length of follow-up was 11 months in the late and 9 months in the early group. The overall management results for the late group showed a 42% favorable outcome, a 17% unfavorable outcome, and a 42% mortality. The early group had an 81% favorable outcome, a 7% unfavorable outcome, and an 11% mortality. Patients in both good and poor conditions fared better in the early group. Seven late group patients rebled, compared to none in the early group. The number of medical complications, the length of hospitalization, and the occurrence of symptomatic vasospasm were all greater in the late group. Vasospasm in the early group occurred only postoperatively and, with the aneurysms secured, was treated more aggressively and successfully with hypertensive/hypervolemic therapy than the predominantly operative vasospasm in the late group.

Adult↗
PubMed1981

Early management of aneurysmal subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study.

The overall results are presented of early medical management and delayed operation among 249 patients studied during the period 1974 to 1977, treated within 3 days of subarachnoid hemorrhage (SAH) and evaluated 90 days after aneurysm rupture. The results included 36.2% mortality, 17.9% survival with serious neurological sequelae, and 46% with a favorable outcome. Of the patients admitted in good neurological condition, 28.7% had died and only 55.7% had a favorable recovery at 90 days after SAH. These figures represent the results despite effective reduction in early rebleeding by antifibrinolytic therapy and successful surgery in those patients reaching operation. Further therapeutic advances are needed for patients hospitalized within a few days after SAH.

Antifibrinolytic Agents↗
PubMed1976

Brain stem dysfunction related to cervical manipulation. Report of three cases.

Three cases of brain stem dysfunction associated with cervical manipulation are reported. The patients exhibited a spectrum of neurologic deficits, ranging from minimal to severe. Literature concerning the relationship of neck movement and vertebrobasilar blood flow is reviewed and an explanation for the ischemia leading to dysfunction is proposed.

Adult↗
PubMed1975

Amantadine in Parkinson's disease. A double-blind, placebo-controlled, crossover study with long-term follow-up.

A double-blind, placebo-controlled, crossover study with long-term follow-up of amantadien i- Parkinson's disease was performed on 26 patients. Other antiparkinsonian medications were discontinued in all but three patients. Amantadine resulted in a statistically significant 12 percent overall improvement over placebo. Twenty of 26 patients, without breaking the code, selected amantadine for long-term usage. Ten patients continued treatment for 10 to 12 months, and an overall statistically significant improvement was noted at 2 weeks and at 1, 2, 3, and 10 to 12 months. Improvements in tremor and rigidity remained relatively constant, while there was some apparent loss of efficacy in timed tests and quality of timed tests. Amantadine appears effective in the long-term treatment of some patients with Parkinson's disease.

Activities of Daily Living↗