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Biomedical subjects

A M Meirowsky

Publications and source records attributed to A M Meirowsky.

17 recordsLinked to original sources

Air sinus wounds: an analysis of 163 consecutive cases incurred in the Korean War, 1950-1952.

Review of 1105 records patients with penetrating craniocerebral injuries incurred in the Korean War revealed 163 cases with air sinus wounds, an incidence of 14.8%. The characteristics of these wounds and their surgical management have been described. Foremost among the complications of air sinus wounds are the development of a cerebrospinal fluid fistula and the occurrence of posttraumatic infection. Prompt and radical debridement with exenteration of the affected sinus and watertight closure of the dura mater represent the key to the reduction of complications when dealing with penetrating wounds involving the air sinuses.

Adult↗

Secondary removal of retained bone fragments in missile wounds of the brain.

Secondary operations for the removal of retained bone fragments have been performed in 116 of the 1133 casualties with craniocerebral missile wounds incurred in the war in Vietnam, 1967 to 1970. Various complications developed in 19 of these 116 casualties. Dehiscence of the wound occurred in eight patients, five of whom developed a cerebrospinal fluid fistula. Infection manifested itself in 16 cases with retained bone fragments prior to their secondary removal; however, infection first became apparent after the secondary operation in seven patients. Two of the seven patients with infection died. The neurological deficit became worse in four of the 116 patients following the secondary removal of a bone fragment: there was complete resolution of that deficit in one, and return to the neurological status existing after the initial operation in another; the other two patients developed a permanently disabling neurological deficit, an incidence of 1.7%.

Adult↗

Cerebrospinal fluid fistulas complicating missile wounds of the brain.

The records of 101 casualties of the war in Vietnam have been analyzed, with particular attention to missile wounds of the brain complicated by a cerebrospinal fluid (CSF) fistula. Fifty-four developed CSF drainage at the wound site, 30 presented with rhinorrhea, and 23 with otorrhea. Fifty of the 101 men developed infection, an incidence of 49.5%. The occurrence of a fistula in vertex wounds can usually be traced to failure to close the dura, or to achieve watertight closure of the dura primarily, or by graft. Approximately two-thirds of compound basilar fractures, complicated by rhinorrhea or otorrhea, are due to direct fractures of the anterior, middle, or posterior fossa. The remaining one-third are due to elusive "discrete" fractures of the base of the skull, occurring at a distance from the entry wound, and not in continuity with the fracture of the vault. While direct basilar fractures can readily be recognized, facilitating repair of the dura overlying the basilar fractures, "discontinuous" fractures pose a challenging diagnostic problem. More commonly occurring in vertex wounds crossing the midline, discontinuous fractures producing rhinorrhea or otorrhea may be identified with the aid of tomograms of the base of the skull. Their early diagnosis may well prove to be a significant factor in the reduction of morbidity and mortality of missile wounds of the brain complicated by a CSF fistula.

Brain Injuries↗

Language and motor disorders after penetrating head injury in Viet Nam.

Aphasia occurred in 244 of 1030 patients with head wounds, correlating with gunshot cause (p < 0.03) and initial loss of consciousness (p < 10(-6)). Aphasia disappeared within 10 years in 84 cases (34%). Sensorimotor aphasia usually changed to motor aphasia; motor aphasia disappeared; and sensory aphasia persisted. These improvements continued years after the accompanying hemiparesis stabilized, and were not related to wound site, depth, or whether the wound was caused by gunshot or fragment. Parietal wounds caused hemiparesis more often (p < 10(-6))than did wounds elsewhere. Regardless of the features of the hemiparesis initially, the severity of the final syndrome was greatest in the hand and arm and least in the face.

Adult↗

Cranioplasty: a review of 1030 cases of penetrating head injury.

A total of 491 cranioplasties performed in a population of 1030 cases of penetrating head injury are reviewed. The morbidity rate was 5.5%, and the mortality rate was 0.2%. The clinical criteria of improving cosmetic defects and restoring craniocerebral protection are established, based on the location and size of the skull defect. Cranioplasty after penetrating head injury should be deferred for a minimum of 1 year to control morbidity. Complication of the original injury and surgical debridement increase the morbidity rate of cranioplasty. Post-traumatic epilepsy is not related to skull defects per se; neither is it affected by cranioplasty. Acrylic is an acceptable cranioplasty material if there is strict adherence to good surgical technique.

Acrylic Resins↗

Moyamoya disease.

A case of Moyamoya disease is discussed, presenting in a young adult with subarachnoid hemorrhage. Moyamoya is a rare form of crebro-vascular occlusive disease, characterized by specific arteriographic findings. The etiology of the disorder is unknown.

Carotid Artery Thrombosis↗