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Biomedical subjects

A S Fleischer

Publications and source records attributed to A S Fleischer.

At least 19 recordsLinked to original sources
PubMed1988

Post-traumatic acute obstructive hydrocephalus.

Two cases of acute obstructive hydrocephalus from intraventricular hemorrhage following head injury are presented. Each patient was involved in a motor vehicle accident and sustained closed-head trauma. Computed tomography scans revealed a fourth ventricular hematoma with obstructive hydrocephalus in each case, and both cases required emergency ventricular drainage to manage acute cerebrospinal fluid hypertension. Ventriculostomy resulted in complete recovery in the first case; however, the second patient eventually underwent ventriculoperitoneal shunting. One patient manifested an eight-hour lucid interval prior to neurologic deterioration.

Adolescent↗
PubMed1987

Management of high cervical-intracranial internal carotid artery traumatic aneurysms.

The successful surgical management of a patient with a traumatic aneurysm of the internal carotid artery (ICA) at the base of the skull and a second traumatic aneurysm of the ipsilateral superficial temporal artery is described. EC-IC bypass was not necessary, and graded occlusion of the ICA was employed. Direct repair was not chosen because of its high risk of distal embolization. Electrophysiologic monitoring techniques are helpful in predicting hemispheric ischemia.

Adult↗
PubMed1987

Patterns of cervical spine injury and their associated lesions.

Motorcycle riding and diving into shallow water continue to present a high risk of cervical spine injury, often complicated by spinal cord damage. In patients with high cervical cord trauma, differentiation of arterial hypotension due to losing vasomotor control from the effects of internal hemorrhage can cause difficulty. In a series of 123 consecutive cases of cervical spine injury, no evidence was found that either early surgical treatment or steroid administration exert a favorable influence on recovery from traumatic myelopathy. When compared with other series, differences were found in the nature, frequency and severity of both spinal and associated injuries, resulting from the relative frequency among the population studied of trauma due to a particular mechanism-traffic accident, diving, industrial injury-and the special functions and location of the hospital from which information is gathered.

Accidents↗
PubMed1984

Acute post-traumatic diabetes insipidus: treatment with continuous intravenous vasopressin.

A young male presented within hours after closed head injury with hypotension, tachycardia, and polyuria. A diagnosis of post-traumatic diabetes insipidus was made. Although a rare entity, the rapid diagnosis of diabetes insipidus and early treatment with vasopressin may have been life-saving in this case. A detailed approach for treatment with continuous intravenous vasopressin may be the most accurate and efficient method of managing acute onset diabetes insipidus, especially in the hemodynamically compromised patient. This will allow for a controlled fluid management in order to achieve hemodynamic stability and prevent aggravation of cerebral edema.

Acute Disease↗
PubMed1983

Use of free latissimus dorsi musculocutaneous flaps in various neurosurgical disorders.

Musculocutaneous (skin-muscle) flaps have been used predominantly by plastic surgeons for a variety of reconstructive purposes. With the advent of microvascular techniques, the area to be reconstructed is no longer limited to the arc of rotation of the vascular pedicle of the muscle. Instead, the muscle and overlying skin that is best suited for the reconstructive procedure may be dissected out as a free flap, with microvascular anastomosis of an arterial supply and venous drainage to locally existing vessels. This report demonstrates the usefulness of musculocutaneous free flaps in the repair of large defects of the scalp, cranium, and dura after trauma or resection of invasive neoplasms. The authors describe the use of a latissimus dorsi free musculocutaneous flap in eight patients who would have required multiple operations to provide coverage by other techniques. There have been no major complications, and adequate repair has been accomplished, even in cases involving exposed brain.

Adult↗
PubMed1983

Effects of intravenous nitroglycerin on the intracranial pressure and volume pressure response.

Ventricular fluid pressure (VFP) and volume-pressure response were measured during nitroglycerin (NTG) infusion in nine patients anesthetized with N2O and fentanyl. The patients' ventilation was controlled, and PaCO2 was kept at 32 +/- 4 mm Hg. When an infusion of 0.01% NTG was given intravenously to decrease the mean blood pressure to 95.1%, 84.7%, and 78.2% of control, the VFP increased from control levels of 9.94 +/- 2.14 mm Hg to 12.89 +/- 2.25, 15.6 +/- 2.85, and 14.43 +/- 3.45 mm Hg, respectively. The volume-pressure response showed a significant increase when blood pressure decreased to 84.7% and 78.2% of control. These results suggest that intravenous NTG caused an increase in the intracranial pressure and a decrease in the intracranial compliance.

Adolescent↗
PubMed1982

Observations during hypervolemic hemodilution of patients with acute focal cerebral ischemia.

Infusions of 5% albumin and/or dextran 40 in nine patients with acute ischemic neurological deficits reduced mean hematocrit values from 41% to 32%, raised mean central venous pressure from 4 to 12 cm H2O, and reduced mean arterial BP from 101 to 94 mm Hg. Six alert patients had ischemic structural damage on cranial computed tomography. All six alert patients with upper arm paresis objectively improved and two others with only dysphasia also improved within 24 hours after infusion initiation. Although the improvement in two patients seemed to be temporarily dependent on the continuing of the infusion, all eight alert patients were eventually weaned without loss of regained function. This report of neurological improvement during hypervolemic hemodilution suggests that augmentation of collateral perfusion secondary to reduced blood viscosity may rapidly relieve cerebral ischemia, impede infarction, and allow time for compensatory mechanisms to maintain blood flow above ischemic thresholds.

Acute Disease↗
PubMed1982

Cutaneous implantation metastasis complicating a superficial temporal-middle cerebral artery anastomosis.

A 52-year-old patient who underwent a superficial temporal-middle cerebral artery anastomosis subsequently developed an unusual squamous cell carcinoma in the skin overlying the anastomosis. The pathological picture and course of events suggest that this tumor was implanted into deeper tissues at the time of operation. Systematic microscopically controlled operation (Mohs' chemosurgical technique) was required to preserve the anastomosis while completely extirpating the tumor.

Carcinoma, Squamous Cell↗
PubMed1982

Complications of detachable balloon catheter technique in the treatment of traumatic intracranial arteriovenous fistulas.

As carotid-cavernous sinus fistulas (CCSF) are not life-threatening, therapeutic attempts should carry a very low morbidity and mortality. The authors believe that utilization of detachable balloons is the treatment of choice for CCSF, although this procedure is not without risk. Seven patients have been treated for high-flow traumatic intracranial fistulas over the past 2 years with detachable balloons using a coaxial catheter system. This paper presents several complications that have been encountered during this experience, and advances suggestions regarding treatment and avoidance of potential complications.

Adolescent↗
PubMed1980

Cerebral vasospasm following aneurysm rupture. A protocol for therapy and prophylaxis.

A retrospective study was made of 195 patients who had ruptured intracranial aneurysms without significant intracerebral hematomas and who recovered to at least Grade III by Hunt and Hess' classification. The first 121 patients underwent aneurysm surgery 10 days to 2 weeks after subarachnoid hemorrhage (SAH) without repeat preoperative angiography and without special attention to volume replacement or avoidance of hypotension. Vasospasm resulted in cerebral ischemia in 15% of this group, more than half of these postoperatively, and was treated successfully in half the patients with a combination of aminophylline and isoproterenol. The later 74 patients were managed with aggressive maintenance of normal circulating blood volume and preoperative angiography at 2 weeks following SAH. If significant vasospasm persisted on angiography, surgery was delayed an additional week and, if spasm was still present then, aminophylline and isoproterenol was added prophylactically to aggressive volume replacement before surgery. In this second group of patients, the incidence of clinical vasospasm was essentially unchanged; however, it was almost completely limited to the preoperative period, and was more effectively treated with aminophylline and isoproterenol. Postoperative vasospasm was almost completely eliminated from the second group of patients.

Aminophylline↗
PubMed1980

Dual cerebral and meningeal supply to giant arteriovenous malformations of the posterior cerebral hemisphere.

Seven cases of giant posterior hemisphere arteriovenous malformations are described. The significance of meningeal feeding vessels from the external carotid artery in addition to the primary cerebral supply through the internal carotid and vertebral arteries to these malformations is discussed. The necessity of bilateral selective external carotid arteriography is stressed, and the value of preoperative embolization is questioned.

Adult↗