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Biomedical subjects

C D Ray

Publications and source records attributed to C D Ray.

At least 19 recordsLinked to original sources
PubMed1992

Noise pollution in the operating room: a hazard to surgeons, personnel, and patients.

Noise levels up to 118 dB--a level that is potentially damaging to the hearing--were measured in the operating room, notably during the use of high-speed gas turbine bone-cutting drills. Suction tips, which had trapped tissue "whistles" inside, yielded noise levels of up to 96 dB. Surgeons, staff, and patients should be cautioned against such noises and shielded in prolonged cases. We offer a review of acoustical criteria for various practical noises and duration of safe exposure.

Adult↗
PubMed1991

Clinical neurosurgery as it relates to the lumbar spine: what it does versus what it says.

Neurosurgeons may derive as much as 62% of their professional income from and perform proportionately as large a number of procedures on the lumbar spine. Publications in neurosurgical journals, presentations at national and international neurosurgical meetings, and participation in organized neurosurgical symposia are, however, relatively sparse in this area of activity. It appears, therefore, that the lumbar spine must have minimal academic interest to neurosurgeons, as compared with the surgical areas where they have clinical domain, i.e., the brain and spinal cord. In that this clear discrepancy between what they do (their source of income) and what they talk about and publish is apparently not well known to neurosurgeons or their professional society directors, this paper is presented as objective, awakening evidence. The potential impact on future patient draw, professional prowess, and income, which may result from a continuation of this wide gap, is also discussed.

Back Pain↗
PubMed1988

Transfacet decompression with dowel fixation: a new technique for lumbar lateral spinal stenosis.

Auto-stabilization consequent to spinal segment instability involves osteophyte formation. The most common lumbar spinal stenoses are due to uncinate process spurs at L 5. These spurs inaccessibly lie ventral to the facet joints. Most surgical methods for lateral stenotic lesions do not address the incipient instability. Facet destructive approaches further destabilize the segment. The new decompressive technique here preserves and stabilizes posterior supporting structures: ligaments are left intact; laminas (and facets) are distracted; 11 mm transfacet holes are bored, exactly dorsal to both the spurs and entrapped ganglia; the entrapment (even a lateral herniated disc) is decompressed through the drilled hole. 12 mm bone dowels are then driven into the holes, immediately stabilizing the segment. The dura is not exposed. Reviewed are fifty transfacet cases. In four, a posterior interbody fusion was performed via the transfacet holes. The procedure presents a new window to spinal lesions.

Bone Transplantation↗
PubMed1987

New kneeling attachment and cushioned face rest for spinal surgery.

Surgical frames, kneeling attachments, and special operating tables for lumbar spinal surgery are designed to promote good positioning, lower the intraabdominal pressure, and reduce epidural bleeding. The frame reported here fulfills these objectives and produces either lumbar spinal extension to reduce paraspinal muscle tension or mild flexion to distract the neural arches. The new frame unit is made of lightweight fiberglass and aluminum, weighing only 14 lb (6.5 kg), and utilizes the hydraulic elevator pump of the operating table as a means to raise or lower the frame. Thus, adjusting the horizontal plane of the lumbar spine requires no separate crank system. The anterior tibial cushions, lying in hemicylindrical troughs, and the ergonomically designed cushions for chest and buttocks improve the distribution of body weight. A new, fully adjustable, cushioned face rest is used to maintain the neck in a neutral position, with the patient placed fully face-down.

Humans↗
PubMed1986

Bone impactors. New instruments for spinal decompression.

I have used these new instruments, designed for the reduction of nerve structure compression by the principle of impaction (driving inward of the outer surface), with success in well over 300 cases; they have proved to be useful, and often indispensible, in most cases having decompressions for lateral stenosis.

Humans↗
PubMed1983

Indwelling epidural morphine for control of post-lumbar spinal surgery pain.

The epidural instillation of morphine for pain control has been utilized for some time, although primarily intraoperatively or for patients with chronic severe pain, as in terminal cancer. Long term indwelling catheter or subarachnoid administration of epidural morphine are both potentially hazardous. However, in relatively brief applications, up to a few days, the epidural administration of morphine sulfate Is effective, safe, and well tolerated when used according to a carefully controlled plan. We report the use of this method as an improved means for the control of post-lumbar surgery pain in 25 cases. These patients were compared with 25 others receiving standard doses of parenteral and oral narcotics. The two groups were quite similar preoperatively. However, patients receiving epidural morphine were more comfortable, had fewer side effects such as nausea and lassitude, and exhibited no respiratory depression. Further, they ambulated sooner, showed no definitive orthostatic hypotension and less ileus, and remained much more alert and cooperative during the initial 48 hours after operation. Hospitalizations were usually shorter by 1 or 2 days. The administration of very small doses (1.0 to 2.5 mg) of morphine every 12 to 24 hours was usually adequate for good to excellent postoperative pain control. Hydroxyzine was sometimes used to potentiate the analgesia between doses. The epidural catheters were routinely removed within about 72 hours. The technique for the intraoperative placement of the epidural catheter and drug administration are detailed. Precautions for catheter placement were carefully followed to prevent dural penetration or intrathecal injection.

Adult↗
PubMed1982

New techniques for decompression of lumbar spinal stenosis.

Central and lateral stenoses of the lumbar neural canal are relatively less common causes of chronic pain in the lumbar back and the legs. However, their incidence is much higher than was previously thought. Accurate anatomical diagnosis was difficult until the advent of high resolution computed tomographic scanning. Appropriate decompressive surgery can now be designed and "guided" by the scans and the clinical syndrome. New or highly modified surgical procedures are now being used with good to excellent clinical results in as high as 80% of the cases depending upon the technique chosen. Many of these cases are failed back surgical cases and those whose diagnoses were not established by standard means, e.g., plain films, myelography, low resolution tomography, discography, etc. The good results reported here include patients with pain and disorders of long standing.

Back Pain↗
PubMed1978

Electrical stimulation: new methods for therapy and rehabilitation.

Electrical stimulation is emerging as a new therapeutic and rehabilitative agent. Reviewed are pain control, restoration of lost functions and alteration of abnormal movement and other functions using electrical stimulation. Reported for acute and chronic pain control use are transcutaneous, dorsal column, spinal cord, peripheral nerve, and direct brain stimulation methods and results. Overall success ranges up to 50% for chronic pain problems and up to 80% for acute pain; e.g., postoperative incisional pain, sports medicine, and trauma. Restoration of lost function has broad implications for the future. These include phrenic nerve pacing for respiration, foot drop control, restoration of bladder function, and grasp control in the spinal cord-injured patient. Amelioration of abnormal function includes stimulation for epilepsy and cerebral palsy, certain symptoms of multiple sclerosis and scoliosis. The effects of electrostimulation are completely reversible and nondestructive. Technical details of devices and stimulus waveforms are also briefly considered.

Acute Disease↗
PubMed1975

Electrical neurological stimulation systems: a review of contemporary methodology.

An analysis of the essentials of both external and implantable neurologic stimulation devices is presented. Specific system requirements have been extracted from clinical experience with neurologic hardware for pain inhibition. Application of these devices includes dorsal column stimulation, transcutaneous nerve stimulation and peripheral nerve stimulation. The electrode, an essential component of any neuro-stimulation system, is examined critically, with particular attention to unanswered questions regarding the electrode tissue interface.

Bioelectric Energy Sources↗