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Biomedical subjects

C F Kieck

Publications and source records attributed to C F Kieck.

11 recordsLinked to original sources
PubMed1984

Intracranial aneurysm with subarachnoid haemorrhage. Surgical results and long-term outcome in 100 cases.

The surgical results and long-term outcome in 100 consecutive cases of intracranial aneurysm with a subarachnoid haemorrhage are described. According to the modified Botterell classification of neurological status, 33 patients fell into grade I, 56 into grade II and 11 into grade III at the time of surgery. There were no deaths associated with the surgical procedure. Two patients were worse off immediately after the operation and 4 others developed delayed ischaemic deficits postoperatively owing to cerebrovascular spasm. Four of these 6 patients made a good recovery but the others remained in a vegetative state. One other patient died from a pulmonary embolism on the 9th postoperative day. A group of patients who had grade IV neurological status at some stage before the operation all tolerated surgery well once their condition had stabilized, and stood an even chance of making a full functional recovery by 3-6 months.

Adult↗
PubMed1984

Naloxone reversal and morphine exacerbation of neurologic deficits secondary to focal cerebral ischemia in baboons.

The effects of an opiate agonist (morphine) and antagonist (naloxone) on neurologic function in conditions of acute and subacute focal cerebral ischemia were tested in a baboon model. Fourteen baboons (Papio papio) underwent unilateral transorbital microsurgical occlusion of the middle cerebral artery (MCA). Blood pressure, heart rate and core temperature were monitored continuously; frequent arterial blood gas measurements were made. Cardiac output, cardiac filling pressures, and regional cerebral blood cross-flow were measured in selected baboons. Naloxone administered intravenously consistently reversed hemiparesis and hemiplegia in all baboons for as long as they lived (4 h to 8 days postocclusion). Morphine administered intravenously converted hemiparesis to hemiplegia; this effect was naloxone-reversible. There were no significant changes in any parameter measured after the administration of either drug. Phenylephrine (used to elevate mean arterial pressure to 20 mm higher than the highest pressure measured after naloxone administration) and isoproterenol (used to elevate cardiac output to 1 l/min higher than the highest value measured after naloxone administration) produced no change in neurologic function. It appears that naloxone can reverse, and morphine exacerbate, focal ischemic neurologic deficits produced in baboons by MCA occlusion. The observed changes in neurologic function are not associated with or mediated by alterations in core temperature or cardiopulmonary functions.

Animals↗
PubMed1984

Vascular lesions due to transcranial stab wounds.

The cases of 109 patients with a transcranial or transorbital stab wound are presented. Angiography in 74 patients revealed 26 vascular lesions: 11 aneurysms, five carotid-cavernous fistulas, three other arteriovenous fistulas, three occlusions, two transections, and two instances of severe vascular spasm. The following important points and pitfalls are stressed: the 30% incidence of vascular lesions, the delayed onset of these lesions and neurological signs from 1 week to several months after trauma, and the incidence of delayed intracranial hemorrhage in four of 11 cases with traumatic aneurysms. The basal location of the lesions is described, and the authors warn against the misleading clinical picture of a trivial scalp wound in the absence of a "slot" fracture, with life-threatening neural and vascular damage on the opposite side. Aggressive investigation and treatment of these lesions are advocated because of the associated high morbidity and mortality rates, especially in patients with aneurysms.

Adult↗
PubMed1984

Beneficial effects of induced hypertension on experimental stroke in awake monkeys.

The authors performed a controlled study of induced hypertension therapy for treatment of experimental stroke in unanesthetized monkeys. Ten control and 10 treated animals were subjected to a 4-hour occlusion of the middle cerebral artery (MCA) by an implanted tourniquet. Neurological status and local cerebral blood flow (CBF) were monitored serially. Local CBF was determined by hydrogen clearance in and around the elevated 20% to 40% by intravenous infusion of phenylephrine hydrochloride. Neuropathological evaluation was performed after about 2 weeks. A 4-hour occlusion of the MCA in control animals caused moderate stable neurological deficits, moderate stable decreases in local CBF, and medium-sized infarcts. With induced hypertension, five of 10 treated animals showed neurological improvement, and eight exhibited increased CBF in the ischemic zone. Average infarct size tended to be smaller in the treated group, although the difference did not reach statistical significance. Hemorrhagic infarcts were not observed. In four animals, phenylephrine caused cardiac dysrhythmias and hypotension which were reversed by appropriate measures. In this unanesthetized primate model of moderate experimental stroke, induced hypertension had beneficial effects on neurological status, local CBF, and infarct size without causing hemorrhagic infarction. Induced hypertension may be beneficial for some clinical cases of focal cerebral ischemia.

Anesthesia, General↗
PubMed1981

Surgical management in subarachnoid haemorrhage with multiple aneurysms.

Direct surgical attack on a ruptured intracranial aneurysm is a generally accepted form of treatment, but because of incomplete knowledge of the natural history, controversy still exists on whether to treat the unruptured aneurysm similarly. In a series of 38 patients with 79 aneurysms, 59 operations were performed. On discharge 93% of the patients could be regarded as in an excellent or good state; 7% died. It is suggested that all aneurysms should be treated surgically but that more than one aneurysm should not be treated at the same operation ig extensive dissection is required to deal with the second one.

Adolescent↗
PubMed1975

Subcutaneous lumbosacral lipomas.

Twenty-four patients with subcutaneous lumbosacral lipomas are discussed. The neurological involvement of the lower limbs with incontinence is stressed, the high incidence of intrathecal tethering is shown, and early exploration is advocated.

Adolescent↗
PubMedDate not supplied

Traumatic atlantoaxial subluxation in children.

We report four children who sustained traumatic atlantoaxial subluxation without a rotatory component, underlying congenital anomaly, or inflammatory cause. Three patients were involved in motor vehicle accidents as pedestrians, and one sustained a rugby injury to his neck. Only one patient sustained an associated head injury. Two patients had neurologic signs on admission directly attributable to the atlantoaxial subluxation. The signs resolved after reduction and stabilization of the subluxation. Three patients were treated conservatively and one operatively. To date, all four patients have had a satisfactory outcome.

Accidents, Traffic↗