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Biomedical subjects

D W Rowed

Publications and source records attributed to D W Rowed.

11 recordsLinked to original sources
PubMed1992

Management of cervical spinal cord injury in ankylosing spondylitis: the intervertebral disc as a cause of cord compression.

Twenty-one patients with universal syndesmophytosis due to ankylosing spondylitis were identified in a consecutive series of 1578 patients with acute spine and spinal cord injuries. They were predominantly male, older than spinal cord-injured patients in general, and most were injured by falls. Approximately one-half were managed by halo-vest immobilization alone with good clinical and radiological outcomes. The remainder required surgery either for recurrent dislocation or for spinal cord compression associated with neurological deterioration. Extradural hematoma, a recognized cause of spinal cord compression in ankylosing spondylitis patients with spinal fractures, was encountered in two patients. Herniated intervertebral disc as a cause of spinal cord compression in ankylosing spondylitis does not appear to have been previously reported and was recognized three times in the present series, once in association with extradural hematoma. The pathology of ankylosing spondylitis is such that the nucleus pulposus tends to be spared, allowing disc herniation to occur in the heavily ossified spine. In virtually all patients, satisfactory correction of the flexion deformity could be safely accomplished following spinal fracture. It is concluded that fracture/dislocations of the cervical spine should be managed initially by halo-vest immobilization, without prior traction and with careful incremental correction of flexion deformity. Decompression is performed as required for extradural hematoma or intervertebral disc herniation, and internal fixation is carried out for recurrent dislocation.

Adult↗
PubMed1992

Recurrence rates of acoustic neuroma in hearing preservation surgery.

Several authors have detailed the microscopic appearance of the acoustic neuroma/cochlear nerve interface. Others have highlighted the anatomic relationships existent between the lateral end of the internal auditory canal (fundus) and the otic capsule, as viewed from the posterior fossa. Based on these findings, several have suggested that hearing preservation attempts are likely associated with tumor persistence. They therefore question the feasibility of hearing preservation surgery. In this study, computerized tomography or magnetic resonance imaging was carried out on 28 patients having previously undergone excision of an acoustic neuroma with intraoperative sparing of the cochlear and facial nerves. Scans were done at least 5 years following surgery. Results of this study and a discussion of the literature follow.

Cochlear Nerve↗
PubMed1992

Conservative management of acoustic neuromas.

The results of this study and others document the biologic behavior of acoustic neuromas. In view of the evidence presented, which describes both variable rates of individual tumor growth and spontaneous regression in size, it would seem prudent that before selecting a nonsurgical treatment modality, the growth rate for the particular tumor in question should be established. To date, none of the literature that addresses the use of focused irradiation has attempted to do so. Our study as well as those of others suggests that the growth rate of acoustic neuromas becomes predictable over time. Based on this observation, a conservative (nontumor excision) management strategy is proposed for selected individuals. Patients to whom this management philosophy has been recommended or who themselves have chosen this option are seen twice yearly. Each visit consists of a thorough neurotologic examination as well as high-definition CT or MRI. Careful comparison of the clinical course as well as calculation of the tumor size is carried out in each instance. If the clinical course and rate of tumor growth remain unchanged over a 3-year follow-up, annual assessments are recommended. In the event of tumor enlargement, surgery may or may not be recommended, depending on the rate of growth and the age of the patient. Our experience suggests that a rate of growth equal to or exceeding 0.2 cm per year constitutes an indication for tumor removal.

Age Factors↗
PubMed1991

Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery.

Cerebrospinal fluid leaks and associated meningitis are the most common life-threatening complications of surgery for acoustic neuromas. This retrospective study reviews 319 patients who had surgery for 321 acoustic tumors at the Sunnybrook Health Sciences Center, University of Toronto, from April 1975 to March 1990. Cerebrospinal fluid leaks occurred after 13.4% of primary tumor operations. Surgical repair was required in 6.2% of all patients; 4.4% needed more than one operation. Meningitis occurred in 5.3% of all patients. These complications were more common in larger tumors and after the combined translabyrinthine middle fossa approach. Transnasopharyngeal eustachian tube obliteration was used to stop recurrent cerebrospinal fluid leaks in two patients.

Adolescent↗
PubMed1979

Current concepts in the immediate management of acute spinal cord injuries.

The management of acute spinal cord injuries has changed considerably during the past 10 years owing to new information about the pathophysiology of cord trauma and new diagnostic and treatment methods. It is now known that the cord suffers not only from the immediate physical effects of trauma, but also from secondary pathologic processes, such as ischemia and edema, which are treatable in the first few hours after injury. New neuroradiologic and neurophysiological techniques, such as the recording of the somatosensory evoked potential, increase the accuracy of diagnosis and prognosis in the acute phase. Current immediate treatment includes the administration of steroids and mannitol, with careful attention to respiratory and cardiovascular homeostasis, to overcome post-traumatic ischemia and edema, and immobilization of the spine with devices such as the halo. New surgical procedures are used in selected cases to improve neurologic recovery, to provide rigid immobilization of the spine or to allow earlier mobilization of the patient. The care of spinal cord injuries in the acute phase is facilitated by multidisciplinary units.

Animals↗
PubMed1978

Somatosensory evoked potentials in acute spinal cord injury: prognostic value.

The somatosensory evoked potential is absent in patients with complete motor and sensory loss below the level of spinal cord injury. When spinal cord injury is incomplete, these alterations in potential may be elicited from stimulation of a nerve entering the cord below the level of injury. The presence of such potentials soon after injury, or their early return, and progressive normalization of the wave form are sensitive early indications of favorable prognosis. Indeed, recovery of the somatosensory evoked potentials frequently precedes major clinical improvement and may occur in advance of clinical recovery or posterior column function.

Adolescent↗
PubMed1978

Traumatic intracerebellar haematoma.

A case of traumatic intracerebellar hematoma is presented. The salient feature of the patient's early clinical course was delayed, rapid deterioration in the absence of antecedent focal neurological findings. The rarity of this lesion and its high mortality due to delay in correct diagnosis have been previously emphasized. Reported cases have followed a subacute clinical course and deterioration has been preceded by focal neurological findings. Prompt ventricular drainage followed by evacuation of the hematoma can be expected to yield a satisfactory clinical result.

Adult↗
PubMed1975

Hypocapnia and intracranial volume-pressure relationship. A clinical and experimental study.

The effect of induced hypocapnia was observed, during intraventricular pressure monitoring, in five patients with chronically increased intracranial pressure (ICP) and in five baboons with acutely raised ICP. The volume-pressure response (VPR) was used as a measure of intracranial elastance (inverse compliance), an index of residual compensatory capacity. The VPR is the acute increase in mean ICP that occurs in response to a constant volume increment to ventricular cerebrospinal fluid. In the patients, hypocapnia produced a decrease in the VPR that was proportional to the decrease in ICP; in the baboons, ICP was substantially decreased with minimal change in the VPR. Both observations indicate that hypocapnia, though it decreases ICP, does not selectively decrease intracranial elastance. This may be a limiting factor in the use of hypocapnia in the management of raised ICP.

Animals↗
PubMedDate not supplied

Thromboendarterectomy for total occlusion of the internal carotid artery: a reappraisal of risks, success rate and potential benefits.

Forty consecutive patients undergoing thromboendarterectomy for total internal carotid artery occlusion were studied in an attempt to determine a) whether careful case selection could be expected to reduce future postoperative mortality and morbidity, b) whether the achieved patency rate justified early operation and c) whether patients in whom patency was restored and maintained had a better long-term prognosis. The results show that a group of patients can be selected that will have low postoperative mortality and morbidity. The success rate for restoration of blood flow is high, particularly if the operation is performed soon after occlusion. The long-term prognosis in patients in whom patency of the internal carotid artery is restored and maintained appears to be better than in those with persistent occlusion of the carotid artery.

Adult↗