Biomedical subjects

E C Haley

Publications and source records attributed to E C Haley.

60 records · Page 4Linked to original sources

PubMed1987

Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study.

Cerebral ischemia from vasospasm is a major cause of death and disability following aneurysmal subarachnoid hemorrhage (SAH). This study examines and compares the relative utility of the initial neurologic examination and early CT in predicting cerebral ischemia after SAH. The influence of antifibrinolytic drugs (AFD) in the development of cerebral ischemia was also studied. AFD increased the risk of cerebral ischemia regardless of the admitting neurologic condition or the findings of CT. Among patients given AFD, impaired orientation or alertness was associated with a higher risk of ischemia. Other neurologic signs were not predictive of ischemia. Clinical features were not predictive of ischemia among patients not given AFD. Focal, thick collections of blood on CT were highly predictive of ischemia, whether or not patients received AFD. Admitting CT is the best prognostic indicator for the development of cerebral ischemia after SAH. It should be used to supplement the clinical examination in selecting patients best suited for therapy to prevent vasospasm.

Antifibrinolytic Agents↗

PubMed1986

Antifibrinolytic therapy in the treatment of aneurysmal subarachnoid hemorrhage.

At the present time, there remains considerable uncertainty regarding the safety and efficacy of antifibrinolytic therapy in the treatment of aneurysmal SAH. Furthermore, there is little to guide us on precisely how to employ the agents. Whether to continue to use antifibrinolytic therapy after considering the results of the 1984 Cooperative Aneurysm Study trial and the Glasgow-Rotterdam-Amsterdam-London trial remains very much a philosophical decision. However, rebleeding is instantly and permanently devastating and 70% fatal, while ischemic deficits from vasospasm have a gradual onset and are potentially reversible. Accordingly, our policy is to continue to use antifibrinolytic therapy in those patients in whom it is desired to delay surgery. Our feeling is that, while there is no demonstrated advantage in acute mortality in either of the previously mentioned series, hypertensive, hypervolemic therapy or calcium channel blocking agents might ameliorate the ischemic consequences of therapy. Accordingly, it is in the context of combined therapy that the reduction in rebleeding will significantly influence patient outcome.

4-Aminobenzoic Acid↗

PubMed1984

Encephalopathy following arteriography: a possible toxic effect of contrast agents.

Three elderly men being evaluated for cerebrovascular disease developed acute confusional states following arteriography with approximately 50 ml of meglumine iothalamate. Two patients became stuporous. All recovered in several days, and no specific cause was found for the disorder. In the absence of other demonstrated abnormalities, we suggest that in each patient the encephalopathy may have been a toxic reaction to the contrast agent.

Aged↗

PubMed1984

Intrauterine and ruptured tubal ectopic pregnancy: a diagnostic challenge.

A case of combined pregnancy, an unusual condition, is presented. A 17-year-old woman came to the emergency department because of left-sided, low abdominal pain. An intrauterine pregnancy and a right-sided ovarian cyst were demonstrated by ultrasound. The presence of the intrauterine pregnancy caused the clinicians to disregard symptoms and physical findings suggesting the concomitant presence of a ruptured left tubal ectopic pregnancy. Forty-eight hours later, when the patient was in impending shock, laparotomy revealed the ruptured left tubal ectopic pregnancy. Surgical treatment was successful. Six weeks later, a blighted ovum was removed from the uterus, confirming that two pregnancies had coexisted. Undue reliance on ultrasonography is criticized, and culdocentesis is advocated.

Adolescent↗

PubMed1983

Treatment of experimental brain abscess with penicillin and chloramphenicol.

Recent reports have indicated that antibiotic therapy alone may be successful in resolving brain abscesses. We utilized an animal model of brain abscess to evaluate the efficacy of penicillin with and without chloramphenicol in preventing the development of brain abscess. When penicillin therapy was initiated at the time of bacterial contamination and continued for four days, the bacteria were eliminated. When therapy was delayed for 24 hr, the number of bacteria in brain tissue samples was significantly reduced, but all samples still contained bacteria. When therapy was delayed for 48 hr, there was no therapeutic benefit. Addition of chloramphenicol to each of these regimens did not significantly alter the results. Extending the duration of therapy to eight days provided no improvement over the results obtained after four days.

Animals↗

PubMedDate not supplied

Thrombus localization with emergency cerebral CT.

PURPOSE: To determine the prevalence of the hyperdense middle cerebral artery sign (HMCAS) in an acute stroke population (treated with intravenous tissue plasminogen activator (tPA) within 90 minutes of stroke onset); to correlate the presence/absence of the sign with arteriographic findings; and to correlate the HMCAS with the volume of subsequent infarction. PATIENTS AND METHODS: 55 patients with acute ischemic stroke underwent CT to exclude cerebral hemorrhage and were then treated with intravenous tPA. The neuroradiologist, blinded to the clinical and arteriographic data, sought the HMCAS on the initial and subsequent scans. RESULTS: The HMCAS was detected by CT in 19 of 55 (34.5%) patients (one false positive). Arteriograms in 14 of the 18 true positive patients confirmed the CT-predicted middle cerebral artery segment in 12. The 18 patients developed infarcts larger than patients not exhibiting the sign (132 cc vs 52 cc, P less than .002). CONCLUSION: The HMCAS does predict middle cerebral artery occlusion and subsequent development of a large infarct.

Brain Ischemia↗