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Biomedical subjects

G L Rea

Publications and source records attributed to G L Rea.

10 recordsLinked to original sources
PubMed1992

Surgical treatment of the spontaneous spinal epidural abscess.

Seven cases of spontaneous epidural abscess are reviewed. Three patients had posterior abscesses and no evidence of vertebral body osteomyelitis. These patients had excellent outcomes with laminectomies and antibiotics. Because of significant vertebral destruction, two patients with vertebral osteomyelitis required posterior fixation after laminectomy. Two other patients with vertebral osteomyelitis had complete destruction of the vertebral body and required anterior decompression and fusion in addition to posterior fixation. In the four patients with vertebral osteomyelitis, morbidity was high, reflecting their age and significant medical problems. This review supports the contention that medically stable patients with posterior epidural abscesses can be treated with laminectomy and antibiotics with little risk of progressive instability. The proper surgical treatment of anterior epidural abscesses secondary to osteomyelitis requires knowledge about the amount of destruction of the supporting columns, the amount of neural compression secondary to the purulence, and the patient's general medical condition.

Abscess↗
PubMed1992

Dural tear following traumatic spinal cord injury. A delayed complication.

Dural tears with leakage of cerebral spinal fluid into surrounding soft tissues can occur after traumatic spinal cord injury. An unusual case presented in a patient with traumatic paraplegia where the onset was delayed and clinical features were suggestive of autonomic dysfunction. The clinical features, pathophysiology and treatment of this interesting complication following traumatic spinal cord injury are discussed.

Adult↗
PubMed1992

Magnetic resonance imaging of trauma to the thoracic and lumbar spine. The importance of the posterior longitudinal ligament.

Magnetic resonance imaging was used to evaluate 24 patients with injuries to the thoracic, thoracolumbar (T12-L1), or lumbar spine. Correlation of the magnetic resonance imaging findings to surgical therapy and outcome was evaluated, with particular attention to the longitudinal ligaments. The ability of the magnetic resonance imaging to detect the extent of trauma to the spinal cord parenchyma and to the anterior and posterior longitudinal ligaments was found to be important in guiding the surgical approach to these spine fractures.

Adolescent↗
PubMed1991

Quantitative assessment of the effect of basal ganglia lesions on the stretch reflex in primates.

The effect of basal ganglia stereotactic lesions on motor tone in 3 primates was quantitated. The elastic and neurogenic forces generated with a controlled stretch of each animal's upper extremities were measured pre- and postlesion, and compared to previous studies. The techniques were sensitive to subtle changes in motor tone that were not clinically apparent. The results suggest that the basal ganglia, through the outflow path of the globus pallidus, is important in controlling the sensitivity of both flexors and extensors to stretch. These quantification techniques also have promise in evaluating treatment regimens for spasticity, rigidity, and other conditions with abnormal motor tone.

Animals↗
PubMed1988

Intrathecal application of drugs for muscle hypertonia.

The literature regarding the intrathecal use of morphine, baclofen, and midazolam to treat spasticity is reviewed. Nine patients with significant spasticity due to different etiologies were treated. Morphine and midazolam decreased spasticity but did not change the patient's functional status. Baclofen improved patient status, but was associated with significant CNS depression in two cases.

Baclofen↗
PubMed1987

Evaluations of combined premotor and supplementary motor cortex lesions on a visually guided arm movement.

The kinematics of a visually guided, multi-joint arm movement were examined before and after combined bilateral premotor and supplementary motor cortex lesions. Two rhesus monkeys were trained to move a manipulandum from a start zone to one of three equally spaced target zones and then return to the initial start zone. Various features of the movement trajectory including space error, time error, peak velocity and turnaround time were quantified and analyzed before and after the premotor and supplementary motor cortex ablations. Statistical analysis showed no major differences in the trajectories toward or away from the target between the pre- and postlesion state. The major difference following the ablation was an increase in the time spent in the target zone, reflecting an increase in time spent in redirecting the trajectory. Normalization of the movement duration revealed a slight delay in the initial part of the movement. These results suggest the premotor and supplementary motor cortex are involved in redirecting the trajectory and/or obtaining the target zone during the execution of a complex movement.

Animals↗
PubMed1987

Intrathecal application of baclofen in the treatment of spasticity.

Baclofen, a derivative of g-aminobutyric acid (GABA) has been known for many years to be a useful drug in the treatment of spinal spasticity. However, when the spasticity is severe, the systemic administration has to be increased, often without therapeutic effects but frequently with central side-effects. Baclofen given intrathecally however, in microgram doses has been previously reported to be effective and safe. A personal experience is reported of 9 severely spastic patients residing in chronic care facilities who were treated from July 1984 to March 1986 with intrathecal baclofen. The spasticity was causing significant nursing care problems, and 6 patients were reduced to a completely bedridden state. Each patient initially received a percutaneous intrathecal drug injection of 0.2-0.7 mg of baclofen to test its efficacy. A subcutaneous intrathecal system for further injections was placed in 6 patients. In 3 patients a decreased level of consciousness was observed. In the 3 cases of multiple sclerosis, intrathecal baclofen resulted in significant reduction of spasticity for 24 to 48 hours after each injection. The spasticity was improved in only one of the 2 cases of posttraumatic paraplegia. The effect was not convincing in the 2 cases of spinal cord tumour, and in the case of cerebral palsy the effect was improvement in spasticity, but also significant drowsiness. Baclofen, in comparison with some other drugs such as morphine or midazolam, also tried intrathecally by the authors, is the most effective in reducing spasticity. Its use however warrants caution, for it can cause decreased consciousness, and there is currently no antagonist.

Adolescent↗
PubMed1987

Interactive computer graphic image analysis for functional neurosurgery.

This study deals with the use of microcomputer graphic analysis of preoperative magnetic resonance imaging (MRI) scans in functional neurosurgical procedures. Three patients (2 treated for thalamotomy and 1 for thalamic stimulation) had preadmission MRI scans which delineated the classic internal landmarks used in functional neurosurgery. These data were then manipulated and stored using a microcomputer-based graphic analysis system. Intraoperative pattern matching of preadmission graphics with the intraoperative skull X-rays allowed determination of the planned target in the x, y and z coordinates. The accuracy of the graphics FM-PC and AC-PC points was confirmed with the use of ventriculography, stimulation, and postoperative MRI scans. This simple, inexpensive method obviates the need for ventriculography, sedation, intraoperative MRI with a scan-compatible frame, and has the accuracy necessary for functional procedures.

Aged↗
PubMed1986

Intrathecal morphine during lumbar spine operation for postoperative pain control.

The analgesic requirements and bladder function of 5 patients who received 1 mg of intrathecal morphine during lumbar spine operation are compared to those of 10 control patients. No analgesics were used by the treatment group for the first 24 hours postoperatively. The test group subsequently required twice the amount of analgesics during the 2nd through 5th days after operation compared to controls. All 5 patients who received intrathecal morphine developed urinary retention for 24 to 36 hours. The brief duration of analgesia, the increased narcotic use after the effects of the morphine dissipated, and urinary retention after a single intraoperative dose of intrathecal morphine suggest caution in using this technique.

Adult↗