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Biomedical subjects

G L Rockswold

Publications and source records attributed to G L Rockswold.

At least 37 records · Page 2Linked to original sources
PubMed1987

Analysis of management in thirty-three closed head injury patients who "talked and deteriorated".

Of 215 patients with severe head injuries, 33 (15%) closed head injury patients who talked before their conditions deteriorated to a Glasgow coma scale score of 8 or less were identified. Of this select group, 15 died (45%), but none of the remaining were left in a vegetative state and 14 patients had a "favorable" outcome (42%). Twenty-five patients (76%) underwent surgical decompression. In these 25 patients, 14 subdural hematomas, 4 epidural hematomas, and 7 intracerebral contusions and hematomas were the initial surgical lesions. Twenty of the 25 patients were operated on within 4 hours (16 within 2 hours) of their neurological deterioration. Eleven of the 25 surgically treated died, for a mortality rate of 44%. All 15 deaths were studied further. Autopsies with examination of the brain were performed in 13 patients. Five patients died with severe brain injuries not complicated by iatrogenic factors, and 4 patients died of severe associated injuries. Iatrogenic factors significantly complicated the deaths of 6 patients (40%). It is concluded that most patients who "talk and deteriorate" have sustained very serious life-threatening injuries. Intracranial hematomas are the most frequent cause of this situation, and rapid diagnosis and decompression is the most important factor in salvaging these patients.

Adult↗
PubMed1986

Civilian gunshot wounds to the brain: prognosis and management.

The extent of treatment for the victims of gunshot wounds to the brain remains quite controversial, particularly when these patients present with extensive neurological dysfunction. We propose guidelines regarding the degree and aggressiveness of therapy. The factors that seem to have a significant impact on the patient's final outcome are the neurological examination at the time of admission, the radiological findings, and the motivation for the shooting. Thus, the authors propose a nonsurgical line of therapy for comatose patients with unilateral or bilateral cerebral gunshot wounds where bone or metal fragments are visualized away from the bullet path on computed tomography scan, particularly when these individuals are suicide victims.

Adolescent↗
PubMed1984

Multimodality evoked potentials in closed head trauma.

Patients with closed head injuries who had Glasgow coma scale scores of 7 or less were studied with evoked potentials soon after trauma. Of the patients, 39 had brain-stem auditory evoked potentials (BAEPs); 12, stroboscopic visual evoked potentials (VEPs); and 23, short-latency somatosensory evoked potentials (SSEPs). Evoked potential results were graded from 1 (normal) to 4 (most abnormal). Outcomes were categorized by the Glasgow outcome scale, with good outcome and moderate disability further classified as "favorable" and severe disability, vegetative state, and death as "unfavorable." The BAEPs and VEPs were reliable predictors of an unfavorable but not a favorable outcome. The SSEPs reliably predicted both kinds of outcomes. No instances of "false pessimism" were encountered in any modality. Evoked potential results were more reliable than intracranial pressure, pupillary light reaction, or motor findings in predicting outcome. Frequent occurrence of peripheral auditory injuries was shown.

Adolescent↗
PubMed1983

Barbiturate therapy in uncontrolled intracranial hypertension.

From July 1978 to September 1981, 27 patients from a group of 210 patients with severe head injuries developed uncontrolled intracranial hypertension despite intensive medical and surgical management. These 27 patients were considered appropriate candidates for barbiturate therapy. Abnormal posturing or flaccidity was present in 70% of the patients, and 41% had bilaterally fixed pupils. Twenty-five of 27 patients had mass lesions requiring operation. Of the 15 patients who responded to barbiturate therapy with normalization of intracranial pressure for 24 hours, 5 died (33% mortality). Nine of the 12 patients who did not respond to the barbiturate therapy died (75% mortality). The total mortality in this group of 27 patients was 52%. Of the survivors, 69% had a recovery classified as good recovery/moderate disability, and 31% were in a severe disability/vegetative state. The morbidity and mortality in these patients is high, but comparisons with previous studies show that this is a selected group of severe head injuries with a high percentage of poor prognostic indicators. Our experience suggests that barbiturates can be effective in lowering intracranial pressure in patients with otherwise unresponsive intracranial hypertension, and, by doing so, may decrease the mortality in a group of patients considered untreatable by the usual therapeutic modalities.

Adolescent↗
PubMed1983

Subependymoma in a 2 1/2-year-old boy. Case report.

Subependymomas are extremely rare tumors in the pediatric population and, when they occur, they are usually of a mixed type with elements of subependymoma and ependymoma. This report is of a 2 1/2-year-old male infant with a pure subependymoma of the fourth ventricle.

Cerebral Ventricle Neoplasms↗
PubMed1981

Emergency twist drill trephination.

We have used the rapid progression of post-traumatic uncal herniation in spite of intensive medical therapy as the indication for twist drill trephination in the emergency department. During a 54-month period, 51 trephinations were performed on 41 patients. The trephine was placed through the temporal bone ipsilateral to the dilated pupil, and the dura mater was opened to allow partial evacuation of the hematoma. All patients subsequently underwent craniotomy, autopsy, and/or cerebral computed tomography (CT). The trephination was diagnostically accurate for the absence or presence of an extracerebral hematoma in 42 of 51 trephinations (82%). In 6 of these cases the dilated pupil responded to partial hematoma evacuation by decreasing in size. In 3 of the 6 there was a marked overall improvement in neurological status subsequent to trephination. These 3 patients later recovered to an independent functional state. Only 23 of these 41 patients (56%) with herniation profiles actually had significant extracerebral hematomas. This fact emphasizes the inadvisability of taking this type of patient directly to the operating room without a diagnostic study. A rapidly performed CT scan is the obvious first choice. However, if there is any delay in obtaining this study or when uncal herniation occurs rapidly, a twist drill trephination can be of value in diagnosing the absence or presence of a treatable extracerebral hematoma. There were no complications related to this procedure in this group.

Adult↗
PubMed1980

Innervation of the urinary bladder in higher primates.

Stimulating electrodes were placed on the terminal branches of the pelvic nerves to the urinary bladder and the pudendal nerve to the sphincters in seven Rhesus monkeys and two chimpanzees. The proximity of the electrodes to these structures assured organ specificity. Evoked responses produced by stimulation of these terminal nerve branches were recorded in the fascicles and rootlets of the lower thoracic, lumbar, and sacral nerve roots. During identical stimulating and recording conditions, the amplitude as well as presence or absence of the evoked responses recorded was variable within the various roots. The amplitude of the evoked responses or their absence depended on the number of fibers within a particular fascicle which conducted impulses to the urinary bladder or the urethral and anal sphincters. By this method, it was determined that there was segregation or compartmentalization of the nervous innervation to the urinary bladder and sphincters within the spinal roots. In addition, the segmental spinal cord origin of the innervation of the urinary bladder was determined for the Rhesus monkey and chimpanzee. In the Rhesus monkey, the pelvic nerves to the urinary bladder arose from the first and second sacral segments and to a much lesser extent from the seventh lumbar segment. In the chimpanzee, the sacral segments one to four gave rise to innervation of the urinary bladder.

Afferent Pathways↗
PubMed1980

Innervation of the external urethral and external anal sphincters in higher primates.

Stimulating electrodes were placed on the terminal branches of the pudendal nerve to the external urethral and external anal sphincters. The proximity of the electrodes to the sphincters assured organ specificity. Evoked responses produced by stimulation of these terminal nerve branches were recorded in the fascicles and rootlets of the lower thoracic, lumbar, and sacral nerve roots. By this method, the segmental spinal cord origin of the innervation of the external urethral and anal sphincters was determined for the Rhesus monkey and chimpanzee. The data indicated that the pudendal nerves to the urethral and anal sphincters in the Rhesus monkey arose from the sixth and seventh lumbar spinal segments and the first and second sacral spinal segments which are homologous to the S-1 and S-4 segments found to give innervation to these structures in the chimpanzee. The primate experiments thus indicate that the spinal origin of the pudendal nerve was more rostrally located by one segment or more than was the origin of the pelvic nerves to the urinary bladder.

Anal Canal↗
PubMed1979

Early diagnosis of delayed posttraumatic intracerebral hematomas.

Nine cases of delayed posttraumatic intracerebral hematomas (DTICH) were found retrospectively among 656 patients with closed head injuries admitted to the Hennepin County Medical Center in a 12-month period. All cases had severe head injuries sustained with the head in motion. The interval from cranial injury to diagnosis of DTICH by computerized tomography (CT) varied from 8 hours to 13 days. Eight patients were comatose on admission, three had focal seizures, and three had focal findings. The diagnosis was made on repeat CT scans obtained because of the development of focal findings in four cases, lack of improvement in four cases, and general neurological deterioration in one case. Four patients had initially negative CT scans. Four demonstrated only extracerebral hematomas on initial CT scan. One patient showed intracerebral hematoma on the initial scan followed by new hematomas on repeat study. The cases presented are discussed in light of pertinent literature.

Accidents, Traffic↗
PubMed1978

Re-evaluation of differential sacral rhizotomy for neurological bladder disease.

The authors describe long-term follow-up results (4 to 6 years) in 13 patients who underwent differential sacral rhizotomy for urgency incontinence. Six patients were originally presented in a preliminary report in 1973. In the last seven patients, a highly selective rhizotomy of sacral fascicles innervating only the urinary bladder was performed. Results in the original six patients appear to be superior to those in patients who underwent a more refined rhizotomy. Possible explanations for this as well as alternative approaches to the treatment of urgency incontinence are briefly discussed.

Animals↗
PubMed1977

The use of sacral nerve blocks in the evaluation and treatment of neurologic bladder disease.

We describe the use of sacral nerve blocks in conjunction with air cystometry and sphincter electromyography to determine the functional innervation of the bladder and sphincters. This technique has aided in the selection of patients for sacral rhizotomy. Phenol sacral nerve blocks have been used successfully in treating hyperactive bladder disease and intractable perineal pain.

Humans↗
PubMed1977

The use of evoked electromyographic responses in diagnosing lesions of the cauda equina.

An electrophysiologic technique to evaluate the anatomic integrity of the peripheral pathways to the bladder and sphincters is described. Evoked electromyographic responses of the anal sphincter are produced by stimulating the bladder wall and urethra. Impulses travel via the pelvic nerves and cauda equina to the conus medullaris, activating the pudendal nerve nucleus and resulting in contraction of the external anal sphincter. Lesions along this pathway produce either prolonged latencies and depressed responses or complete loss of response. Correlation of the results of this technique in 110 patients with clinical myelographic and operative findings indicates that the technique is a useful clinical tool.

Anal Canal↗