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G Stranjalis

Publications and source records attributed to G Stranjalis.

32 records · Page 2Linked to original sources
PubMed1996

Perfluorochemical oxygen carriers: potential uses in neurosciences.

In this article we review recent developments in the field of "first-" and "second-generation" perfluorochemical (PFC) oxygen carriers. Particular emphasis is placed on the latest research and its implications regarding the clinical and experimental neurosciences. These compounds are ideally suited to the transportation of O2 within the vascular system. Two properties that facilitate their use in this respect are their very high solubility coefficients for O2 and CO2 and their biological inertness. Unfortunately, their widespread use has been limited by logistical difficulties associated particularly with their molecular behavior in vivo. However, advances in PFC technology have led to renewed interest. A potential role for second-generation PFCs in cerebral protection is exciting. Other possible significant applications are slowly becoming established in clinical practice. Currently under investigation are potential uses in the management of severe head injuries, radiotherapy or chemotherapy of malignant brain tumors, protection against air embolism, preservation of organs for transplantation, and as a tool in microsurgery of the retina or other parts of the CNS. Diagnostic neuroimaging applications could include the employment of PFCs as adjuncts in ultrasound, Doppler, computed tomography (CT), and magnetic resonance (MR) to achieve enhanced imaging and precise staging of inflammatory, neoplastic, and vascular disease processes. Research applications could include their use in magnetic resonance imaging and spectroscopy in assessing cerebral blood flow, local oxygen tension, and brain metabolism, in molecule-specific imaging, and as physiological markers of O2, ions, and pH.

Animals↗
PubMed1995

Functional outcome in patients after excision of extracanalicular acoustic neuromas using the suboccipital approach.

An audit of surgery for acoustic neuroma was carried out to determine the frequency and nature of postoperative symptoms and their impact upon the patient's quality of life and vocation. Fifty-six patients were interviewed between 6 months and 5 years (mean 26 months) after surgical excision of an acoustic neuroma. The objective surgical results in these patients are good, with normal or near normal functional preservation rates of 80% for the facial nerve (House-Brackmann grade I/II), and 27.3% for a previously functioning acoustic nerve. Despite this there was no significant overall reduction in the reported occurrence of balance problems, tinnitus, headache and other neurological sequelae of the tumour after surgical excision. In 20% of the patients persistent symptoms, including deafness and facial weakness, had prevented the resumption of former social activities. As a result of these symptoms 8.6% of the patients were certified medically unfit for work, but of those employed preoperatively over 70% had returned to their jobs. The success of neuro-otological surgical management of acoustic neuroma is offset by some degree of chronic morbidity. Our patients expressed the need to know whether their symptoms would resolve, but were often too afraid to ask. Patients can be reassured that the majority resume their former social and vocational activities, but should be advised that some symptoms can persist or occur de novo after surgery. Our data suggest that early intervention would reduce the incidence of these troublesome sequelae.

Adult↗
PubMed1993

Successful removal of intramedullary spinal cord metastasis: case report.

Intramedullary metastatic disease accounts for 5% of CNS metastases. This report describes a 47-year-old female with the simultaneous presentation of primary breast carcinoma and a solitary brain metastasis, both treated surgically. She represented with an increasing hemiparesis due to a spinal cord metastasis 4 years later. The cord lesion was removed microsurgically using a CO2 laser. Postoperatively she made a good recovery and lived independently for 2 years. The rationale for aggressive surgical treatment is discussed.

Brain Neoplasms↗
PubMed1992

MRI in the diagnosis of spinal extradural angiolipoma.

We report the case of a 68-year-old woman with a 1-year history of progressive spastic paraparesis, due to an extradural angiolipoma of the mid-thoracic spine. The MRI appearance of the angiolipoma is reported here for the first time. This appearance is characteristic, allows preoperative diagnosis and assists planning of the surgical approach.

Aged↗
PubMed1992

Outcome following surgical evacuation of traumatic intracranial haematomas in the elderly.

In order to determine the factors influencing outcome following craniotomy for trauma in patients over the age of 65 and to establish criteria for surgical intervention, the authors carried out a retrospective analysis of the hospital and general practice records of all head injury patients over the age of 65 who underwent a craniotomy for evacuation of a post-traumatic haematoma within 7 days of injury at Frenchay Hospital during a 10-year period (1980-89). Outcome was measured using the Glasgow Outcome Scale and patients were allotted to a good outcome group (good recovery or moderate disability but independent) or a poor outcome group (severe disability, vegetative state of death). There were 35 men and 31 women with a mean age of 72.5 years (range 65-85 years). The mortality rate was 61% and 9% of patients survived in a severely disabled or vegetative state. All 20 (30%) patients with a good outcome had a Glasgow Coma Score (GCS) of 5 or more immediately before surgery. All 18 (27%) patients with a GCS of 4 or less and all 22 (33%) patients with unilateral or bilateral pupillary dilatation had a poor outcome. Outcome was significantly worse in the older patients (75-85 years) compared with the younger patients (65-74 years) and in those patients requiring craniotomy within 24 hours of injury, but the mechanism of injury (fall or road traffic accident), the presence or absence of skull fractures and limb fractures and the pre-operative CT scan appearances did not influence outcome. This study confirms the high probability of poor outcome following surgical evacuation of traumatic intracranial haematomas for elderly head-injured patients with pupillary dilatation or extensor motor responses. Craniotomy under these circumstances is not justified.

Aged↗
PubMed1991

The value of autopsies in neurosurgery.

Many previous studies have reported the value of autopsy in assessing clinical diagnostic accuracy. None of them however, assessed the value of autopsies in a specific clinical speciality. The authors reviewed the findings of 123 consecutive neurosurgical autopsies with reference to the premortem clinical diagnoses. The study showed that 7% of cases had a wrong clinical diagnosis and in 9% of cases the clinical diagnosis was incomplete. Only in 5% of all cases knowledge of the autopsy findings would have led to a change in management and outcome. The autopsies also confirmed that 11% of cases died following a surgical complication and in 3% of cases the primary cause of death was non-neurosurgical. The latter was a previously unrecognised finding in 8% of autopsies. The autopsy will remain a valuable means of clinical audit and the increasing financial pressures to reduce the number of autopsies should be resisted.

Adolescent↗
PubMedDate not supplied

The outcome of surgery of aneurysmal subarachnoid haemorrhage.

Aneurysmal subarachnoid haemorrhage is a challenging pathology which remains a cause of considerable mortality and morbidity. To demonstrate to general practitioners the results of surgery for this condition a retrospective study of 160 consecutive cases who had undergone aneurysmal surgery was carried out. On admission 57% of cases had a good Hunt and Hess grade (grades I and II) and 43% a poor grade (grades III, IV and V). Twelve per cent of cases had a pre-existing hypertension and 73% of cases were treated with nimodipine. Angiography was performed from 0 to 73 days (median 3 days) after the bleed. Early surgery (within the first three days after the bleed) was performed in 41% of cases. Twenty-two per cent of cases rebled before surgery from 1 to 69 days after initial presentation (median seven days). Delayed cerebral ischaemia was diagnosed in 38% of cases, but only 15% of cases had evidence of low density on the CT scan. The outcome was determined at six months using the 'Glasgow outcome scale'. Fifty-five per cent of cases made a good recovery (back to normality), 15% a fair recovery (moderately disabled but independent), 15% a poor recovery (severely disabled and dependent), and 15% died. The significant poor prognostic factors were: a poor pre-operative Hunt and Hess grade, the presence of an intracerebral haematoma or angiographic spasm, evidence of rebleeding and early surgery without treatment with nimodipine. Other factors which did not reach a statistical significance include: age, presence of subarachnoid and intraventricular blood on CT, timing of surgery, history of long-standing hypertension, intraoperative rupture, and the development of hydrocephalus or delayed ischaemia.

Adolescent↗