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Biomedical subjects

J E Bailes

Publications and source records attributed to J E Bailes.

At least 37 records · Page 2Linked to original sources
PubMed1992

Comparison of the effects of total blood substitution during two different levels of hypothermic cardiac arrest.

The effect of total blood replacement with a solution containing neither hemoglobin nor fluorocarbon was studied under two different levels of hypothermia. Ten dogs were anesthetized and esophageal temperature lowered to about 24 degrees at which time exsanguination began. Upon cardiac arrest and the completion of exsanguination, continuous whole body closed chest extracorporeal circulation of an oxygenated blood substitute was begun. Hematocrit was 1% while core temperature remained less than 10 degrees C for 3 hours of perfusion during which nadirs of 1.3 degrees C (Group I, N = 5) and 7.3 degrees (Group II, N = 5) were achieved. Replacement of the perfusate with whole blood began once the dog was rewarmed to approximately 10 degrees C. All dogs survived the procedure. Two dogs from each group died by the fourth post-operative day but the others survived long term. Group II showed a faster return to normal based on motor behavioral, biochemical and hematological changes. Thus the combination of profound hypothermia and complete blood substitution with a solution lacking any special oxygen carrying molecule, can be tolerated for 3 hours using both levels of hypothermia, however, the warmer one appears to be associated with faster recovery.

Animals↗
PubMed1992

Complete blood substitution during profound hypothermic cardiac arrest in dogs.

This study compared the effects of 3 hours of cardiac arrest performed at 2 different levels of profound hypothermia in totally exsanguinated, blood substituted dogs. Dogs (N = 10) were anesthetized and esophageal temperature was lowered to 24 degrees at which time exsanguination began. Once exsanguination was complete and the heart had arrested, continuous whole body perfusion of an oxygenated blood substitute solution was performed for 3 hours. Core temperature during this period remained below 10 degrees C and reached nadirs of 1.3 degrees C in Group 1 (N = 5) versus 7.3 degrees C in Group II (N = 5). Once the dog was allowed to rewarm to 10 degrees C replacement of the perfusate with blood was begun. All dogs survived the procedure but 2 dogs from each group died by 4 days following the experiment. The remaining 6 dogs were observed for between 10 and 85 days. The group perfused with blood substitute at the warmer nadir had a faster recovery of motor behavior and showed smaller changes from normal in several biochemical and hematological parameters. These findings indicate that profound hypothermia and total blood substitution can be successfully achieved at either temperature nadir, but the warmer level appears to be associated with a faster recovery.

Animals↗
PubMed1992

Thromboendarterectomy of the symptomatic occluded internal carotid artery.

A retrospective review of 42 patients (mean age 61.4 years) with surgically managed symptomatic internal carotid artery occlusion is reported. A standardized surgical protocol aimed at restoration of flow in the vessel was used. Presenting symptoms included hemispheric transient ischemic attacks in 68% of patients, new fixed neurological deficits in 28%, amaurosis fugax in 28%, and stroke-in-evolution in 9%. Twenty-four arteries were successfully reopened. A proximal remnant angioplasty (stumpectomy) was performed alone in nine patients or in combination with an external carotid endarterectomy in nine. In four patients with persisting symptoms who failed to achieve primary restoration of flow, a superficial temporal-to-middle cerebral artery bypass procedure was performed. The permanent surgical morbidity rate was 2% and the surgical mortality rate was 0%. Transient postoperative deficits were present in three patients (7%). Follow-up review at a mean of 40 months was obtained in 39 patients (93%). Following surgical intervention, five patients died of unrelated causes, two had neurological events consistent with a transient cerebral ischemic attack, and two had vertebrobasilar insufficiency. No patient suffered from stroke. Of the 24 successfully reopened vessels, follow-up ultrasound evaluations were obtained in 17 (73%) at a mean of 28 months after surgery. In 15 patients (88%) the vessels were widely patent, one (5.8%) had stenosis greater than 70%, and one (5.8%) showed asymptomatic reocclusion. Reopening occluded internal carotid arteries in selected patients is associated with low surgical morbidity and mortality rates. Further studies are necessary to determine the impact of this surgical therapy on the natural history of this condition.

Algorithms↗
PubMed1992

Blood substitution: an experimental study.

Priming fluids for cardiopulmonary bypass have been extremely varied, with resultant hemodilution. Furthermore, major surgeries utilizing cardiopulmonary bypass require multiple postoperative transfusions of blood and blood products. The appeal of having a readily available blood substitute for major cardiovascular and neurosurgical operations could prove to be a life saver, while also eliminating the risk of diseases transmitted by transfusion. Blood substitutes could also lessen the reported complications resulting from blood damage due to prolonged circulation of the blood by the extracorporeal pump. A technique was examined in 15 dogs using hypothermia for maximum metabolic suppression, incorporating an aqueous blood substitute (Cryomedical Sciences, Inc., Rockville, MD). The anesthetized animals were cannulated for extracorporeal pump oxygenation. As temperature was lowered the dogs were exsanguinated and volume replaced with blood substitute to lower the hematocrit to less than 1%. After 3 hours of cardiac arrest and continuous perfusion at a core temperature less than 10 degrees C, rewarming began. When temperature reached greater than or equal to 10 degrees C, the blood substitute was drained and the animals were autotransfused. The heart was started at 15 degrees C and spontaneous respiration resumed at 29 degrees C. Using the first generation blood substitute the survival rate was maximal (100%) at 2.5 hrs under 10 degrees C and 3 hours of cardiac arrest. Research is underway on a new blood substitute, which is to serve as a universal hypothermic preservation solution (in situ organ preservation).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Continuous postoperative monitoring of cortical blood flow and intracranial pressure.

A new technique to continuously monitor cortical blood flow and intracranial pressure in postoperative patients is described. A thermal diffusion flow probe with a pressure port is left in contact with the cortex at craniotomy. Postoperative intracranial pressure--cortical blood flow can be monitored and acute changes or trends are readily detected. The thermal flow probe has been previously compared with radioactive xenon (133Xe) clearance and hydrogen clearance methods of measuring cortical blood flow in animals. The technique gives a real-time quantitative indication of flow. Changes in cortical blood flow can be observed within a few seconds and the effects of treatment can be readily observed. Changes in flow due to vasospasm have been demonstrated in subarachnoid hemorrhage. It is anticipated that information learned from this method will aid in the management of patients with head trauma, tumors, and subarachnoid hemorrhage.

Brain↗
PubMed1991

Management of athletic injuries of the cervical spine and spinal cord.

Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral column and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty-five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Ultraprofound hypothermia with complete blood substitution in a canine model.

The potential for hypothermia to prevent or ameliorate ischemic injury to the central nervous system is well known. To determine if a more prolonged period of metabolic suppression with blood substitution is possible, a method was developed to lower body temperature to near the freezing point. Eight adult mongrel dogs underwent closed-chest extracorporeal circulation with both external and internal body cooling. As they were cooled, progressive hemodilution was employed until complete exsanguination and blood substitution with an aqueous solution was accomplished. Continuous circulation and a core temperature at a mean of 1.7 degrees C were maintained from 2 1/2 to 3 hours. After rewarming to 20 degrees C, the animals were autotransfused and allowed to recover. Of the eight animals, two died due to technical factors related to cardiac defibrillation. Of the six surviving animals, five survived over a long period and one died on the 10th postoperative day with hepatorenal failure resulting from a presumed blood transfusion incompatability reaction. All six showed normal neurological function and kennel behavior, except one dog with mild weakness of a hindlimb. When the dogs were sacrificed 1 to 2 months postoperatively, all organs were histologically normal. Specifically, there was no gross or microscopic evidence of ischemic or hypoxic injury to any central nervous system structures. This pilot study demonstrates that it is possible to successfully achieve complete exsanguination, blood substitution, and ultraprofound body temperature, while continuous circulation of the blood substitute is maintained. With the capability of controlling and repeatedly performing washout of the extracellular environment and by reaching lower temperatures, it may be possible to attain greater cellular metabolic suppression. This perhaps will extend the allowable times for circulatory arrest procedures. In addition, "bloodless ischemia" may be beneficial in removing both blood substances and formed elements which may mediate organ ischemia. With replacement of blood at warm temperatures, coagulopathy is avoided. This preliminary evidence demonstrates potential in the combination of ultraprofound hypothermia and complete blood component substitution. However, further study is required to confirm the potential of achieving circulatory arrest of longer duration.

Animals↗
PubMed1990

Diving injuries of the cervical spine.

From 1975 to 1986, 2435 patients were admitted to the Northwestern University-Midwest Regional Spinal Cord Injury Unit. Of these, 220 patients (9.0%) had documented neck fractures from diving accidents, representing the largest series of acute diving injuries yet analyzed. The average age of these patients was 21 years, and males predominated. Two hundred twelve patients (96.4%) were admitted within 48 hours of injury. Associated injuries were rare: none had intracranial mass lesions or systemic injuries, and only nine were near-drowning victims who required endotracheal intubation. The most common levels of injury were C-5 (140 fractures) and C-6 (85 fractures), with 70 patients having fractures at more than one level. Neurological injury was sustained in 154 (70.0%) patients, while 66 (30.0%) patients were neurologically intact. One hundred forty-seven (66.8%) patients underwent posterior cervical fusion, and anterior fusion was performed in 36 (16.4%), allowing for early ambulation and an average hospital stay of 17 days. Hospitalization was relatively uncomplicated, with urinary tract infection in 121 (55.0%), pneumonia in nine (4.1%), and deep vein thrombosis in 24 (10.9%). Long-term follow up averaged 5 years and was obtained in 160 (72.7%) patients. Sixteen (10.0%) improved neurologically, five (3.1%) deteriorated, and 139 (86.9%) were unchanged. Notably, this large study shows that diving accidents occur in a young, healthy population who sustain essentially no other associated intracranial or systemic injuries and have few serious hospital complications. Such patients may be mobilized early in their care after either internal or external stabilization. Subsequent long-term neurological improvement can be expected to occur in about 10% of patients. The importance of water safety and injury prevention is stressed.

Adolescent↗
PubMed1990

Percutaneous automated biopsy in the diagnosis of primary infectious spondylitis.

Three cases of primary infectious spondylitis, two caused by Staphylococcus aureus and one by tuberculosis, were diagnosed using the method previously described for automated percutaneous discectomy. All three patients, in whom biopsy using fine needle techniques previously was unsuccessful, had positive cultures from specimens obtained using the automated method. The method combines the advantages of local anesthesia and minimal morbidity with the obtaining of adequate material for culture and pathological examination.

Adult↗
PubMed1990

Management morbidity and mortality of poor-grade aneurysm patients.

Preliminary experience with the occasional good survival of patients in Hunt and Hess Grade IV or V with aneurysmal subarachnoid hemorrhage (SAH) led to a prospective management protocol employed during a 2 1/2-year period. The protocol utilized computerized tomography (CT) scanning to diagnose SAH and to obtain evidence for irreversible brain destruction, consisting of massive cerebral infarction with midline shift or dominant basal ganglia or brain-stem hematoma. These patients, along with those who exhibited poor or absent intracranial filling on CT or angiography, were excluded from active treatment and given supportive care only. All other patients had immediate ventriculostomy placement and, if intracranial pressure (ICP) was controllable (less than or equal to 30 cm H2O without an intracranial clot or less than or equal to 50 cm H2O in the presence of a clot), went on to have craniotomy for aneurysm clipping. Aggressive postoperative hypertensive, hypervolemic, hemodilutional therapy was subsequently employed. Of 54 patients with poor-grade aneurysms, ventriculostomy was placed in 47 (87.0%) and yielded high ICP's in the overwhelming majority, with the mean ICP being 40.2 cm H2O. Nineteen poor-grade aneurysm patients received no surgical treatment and survived a mean of 31.8 hours with 100% mortality. Thirty-five patients underwent placement of a ventriculostomy, craniotomy for aneurysm clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemic, hemodilutional therapy. The outcome at 3 months of the 35 patients who were selected for active treatment was good in 19 (54.3%), fair in four (11.4%), poor in four (11.4%), and death in eight (22.9%). It is concluded that poor-grade aneurysm patients usually present with intracranial hypertension, even those without an intracranial clot. Based on radiographic rather than neurological criteria, a portion of these patients can be selected for active and successful treatment. Increased ICP can be present without ventriculomegaly, and immediate ventriculostomy should be performed. As long as ICP is controllable, craniotomy and postoperative intensive care can effect a favorable outcome in a significant percentage of these patients.

Cerebral Hemorrhage↗
PubMed1989

Laser-assisted nerve repair in primates.

Studies on the peripheral nerves in rats and other species have helped in the development of laser-assisted nerve anastomosis (LANA), but offer little in evaluating the efficacy of this technique in primates. The authors present a study of LANA in the peripheral nerves of rhesus monkeys. Twelve adult rhesus monkeys underwent bilateral resection of a portion of the peroneal nerve followed by placement of autogenous sural nerve interposition fascicular grafts. The grafts were completed with conventional microsurgical suture technique on one side and with LANA on the other. At 5, 8, 10, and 12 months, the grafted nerves were evaluated for continuity, nerve conduction, and histology (both light and electron microscopy). No significant difference in continuity, conduction velocity, nerve degeneration, nerve regeneration, axon fiber number, or axon fiber density was found in any animal between grafts performed by conventional microsuture and LANA grafts. There was no difference in distal or proximal myelinated fiber density between the LANA grafts and the conventional microsuture grafts. It was concluded that LANA is as effective as microsurgical suture nerve anastomosis in a primate model of nerve repair and grafting.

Animals↗
PubMed1989

Management of cervical spine injuries in athletes.

Trauma to the spinal column may cause a variety of clinical syndromes depending on the type and severity of the impact and bony displacement as well as secondary insults such as hemorrhage, ischemia, and edema. Complete spinal cord injury results in a transverse myelopathy, with total loss of spinal function below the level of the lesion. This insult is caused by either anatomic disruption of the spinal cord or hemorrhagic or ischemic injury at the site of injury. Complete injury patterns are rarely reversible, although, with long-term follow-up, improvement of one spinal level may be seen as a result of resolution of initial segmental traumatic cord swelling.

Athletic Injuries↗
PubMed1988

The effects of intravenous prostacyclin in a model of microsurgical thrombosis.

Numerous agents have been administered in an attempt to achieve specific biochemical antiplatelet activity. A model of microsurgical trauma was utilized to create a nonocclusive thrombus, similar to what occurs in the postoperative period. Prostacyclin (PGI2) was given in a high intravenous dose which caused in vitro inhibition of platelet aggregation in rats and rabbits. Although hematological and cardiovascular side effects of PGI2 were tolerated, in vivo platelet thrombus formation persisted and constituted 25-75% of the postoperative thrombus. Even though platelets were inhibited by PGI2, other significant stimuli remained at the site of injury for activation and participation of platelets in the formation of a thrombus.

Animals↗
PubMed1987

Review of tissue welding applications in neurosurgery.

New technical advances have made feasible the utilization of low-powered laser energy for constructive applications. Experience with laser bonding of blood vessels, peripheral nerves, and dura has been obtained. These studies are summarized, and the future potential of laser bonding of tissues of the central nervous system is discussed.

Animals↗
PubMed1987

Laser-assisted end-to-side anastomosis.

The milliwatt CO2 laser was used to anastomose rat carotid arteries in an end-to-side fashion, and this technique was compared to the standard suture technique. Vessels were studied at two to six weeks. All anastomosis were patient and overall, there was a 78.6 percent rate of aneurysm formation in the laser cohort, compared with 7.1 percent with suture (p less than 0.001 Fisher exact). Vessels and aneurysm histology were similar to those previously reported for the end-to-end technique.

Anastomosis, Surgical↗
PubMed1986

Comparison of myointimal hyperplasia in laser-assisted and suture anastomosed arteries. A preliminary report.

Use of the milliwatt CO2 laser to perform microvascular anastomoses is associated with characteristic histologic changes, including intimal hyperplasia and medial necrosis. The extent of myointimal proliferation after both suture and laser-assisted vascular anastomosis was assessed in the rat femoral artery model. At 2 weeks the average intimal height of the laser-anastomosed vessels was 11.7 +/- 2.2 microns (mean +/- standard error of the mean) vs. 21.3 +/- 3.2 microns for sutured arteries (p less than 0.05). By 6 weeks the groups were equivalent (laser, 25.6 +/- 4.6 microns; suture, 17.3 +/- 1.2 microns; p, not significant). The medial changes associated with the laser-assisted method appear to inhibit the proliferative response at 2 weeks but are reversed by 6 weeks.

Animals↗