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Biomedical subjects

J R van Dellen

Publications and source records attributed to J R van Dellen.

At least 19 recordsLinked to original sources
PubMed1992

Levels of catecholamine in plasma and cerebrospinal fluid in aneurysmal subarachnoid hemorrhage.

Despite intensive investigation into the cause of cerebral vasospasm (focal ischemic deficit) after subarachnoid hemorrhage, the morbidity and mortality associated with this condition remain high. Various studies have shown levels of catecholamine in plasma and cerebrospinal fluid (CSF) to be increased in subarachnoid hemorrhage, and it is possible that these vasoactive substances play an important role in the subsequent vasospasm. In an attempt to elucidate this possibility, the study presented here was undertaken to investigate the relationship between catecholamine levels in plasma and CSF and focal ischemic deficit (FID); the rupture of aneurysms on blood vessels supplying the hypothalamus as compared with the rupture of aneurysms on blood vessels supplying other areas of the brain; and the clinical outcome of the patients. Concentrations of adrenaline and noradrenaline in plasma and CSF samples obtained from 21 patients who had suffered aneurysmal subarachnoid hemorrhage were determined by a radioenzymatic technique. Significantly higher levels of adrenaline were found at the time of surgery in the CSF of patients with FID. A similar trend, though not statistically significant, was also observed for plasma. Patients with a rupture of aneurysms on blood vessels supplying the hypothalamus showed a tendency towards higher catecholamine levels in plasma and CSF. Subjects with a bad clinical outcome (i.e., those who were severely disabled or had died) had significantly higher levels of catecholamine in plasma than did those with a good clinical outcome (i.e., those with moderate or no disability). Further detailed analysis of the interrelationships showed that, within the group of patients with FID, those with rupture of aneurysms on blood vessels supplying the hypothalamus had significantly higher catecholamine levels in plasma than did those with rupture of aneurysms on other cerebral vessels. Furthermore, in the group of patients with rupture of aneurysms on blood vessels supplying the hypothalamus, those with a bad clinical outcome had significantly higher catecholamine levels in plasma than did those with a good clinical outcome. These findings lend support to the possibility that damage to the hypothalamus and subsequent elevations in catecholamine levels may be associated with FID and poor clinical outcome.

Adult↗
PubMed1992

Penetrating stab wounds to the brain: the timing of angiography in patients presenting with the weapon already removed.

Angiography is always necessary in patients with penetrating stab wounds to the head, to exclude unexpected vascular lesions. The most important, since they are seldom clinically evident, are traumatic aneurysms and arteriovenous fistulae. It has previously been proposed that carotid angiography should be delayed until the start of the second week, to allow for better visualization of these complications. However, traumatic aneurysms can rupture at any time after the injury, and the mortality resulting from a second hemorrhage is unacceptably high. A prospective study was undertaken in which 330 patients with penetrating stab wounds to the head underwent angiography as soon as possible after admission. In 250 of these patients (76%), the weapon had already been removed by the assailant, and there was radiological evidence of penetration of the dura. Of these 250, 130 patients underwent angiography within 7 days of the injury. Another 51 patients, who presented late, underwent angiography more than 7 days after the injury. The timing of angiography did not affect the identification of traumatic aneurysms, the incidence of which was 12% in both groups. Of the patients with cranial stabs and who required urgent evacuation of intracerebral hematomas, 10% had traumatic aneurysms that could be dealt with simultaneously. No patient in this series suffered a secondary hemorrhage. We conclude that it is neither necessary nor safe to delay angiography. In some patients, either because of vasospasm or "cut-off" of a vessel, a second angiogram may be necessary to further elucidate a vascular abnormality that might not have been evident originally.

Adolescent↗
PubMed1988

Prevention of death from head injury in Natal.

A detailed review of 100 consecutive head injury deaths in the Natal area was undertaken after forensic autopsies had been performed; neurohistological examination was carried out in 69 cases. It was found that one-third of deaths could have been prevented by medical treatment. Hypoxic and ischaemic brain damage was judged to be a contributing cause of death in 88% of all victims. Factors isolated as major causes of preventable death included: failure to prevent hypoxic brain damage by timeous endotracheal intubation and rapid resuscitation; major delays in referral from feeder hospitals; and failure to detect intracerebral haematomas and contusions which subsequently caused raised intracranial pressure. Recommendations for improving this situation are discussed, with particular reference to the situation in Natal.

Adult↗
PubMed1988

Praziquantel (pyrazinoisoquinolone) in active cerebral cysticercosis.

A prospective open therapeutic study on volunteers with active neurocysticercosis using pyrazinoisoquinolone (Praziquantel) has shown that it is a safe and effective drug. Objective assessment of the effect of treatment was by high resolution sequential computed tomographic scanning. Sixty-six patients received the drug. Forty-one records were available for complete analysis at the end of 1 year of follow-up. The concomitant use of steroids reduced side effects significantly. A 98% improvement was achieved.

Adolescent↗
PubMed1988

A double-blind placebo-controlled trial of perioperative prophylactic antibiotics for elective neurosurgery.

In this study, 417 patients undergoing "clean" elective neurosurgical operative procedures were randomized to receive a broad-spectrum antibiotic (piperacillin) or placebo given as three perioperative doses, each 6 hours apart. Randomization was carried out by hospital pharmacists, and the investigators remained blinded until the end of the study. Twenty cases were excluded from analysis because either an unforeseen second operation was performed or antibiotic therapy was initiated within 30 days after surgery to treat infection or the risk of infection. Twelve of the 205 patients treated with placebo developed postoperative wound sepsis, and four of the 192 piperacillin-treated patients developed wound sepsis--a statistically significant difference (p less than 0.05, Fisher's exact test). Piperacillin thus appeared to reduce the incidence of neurosurgical wound infection in this study.

Anti-Bacterial Agents↗
PubMed1987

Seventy black epileptics. Cysticercosis, computed tomography and electro-encephalography.

Computed tomography (CT) in a group of 70 black patients with epilepsy showed cerebral cysticercosis in 30%, with signs of activity in 12.9%. The possibility of effective treatment in active cysticercosis makes CT an important investigation of epilepsy in this population. Electro-encephalography is of some practical value in patients in whom CT is negative.

Adolescent↗
PubMed1987

Cerebellar abscess: the impact of computed tomographic scanning.

Thirty-four cases of cerebellar abscess, diagnosed by computed tomographic (CT) scanning, were managed according to a standard protocol during a 4-year period. Triple high dosage intravenous antibiotics were used, open catheter drainage of the abscess was instituted, and external ventricular drainage was added if obvious hydrocephalus was present. Seventeen patients made a good recovery, and five remained minimally disabled. Ten patients died, and two were left severely disabled. A relationship between the level of consciousness on admission and final outcome was established. In addition, two particular CT scan features (viz. the presence of hydrocephalus and the stage of the abscess) were significant adverse prognostic factors.

Brain Abscess↗
PubMed1986

Persistence of a mycotic aneurysm of the intracavernous carotid artery.

Mycotic aneurysms of the intracavernous portion of the carotid artery are rare, especially in children. In reported cases, treatment has been by antibiotics alone, or by some form of carotid surgery. In the present case only antibiotic therapy was used. Subsequent angiography showed spontaneous thrombosis of the internal carotid artery, but persistence of the mycotic aneurysm. The implications of these findings are discussed with regard to the management of the condition.

Aneurysm, Infected↗
PubMed1986

Experience with Althesin in the management of persistently raised ICP following severe head injury.

Of 243 patients who underwent intracranial pressure (ICP) monitoring after severe head injury, 42 (17%) were found to have severe persistently raised ICP, in spite of hyperventilation, mannitol, and surgical decompression. Althesin was infused to reduce ICP in these patients. This agent was shown to be effective and safe in reducing ICP, and a significant improvement in cerebral perfusion pressure was demonstrated. In this respect, Althesin may be more effective than barbiturates. However, no improvement in patient outcome was demonstrated in this series.

Adolescent↗
PubMed1985

Nonoperative management of extradural hematoma.

Extradural hematomas (EDHs) do not always require surgical evacuation. We report a subgroup of conscious patients harboring EDHs who were referred for computed tomographic (CT) scanning several days after head injury with neurological signs that were static or improving. Twelve patients with EDHs 12 to 38 ml in volume were offered nonsurgical management and were followed by serial CT scanning. All patients made a complete neurological recovery and showed resolution of the hematoma on CT scanning over a period of 3 to 15 weeks. The features that may make an extradural hematoma suitable for conservative treatment are discussed.

Adolescent↗
PubMed1978

Dandy-Walker syndrome.

The problem of a patient with hydrocephalus, a posterior fossa 'cyst' and a cerebellar malformation is rather rare. Four cases of the syndrome are presented. The clinical manifestations, pathology, radiological investigations and management of the condition are briefly discussed.

Child↗
PubMed1978

Failure of computerized tomography to differentiate between radiation necrosis and cerebral tumour.

Post-radiation cerebral necrosis simulating tumours was found in 2 patients by computerized axial tomography (CAT). The appearance was indistinguishable from that of a recurrent tumour in one patient and a glioma in the second. The significance of the scan findings was only realized after surgery and histological examination. The investigation appears to offer no assistance in differentiating between these conditions.

Adult↗
PubMed1978

Stab wounds of the skull.

Sixteen cases of penetrating stab wounds of the head, where the knife blade has still been in situ on arrival at hospital, are presented. The indications for cerebral angiography, to establish vascular injury, and the spectrum of presentation are discussed. A technique of safe removal is described. There were no fatalities in the cases reviewed.

Adolescent↗
PubMed1977

Treatment-orientated classification of subarachnoid haemorrhage.

The prognosis of patients with cerebral aneurysms has improved greatly with modern management, notably hypotensive and steroid therapy and microneurosurgical techniques. A new classification of subarachnoid haemorrhage is discussed to clarify the early management of patients and their referral to specialized units for intensive medical care and curative surgery.

Brain Edema↗
PubMed1977

Interhemispheral subdural empyema.

Five cases of localized interhemispheral suppuration are reported. A short description of the 'falx syndrome' is given. The angiographic features of the cases are described.

Adolescent↗