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Biomedical subjects

L J Cerullo

Publications and source records attributed to L J Cerullo.

At least 37 records · Page 2Linked to original sources
PubMed1985

Microvascular anastomosis using the milliwatt CO2 laser.

The milliwatt CO2 laser was used to anastomose small vessels in a rat femoral artery model. The technique requires multiple brief applications of 60-70 mW after placement of three equidistant 10-0 nylon stay sutures. The vessel histology is described immediately and 1, 3, 7, and 21 days after the procedure. The laser effects tissue bonding through changes in the collagen of the adventitia and media. Subsequent healing consists of new collagen deposition in the adventitia and reendothelialization of the intima associated with neointimal proliferation at 3 weeks.

Animals↗
PubMed1985

Fibrinolytic activity following laser-assisted vascular anastomosis.

New technology has allowed tissue bonding to be feasible using carbon dioxide laser energy. Laser-assisted vascular anastomosis (LAVA) has shown comparable patency results with standard suture anastomosis, but LAVA procedures produce thermally induced transmural structural alterations. To assess functional intimal recovery in LAVA versus sutured vessels, a fibrinolytic slide technique was utilized in 21 rats which had LAVA performed in one femoral artery while the opposite limb underwent a conventional microsuture anastomosis. Conventional anastomosis had persistent fibrinolytic activity while LAVA had return of fibrinolytic activity by 48 hours. Intimal fibrinolysis inhibition following LAVA is reversible and this technique does not lead to an increased incidence of thrombosis.

Animals↗
PubMed1985

Comparison of bursting strength between suture- and laser-anastomosed vessels.

The bursting strength of suture- and laser-assisted vascular anastomosis (LAVA) was assessed using a standard rat femoral artery model. Vessels were studied from 1 hour to 3 weeks. LAVA arteries consistently demonstrated lower bursting strengths than those of suture controls, with significant differences at 1 day, 3 days (P less than 0.001), and 1 weeks (P less than 0.01). Return of strength occurred in a pattern reminiscent of wound-healing models. Relatively low bursting strengths at 1 and 3 days in the LAVA cohort may explain the high aneurysm rate reported to complicate this procedure.

Animals↗
PubMed1985

Facial injuries associated with cervical fractures: recognition, patterns, and management.

Publications in both the orthopedic and maxillofacial literature have noted the association of cervical spine and facial injuries. However, because the incidence of spinal injury is low, we found no study which documented the relationship between maxillofacial and cervical spine injuries. The present study reviewed 982 cervical spine injuries in two major trauma centers, finding a 19.3% incidence of facial injury. Fourteen per cent of patients had soft-tissue injuries and 8.6%, facial fractures. Important relationships were noted between fractures of the mandible and upper cervical spine, and soft-tissue injuries of the upper face and fractures of the lower cervical spine. Methods of care adapted to the combined injuries are described. The study concludes that examination of the face for soft-tissue and bony injuries may give important clues on the direction and intensity of the force injuring the cervical spine.

Adolescent↗
PubMed1985

Brain edema: ultrasound examination.

Sonographic examination of the brain in 10 patients who had cortical mass lesions was performed. Results were compared with findings of CT. In each case, brain edema surrounded the lesion, and the adjacent white matter had a diffusely echo-genic appearance that corresponded to the area of brain edema seen on CT.

Adult↗
PubMed1985

Pneumocephalus in patients with CSF shunts.

The authors present two cases of pneumocephalus occurring in patients with permanent shunts and review nine previously reported cases. Mental status changes and headache are the most common presenting symptoms. Six of the 11 cases of pneumocephalus occurred in patients with shunt placement for hydrocephalus secondary to aqueductal stenosis. In these patients, thinned cerebrospinal fluid barriers secondary to long-standing increased intracranial pressure may predispose them to pneumocephalus. Temporary extraventricular drainage is an effective method of treatment in this group of patients. Two other etiologies are identified with significance to treatment, and the role of craniotomy is discussed.

Adolescent↗
PubMed1985

Comparison of the effect of the carbon dioxide laser and the bipolar coagulator on the cat brain.

The carbon dioxide laser has recently received clinical acceptance in neurosurgical practice. There are, however, few studies reported in the neurosurgical literature, either clinical or experimental, concerning its safety or efficacy on a physiological level by comparison to a more conventional tool. This study is not a description of a surgical technique, but is rather a basic physiological comparison of two surgical instruments. In this study, 11 cats were pretreated with the protein-bound dye, Evans blue. A corticotomy was performed in one hemisphere with the carbon dioxide laser and in the other with a microbipolar coagulator and a sharp blade. The subsequent extravasation of dye was presumed to be proportional to the amount of blood-brain barrier disruption associated with each lesion. When effective power settings for the two devices were compared, the laser lesions had significantly less extravasation of blue dye. This indicated that there was less damage to the blood-brain barrier surrounding laser corticotomy than surrounding conventional bipolar coagulation and sharp dissection at comparable power settings for each modality.

Animals↗
PubMed1984

Laser workshops in neurological surgery.

With the recent increased popularity of laser use in neurosurgery, there arises the question of the value and necessity of a "hands-on" laser workshop in preparing the surgeon for clinical use of the instrument. To find an answer, a questionnaire was recently circulated to those who had participated in such a workshop. Participants were asked whether they were actually using the laser clinically since attending the workshop and, if so, the type of laser they were using. Whether the course was influential in their decision to use a laser and whether they felt they could have used the instrument without such a course was also asked. In addition, the surgeons were asked how long it took them to become comfortable using the laser. The types of procedures, the percentage of operative cases and the mode (freehand or microlinked) in which the laser was used was also investigated. Finally, absolute indications for laser use in neurosurgery and methods to improve laser education were sought. The answers were varied and interesting, but it is our conclusion that a "hands-on" workshop is both a valuable and necessary means of preparing a neurosurgeon for clinical use of a laser, and participation in such a course should be encouraged.

Clinical Competence↗
PubMed1984

Use of the laser in neurosurgery.

The laser has become the neurosurgical tool of the 1980s. In neurosurgery, the most important attribute of the laser is its ability to precisely vaporize tissue with minimal mechanical and thermal damage to the surrounding sensitive structures. Although the Nd:YAG laser has use in this medical specialty, the CO2 laser, with its immediate absorption in water, with resultant minimization of scatter and spread to surrounding and deeper tissue, is the most useful laser in neurosurgery and the focus of this article.

Brain Neoplasms↗
PubMed1983

Anesthesiologic considerations in laser neurosurgery.

The laser has been welcomed to the neurosurgical armamentarium because of the inherent precision and gentleness of the no-touch technique. In order to maximize laser safety and efficacy, however, certain anesthesiologic considerations, specific to neurosurgery, must be realized. Motion of patient (target) during routine anesthesiologic checks or as the result of physiologic excursions during myocardial contraction and respiration must be minimized. Ventilatory parameters, anesthetic agents, and cardio active drugs are considered.

Anesthesia, General↗
PubMed1983

Serum potassium levels during prolonged hypothermia.

Hypokalemia (mean serum potassium 2.3 +/- 0.4 mEq/l) was observed in six hypothermic patients (30 degrees - 32 degrees C) with head injuries or brain hypoxia. In the first three patients, potassium was administered to maintain serum levels above 3.5 mEq/l and on rewarming after 48 h of hypothermia hyperkalemia (peak serum potassium = 7.1 +/- 0.5 mEq/l) associated with cardiac arrhythmias developed. The remaining three patients received sufficient potassium to approximately replace measured losses during the hypothermic period. These patients did not become hyperkalemic on rewarming. Clinically insignificant sinus bradycardia, premature atrial contractions and junctional rhythms were seen during hypothermia with hypokalemia. We conclude that hypothermia produces hypokalemia by a shift of potassium from the extracellular to intracellular or extra vascular spaces. Potassium therapy during controlled hypothermia in the range 30 degrees - 32 degrees C should only replace measured losses.

Arrhythmias, Cardiac↗
PubMed1982

Radiologic evaluation of surgical cervical spine fusion.

Preoperative, intraoperative, and postoperative radiologic evaluation of surgical cervical spine fusion plays an integral part in the management of cervical spine injuries. The radiographic anatomy of the basic types of anterior, posterior, and combined fusions and the indications for their performance are discussed. A retrospective review of 210 consecutive cervical spine fusions showed a 21.1% radiographic complication rate for anterior fusions and only 3.9% for posterior fusions. The high complication rate of anterior fusions is related to the performance of anterior fusion in the presence of unrecognized posterior instability. Radiographically identified complications must be correlated with the clinical neurologic examination in each case since the spectrum of radiographic complications may be compatible with a clinically satisfactory result.

Adolescent↗
PubMed1981

Multiple brain abscesses.

A young woman with 12 separate brain abscesses was treated medically after aspiration of one abscess for diagnostic bacteriological examination. She made an excellent recovery with only minimal residual neurological dysfunction. Surgical aspiration for detailed bacteriological studies followed by appropriate antimicrobial therapy is an effective way of treating multiple brain abscesses in the neurologically stable patient.

Adult↗
PubMed1980

Transabdominal neurostimulation in treatment of neurogenic ileus.

Transabdominal neurostimulation (TANS) is an innovative concept used in the treatment of neurogenic ileus, which frequently follows chronic spinal cord or neurological lesions. It was used in the treatment of neurogenic ileus in 21 patients at Northwestern Memorial Hospital with rapid resolution of the ileus, elimination of nasogastric tubes, and institution of oral feedings soon after application. Major advantages in using TANS are effective resolution of ileus, ease of application, and lack of major gastrointestinal complications, especially those produced by nasogastric tubes.

Adult↗
PubMed1980

Femoral-cerebral angiography in infants and children. Analysis and comparison with direct puncture/retrograde brachial technique.

The technique of femoral-cerebral catheterization in infants and children is described, and a series of 1,869 procedures is analyzed for complications. Clinical complications occurred in 12 of 678 or 1.8% of examinations while radiographic complications were discovered in 38 of 1,869 or 1.1% of procedures. The results are compared to a similar retrospective study of a large series (2,184 procedures) of direct puncture/retrograde brachial studies in a similar patient population at the same institution in which there was a 2.6% clinical complication rate and a 4.3% radiographic complication rate. Those factors which predispose to complications, clinical or radiographic, are more pronounced in the younger age groups but affect the direct puncture/retrograde brachial technique to a greater degree. The lower morbidity, greater selectivity and improved comfort make the femoral-cerebral route preferable for neuroangiographic studies in infants and children.

Brain Diseases↗
PubMed1979

Percutaneous epidural neurostimulation in modulation of paraplegic spasticity. Six case reports.

Six cases of paraplegic, post-traumatic spasticity, alleviated by percutaneous epidural neurostimulation with temporary or permanent implanted neuroelectrodes from the L1 to L4 intervertebral levels are presented. Modulation of this spasticity and secondary beneficial physiological effects were achieved, including regulation of bowel regimens, production of sweating and piloerection below the level of the lesion, and morning erections. The main advantages of percutaneous epidural neurostimulation in modulating spasticity are the avoidance of destructive neurosurgical procedures, the regulation of secondary physiological and autonomic responses, the avoidance of antispasticity medications, and the reversibility of the neurostimulation procedure.

Adolescent↗