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L Kesterson

Publications and source records attributed to L Kesterson.

22 records · Page 2Linked to original sources
PubMed1989

Posterior cervical interspinous compression wiring and fusion for mid to low cervical spinal injuries.

A technique of posterior cervical interspinous compression wiring and fusion, which offers significant immediate stability, is presented. Its efficacy in 50 consecutive cases illustrates its utility. The technique involves the passage of an interspinous cerclage wire. Rather than placement of onlay laminar and facet grafts, a split-thickness tricortical iliac-crest graft is compressed against the involved medial laminae and spinous processes bilaterally. These grafts are held in place by a compression wire, which encircles the grafts and thus sandwiches the spinous processes between them. This virtually ensures subsequent bone fusion and offers substantial acute stability. The compression wire offers an added advantage of encircling the cerclage wire, thus pulling it dorsally. This significantly diminishes translational mobility at the unstable segment. It also minimizes hyperextension at the unstable segment via medial compression of the grafts into the interspinous space. The fusion of a minimal number of spinal segments is emphasized. This substantially diminishes the chance of flexible kyphosis and degenerative changes, both above and below the fusion site. A three- or four-level fusion was performed in only 11 patients. The remaining 39 patients underwent two-level fusion. A solid bone fusion was achieved in all cases, with a follow-up period of at least 6 months. In one patient, the spinous process fractured, necessitating an anterior fusion procedure. The technique presented here appears to acutely offer a very stable construct and, in addition, is a simple and straightforward procedure for the treatment of the unstable cervical spine.

Adolescent↗
PubMed1989

The apnea test for the determination of brain death.

By conventional criteria, an apneic patient's PaCO2 must be greater than 60 mm Hg before apnea can be attributed to brain death. The rate of a PaCO2 increase in the apneic patient traditionally has been thought to be in the range of 3 mm Hg/min. In order to assess the validity of these data and the validity of the "apnea test" for determination of brain death, the results of this test were reviewed in 20 patients. In all patients, arterial blood samples were drawn for blood gas measurements every 2 minutes following the cessation of volume ventilation (with an oxygen cannula at 6 liters O2/min passed into the tracheobronchial tree). The rate of PaCO2 increase was noted to be very erratic. The average rate of rise was 3.7 +/- 2.3 mm Hg/min (+/- standard deviation). This, however, varied from 0.5 to 10.5 mm Hg/min and was not predictable from the variables evaluated. The rate of PaCO2 increase was noted to decline throughout the duration of the test. This ranged from 3.9 +/- 1.2 mm Hg/min (for patients with baseline PaCO2 less than or equal to 30 mm Hg) and 4.5 +/- 1.9 mm Hg/min (for patients with baseline PaCO2 greater than or equal to 30 mm Hg) in the first 4 minutes of the test to an average of 0.92 mm Hg/min for patients with test lasted longer than 12 minutes. These unpredictable results might be related to CO2 washout, atelectasis, cardiac ventilations, or other yet-undefined parameters. The nonlinear relationship between rate of PaCO2 increase and time following onset of apnea resulted in the test being prolonged in several patients. In these patients, the PaCO2 approached 60 mm Hg in an asymptotic fashion. These lengthy tests could have been avoided by utilizing a standardized apnea test with a baseline PaCO2 of 40 mm Hg or greater. The observation that a high baseline PaCO2 greatly augments the efficiency and safety of the test allows criteria that have previously been based on conjecture to be documented and applied clinically. A standardized apnea test, utilizing these principles, may satisfy many of the criticisms regarding brain-death testing that have been raised by neurologists, neurosurgeons, and transplant surgeons.

Adult↗