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Biomedical subjects

P L Gildenberg

Publications and source records attributed to P L Gildenberg.

At least 55 records · Page 3Linked to original sources
PubMed1984

Post-traumatic subdural hygromas: observations concerning a surgical enigma.

Four per cent (38) of 881 head injured patients developed known subdural hygromas. Their times of onset and course were variable. However, only two large hygromas seemed clinically significant. Hygromas were more frequent when intracranial pressure monitors were placed, possibly due to opening of the arachnoid, particularly if intracranial pressure was low. But, of course, monitors were only inserted in more severely injured patients. The use of Richmond bolts to drain subdural hygromas in a controlled fashion while monitoring intracranial pressure is suggested.

Adult↗
PubMed1984

Limited myelotomy for the treatment of intractable cancer pain.

In midline myelotomy a small mechanical or radiofrequency lesion was made at the centre of the spinal cord at a single segment at the thoracolumbar junction or at C1. This procedure was used for the management of cancer pain in 20 patients, in four of whom it was combined with unilateral cordotomy. Of 14 patients with myelotomy alone at the thoracolumbar junction 10 (71.5%) had satisfactory relief of pain, with no complications or untoward side-effects.

Afferent Pathways↗
PubMed1983

Civilian gunshot wounds: the limits of salvageability.

Patients who have suffered gunshot wounds in civilian settings, who present with posturing and in whom the bullet has passed through the geographical centre of the brain have generally not been felt to be salvageable. However, surprisingly favourable outcomes in two such patients have led us to believe that some such patients may deserve aggressive treatment.

Adolescent↗
PubMed1983

Stereotactic neurosurgery and computerized tomographic scanning.

The marriage of computerized tomographic (CT) scanning and stereotactic surgery opens up new technical possibilities, as it becomes feasible to introduce a probe into any lesion which is identified on a CT scan. The various CT stereotactic techniques are reviewed, and generally involve four variations. The head holder of a standard stereotactic apparatus can be adapted to the CT scanner to interdigitate the coordinates of both devices in a known relationship. Second, some types of CT scanners allow the visualization of the vertical coordinate. Third, a stereotactic microdrive can be incorporated into the scanner. Finally, a simple aiming device can be attached to the patient's head and repeated scans taken as the probe is advanced to the target. Various authors have reported the use of techniques for biopsy, aspiration of cysts or hematomas, insertion of radioisotopes, or as an adjunct to open surgery.

Biopsy, Needle↗
PubMed1982

Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications.

Eight-seven consecutive children with head injury were evaluated within two hours of injury by clinical examination, by computed tomographic brain images, and for systemic blood clotting disorders. All were treated by a standard regimen and survival rates calculated according to the initial neurologic abnormalities and pathology of the injury. Patients with the more severe neurologic abnormalities and those with more brain tissue destruction had poorer survival rates. However, 71% of all patients had one or more abnormal clotting tests and 32% had the disseminated intravascular coagulation and fibrinolysis syndrome by laboratory criteria. The mortality was over four times greater in those patients with DIC compared to those with normal clotting values. Our findings indicate that minor hemostatic abnormalities are the rule in head-injured children, that DIC occurs in nearly one-third of cases, and that DIC is associated with a marked increase in the mortality after brain injury: DIC may be a treatable secondary effect of head trauma that could decrease the mortality.

Adolescent↗
PubMed1982

Calculation of stereotactic coordinates from the computed tomographic scan.

A protocol has been developed to use the GE 8800 scanner and its resident programs to calculate stereotactic coordinates, which has made it possible to use any stereotactic apparatus without modifying the apparatus in order to introduce a cannula into any lesion visualized on a computed tomographic (CT) scan to biopsy tumors, drain abscesses, implant radioisotopes, etc. The CT scanning is done in a routine fashion except that a lateral ScoutView, with the planes of each CT slice indicated, is included. Once the CT scan has been completed, resident programs for measuring distances are used to establish a zero point on a reference plane, from which all other coordinates can be defined. The stereotactic procedure is done at a separate time in the operating room, using the coordinates derived from the CT scan. The ScoutView image is compared to the lateral x-ray film taken during the stereotactic procedure to establish the location of the targets. It has been estimated that the accuracy of this system is 3 mm. Abscesses less than 1 cm in diameter deep within the cerebral hemisphere have been accurately aspirated and tumor biopsies have been successfully taken.

Biopsy↗
PubMed1981

The efficacy of Doppler monitoring for the detection of venous air embolism.

Venous air embolism can usually be detected by the use of a precordial Doppler ultrasound monitor at an air infusion rate as low as 0.015 ml/kg/min, and consistently at a rate of 0.021 ml/kg/min. This is in contrast to previously reported thresholds wherein the first physiological change, a gasp, occurs at 0.36 ml/kg/min, electrocardiographic changes first take place at 0.60 ml/kg/min, drop in blood pressure at 0.69 ml/kg/min, increased central venous pressure at 0.40 ml/kg/min, and end-tidal CO2 decreases at 0.42 ml/kg/min. The first change in heart sounds monitored through an esophageal stethoscope is not detectable until an air infusion rate of 1.70 ml/kg/min, and the classical mill-wheel murmur does not occur until 1.96 ml/kg/min. This demonstrates that Doppler ultrasound can detect venous air embolism before the earliest physiological changes, in contrast to most other methods which do not detect venous air embolism until after cardiopulmonary changes have become well established.

Animals↗
PubMed1980

Influence of dorsal column stimulation upon human thalamic somatosensory-evoked potentials.

2 patients with previously implanted dorsal column stimulators underwent basal thalamotomy for the treatment of pain, which provided the opportunity to record evoked potentials from the intralaminar (IL) and ventroposterolateral (VPL) areas of the thalamus. Short latency evoked potentials recorded from VPL were not influenced by dorsal column stimulation. However, very long latency (500 ms) potentials recorded bilaterally in IL were modified by stimulation of the dorsal columns of the spinal cord at frequencies between 20 and 40 HZ.

Electric Stimulation↗