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Biomedical subjects

R L Saunders

Publications and source records attributed to R L Saunders.

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

The false fontanel.

In the neonate, palpation of the anterior fontanel is recognized as a simple and reliable means for estimating intracranial pressure. With closure of the fontanel this aspect of the clinical examination is lost. The authors report a series of 15 shunted infants and children in whom a false fontanel was created by making a 2-cm craniectomy in the right parietal region and excising the underlying internal pericranium. This produces a cranial opening which, like the anterior fontanel, can be used for palpation and real-time ultrasound imaging of the brain. By removing the internal pericranium, reossification of the defect is delayed by more than 12 months. Sparing the dura propria avoids the risks of cerebrospinal fluid leak or brain herniation into the cranial window. This procedure is reported to be simple, reliable, and of value in assessing shunt function in hydrocephalic infants and young children. An illustrative case report is presented.

Cerebrospinal Fluid Shunts↗
PubMed1983

Relief of continuous chronic pain by intraspinal narcotics infusion via an implanted reservoir.

Ten patients with intractable pain (five cancer and five nonmalignant) were treated with continuous intraspinal morphine delivered by an implanted continuous infusion system. Both patient groups were evaluated and compared using an identical battery of psychometric examinations administered before and 12 weeks after therapy. The cancer-pain group reported significant reduction in pain on serial visual pain analogue scales at 12 weeks compared with no change in the nonmalignant-pain group reports despite a much lower baseline report in the cancer group. Both groups of patients reduced their oral narcotic requirement significantly during continuous intraspinal morphine infusion. While the cancer patients took more oral narcotic at baseline, at 12 weeks no difference existed in oral intake between the two groups. Both groups required significant serial increases in infused morphine, indicating that spinal opiate receptor tolerance occurs. The results of this study confirm the sustained analgesic efficacy reported earlier in cancer-related pain syndromes, thus supporting further cautious expansion of this therapy within the cancer-related pain population. In contrast, a poor response was seen in the nonmalignant-pain group, consistent with the unsatisfactory responses to many potentially analgetic approaches to chronic nonmalignant pain. We are thus discouraged from further use of this therapy in the patient with chronic nonmalignant pain.

Administration, Oral↗
PubMed1983

Twist drill craniostomy and closed system drainage of chronic and subacute subdural hematomas.

Based on reports in the literature on the success and low morbidity of twist drill craniostomy (TDC) and closed system drainage (CSD) for chronic subdural hematomas, a prospective study was initiated in 1981 and included all symptomatic patients presenting with a history and clinical and computed tomographic (CT) findings consistent with subacute or chronic subdural hematoma. A total of nine patients were treated with TDC and CSD as the initial procedure. An asymptomatic or progressively improving patient with greater than 50% reduction in subdural size by repeat CT scan was set as the end point of therapy. There were no complications, all patients improved with drainage, and seven were cured by this method alone. The results are compared retrospectively to surgically treated patients, and an overall decrease in morbidity and length of hospitalization are noted. The technique and CT scan correlations are described, and the rationale for use of this method is discussed in terms of our current understanding of the pathophysiology and complications of the disease.

Aged↗
PubMed1982

Pediatric cerebellar infarction: case report and review of the literature.

Infarction in the vertebrobasilar system is uncommon in children. Cerebellar infarction presenting as a posterior fossa mass lesion is distinctly rare. We recently treated a 13-year-old boy with such a lesion as a complication of basilar artery migraine. A review of the literature on vertebrobasilar infarction in children is presented and the therapeutic alternatives in cerebellar infarction are discussed.

Adolescent↗
PubMed1982

Implanted continuous epidural morphine infusion system. Preliminary report.

A number of reports have shown that epidural or intrathecal administration of morphine provides pain relief. Since February, 1981, the authors have used an implantable pump and epidural catheter for continuous epidural morphine infusion in patients with chronic pain. This system has functioned well, without respiratory or infectious complications. Functional characteristics of the system, technique of implantation, and preliminary results in two patients treated by this method are presented.

Adenocarcinoma↗
PubMed1982

Intraspinal narcotic tolerance: preliminary experience with continuous bupivicaine HCL infusion via implanted infusion device.

Spinal opiate receptor tolerance is the major limitation of continuous intraspinal narcotic analgesia delivered by implanted reservoir pump. Six intractable pain patients receiving continuous epidural morphine were given trials of low dose bupivicaine HCL in order to assess the effects on implanted reservoir function, analgesia, and safety. Daily infusion of 2.6-18.8 mg bupivicaine HCL had no consistent effect on flow rates. Subjectively, three patients had at least partial relief of pain while their intraspinal morphine doses were weaned. No sympathectomy was appreciated at these doses. The future of continuous intraspinal analgesia might require further advances in implantable infusion pump technology to allow manipulation of both daily infusion doses and multiple intraspinal analgesics. Further study is needed to assess the safety and effectiveness of higher continuous intraspinal bupivicaine doses for chronic pain relief.

Artificial Organs↗
PubMed1981

Upright patient positioning in the management of intracranial hypertension.

Utilizing either a subarachnoid screw or an intraventricular cannula, intracranial pressure was continuously monitored in 24 patients with established or potential neurological impairment of various etiologies. Marked diminution in intracranial pressure was observed in the sitting or semisitting position in the 13 patients with documented intracranial hypertension as well as in the 11 in whom intracranial pressure was not elevated. This sustained effect was noted even when superimposed on intensive medical management of intracranial hypertension.

Adolescent↗
PubMed1981

Citrobacter meningitis and cerebral abscess in early infancy: cure by moxalactam.

A 7-week-old boy developed multiple cerebral abscesses as a complication of neonatal Citrobacter diversus meningitis. He was successfully treated medically with the experimental beta-lactam antibiotic, moxalactam. This is the first nonsurgical cure of brain abscess in early infancy. Fifty-eight percent of all previously reported cases of Citrobacter meningitis were complicated by brain abscess, mandating early, and serial computed tomography scanning in patients afflicted with the disorder. Moxalactam may become the chemotherapeutic agent of choice for the treatment of this serious neonatal infection.

Brain Abscess↗
PubMed1981

Lumbar disc protrusion in children.

Forty-three cases of surgically treated lumbar disc protrusion in patients 21 years or younger are analyzed. The results were generally good. Ten percent of the patients required reoperation within 3 years. No major complications were experienced. Follow-up observation ranged from 4 to 30 years. Disc protrusion should be considered in the differential diagnosis of children with back and sciatic pain, and early myelography should be carried out in the refractory case. The symptoms, signs, myelograms, and surgical findings are usually similar to those of the adult patient with a disc protrusion.

Adolescent↗
PubMed1981

External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants.

Over a 3-year period, 11 premature infants with intraventricular hemorrhage and posthemorrhagic hydrocephalus were managed initially with prolong external ventricular drainage via a subcutaneously tunneled catheter. The mean duration of drainage for this group was 20.7 days. Although two patients died before shunting was considered, no morbidity or mortality was observed to result from this technique. Seven patients required a shunt after stabilization of their medical problems. Two patients, followed for 24 and 40 months, have not required shunting procedures. External ventricular drainage via a subcutaneously tunneled catheter has been found to be a safe and reliable initial method of treating posthemorrhagic hydrocephalus in premature infants.

Cerebral Hemorrhage↗