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Biomedical subjects

R Spetzler

Publications and source records attributed to R Spetzler.

13 recordsLinked to original sources
PubMed1991

Early treatment of ischemic stroke with a calcium antagonist.

We performed a feasibility and safety study (phase II) of nicardipine, a calcium antagonist, in 57 patients. The objectives of the study were to begin therapy as early as possible (less than or equal to 12 hours) after the onset of ischemic stroke and to administer as high a dose as possible. All patients received an intravenous infusion of nicardipine for 72 hours, starting with a dose of 3 mg/hr and increasing to a maximum dose of 7 mg/hr. Upward titration of the dose was limited by a 10% decrease in blood pressure or a 20 beats/min increase in pulse. Intravenous therapy was followed by 30 days of oral therapy. The mean +/- SD interval from onset of stroke to commencement of therapy was 9.1 +/- 5.4 hours. Adverse reactions consisted primarily of hypotension requiring discontinuation of therapy in four patients. Score on a graded neurologic examination increased from 41/100 at baseline to 64/100 at 3 months for the 41 patients completing follow-up. There was no correlation between the dose of nicardipine administered and outcome, but the 11 patients starting therapy less than or equal to 6 hours after onset did better than those starting therapy 6-12 hours after onset. Further study of very early therapy with nicardipine is justified.

Blood Pressure↗
PubMed1990

Pilot study of nicardipine for acute ischemic stroke.

The author performed a pilot study of nicardipine (NC), a Ca(+)+ channel blocker, to study its dosing, toxicity, and possible efficacy for hemispheric cerebral infarction within 12 hours (mean 6.9 hr) of onset to determine the advisability of proceeding with a multi-centered controlled trial. NC was administered IV (3 to 7 mg/hr) X 72 hours by titrating dose to mean arterial blood pressure (MABP not less than 10% of baseline), then orally X 30 days. Forty-three patients have been entered; mean age 63 (range 34-89), 25 male and 18 female. Only 3 had CT evidence of infarct on entry. Results have shown improvement in a 100-point (pt) graded exam (40 pts at entry, 68 pts at 3 months). Of 20 patients completing 3 months' evaluation, 17 improved and none worsened. Sixteen out of 20 were at home and 8 had minimal or no impairment. Mean Barthel's index was 72. Mean maximal serum NC level was 75 ng/mL. MABP decreased from 103 (entry) to 83 (72 hours). A larger controlled study is warranted to determine the efficacy of NC for acute cerebral infarct.

Acute Disease↗
PubMed1978

Head injury and early signs of tentorial herniation: a management dilemma.

In 100 patients intracranial exploration was done soon after severe head injury when signs of transtentorial herniation were present. A third of patients had extracerebral hematomas shown on initial burr hole examination. An additional 18 percent had parenchymal clots of clinical significance disclosed only by angiography after burr hole exploration or at autopsy. Half the patients in whom exploration was done did not have intracranial hematomas of sufficient size to warrant an operative approach. Detailed neurological examinations soon after injury and the availability of more rapid diagnostic tools may improve the accuracy of early diagnosis and allow more specific prognostication in patients with severe head injury.

Adolescent↗
PubMed1977

Simplified percutaneous lumboperitoneal shunting.

A single unit percutaneous lumboperitoneal shunt has been designed for both diagnostic and therapeutic purposes. Ease of insertion makes this shunt a useful tool in the treatment and diagnosis of communicating hydrocephalus.

Adolescent↗
PubMed1976

Selection of patients for extra-intracranial arterial bypass surgery based on rCBF measurements.

Extracranial intracranial arterial anastomosis is gaining acceptance as a form of treatment in selected cases with ischemic cerebrovascular disease. To establish indications for this operation and to provide an objective assessment of postoperative results, regional cerebral blood flow (rCBF) studies were performed in 110 patients with cerebrovascular insufficiency considered for extra-intracranial bypass surgery. The 133Xe intracarotid injection method with 16 externally placed detectors was used for measuring rCBF. Postoperatively, rCBF was measured in 40 patients. From these results our present criteria for surgery have evolved. The probability of a good postoperative result is best in patients who showed focal cerebral ischemia or a moderate general reduction of CBF with an additional ischemic focus. The operation is contraindicated in patients with either normal or severely reduced CBF values (less than 60% of normal).

Adult↗
PubMed1976

Clinical experience with extra-intracranial arterial anastomosis in 65 cases.

Clinical results of an extra-intracranial arterial bypass (EIAB) procedure for cerebral ischemia are assessed in 65 patients. The 5-year-study suggests that the EIAB procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients. Correlation with angiography and regional cerebral blood flow (rCBF) studies are discussed. It is felt that rCBF measurements offer the best diagnostic test to determine which patients are suitable for surgery by revealing if an ischemic or relative ischemic focus is present. The surgical procedure is contraindicated in acute cerebral ischemia and when the rCBF study reveals general reduction of cerebral blood flow as opposed to a localized ischemic focus.

Adult↗
PubMed1976

Microvascular bypass surgery. Part 1: anatomical studies.

Microvascular anatomical studies were performed to ascertain the most suitable cortical vessel for extracranial-intracranial arterial bypass (EIAB). The three most commonly used cortical areas (the tip of the frontal lobe, the tip of the temporal lobe, and the area at the angular gyrus) were examined in detail. Because of their accessiblity and size, the cortical arteries in the area of the angular gyrus offer the most suitable location for creating an EIAB.

Cerebral Arteries↗
PubMed1976

Microvascular bypass surgery. Part 2: physiological studies.

Intraoperative electromagnetic blood flow measurements were recorded in 15 patients undergoing extracranial-intracranial arterial bypass surgery. The initial average blood flow of 28.2 cc/min supplies 8.4% of the expected flow from one internal carotid artery. Blood flow probably increases postoperatively, as evidenced by angiographic enlargement of the bypass and its recipient cortical arteries.

Adult↗