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Biomedical subjects

R Torkelson

Publications and source records attributed to R Torkelson.

8 recordsLinked to original sources
PubMed1997

Surgical treatment of intractable seizures with multilobar or bihemispheric seizure foci (MLBHSF).

BACKGROUND: Patients with multilobar or bihemispheric seizure foci (MLBHSF) are generally not considered candidates for major resective surgery because of the high risk of complications. A combination of relatively less invasive surgical procedures were used to treat 19 patients with intractable seizures with MLBHSF. METHODS: Epileptogenic areas were identified via standard techniques. Locations of the seizure foci were in two lobes of a hemisphere in 11 patients, three lobes of a hemisphere in four patients, four lobes of a hemisphere in one patient, and both hemispheres in three patients. All 19 patients had multiple subpial transections; in addition, seven patients had small topectomies and nine patients had amygdala hippocampotomies. RESULTS: The longest follow-up is 54 months and the median for follow-up is 33 months. Nine patients (47%) are either free of seizures or have only rare seizures; eight patients (41%) have greater than 90% reduction in seizure frequency; one patient (6%) has complete cessation of myoclonic seizures and secondary generalization, and greater than 50% reduction in partial complex seizures; and one patient (6%) has greater than 50% reduction in seizure frequency. There were no permanent operative complications. CONCLUSION: Though the follow-up is relatively short and the number of patients is small, these results are encouraging, because the majority of patients in this group were poor surgical candidates.

Adolescent↗
PubMed1997

Isolation of dominant seizure foci by multiple subpial transections.

Dominant seizure foci (DSF) are seizure foci that do not respond to multiple subpial transections (MST). DSF were isolated in 15/31 patients who underwent MST in the past 6 years. These patients had MST over both hemispheres (6 patients) or over multiple lobes of one hemisphere (9 patients). DSF measured 0.5-1 cm in diameter and numbered 1-4 (in each patient). Their excision resulted in dramatic improvement in EEG over wide areas of the cortex. The longest postoperative follow-up is 67 months, with a median of 21 months. Nine of 15 patients are free of seizures, 3/15 have rare seizures, 2/15 have > 90% reduction in seizure frequency, and 1/15 has > 70% reduction in seizure frequency with improvement in motor and speech functions. In summary, DSF are resistant to MST and influence the electrical activity of the surrounding cortex. MST combined with excision of DSF resulted in good seizure control in this series, which included patients with multilobar and bihemispheric seizure foci.

Adolescent↗
PubMed1995

Stereotactic volumetric radiofrequency lesioning of intracranial structures for control of intractable seizures.

Computed tomography (CT) scans provide three-dimensional information about intracranial structures, which can be used to place stereotactically guided radiofrequency (RF) lesions and destroy a targeted volume of tissue. This technique was used for lesioning of the corpus callosum (CC) or the amygdala-hippocampus complex (AHC) in 9 patients with intractable seizures. The procedures were monitored by intraoperative CT scans. Lesions were made in the AHC in 7 patients and the CC in 2 patients. In addition, multiple subpial transection (MST) was performed in 6 patients. The longest follow-up is 29 months with a median of 19 months. Five patients (56%) are free of seizures, 3 patients (33%) have greater than 90% reduction in seizure activity and 1 patient (11%) has greater than 50% but at most 90% reduction in seizure activity. There were no complications except for temporary hemiparesis following MST in 1 patient. The results suggest that stereotactic volumetric RF lesioning of the AHC and the CC may be safe and effective in controlling intractable seizures.

Adolescent↗
PubMed1995

Minimally invasive surgical approach for intractable seizure.

Minimally invasive procedures (multiple subpial transection, topectomy and amygdalahippocampotomy) were used to treat 24 patients with intractable seizures. The seizure foci were in both hemispheres in 3 patients, all 4 lobes of a hemisphere in 1 patient, 3 lobes of a hemisphere in 5 patients, 2 lobes of a hemisphere in 11 patients and the temporal lobe alone in 4 patients. The longest follow-up is 41 months, with a median of 18 months. Sixteen patients have a follow-up of more than 1 years, with excellent results in 10 (66%) and good in the remaining 6 (38%). There were no permanent complications These results are encouraging, because the majority of the patients were poor candidates for surgery.

Adolescent↗
PubMed1984

Increased cerebrospinal fluid 5-hydroxytryptamine and 5-hydroxyindoleacetic acid in Kleine-Levin syndrome.

A 17-year-old man with the Kleine-Levin syndrome died unexpectedly of cardiopulmonary arrest during a period of autonomic instability that followed an episode of megaphagia. At autopsy, the only pertinent finding was mild depigmentation of the locus ceruleus and substantia nigra. Premortem CSF levels of 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) levels were elevated. These findings indicate that many symptoms of the Kleine-Levin syndrome are a result of a neurotransmitter imbalance in the serotonergic pathway of the brainstem.

Adolescent↗
PubMedDate not supplied

Quality improvement approach to nursing care planning: implementing practical computerized standards.

Care planning continues to be be an integral part of nursing, yet it is often criticized by professionals as time-consuming, repetitious, and inconsistent. This problematic situation prompted the development and implementation of an interdisciplinary automated care-planning system that interfaces with a preexisting data base. The advantages of the system include standardization of care, consolidated documentation, provision of patient education tools, shared responsibility during the patient's length of stay, and minimal cost. Evaluation of the system demonstrated quality improvement in the documentation of patient education and compliance in meeting JCAHO nursing process standards.

Education, Nursing, Continuing↗
PubMedDate not supplied

Perception of "no code" and the role of the nurse.

CPR is now the rule rather than the exception and death is often viewed as the ultimate failure in modern medicine, rather than the final event of the natural life process (Stevens, 1986). The "No Code" concept has created a major dilemma in health care. An interagency collaborative study was conducted to ascertain the perceptions of nurses, physicians, and laypersons about this issue. This article deals primarily with the nurse's role and perceptions of the "No Code" issue. The comparison of nurses' perceptions with those of physicians and laypersons is unique to this study. Based on this research, suggestions are presented that will assist nursing educators and health care professionals in managing this complex dilemma.

Attitude of Health Personnel↗