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Biomedical subjects

S J Barrer

Publications and source records attributed to S J Barrer.

11 recordsLinked to original sources
PubMed1997

Outcome of carpal tunnel release surgery in patients with diabetes.

The surgical outcomes in 149 patients with diabetes and carpal tunnel syndrome who underwent transverse carpal ligament release surgery are reported. Associated factors such as insulin dependence, length of time with diabetes, electrodiagnostic studies, severity of neurological deficit, presence of polyneuropathy, and cervical disc disease were considered. Analysis of preoperative and postoperative symptoms, clinical findings, diagnostic studies, and patient self-assessment indicated that the majority of patients with diabetes experienced a favorable surgical outcome, regardless of any associated factors. Eighty-four percent of the patients reported good to excellent postoperative results in their hands. Further analysis of the subpopulation of insulin-dependent diabetics showed that 81% experienced good to excellent postoperative results. These results compare favorably with those of the control group: 200 nondiabetic patients, of whom 90% rated their results from carpal tunnel release surgery as good to excellent. There were no major complications in any group.

Journal Article↗
PubMed1992

Bilateral carpal tunnel release at one operation: report of 228 patients.

The division of the transverse carpal ligament for relief of carpal tunnel syndrome has been a standard operative procedure since the early 1950s. The surgical technique, however, is controversial, and the literature is rife with individual preferences and biases. This report describes our results in 228 tensor fasciae patients who underwent a bilateral carpal ligament release in one procedure that used a small transverse incision in the wrist crease. When the patients' responses to a questionnaire, records of postoperative visits, and follow-up phone calls were analyzed, 216 patients (94.7%) had a satisfactory outcome. One hundred fifty-five patients were working before surgery, with 88.3% back to work in 6 weeks or less. There were no major complications.

Activities of Daily Living↗
PubMed1991

Carpal tunnel syndrome: surgical treatment using the Paine retinaculatome.

The operative technique for the relief of carpal tunnel syndrome has remained controversial. This report presents the results of 445 patients or 577 hands operated on using a transverse technique that varies little from that described by Paine and Polyzoidis. The patients were followed for 9 months to 3 years. In addition to the data received from follow-up visits, a questionnaire was sent to each patient for evaluation of their results. All surgery was performed under local anesthesia, sometimes with intravenous supplement. Of the 445 patients, 313 had unilateral operations and 132 had bilateral operations at one sitting. Postoperatively, normal hand function was achieved in 59.4% of patients in 1 week or less. Of the 577 hands operated on, 535 (92.7%) exhibited satisfactory results from surgery. No patient required postoperative physical therapy or splinting. There were no injuries to the median nerve or any of its branches.

Carpal Tunnel Syndrome↗
PubMed1987

Effects of angioplasty upon carotid sinus mechanical properties and blood pressure control in the dog.

The effects of vein patch angioplasty of the carotid sinus upon carotid sinus control of blood pressure and carotid sinus mechanical properties were studied in nine vagotomized dogs. Pressures in the isolated carotid sinuses were increased from 60 to 180 mm Hg in steps of 30 mm Hg, and the resulting reflex changes in mean aortic pressure were measured both before and after unilateral angioplasty. Angioplasty significantly decreased aortic pressure for carotid sinus pressures above 60 mm Hg, decreased the calculated carotid sinus reflex set point pressure, and increased the range of control of arterial blood pressure together with the maximal capacity of the arterial baroreceptors to effect vasoconstriction. In five dogs, concomitant changes in carotid sinus diameter were measured. From the latter, together with accompanying changes in sinus wall geometry, were calculated the tension-strain modulus of elasticity of the carotid sinus wall, together with the radial displacement of the media-adventitial junction. Calculated increases in the latter were consistent with the observed increased effectiveness of the carotid sinus baroreceptors after angioplasty. It was concluded that the modification of blood pressure and its control was predominantly due to the surgical exaggeration of normal carotid sinus geometry accompanied by modest changes in carotid sinus wall mechanical properties.

Animals↗
PubMed1987

Connective tissue analysis of the canine circle of Willis in hypertension.

The collagen and elastin contents of the major arterial components of the canine circle of Willis (basilar artery, posterior cerebral artery, internal carotid artery, middle cerebral artery, and anterior cerebral artery) were determined as measures of the passive mechanical properties of these vessels. Studies were carried out in seven normotensive dogs and seven dogs in which experimental renal hypertension of 3 months duration had been induced. In the normotensive animals, the collagen content of the middle cerebral artery exceeded that of the other vessels considered. The elastin content and the total connective tissue were not significantly affected by arterial site. The middle cerebral artery collagen to elastin ratio was greater than corresponding values for the basilar, posterior cerebral, and internal carotid arteries. Connective tissue differences were less pronounced in the hypertensive animals. No component of the canine circle of Willis in the hypertensive dogs showed a significantly different collagen content, elastin content, total connective tissue content, or collagen to elastin ratio. In comparing cerebral vessels from normotensive and hypertensive dogs, total connective tissue values were greater in hypertension for all arterial sites considered. These acute physiological changes in connective tissue content over small distances in intracranial blood vessels from normotensive animals, together with unique connective tissue responses of these vessels to short term hypertension, may suggest additional possible factors important in the natural history of cerebrovascular pathological conditions.

Animals↗
PubMed1984

Re-operation for recurrent brain tumors in children.

In order to determine the efficacy of re-operating on recurrent brain tumors, we did a retrospective analysis of 39 children who underwent such surgery between 1975 and the present. A total of 52 procedures was performed for recurrence of both benign and malignant tumors. 9 patients are neurologically normal and 12 are independent but left with some sort of neurologic deficit for an average of 31 months and 32 months, respectively, postoperatively. 1 child presented severely handicapped and remains so 18 months after his most recent surgery. 17 patients died. 11 improved after re-operation and lived an average of 12 months. 4 were unimproved with an average survival of 10 months. There were 2 surgical deaths for an operative mortality of 4%. We feel that re-operation is a useful therapy for both benign and malignant recurrent brain tumors, and prolongs both the quantity and quality of life in appropriately selected patients.

Astrocytoma↗
PubMed1983

Cerebrospinal fluid myelin basic protein in hydrocephalus.

Immunoreactive myelin basic protein (MBP) levels were measured in cerebrospinal fluid (CSF) samples taken from 57 patients with active hydrocephalus (age range 3 weeks to 60 years). Of these patients, 28 (49%) had elevated MBP values (greater than 4.5 ng/ml). Elevated MBP levels were found in 44% of patients with congenital hydrocephalus, 75% of patients with posttraumatic hydrocephalus, 80% of patients with normal-pressure hydrocephalus, and 83% of patients with porencephaly. Also associated with abnormal MBP levels was the ventricular size as measured by computerized tomography scanning (chi 2: p less than 0.05): 36% of the patients with small ventricles (ventricle:brain ratio 0 to 0.4:1) had elevated MBP in the CSF, whereas 61% of those with moderate ventricles (0.41 to 0.6:1 ratio) and 100% of those with large ventricles (0.61 to 0.85:1 ratio) had abnormal values. Only 33% of those with maximal hydrocephalus (0.86 to 1.0:1 ratio) had elevated MBP levels, perhaps because of dilution effects. In three patients in whom CSF was obtained simultaneously by ventricular and lumbar punctures, the ventricular fluid had a consistently higher concentration of MBP, suggesting a cerebral origin. It is concluded that active hydrocephalus produces significant periventricular demyelination, probably as the result of mechanical stretching.

Adolescent↗
PubMed1980

Global rostral midbrain dysfunction secondary to shunt malfunction in hydrocephalus.

Two cases of congenital hydrocephalus with shunt malfunction are described. Both patients presented with clinical syndromes suggestive of global rostral mesencephalic dysfunction, including the sylvian aqueduct syndrome, a parkinsonian-like state, and quadriparesis. Each had computed tomographic findings that showed marked dilatation of the lateral and 3rd ventricles, and both improved with revision of their shunts. The anatomical substrates of the clinical findings are reviewed. A discussion of the probable mechanism proposes that dilatation of the 3rd ventricle and rostral aqueduct sufficiently explains the entire syndrome. (Neurosurgery, 7: 322-325, 1980).

Adolescent↗