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Biomedical subjects

T B Ducker

Publications and source records attributed to T B Ducker.

At least 91 records · Page 5Linked to original sources
PubMed1981

Calculated recovery rates in severe head trauma.

In a series of 120 head-injured patients, recovery rates (rr) were calculated separately on the basis of either Glasgow come scale (GCS) scores or Maryland coma scale (MCS) scores; the latter contains the three variables of the GCS, excludes unevaluable responses, and provides more information concerning the status of brain stem reflexes and motor lateralization. The early (Day 3/4 vs. Day 1) and late (Day 8/14 vs. Day 1) recovery rates from the two scales generally agree (r = 0.76; r = 0.79), but in 39 of 94 patients the MCSrr and GCSrr disagreed by more than 10%. When the MCSrr was greater than the GCSrr, it more accurately reflected a favorable outcome. Graphic representations of clinical courses through serial plots of raw scores were more reliable when unaffected by intubation, sedation, swollen eyelids, casts, etc.; this was more often achieved with serial plots of MCS scores, which are graded as percentages of testable function. Final outcomes (good/disabled vs. vegetative/dead) were well predicted by Day 1 MCS scores above or below 35% (chi 2 = 27.63; p less than 0.001) and Day 1 GCS scores above or below 7 (chi 2 = 23.21; P less than 0.001). However, in 57 very sick patients (Day 1 GCS less than or equal to 7), the GCS did no better than chance (26 good, 31 bad outcomes), whereas 20 of 26 patients with a Day 1 MCS score of less than or equal to 35% had bad outcomes. In patients with severe multiple injuries, the Maryland coma scale may provide a more sensitive index of clinical course; a Day 1 MCS raw score of less than or equal to 35% is of grave prognostic significance.

Adolescent↗
PubMed1981

Steroids in severe head injury: A prospective randomized clinical trial.

This is a prospective randomized study of the efficacy of steroid therapy in patients with severe head injury. One hundred patients were randomized into two equal groups: the steroid group received 5 mg/kg/day of methylprednisolone, and the nonsteroid group received no drug. The groups were similar in their clinical features. All patients received a standardized therapeutic regimen. The patients were also classified as early responders or nonresponders to the overall treatment protocol without regard to steroid administration, on the basis of change in Glasgow Coma Scale score during the first 3 days of admission. There was no statistically significant difference in the outcome of the steroid and nonsteroid group at 6 months. Of the responders who were on steroids, 74% had good outcomes or were disabled, compared with 56% of the responders who did not receive steroids. In the nonresponder group, the patients on steroids were actually associated with a worse outcome than those who did not receive steroids: 75% of the nonresponders who received steroids were dead or vegetative, compared to 56% of those who were not receiving steroids. The data suggest that: 1) the effect of steroids may be different for different patient groups; 2) in order to identify these patients, a sensitive coma scale is needed; and 3) a rational approach to steroid therapy in head-injured patients may be to start all patients on steroids, but to discontinue their use in patients identified as not benefiting from steroid therapy.

Adolescent↗
PubMed1980

The role of computed tomography in acute head injury.

Computed tomography (CT) of the head provides the ability to rapidly evaluate patients with acute head injuries. Moreover, CT aids in surgical planning, prognosticating outcome and recovery time, and monitoring nonsurgical injuries. The authors review the ways in which CT is employed in a multiple trauma center.

Brain Injuries↗
PubMed1980

Minimyelogram in cervical spinal cord trauma.

Fifty-eight patients with a clinical or radiographic diagnosis of cervical spinal cord injury underwent Pantopaque myelography on an emergency basis. Twenty-five per cent of these patients demonstrated evidence of spinal cord compression after reduction by spinal traction, as evidenced by the presence of a myelographic defect. Less than half of these patients had a defect that the authors thought required emergency surgical decompression. Two of the five patients so operated upon demonstrated an improvement in neurological function after operation that was much greater than that which would have been predicted before operation. The finding of these few patients who made a significant improvement after operation may justify the myelographic investigation of all patients with evidence of serious cervical spinal cord injury. Based on our experience, Pantopaque myelography may offer adequate, accurate, and useful information for the immediate management of spinal cord-injured patients.

Arachnoiditis↗
PubMed1979

Complete sensorimotor paralysis after cord injury: mortality, recovery, and therapeutic implications.

In 273 completely paralyzed cord injured patients, the 1-year mortality was 34% in the patients with cervical fractures and 7% in the patients with thoracic and thoracolumbar fractures. Recovery of useful motor function return occurred in 6.7% of the cervical and 11% of the thoracic and thoracolumbar patients; only 1% of the patient population became completely normal. No specific treatment could be singled out as aiding recovery. A case with recovery from complete paralysis after C5--6 fracture-dislocation is presented.

Adolescent↗
PubMed1979

Motor classification of spinal cord injuries with mobility, morbidity and recovery indices.

In this article, we have presented a new motor classification of patients with spinal cord injuries. This system of classification provides statistically discrete subdivisions. The patients in each of the subdivisions of the classification can be mathematically summarized with numerical indices which then may be accurately analyzed statistically. This allows the clinical researcher in spinal cord injuries to evaluate current treatments and assess the potential of new treatments and assess the potential of new treatment regimes. In addition, tables of MIi and recovery rates have been presented to aid in the correct classification of new patients and in the prediction of their present chances of motor recovery. Last, we have introduced a standardized motor examination, based on past experience, that will aid in the direct comparison of future results for any spinal cord treatment regimes.

Humans↗
PubMed1978

Experimental spinal cord trauma, I: Correlation of blood flow, tissue oxygen and neurologic status in the dog.

Spinal cord blood flow and tissue oxygen were measured concurrently in a series of paraplegic dogs subjected to experimental spinal cord trauma. Injury to the spinal cord sufficient to cause clinical paraplegia is associated with a significant (P less than 0.01) decrease in blood flow in the central spinal cord from 15.2 to 6.1 ml/min/100gms at two to three hours following injury. Also, at two and three hours post-injury, paraplegic dogs demonstrate a significant (P less than 0.01) decrease in tissue oxygen levels from 35-39 mm Hg to 17-24 mm Hg. No significant changes occurred in systemic blood pressure or carotid blood flow. A delay often precedes the significant onset of blood flow and tissue oxygen alterations, which suggests that therapeutic efforts could be directed during this critical interval.

Animals↗
PubMed1978

Experimental spinal cord trauma, II: Blood flow, tissue oxygen, evoked potentials in both paretic and plegic monkeys.

Graded clinical motor deficits were produced in a series of Rhesus monkeys subjected to experimental spinal cord trauma from a variety of impact loads. An argon washout technique was used to measure spinal cord blood flow; tissue oxygen carbon dioxide, and somatosensory evoked potentials (SEPs) were also monitored. Each animal received a clinical grade and, after a week of study, the spinal cords were removed for histopathological grading. Blood flow in paraplegic animals was significantly decreased at two hours and seven days following injury (5 ml/min/100 gms tissue); paraparetic animals showed no significant difference from preinjury levels (14 ml/min/100 gms tissue). Animals which completely recovered demonstrated increased flow (27 ml/min/100 gms tissue). Composite tissue oxygen was generally depressed in paraplegic animals (28 mm Hg/kg) but showed no clear pattern in other groups. Only 8% of monkeys rendered paraplegic preserved a somatosensory evoked potential (SEP) at five minutes after injury. Paraparetic animals were more likely (40%) to show initial preservation of the SEP and in normal animals, the SEP always returned by three hours. Histopathological grading tended to parallel clinical grading in 92% of the cases. Although the extremes of possible postinjury deficits (complete paraplegia or recovery) can be predicted from a combination of these measurements, incomplete lesions (whether judged clinically or pathologically) present a more variable picture.

Animals↗
PubMed1978

Experimental spinal cord trauma, III: Therapeutic effect of immobilization and pharmacologic agents.

A wide variety of pharmacologic agents has been suggested to serve as therapeutic adjuncts in the management of acute spinal cord trauma. The present study was conducted to determine what effect, if any, these agents have when they are added to immobilization of the spinal column, the most widely used clinical measure. Rhesus monkeys were subjected to different levels of experimental spinal cord injury with and without subsequent immobilization by means of a figure of eight ligature. In the control group, five of six animals impacted at 500 gm-cm were paraplegic. In the immobilized animals, three of four animals impacted at 500 gm-cm recovered completely and the fourth was only mildly paraparetic. Paraplegia could not be uniformly produced in this group until 800 gm-cm forces were routinely employed. In the second phase of the study, only immobilized animals were used, with and without drug therapy. No change in the force-injury curve, above and beyond that from immobilization, can be demonstrated for monkeys given dextran, phenobarbital, methyldopa, phenoxybenzamine or vasopressors. The pathophysiologic concepts upon which such agents are advocated should be reassessed. Spinal immobilization can significantly improve the clinical outcome following experimental spinal cord injury, it may also serve to control some of the variability previously observed in pharmacologic experiments.

Animals↗
PubMed1977

Prognosis of surgically treated intracranial arterial aneurysm patients.

From 1969 to 1973, we undertook a direct surgical therapeutic approach with 62 patients who had intracranial aneurysms. The surgical mortality for patients in the first three clinical grades was 5%. Sixty-eight percent of the entire group of patients had improved conditions at follow-up. When these results are compared to the expected outcome of the natural course of the disease under conservative management, the superiority of the direct approach is seen. With the aid of modern instrumentation, anesthesia, steroid therapy, and magnification, neurosurgical centers handling a reasonable volume of these cases should achieve comparable results.

Blood Pressure↗
PubMed1977

Spinal cord injury. The role of vascular damage in the pathogenesis of central hemorrhagic necrosis.

We postulated that damage to the endothelial lining of the spinal cord vasculature is a major factor in the pathogenesis of the characteristic lesion of the spinal cord (progressive, central, hemorrhage necrosis) that occurs after acute trauma. Endothelial damage may occur as a result of primary injury to the vessels or after arterial spasm. This damageresults in deposition of platelets and formation of thrombi on the exposed subendothelial tissues and embolization of such thrombi to smaller vessels of the spinal cord parenchyma.

Animals↗
PubMed1977

Metabolic factors in surgery of peripheral nerves.

Respect for the metabolic changes within the neuron is critical in planning peripheral nerve surgery. Only by understanding the different metabolic responses of the nerve tissue and the supportive tissue can anastomosis be planned where the budding neuron stands its best chance of successfully regenerating across a repair site. Often, a short delay in nerve repair is indicated. With all factors ideal, good motor function can be counted on across one joint from the next group of muscles. Rarely is there good function across two joints. Protective sensory function can be achieved distally even under the most adverse metabolic conditions because of the independent metabolic state of these end organs.

Age Factors↗
PubMed1977

Proprioceptive pathways of the spinal cord.

In the Macaque, surgical lesions were made in the dorsal funiculus, in the dorsolateral funiculus, and through half of the spinal cord. The somatosensory and motor capacity of the animal were examined neurologically and electrophysiologically. The exact lesion was then confirmed pathologically in detail. The results of these experiments indicate that limb position information from the distal limb and proximal limb are relayed to the brain in two different fashions. Distal limb position information, especially the cortical representation of the limbs' volar surface as it moves in space, is drastically impaired by dorsal funiculus or posterior white column lesions. Proximal limb position may or may not be impaired by similar lesions, for this information while initially in the dorsal or posterior white columns is sorted out (as it ascends in the spinal cord) to the dorsolateral funiculus or white columns. For example, in the lower thoracic spinal cord, both distal and proximal hind limb sensation are impaired by posterior white column damage; in the cervical cord, only distal sensation is impaired by the same lesion, and proximal information is spared. We refer to this neuroanatomic rearranging as "fibre sorting", and we believe that it is clinically significant in spinal cord disease.

Afferent Pathways↗