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Biomedical subjects

T J Leipzig

Publications and source records attributed to T J Leipzig.

12 recordsLinked to original sources
PubMed2001

A multicenter, prospective, randomized trial evaluating a new hemostatic agent for spinal surgery.

STUDY DESIGN: A prospective, randomized trial comparing Proceed, a gelatin-based hemostatic sealant (treatment), with Gelfoam-thrombin (control) in stopping intraoperative bleeding during spinal surgery. OBJECTIVES: To determine the effectiveness and safety of Proceed. SUMMARY OF BACKGROUND DATA: Proceed has been tested in animal models to determine its safety and effectiveness as a hemostatic agent. The current study was conducted under a Food and Drug Administration-approved Investigational Device Exemption to evaluate the effectiveness and safety of Proceed in humans. METHODS: For this study, 127 patients undergoing spinal surgery were randomized into either the treatment or control group after standard surgical means to control bleeding had failed. The bleeding site was evaluated at 1, 2, 3, 6, and 10 minutes after the hemostatic agent was applied. The application was considered successful if the bleeding stopped within 10 minutes. Follow-up evaluation was performed at 12 to 36 hours, then at 6 to 8 weeks after surgery. RESULTS: Proceed stopped bleeding in 98% of the patients (first bleeding site only) within 10 minutes, as compared with 90% of the control patients (P = 0.001). At 3 minutes, successful hemostasis had been achieved in 97% of the Proceed group, as compared with 71% of the control group (P = 0.0001). There was no difference in the adverse event profile between the two groups. CONCLUSIONS: A significantly larger number of bleeding sites had achieved hemostasis with Proceed than with Gelfoam-thrombin at 1, 2, and 3 minutes after application. Proceed was as safe as Gelfoam-thrombin when used for hemostasis during spinal surgery procedures.

Administration, Topical↗
PubMed1998

Role of intraoperative angiography in the surgical treatment of cerebral aneurysms.

UNLABELLED: The benefit of using intraoperative angiography (IA) during aneurysm surgery is still uncertain. OBJECT: In this prospective study, the authors evaluate the radiographically demonstrated success of surgical treatment in 151 consecutive patients harboring 173 aneurysms who selectively underwent IA examination. The authors also assess the frequency with which IA led to repositioning of the aneurysm clip. METHODS: Intraoperative angiography was used selectively in this series, based on the surgeon's concern about the potential for residual aneurysm, distal branch occlusion, or parent vessel stenosis. Specific variables were analyzed to determine their impact on the incidence of clip repositioning and the accuracy of IA was evaluated by direct comparison with postoperative angiography (PA) in 90% of the cases in which IA was used. CONCLUSIONS: The selective use of IA led to successful treatment as shown by PA, with a low incidence of unexpected residual aneurysm (3.2%), distal branch occlusion (1.9%), and parent vessel stenosis (0%). Intraoperative angiography led to immediate repositioning of the aneurysm clip in 27% of the cases. Anterior cerebral artery aneurysms required clip repositioning less often and superior hypophyseal artery aneurysms required repositioning more often than aneurysms in other locations. Large and giant aneurysms required clip repositioning more often than small aneurysms; however, they were also more likely to display false success on IA as determined by PA. Aneurysms arising along the internal carotid artery were more likely to display successful clipping on IA, as determined by PA, than were aneurysms in other locations. The results of this series support the selective use of IA in the treatment of complex aneurysms, particularly large and giant aneurysms as well as superior hypophyseal artery aneurysms. As measured by PA, IA will improve the outcome of these patients.

Adult↗
PubMed1997

Reducing the risk of rebleeding before early aneurysm surgery: a possible role for antifibrinolytic therapy.

Previous studies on the initial nonoperative management of aneurysmal subarachnoid hemorrhage (SAH) demonstrated that antifibrinolytic therapy reduced the risk of rebleeding by approximately 50%; however, prolonged antifibrinolytic treatment was associated with an increase in the incidence of hydrocephalus and delayed ischemic deficit. When early surgical intervention became routine for ruptured aneurysms, the use of antifibrinolytic therapy diminished. However, early surgery is generally performed in the first several days after SAH and the risk of rebleeding remains until the aneurysm is obliterated. Based on a review of the literature, the authors formed two hypotheses: 1) the high-dose intravenous administration of epsilon-aminocaproic acid (EACA), an antifibrinolytic agent, might reduce the risk of recurrent hemorrhage in the interval between SAH and early surgical intervention, and 2) a short course of EACA might not produce the increase in complications previously associated with its prolonged administration. The use of preoperative high-dose EACA therapy was evaluated in 307 patients to determine its safety and efficacy in reducing the incidence of rebleeding before early aneurysm surgery. All patients were admitted within 3 days of their SAH and were classified as Hunt and Hess Grades I to III. Only four patients (1.3%) suffered a recurrent hemorrhage. This compares favorably to the rebleeding rate of 5.7% reported for the early surgery group in the International Cooperative Study on the Timing of Aneurysm Surgery. The incidence of hydrocephalus or symptomatic vasospasm was not unduly elevated in patients receiving preoperative EACA. Thirty-five patients (11.4%) needed temporary cerebrospinal fluid drainage during their hospitalization and, overall, 8.8% required a ventriculoperitoneal shunt. The mean age of the patients who required a shunt was nearly 10 years older than the general study population. Seventy-one patients (23%) developed symptomatic vasospasm and 8.1% suffered a stroke. This study indicates that a brief course of high-dose EACA is safe and may be beneficial in diminishing the risk of rebleeding in good-grade patients prior to early surgical intervention. Further investigation is planned based on these promising results.

Adult↗
PubMed1991

Retrograde suction decompression of an ophthalmic artery aneurysm using balloon occlusion. Technical note.

A large ophthalmic artery aneurysm was ligated using a modification of the retrograde suction technique described by Batjer and Samson. Temporary proximal occlusion of the internal carotid artery was accomplished with a double-lumen balloon catheter, and distal occlusion was performed with a temporary clip. The aneurysm was collapsed by gentle aspiration through the distal lumen of the balloon catheter. This greatly facilitated dissection and clip ligation of the aneurysm.

Adult↗
PubMed1988

Infections of mechanical cerebrospinal fluid shunts.

In the United States approximately 16,000 CSF shunt operations are performed annually in the treatment of patients with hydrocephalus. Despite a reduction in the incidence of ventricular shunt infections from previous rates of 15 to 30 percent to rates of 5 to 10 percent in recent years, shunt infections remain the most important complication of the treatment of hydrocephalus and contribute significantly to excess morbidity and mortality. Skin flora organisms such as S. epidermidis, S. aureus, and Proprionibacterium are the most common infecting organisms, and the clustering of approximately 70 percent of infections within the 2-month postoperative period strongly suggests that colonization during shunt placement is an important initiating event. In infections caused by S. epidermidis the production of a glycocalyx slime appears to be an important pathogenetic factor. Clinical manifestations of shunt infections are often non-specific, and fever is the only consistent finding. Therefore, a high index of suspicion and a low threshold for diagnostic evaluation are indicated. Needle aspiration of the shunt reservoir or tubing is the single most reliable diagnostic step and is a procedure remarkably free of complications. The most effective treatment regimen is removal of the infected shunt, treatment with effective systemic antibiotics, and replacement of a new shunt in a new site after evidence of CSF inflammation has subsided. Recent preliminary experience combining systemic antibiotics, local instillation of antibiotics into the shunt reservoir or tubing, and revision of the distal shunt appears to offer hope of an effective alternative therapy without total shunt removal. Comparison of this approach to the previous "gold standard" in a well-designed prospective study is a high priority. In addition, attempts to reduce bacterial colonization of shunts by development of new shunt materials and the evaluation of newer antibiotics such as the quinolones in the prophylaxis and/or therapy of shunt infections should be encouraged.

Anti-Bacterial Agents↗
PubMed1986

The tortuous or kinked carotid artery: pathogenesis and clinical considerations. A historical review.

The significance and management of cervical carotid artery tortuosity are controversial. One hundred eighteen cases of angulation of the common carotid artery and over 800 cases of elongation of the internal carotid artery have been reported. The etiology, presentation, diagnosis, and treatment of each entity are reviewed. Angulation of the common carotid artery is often managed conservatively. For clarity, elongations of the internal carotid artery should be classified as either tortuosities or kinks. Some patients with kinks of the internal carotid artery will have episodes of cerebrovascular insufficiency related to the position of their heads. Such patients merit thorough diagnostic evaluation. When other etiologic factors have been eliminated, patients in this group may benefit from a surgical procedure directed at the vascular abnormality. Applicable surgical techniques are discussed.

Carotid Arteries↗
PubMed1986

Heart rate variability in neurosurgical patients.

Cardiac monitors determine heart rate by counting the number of beats in a given time interval. The normal heart, however, does not beat at a constant rate. Instead, there is a continuous change in heart rate on a beat-by-beat basis. This is termed the instantaneous heart rate and it represents the projected rate per minute that the heart would beat if only one R-R interval (the time between sequential R waves) was repeated throughout a 60-second period. Calculation of the instantaneous heart rate for each heart beat (R-R interval) produces a pattern that demonstrates the variability in heart rate. This instantaneous heart rate pattern was prospectively studied in 102 patients admitted to a neurosurgical intensive care unit. Short-term (STV) and long-term (LTV) heart rate variability were compared to the Glasgow coma scale as a method for patient assessment. LTV seems to be the most useful heart rate parameter in the clinical setting, and both STV and LTV performed better in the serial evaluation of patients. Two postulations found in the heart rate literature were not borne out in this study. First, we did not find a strong correlation between elevated intracranial pressure and decreases in heart rate or variability, as previously reported by Lowensohn et al. Second, the morphological classification of heart rate patterns described by Evans in his study of head-injured patients did not carry the same prognostic value when applied to this broad spectrum of patients with a variety of acute neurological disorders. Heart rate and its variability is a simple parameter to monitor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Treatment of mycotic aneurysms.

Mycotic intracranial aneurysms may be treated by antibiotic therapy alone. Careful evaluation of this mode of treatment has been hampered by inadequate angiographic and microbiological documentation. The present case details the successful conservative management of one of these lesions in a patient who had previously undergone craniotomy for a separate mycotic aneurysm.

Adult↗
PubMed1985

Evaluation and treatment of cerebral ischemia. Carotid endarterectomy and extracranial-intracranial bypass.

Patients with cerebral ischemia comprise an extremely heterogeneous group that makes analysis of treatment extremely difficult. Given the wide range of findings in the literature, one may select specific reports to justify a predetermined viewpoint. The study of Easton and Sherman has elicited a disproportionate amount of attention. Of the thousands of reported patients in the literature, this study of 228 patients with high postoperative morbidity and mortality has regrettably been cited often as the potential representative of surgical outcome in community hospitals. Undoubtedly, surgical skill varies and may affect results. Not all studies, however, support the contention that such procedures can only be performed adequately by surgeons who frequently do such operations. Most importantly, this study should redraw our attention to the fact that the success of the individual surgeon must be evaluated for any given procedure. With proper selection of patients, both carotid endarterectomy and EC-IC bypass procedures have proved to be safe and effective. In general, technical advances have heralded surgical results that appear to be superior to medical management, or no treatment, in a wide range of patients with cerebrovascular disease. Surgical results can only be evaluated when a procedure is fully developed technically and a large number of cases are accumulated. For carotid endarterectomy, and more recently EC-IC bypass, the necessary information is becoming available. However, the classification of patients to which these procedures should be applied has lagged behind. Given the variability in patients with cerebrovascular disease, this is somewhat understandable. Properly controlled studies would necessarily be unrealistically large. However, the technology and subsequent data that should be developed throughout the next decade will provide us with important information about brain ischemia and metabolism. This new technology should allow us to more completely define the exact nature of ischemic events in the individual patient. This will lead to better classification of patients and, ultimately, will improve patient selection for any methods of treatment, either medical or surgical.

Aged↗
PubMed1984

Causalgic pain relieved by prolonged procaine amide sympathetic blockade. Case report.

Reversible sympathetic blocks diagnostically relieve causalgic pain. At times, repeated blocks may be therapeutic. Causalgic pain of the left hand was successfully treated in a nonsurgical candidate by a continuous infusion of local anesthetic (procaine) into the region of the stellate ganglion. This technique was performed without significant complication and gave relief from the causalgia for extended periods of time. It may provide an effective alternative to surgical sympathectomy in high-risk patients.

Autonomic Nerve Block↗
PubMed1983

Deflation of metrizamide-filled balloon used to occlude a carotid-cavernous fistula. Case report.

A carotid-cavernous fistula was occluded by a detachable latex balloon. Because of technical problems, the contrast-filled balloon was left in a precarious position in the ostium of the fistula. Premature deflation of the balloon would have resulted in intra-arterial migration of the device. Approximately 1 week is required for the balloon to become secured in place by fibrous attachment to the vascular wall. For success, if the ligature is adequate, a detachable Debrun balloon should remain inflated for this period of time. The deflation process was monitored radiographically in this patient. The balloon remained inflated for at least 2 weeks. A short summary of the experience with deflation of various contrast-containing balloon devices in the treatment of carotid-cavernous fistulas is given. Metrizamide may be the best contrast agent for use in these devices.

Adult↗