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W Lewelt

Publications and source records attributed to W Lewelt.

10 recordsLinked to original sources

Increased vulnerability of the mildly traumatized rat brain to cerebral ischemia: the use of controlled secondary ischemia as a research tool to identify common or different mechanisms contributing to mechanical and ischemic brain injury.

Fasted Wistar rats were subjected to either a mild mechanical injury, 6 min of transient forebrain ischemia, or a mild mechanical injury followed 1 h later by 6 min of forebrain ischemia. EEG and evoked potentials were assessed intermittently and morphological analyses were performed after 7 days postinjury survival. In all groups complete qualitative recovery of electrical activity and general behavior was observed with 7-day survival. However, rats subjected to combined concussion and ischemia displayed EEG spike activity and a delayed return of EEG and evoked potentials during acute recovery not evident in other groups. No overt neuronal cell loss was seen in trauma alone and was minimal or absent in ischemia alone. However, extensive bilateral CA1 and subicular pyramidal cell loss was found in the septal and mid-dorsal hippocampi in the combined trauma and ischemia group. In contrast, no overt axonal injury was found in any group. We conclude that even mild mechanical injury can potentiate selective ischemic hippocampal neuronal necrosis in the absence of overt axonal injury. This potentiation also occurs in conjunction with more generalized electrophysiological disturbances such as EEG evidence of postischemic neuronal hyperactivity suggesting that mild concussion may also decrease the threshold for post-ischemic neuronal excitation. These results suggest the potential of this model for examining common or different injury mechanisms in mechanical and ischemic brain injury.

Animals

Combined pretrauma scopolamine and phencyclidine attenuate posttraumatic increased sensitivity to delayed secondary ischemia.

Fasted Wistar rats were given a mild level of traumatic brain injury (TBI) and then subjected to 6 min of transient forebrain ischemia 24 h posttrauma. One group was given simultaneous 1 mg/kg scopolamine and 4 mg/kg phencyclidine intraperitoneally (IP) 15 min before trauma and another group an equal volume of plasmalyte A solution. After 7 days of postinjury survival, placebo-treated rats demonstrated increased posttraumatic vulnerability to secondary ischemic CA1 neuronal death even 24 h after trauma. This finding confirmed that increased posttraumatic ischemic vulnerability persists for at least 24 h even following mild trauma. Combined muscarinic receptor and N-methyl-D-aspartate (NMDA) receptor coupled ion channel blockade given and present during the mild TBI statistically attenuated this enhanced secondary ischemic CA1 neuronal death and thus posttraumatic increased ischemic vulnerability. Placebo-treated rats had 335.3 +/- 93.6 CA1 neurons/10(6) microns 2 and drug-treated rats had 844.8 +/- 184.9 CA1 neurons/10(6) microns 2. This result suggests that muscarinic and/or NMDA receptor-mediated events confined to TBI and the early posttraumatic period are in part responsible for the phenomenon of increased posttraumatic ischemic vulnerability.

Animals

Dynamics of the blood pressure changes in sodium nitroprusside induced controlled arterial hypotension in neurosurgery.

Dynamics of the arterial blood pressure changes under the influence of intravenous infusion of sodium nitroprusside (SN) were studied in 12 patients operated on for intracranial aneurysms. Adequate measures were undertaken to avoid blood pressure (BP) changes due to the anaesthetic procedure itself. It was found that the speed of BP lowering corresponded to the rate of infusion, and could easily reach 10 mm Hg/min. After stopping the infusion, the BP recovery rate averaged a mean speed of 8.5 mm Hg/min, varying from 3.8 to 12 mm Hg/min. High speeds of BP lowering and recovery achieved with the use of SN are the main advantages of this hypotensive agent in neurosurgical procedures.

Adult

[Sodium nitroprusside in controlled arterial hypotension during neurosurgical operations].

A 0.02% solution of sodium nitroprusside was given in intravenous drip infusion for induction of controlled arterial hypotension during intracranial operations. The drug was given to 9 patients operated upon for aneurysms and 2 patients with intracranial meningiomas. It was observed that arterial blood pressure could be easily controlled in this way for the purposes of operation.

Adult

Controlled arterial hypotension during neurosurgical operations.

Controlled arterial hypotension was applied in 62 hyperventilated patients during neurosurgical operations. Hypotension was obtained using trimetaphan (19 cases), trimetaphan and halothane (32 cases) and sodium nitroprusside (11 cases). It was found that the action of sodium nitroprusside was the quickest and lasted the shortest, which considerably facilitated the control of hypotension. Halothane permitted hypotension to be obtained rapidly but in certain cases it prolonged the hypotensive action of trimetaphan.

Adolescent

[Cerebrospinal fluid pressure measurements in the ventricular system during and after surgery in patients with supratentorial brain tumors].

In the light of CSFP measurements by Lundberg's method in 46 patients the authors showed the role of hyperventilation in lowering of intracranial pressure. A considerable efficacy of dexamethasone was demonstrated as well, the use of this drug permitted to achieve stabilization of CSFP during and after the operation. The investigations showed a considerable effectiveness of such drugs as mannitol and furosemide in lowering of CSFP. Pancuronium was found to be superior to suxamethonium for administration during induction of anaesthesia because the former caused no CSFP rise. In polygraphic investigations of nocturnal sleep with parallel recording of CSFP a rise of CSFP was demonstrated during REM phase of sleep.

Anesthesia

Hyperventilation in neurosurgery.

An outline of the nature and varieties of hyperventilation is presented together with a discussion on the role of artificial hyperventilation in the management of neurosurgical patients. Attention is called to the value of gasometric investigations in the ventricular cerebrospinal fluid for evaluation of disturbances in pH of the intracranial environment and possible effectiveness of hyperventilation. The results of our measurements of cerebrospinal fluid pressure are presented in 21 cases of supratentorial cerebral tumours in which controlled ventilation with hyperventilation was conducted. In 19 cases, the cerebrospinal fluid pressure fell by a mean of 44.3% with a simultaneous fall of PaCO2 by 29.3%. In the conclusions the authors stress the role of hyperventilation in the lowering of raised cerebrospinal fluid pressure and prevention of cerebral oedema.

Acid-Base Imbalance

[Changes in cerebrospinal fluid pressure in patients with hydrocephalus of various intensities].

In 12 patients with hydrocephalus caused by posterior fossa tumours continuous measurements of intraventricular CSFP were done before and after implantation of ventriculoatrial valve and after tumour removal. A fall of the mean CSFP from 31.57 mm Hg to 15.32 mm Hg was observed after valve implantation, and a further fall of the mean CSFP to 10.55 mm Hg after removal of the tumour. After valve implantation pathological A and B waves disappeared. Absence of improvement after different stages of treatment indicated poor functioning of the valve, but it was observed also in patients with inoperable tumours.

Adult