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Angelo L. Maset, Anthony Marmarou, John D. Ward, Sung Choi, Harry A. Lutz, Danny Brooks, Richard J. Moulton, Antonio DeSalles, J. Paul Muizelaar, Hope Turner and Harold F. Young

S ince the introduction of intracranial pressure (ICP) measurement by Guillaume and Janny 4 and Lundberg, 13 ICP monitoring has been a useful adjunct in the management of patients with brain injury. Clinical studies reported during the last decade have described the close correlation between intracranial hypertension and outcome. 2, 7, 9, 16, 17, 20–22 Other reports have emphasized the neurological deterioration resulting from secondary insult to the brain induced by depletion of volume-buffering capacity and development of high ICP. As a result of these

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magnitude is not greater than that seen with mannitol alone, with the following distinction. With mannitol, hypertension occurs within 45 minutes of diuretic infusion, and is due to a transient increased intravascular volume; with osmotic-loop diuresis, it occurs after peak diuresis, and is presumably related to an increased angiotensin plasma level (unpublished data).

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Benjamin Kaufman, Martin H. Weiss, Harold F. Young and Frank E. Nulsen

this time there is an absolute decrease in the intracranial dimensions of the skull (the Holter valve used as a standard in the correction for magnification) and consequently a decrease in the intracranial volume. The paranasal sinuses and mastoid air cells show a prominent overgrowth. Fig. 2. Lateral radiograph of a 19-year-old boy 11 months after a membranous aqueduct stenosis had been treated by CSF shunting. There is a definite thickening of the calvaria which at comparable sites in the frontal region now measures 9 mm whereas the initial thickness

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Michael E. Carey, Harold F. Young, Berkley L. Rish and Jacob L. Mathis

, in Ravitch MM (ed): Current Problems in Surgery — Military Surgical Practices of the United States Army in Vietnam. Chicago, Year Book Medical Publishers, 1966 17. Rowe SN : Infections following acute gunshot wounds of the brain , in Coates JB Jr (ed): Medical Department United States Army Surgery in World War 2, Volume 1. Neurosurgery. Washington DC , Office of the Surgeon General, Department of the Army , 1958 pp 201 – 213 Rowe SN: Infections following acute gunshot wounds of the brain, in

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Philippe Gadisseux, John D. Ward, Harold F. Young and Donald P. Becker

output. Nitrogen intake is easily calculated from the volume and the composition of all the fluids administered to the patient. Nitrogen loss is measured by collecting urine, feces, and drainage fluids and by determining their nitrogen content by a Kjeldahl method. Protein turnover rate has been studied after administration of trace amounts of labeled amino acids. In 1930, Cuthbertson 44 observed a rapid rise of urinary nitrogen, peaking in about 3 to 6 days, after long-bone fracture. Since then, nitrogen losses have been reported in various groups of patients after

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Jason L. Schroeder, Jason M. Highsmith, Harold F. Young and Bruce E. Mathern

contrast, in our study we found that 100% FiO 2 could restore O 2 measures to preinjury levels, which potentially suggests a different degree of injury or less disturbance of the micro-circulation. Although volume expansion and hemodilution clearly occur with either injection, it is apparent that PFC treatment yields higher O 2 levels than saline control. This benefit appears to be related to the high concentration of O 2 that dissolves in PFCs. The PFCs enhance tissue oxygenation by increasing the O 2 content of the blood, carrying O 2 to areas of decreased red

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Anthony Marmarou, Panos P. Fatouros, Pal Barzó, Gennarina Portella, Masaaki Yoshihara, Osamu Tsuji, Takuji Yamamoto, Fred Laine, Stefano Signoretti, John D. Ward, M. Ross Bullock and Harold F. Young

, particularly in cases of contusion, in which the fluid migration is more easily visualized using CT techniques. 17 However, the rapid expansion of injured brain that is witnessed during surgery further bolstered the blood-volume theory, and it was posited that the expansion was due to the vasoparalysis of resistance vessels and a subsequent increase in blood volume. 27 In the laboratory, several investigators have documented the increase in brain water that accompanies experimental injury and, as a result, the terms “swelling” and “edema” have been used interchangeably

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Outcome after severe head injury

Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients

Anthony M. Alberico, John D. Ward, Sung C. Choi, Anthony Marmarou and Harold F. Young

findings were attributed to vasodilatation and initial hyperemia. While this phenomenon does occur in certain patients, it does not appear to be the case in the majority of pediatric patients. Whether increased ICP is due to hyperemia with increased cerebrovascular volume in children is still open to debate. In work done at the MCV Hospital (JP Muizelaar, personal communication, 1987), CBF was measured in a series of 32 children during the first few days after injury. There were only three patients with CBF values above normal (± standard deviation at normal PaCO 2

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Gerrit J. Bouma, J. Paul Muizelaar, Warren A. Stringer, Sung C. Choi, Panos Fatouros and Harold F. Young

with a xenon gas delivery system and CBF software package. Patients were paralyzed with vecuronium bromide and ventilated with a volume-cycled respirator † during the studies. Scans were performed in three axial planes with a thickness of 5 mm, each 20 mm apart, with the lowest plane chosen to include portions of the brain stem and the cerebellum. After completion of two baseline scans at each level, a mixture of 32% stable xenon gas ‡ and 68% oxygen was administered through the respirator for 4.5 minutes, during which four additional scans were performed at each

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Ronald L. Hayes, Bruce G. Lyeth, Larry W. Jenkins, Richard Zimmerman, Tracy K. McIntosh, Guy L. Clifton and Harold F. Young

-covered Plexiglas piston mounted on O-rings. The opposite end of the reservoir is fitted with a transducer housing ending with a Leur-loc fitting (2.6 mm inside diameter). The entire system is filled with isotonic saline at 37°C. Injury is induced by the descent of a metal pendulum striking the piston, thereby injecting a small volume of saline epidurally into the closed cranial cavity and producing brief displacement and deformation of neural tissue. The resulting pressure pulse is measured in atmospheres (atm) by an extracranial transducer and recorded on a storage oscilloscope