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  • Author or Editor: Thoralf M. Sundt Jr x
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Thoralf M. Sundt Jr.

✓ On June 30, Mrs. Jean Lawe will step down as Managing Editor of the Journal of Neurosurgery. She has worked on the Journal since 1965, when Dr. Louise Eisenhardt retired as the first Editor. Since that time the Journal has grown in size and circulation, and production has become fully computerized. In her valedictory, Mrs. Lawe summarizes her years with the Journal and her approach to scientific editing.

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Thoralf M. Sundt Jr.

✓ The author reviews a form of management for patients deteriorating preoperatively or postoperatively from apparent ischemia attributed to progressive vasospasm after a subarachnoid hemorrhage. The clinical picture and relative frequency of this complication are considered in relationship to the status (grade) of the patient, location of the aneurysm, and ultimate neurological recovery. Experience suggests that the drug regimen reported is useful when instituted early after the onset of symptoms and is safe with proper monitoring techniques. The data do not justify early operative intervention after a subarachnoid hemorrhage, operation when there is angiographic evidence of severe spasm, or expectation of a dramatic effect in patients with a profound deficit or a fixed deficit several hours old.

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Thoralf M. Sundt Jr.

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Thoralf M. Sundt III and Thoralf M. Sundt Jr.

✓ Experience in cardiovascular and peripheral vascular surgery with saphenous vein bypass conduits is reviewed. It is clear that meticulous technique and graft preparation are crucial to short-term and long-term patency. The risk of early thrombosis is related to damage to the graft 's native intima, graft flow, and coagulability of the patient 's blood. Attention to atraumatic harvesting techniques and perfection of anastomoses are crucial to minimizing intimal damage. Graft inflow and outflow are fundamental principles. The use of vitamin K antagonists and platelet inhibitors may improve graft survival. Subacute occlusion is related to structural alterations in the grafts themselves. These include intimal hyperplasia and medial fibrosis as the grafts become “arterialized,” valve fibrosis, aneurysmal dilatation, clamp stenosis, and suture stenosis. Long-term patency is threatened primarily by atherosclerosis in the graft itself. There is some evidence that care in vein harvesting and implantation as well as the use of anticoagulant agents affect the development of this complication.

A technique for graft preparation is presented that is based on the experience of the authors in harvesting grafts for both cerebral and coronary bypass conduits.

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Thoralf M. Sundt Jr. and George Kees Jr.

✓ The authors have designed a miniclip and a microclip for occlusion of small perforating vessels deep in the operative wound. These clips are intended for permanent occlusion but may be used for temporary hemostasis.

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Clip-grafts for aneurysm and small vessel surgery.

Part 4: Relative application to various aneurysms and repair of anterior communicationg aneurysms using right-angle clip holder.

Thoralf M. Sundt Jr.

✓ Analysis of the use of the clip-graft for intracranial aneurysms indicates that the clip-graft is chiefly applicable to internal carotid and anterior communicating artery aneurysms. The development of the right-angle clip holder has extended its use to anterior communicating artery aneurysms that project posteriorly or superiorly. The dangers of dissection in the septal region are discussed. With few exceptions, the clip-graft is not applicable to the vertebrobasilar system or middle cerebral artery trifurcation aneurysms, although it has been used for aneurysms arising from the trunk of the latter vessel.

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Douglas Chyatte and Thoralf M. Sundt Jr.

✓ The authors have previously demonstrated that high-dose methylprednisolone (30 mg/kg intravenously every 8 hours) prevents severe chronic vasospasm in dogs. In the present study, lesser doses of methylprednisolone (15 mg/kg intravenously every 8 hours) and dexamethasone (0.1 mg/kg intravenously every 8 hours), although better than no treatment at all, were significantly less effective than the higher dose of methylprednisolone. These data suggest that methylprednisolone can prevent chronic experimental vasospasm from occurring only when given in high doses (30 mg/kg).