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Phanor L. Perot Jr. and Darrell D. Munro

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Stephen E. Rawe and Phanor L. Perot Jr.

✓ Experimental contusion paraplegic injury to the posterior spinal cord in cats results in a sudden increase of systemic blood pressure to between 200 and 250 mm Hg, and an increase in pulse pressure and a slowing of pulse rate. This initial hypertensive phase lasts approximately 3 to 4 minutes, and then is followed by a hypotensive phase. This pressor response is mediated by the alpha adrenergic receptor sites of the peripheral sympathetic nervous system and can be blocked by intravenous phenoxybenzamine, an alpha adrenergic blocking agent. The hypotensive phase is the result of an overall reduction in alpha adrenergic vascular tone and can be reversed by the infusion of metaraminol or intravenous fluids. The alterations in blood pressure that follow impact injury are most likely related to alterations of peripheral arteriolar resistance and venous return of blood to the heart.

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Robert L. Allen, Phanor L. Perot Jr. and Steven K. Gudeman

✓ Computerized tomography metrizamide myelography was performed in 46 patients with acute, nonpenetrating cervical spinal cord injuries. By visualizing the spinal canal, spinal cord, and any compressive lesion, the study proved valuable in the decision as to whether surgical decompression was indicated and what approach should be used. Eleven patients were found to have significant spinal cord compression, 10 of whom were treated surgically. The technique, results, and complications resulting from the study are discussed.

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The histopathology of experimental spinal cord trauma

The effect of systemic blood pressure

Stephen E. Rawe, William A. Lee and Phanor L. Perot Jr.

✓ The early sequential histopathological alterations following a concussive paraplegic injury to the posterior thoracic spinal cord in cats were studied. The lack of significant progression of hemorrhages over a 4-hour period after injury indicates that most hemorrhages probably occur within the first hour. The marked enhancement or retardation of hemorrhages in the post-injury period, when the blood pressure was increased or decreased, respectively, demonstrates the loss of autoregulation of spinal cord vasculature at the trauma site after a concussive paraplegic injury. Progressive edema formation was evident over a 4-hour period following injury, and it could be enhanced or retarded by elevation or reduction of the systemic blood pressure.

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John T. Lucas, Gordon D. Hungerford and Phanor L. Perot Jr.

✓ The authors describe a case of nontraumatic atlantoaxial dislocation secondary to acute rheumatic fever, in which there appeared to be fibrous fusion between the axis and the atlas in the subluxed position. The dislocation was reduced by means of combined traction and steroid therapy. Fibrous fusion occurred in the realigned position after immobilization.

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John T. Lucas, Thomas B. Ducker and Phanor L. Perot Jr.

✓ The authors report the results of a questionnaire regarding the use of hypertonic saline for the control of pain. Of 2105 patients so treated, nearly 11% had an adverse temporary symptom or sign, reported as an untoward reaction; slightly over 1% suffered a significant morbidity, of which paraplegia or quadriplegia was by far the most common, and two patients died (0.1%).

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Shokei Yamada, Phanor L. Perot Jr., Thomas B. Ducker and Isabel Lockard

✓ A new myelotomy knife is described and a procedure, designed to sever certain reflex connections while preserving as many corticospinal connections as possible, is presented. Through intermittent dorsal midline incisions the gray matter lateral to the central canal is severed bilaterally under the microscope from L-1 to S-1. This procedure relieved mass spasms and hyperactive reflexes in 14 paraplegic or tetraplegic patients, but preserved postural reflexes and whatever voluntary motor power the patients had prior to myelotomy. Before myelotomy all patients were bedridden. Afterward nine patients were able to use a wheel chair and five were able to walk with the use of parallel bars or crutches.

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Shokei Yamada, Frederic D. Schuh, J. Shand Harvin and Phanor L. Perot Jr.

✓ The authors report their technical experience with the en bloc subtotal temporal bone resection of cancer of the external ear involving the temporal bone. With the cooperation of an experienced plastic surgery team, coverage of the large defect with a rotation flap makes this procedure successful by wound healing per primam. Complications such as hemorrhage, vascular thrombosis, and brain abscess can be minimized by strict application of neurosurgical and plastic surgery techniques. Two successful cases are described in detail.

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Paul D. Garen, James M. Powers, J. Stovall King and Phanor L. Perot Jr.

✓ A rare tumor closely associated with the trigeminal ganglion produced a syndrome of atypical facial pain in a 44-year-old man. Two previous reports have designated similar tumors as “fibro-osseous lesions.” The distinctive morphological appearance is illustrated and possible histogenesis discussed.

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David G. Changaris, James M. Powers, Phanor L. Perot Jr., G. Douglas Hungerford and George B. Neal

✓ Symptomatic subarachnoid hemorrhage (SAH) in a young patient originated in a non-obstructive lateral ventricular subependymoma. A brief review of brain tumors known to cause SAH is discussed. The computerized tomography scans are presented.