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The Surgical Treatment of Arnold-Chiari Malformation in Adults

An Explanation of Its Mechanism and Importance of Encephalography in Diagnosis

W. James Gardner and Robert J. Goodall

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Robert A. Moody and James L. Poppen

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Robert M. Crowell and James G. Wepsic

✓ Two teen-age male cousins with hereditary multiple exostoses developed cord compression secondary to chondrosarcoma. The clinical presentation, diagnostic work-up, surgical treatment, pathological findings, and postoperative course are described in each patient.

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Robert A. Ratcheson and James A. Ferrendelli

✓ Regional cortical levels of organic phosphates and carbohydrates were measured in cat brains, enzymatically inactivated by the technique of “funnel freezing” 1 hour after occlusion of a middle cerebral artery (MCA). Significant metabolic alterations occurred in all hemispheres ipsilateral to the site of occlusion. However, there was marked interindividual variability, with changes ranging from only slight increases in lactate, pyruvate, and adenosine monophosphate (AMP) in small regions of cortex at one extreme, to profound depletion of high-energy phosphates, depression of glucose and pyruvate levels, and increased lactate, adenosine diphosphate (ADP) and AMP levels in much of the hemisphere of the most severely involved animals. In contrast, metabolic changes in the hemisphere contralateral to the site of occlusion were very few or nonexistent. In addition, in all ipsilateral hemispheres there were regions peripheral to the areas of greatest metabolic alteration where there was excessive elevation of glucose levels. The results demonstrate that occlusion of a major cerebral vessel does not produce metabolic changes that are consistent in their distribution or severity. However, the findings of this study probably depict some of the complicated metabolic events that occur clinically during thrombotic or embolic infarction of brain.

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James T. Stuntz and Robert M. Shuman

✓ A case is presented in which the atrial tip of a ventriculoatrial shunt formed a fistulous connection with the bronchial tree in a child. This resulted in acute bronchopneumonia, pneumocephalus, and ventriculitis. Pneumocephalus was created by an artificial respirator forcing air along the shunt tract during treatment of bronchopneumonia. Sudden death was related to transtentorial herniation. The diagnosis of a cerebrobronchial fistula should be entertained in shunt patients with respiratory distress and radiographic pulmonary densities unresponsive to antibiotics.

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Richard F. Bulger, James E. Rejowski and Robert A. Beatty

✓ In a series of 375 patients with anterior cervical fusions, long-term follow-up results complete with laryngeal examination were obtained in 102 patients. One patient was found to have an inferior laryngeal nerve palsy, and one had a superior laryngeal nerve palsy. Both deficits were thought to be the result of surgical trauma. Measures to minimize the incidence of vocal cord paralysis include careful surgical technique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.

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W. James Gardner, Averill Stowell and Robert Dutlinger

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Robert L. McLaurin, Raul Vernal and James H. Salmon

✓ Fractures and dislocations involving C-1 and C-2 vertebrae have usually been treated by prolonged external immobilization or by internal fixation and fusion. This is a report of 12 patients treated by internal fixation by wiring only. Follow-up studies, up to 4 years, demonstrated healing of the bone and no late neurological sequelae. The advantage of internal fixation in reducing hospitalization and immobilization is accepted. The authors believe that in most instances the addition of bone fusion to the operative procedure is not essential and may increase morbidity.

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Kenneth H. Abbott, James R. Gay and Robert J. Goodall

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James V. Gainer Jr. and G. Robert Nugent

✓ Mongrel cats with experimental cryogenic brain lesions were treated with the carotenoid compound crocetin. It has been shown that crocetin increases the diffusion speed of oxygen through plasma, and should provide a net increase in available oxygen to the capillary endothelial cell. The treated group of animals showed a significant reduction in edema as compared to a comparable control group. It is suggested that oxygen availability is an important factor in vasogenic edema.