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Carotid ligation and cerebral ischaemia
Başlık:
Carotid ligation and cerebral ischaemia
Yazar:
Jawad, Khalil, author.
ISBN:
9780438060098
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (231 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 76-08C.
Advisors: Bryan Jennett.
Özet:
CHAPTER I The history of carotid ligation is outlined, followed by a review of the various methods for predicting its tolerance. Reported series on ligation and their results are summarized. CHAPTER II The patients studied are classified according to the site and clinical presentation of their aneurysms, age, neurological status at time of surgery, time from last subarachnoid haemorrhage, and the presence or absence of hypertension. CHAPTER III The methods used in this study and the criteria for patient selection for carotid ligation are described. The effects on CBF of various anaesthetic agents used during surgery are discussed. CHAPTER IV The use of CBF and IGAP measurements in predicting tolerance of carotid ligation is compared in 108 patients with clinical predictions of the type used in aneurysm surgery based on age of the patient, arterial hypertension, subarachnoid haemorrhage, time from last haemorrhage, and neurological status on a modified Botterell scale. These clinical factors have been found to be of little value in predicting which patient will and will not develop cerebral ischaemia following carotid occlusion. CHAPTER V Angiographic assessment of collateral circulation to the brain at the circle of Willis is compared with measurements of CBF and ICAP in the prediction of tolerance of carotid ligation in 101 patients. No single angiographic feature can provide the predictive information on which to base patient selection for ligation which CBF and ICAP measurements provide. None of these features has shown a significant influence on the incidence of postoperative ischaemia. Bilateral foetal type of PCAs are associated with significantly lower carotid artery back pressure on temporary carotid occlusion, but this angiographic feature is not associated with a significant reduction in the rate of successful carotid ligation. It is concluded that accurate forecast as to tolerance or otherwise of carotid ligation cannot be made using standard angiography. CHAPTER VI Measurements of various indices derived from arterial and jugular venous blood gas and pH values during temporary carotid clamping are compared with measurements of CBF and ICAP in 15 patients referred for carotid ligation. Cerebral venous blood gas measurements do not provide a reliable index of cerebral ischaemia. CHAPTER VII Digital compression of the carotid artery with clinical testing, EEG monitoring and CBF measurements using the inhalation method are compared with measurements of CBF and ICAP during temporary carotid clamping in the prediction of tolerance of carotid ligation. This refined Matas test has been found to be of limited value. CHAPTER VIII The pre- and postligation inhalation and the operative injection CBF measurements are compared in 17 patients. The possible mechanisms explaining the observed changes are discussed. CHAPTER IX In this chapter the results are presented. Examination of the variations in Paco2 during CBF measurements in the 3 series and its control under local and general ajiaesthesia shows that it has been best controlled in series III and under general anaesthesia. Common carotid clamping results in a significsuit elevation of SAP presumably through the carotid sinus reflex, whereas IC clamping produces no significant changes in SAP. Patients with postligation ischaemia show significantly lower CBF values and significaint reductions in CBF during clamping which are not observed in patients without ischaemia. The significantly lower CBF values and significant reductions in flow during clamping observed in the rejected but not in the ligated patients result from patient selection based on CBF criteria. The ICAP is significantly reduced during clamping in all groups, but, most markedly in the rejected patients. No correlation is found between clamped ICAP values and the incidence of ischaemia. The EEG can reliably detect disastrous ischaemia, but may miss lesser degrees. It also gives false predictions sometimes. Finally, the effects of the evolving CBF criteria on patient selection for ligation and the incidence of postoperative ischaemia are studied. The use of the current CBF and ICAP criteria has resulted in a significant reduction in the rejection rate and in no patient developing permanent or delayed neurological deficits after ligation. CHAPTER X This deals with the question of predicting cerebral ischaemia in carotid ligation using CBF and ICAP criteria.
Notlar:
School code: 0547
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
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XX(684786.1) | 684786-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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