Rouzbeh Kordestani - Academia.edu (original) (raw)

Papers by Rouzbeh Kordestani

Journal of Pharmacy and Pharmacology, 1998

This study investigated the release of calcitonin-gene related peptide-like (CGRP) immunoreactivi... more This study investigated the release of calcitonin-gene related peptide-like (CGRP) immunoreactivity and bronchoconstriction induced by pH 6 buffer in guinea-pig isolated perfused lung. Both pH 6-induced CGRP-like immunoreactivity and bronchoconstriction were completely abolished after systemic pretreatment with capsaicin. Pretreatment with the NK2 receptor antagonist SR 48968 (5 times 10−7M) completely inhibited bronchoconstriction and significantly reduced the immunoreactivity induced by the pH 6 buffer. The NK1 antagonist SR 140333 (5 times 10−7M) and, to a lesser extent the NK1 antagonist CP 96345, morphine (5 times 10−6M), the α2-adrenoceptor agonist UK 14304 (10−7M) and betamethasone (10−6M) significantly reduced both pH 6-induced bronchial response and CGRP-like immunoreactivity overflow. The effects of morphine and UK14304 were partially reversed by naloxone (5 times 10−5M) and idazoxan (5 times 10−5M). Therefore, NK1, NK2, μ-opioid, α2-adrenoceptor and glucocorticoid recepto...

Neurosurgery Clinics of North America, 1995

Gunshot wounds constitute a devastating source of pathology in today's society. Approximately 16,... more Gunshot wounds constitute a devastating source of pathology in today's society. Approximately 16,500 people die of gunshot wounds to the brain each year, and this statistic is increasing at a staggering rate. 27 • 34 The majority of the patients who suffer from gunshot wounds to the head do not survive the initial insult. 4 • 12 • 19 • 20 • 25 • 45 Siccardi and coworkers, 61 in a prospective study of 314 patients, found that 73% died at the scene, another 12% died within 3 hours of injury, and an additional 7% died later, with a total mortality of 92%. Similarly, data from the Traumatic Coma Data Bank reveals a mortality of 88% in this population.12 More aggressive surgical treatment of these patients has been used in an effort to improve their outcome. 2 • 7 • 24 • 63 These series, however, have failed to show a significant increase in survival or a decrease in morbidity. These findings demonstrate the severe impact and the grave nature of this pathology. Gunshot wound to the head remains a complicated, poorly understood pathophysiology From the Neurovascular Surgery Section (NAM), Neurosurgical Intensive Care (NAM), the Cerebral Blood Flow Laboratory (RKK, NAM), and the Division of Neurosurgery (RKK, NAM, DQMcB),

Neurosurgery, 1997

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Ent... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining ...

Journal of Neurosurgery, 1997

✓ As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and s... more ✓ As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe—cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 ± 4, 36.5 ± 4.2, and 49.4 ± 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 ± 6, 32.7 ± 2.9, and 33.4 ± 4.7 mm Hg, respectivel...

Journal of Reconstructive Microsurgery, Jun 1, 2007

This study was initiated to establish a treatment algorithm for preoperative evaluation of donor ... more This study was initiated to establish a treatment algorithm for preoperative evaluation of donor sites prior to the harvest of free osteocutaneous flaps, in the setting of complex mandibulofacial reconstruction. A total of 29 consecutive patients were treated between 1999 and 2003 in a university-based setting. Reconstructions were completed using either a free fibula osteocutaneous flap or a radial forearm free flap. Functional and aesthetic results were determined by completing a thorough patient physical examination postoperatively. We hypothesized that a routine preoperative angiogram at the donor site was unnecessary. The Allen's test was the only preoperative evaluation completed in the 13 patients undergoing the free radial forearm reconstruction. In the remaining 16 patients undergoing free fibula reconstruction, a thorough physical examination was completed, along with noninvasive Doppler examinations. No angiograms were obtained. Using this systematic approach, no ischemic complications were observed at the donor site. Only two complete flap losses were seen, one in each group, due to microvascular thrombosis. We conclude that preoperative assessment of the donor site(s) with only an Allen's test in the free radial forearm group and a thorough pulse exam and a noninvasive Doppler in the free fibula group appear adequate. Routine preoperative angiogram of the donor extremity may be unnecessary and place the patient at additional risk for associated complications.

Infectious Diseases in Clinical Practice, 2008

Neurosurgery Clinics of North America

Available data on the subject of cerebrovascular dynamics after penetrating craniocerebral injury... more Available data on the subject of cerebrovascular dynamics after penetrating craniocerebral injury and their effect on outcome were reviewed. Following penetrating injury, CBF is depressed, as is cerebral metabolism. This decreased flow likely is associated with poor outcome as previously shown in closed head injuries. A phenomenon interrelated with a decreased blood flow is posttraumatic vasospasm. Vasospasm occurs in a significant percentage of patients as demonstrated both by TCD and angiography, and there is a strong relationship with SAH. Vasospasm following penetrating injury has an onset and time course similar to that seen in both closed head injury and aneurysmal SAH. Vasospasm following penetrating craniocerebral injury may be a cause of secondary ischemic injury, but further study is needed before the prognostic significance of this phenomenon is defined. For now, drawing a parallel with closed head injury and aneurysmal SAH, it can be inferred that vasospasm following cranial gunshot wound may be an important pathophysiologic factor. Because interventions are available to combat vasospasm, including medications (e.g., nimodipine), volume expansion, and elevation of blood pressure, the authors believe that identification and treatment of this potentially damaging condition are compelling, especially in patients whose CT scans demonstrate SAH.

Infectious Diseases in Clinical Practice, 2004

Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950,... more Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950, almost all caused by Actinomyces israelii. These patients often present with symptoms of heart failure, but myocardial involvement is unusual. We present a unique case of ...

Infectious Diseases in Clinical Practice, 2004

Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950,... more Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950, almost all caused by Actinomyces israelii. These patients often present with symptoms of heart failure, but myocardial involvement is unusual. We present a unique case of ...

Plastic and Reconstructive Surgery, 2006

116: 1796, 2005), that was categorized as an Editorial. I have since been told by Dr. Rohrich tha... more 116: 1796, 2005), that was categorized as an Editorial. I have since been told by Dr. Rohrich that this was an unfortunate error by the publisher. In any event, com-ments and observations made by the author, an ophthal-mologist, do warrant some comment. We all know the ...

Plastic and Reconstructive Surgery, 2006

The purpose of this study was to determine whether, in fact, infants with deformational plagiocep... more The purpose of this study was to determine whether, in fact, infants with deformational plagiocephaly, or plagiocephaly without synostosis, demonstrated cognitive and psychomotor developmental delays when compared with a standardized population. Through this study, we chose to expand upon our earlier findings from 2001 on patients with deformational plagiocephaly. The study population includes a total of 110 consecutive patients, prospectively followed then retrospectively reviewed. Each infant was assessed using the Bayley Scales of Infant Development-II scoring system. The developmental analysis was categorized as either mental or psychomotor using the mental developmental index or the psychomotor developmental index, respectively. These infants were subcategorized into four groups: accelerated, normal, mild, or severely delayed. The groups were then compared with a standardized Bayley's age-matched population, using chi-square test goodness-of-fit tests. Infants with deformational plagiocephaly were found to have significantly different psychomotor development indexes and mental developmental indexes when compared with the standardized population (p < 0.0001; p < 0.0001). With regards to the mental developmental index scores, none of the infants with deformational plagiocephaly were accelerated, 90 percent were normal, 7 percent were mildly delayed, and 3 percent were severely delayed. With regards to the psychomotor development index scores, none of infants were accelerated, 74 percent were normal, 19 percent were mildly delayed, and 7 percent were severely delayed. This study indicates that before any intervention, infants with deformational plagiocephaly show significant delays in both mental and psychomotor development. Also of particular note is that no child with deformational plagiocephaly showed accelerated development.

Neurosurgery, 1997

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Ent... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining ...

Neurosurgery, 2002

Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compressi... more Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compression of the median nerve anywhere along its course. We present the case of delayed median nerve neuropathy after the placement of a vascular graft in the arm. An arm shunt was placed in the nondominant upper extremity in a 60-year-old man with end-stage renal disease. Twelve hours postoperatively, the patient developed neurapraxia in the median nerve distribution in the hand. Exploration of the arm revealed a lipoma coursing along and deep to the median nerve. Resection of the lipoma decompressed the nerve. In this patient, median nerve neuropathy was caused by a lipoma and postoperative swelling from placement of the vascular graft. The swelling that occurred after the shunt placement unmasked subclinical compression of the nerve by a lipoma deep to the median nerve. To our knowledge, this report is unique in documenting damage to the median nerve after vascular graft placement as a result of an occult mass.

Journal of Reconstructive Microsurgery, 2007

This study was initiated to establish a treatment algorithm for preoperative evaluation of donor ... more This study was initiated to establish a treatment algorithm for preoperative evaluation of donor sites prior to the harvest of free osteocutaneous flaps, in the setting of complex mandibulofacial reconstruction. A total of 29 consecutive patients were treated between 1999 and 2003 in a university-based setting. Reconstructions were completed using either a free fibula osteocutaneous flap or a radial forearm free flap. Functional and aesthetic results were determined by completing a thorough patient physical examination postoperatively. We hypothesized that a routine preoperative angiogram at the donor site was unnecessary. The Allen's test was the only preoperative evaluation completed in the 13 patients undergoing the free radial forearm reconstruction. In the remaining 16 patients undergoing free fibula reconstruction, a thorough physical examination was completed, along with noninvasive Doppler examinations. No angiograms were obtained. Using this systematic approach, no ischemic complications were observed at the donor site. Only two complete flap losses were seen, one in each group, due to microvascular thrombosis. We conclude that preoperative assessment of the donor site(s) with only an Allen's test in the free radial forearm group and a thorough pulse exam and a noninvasive Doppler in the free fibula group appear adequate. Routine preoperative angiogram of the donor extremity may be unnecessary and place the patient at additional risk for associated complications.

Journal of Neurosurgery, 1997

As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and sev... more As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe-cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 +/- 4, 36.5 +/- 4.2, and 49.4 +/- 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 +/- 6, 32.7 +/- 2.9, and 33.4 +/- 4.7 mm Hg, respectively. There were significant differences across Groups 1, 2, and 3 regarding mean age, percentage of individuals younger than 35 years of age (42.9%, 23.1%, and 76.5%, respectively), incidence of patients requiring evacuation of intradural hematomas (57.1%, 38.5%, and 17.6%, respectively) and incidence of abnormal pupils (57.1%, 61.5%, and 32.4%, respectively). Favorable neurological outcome at 6 months postinjury in Groups 1, 2, and 3 was 0%, 46.2%, and 58.8%, respectively (p < 0.05). Further analysis of patients in Group 3 revealed that of 14 with poor outcomes, six had one or more episodes of hyperemia-associated intracranial hypertension (simultaneous CBF > 55 ml/100 g/minute and ICP > 20 mm Hg). These six patients were unique in having the highest CBFs for postinjury Days 1 to 5 (mean 59.8 ml/100 g/minute) and the most severe degree of intracranial hypertension and reduced cerebral perfusion pressure (p < 0.0001). These results indicate that a phasic elevation in CBF acutely after head injury is a necessary condition for achieving functional recovery. It is postulated that for the majority of patients, this rise in blood flow results from an increase in metabolic demands in the setting of intact vasoreactivity. In a minority of individuals, however, the constellation of supranormal CBF, severe intracranial hypertension, and poor outcome indicates a state of grossly impaired vasoreactivity with uncoupling between blood flow and metabolism.

Journal of Neurosurgery, 1996

✓ The role of posttraumatic hyperemia in the development of raised intracranial pressure (ICP) ha... more ✓ The role of posttraumatic hyperemia in the development of raised intracranial pressure (ICP) has important pathophysiological and therapeutic implications. To determine the relationship between hyperemia (cerebral blood flow (CBF)> 55 ml/100 g/minute), ...

Journal of Pharmacy and Pharmacology, 1998

This study investigated the release of calcitonin-gene related peptide-like (CGRP) immunoreactivi... more This study investigated the release of calcitonin-gene related peptide-like (CGRP) immunoreactivity and bronchoconstriction induced by pH 6 buffer in guinea-pig isolated perfused lung. Both pH 6-induced CGRP-like immunoreactivity and bronchoconstriction were completely abolished after systemic pretreatment with capsaicin. Pretreatment with the NK2 receptor antagonist SR 48968 (5 times 10−7M) completely inhibited bronchoconstriction and significantly reduced the immunoreactivity induced by the pH 6 buffer. The NK1 antagonist SR 140333 (5 times 10−7M) and, to a lesser extent the NK1 antagonist CP 96345, morphine (5 times 10−6M), the α2-adrenoceptor agonist UK 14304 (10−7M) and betamethasone (10−6M) significantly reduced both pH 6-induced bronchial response and CGRP-like immunoreactivity overflow. The effects of morphine and UK14304 were partially reversed by naloxone (5 times 10−5M) and idazoxan (5 times 10−5M). Therefore, NK1, NK2, μ-opioid, α2-adrenoceptor and glucocorticoid recepto...

Neurosurgery Clinics of North America, 1995

Gunshot wounds constitute a devastating source of pathology in today's society. Approximately 16,... more Gunshot wounds constitute a devastating source of pathology in today's society. Approximately 16,500 people die of gunshot wounds to the brain each year, and this statistic is increasing at a staggering rate. 27 • 34 The majority of the patients who suffer from gunshot wounds to the head do not survive the initial insult. 4 • 12 • 19 • 20 • 25 • 45 Siccardi and coworkers, 61 in a prospective study of 314 patients, found that 73% died at the scene, another 12% died within 3 hours of injury, and an additional 7% died later, with a total mortality of 92%. Similarly, data from the Traumatic Coma Data Bank reveals a mortality of 88% in this population.12 More aggressive surgical treatment of these patients has been used in an effort to improve their outcome. 2 • 7 • 24 • 63 These series, however, have failed to show a significant increase in survival or a decrease in morbidity. These findings demonstrate the severe impact and the grave nature of this pathology. Gunshot wound to the head remains a complicated, poorly understood pathophysiology From the Neurovascular Surgery Section (NAM), Neurosurgical Intensive Care (NAM), the Cerebral Blood Flow Laboratory (RKK, NAM), and the Division of Neurosurgery (RKK, NAM, DQMcB),

Neurosurgery, 1997

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Ent... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining ...

Journal of Neurosurgery, 1997

✓ As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and s... more ✓ As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe—cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 ± 4, 36.5 ± 4.2, and 49.4 ± 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 ± 6, 32.7 ± 2.9, and 33.4 ± 4.7 mm Hg, respectivel...

Journal of Reconstructive Microsurgery, Jun 1, 2007

This study was initiated to establish a treatment algorithm for preoperative evaluation of donor ... more This study was initiated to establish a treatment algorithm for preoperative evaluation of donor sites prior to the harvest of free osteocutaneous flaps, in the setting of complex mandibulofacial reconstruction. A total of 29 consecutive patients were treated between 1999 and 2003 in a university-based setting. Reconstructions were completed using either a free fibula osteocutaneous flap or a radial forearm free flap. Functional and aesthetic results were determined by completing a thorough patient physical examination postoperatively. We hypothesized that a routine preoperative angiogram at the donor site was unnecessary. The Allen's test was the only preoperative evaluation completed in the 13 patients undergoing the free radial forearm reconstruction. In the remaining 16 patients undergoing free fibula reconstruction, a thorough physical examination was completed, along with noninvasive Doppler examinations. No angiograms were obtained. Using this systematic approach, no ischemic complications were observed at the donor site. Only two complete flap losses were seen, one in each group, due to microvascular thrombosis. We conclude that preoperative assessment of the donor site(s) with only an Allen's test in the free radial forearm group and a thorough pulse exam and a noninvasive Doppler in the free fibula group appear adequate. Routine preoperative angiogram of the donor extremity may be unnecessary and place the patient at additional risk for associated complications.

Infectious Diseases in Clinical Practice, 2008

Neurosurgery Clinics of North America

Available data on the subject of cerebrovascular dynamics after penetrating craniocerebral injury... more Available data on the subject of cerebrovascular dynamics after penetrating craniocerebral injury and their effect on outcome were reviewed. Following penetrating injury, CBF is depressed, as is cerebral metabolism. This decreased flow likely is associated with poor outcome as previously shown in closed head injuries. A phenomenon interrelated with a decreased blood flow is posttraumatic vasospasm. Vasospasm occurs in a significant percentage of patients as demonstrated both by TCD and angiography, and there is a strong relationship with SAH. Vasospasm following penetrating injury has an onset and time course similar to that seen in both closed head injury and aneurysmal SAH. Vasospasm following penetrating craniocerebral injury may be a cause of secondary ischemic injury, but further study is needed before the prognostic significance of this phenomenon is defined. For now, drawing a parallel with closed head injury and aneurysmal SAH, it can be inferred that vasospasm following cranial gunshot wound may be an important pathophysiologic factor. Because interventions are available to combat vasospasm, including medications (e.g., nimodipine), volume expansion, and elevation of blood pressure, the authors believe that identification and treatment of this potentially damaging condition are compelling, especially in patients whose CT scans demonstrate SAH.

Infectious Diseases in Clinical Practice, 2004

Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950,... more Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950, almost all caused by Actinomyces israelii. These patients often present with symptoms of heart failure, but myocardial involvement is unusual. We present a unique case of ...

Infectious Diseases in Clinical Practice, 2004

Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950,... more Abstract: Actinomycosis pericarditis is a rare infection, with only 19 reported cases since 1950, almost all caused by Actinomyces israelii. These patients often present with symptoms of heart failure, but myocardial involvement is unusual. We present a unique case of ...

Plastic and Reconstructive Surgery, 2006

116: 1796, 2005), that was categorized as an Editorial. I have since been told by Dr. Rohrich tha... more 116: 1796, 2005), that was categorized as an Editorial. I have since been told by Dr. Rohrich that this was an unfortunate error by the publisher. In any event, com-ments and observations made by the author, an ophthal-mologist, do warrant some comment. We all know the ...

Plastic and Reconstructive Surgery, 2006

The purpose of this study was to determine whether, in fact, infants with deformational plagiocep... more The purpose of this study was to determine whether, in fact, infants with deformational plagiocephaly, or plagiocephaly without synostosis, demonstrated cognitive and psychomotor developmental delays when compared with a standardized population. Through this study, we chose to expand upon our earlier findings from 2001 on patients with deformational plagiocephaly. The study population includes a total of 110 consecutive patients, prospectively followed then retrospectively reviewed. Each infant was assessed using the Bayley Scales of Infant Development-II scoring system. The developmental analysis was categorized as either mental or psychomotor using the mental developmental index or the psychomotor developmental index, respectively. These infants were subcategorized into four groups: accelerated, normal, mild, or severely delayed. The groups were then compared with a standardized Bayley's age-matched population, using chi-square test goodness-of-fit tests. Infants with deformational plagiocephaly were found to have significantly different psychomotor development indexes and mental developmental indexes when compared with the standardized population (p < 0.0001; p < 0.0001). With regards to the mental developmental index scores, none of the infants with deformational plagiocephaly were accelerated, 90 percent were normal, 7 percent were mildly delayed, and 3 percent were severely delayed. With regards to the psychomotor development index scores, none of infants were accelerated, 74 percent were normal, 19 percent were mildly delayed, and 7 percent were severely delayed. This study indicates that before any intervention, infants with deformational plagiocephaly show significant delays in both mental and psychomotor development. Also of particular note is that no child with deformational plagiocephaly showed accelerated development.

Neurosurgery, 1997

Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Ent... more Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Neurosurgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining ...

Neurosurgery, 2002

Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compressi... more Median nerve neuropathy can be clinically devastating to a patient. It can be caused by compression of the median nerve anywhere along its course. We present the case of delayed median nerve neuropathy after the placement of a vascular graft in the arm. An arm shunt was placed in the nondominant upper extremity in a 60-year-old man with end-stage renal disease. Twelve hours postoperatively, the patient developed neurapraxia in the median nerve distribution in the hand. Exploration of the arm revealed a lipoma coursing along and deep to the median nerve. Resection of the lipoma decompressed the nerve. In this patient, median nerve neuropathy was caused by a lipoma and postoperative swelling from placement of the vascular graft. The swelling that occurred after the shunt placement unmasked subclinical compression of the nerve by a lipoma deep to the median nerve. To our knowledge, this report is unique in documenting damage to the median nerve after vascular graft placement as a result of an occult mass.

Journal of Reconstructive Microsurgery, 2007

This study was initiated to establish a treatment algorithm for preoperative evaluation of donor ... more This study was initiated to establish a treatment algorithm for preoperative evaluation of donor sites prior to the harvest of free osteocutaneous flaps, in the setting of complex mandibulofacial reconstruction. A total of 29 consecutive patients were treated between 1999 and 2003 in a university-based setting. Reconstructions were completed using either a free fibula osteocutaneous flap or a radial forearm free flap. Functional and aesthetic results were determined by completing a thorough patient physical examination postoperatively. We hypothesized that a routine preoperative angiogram at the donor site was unnecessary. The Allen's test was the only preoperative evaluation completed in the 13 patients undergoing the free radial forearm reconstruction. In the remaining 16 patients undergoing free fibula reconstruction, a thorough physical examination was completed, along with noninvasive Doppler examinations. No angiograms were obtained. Using this systematic approach, no ischemic complications were observed at the donor site. Only two complete flap losses were seen, one in each group, due to microvascular thrombosis. We conclude that preoperative assessment of the donor site(s) with only an Allen's test in the free radial forearm group and a thorough pulse exam and a noninvasive Doppler in the free fibula group appear adequate. Routine preoperative angiogram of the donor extremity may be unnecessary and place the patient at additional risk for associated complications.

Journal of Neurosurgery, 1997

As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and sev... more As part of a prospective study of the cerebrovascular effects of head injury, 54 moderate and severely injured patients underwent 184 133Xe-cerebral blood flow (CBF) studies to determine the relationship between the period of maximum blood flow and outcome. The lowest blood flows were observed on the day of injury (Day 0) and the highest CBFs were documented on postinjury Days 1 to 5. Patients were divided into three groups based on CBF values obtained during this period of maximum flow: Group 1 (seven patients), CBF less than 33 ml/100 g/minute on all determinations; Group 2 (13 patients), CBF both less than and greater than or equal to 33 ml/100 g/minute; and Group 3 (34 patients), CBF greater than or equal to 33 ml/100 g/minute on all measurements. For Groups 1, 2, and 3, mean CBF during Days 1 to 5 postinjury was 25.7 +/- 4, 36.5 +/- 4.2, and 49.4 +/- 9.3 ml/100 g/minute, respectively, and PaCO2 at the time of the CBF study was 31.4 +/- 6, 32.7 +/- 2.9, and 33.4 +/- 4.7 mm Hg, respectively. There were significant differences across Groups 1, 2, and 3 regarding mean age, percentage of individuals younger than 35 years of age (42.9%, 23.1%, and 76.5%, respectively), incidence of patients requiring evacuation of intradural hematomas (57.1%, 38.5%, and 17.6%, respectively) and incidence of abnormal pupils (57.1%, 61.5%, and 32.4%, respectively). Favorable neurological outcome at 6 months postinjury in Groups 1, 2, and 3 was 0%, 46.2%, and 58.8%, respectively (p < 0.05). Further analysis of patients in Group 3 revealed that of 14 with poor outcomes, six had one or more episodes of hyperemia-associated intracranial hypertension (simultaneous CBF > 55 ml/100 g/minute and ICP > 20 mm Hg). These six patients were unique in having the highest CBFs for postinjury Days 1 to 5 (mean 59.8 ml/100 g/minute) and the most severe degree of intracranial hypertension and reduced cerebral perfusion pressure (p < 0.0001). These results indicate that a phasic elevation in CBF acutely after head injury is a necessary condition for achieving functional recovery. It is postulated that for the majority of patients, this rise in blood flow results from an increase in metabolic demands in the setting of intact vasoreactivity. In a minority of individuals, however, the constellation of supranormal CBF, severe intracranial hypertension, and poor outcome indicates a state of grossly impaired vasoreactivity with uncoupling between blood flow and metabolism.

Journal of Neurosurgery, 1996

✓ The role of posttraumatic hyperemia in the development of raised intracranial pressure (ICP) ha... more ✓ The role of posttraumatic hyperemia in the development of raised intracranial pressure (ICP) has important pathophysiological and therapeutic implications. To determine the relationship between hyperemia (cerebral blood flow (CBF)> 55 ml/100 g/minute), ...