Riassunto
A workshop on Dynamic Aspects of Cerebral Edema was organized to pro vide an opport~nitY,for interdisciplinary and detailed consideration of this subject, so crucial in neurology and neurosurgery. The previ ous workshops were held in Vienna in 1965 and in Mainz in 1972. In the meantime, our ideas on mechanisms of resolution of cerebral edema had been changing drastically. Controversy had arisen regarding the role of biogenic amines in the development of edema. Active work in several centers had indicated the possibility of a reversible compo nent in edematous changes associated with ischemia, the control of which could be of therapeutic significance in the problem of stroke. It was felt that a thorough discussion, at this time, by those involv ed in these various studies should help to resolve the controversies, to crystallize the implications of the new findings, and to evaluate their application for patient care. In preparing the proceedings for publication we have edited the manu scripts and selected the discussions with an aim to highlight new find ings, to make this volume readable, and to eliminate duplication. We gratefully acknowledge financial support from the institutions and organizations previously listed. Many individuals contributed to the success of the workshop and the preparation of the proceedings for publication. Doctors J.B. Brierley, I. Klatzo, H.J. Reulen, and A.G.
Contenuti
Section I Blood-Brain Barrier and Its Disturbances Chairmen: R.A. Fishman and I. Klatzo.- 1. Transport Properties of Capillaries Isolated From the Brain.- 2. Central Noradrenergic Regulation of Brain Microcirculation.- 3. Absence of Brain Edema After Reversible Osmotic Opening of the Blood-Brain Barrier.- 4. Bypass of the Blood-Brain Barrier to Proteins Without Brain Tissue Damage.- 5. Water Content of Rat Brain in Acute Arterial Hypertension.- 6. Determination of Cerebral Edema by Quantitative Morphometry.- 7. The Blood-Brain Barrier in Experimental Seizures.- 8. An Ultrastructural Substrate for the Resolution of Post-Irradiation Brain Edema.- 9. Delayed Vasogenic Edema Following Irradiation of the Monkey Brain.- Section II Vasogenic Edema Chairmen: J.B. Brierley, K.A.C. Elliott, D.M. Long, and F. Plum.- 1. Early Hemodynamic Changes at the Microcirculatory Level Following Focal Cryogenic Injury Over the Cortex.- 2. The Starling Hypothesis of Capillary Fluid Exchange in Relation to Brain Edema.- 3. Cerebrovascular Reactivity Related to Focal Brain Edema in the Primate.- 4. Brain Edema and Blood Pressure Measurements in Unanesthetized Hypertensive Rats with Cortical Lesions.- 5. Triethyl Tin-Induced Cerebral Edema: Implications for Determination of Cerebral Blood Flow in Edematous Tissue.- 6. The Movements of Water and Solutes in the Brains of Mammals.- 7. Production, Circulation and Absorption of Brain Interstitial Fluid.- 8. Clearance of Serum Albumin From Brain Extracellular Fluid: A Possible Role in Cerebral Edema.- 9. The Role of Tissue Pressure and Bulk Flow in the Formation and Resolution of Cold-Induced Edema.- 10. The Time Course of Brain Tissue Pressure and Local CBF in Vasogenic Edema.- 11. The Dynamics of Small and Large Molecules in the Extracellular Space and Cerebrospinal Fluid Following Local Cold Injury of the Cortex.- 12. Movement of Water Between Blood, Brain and CSF in Cerebral Edema.- 13. Some Further Studies on Vasogenic Edema.- 14. The EEG in Cerebral Edema.- 15. The Role of Monoamines in the Development of Cold-Induced Edema.- 16. Dependence of Traumatic Brain Edema on Immunologic Reactivity Against Tissue Antigens.- 17. Tissue and Plasma Factors in Cerebral Edema.- 18. Changes in the Sulfhydryl Group Level and Influence of Exogenous Glutathione on Dynamics of Vasogenic Brain Edema.- Section III Edema Associated with Ischemia Chairmen: W.F. Caveness and T.W. Langfitt.- 1. Pathophysiologic Aspects of Ischemic Edema.- 2. Transport Studies in Ischemic Cerebral Edema.- 3. Monoamines in Cerebral Ischemia in Relation to Brain Edema.- 4. The Role of Biogenic Amines in the Progression of Cerebral Ischemia and Edema: Modification by p-Chlorophenylalanine, Methysergide, and Pentoxyfilline.- 5. The Role of Monoamines and Cyclic AMP in Ischemic Brain Edema.- 6. The “Low-Flow” State Following Total Cerebral Ischemia.- 7. Development and Resolution of Ischemic Brain Swelling.- 8. Edema Formation in the Isolated Canine Brain: Anoxia vs. Ischemia.- 9. Microvascular Alterations and Edema in Focal Cerebral Ischemia.- 10. Hemispheral Ischemic Cerebral Cortical Edema in a Primate (M. Mulatta).- 11. Relationship Between Ischemic Neuronal Damage and Edema in Primate and Rodent Brain.- 12. Ischemic Cerebral Edema and Hyperemia in the Process of Cerebral Infarction.- Section IV Clinical and Therapeutic Considerations Chairmen: R. Ethier, W. Feindel, and H.J. Reulen.- 1. Water, Specific Gravity and Histology as Determinants of Diagnostic Computerized Cranial Tomography (CCT).- 2. Computed Tomography of Vasogenic Cerebral Edema.- 3. CT Findings in Brain Edema Compared with Direct Chemical Analysis of Tissue Samples.- 4. Cerebral Edema and Blood Volume in Man Measured by CT Scan.- 5. A New Therapy Regimen for Brain Edema.- 6. The Effect of Dexamethasone and Diuretics on Peritumor Brain Edema: Comparative Study of Tissue Water Content and CT.- 7. Ultrastructural Studies on Formation of Edema and Its Treatment Following Experimental Brain Infarction in Monkeys.- 8. Experimental Spinal Cord Injury: Effects of Steroids and/or Cooling on Edema, Electrolytes, and Motor Recovery.- 9. Brain Edema After Head Injury.- 10. Effects of Glycerol Treatment on CSF Pressure and rCBF in Patients With Cerebral Infarction.- 11. The Effect of Dexamethasone on Intracranial Pressure in Patients with Supratentorial Tumors.- 12. Double-Blind Study on the Effects of Steroids on Severe Closed Head Injury.- 13. Re-evaluation of Short-Term Steroid Therapy for Perifocal Brain Edema.- 14. The Influence of Various Doses of Dexamethasone on Intracranial Pressure in Patients with Severe Head Injury.- Clinical Panel Discussion: Current Modes of Therapy.- Workshop Summary.- Selected Discussions. Sections I–IV.
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