Ralph W. Alman

Cerebral metabolism in hepatic insufficiency

S TUDIES dealing with neurologic disturbances associated with hepatic insufficiency have been confined chiefly to attempts at identifying the neurotoxic substance or substances responsible for the condition. For the most part, attention has been directed to the concentration of ammonia and other nitrogenous or sulfur-containing compounds in the arteriallP3 and cerebral venous blood.4 It is believed that these substances may alter the activity of certain enzyme complexes concerned with intermediate cerebral metabolism.4 In the present study, cerebral hemodynamics and oxygen utilization of patients with varying degrees of neurologic dysfunction associated with hepatic insufficiency were investigated to determine whether or not changes in the functions mentioned could be correlated with alterations in blood ammonia and pyruvate levels or with electroencephalographic activity.

Apparatus for continuous blood-pressure observation.

IN the course of a series of investigations concerning human cerebral hemodynamics a relatively inexpensive, compact apparatus was improvised for continuous observation of the mean arterial blood p...

Prognostic Uncertainties in Cerebral Vascular Disease

Excerpt A previous communication reported the results of a correlative study undertaken to compare aortocranial and intracerebral angiographic findings with clinical impressions derived from neurol...

Cerebral Vascular Disease Current Problems of Etiology, Diagnosis, and Treatment

IN CEREBRAL vascular disease, difficulties in pathogenesis, diagnosis, and treatment are at present the rule rather than the exception. This discomforting situation is due to our rather limited knowledge concerning the etiology and pathogenesis of vascular disease in general, to the relative inaccessibility of the human brain, and to the resultant paucity of rational therapeutic modalities. It is the purpose of this discussion to review some of the more pressing problems related to cerebral vascular disease.

CURRENT THERAPEUTIC CONCEPTS OF CEREBRAL AND MYOCARDIAL VASCULAR DISEASE.

The intuitive belief that what is good for one organ should be good for the other, can, to a considerable extent, be supported by various physiologic analogies between the two, bearing in mind that the product of myocardial activity is mechanical energy while that of the brain is neuronal energy, and that oxygen needs of the heart vary with changes in workload while those of the brain remain relatively constant. Physiologically, both heart and brain are characterized