Identification of amiodarone in corneal deposits.
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Aged↗
Biomedical subjects
A H Friedman
Publications and source records attributed to A H Friedman.
Identification of early recurrence of primary central nervous system tumors by [18F]fluorodeoxyglucose positron emission tomography.
As aggressive neurosurgery and adjuvant therapy have become standard care for most patients with primary central nervous system (CNS) tumors, limitations of posttreatment neuroimaging techniques have become more apparent. Interpretation of computed cranial tomography (CT) and magnetic resonance imaging (MRI) in patients with brain tumors is complicated by changes related to surgery, corticosteroids, radiation, and chemotherapy. We investigated the role of 18F-2-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (FDG-PET) in these difficult diagnostic situations by obtaining FDG-PET scans in 5 patients following temporal lobectomy for epilepsy, in 5 patients with recurrent anaplastic gliomas before and after corticosteroid therapy, and in 5 patients after the development of histologically confirmed radionecrosis. We also obtained postoperative FDG-PET scans in 32 consecutive patients undergoing initial resection of a primary brain tumor. Our results indicate that glucose uptake as detected by FDG-PET scanning with [18F]fluorodeoxyglucose is not increased in the postoperative period; is not affected by steroid therapy; and accurately predicts early recurrence of tumor, supplementing other predictors of tumor behavior, including extent of resection, histological diagnosis, and postoperative CT. Thus PET using [18F]fluorodeoxyglucose can contribute to the optimum management of patients with primary brain tumors.
Adult↗
Loss of hippocampal acetylcholinesterase staining after fornix lesion in the monkey.
Cholinergic denervation of the hippocampal formation has been extensively studied in rodents but not in primates. Therefore we studied the changes in acetylcholinesterase histochemical staining of the hippocampus occurring after bilateral transection of the fornices in the cynomolgus monkey. Animals were sacrificed 1.5, 6, 13, and 23 weeks after surgery. We found a 40-50% reduction in the density of acetylcholinesterase-positive fibers in the four analyzed regions (dentate gyrus, CA3, CA1, and subiculum) 1.5 week after surgery and a 60-80% reduction at longer time intervals. The characteristic diffuse AChE staining found in hippocampi from control animals disappeared after fornix lesion, except in the inner third of the molecular layer of the dentate gyrus. We did not find any evidence of spontaneous cholinergic reinnervation over the 6-month period. Thus, as in rats, fornix lesion produces dramatic changes in hippocampal AChE staining, presumably caused by a massive cholinergic denervation. However, in contrast to rodents, spontaneous reinnervation does not seem to occur in the months following the lesion in primates.
Acetylcholinesterase↗
Ganglioglioma: a clinical study with long-term follow-up.
Gangliogliomas are uncommon tumors of mixed neoplastic glial and neuronal elements. Because of their low incidence, few large series exist that fully describe the clinical characteristics of patients afflicted with this tumor. We have reviewed the medical records of 20 patients at Duke University Medical Center with histologically proven gangliogliomas. These patients typically presented within the first three decades of life and their most common presenting symptom was seizures. Therapies included surgical resection, either partial or total, radiation therapy, and/or chemotherapy. Long-term follow-up was achieved by chart review and by telephone interview. Patients who underwent gross total resection alone seemed to fare the best when comparing all treatment groups, and we therefore recommend this as the main form of treatment.
Adolescent↗
Influence of the type of surgery on the histologic diagnosis in patients with anaplastic gliomas.
Stereotactic biopsy of CNS tumors provides a small amount of tissue for pathologic diagnosis. This potentially leads to inaccurate grading of gliomas because of their histologic heterogeneity. We compared histologic diagnoses in a consecutive series of 329 patients with newly diagnosed anaplastic gliomas whose diagnoses were established by either stereotactic biopsy or open resection. Of 262 patients undergoing resection, 214 (82%) had glioblastomas and 48 (18%) had anaplastic astrocytomas (AAs). Of 67 patients undergoing stereotactic biopsy, 33 (49%) had glioblastomas and 34 (51%) had AAs. This difference suggests that some AAs diagnosed by stereotactic biopsy are actually glioblastomas and has important implications for the design and interpretation of clinical trials.
Adult↗
Interstitial chemotherapy with drug polymer implants for the treatment of recurrent gliomas.
Malignant gliomas have been difficult to treat with chemotherapy. The most effective agent, BCNU (carmustine), has considerable systemic toxicity and a short half-life in serum. To obviate these problems, a method has been developed for the local sustained release of chemotherapeutic agents by their incorporation into biodegradable polymers. Implantation of the drug-impregnated polymer at the tumor site allows prolonged local exposure with minimal systemic exposure. In this Phase I-II study, 21 patients with recurrent malignant glioma were treated with BCNU released interstitially by means of a polyanhydride biodegradable polymer implant. Up to eight polymer wafers were placed in the resection cavity intraoperatively, upon completion of tumor debulking. The polymer releases the therapeutic drug for approximately 3 weeks. Three increasing concentrations of BCNU were studied; the treatment was well tolerated at all three levels. There were no adverse reactions to the BCNU wafer treatment itself. The average survival period after reoperation was 65 weeks for the first dose group, 64 weeks for the second dose group, and 32 weeks for the highest dose group. The overall mean survival time was 48 weeks from reoperation and 94 weeks from the original operation. The overall median survival times were 46 weeks postimplant and 87 weeks from initial surgery. Eighteen (86%) of 21 patients lived more than 1 year from the time of their initial diagnosis and eight (38%) of 21 patients lived more than 1 year after intracranial implantation of the polymer. Frequent hematology, blood chemistry, and urinalysis tests did not reveal any systemic effect from this interstitial chemotherapy. Since the therapy is well tolerated and safe, a placebo-controlled clinical trial has been started. The trial will measure the effect of the second treatment dose on survival of patients with recurrent malignant glioma.
Brain Neoplasms↗
Hemangiopericytoma of the sciatic nerve. Case report.
The authors report the case of a hemangiopericytoma arising in a sciatic nerve. It was found to be invasive within the epineurium but sparing surrounding tissues. Adequate resection required sacrifice of the nerve. Hemangiopericytomas can be added to the short list of mesodermal peripheral-nerve tumors.
Adult↗
Neurotization of elements of the brachial plexus.
Satisfactory therapy for an avulsion injury of the brachial plexus has yet to be described. Dorsal root entry zone lesions will usually mitigate the searing pain which is so disabling in some of these patients. Neurotization procedures are effective in restoring limited function to these patients. The most useful isolated movement of the upper extremity is elbow flexion, which is thus the primary target of neurotization procedures. Intercostal nerves and elements of the cervical plexus are the most commonly used donor nerves for neurotization procedures. From our experience and from a review of the literature, it appears that these procedures will be successful in approximately 50% of cases. It must be stressed that before performing a nerve transfer, the surgeon must be certain that the patient is not a candidate for a simple nerve graft.
Adolescent↗
Increased AMPA-sensitive quisqualate receptor binding and reduced NMDA receptor binding in epileptic human hippocampus.
Based on results from the kindling model of epilepsy, we hypothesized that enhanced binding of radioligands to the NMDA receptor and decreased binding to the alpha-amino-3-hydroxy-5-methyl-4- isoxazolepropionate (AMPA)-sensitive quisqualate (ASQ) receptor would be found within epileptic hippocampi of humans with complex partial epilepsy (CPE). To test these hypotheses, we used tissue that was surgically removed from patients with intractable CPE, and control tissue that was obtained at autopsy. We used autoradiographic techniques to measure ASQ receptor binding (with 3H-AMPA as the radioligand) and binding to 2 sites on the NMDA receptor/channel complex: the agonist recognition site (with 3H-glutamate) and the phencyclidine (PCP) binding site that resides within the NMDA channel [with 3H-N-(1-[thienyl]cyclohexyl) piperidine (TCP) in the presence of saturating concentrations of NMDA and glycine]. Measurements of receptor binding were corrected for pathologic alterations in neuronal density. Contrary to our expectations, ASQ receptor binding was significantly increased (100%; p less than 0.02) in the dentate gyrus stratum moleculare in patients with CPE (n = 8), and it was unchanged in other hippocampal regions. In nearby sections from the same specimens, binding was significantly decreased to the agonist recognition site of the NMDA receptor in the stratum oriens of area CA3 (46%; p less than 0.05) and was also decreased to the PCP site in the stratum radiatum and stratum oriens of CA3 (44% and 74%, respectively; p less than 0.05). The increase in ASQ receptor binding may contribute to hyperexcitability in these epileptic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Catecholaminergic innervation of the hippocampus in the cynomolgus monkey.
We studied the immunocytochemical distribution of catecholaminergic fibers in the hippocampal formation from two cynomolgus monkeys by using phenylethanolamine-N-methyltransferase, dopamine-beta-hydroxylase, and tyrosine-hydroxylase antibodies. There were no phenylethanolamine-N-methyltransferase immunoreactive fibers suggesting the lack of epinephrine containing fibers. In order to compare the distributions of tyrosine-hydroxylase and dopamine-beta-hydroxylase immunoreactive fibers, we counted fibers in four hippocampal regions, the dentate gyrus, CA3, CA1, and the subiculum at three different rostrocaudal levels. The distributions of dopamine-beta-hydroxylase and tyrosine-hydroxylase immunoreactive fibers were overlapping but clearly different, suggesting that the hippocampus receives both noradrenergic and dopaminergic inputs in primates. Dopamine-beta-hydroxylase-immunoreactive fibers were present in moderate density and roughly evenly distributed throughout the hippocampus. Tyrosine-hydroxylase immunoreactive fibers were found in high density in the dentate gyrus, in the stratum lacunosum-moleculare, and in the molecular layer of the subiculum. There were only minor side-side and rostrocaudal differences in the distribution of tyrosine-hydroxylase and dopamine-beta-hydroxylase immunoreactive fibers. The identification of a putative dopaminergic projection to primate hippocampus, which is more dense and widely distributed than in the rodent, parallels similar increases in dopaminergic projections reported for primate cerebral neocortex.
Animals↗
The identification of adrenergic receptors in human pial membranes.
Recent experimental work has suggested that the adrenergic nervous system is important in regulating cerebral blood flow under conditions of hypoxia and systemic arterial hypertension. Although previous investigations have demonstrated the presence of adrenergic neurons adjacent to human cerebral vessels, the nature of adrenergic receptors on human cerebral blood vessels remains poorly defined. The present study was performed to characterize adrenergic reception on membranes prepared from human pia, a rich source of small blood vessels, using radioligand binding techniques. Adrenergic membrane receptors were characterized using the binding of [3H]dihydroalprenolol for the beta subtypes and [3H]prazosin and [3H]yohimbine for the alpha subtypes. Displaceable binding was demonstrated with each agent. A small series of adrenergic agents competed for the [3H]dihydroalprenolol, [3H]yohimbine, and [3H]praz binding sites in a fashion suggesting the presence of alpha 1-, alpha 2-, beta 1-, and beta 2-receptors on the vessels within human pia.
Alprenolol↗
Repair of isolated axillary nerve lesions after infraclavicular brachial plexus injuries: case reports.
Stretch injuries of the infraclavicular brachial plexus have a much better prognosis for spontaneous recovery than do their supraclavicular counterparts. We present three patients with stretch injuries of the infraclavicular brachial plexus who had spontaneous restoration of function in all muscles except the deltoid. Decreased shoulder abduction was a serious handicap to these individuals. At surgical exploration, each patient had an isolated, complete axillary nerve disruption at the quadrilateral space. Deltoid muscle function was restored in all three patients by repair of the axillary nerve with sural nerve grafts across the quadrilateral space.
Accidents↗
Retinal dysfunction as an initial ophthalmic sign in AIDS.
Three cases of patients with AIDS in whom severe retinal dysfunction preceded the development of widespread funduscopic abnormalities are presented. The disparity between the minimal extent of visible retinal lesions and the severe loss of retinal function was confirmed by visual field and electroretinographic studies. This pattern of early visual loss in AIDS patients may represent infection of the retina by the HIV virus.
Acquired Immunodeficiency Syndrome↗
Choroidal lesions in patients with AIDS.
Seven cases of bilateral, scattered, yellow-white choroidal lesions have been seen in AIDS patients since January 1988. One resulted from presumed extension of cryptococcal meningitis into the optic nerve and choroid. All the remaining six patients had pneumocystis pneumonia at some time during the course of the disease and were receiving aerosolised pentamidine therapy. None died quickly of disseminated Pneumocystis carinii infection, unlike previously reported patients. Mycobacterial infection was also present in five of these six patients. The differential diagnosis of this entity in AIDS patients is discussed.
Acquired Immunodeficiency Syndrome↗
Anterior temporal lobectomy for complex partial seizures: evaluation, results, and long-term follow-up in 100 cases.
We report evaluation and results in 100 patients who had undergone anterior temporal lobectomy for intractable complex partial seizures. Average follow-up was 9.0 years (range, 2 to 21 years). In the 2nd postoperative year, 63% were seizure free, 16% were significantly improved, and 21% were considered not significantly improved. Mean number of seizures in the last group was 27% of preoperative levels. Surgical results did not change significantly in subsequent postoperative years; good outcomes tended to persist over the longer term. We also examined the utility of continuous depth electrode monitoring in the evaluation of patients with independent bitemporal interictal epileptiform activity. Despite limited numbers of subjects in this category, there was a trend toward improved surgical outcome when such subjects were evaluated with depth electrodes.
Adolescent↗
MR imaging in patients with temporal lobe seizures: correlation of results with pathologic findings.
Thirty-nine consecutive patients with medically intractable complex partial seizures were studied with electroencephalography and MR imaging to localize an epileptogenic focus for temporal lobectomy. The patients were divided into three groups on the basis of pathologic findings after lobectomy: Group 1 comprised 13 patients with neoplasms, hamartomas, or cysts; group 2 comprised 13 patients with moderate and severe mesial temporal sclerosis (one patient was included in both groups 1 and 2); and group 3 comprised 14 patients who underwent aspiration lobectomy, which yielded limited tissue for pathologic study so no pathologic diagnosis was made. The majority of the patients in group 3 were assumed to have mesial temporal sclerosis. Abnormal MR signal in the temporal lobe on T2-weighted images was graded as minimal increase (1+), intermediate or moderate increase (2+), and very significant increase (3+). An abnormal signal was demonstrated in 26 (67%) of the 39 patients. In group 1, the tumor/cyst subgroup, an abnormal signal was seen in all 13 patients. Most had 3+ signal. There was increased signal in eight (62%) of 13 patients in group 2 and in six (43%) of 14 patients in group 3. This study suggests that MR can detect almost all tumors and a significant number of mesial temporal sclerosis lesions in individuals with complex partial seizures. On the basis of this small series, individuals who exhibit significant signal (3+) can be expected to have neoplasms, hamartomas, or cysts, and patients who exhibit minimal signal (1+) will usually have mesial temporal sclerosis.
Adult↗
Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries.
Despite technical advances, the ability to restore motor function following a brachial plexus avulsion is limited. Twenty patients who suffered the loss of elbow flexion following a brachial plexus avulsion injury underwent a neurotization procedure in an attempt to restore that lost function. Of 16 patients who underwent intercostal to musculocutaneous nerve anastomosis, seven obtained good elbow flexion. Four patients who no longer had a viable biceps brachialis muscle underwent an anastomosis between transposed intercostal nerves and a free vascularized gracilis muscle grafted to the position of the biceps. Two of these patients obtained good elbow flexion. Although synkinesis between the biceps brachialis and the inspiratory muscles can be demonstrated during coughing and deep inspiration, the patients learn to flex their reinnervated biceps brachialis muscle and maintain flexion independent of respiration.
Adolescent↗
Ocular toxoplasmosis in AIDS patients.
We describe 16 cases of ocular and, in some patients, associated CNS toxoplasmosis in AIDS patients. T gondii is commonly associated with infection in the immunocompromised host. The lesions are most often seen in the CNS and eyes; involvement in the brain, heart, lung, liver, spleen, and lymph nodes may be observed. CNS involvement by toxoplasmosis may be an initial manifestation of AIDS and may be associated with discrete or diffuse lesions. CT scan and MR imaging may demonstrate a multitude of lesions often displaying the characteristic ring-shaped enhancement after contrast injection. Ocular involvement by toxoplasmosis, though less common than CNS involvement, is characterized by several features. These may be manifested as single or multifocal retinal lesions in one or both eyes or massive areas of retinal necrosis. Invariably these lesions are unassociated with a pre-existing retinochoroidal scar suggesting that the lesions are a manifestation of acquired rather than congenital disease. Presence of IgM antibodies may support this observation although antibody levels in AIDS patients may not reflect the magnitude of disease. Vitreous reaction is often minimal. Anterior uveitis has been reported in one case. Treatment of the ocular infection with pyrimethamine, clindamycin and sulfadiazine is effective in over 75% of patients. Once resolution of the ocular infection is observed, maintenance therapy is continued as relapses occur in the absence of treatment. Corticosteroid treatment is unnecessary and its use has been associated with the development of CMV retinitis. Other retinal infections in AIDS patients which should be considered in the differential diagnosis include CMV, herpetic-associated ARN and syphilis. Concomitant CMV and toxoplasmosis in the same eye have been seen.
Acquired Immunodeficiency Syndrome↗