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Biomedical subjects

D H Reigel

Publications and source records attributed to D H Reigel.

At least 37 records · Page 2Linked to original sources
PubMed1979

Biopsy of pediatric brain stem tumors.

26 patients, average age of 7.3 years, has biopsies of a brain stem tumor. 62% of the patients presented with hydrocephalus, and ventriculoperitoneal shunts were placed 7-10 days prior to biopsy. The midbrain was biopsied 13 times, the pons 3 and the medulla 12 times. Tissue for histopathologic examination was obtained at each operation and demonstrated astrocytoma in 13 patients, glioblastoma in 6, 'no tumor seen' in 5 and ependymoma in 2. Astrocytomas were usually located in the upper brain stem, and all of the glioblastomas were located in the medulla. The operative mortality was zero, and the morbidity was largely related to increased cranial nerve deficit. All the astrocytoma patients were treated with radiation only; whereas, 4 patients with glioblastoma were treated with vincristine, CCNU and methylprednisone in addition to radiation as described by the Children's Cancer Study Group (CCG-944). 3 patients with 'no tumor' were not treated and are alive and well 15-41 months following operation. 2 patients with no tumor were treated, one as a glioblastoma multiforme, subsequently verified at postmortem examination, and one as a midbrain astrocytoma. 1 patient with astrocytoma died 3 months following operation, all the remainder are living and well 4-51 months following operation. Irrespective of the treatment, all 7 patients with glioblastoma expired within 9 months of diagnosis. The prognosis for survival for patients with brain stem astrocytoma is superior to those with glioblastoma multiforme. Specific histopathologic correlation with clinical management may lead to improved and prolonged survival for patients with brain stem glioma.

Astrocytoma↗
PubMed1979

Arteriovenous malformations of the spinal cord in children.

Spinal arterivenous malformations occur in the pediatric age range more commonly than previously acknowledged. An analysis of 64 cases with onset under 18 years of age demonstrates pain to be the most common first symptom. A long delay to diagnosis permits development of significant paresis or plegia in the majority. Correctly performed myelography (with supine views) provided the diagnosis in 60%. A radical microsurgical excision appears to offer the best long-term results.

Adolescent↗
PubMed1978

Cricopharyngeal achalasia associated with Arnold-Chiari malformation in childhood.

Six patients with myelomeningocele and the Arnold-Chiari malformation developed cricopharyngeal achalasia and lower cranial nerve deficits. Diagnosis is established by cine-esophagram. Distortion of the brain stem or cranial nerves secondary to the Arnold-Chiari malformation may produce the autonomic imbalance necessary for cricopharyngeal achalasia. Treatment is supportive and includes verification of cerebral spinal fluid shunt function. Suboccipital craniectomy may reverse progressive lower cranial nerve deficits and reduce cricopharyngeus spasm. Cricopharyngeal myotomy may be considered when the cranial nerve deficits and cricopharyngeal achalasia are fixed, irreversible, and continue to cause disability.

Arnold-Chiari Malformation↗
PubMed1978

External drainage for ventricular infection following cerebrospinal fluid shunts.

57 children with shunt-related ventricular infection were treated with external ventricular drainage and a combination of systemic and intraventricular antibiotics. For persistent infection or inadequate drainage volume the external ventricular drain was promptly changed. Cerebrospinal fluid cultures of 54 (95%) of the children became sterile within an average of 5.1 days. As soon as three consecutive 48-hour cultures of the cerebrospinal fluid were negative, the external ventricular drainage was removed and a new ventriculoperitoneal shunt was inserted. Provided that three consecutive 48-hour cultures of the cerebrospinal fluid were negative at the time of reinstitution of ventriculoperitoneal shunting, low cerebrospinal fluid glucose readings were not associated with any greater risk of recurrent infection than following primary ventriculoperitoneal shunting.

Anti-Bacterial Agents↗
PubMed1977

Management of hydrocephalus secondary to posterior fossa tumors.

The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal., 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p less than 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal

Brain Neoplasms↗
PubMed1977

Intracranial pressure: monitoring and normalization therapy in children.

The clinical course of 42 children with intracranial pressure monitoring was reviewed. Intracranial hypertension was documented in a variety of diagnostic categories. Therapy was titrated to maintain a baseline intracranial pressure of less than 15 torr (mm Hg), and to decrease the frequency of spontaneous and reactive pressure waves. Ventricular drainage, controlled hyperventilation, intravenous glycerol osmotherapy, therapeutic hypothermia, and barbiturate loading were employed as needed to achieve those goals. Survival was significantly related to average and peak intracranial pressure levels and to the degree of serum hyperosmolality that developed during therapy.

Adolescent↗
PubMed1976

Intra-operative evoked potential studies of newborn infants with myelomeningocele.

Somatosensory evoked potentials were studied in seven infants during surgery for repair of thoraco-lumbar myelomeningocele. All were operated on during the first 24 hours of life. Because anaesthetics were known to suppress somatosensory evoked potentials, narcotics and muscle relaxants were used for anesthesia. Before surgical dissection, stimulation of median nerves evoked cortical responses in five of the seven patients. After dissection, evoked potentials could be retrieved from the neural plaque with peroneal nerve stimulation in five of the seven infants. Stimulation of the neural plaque produced cortical responses in five of the seven but cortical responses with long latencies could be obtained from peroneal nerve stimulation in only two of the seven patients. In two patients lumbar-root stimulation distal to the plaque produced low-amplitude and delayed-latency cortical responses. These findings indicate that the distal nerves and neural plaque may have intact afferent connections with the cortex: therefore at surgical repair the neural plaque has been meticulously preserved.

Afferent Pathways↗
PubMed1975

Myelography in patients with medulloblastoma.

Unsuspected metastatic medulloblastoma involving the spinal cord was detected by myelography in 2 of 3 patients with newly diagnosed medulloblastoma. Myelography revealed unsuspected spinal cord metastases in an additional patient with recurrent medulloblastoma in the posterior fossa. The authors suggest that myelography be performed prior to radiotherapy in all patients with either primary medulloblastoma or recurrence in the posterior fossa.

Adolescent↗
PubMed1970

Cerebral release of gastric acid inhibitor.

1. Gastric juice collected during electro-anesthesia and limbic system stimulation in monkeys contains a substance which, when injected into other monkeys, produces reduction in basal gastric acid secretion. 2. Cross-circulation experiments indicate that a factor producing reduction in acid secretion is also present in blood during electroanesthesia.

Animals↗