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Biomedical subjects

D M Kaufman

Publications and source records attributed to D M Kaufman.

At least 73 records · Page 4Linked to original sources
PubMed1980

Infectious agents in spinal epidural abscesses.

Of 27 cases of spinal epidural abscess, 19 were caused by bacteria, 7 by Mycobacterium tuberculosis, and 1 by Echinococcus granulosus. Blunt trauma and cutaneous infections were the most frequent preceding events in bacterial cases. Tuberculous abscess was usually the sole manifestation of reactivation of dormant tuberculosis. Drug addiction, the most common cause in young adults, was associated with gram-negative infections. Whatever the infectious agent, paraparesis for longer than 4 days led to a poor outcome. Myelography was the best diagnostic test, whereas lumbar puncture and percutaneous bone biopsy offered little specific information.

Abscess↗
PubMed1979

Detection of cognitive deficits by a brief mental status examination: the Cognitive Capacity Screening Examination, a reappraisal and a review.

Results of a brief mental status questionnaire, the Cognitive Capacity Screening Examination (CCSE), were compared with the clinical evaluations of 59 patients on a neurology service. In 71% of the cases, the CCSE scores correctly indicated a cognitive deficit (true-positive) or the absence of one (true-negative); false-negative results were observed in 15% and questionable negative results were found in 10%. Abnormal neurologic physical signs were present in 90% of all patients with cognitive deficits. In this population, although positive CCSE scores were reliable, negative scores were often misleading. Mild diffuse intellectual dysfunction (dementia) and some discrete intellectual deficits (aphasia and anosognosia) went undetected. Cognitive deficits associated with major cerebral disease were unappreciated in nine patients. Caution is recommended in interpreting negative CCSE scores. Abbreviated screening devices are only a preliminary approach to mental status evaluation; this test requires further refinement.

Aged↗
PubMed1979

Computed tomography in Herpes simplex encephalitis.

Eight patients with Herpes simplex encephalitis had computed cranial tomography (CT). In every case, areas of decreased attenuation were found in the temporal lobe(s); these areas extended to the insular cortex and often to the frontal or parietal lobes. This change developed between the third and the eleventh day of illness. It was present, sometimes only in retrospect, in patients who were alert as well as patients who were comatose. Compared to the isotopic brain scan, electroencephalogram, and cerebral angiogram, CT demonstrates changes that are indicative of H simplex early enough in the course of the illness to be therapeutically useful.

Adult↗
PubMed1978

Recent cases of intracranial tuberculomas.

While intracranial tuberculomas have become uncommon in industrial nations, 12 patients with signs and symptoms of an intracranial mass lesion were recently found to have tuberculomas. Clinical findings suggestive of tuberculosis were frequently subtle or absent. Five patients did not have extracranial tuberculosis. Two patients had intracranial tuberculomas that became superinfected with bacteria and appeared initially as pyogenic brain abscesses. Intracranial tuberculomas in this country almost always occur in adults and represent reactivation of dormant infection. Medical therapy alone is indicated as the initial therapy except in the presence of intolerably increased intracranial pressure. A chemotherapeutic regimen is suggested.

Adult↗
PubMed1977

Computed tomography (CT) in the diagnosis of intracranial abscesses. Brain abscess, subdural empyema, and epidural empyema.

Nine cases of brain abscess, five of subdural empyema, and one of epidural empyema with associated subdural empyema were identified using computed tomography (CT). Smal and multiple abscesses as well as unilateral, bilateral, and parafalcine empyemas were detected. These lesions were demonstrated rapidly and accurately, even in areas that are demonstrated poorly by other diagnostic techniques. No false-negative studies were found in cases of brain abscess or subdural empyema. However, since the appearance of brain abscesses of CT scans is similar to that of neoplastic and vascular lesions, false-positive reports of brain abscess were encountered.

Brain Abscess↗
PubMed1976

Intracranial surgery for cerebral artery aneurysms. Five years' experience.

During the previous five years, there were 133 cases of intracranial surgery for cerebral artery aneurysms. For patients with aneurysms in the anterior circulation and in good preoperative condition, the surgical morbidity was 28% and the mortality was 19%. A depressed sensorium preoperatively, an age of 50 years or above, and an interval of less than 15 days from rupture to surgery were associated with markedly increased mortality. The results of this series, which do not compare favorably with those from foreign referral centers, are partially the result of disproportionate numbers of patients in those poor-risk groups. The possible advantages of regionalization are, nevertheless, apparent. Further comparative studies should be conducted on an interinstitutional basis.

Age Factors↗
PubMed1976

Focal angiographic abnormalities with subdural empyema.

Thirteen patients with subdural empyema underwent arteriography preoperatively and three were restudied postoperatively. Arterial vascular changes were found in nine cases and consisted of localized or diffuse arterial irregularities. In two cases the arterial changes resolved with effective therapy. These arterial changes are similar in appearance and response to therapy to those noted with meningitis; however, in this series they were shown to have occured in seven cases with subdural empyema but without associated meningitis. Therefore, empyema alone may cause localized or diffuse arterial irregularities.

Adolescent↗
PubMed1976

Central nervous system aspergillosis in two young adults.

Unusual and unique features were present in the cases of two patients with central nervous system aspergillosis: One had a previously unreported complication of aspergillosis, extracranial internal carotid artery thrombosis documented by angiography, and in the other patient, cerebral granulomas developed from Aspergillus fumigatus in association with intravenous narcotic abuse. The latter etiologic mechanism was suggested once before. Neither of these patients showed other underlying disease. A detailed neuropathologic examination correlated the salient clinical findings with formation of aspergillosis cerebral granulomata, basilar meningitis, and arterial occlusion. Diagnostic and therapeutic methods in this disease are limited.

Adult↗
PubMed1975

Subdural empyema: analysis of 17 recent cases and review of the literature.

Subdural empyema is an intracranial infection that has remained difficult to diagnose and to treat. Seventeen patients with this infection, treated between 1967 and 1974, are analyzed and compared to published series with particular regard to diagnosis using newer procedures and treatment, considering the primary focus of infection. The infection is usually located in the supratentorial spaces, is often bilateral, and results most often from para-nasal sinusitis (single most common cause), otitis, neurosurgical operative infections, and meningitis in infants. Patients suffering from subdural empyema generally present with rapid onset of depressed sensorium, seizures, focal neurological deficits, and signs of increased intracranial pressure, following a period of days to weeks characterized by headache and fever. All 17 of our patients demonstrated localizing neurological signs and 16 manifested either fever or leukocytosis. Diagnostic studies, except for cerebral arteriography, do not reliably corroborate or exclude the diagnosis. Cerebral arteriography established the diagnosis and defined the location and extent of the empyema in all of our cases. The EEG and brain scan produced frequent false-negative and/or non-localizing results in 10 and 8 patients, respectively. The cerebrospinal fluid was abnormal from all 15 patients examined by lumbar puncture, but the findings were similar to those in other infectious and non-infectious central nervous system diseases. Signs of transtentorial herniation developed within eight hours following lumbar puncture in three of seven patients who had exhibited signs of increased intracranial pressure before the procedure was performed. Bacterial cultures were positive in 13 of our cases. A review of our data and that of other studies indicates that the organisms associated with subdural empyema are consistent with those expected from infections of the primary site; e.g. sinusitis, otitis, meningitis, site of prior neurosurgery. A therapeutic approach is suggested which emphasizes specific antibiotic regimens appropriate to the primary site of infection and prompt neurosurgical intervention with evacuation of the subdural spaces bilaterally. In general, combination antimicrobial therapy employing high parenteral doses of penicillin G, a semi-synthetic penicillinase-resistant penicillin and chloramphenicol is recommended.

Adolescent↗
PubMedDate not supplied

A quantifiable, Brief Mental Status Examination for emergency patients.

Although paramedics and emergency department (ED) personnel are routinely required to assess the mental states of patients they are attempting to treat, no structured and easily administered tool has been validated for their use. The objective of this study was to determine whether a quantitative Brief Mental Status Examination (BMSE) can serve as such a tool. The six-item BMSE was administered to 100 ED patients for whom an assessment of mental status was warranted. The standard assessment of mental status (normal, mildly impaired, or severely impaired) and competence to refuse emergency care were provided by the attending physician. The usefulness and ease of administration of the BMSE were rated by the physicians and nurses administering it. We found that BMSE scores correlated significantly with physicians' assessments of patients' mental status and competence to refuse care. Using physician assessment as a standard, the BMSE had a sensitivity of 72% and a specificity of 95% in identifying severely impaired individuals. Examiners' ratings of ease of administration were closely related to the degree of impairment found. Finally, examiners rated the BMSE as useful in 98% of cases. We conclude from these preliminary results that the BMSE, upon further testing, may prove to be a valid and useful tool for assessing the mental states of emergency patients in both prehospital and ED settings.

Attitude of Health Personnel↗
PubMedDate not supplied

Cranial nerve palsies in Streptococcus pneumoniae meningitis.

Cranial nerve palsies are uncommon in nontuberculous bacterial meningitis. We report a patient with Streptococcus pneumoniae meningitis, multiple cranial nerve involvement, and cerebellar signs suggestive of basilar meningitis. Nontuberculous bacterial meningitis should be considered in the differential diagnosis of basilar meningitis.

Adolescent↗
PubMedDate not supplied

Cerebellar hemorrhage: reliability of clinical evaluation.

Surgery without confirmatory radiological contrast studies has been advocated in patients suspected of having a cerebellar hemorrhage. To determine the reliabiligy of the clinical evaluation, records were reviewed of 33 patients in whom the diagnosis of cerebellar hemorrhage was initially suspected or subsequently confirmed. In 13 patients the correct diagnosis had been made initially by clinical evaluation, but in ten patients the correct diagnosis was not suspected at the initial evaluation. The remaining ten patients had typical backgrounds, symptoms, and signs of a spontaneous cerebellar hemorrhage, but radiological contrast studies and clinical observation indicated that other neurological lesions were responsible. Thus, utilizing solely the clinical evaluation, the diagnosis of cerebellar hemorrhage may be made only with difficulty and not with the certainty required for emergency surgery.

Adult↗
PubMedDate not supplied

Achieving cardiovascular health through continuing interprofessional development.

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.

Behavior Therapy↗