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D P Becker

Publications and source records attributed to D P Becker.

At least 163 records · Page 9Linked to original sources
PubMed1981

Midbrain lesions: frequent and significant prognostic feature in closed head injury.

Midbrain lesions were found in 23 of 35 autopsied, head-injured people. These lesions were interpreted as "primary"--that is, occurring at the time of impact. This interpretation was concordant with the clinical data, although the difficulty in establishing the precise moment at which the lesions were initiated in any individual case was recognized. Correlative clinicopathological data in head-injured people showed that midbrain damage could be determined by evoked potentials (EPs). In a total of 165 head-injured patients, the early presence or absence of evidence for midbrain lesions on EP examination was a powerful prognostic indicator of death or recovery, respectively. Autopsy and EP data showed that midbrain damage almost always occurred in the presence of hemispheric injury, but this fact should not obscure either the high frequency of midbrain lesions in those dying of head injury or the great prognostic value of their presence or absence.

Brain Stem↗
PubMed1981

Primary dural melanoma: a clinical and morphological study.

This study reviews the literature pertaining to primary meningeal melanoma and reports the clinical and ultrastructural findings in a case where the tumor appeared to be of pachymeningeal (dural) origin. This is clearly a departure from all previously described cases, in which a leptomeningeal (pial-arachnoidal) origin was either defined or assumed. Clinically, this case was remarkable in its rarity, its presentation as a cerebellopontine angle syndrome, and its occurrence in a Negro, a race in which melanomas are uncommon. Ultrastructurally, the tumor did demonstrate the presence of basement membrane abnormalities and numerous endothelial fenestrations. However, it was found to be made up of a homogenous cell population, consisting only of electron-lucent, melanin-laden cells. The mixed cell population noted previously in a primary leptomeningeal melanoma was not found in this tumor. In view of the fact that this patient continues to do well 1 1/2 years after operation, with no evidence of tumor recurrence, it is suggested that a homogenous cell population noted on electron microscopy could indicate a better prognosis. In addition, it may also indicate a pachymeningeal rather than a leptomeningeal origin for the tumor. A plea is made for greater specificity in terminology when describing primary meningeal melanomas and for a concerted effort to distinguish between those of dural and those of leptomeningeal origin.

Adult↗
PubMed1981

Significance of CT in head injury: correlation with intracranial pressure.

The authors correlated the computed tomographic (CT) findings and intracranial pressure (ICP) in 150 consecutive comatose head injury patients to determine if noninvasive CT can help identify the patients not requiring ICP monitoring. The study reveals that a majority of patients (55%) with hemorrhagic lesions shown by CT suffer from intracranial hypertension and require ICP monitoring for proper management. Of the patients with normal initial CT, 98% had normal ICP during the first 24 hr. Of the patients with normal CT, 15% developed intracranial hypertension later, irrespective of the initial Glasgow coma scale score or age. More than half of the patients who developed intracranial hypertension subsequently had normal ICP through the first 48 hr. The study indicates that ICP monitoring need not routinely be performed on admission on severe head injury patients with a normal CT. However, repeat CT at 24--48 hr before ICP monitoring in patients with initially normal CT may be valuable, particularly if their clinical status deteriorates.

Adolescent↗
PubMed1981

Further experience in the management of severe head injury.

A prospective and consecutive series of 225 patients with severe head injuries who were managed in a uniform way was analyzed to relate outcome to several clinical variables. Good recovery or moderate disability were achieved by 56% of the patients, 10% remained severely disabled or vegetative, and 34% died. Factors important in predicting a poor outcome included the presence of intracranial hematoma, increasing age, abnormal motor responses, impaired or absent eye movements or pupil light reflexes, early hypotension, hypoxemia or hypercarbia, and elevation of intracranial pressure over 20 mm Hg despite artificial ventilation. Most of these predictive factors were assessed on admission, but a subset of 158 patients was identified in whom coma was present on admission and was known to have persisted at least until the following day. Although the mortality in this subset (40%) was higher than in the total series, it was lower than in several comparable reported series of patients with severe head injury. Predictive correlations were equally strong in the entire series and in the subset of 158 patients with coma. A plea is made for inclusion in the definition of "severe head injury" of all patients who do not obey commands or utter recognizable words on admission to the hospital after early resuscitation.

Adolescent↗
PubMed1981

Noninvasive localization of brain-stem lesions in the cat with multimodality evoked potentials: correlation with human head-injury data.

Multimodality evoked potential (MEP) data from over 300 comatose head-injured patients suggest that central nervous system dysfunction of the brain stem and/or hemispheres can be localized with this noninvasive neuroelectric technique. Based on this work, decerebrate motor posturing and prolonged coma are not associated with brain-stem dysfunction but rather with dysfunction of the hemispheres, while absent pupillary and oculocephalic responses are correlated with brain-stem dysfunction alone. However, the accuracy with which MEP data localized human brain-stem or hemispheric dysfunction could not be confirmed by pathological correlation because of low mortality and the small number of autopsies obtained in the patients who died. Therefore, this study was undertaken in an animal model of brain-stem lesion. Complete brain-stem transections were made at the cervicomedullary junction, the medulla just caudal to the eighth nerve, and at the intercollicular region. All cortical visual evoked potential (VEP) peaks were reduced in amplitude and delayed by each of the brain stem transections, but none of the peaks was abolished. In spite of brain-stem transection, VEP's can be used to gain information about hemispheric function. Somatosensory (SEP) and auditory cortically generated evoked potentials (AEP) were abolished by these brain-stem transections, but early-latency brain-stem SEP and AEP data could accurately localize specific areas of brain-stem dysfunction caused by the lesions. Observations made on human MEP data seen to be confirmed by these animal experiments. Correlations between human and cat MEP data are discussed.

Animals↗
PubMed1981

Improved confidence of outcome prediction in severe head injury. A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning, and intracranial pressure.

An analysis of clinical signs, singly or in combination, multimodality evoked potentials (MEP's), computerized tomography scans, and intracranial pressure (ICP) data was undertaken prospectively in 133 severely head-injured patients to ascertain the accuracy, reliability, and relative value of these indicants individually, or in various combinations, in predicting one of two categories of outcome. Erroneous predictions, either falsely optimistic (FO) or falsely pessimistic (FP), were analyzed to gain pathophysiological insights into the disease process. Falsely optimistic predictions occurred because of unpredictable complications, whereas FP predictions were due to intrinsic weakness of the indicants as prognosticators. A combination of clinical data, including age, Glasgow Coma Scale (GCS) score, pupillary response, presence of surgical mass lesions, extraocular motility, and motor posturing predicted outcome with 82% accuracy, 43% with over 90% confidence. Nine percent of predictions were FO and 9% FP. The GCS score alone was accurate in 80% of predictions, but at a lower level of confidence (25% at the over-90% level), with 7% FO and 13% FP. Computerized tomography and ICP data in isolation proved to be poor prognostic indicants. When combined individually with clinical data, however, they increased the number of predictions made with over 90% confidence to 52% and 55%, respectively. Data from MEP's represented the most accurate single prognostic indicant, with 91% correct predictions, 25% at the over-90% confidence level. There were no FP errors associated with this indicant. Supplementation of the clinical examination with MEP data yielded optimal prognostic power, an 89% accuracy rate, with 64% over the 90% confidence level and only 4% FP errors. The clinical examination remains the strongest basis for prognosticating outcome in severe head injury, but additional studies enhance the reliability of such predictions.

Adult↗
PubMed1981

Prognostic implications of early multimodality evoked potentials in severely head-injured patients. A prospective study.

Results of multimodality evoked potential (MEP) studies recorded from 100 comatose patients soon after severe head injury were analyzed prospectively, using a previously established grading system, to assess the prognostic value of MEP's with respect to patient outcome, to evaluate the effect of clinically relevant sequelae of head injury on the prediction of outcome by MEP's and to describe time to clinical recovery as a function of initial MEP grade. Graded MEP's when recorded in the first few days after head injury, could predict patient outcome at 1 year with approximately 80% accuracy. Exclusion from the analysis of patients who died from causes unrelated to the brain and those with severe systemic complications that occurred after the evoked potentials were recorded improved the accuracy of outcome prediction to nearly 100%. The presence of a mass lesion requiring surgery reduces the probability if good to moderate outcome for a given MEP grade by approximately 25% to 40% from the seen in patients without mass lesions. The clinical outcome predicted shortly after head injury by MEP grades may not be realized for many months. Patients with mild MEP abnormality (Grade I or II) generally reach their outcome by 3 to 6 months, whereas those with more severe deficits (Grade III) may not show improvement for at least 1 year.

Adolescent↗
PubMed1981

Reversible brain-stem dysfunction following acute traumatic subdural hematoma: a clinical and electrophysiological study.

Of 366 consecutive patients with severe head injury, treated and managed by a uniform protocol, 61 (17%) were admitted with signs of severe brain-stem dysfunction. Forty-three of the 61 patients (70%) had surgical mass lesions and 30% had diffuse brain damage. Twelve of the 61 patients (20%) survived, but only six patients made a good to moderately disabled recovery. All six of these patients had a traumatic acute subdural hematoma (SDH). The records of the 20 comatose patients with an acute SDH and severe brain-stem dysfunction were reviewed to discover which factors contributed to functional recovery. The average survivor was operated on within 2 1/2 hours after injury and the nonsurvivors within 4 1/2 hours. Prompt surgical intervention and prudent control of postoperative intracranial pressure were major factors in preventing permanent brain-stem damage, with a significance of p less than 0.05 and p less than 0.02, respectively. Measurement of multimodality evoked potentials in the early postoperative period correctly distinguished between reversible and irreversible brain-stem dysfunction in six of the seven patients.

Adult↗
PubMed1981

Galactorrhea-amenorrhea syndrome: follow-up of forty-five patients after pituitary tumor removal.

Forty-five patients with galactorrhea-amenorrhea were followed during a period of 1 to 8 years (mean 3.1) after transsphenoidal prolactinoma removal. The ratios of patients who appear to be cured to the total numbers treated were 20 patients of 27 with grade I tumors; six of 10 with grade II; two of five with grade III; and none with grade IV tumors. Six patients with normal prolactin levels one week postoperatively had relapse later, as did three with normal prolactin levels 2 months postoperatively. A normal prolactin level 6 months postoperatively predicted ultimate cure. The 19 pregnancies that occurred in 15 patients, four with high prolactin levels, were uneventful. Prolactin rose normally with pregnancy and returned to prepregnancy level in all but one patient. Prolactin responses to stimulation tests were blunted for 6 months after successful tumor removal. By 1 year, responses to thyrotropin releasing hormone and metoclopramide tests were returning to normal, although responses to chlorpromazine and hypoglycemia remained blunted. The postoperative inhibition of normal lactotropes for 6 months is suggested. Ultimate cure cannot be determined before 6 months and conception should be deferred until then.

Adenoma↗
PubMed1980

Detection of occult abdominal trauma in patients with severe head injuries.

Among 109 consecutive victims of severe head injury, intra-abdominal injury could not be excluded in 87. These patients were considered to be at risk from occult intra-abdominal haemorrhage. 60 patients underwent diagnostic peritoneal lavage. 10 of these had a positive lavage, correctly indicating intra-abdominal haemorrhage. In each case a lesion requiring surgical repair was identified. 49 patients had a negative lavage, and only 1 of these patients subsequently showed signs of a missed intra-abdominal lesion. 13 patients had low systolic blood-pressure (< 90 mm Hg) on admission, and 4 of these had positive lavage. Of 47 patients with systolic blood-pressure of 90 mm Hg or greater on admission, 6 had positive lavage. 15 patients were deeply comatose with no eye-opening or verbal response and an extensor or no motor response to painful stimuli. 6 of these had positive peritoneal lavage. We conclude that diagnostic peritoneal lavage should form an integral part of the evaluation of comatose patients with head injury, particularly those whose level of consciousness is most depressed, whether or not clinical signs of shock, abdominal injury, or occult haemorrhage are present.

Abdominal Injuries↗
PubMed1980

Phencyclidine abuse mimicking head injury.

Phencyclidine hydrochloride (PCP) is a psychoactive drug that in small doses produces agitation, excitement, and disorientation, but in larger doses results in stupor, convulsions, coma, and death. Two accident victims under the effects of phencyclidine were in coma. A history of phencyclidine abuse was not initially available in either instance. Head injury was suspected in both patients, although their neurological symptoms suggested a state of sensory blockade. Phencyclidine abuse should be considered in all patients with atypical coma despite a clear history of trauma.

Adult↗
PubMed1980

Chronic neck and back pain: a reassessment of usual surgical treatment.

One hundred seventeen patients with chronic (noncancerous) back or neck pain had multidisciplinary evaluation in the Medical College of Virginia Pain Center and were followed up for one year. They ranged in age from 26 to 57 years. The 57 patients who had surgery had an average of 2.5 procedures (either laminectomies or back fusion) and only five of them returned to work. By contrast, 16 of 60 patients who had not had operation were able to secure employment after evaluation and treatment in the Pain Center.

Back Pain↗
PubMed1980

Statistical methods for determining prognosis in severe head injury.

Determining the prognostic significance of clinical factors for patients with severe head injury can lead to an improved understanding of the pathophysiology of head injury and to improvement in therapy. A technique known as the sequential Bayes method has been used previously for the purpose of prognosis. The application of this method assumes that prognostic factors are statistically independent. It is now known that they are not. Violation of the assumption of independence may produce errors in determining prognosis. As an alternative technique for predicting the outcome of patients with severe head injury, a logistic regression model is proposed. A preliminary evaluation of the method using data from 115 patients with head injury shows the feasibility of using early data to predict outcome accurately and of being able to rank input variables in order of their prognostc significance.

Blood Pressure↗
PubMed1980

The use of the laser in neurological surgery.

Lasers generate unidirectional beams of monochromatic, and temporally and spatially coherent electromagnetic radiation that are capable of vaporizing and coagulating biological tissue. Specific physical characteristics of laser energies of different wavelengths impart to each form of surgical laser specific potentials for clinical use in neurological surgery. The major advantages of surgical lasers appear to be improved precision, reduction of surgically related mechanical trauma, reduction of blood loss, and decreased operative time. Improvement of operative mortality and morbidity and increased longevity that might result from its use would make the laser cost effective.

Argon↗
PubMed1980

The treatment of acromegaly by transsphenoidal surgery.

Pituitary tumors were removed transsphenoidally in 32 patients with acromegaly. Ten patients had high prolactin (PL) levels as well as elevated growth hormone (GH) levels. In 24 patients, GH levels were lowered to 5 ng/mL or less and remained low. The PL level was reduced to normal in eight patients. Of three patients with postoperative GH levels of 6 to 10 ng/mL, one patient remains in this range but two have relapsed. Five patients showed only a partial lowering in GH level. Pituitary irradiation lowered the level further. Hypopituitarism developed in four patients. Permanent diabetes insipidus occurred in one patient and meningitis developed in another. They subsequently recovered. There were no deaths. Abnormal GH responses to hyperglycemia, hypoglycemia, and levodopa returned to normal following surgery. Transsphenoidal tumor removal appears to be an effective treatment for acromegaly.

Acromegaly↗