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Biomedical subjects

E Rossitch

Publications and source records attributed to E Rossitch.

At least 37 records · Page 2Linked to original sources

Isolated central nervous system aspergillosis in the acquired immunodeficiency syndrome.

Aspergillus infection involving the central nervous system are unusual, but should be included in the differential diagnosis in patients with the acquired immunodeficiency syndrome and neurologic signs and symptoms. Of the few reported AIDS cases with central nervous system aspergillosis, the majority have had focal brain abscesses. We report an atypical case that presented as a basal meningitis with pontine infarction secondary to invasive Aspergillus sinusitis.

Acquired Immunodeficiency Syndrome↗

Kenneth McKenzie, Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis.

In 1923, Dr. Kenneth McKenzie trained at the Peter Bent Brigham Hospital under Dr. Harvey Cushing. At that time, a patient with spasmodic torticollis came to Cushing and was treated with an innovative operation for this disorder with good results. This case sparked an interest in Dr. McKenzie, who published the case 1 year later. In reviewing the surgical histories from the Peter Bent Brigham Hospital, we have found the original records of this well-documented case. The record includes postoperative drawings of the intraoperative field by Dr. Cushing, a sketch by Dr. McKenzie illustrating the postoperative sensory examination, and pre- and postoperative photographs of the patient.

History, 20th Century↗

L-arginine normalizes endothelial function in cerebral vessels from hypercholesterolemic rabbits.

We hypothesized that normal vascular reactivity could be restored in vessels from hypercholesterolemic animals by exposing them to L-arginine, the precursor of endothelium-derived relaxing factor (EDRF). Basilar arteries were harvested from New Zealand white rabbits fed normal chow or that supplemented with 2% cholesterol for 10 wk. Vessels were cannulated for perfusion at physiologic pressure. Changes in vessel diameter were monitored by videomicroscopy. In comparison to normal vessels, those from hypercholesterolemic animals vasoconstricted more to KCl, endothelin (E), and 5-hydroxytryptamine (5-HT). Conversely, vasodilation to acetylcholine (ACh) (but not that to verapamil) was significantly impaired in the hypercholesterolemic animals. In vitro administration of L-arginine (3 mM) for 45 min normalized vasodilation to ACh and vasoconstriction to E, 5-HT, and KCl in the isolated vessels from hypercholesterolemic animals. This effect was stereospecific, since D-arginine had no effect. To conclude, these data confirm that hypercholesterolemia attenuates endothelium-derived relaxation, and enhances the sensitivity of these vessels to vasoconstrictors. In vitro administration of L-arginine normalized vascular reactivity of isolated vessels from hypercholesterolemic animals. Thus, hypercholesterolemia induces a reversible endothelial dysfunction that may be corrected by supplying the precursor of EDRF, L-arginine.

Acetylcholine↗

Flow activates an endothelial potassium channel to release an endogenous nitrovasodilator.

Flow-mediated vasodilation is endothelium dependent. We hypothesized that flow activates a potassium channel on the endothelium, and that activation of this channel leads to the release of the endogenous nitrovasodilator, nitric oxide. To test this hypothesis, rabbit iliac arteries were perfused at varying flow rates, at a constant pressure of 60 mm Hg. Increments in flow induced proportional increases in vessel diameter, which were abolished by L,N-mono-methylarginine (the antagonist of nitric-oxide synthesis). Barium chloride, depolarizing solutions of potassium, verapamil, calcium-free medium, and antagonists of the KCa channel (charybdotoxin, iberiotoxin) also blocked flow-mediated vasodilation. Conversely, responses to other agonists of endothelium-dependent and independent vasodilation were unaffected by charybdotoxin or iberiotoxin. To confirm that flow activated a specific potassium channel to induce the release of nitric oxide, endothelial cells cultured on micro-carrier beads were added to a flow chamber containing a vascular ring without endothelium. Flow-stimulated endothelial cells released a diffusible vasodilator; the degree of vasorelaxation was dependent upon the flow rate. Relaxation was abrogated by barium, tetraethylammonium ion, or charybdotoxin, but was not affected by apamin, glybenclamide, tetrodotoxin, or ouabain. The data suggest that transmission of a hyperpolarizing current from endothelium to the vascular smooth muscle is not necessary for flow-mediated vasodilation. Flow activates a potassium channel (possibly the KCa channel) on the endothelial cell membrane that leads to the release of nitric oxide.

Animals↗

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↗

Arteriovenous malformation of the great vein of Galen associated with patent ductus arteriosus. Report of three cases and review of the literature.

The arteriovenous malformation of the vein of Galen (AVG), composed of a fistula between medium to large arteries and the vein of Galen, is frequently fatal in the neonatal period. We now report three cases of infants with AVG and associated patent ductus arteriosus (PDA), and review the literature for these associated findings. The presence of a PDA can result in severe vascular derangement in the postoperative period, and further complicate management of these infants. Analysis of this abnormal central circulation may contribute to a better understanding and therefore outcome for this unfortunate group of patients.

Cerebral Veins↗

Historical vignette. The neurosurgeon's neurosurgeon: cushing operates on a Penfield.

In his autobiography, Dr. Wilder Penfield relates the medical history of his sister, Mrs. Ruth Inglis, who developed a right frontal oligodendroglioma. Penfield performed the initial craniotomy on her, and after her death, reported the case in a paper on frontal lobe function in humans. Although Penfield has provided more than adequate information on certain aspects of his sister's illness, little has been published concerning her subsequent operation performed by Dr. Harvey Cushing at the Peter Bent Brigham Hospital. We feel this case is significant for several reasons. First, it sheds some light on Penfield's personal relationship with Cushing and his sister; it also shows the deep interest that Dr. Cushing took in his patients. Second, this case nicely illustrates how Cushing used his postoperative drawings to make his operative notes more precise. Finally, we see a sample of the work done by Dr. Louise Eisenhardt as pathologist at the Peter Bent Brigham Hospital.

Boston↗

Clinical and pathological analysis of spinal cord astrocytomas in children.

Twelve children with pathologically confirmed, well-differentiated spinal cord astrocytomas were studied, and correlations among the degree of resection, pathological characteristics, and time of recurrence were examined. Eight tumors were sampled for biopsy or subtotally resected, and 4 were thought to have been totally removed. Clinical recurrence was seen in 4 of 12 patients, 2 of whom died of their disease. The time to recurrence was 1, 2, 2, and 35 years, respectively. The other 8 children remain free of symptoms, with follow-up ranging from 6 months to 35 years (mean, 8.8 years). In 3 of 8 patients who underwent biopsy or subtotal resection, the tumor recurred, and 2 patients died, whereas there was one recurrence in the patients in whom a "total" resection had been obtained. The histologically well-differentiated nature of the lesions correlated well with the relatively prolonged clinical course seen in this series during the period of observation. The relatively long clinical courses seen in our limited series should be considered before high-risk therapy for spinal cord astrocytomas in children is implemented. The presence of four pilocytic astrocytomas in this group was of special interest, and it seems likely that these discrete neoplasms can be distinguished from the more infiltrating fibrillary astrocytic neoplasms by magnetic resonance imaging with enhancement with gadopentetate dimeglumine.

Adolescent↗

Role of stereotactic radiosurgery with a linear accelerator in treatment of intracranial arteriovenous malformations and tumors in children.

Between 1986 and 1988, 16 children were treated for 10 arteriovenous malformations and 6 recurrent intracranial tumors with stereotactic radiation therapy using a modified Clinac 6/100 linear accelerator. The median age of our patients was 10.5 years. For the group with arteriovenous malformation, follow-up ranged from 6 months to 37 months (median was 20 months). No patient bled during the follow-up period. Five of eight patients with follow-up longer than 12 months have achieved complete obliteration of their arteriovenous malformation by angiogram. The four remaining patients who have not achieved a complete obliteration are awaiting their 2-year posttreatment angiogram. The other patient has been treated within the year and have not yet been studied. Five of the six recurrent tumor patients are alive with a median follow-up of 8 months. The remaining patient was controlled locally, but he died of recurrent disease outside the area treated with radiosurgery. The radiographic responses of these patients have included three complete responses, two substantial reductions in tumor volume (greater than 50%) and one stabilization. Despite previous radiotherapy, there have been no significant complications in these patients. We conclude that stereotactic radiation therapy using a standard linear accelerator is an effective and safe technique in the treatment of selected intracranial arteriovenous malformations and tumors in children. In addition, stereotactic radiosurgery may have unique applications in the treatment of localized primary and recurrent pediatric brain tumors.

Adolescent↗

[Harvey Cushing: neurosurgeon and artist].

Harvey Cushing was a man of many talents. He was a skilled, surgeon, scientist, author and bibliophile. In addition, he was an accomplished artist for both medical non-medical subjects. In this paper, we present three surgical drawings of Dr Cushing's that are representative of the nearly one hundred drawings we have thus far found with his operative notes in the Peter Bent Brigham Archives. We will also discuss Cushing's non-medical art, some of the best of which is of the French countryside.

Art↗

Cerebral toxoplasmosis in patients with AIDS.

Toxoplasma gondii, a previously rare cause of central nervous system infection, has become a major cause of encephalitis in patients with acquired immunodeficiency syndrome. The diagnosis of cerebral toxoplasmosis should be kept in mind when neurologic signs and symptoms develop in patients with AIDS. Patients with positive serology and characteristic lesions on computed tomographic scans should receive two weeks of antitoxoplasma therapy. Biopsy is recommended for patients with atypical presentation, negative serology, progressive clinical deterioration or differential response of lesions to empiric therapy.

Acquired Immunodeficiency Syndrome↗

Behavioral effects of neurotensin: operant responding and assessment of 'anhedonia'.

Neurotensin and antipsychotic drugs share certain properties. This study investigates whether neurotensin and neuroleptics share the ability to produce 'anhedonia'. A dose-response curve for the effect of neurotensin on continuously reinforced behavior was obtained in Experiment 1. Centrally administered neurotensin reduced food-reinforced responding. Based on the results of Experiment 1, a dose of neurotensin (0.95 micrograms) was chosen which had minimal effects on food-reinforced operant responding. To test for anhedonia, repeated presentations of this dose were given. Because response rates did not decrease over repeated testing, no evidence for anhedonia was found.

Animals↗

The development of neurosurgical techniques: the postoperative notes and sketches of Dr. Harvey Cushing.

In the early development of American neurosurgical techniques, Harvey Cushing is often considered the founding father. As an accomplished artist and prolific writer his original operative sketches and detailed notes at the Peter Bent Brigham Hospital (1912-1932) are now being explored as early documentation of this pioneering surgeon's development of a field. We present four brain tumor cases with his unpublished sketches and direct quotations to illustrate both the trials and tribulations of those times and Cushing's innate surgical genius.

Brain Neoplasms↗