Biomedical subjects
Publications and source records attributed to E Rossitch.
A case of a brain stem abscess that was successfully treated using CT guided stereotaxy together with antibiotic therapy is presented. The literature is reviewed and the role of stereotaxy in the treatment of brain stem abscess is discussed.
Nine patients with autonomic dysfunction syndrome (ADS) characterised by sympathetic discharge and extensor posturing are presented. Morphine was given to three patients and in all cases consistently stopped the episodes. Dantrolene was given to one patient and reduced the severity of the extensor posturing without affecting the other components of the ADS. Bromocriptine was given to three patients and appeared to have both short- and long-term effects. Acutely, the drug partially corrected the hyperthermia and diaphoresis associated with these episodes. Two patients were given bromocriptine long-term. In one patient, the ADS was completely controlled and in the other, the frequency of the episodes decreased. The autonomic dysfunction syndrome appears to be related to both severe closed head injury and acute hydrocephalus. The clinical similarity of the two diverse etiologic groups and the absence of precipitating increased ICP in the former suggests the common theme is a release of the brain stem from higher control. The responses to morphine and bromocriptine suggest that the opiate and dopaminergic pathways play roles in the entity.
Cisplatin is a recognized neurotoxic agent that commonly causes ototoxicity and peripheral neuropathy. In conjunction with characteristic peripheral neuropathy, two patients treated with high-dose cisplatin developed Lhermitte's sign, a manifestation of posterior column spinal cord pathology. After cisplatin therapy was stopped, this symptom gradually resolved. This suggests that at high doses cisplatin may also cause demyelinating central nervous system lesions involving the spinal cord.
Nonabsorbable silk sutures have been a frequently used foreign material in neurosurgery. In general, they are reliable and safe with minimal bio-incompatibility. Three pediatric neurosurgical patients came to clinical attention, however, because of delayed foreign-body reactions to silk sutures. The delayed atypical presentation of these patients delayed appropriate diagnosis and therapy. In two patients, the reaction presented as a delayed inflammation 7 years following surgical suture placement. In the other patient, the reaction caused delayed recurrent shunt failures and surgical wound breakdown. These three cases are used to introduce a discussion of the delayed response of the host to foreign material and its pertinence to neurosurgery.
A deafferentation syndrome can be produced in rats by dorsal root ganglionectomies. This syndrome consists of scratching and/or biting of the anesthetic limb to the point of amputation. This behavior may serve as an experimental model to study certain aspects of chronic dysesthesias and/or pain caused by deafferentation in man. In this study, we made behavioral observations on the deafferentation syndrome and examined the possibility that intraventricular neurotensin and cholecystokinin alter the course of this syndrome. We found that neurotensin accelerated the scratching component without affecting the biting behavior. Cholecystokinin, however, attenuated the release of both components of the syndrome.
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Two patients came to clinical attention because of foreign body reactions to rubber catheters. In one patient, the reaction presented as multiple levels of aseptic meningitis and, in the second patient, the reaction caused an intracranial mass with localized neurological dysfunction.
An acridine antitumor agent, 4'-(9-acridinylamino)methanesulfon-m-anisidide, has been found to be an extremely potent competitive inhibitor of aldehyde oxidase (EC 1.2.3.1). The inhibitor constant (Ki) was determined to be 0.06 microM. The degree of enzyme inhibition was quite sensitive to small changes in the structure of the inhibitor's anisidide moiety. Drug inhibition was specific for aldehyde oxidase and inhibition was not detected with the other mammalian molybdenum iron-sulfur flavoenzyme, xanthine oxidase (EC 1.2.3.2). Members of the 4'-(9-acridinylamine)methanesulfonanilide series might be useful probes in the study of the structure and function of aldehyde oxidase.
An isolated oculomotor nerve palsy is very rarely the presenting sign of a pituitary adenoma. It may occur slowly due to mechanical compression or rapidly, secondary to pituitary apoplexy. Magnetic resonance imaging (MRI) with and without gadolinium DTPA enhancement provides excellent anatomical detail and is useful in the planning of the operative procedure. When correctly diagnosed and treated, the third nerve dysfunction appears to be reversible. We report a case of a pituitary adenoma presenting with an isolated, partial oculomotor nerve palsy in the setting of apoplexy. The pathophysiology, prognostic factors and MRI findings of this entity are discussed.
Fournier's gangrene is a rare, multi-organism infection of the perineum. The disease is most often confined to the groin area with distant spread being extremely unusual. A ase of spinal epidural abscess as a complication of Fournier's gangrene is presented. The infection appears to have spread by the hematogenous route. The patient had several symptoms, including fever, which could have provided an early diagnostic clue. Multiple fever workups were negative, however, and the diagnosis was not made until quadriplegia developed. A lumbar puncture as part of the fever workup might have allowed for an earlier diagnosis and more prompt surgery.