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Biomedical subjects

H Deutsch

Publications and source records attributed to H Deutsch.

At least 19 recordsLinked to original sources
PubMed2001

Pediatric intramedullary spinal cavernous malformations.

STUDY DESIGN: A retrospective analysis of a large single institution pediatric intramedullary tumor database. The database was searched for all pediatric intramedullary cavernous malformations. OBJECTIVES: To review the authors' experience with three pediatric intramedullary cavernous malformations, review the previous literature, and discuss the surgical management for these rare lesions. SUMMARY OF BACKGROUND DATA: Cavernous malformations can occur throughout the central nervous system; however, the intramedullary spinal cord is a rare location. More recent estimates indicate that cavernous malformations constitute 5% of all vascular malformations. There is no series that reports the management of pediatric intramedullary cavernous malformations. METHODS: There were 181 pediatric intramedullary lesions in the tumor database. A review revealed three children with a mean age of 13.3 years (range, 8-19 years) with intramedullary cavernous malformations. All these children presented with an acute motor deficit that prompted radiographic imaging and diagnosis. All the children underwent laminectomy and gross total removal of the lesion. All the malformations abutted the dorsal pial surface and created a blue discoloration, which was evident after opening the dura. RESULTS: Approximately 10% of all intramedullary cavernous malformations present in the pediatric population. Pediatric lesions, unlike those in adults, have an acute presentation, and the lesions are typically found in the cervical region. The surgical removal of these malformations results in a good functional outcome. The entire neuraxis should be screened because there is a high incidence of multiple lesions. CONCLUSIONS: The surgical removal of these malformations results in a good functional outcome. The entire neuraxis should be screened because there is a high incidence of multiple lesions.

Adolescent↗
PubMed2001

Adjunctive use of endoscopy during posterior fossa surgery to treat cranial neuropathies.

OBJECTIVE: The objective of this study was to determine the utility and safety of rigid endoscopy as an adjunct during posterior fossa surgery to treat cranial neuropathies. METHODS: A suboccipital craniotomy was performed for 19 patients with non-neoplastic processes involving the Vth, VIIth, and/or VIIIth cranial nerves. Ten patients with trigeminal neuralgia (n = 8), hemifacial spasm (n = 1), or intractable tinnitus (n = 1) underwent primarily microvascular decompression procedures. One patient with geniculate neuralgia underwent nervus intermedius sectioning combined with microvascular decompression. Eight patients underwent unilateral vestibular nerve neurectomies for treatment of Meniere's disease. A 0- or 30-degree rigid endoscope was used in conjunction with the standard microscopic approach for all procedures. RESULTS: All patients experienced resolution or significant improvement of their preoperative symptoms after posterior fossa surgery. The endoscope allowed improved definition of anatomic neurovascular relationships without the need for significant cerebellar or brainstem retraction. Cleavage planes between the cochlear and vestibular nerves entering the internal auditory canal and sites of vascular compression could not be microscopically observed for several patients; however, endoscopic identification was possible for all patients. There were no complications related to the use of the endoscope. CONCLUSION: The rigid endoscope can be used safely during posterior fossa surgery to treat cranial neuropathies, and it allows improved observation of the cranial nerves, nerve cleavage planes, and vascular anatomic features without significant cerebellar or brainstem retraction.

Adolescent↗
PubMed2000

Endoscopic endocrine neck surgery with carbon dioxide insufflation: the effect on intracranial pressure in a large animal model.

BACKGROUND: Endoscopic endocrine neck surgery requires insufflation with carbon dioxide (CO(2)) at 10 to 15 mm Hg, which may decrease the cerebral venous return and increase intracranial pressure. This study evaluated the effect of CO(2) neck insufflation on intracranial pressure (ICP) and hemodynamic parameters. METHODS: Fifteen pigs underwent endoscopic thyroid dissection. Insufflation was performed with CO(2) at 0 (sham), 10, 15, and 20 mm Hg and with helium at 20 mm Hg with 3 pigs in each group. ICP, mean arterial pressure, central venous pressure (CVP), cardiac output, and blood gas were measured at baseline, 30, 60, and 120 minutes. RESULTS: There were no differences in mean ICP between the sham group and CO(2) insufflation at 10 mm Hg. Mean ICP increased significantly with CO(2) at 15 and 20 mm Hg and with helium at 20 mm Hg. A significant increase in CVP occurred in pigs operated with CO(2) at 20 mm Hg. We observed jugular vein collapse under all insufflation pressures; however, pigs operated at 10 mm Hg were able to maintain an intermittent blood flow. CONCLUSIONS: A severe increase in ICP occurs with insufflation pressures higher than 15 mm Hg, possibly as a result of decreased cervical venous blood flow. Carbon dioxide insufflation up to 10 mm Hg does not alter ICP and is recommended for clinical application in endoscopic neck surgery.

Animals↗
PubMed2000

Minimally invasive spine surgery: an animal model for endoscopic approach to the anterior cervical and upper thoracic spine.

BACKGROUND: Minimally invasive video-assisted techniques are currently used for thoracic and lumbar spine surgery with the aim of reducing the morbidity. Recently, an endoscopic approach has been used for endocrine neck surgery, with reduced pain and improved cosmetic results. PURPOSE: To develop an animal model for an endoscopic neck approach to the anterior cervical and upper thoracic spine. METHODS: Five pigs were used. A combination of one 5- and two 3-mm laparoscopic instruments was used to dissect the spine, and dedicated instrumentation was then used to perform discectomies. Carbon dioxide was insufflated at 10 mm Hg. Dissection was carried out upward and downward on the anterior aspect of the spine; discectomy was performed at various levels and evaluated at autopsy. RESULTS: All pigs tolerated the procedure well. Visibility of the cervical spine was excellent, and exposure from C1 to T3 was obtained. For discectomy, an additional 10-mm trocar was inserted, and discectomy of C3-C4 and C4-C5 was performed. Proper location and adequacy were confirmed at autopsy. CONCLUSION: The endoscopic neck approach allows exposure of the entire cervical spine and the upper thoracic spine in the porcine model. This approach has the potential to reduce the morbidity associated with the open cervical approach and provides a wider view and exposure than conventional open surgery. The availability of the porcine model allows the acquisition of the necessary technical skills before introducing this advanced procedure in humans.

Animals↗
PubMed2000

Somatosensory evoked potential monitoring in anterior thoracic vertebrectomy.

OBJECT: Spine surgeons have used intraoperative cortical and subcortical somatosensory evoked potential (SSEP) monitoring to detect changes in spinal cord function when intraoperative procedures can be performed to prevent neurological deterioration. However, the reliability of SSEP monitoring as applied to anterior thoracic vertebral body resections has not been rigorously assessed. METHODS: The authors retrospectively reviewed hospital charts and operating room records obtained between August 1993 and December 1998 and found that SSEP monitoring was used in 44 surgical procedures involving an anterior approach for thoracic vertebral body resections. There were no patients in whom SSEP changes did not return to baseline during the surgical procedure. Patients in four cases, despite their stable SSEP recordings throughout the procedure, were noted immediately postoperatively to have experienced significant neurological deterioration. The false-negative rate in SSEP monitoring was 9%. Sensitivity was determined to be 0%. CONCLUSIONS: It is important to recognize high false-negative rates and low sensitivity of SSEP monitoring when it is used to record spinal cord function during anterior approaches for thoracic vertebrectomies. The insensitivity of SSEPs for motor deterioration during anterior thoracic vertebrectomies is likely due to the limitation of SSEPs, which monitor only posterior column function whereas motor paths are conveyed in the anterior and anterolateral spinal cord. The authors believe that SSEPs can not be relied on to detect reversible spinal damage during anterior thoracic vertebrectomies.

Adult↗
PubMed2000

Spinal intramedullary cavernoma: clinical presentation and surgical outcome.

OBJECT: Improved neuroimaging techniques have led to an increase in the reported cases of intramedullary cavernomas. The purpose of this study was to define the spectrum of presenting signs and symptoms in patients with spinal intramedullary cavernomas and to analyze the role of surgery as a treatment for these lesions. METHODS: The authors reviewed the charts of 16 patients who underwent surgery for spinal intramedullary cavernomas. All patients underwent preoperative magnetic resonance imaging studies. Cavernomas represented 14 (5.0%) of 280 intramedullary lesions found in adults and two (1.1%) of 181 intramedullary lesions found in pediatric cases. A posterior laminectomy and surgical resection of the malformation were performed in all 16 patients. CONCLUSIONS: Magnetic resonance imaging is virtually diagnostic for spinal cavernoma lesions. Patients with spinal intramedullary cavernomas presented with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage within the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and the resulting gliotic reaction to hemorrhagic products. There is no evidence that cavernomas increase in size. The rate of rebleeding is unknown, but spinal cavernomas appear to be clinically more aggressive than cranial cavernomas, probably because the spinal cord is less tolerant of mass lesions. Complete surgical removal of the cavernoma was possible in 15 of 16 of the authors' cases.

Adolescent↗
PubMed1999

Effects of methylphenidate analogues on phenethylamine substrates for the striatal dopamine transporter: potential as amphetamine antagonists?

Methylphenidate (MPD) was found to inhibit competitively the striatal dopamine transporter (DAT) and bind at sites on the DAT in common with both cocaine (a non-substrate site ligand) and amphetamine (a substrate site ligand). Some methylphenidate analogues modified on the aromatic ring and/or at the nitrogen were tested to determine whether the profile of inhibition could be altered. None was found to stimulate the release of dopamine in the time frame (< or = 60 s) of the experiments conducted, and each of the analogues tested was found to noncompetitively inhibit the transport of dopamine. It was found that halogenating the aromatic ring with chlorine (threo-3,4-dichloromethylphenidate hydrochloride; compound 1) increased the affinity of MPD to inhibit the transport of dopamine. A derivative of MPD with simultaneous, single methyl group substitutions on the phenyl ring and at the nitrogen (threo-N-methyl-4-methylphenidate hydrochloride; compound 2) bound at a site in common with MPD. A benzyl group positioned at the nitrogen (threo-N-benzylmethylphenidate hydrochloride; compound 3) imparted properties to the inhibitor in which binding at substrate and non-substrate sites could be distinguished. This analogue bound at a mutually interacting site with that of methylphenidate and had a K(int) value of 4.29 microM. Furthermore, the N-substituted analogues (compounds 2 and 3), although clearly inhibitors of dopamine transport, were found to attenuate dramatically the inhibition of dopamine transport by amphetamine, suggesting that the development of an antagonist for substrate analogue drugs of abuse may be possible.

Algorithms↗
PubMed1992

Laparoscopic herniorrhaphy.

Laparoscopic preperitoneal prosthetic repair of inguinal and femoral hernias was done in 27 patients, including 18 indirect, nine direct, and two femoral hernias. In four patients bilateral hernias were repaired simultaneously. General anesthesia with endotracheal intubation was used in all patients. Three laparoscopic cannulas were inserted. The peritoneum overlying the internal inguinal ring and floor of Hesselbach's triangle was opened. If an indirect hernia sac was found, it was dissected off the cord structures. A polypropylene prosthesis was used to occlude any potential canal space and to reinforce the pelvic floor. No major operative complications or early recurrences (follow-up, 1-7 months) occurred. Patients were to return to full employment an average of 5 days after surgery (range, 3-7 days).

Hernia, Inguinal↗
PubMed1989

On satisfaction, happiness and ecstasy.

In her 1927 'On satisfaction, happiness and ecstasy' Helene Deutsch took a respectful attitude toward religious phenomena. She was also talking about emotional states that Freud was apt not to want to write about because of his own scepticism concerning them. She even touched with understanding tolerance on the blissfulness of religious communion. She proceeded from the premise of a universal striving in each individual for psychological unity. She used two case histories to illustrate how both sexual satisfaction and sublimation could involve heightened phases of dejection. She accounted for the sense of ecstasy by the temporarily undisturbed unity between ego and non-ego. This translation should help counter-act the ahistoric tendency to look on early psychoanalysis only from the perspective of our own preoccupations. In her interest in the 'feeling of happiness' Helene Deutsch was anticipating later thinking which sought to include within psychoanalytic theory the integrative processes that constitute harmony.

Coitus↗
PubMed1988

Vitamin status of inpatients with chronic cephalgia and dysfunction pain syndrome and effects of a vitamin supplementation.

66 female inpatients with dysfunction pain syndrome, chronic cephalgia and facial pain participated in a randomized, placebo-controlled double-blind study, half the patients receiving a multivitamin preparation for 12 days and the other half a placebo. The biochemically determined vitamin status at the start of the study revealed gaps in the coverage of the vitamin supply, particularly with regard to the vitamins thiamin, riboflavin and folic acid. 65% of the patients showed a subclinical vitamin deficiency of two or more vitamins. With regard to the development of pain during the study no statistically significant differences could be determined, however, between the active-treatment and placebo groups. Nevertheless, a clear reduction in pain was more frequently observed in the active-treatment group, and a deterioration of pain more frequently in the placebo group. A reduction in pain was reported more often by patients in whom the values of alpha-ETK, alpha-EGOT, folic acid and cyanocobalamin improved in the course of the study. Vitamin administration in physiological doses evidently have only weak effects on the behavior of pain; analgesic vitamin effects may be presumed in the case of correspondingly high therapeutic doses for a prolonged period.

Adult↗
PubMed1987

Effect of head-neck position on elbow flexor muscle torque production.

The purpose of this study was to investigate whether the tonic neck reflex affects elbow flexor muscle torque production in healthy, young adults and which head-neck (H-N) positions have the greatest influence. Forty-eight male and female students between the ages of 18 and 35 years volunteered as subjects. Head-neck positions involving the sagittal and horizontal planes and combinations of these were tested. The nondominant hand was used to apply tension to the lever of an isokinetic analyzer under both isometric (static) and isotonic (dynamic) conditions. Peak torque was determined for each H-N position under each condition. Differences in peak torque were elicited more easily from the female subjects than from the male subjects. Head-neck rotation (horizontal plane) appeared to have a greater influence on elbow flexor muscle torque production than movements in the sagittal plane, particularly when movements in the two planes were combined. We concluded, therefore, that H-N position must be considered during rehabilitation of the upper extremity.

Adolescent↗
PubMed1987

[Diagnosis of cor triatriatum dextrum with imaging procedures].

Cor triatriatum dextrum is a rare malformation of the right atrium usually without typical signs or symptoms. Today the intra vitam diagnosis of C.t.d. is done by echocardiography, MR and angiocardiography. Once the diagnosis is established, surgical correction of this anomaly is possible in symptomatic patients.

Angiocardiography↗
PubMed1984

[Detection of patients at risk for sudden heart death by long-term ECG. The role of life-threatening ventricular arrhythmias].

Recognition of patients at risk of sudden cardiac death and prevention of such lethal events represent important and, for the most part, unresolved problems in clinical cardiology. From pathologic-anatomical and clinical studies of instances of sudden death it is known that in more than 80% the lethal electrical events, that is ventricular fibrillation, are attributable to myocardial ischemia, usually due to coronary artery disease. Experience in experimental studies as well as in treatment of patients with myocardial infarction on coronary care units has shown that certain types of arrhythmias such as frequent, multiform, repetitive and early-occurring (R-on-T) ventricular premature beats, in particular, may be associated with sudden arrhythmic cardiac death. Accordingly, in 1971, Lown and Wolf proposed a system for grading of ventricular arrhythmias and their severity which assumed world-wide importance for clinical and prognostic studies. This system of classification contains quantitative and qualitative criteria and is ordered in part on exclusion and in part on hierarchy, in which it is implied that the hierarchy of ventricular premature beats corresponds with that of the risk of death. Since the system enables only semiquantitative delineation of ventricular arrhythmias whose absolute number, however, within a given observation period appears to be of prognostic relevance and, additionally, since the Lown system is encumbered by the fact that classification is based only on the most severe arrhythmia with subsequent loss of information regarding concurrent arrhythmias of lesser severity, Bigger and his associates, in 1978, suggested a modification to provide quantification of all ventricular premature beats. In addition to the problems inherent to grading ventricular premature beats, further problems are also incurred with respect to spontaneous variability of ventricular arrhythmias. Based on statistical considerations and clinical studies accordingly, adequate assessment of complex ventricular arrhythmias prerequisites continuous monitoring for a period of 24 to 48 hours. Furthermore, for the exact recognition and quantitative detection of ventricular arrhythmias, the reliability of the individual systems for continuous ECG monitoring plays an important role since, by no means, have they all been validated in arrhythmia-detection capabilities. Since 1971, a number of clinical studies have shown, in particular, that complex ventricular arrhythmias are of important prognostic relevance in characterization of patients at risk of sudden cardiac death. The results may be summarized as follows: Ventricular premature beats can be found frequently in

Adult↗
PubMed1982

[Continuous registration of micropotentials of the human heart. Initial experiences with a new high resolution ECG amplifier system].

A new ECG-amplifier system for recording cardiac microvolt potentials from the body surface is described. The improvement in signal-to-noise ratio was achieved by using specially designed suction electrodes, which were isolated from each other; by applying parallel signal averaging from four electrode pairs via four low-noise amplifiers; and by conducting the registration in Faraday cage. in 14 normal subjects, 12 patients with coronary heart disease and one patient with surgically corrected ventricular septal defect and pulmonary stenosis, pre-P-potentials (possible sinus node activity), His bundle potentials and ventricular late potentials were recorded with differing degrees of success. Variations of the time intervals to the preceding QRS complex were observed within the S-T segment in six of nine patients with demonstrable ventricular late ventricular late potentials. The advantage of such continuously recording ECG system lies in the highly accurate registration of cardiac micropotentials, particularly with ventricular late potentials that are changing in time, whereas the signal-averaging technique does not provide such possibilities.

Adolescent↗