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Biomedical subjects

H H Kaufman

Publications and source records attributed to H H Kaufman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Treatment of calcified cephalohematoma.

This is a case report concerning the surgical treatment of a calcified cephalohematoma, which was possibly caused by an intrauterine fetal monitor. This is the first report of this particular entity as a complication of an intrauterine fetal monitor. As far as we can determine, there is no detailed information available about surgical decision making or surgical techniques for removing such lesions. We operated because of the size and persistence of the lesion. We developed a procedure in which we used the bony cap of the cephalohematoma for a cranioplasty, securing it with microplates.

Bone Plates↗
PubMed1993

Intracerebral hematoma related to thrombolysis for myocardial infarction.

The incidence of intracerebral hematomas after myocardial infarction increases after thrombolysis. As noted in the case described, clots formed after the administration of thrombolytic agents may remain liquid, and this blood can be drained by a catheter. However, in this case, the patient continued to bleed locally. This problem requires the development of methods to stop such ongoing local bleeding. It may be prevented in the future by improved thrombolytic drugs.

Aged↗
PubMed1993

Childhood meningioma associated with meningio-angiomatosis. Case report.

This paper reports childhood meningioma in association with meningioangiomatosis. The patient was an 11-month-old baby boy who presented with a left focal seizure. He had no stigmata of neurofibromatosis. Computerized tomography and magnetic resonance imaging revealed an extra-axial, contrast-enhancing mass in the interhemispheric fissure which indented the right frontal lobe. The tumor was totally removed. Microscopically, the lesion was a fibrous and transitional meningioma with foci of necrosis and scattered mitotic figures. The adherent neural parenchyma showed the histological features of meningioangiomatosis. It is concluded that meningioangiomatosis may accompany childhood meningiomas more often than is generally appreciated.

Angiomatosis↗
PubMed1993

Treatment of head injuries in the American Civil War.

At the time of the American Civil War (1861-1865), a great deal was known about closed head injury and gunshot wounds to the head. Compression was differentiated from concussion, but localization of lesions was not precise. Ether and especially chloroform were used to provide anesthesia. Failure to understand how to prevent infection discouraged physicians from aggressive surgery. Manuals written to educate inexperienced doctors at the onset of the war provide an overview of the advice given by senior surgeons. The Union experiences in the treatment of head injury in the Civil War were discussed in the three surgical volumes of The Medical and Surgical History of the War of the Rebellion. Wounds were divided into incised and puncture wounds, blunt injuries, and gunshot wounds, which were analyzed separately. Because the patients were not stratified by severity of injury and because there was no neuroimaging, it is difficult to understand the clinical problems and the effectiveness of surgery. Almost immediately after the war, increased knowledge about cerebral localization and the development of antisepsis (and then asepsis) permitted the development of modern neurosurgery.

Brain Injuries↗
PubMed1993

Localized hypertrophic mononeuropathy involving spinal roots and associated with sacral meningocele. Case report.

Hypertrophic nerve lesions displaying onion-bulb cellular formations are quite rare in the absence of a generalized hypertrophic neuropathy. The isolated peripheral nerve lesion has been termed "localized hypertrophic mononeuropathy" (LHN), and fewer than 30 cases of this condition have been reported. Very little is known regarding the etiology and the natural course of this rare disorder. A unique case of LHN afflicting spinal roots in association with a sacral meningocele is reported with a brief review of the relevant literature. The unique features of this case not only reveal a variable clinical presentation of the disease but also support the theory that LHN may be a localized reaction to nerve trauma or entrapment.

Adult↗
PubMed1993

Indications for carotid endarterectomy.

Stroke is a major health problem in the United States. Carotid endarterectomy has been performed to prevent stroke in symptomatic and asymptomatic patients with carotid atherosclerosis. The rationale for this approach has been questioned recently and several studies were begun to determine the proper role of surgery. The initial results from studies of symptomatic patients demonstrate that surgery is urgently indicated if stenosis is at least 70%, but not if it is less than 30%. Patients with intermediate amounts of stenosis are still being evaluated. Early evidence suggests that surgery is not indicated for asymptomatic patients, but two major trials are still in progress. Surgeons performing this procedure must demonstrate low perioperative morbidity and mortality. In addition, the use of ultrasound as a screening procedure is being re-evaluated. We suggest rapid referral and evaluation of symptomatic patients with angiography, and treatment of asymptomatic patients with aspirin.

Arteriosclerosis↗
PubMed1992

Ventriculopleural shunting used as a temporary diversion.

Due to the limited absorptive capacity of the pleural cavity, infants and young children are not generally ideal candidates for ventriculopleural shunts. We report using chest cavities as alternate for temporary diversion of CSF in a young child. Venous access to the cervical region could not be utilized because of scarring from previous procedures, while peritoneal access was contraindicated due to repeated pseudocyst formation. Pleural effusions were removed by thoracentesis when necessary, and the shunt catheter was changed to the opposite side of the chest when the effusions reaccumulated within one week. Utilizing the ventriculopleural shunts allowed us to temporize her non-communicating hydrocephalus for a period of one year, until a definitive CSF procedure by direct intracardiac placement of the distal catheter could be performed.

Cerebrospinal Fluid Shunts↗
PubMed1992

Chronic extradural haematomas: indications for surgery.

Non-invasive neuro-imaging has led to the detection of minimally symptomatic or asymptomatic chronic extradural haematomas. Our experience and review of the literature suggests that, as in the case of chronic subdural haematomas, there is development of membranes and liquifaction of the clot which may permit drainage of such collections through twist drill or burrholes. The time from development and the neuro-imaging chanes on CT and MRI can suggest the age and nature of the clot and thus permit timing of surgery so that drainage may be accomplished with a minor procedure.

Adult↗
PubMed1992

The future. Prospects of innovative treatment of intracerebral hemorrhage.

Aggressive surgical as well as medical management strategies have had limited success with improving outcomes from spontaneous intracerebral hematomas. Future prospects of treatment will undoubtedly focus on less invasive, better tolerated procedures to remove hematomas in select patients. Some success has been achieved with a coupling of stereotactic technology, fibrinolytic agents, and mechanical devices, which can remove solid portions of hematoma through narrow probes. Newer technology also has involved laser endoscopic and small ultrasonic probes to facilitate morcellation and subsequent aspiration without the problems associated with a major intracranial procedure.

Cerebral Hemorrhage↗
PubMed1991

A national survey of neurosurgical care for penetrating head injury.

We report results of a survey on the management patterns of penetrating head injury (PHI). American neurosurgeons (N = 2969) were asked to participate in a mail survey. One thousand one hundred twenty-eight responded, providing detailed information about their practices, their opinions concerning diagnostic testing, nonoperative therapy, and surgical debridement for PHI. Although there was agreement on some areas of management and care, including the use of computed tomography scanning, antibiotics, anticonvulsants, and a few surgical indications/contraindications, there was wide variation on a significant number of points. These included testing for coagulopathy; use of corticosteroids, intracranial pressure monitoring, and barbiturate coma; and surgical indications including debridement of contusions, removal of fragments, location of injury, and Glasgow Coma Score 5-8. Many nonoperative decisions were influenced by the presence of neurosurgical residents, whereas the decision to operate was based primarily on judgment of patient salvageability. This survey uncovered disagreement on several crucial issues in the care of patients with penetrating head injury and the need for continued research in this area of patient care.

Adult↗
PubMed1991

Millipore analysis of valvular fluid in sterile valve malfunctions.

Malfunctions of sterile shunts may result from valvular dysfunction. The cerebrospinal fluid shunt valves of 14 patients were excised during surgery for sterile shunt malfunctions. In 6 patients, the malfunction was due specifically to a valve malfunction. Cerebrospinal fluid from each valve was passed through a millipore filter, which was then stained using either hematoxylin and eosin or periodic acid-Schiff. The stained millipore filters were examined by a neuropathologist who was unaware of the cause of the shunt malfunction. Although inflammatory cells were detected in all cases, the patients with valve malfunctions were found to have numerous macrophages and giant multinucleated reactive cells within their valves, while cerebrospinal fluid from valves that had been removed during shunt revisions for reasons other than a malfunctioning valve contained only rare mononuclear cells or macrophages. No valve contained erythrocytes, fibrinous matter, neural or glial tissue, or choroid plexus. The possible causes of valve malfunction, including infection and allergic reactions, are discussed. All patients did well after simple replacement of the valve.

Adolescent↗
PubMed1991

Ethical and legal responsibilities of the neurosurgeon: selected topics.

There are many ethical and legal implications in a variety of activities in the neurosurgeon's day-to-day practice. Awareness of and proper attention to these issues are a professional responsibility that should be attended to, to ensure that the practice of medicine is carried out efficiently and effectively, to maintain public confidence, and to try to avoid micromanagement by third parties. The authors discuss four such subjects of particular interest to them, namely: 1) reporting of certain diseases and conditions to authorities and third parties; 2) acting without the consent of the patient to prevent harm to him or her and/or others; 3) reporting problems with drugs and devices; and 4) the detection and treatment of colleagues impaired by alcohol, drugs, or mental or physical illness.

Confidentiality↗
PubMed1991

Treatment of civilian gunshot wounds to the head.

Gunshot wounds to the head are a common problem in the United States. A review of the literature and a survey of neurosurgeons suggests some differences of opinion regarding treatment. But the series upon which these opinions are based may be quite different. Disseminated intravascular coagulation can be a major problem. CT scanning is important for surgical decision making. Angiography should be used in cases in which bullets have passed near major vessels. We suggest an aggressive approach, with evacuation of clots and monitoring of intracranial pressure and treatment of elevations, as well as the routine use of anticonvulsants and antibiotics. Vocational rehabilitation is also important.

Cerebral Angiography↗