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Biomedical subjects

I S Ciric

Publications and source records attributed to I S Ciric.

At least 19 recordsLinked to original sources
PubMed1998

The history of neurological surgery at Northwestern University.

The residency program in neurological surgery at Northwestern University was founded in 1924 by Loyal Davis and was formally accredited by the American Board of Neurological Surgery in 1946. Allen Kanavel, mentor to Davis, was one of the original members of the Society of Neurological Surgeons. Five individuals have served as chief of neurosurgery at Northwestern: Davis, Paul Bucy, Anthony Raimondi, Albert Butler, and H. Hunt Batjer. Davis was the first surgeon west of the Appalachians to limit his work to neurosurgery. Between 1954 and 1963, there were two independent neurosurgery residency programs at Northwestern, one headed by Davis and the other by Bucy. A master surgeon and superb teacher, Bucy trained more than 65 residents and became one of the greatest authors and leaders in the field of neurosurgery. Neurosurgical training at Northwestern has traditionally emphasized excellence of patient care, strong resident and student teaching, and basic science research. Through the years, a major strength of the program has been its clinical volume and diversity. Four hospitals have played major roles in the program: Northwestern Memorial Hospital (created by the merger of Chicago Wesley Memorial Hospital and Passavant Memorial Hospital), Children's Memorial Hospital, Evanston Hospital, and the Veterans Administration Lakeside Hospital. This article traces the development of neurological surgery at Northwestern, with an emphasis on its historical background and the contributions of Kanavel, Davis, and Bucy. The present philosophy and structure of the training program and the program's future under the direction of Batier are also described.

Chicago↗
PubMed1991

Interstitial chemotherapy with drug polymer implants for the treatment of recurrent gliomas.

Malignant gliomas have been difficult to treat with chemotherapy. The most effective agent, BCNU (carmustine), has considerable systemic toxicity and a short half-life in serum. To obviate these problems, a method has been developed for the local sustained release of chemotherapeutic agents by their incorporation into biodegradable polymers. Implantation of the drug-impregnated polymer at the tumor site allows prolonged local exposure with minimal systemic exposure. In this Phase I-II study, 21 patients with recurrent malignant glioma were treated with BCNU released interstitially by means of a polyanhydride biodegradable polymer implant. Up to eight polymer wafers were placed in the resection cavity intraoperatively, upon completion of tumor debulking. The polymer releases the therapeutic drug for approximately 3 weeks. Three increasing concentrations of BCNU were studied; the treatment was well tolerated at all three levels. There were no adverse reactions to the BCNU wafer treatment itself. The average survival period after reoperation was 65 weeks for the first dose group, 64 weeks for the second dose group, and 32 weeks for the highest dose group. The overall mean survival time was 48 weeks from reoperation and 94 weeks from the original operation. The overall median survival times were 46 weeks postimplant and 87 weeks from initial surgery. Eighteen (86%) of 21 patients lived more than 1 year from the time of their initial diagnosis and eight (38%) of 21 patients lived more than 1 year after intracranial implantation of the polymer. Frequent hematology, blood chemistry, and urinalysis tests did not reveal any systemic effect from this interstitial chemotherapy. Since the therapy is well tolerated and safe, a placebo-controlled clinical trial has been started. The trial will measure the effect of the second treatment dose on survival of patients with recurrent malignant glioma.

Brain Neoplasms↗
PubMed1989

Reoperation for malignant astrocytoma.

We evaluated 15 consecutive patients with malignant astrocytomas who were reoperated for functional status and survival. Their Karnovsky Performance Status (KPS) was not changed by surgery. None suffered perioperative death, wound infection, or complications. Patients with glioblastoma maintained KPS unchanged for a mean of 13 weeks (median, 10 weeks); with anaplastic astrocytoma, mean, 37.2 weeks (median, 24 weeks). Life spans were approximately twice that of non-reoperated historical controls. Reoperation for patients with recurrent malignant astrocytoma should be seriously considered when a gross total re-resection can be the goal in a patient whose tumor is in an accessible brain region.

Adult↗
PubMed1987

Current concepts in neuroradiological diagnosis of acoustic neuromas.

Two hundred twenty-one cases with clinical suspicion of a cerebellopontine angle (CPA) and/or internal auditory canal (IAC) lesions were evaluated in our hospital in the last 21/2 years by various radiological modalities. Fifty-two tumors were diagnosed and surgically removed; 48 were acoustic neuromas (33 large tumors and 15 intracanalicular small tumors) and 4 meningiomas. Polytomography detected 10 lesions out of 15 (66.7%) with 5 false-negative (33.3%) and 4 false-positive (26.7%) studies. Routine CT scan visualized large and enhancing lesions (37 out of 52), but missed the small intracanalicular tumors (15 tumors) which were only visualized by CT scan combined with cisternography or magnetic resonance imaging (MRI). MRI diagnosed 23 lesions out of 23 (100%) with no false-positive or negative studies, including 8 intracanalicular small tumors missed on the routine CT scans. MRI is far more reliable in the radiological diagnosis of CPA and IAC lesions.

Cerebellar Neoplasms↗
PubMed1986

Milliwatt carbon dioxide laser and hepatic surgery in mice: surgical technique and pathology.

The milliwatt carbon dioxide laser was used to induce focal lesions and to perform wedge resections in the livers of 75 strain A mice. The procedures were feasible and well tolerated by the mice, with only one postoperative death in the wedge resection group in an early experiment. The hepatic lesions produced by the laser were characterized histologically by an inner area of vaporization, an intermediate area of coagulation necrosis, and an outer rim of cells with variable damage. The lesions healed by fibroblastic proliferation and scar formation with no hepatocytic contribution. The small vessel and bile ductule sealing effect of CO2 laser, together with the sound healing of laser-induced wounds, highlights the usefulness of this modality in liver surgery in general, and suggests its particular application in the treatment of liver trauma and a variety of hepatic focal lesions, neoplastic or otherwise.

Animals↗
PubMed1985

Vascular malformations of the thalamus with normal angiograms.

We describe two patients with fatal vascular malformations of the thalamus whom we thought had gliomas. They had progressive neurological impairment with subacute onset as adults. Computed tomography showed lesions of increased density with slight post-contrast enhancement; cerebral angiography was normal. Without biopsy, they received radiation therapy without benefit. Two other patients with similar radiological studies have done well with conservative treatment. We believe that these lesions have a distinctive appearance on CT, that vascular malformations can be diagnosed, even with normal cerebral angiograms, and distinguished with reasonable certainty from gliomas.

Adult↗
PubMed1982

[Transsphenoidal Microneurosurgery. Part 4: Neuroophthalmological cure in pituitary adenoma].

Fifty-nine pituitary adenomas treated with transsphenoidal approach were analyzed in the light of visual field defects and the postoperative cure rates. Twenty-six cases had visual field defects. The majority of the defects were temporal 1/2 or superior 1/4, although atypical deficits such as incongruous homonymous hemianopsia, nasal 1/2 defect, superior 1/2 defect, peripheral constrict were seen. The visual field defects were correlated with the size of the tumor in Hardy and Vezina classification of the suprasellar extension. The visual field defects appeared in 100% of Type C, 89% of Type B, 50% of Type A, 0% of Type O. In 24 out of 26 patients with preoperative visual field defect, the visual field improved either to normal or wider fields postoperatively. There were 9 patients with optic atrophy, which also showed the correlation with the tumor size. Only the tumor of Type B or C revealed optic atrophy but still 45.4% patients in this group had no optic atrophy. The visual field defect in 85% of the patients without optic atrophy improved to normal post-operatively, while 66% with mild and only 20% with severe optic atrophy showed complete recovery. In conclusions, authors emphasize followings. 1) Improvement rate in the visual field defect of pituitary adenomas by transsphenoidal approach was superior to the previously reported rates by transcranial operations. 2) The factors affecting the functional prognosis in the visual field defect are the natures of the tumor, surgical approach and the factors affecting the plasticity of the optic nerves. The existence and degree of optic atrophy could be one of the references for the plasticity of the optic nerves. 3) There is a close relation between the morphological potential of the tumor and optic atrophy/visual field defect. From these standpoints of view, the early diagnosis and treatment should be emphasized.

Adenoma↗