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Biomedical subjects

J B Posner

Publications and source records attributed to J B Posner.

At least 163 records · Page 9Linked to original sources
PubMed1984

Metronidazole in the treatment of metastatic brain tumors. Results of a controlled clinical trial.

We measured the effect of the radiation enhancer metronidazole on patients with metastatic brain tumors undergoing radiation therapy (RT) in a randomized controlled study. Metronidazole was given in a dose of 6 g/m2 4 hr before each of the first 3 doses of RT to the whole-brain. A total of 3000 rad was delivered in 6 doses. Patients were followed by serial neurological examinations and CT scans. The metronidazole group did not differ from the control group when measured in terms of survival, clinical improvement or improvement on CT scan, whether measured 2 months or 6 months following treatment. Nausea and vomiting was a significant side effect, preventing about 10% of patients from completing the treatment. Metronidazole appears to have no substantial radiation enhancing effect on metastatic brain tumors.

Anticonvulsants↗
PubMed1984

Subacute encephalitis in acquired immune deficiency syndrome: a postmortem study.

Thirty-one out of 40 patients with the acquired immune deficiency syndrome examined at autopsy had significant central nervous system disease. A subacute encephalitis, found in 19 patients, was the most frequent finding and was characterized by marked brain atrophy and a progressive dementing illness. This entity is linked to cytomegalovirus (CMV) by typical histopathology and association with systemic CMV infection with supportive evidence of positive immunohistochemical staining of tissue sections and, in one case, identification of CMV-type viral particles by electron microscopy. However, brain tissue cultures have been negative, making the etiology of subacute encephalitis not entirely clear.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Bacterial infections of the CNS in neutropenic patients.

In neutropenic patients, fever and mental status changes are frequently the only overt clinical manifestations of bacterial infections of the CNS. Prominent headache and meningeal signs are exceptional. CNS infections may occur even in patients receiving large doses of broad-spectrum antibiotics. CSF culture and Gram's stain are required to establish or exclude the diagnosis and are often positive, even in patients receiving antibiotics for other indications. The CSF cell counts and chemistries are helpful if abnormal, but, when normal, provide no assurance that infection is not present. The CSF glucose can be lowered in the absence of pleocytosis, but a low CSF glucose is neither sensitive (27% in this series) nor specific. Lumbar puncture is hazardous in many neutropenic patients because of simultaneous thrombocytopenia; lumbar puncture should be performed by an experienced physician after platelet transfusions. The outcome of CNS infection depends on the underlying clinical disorder and on bone marrow recovery. The use of third-generation cephalosporins, new semisynthetic penicillins, and intrathecal administration of aminoglycosides may improve outcome.

Agranulocytosis↗
PubMed1983

Incidence and treatment of peripheral venous thrombosis in patients with glioma.

The incidence, prevention, and treatment of peripheral venous thrombosis were studied retrospectively in 381 patients with malignant glioma. Of 264 patients who did not receive antithrombotic prophylaxis, 97 (36.7%) developed clinical phlebitis confirmed by venography. Sixty-six cases occurred within 6 weeks of craniotomy. By contrast, only 12 (10%) of 117 patients who received intermittent pneumatic pressure to the calves during craniotomy developed phlebitis (4 patients with 6 weeks of the surgery). Of the 109 patients with venous thrombosis, 103 were treated with anticoagulants. Of the 6 patients treated conservatively, 3 died of pulmonary emboli. Intracranial hemorrhage occurred in 1.9% of the patients taking anticoagulants and in 2.2% of those who did not develop phlebitis. We conclude that patients with malignant gliomas have a high risk of developing peripheral venous thrombosis; that antithrombotic therapy reduces the incidence of thrombosis following craniotomy; and that, in patients who develop phlebitis, anticoagulation reduces the risk of pulmonary emboli without increasing the risk of intracranial hemorrhage.

Astrocytoma↗
PubMed1983

Neurological complications of acquired immune deficiency syndrome: analysis of 50 patients.

Fifty patients with acquired immune deficiency syndrome had complications affecting the central or peripheral nervous systems or both. The patients were either male homosexuals, intravenous drug abusers, or recently arrived Haitian refugees. They ranged in age from 25 to 56. Central nervous system complications were of four kinds: (1) Infections included Toxoplasma gondii abscesses in 5 patients, progressive multifocal leukoencephalopathy in 2, cryptococcal meningitis in 2, Candida albicans in 1, and possible Mycobacterium avium intracellulare in 3. Eighteen patients suffered a subacute encephalitis possibly attributable to cytomegalovirus infection. (2) Tumors consisted of primary lymphoma of the brain in 3 patients and meningeal invasion by systemic lymphoma in 4. (3) Vascular complications included nonbacterial thrombotic endocarditis in 2 patients and cerebral hemorrhages in the setting of thrombocytopenia in 3. (4) Undiagnosed central nervous system problems were evidenced as focal brain lesions in 3 patients and self-limiting aseptic meningitis in 4. Peripheral neuropathy occurred in 8 patients.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Brain metastasis localized to an area of infarction.

A patient with adenosquamous carcinoma of the cervix developed brain metastases limited to an area of evolving infarction. This preferential localization of tumor in an area of previous tissue injury with neovascularization provides support, in the human, for the importance of local vascular factors in the development of brain metastases.

Adenocarcinoma↗
PubMed1983

Brain metastases from colon cancer.

Between 1977 and 1980 we evaluated 40 patients who developed brain metastases from colon cancer (4% of total patients with colon cancer). The brain metastasis was discovered in only one patient prior to cancer diagnosis; all others had known colon cancer for 2 to 48 months (median 24.5 months) prior to neurologic presentation. The colon tumor was left-sided in 32; 32 had regional lymph node metastases at neurological presentation; 37 patients had extensive systemic metastasis as well as the brain lesion. Median survival from onset of therapy for brain metastasis was 9 weeks in 32 radiation therapy (RT) treated patients (range, 2-57 weeks), 37 weeks in 7 surgically resected patients (2-84 weeks), and 4 weeks (3.5 weeks) in 2 chemotherapy patients. Follow-up demonstrated recurrent tumor (median 4 months). The prognosis for patients with brain metastasis in colon cancer is poor, regardless of therapy.

Adenocarcinoma↗
PubMed1983

Intra-arterial BCNU in the treatment of metastatic brain tumors.

Thirty-one patients with metastatic brain tumors that either failed to respond or recurred after conventional therapy were treated by intra-arterial infusion of 100 mg/m2 of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) into either a carotid or vertebral artery. Five patients (three with lung cancer, one with breast cancer and one with melanoma) had a partial response of the tumor(s) in the distribution of the injected artery. In two patients, brain metastases not in the distribution of the injected artery enlarged, while the tumors perfused by the injected artery responded. In one of these patients, subsequent infusion of BCNU to the enlarging tumor resulted in a partial response. Among responders, the median survival following onset of BCNU was 17 weeks. One patient remains alive and well at 30 weeks. No permanent neurological, retinal or systemic toxicity was observed.

Adult↗
PubMed1983

Syncope from head and neck cancer.

We have examined 17 patients suffering from recurrent syncope caused by carcinoma of the head and neck. The tumor originated in the mouth in seven, larynx in six, nasopharynx in three and parotid gland in one, and involved cervical lymph nodes at diagnosis in 12. Sixteen patients had previously had radical neck dissections and 12 had had radiation therapy. Recurrent carcinoma was present in 16. Spells resolved spontaneously in four, improved with treatment in 11 and continued in two. The syncope was spontaneous in 15 and induced only by suctioning or carotid sinus massage in two. Suctioning also produced attacks in four others, as did carotid sinus massage in five of ten tested. Acute severe unilateral head or neck pain preceded spontaneous syncope in 11. Sixteen patients had both profound bradycardia and hypotension during most spells, but ten had syncope with hypotension only, either spontaneously or following cardiac pacing or atropine to prevent bradycardia. Seizure activity accompanied syncope in eight. Anticholinergics improved 7/12, carbamazepine 2/5, carotid ligation 1/1 and intracranial sectioning of the glossopharyngeal nerve 1/1. Local radiation may have helped 4/10. Cardiac pacing was ineffective in 3/3 due to the development of pure vasodepressive syncope. Autopsy in 2/2 showed tumor involving the glossopharyngeal and vagus nerves. Syncope in these patients is under-recognized, frequently is due to vasodepression, and suggests recurrent carcinoma.

Aged↗
PubMed1983

Brain metastasis from melanoma.

Eighty-one patients with brain metastasis from melanoma were identified at Memorial Sloan-Kettering Cancer Center (MSKCC) between 1978 and 1980. Of 78 evaluable patients, 51 (65%) had multiple brain metastases. Of 64 patients with non-contrast CT scans, 29% had hemorrhagic metastases. Leptomeningeal metastases were found in 15 patients. Patients were grouped into three categories: Group 1, multiple brain metastases treated with radiation therapy (RT) (n = 49); Group 2, single brain metastasis treated with RT (n = 17); Group 3, single brain metastasis treated with surgery with or without RT (n = 9). Median survivals for Groups 1, 2 and 3 were 11, 9 and 41 weeks, respectively. Eighty-six percent, 65% and 33% of patients in Groups 1, 2 and 3, respectively, were steroid-dependent until death. Seizures occurred in 38 patients (48%). In 17 (21%), seizures were the first manifestation of metastasis. Of 51 patients not receiving prophylactic anticonvulsants, 37% had seizures. Of 12 patients treated prophylactically, 17% developed seizures. Surgical extirpation should be considered in highly selected patients with brain metastasis from melanoma. Prophylactic anticonvulsants are recommended if there is no contraindication.

Adrenal Cortex Hormones↗
PubMed1983

Neurological complications of Kaposi's sarcomat. An analysis of 5 cases and a review of the literature.

We analyzed the neurological complications in 25 patients with Kaposi's sarcoma, 5 encountered at Memorial Sloan-Kettering Cancer Center and 20 culled from the literature. Patients with all clinical forms of Kaposi's sarcoma [14 classical cases, 2 African cases, 5 cases associated with immunosuppressive therapy and 4 cases associated with acquired immunodeficiency syndrome (AIDS)] suffered neurological dysfunction which included neoplastic involvement of the nervous system (Kaposi's sarcoma or another primary), autoimmune disorders and opportunistic infections. Neoplastic involvement was recorded most frequently in patients with classical and African Kaposi's sarcoma and was favored in a setting of extensive tumor dissemination. Opportunistic infections (cryptococcal meningitis and cerebral toxoplasmosis) were observed in all forms of Kaposi's sarcoma but were most frequent in AIDS cases and correlated with the degree of immune dysfunction. Our data suggest that more diverse opportunistic central nervous system infections, neurological disorders of an autoimmune nature, and neoplastic involvement of the nervous system are to be anticipated in AIDS.

Adult↗
PubMed1983

Quantitative CT assessment of furosemide- and mannitol-induced changes in brain water content.

We studied the effects of two commonly employed antiedema agents, mannitol and furosemide, on CT brain density in eight patients with primary and metastatic brain tumors. Noncontrast CTs were performed before and after IV furosemide or IV mannitol, and serial blood samples were analyzed for osmolality. Computer-generated frequency histograms of CT numbers from "before-and-after" brain slices were using quantile-quantile (QQ) plots and the Kruskal-Wallis statistic. After IV mannitol, there was a progressive increase in CT brain density, which corresponded to an upward shift in the QQ plot over the range 0 to 70 Hounsfield units. The differences between baseline and posttreatment histograms for mannitol patients were significantly different from controls, and maximum differences coincided with peak serum osmolality. No statistically significant effects were observed in the furosemide group despite maximal diuresis. The relative magnitude of the quantitative changes observed after mannitol and furosemide administration are consistent with anticipated changes in brain water content.

Brain Edema↗
PubMed1982

Diagnosis and treatment of leptomeningeal metastases from solid tumors: experience with 90 patients.

The clinical findings and response to treatment of leptomeningeal metastases from solid tumors are analyzed in 90 patients treated at Memorial Sloan-Kettering Cancer Center during the period from January 1975 to February 1980. Patients included those who had either typical clinical findings of leptomeningeal tumor or conclusive laboratory evidence supporting the diagnosis. Carcinoma of the breast (46 patients), lung (23 patients) and melanoma (11 patients) were the common primary tumors. Symptoms of leptomeningeal metastasis occurred as the presenting sign in five patients and as late as ten years after the primary tumor was diagnosed in four other patients. Most patients had active systemic disease outside the nervous system. Signs and symptoms could be classified as involving either the brain, cranial nerves, or spinal nerves. Most patients had either symptoms or signs in more than one area at the time the diagnosis was established. The initial spinal fluid examination was abnormal in all but three patients, but only 49 had cytologic evidence of leptomeningeal metastases. Repeated spinal fluid assay yielded a positive cytology in 82 patients. Measurement of biochemical markers, including beta-glucuronidase, carcinoembryonic antigen and lactic dehydrogenase, assisted in the diagnosis. Approximately half of the patients treated by intraventricular methotrexate experienced improvement or stabilization of neurological symptoms for more than a month; median survival was 5.8 months after diagnosis, with a range of 1--29 months. In 18 patients disease was limited to the nervous system, and median survival was eight months, with four patients surviving one year and two patients for two years. Side effects of therapy were, for the most part, minor. We conclude that vigorous treatment of leptomeningeal metastases with intrathecal chemotherapeutic agents improves symptomatology in some patients, and at times prolongs survival.

Adult↗
PubMed1981

Lactic dehydrogenase isoenzymes in the cerebrospinal fluid of patients with systemic cancer.

Lactic dehydrogenase (LDH) isoenzymes were measured in the cerebrospinal fluid (CSF) patients suffering a variety of cancer-related neurologic problems. LDH-5 isoenzyme as a percentage of total LDH activity was abnormally elevated (above 10 to 15%) in leptomeningeal infiltration by carcinoma (breast carcinoma, lung carcinoma, and malignant melanoma) but not in other types of CNS metastases. Abnormal LDH isoenzyme patterns were also seen with CSF infections in which a granulocytic pleocytosis was present. In the absence of infection, an elevated LDH isoenzyme 5:1 ratio suggested leptomeningeal tumor and, when used with other CSF markers (beta-glucuronidase and CEA), LDH, isoenzymes aid in early detection of this metastatic neoplastic process. They may also help to differentiate leptomeningeal tumor from other chronic meningitides. Measurement of CSF markers also aids in assessing the effectiveness of treatment since marker levels often vary with the clinical course.

Brain Neoplasms↗