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Biomedical subjects

J Ransohoff

Publications and source records attributed to J Ransohoff.

At least 73 records · Page 4Linked to original sources
PubMed1984

Efficacy of methylprednisolone in acute spinal cord injury.

A multicenter double-blind randomized trial was conducted to examine the efficacy of a high dose of methylprednisolone (1,000-mg bolus and daily thereafter for ten days) compared with a standard dose (100-mg bolus and daily thereafter for ten days) in 330 patients with acute spinal cord injury. No difference in neurological recovery of motor function or pinprick and light touch sensation was observed between the two treatment groups six weeks and six months after injury. The lack of a treatment effect was independent of the severity of the initial lesion or the time from injury to starting treatment. Although not statistically significant, early case fatality was greater in the high-dose protocol (relative risk of 3.1 and 1.9, less than or equal to 14 and 15 to 28 days after injury, respectively) but not from 29 to 210 days after injury. Wound infections of both trauma and operative sites were more prevalent in the high-dose regimen (relative risk of 3.6).

Acute Disease↗
PubMed1984

Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization.

Functional angiographic investigation and percutaneous embolization using detachable balloons in nine carotid cavernous aneurysms, three petrous aneurysms, one vertebral artery aneurysm, and one posterior inferior cerebellar aneurysm are reported. A double-lumen balloon catheter is used to evaluate acute tolerance to occlusion of the carotid or vertebral arteries. Occlusion is tested under systemic heparinization. Local perfusion of heparinized saline, proximal as well as distal, to the balloon occlusion is used. The procedure was successful in all but one cavernous aneurysm. The arterial lumen was sacrificed in all cases. Clinical improvement occurred in all successful cases. Retro-orbital pain was relieved in all. Ocular cranial nerve palsies improved or resolved in most. One delayed ophthalmic episode that improved represents the only complication. No such embolic problems occurred in any case in which the cavernous carotid artery was occluded by balloon trapping. The delayed embolic complications after carotid artery occlusion are related to the collateral vessels to the C-4 and C-5 segments of the artery. Balloon trapping decreases the length of the thrombosed segment and prevents retrograde filing of the aneurysm.

Adult↗
PubMed1984

[Intraoperative localization of space-occupying intracranial processes using ultrasound].

During a two-year period, intra-operative ultrasonic explorations were performed in 44 patients for the purpose of localisation of intracranial masses. This facilitated accurate intraoperative assessment of the location and consistency of the mass. We consider operative ultrasound to be an invaluable adjunct to surgery of small intracerebral masses.

Brain Edema↗
PubMed1984

Hearing preservation--posterior fossa approach.

In patients with acoustic neurinomas protruding less than 2 cm from the porus acusticus and free of the brain stem, hearing can often be preserved. Our neurosurgical/otologic team uses the combined suboccipital/transmeatal approach with the patient in the seated position. This operation has been attempted on 21 patients from 1974 to 1982. Nine had tumors larger than 2 cm that touched the brain stem; one had useful hearing preserved. Of the 12 patients with tumors smaller than 2 cm, hearing at or near the preoperative level was preserved in seven. In one patient, hearing was improved. There have been up to 7 years of follow-up with no recurrences of the neurinomas or diminution of hearing evident on computed tomographic scan. All had preservation of the seventh cranial nerve, while complications were mild and comparable to the remainder of our 101 patients operated on during the same period. We will review the surgical technique and audiologic results in detail.

Adolescent↗
PubMed1984

Percutaneous transvascular treatment of giant carotid aneurysms: neuro-ophthalmologic findings.

Twelve of 17 patients with cavernous carotid aneurysms had balloon embolization directed through a percutaneous double lumen catheter for progressive pain, ophthalmoplegia, or visual loss. Functional angiography was carried out with systemic heparinization and double-lumen balloon catheters to test tolerance to carotid occlusion. Eleven were successfully treated, though two patients with initial preservation of the ipsilateral carotid artery had unplanned deflation of the balloon, necessitating re-embolization. No serious permanent neurologic complications occurred. All patients had complete resolution of pain, and nine had improvement in the extraocular eye muscle and lid function. Balloon trapping of the cavernous carotid artery, rather than placing the balloon directly into the aneurysm, resulted in involution of the aneurysm and decompression of the involved cranial nerves.

Adult↗
PubMed1984

Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization.

Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.

Angiography↗
PubMed1983

Transient neurologic disturbances, brain tumors, and normal computed tomography scans.

During a 4-year period, four patients presented with transient disturbances in neurologic function that were diagnosed as seizures in two and transient ischemic attacks in the other two. Computed tomography (CT scan), both with and without contrast, was normal in all four patients. Isotopic brain scans (3 patients), cerebral angiograms (4 patients), and lumbar punctures (4 patients) were normal. Electroencephalograms (EEG) were normal in two patients and abnormal in two patients (consisting of focal slowing). Within 4.5 months, all patients developed symptoms and signs of a brain tumor, and in all four, CT scan now revealed a large mass lesion which at surgery was shown to be a malignant astrocytoma. These four patients constituted 4% of the total number of patients with malignant astrocytomas that were seen at the NYU Medical Center during this same time period. It is stressed that the CT scan may be normal early in the course of patients with brain tumors, particularly if they present with a transient disturbance in neurologic function. The first evidence of the tumor in such patients may be a slow-wave abnormality on the EEG. Patients who are suspected of having a brain tumor should, if the initial CT scan is normal, have the scan repeated later.

Adult↗
PubMed1983

Immunity to transplantable nitrosourea-induced neurogenic tumors. II. Immunoprophylaxis of tumors of the brain.

An effective method was sought to immunize rats against the growth of intracerebrally (IC) injected T9 tumor, a gliosarcoma cell line. Rats which were immunized with either 10(6) T9 cells mixed with 0.14 mg C. parvum, or 10(7) irradiated T9 cells showed tumor immunity to intradermal (ID) transplantation. However, to obtain tumor immunity to an IC challenge of T9 cells, rats initially had to reject an ID challenge of T9 cells. After sequential rejections of ID challenges of as many as 10(7) cells, a high degree of immunity was obtained, allowing rejection of up to 5 X 10(6) T9 cells injected IC. Spleen cells from highly immunized rats mixed with T9 cells at a ratio of 1:25 (tumor:spleen) destroyed T9 tumor cells in a Winn test. Normal spleen cells had no effect on tumor growth. We conclude that: 1) T9 cells are moderately immunogenic, 2) an effective method of immunization of CDF rats against ID transplanted T9 cells is 10(6) T9 cells with 0.14 mg C. parvum or 10(7) irradiated T9 cells, 3) a higher degree of tumor immunity is necessary to reach the brain than is needed to reach the periphery, and 4) spleen cells of highly immunized rats are cytotoxic to T9 tumor cells.

Animals↗
PubMed1983

Early correction of orbicularis oculi paralysis with an encircling silicone prosthesis.

Fifteen patients with paralysis of the 7th and 5th nerves or the 7th nerve alone were treated with an encircling silicone prosthesis. There has been no serious ocular complication observed over the last 3 years. The prosthesis has been removed in 9 of the 15 patients in whom good 7th nerve recovery has occurred. In the remaining 6 patients, the prosthesis is being well tolerated.

Cranial Nerve Diseases↗
PubMed1983

Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma.

Within 3 weeks of definitive surgery, 609 patients with histologically demonstrated, supratentorial malignant glioma were randomized to receive, in addition to 6000 rads of radiotherapy, one of four treatment regimens: carmustine (BCNU), high-dose methylprednisolone, procarbazine, or BCNU plus high-dose methylprednisolone. We analyzed the data for the total randomized population and for the 527 patients (87% with glioblastoma multiforme) in whom the initial protocol specifications were met (the valid study group). Significantly longer survival was experienced by patients receiving procarbazine or BCNU alone compared to those receiving only high-dose methylprednisolone. No other pairwise comparisons demonstrated differences significant at the 0.05 level. However, the combination of BCNU plus high-dose methylprednisolone tended to be less effective than BCNU alone in patients with poor prognosis. This study indicates that BCNU and procarbazine are moderately useful agents in conjunction with radiotherapy for patients with malignant glioma. In addition, future protocols may allow use of corticosteroids in conventional dosages for treating cerebral edema and controlling symptoms; conclusions based on survival as the endpoint are unlikely to be affected by administering steroids at somewhat greater than the usual dose. More effective regimens for the treatment of malignant glioma should be sought.

Adolescent↗
PubMed1982

Malignant glioma. Results of combined modality therapy.

Multimodal treatment of malignant gliomas is routinely used at New York University Medical Center. Overall, our treatment program has resulted in survival rates of 78% at six months, 51% at one year, and 7% at five years for these high-grade brain tumors. However, various subgroups (based on tumor or host factors, or both) fared significantly better or worse than others. Particularly limited survival rates were found in patients who experienced paresis/paralysis or impaired mental function, who had tumors that were markedly anaplastic, who were elderly, or who for a variety of reasons did not receive the multimodal treatment we consider optimal.

Adult↗
PubMed1982

A study of reactions to Corynebacterium parvum (C. parvum) in the brain and dermis of the rat.

A comparative analysis was made of the histological changes caused by Corynebacterium Parvum (C. parvum) infected into the brain and dermis of normal and C. parvum presensitized rats. Control rats were injected with saline. It was shown that for approximately 3 days after the intracerebral injection the brain reacted with a polymorphonuclear cell infiltration. This reaction was replaced in order by lymphocytes, macrophages, and finally by epithelioid cells progressing to granuloma. The histological changes were similar but more intense in the dermis than in the brain. Lymphocytes reached a peak by day 7, macrophages by day 3, and epithelioid cells by day 18. In comparison to the dermis, the cellular infiltration in the brain is more delayed, less intense and of longer duration. Intracerebral saline induced a moderate lymphocytic infiltrate, and in C. parvum presensitized rats a more intense macrophagic response. It is concluded that the brain of the rat, especially in presensitized animal, mounts an inflammatory response to C. parvum which is morphologically similar to that seen in the skin.

Animals↗
PubMed1982

Measurement of spinal cord ischemia during operations upon the thoracic aorta: initial clinical experience.

Paraplegia has been an unpredictable, devasting complication following operations upon the thoracoabdominal aorta for over 30 years. The frequency ranges from 0.5% with operations for coarctation to as high as 15% following surgery for thoracoabdominal aneurysms. Both uncertainty and controversy exist about the value of different protective methods during aortic crossclamping (AXC): heparinized shunts, partial bypass, and reimplantation of intercostal arteries. This report describes the authors' initial clinical experience with a highly sensitive indicator of spinal cord ischemia, somatosensory evoked potentials (SEP) in an attempt to prevent paraplegia associated with surgical procedures on the thoracoabdominal aorta. Seven consecutive patients (one coarctation, five thoracic aneurysms, one thoracoabdominal aneurysm) underwent continuous operative monitoring of SEP. Cortical response to simultaneous electrical stimulation (20 mAmps, 0.6 mSec., 2.3 cps) of both the right and left posterior tibial nerves was recorded before, during, and after AXC, and following operation. When ischemic changes were detected by SEP, increasing distal circulation by different maneuvers (heparinized shunt, femoral-femoral bypass, reimplantation of intercostal arteries) reversed these changes. In two patients with thoracic aneurysms, ischemic changes appeared within three minutes after AXC and all potentials disappeared in nine minutes. Rapid insertion of a graft (AXC 28 and 37 minutes) resulted in SEP return 40 minutes following restoration of flow. These changes were prevented by a heparinized shunt in two patients, femoral/femoral bypass in one, and T8-T9 intercostal reimplantation in one. No SEP changes occurred in the patient with coarctation. No postoperative neurologic complications occurred. Continuous operative monitoring of SEP has exciting possibilities for preventing paraplegia. It is simple, highly sensitive, and seems to provide a precise measurement of adequacy of circulation to the spinal cord.

Adolescent↗
PubMed1982

Role of radiation therapy in the management of meningioma.

Surgery is the accepted form of treatment of meningioma; the role of radiotherapy has not been clearly established. With this in mind, we have reviewed our experience with radiation therapy in the management of meningiomas at New York University Medical Center. Sixty-eight patients fell into three groups. Forty-three (Group A) underwent operation followed by radiation therapy, 14 patients (Group B) had radiation for recurrence after operation, and 11 patients (Group C) had radiation therapy as the primary treatment. In Group A, 41 of 43 are alive. During a follow-up of 1 to 10 years, only 2 have deteriorated. Five of 14 Group B patients showed neurological improvement and 7 showed deterioration, including 5 who died of tumor. All 11 patients in Group C are alive with follow-up periods of 3 to 6 years; 9 of these show improvement in neurological function. Eleven patients had malignant meningioma, of whom 8 are alive and stable. We present 4 case reports, including computed tomographic scans that show evidence of tumor necrosis after radiation therapy. Pathological verification of tumor necrosis is presented in 1 case. We believe that radiation therapy has an established role in the treatment of incompletely excised, recurrent, or malignant meningiomas and, in some cases, as the initial management of meningiomas. Indications for treatment and guidelines are presented.

Bone Neoplasms↗
PubMed1982

Long term survival among patients with malignant brain tumors.

Eight of 57 patients (14%) with malignant astrocytomas lived at least 2 years. The mean survival time was 143 weeks (range, 104 to 250 weeks). All of the patients were treated with operation, radiation, and chemotherapy. Four of the 8 patients died because of tumor recurrence, 1 died from a second primary tumor, 2 died of cases unrelated to the tumor, and 1 is still alive. Diffuse cortical dysfunction associated with cortical atrophy that could not be related to tumor regrowth and was not explained by focal deficits, psychotic of depressive thought disorders, metabolic or endocrine abnormalities, or hydrocephalus developed in the 3 longest-surviving patients. The diffuse dysfunction was initially apparent only through psychometric testing, but eventually became so disabling as to result in 2 of the 3 patients retiring from work. Although small, but gratifying, gains have been made in the treatment of patients with malignant brain tumors, accompanying these gains have been problems of a magnitude that is only now beginning to be appreciated.

Adult↗
PubMed1982

Serologic analysis of nitrosourea-induced rat gliomas.

Inbred CDF rats (cesarean-delivered F344 rats) were immunized with either a nitrosourea-induced glioma EA-285 or its subline EA-285A and both with and without Corynebacterium parvum. A humoral immune response in syngeneic rats to the immunizing tumor was demonstrated with micromodifications of different rosette assays (immune adherence assay, protein-A assay, and anti-C3-mixed hemadsorption assay). Extensive absorption studies of two immune sera with the highest reactivity revealed two glioma-specific antigens (or two components of one antigen) on the cell surface of the cloned tumor subline. One antigen was present only on the cell surface of the subline of the glioma used for both immunization and absorption analyses. The other antigen appeared on the cell surface of both the cloned subline EA-285A and the parental cell line EA-285. These preliminary studies showed that CDF rats immunized against a syngeneic glioma mounted a humoral immune response that appeared to be individually tumor-specific.

Animals↗