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Biomedical subjects

K D Post

Publications and source records attributed to K D Post.

At least 55 records · Page 3Linked to original sources
PubMed1990

Intramedullary ependymoma of the spinal cord.

A consecutive series of 23 patients underwent operative removal of an intramedullary spinal cord ependymoma between January, 1976, and September, 1988. Thirteen women and 10 men between the age of 19 and 70 years experienced symptoms for a mean of 34 months preceding initial diagnosis. Eight patients had undergone treatment prior to tumor recurrence and referral. Mild neurological deficits were present in 22 patients on initial examination. The location of the tumors was predominantly cervical or cervicothoracic. Radiological evaluation revealed a wide spinal cord in all cases. Magnetic resonance (MR) imaging was the single most important radiological procedure. At operation, a complete removal was achieved in all patients. No patient received postoperative radiation therapy. Histological examination revealed a benign ependymoma in all cases. The follow-up period ranged from 6 to 159 months (mean 62 months) with seven patients followed for a minimum of 10 years after surgery. Fourteen patients underwent postoperative MR imaging at intervals ranging from 8 months to 10 years postoperatively. No patient has been lost to follow-up review and there were no deaths. No patient showed definite clinical or radiological evidence of tumor recurrence during the follow-up period. Recent neurological evaluation revealed functional improvement from initial preoperative clinical status in eight patients, no significant change in 12 patients, and deterioration in three patients. The data support the belief that long-term disease-free control of intramedullary spinal ependymomas with acceptable morbidity may be achieved utilizing microsurgical removal alone.

Adult↗
PubMed1990

Intradural extramedullary tumors in adults.

Meningioma, nerve sheath tumors, and filum terminale ependymoma account for over 90% of primary intradural extramedullary tumors in adults. The demographics, radiological evaluation, and surgical techniques employed for their removal are reviewed in this article. The authors' approach to intraspinal tumors with extraspinal extension is discussed.

Adult↗
PubMed1990

Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients.

A retrospective review of 16 consecutive patients with pituitary apoplexy treated over a 10-year period is reported. Eight men and 8 women (mean age, 48 years) underwent transsphenoidal decompression after an average duration of symptoms of 19 days. The diagnosis of pituitary apoplexy was made by the sudden onset of headache (88%), nausea (56%), or meningismus (13%), with or without visual disturbances (75%), in the setting of a sellar tumor on computed tomographic or magnetic resonance imaging scans. Thirteen of 16 patients showed significant improvement of symptoms after surgery (average follow-up, 2.5 years). In addition, 5 patients with clinically silent yet extensive pituitary hemorrhage were treated. Although extensive pituitary hemorrhage often produced fulminant apoplexy, it also presented insidiously over many days with few, if any, clinical signs. Rapid diagnosis, endocrine replacement, and transsphenoidal decompression constituted effective therapy. Magnetic resonance imaging (after at least 12 hours of symptoms) was superior to computed tomography in detecting hemorrhage.

Adenoma↗
PubMed1989

Craniofacial resection of ossifying fibromas and osteomas of the sinuses.

Massive fibro-osseous lesions of the frontal and ethmoidal sinuses are rare. If left untreated, these lesions can produce chronic infection, orbital complications, and/or intracranial events. In the past, resection of these lesions has usually been subtotal and a risk of damage to intracranial structures existed, particularly to the dura, due to poor exposure, and a high recurrence rate was also present. We have treated eight such lesions with a combined craniofacial approach for total resection with resolution of symptoms, without recurrence, and without occurrence of cerebrospinal fluid leak, damage to the orbital contents or intracranial structures, or resultant cosmetic deformity.

Adolescent↗
PubMed1989

Lymphocytic hypophysitis. Report of 3 new cases and review of the literature.

Lymphocytic hypophysitis is an uncommon but increasingly recognized disorder characterized by chronic inflammation and destruction of the anterior pituitary. Three new cases are presented here with a review of the 27 previously reported cases. The disease affects primarily young women in late pregnancy or in the postpartum period but also has been described in postmenopausal women and in one man. It presents as an expanding intrasellar mass or as partial or panhypopituitarism. The etiology may be autoimmune. The natural history of this entity begins with enlargement of the pituitary secondary to inflammatory infiltration and progresses to atrophy of the gland with destruction of pituitary tissue and replacement with fibrosis. At least 1 patient had documented recovery of pituitary function, and the overall potential incidence of recoverable function is unknown. Our improved understanding of this disease has led us to conclude that surgical intervention is not always necessary.

Adolescent↗
PubMed1989

Metastatic carcinoma to the pituitary gland.

Four patients with metastatic carcinoma to the pituitary gland are presented. Two of these patients had no previous history of malignancy and, based on clinical, laboratory, and radiological evaluation, a preoperative diagnosis of pituitary adenoma was made. In one patient, the histological diagnosis of two consecutive tumour specimens, obtained 1 year apart, was pituitary adenoma. The correct diagnosis of metastatic renal-cell carcinoma was not ascertained until autopsy. In the second patient, a diffusely infiltrating breast carcinoma was diagnosed by mammography and confirmed by biopsy, after pathological examination of the sellar tumour revealed carcinoma. The third patient underwent mastectomy 3 years earlier for breast carcinoma and had known metastatic disease. The fourth patient had known metastatic endometrial carcinoma when she became symptomatic from a pituitary metastasis. The incidence, clinical features, and pathophysiology of metastatic carcinoma to the pituitary gland are discussed.

Adult↗
PubMed1988

Atlantoaxial subluxation in psoriatic arthropathy.

Symptomatic atlantoaxial dislocation occurs rarely in psoriatic arthropathy and has previously been reported only as a late complication in this disorder. We report severe upward axial dislocation and acquired basilar impression as a presenting manifestation of psoriatic arthropathy. Magnetic resonance imaging is useful in evaluating this condition.

Adult↗
PubMed1988

Metastatic carcinoma to pituitary adenoma. Report of two cases.

The authors present two patients with symptomatic carcinomas which have metastasized to pituitary adenomas. Despite the advanced age of these patients, the preoperative clinical and radiologic evaluations were consistent with pituitary adenoma. There was no previous history of malignancy in either patient, and the symptomatic pituitary metastases were responsible for the initial presentations. A review of the literature is presented with emphasis on the incidence and possible factors responsible for tumors metastasizing to distant neoplasms.

Adenoma↗
PubMed1988

Cavernous malformations of the spinal cord.

Six patients with intramedullary cavernous malformations of the spinal cord are presented. Four men and two women presented with acute, subacute, or episodic signs and symptoms of spinal cord dysfunction, ranging in duration from 3 days to 25 years. All patients underwent operative resection of the malformation. Complete removal was achieved in five patients. Neurological function either stabilized or improved postoperatively in all patients; follow-up ranged from 4 to 84 months. The increasing awareness of the propensity for recurrent hemorrhage, clinical features, and resectability of these malformations are discussed.

Adolescent↗
PubMed1988

Trigeminal schwannoma. Surgical series of 14 cases with review of the literature.

A consecutive series of 14 patients with trigeminal schwannoma managed surgically at the Neurological Institute of New York since 1970 is reported. Nine women and five men (mean age 40 years) were diagnosed following a mean symptom duration of 33 months. Abnormalities of trigeminal nerve function were present in 11 patients on admission examination. Facial pain was a prominent feature in eight patients. Two patients, both with schwannomas arising from the trigeminal root, presented initially with typical trigeminal neuralgia. Additional cranial nerve palsies or cerebellar or pyramidal tract signs were noted in eight patients. The surgical approach to these tumors depends on their anatomical location. Four patients had tumors confined to the middle fossa, three patients had tumors limited to the posterior fossa, and seven patients had both supratentorial and infratentorial components of their tumors. Twenty operative procedures were performed on these patients, resulting in complete extirpation in six patients, nearly complete removal in seven patients, and partial removal in one patient. Adherence of the tumor to the lateral wall of the cavernous sinus or the brain stem precluded total removal. There was one postoperative death. In the immediate postoperative period, abnormalities of cranial nerves controlling the extraocular muscles were common. In general, these deficits were transient; however, some permanent loss of trigeminal nerve function occurred in nine patients. Two patients required tarsorrhaphy for neurotropic keratitis, and two patients underwent cerebrospinal fluid (CSF) shunting procedures for hydrocephalus or for a persistent CSF leak. The follow-up period ranged from 4 to 177 months (mean 47 months). The clinical features, anatomical considerations, and surgical approach to these rare tumors are discussed. A clinical review of 106 additional cases of trigeminal schwannoma, reported in the English literature since 1935, is also presented.

Adolescent↗
PubMed1987

Differential diagnosis of pituitary tumors.

Many parasellar lesions may mimic pituitary adenomas clinically, endocrinologically, and radiologically. Certain patterns do lead suspicion toward the correct diagnosis, whereas in other cases the diagnosis may be difficult. For most of these lesions, the treatment of choice is different from that for a pituitary tumor, so correct diagnosis is of paramount importance. The presenting signs and symptoms as well as radiologic manifestations of parasellar tumors and conditions are discussed.

Abscess↗
PubMed1986

Motilin-related immunoreactivity in mammalian adenohypophysis.

Motilin, a gut peptide recently demonstrated in the mammalian brain and anterior pituitary, was localized immunocytochemically in rat, guinea pig, and human anterior pituitary glands with two antisera to synthetic porcine motilin. Adjacent sections of normal glands were immunostained for motilin, growth hormone, and prolactin reactivity. Motilin reactivity was consistently seen in somatotrophic regions of the mammalian glands and in many instances was colocalized in individual somatotrophs traced in adjacent sections stained for growth hormone. There was no motilin activity discerned in prolactin-secreting regions of the gland. These studies reinforce the close relationship of motilin or a motilin-like peptide with growth hormone in normal somatotrophs. Further anatomical and in vitro studies with tumor material will be useful in elucidating the physiological relationship of motilin to growth hormone.

Animals↗
PubMed1986

Management of pituitary tumors.

Pituitary adenomas represent the only true adenomas of the cranial cavity. In 1000 asymptomatic pituitary glands examined at autopsy, there was a 22.4 per cent incidence of undetected microadenomas. Advances in diagnostic endocrinology, in radiologic imaging, and in surgical and medical treatments have brought many more patients to the attention of the authors. Over the last 10 years, their treatment approaches have evolved to those presented in this article.

Acromegaly↗
PubMed1985

Ciliated craniopharyngioma.

A tumor of Rathke's cleft origin was studied, which showed some histologic features consistent with craniopharyngioma, but also had ciliated and mucin-containing cells more commonly observed in Rathke's cleft cysts. The combination of features provides further evidence that craniopharyngiomas and Rathke's cleft cysts have a common embryonic origin.

Craniopharyngioma↗
PubMed1984

Long-term follow-up of transsphenoidal selective adenomectomy for prolactinoma.

Although transsphenoidal selective resection of prolactinoma has high cure rates and low morbidity, the frequency of late recurrence of adenoma is controversial. Long-term follow-up data were available on 29 of our patients having initial return to normal prolactin levels after microadenoma resection; in 24, prolactin levels remained normal at 50 +/- 3 months' (range, 11 to 81 months) follow-up. Five patients manifested hyperprolactinemia again after intervals of six to 16 months. In five patients with normal prolactin levels immediately after macroadenoma resection, who were available for long-term follow-up, prolactin levels remained normal in four at 41 +/- 3 months; one patient had a relapse 78 months after surgery. Testing of prolactin secretory dynamics six weeks postoperatively was not predictive of who would suffer relapse. It is not known whether these relapses are due to regrowth of tumor remnants or represent new tumor formation.

Adenoma↗
PubMed1984

Depression of circulating blood volume in patients after subarachnoid hemorrhage: implications for the management of symptomatic vasospasm.

The result of 42 blood volume determinations made with autologous red blood cells labeled with chromium-51 are reported. The subjects consisted of 11 control patients and 25 patients with recent subarachnoid hemorrhage (SAH). The mean red blood cell volume (RBCV) and the total blood volume (TBV) for female patients after SAH were significantly lower than corresponding control values (P less than 0.01). No depression of blood volume was found in males as a group. Seventy-two per cent of females had below-normal RBCV and 50% had below-normal TBV. Fifteen patients demonstrated angiographic vasospasm or signs of cerebral ischemia. Only 1 patient with asymptomatic vasospasm had a below-normal RBCV or TBV, whereas 6 of 7 patients with symptomatic vasospasm had a subnormal RBCV or TBV. The mean RBCV and mean TBV for female patients with symptomatic vasospasm were significantly lower than corresponding control values (P less than 0.02) and lower than values for female patients with asymptomatic vasospasm (P less than 0.05). The data suggest that volume status may be the important differential between asymptomatic and symptomatic vasospasm. Delayed ischemic deficits can be expected to develop in patients who have both spasm of the intracranial vessels and decreased TBV. Patients with normal blood volume are far less likely to experience cerebral ischemia, even if vasospasm develops.

Adult↗
PubMed1983

Sclerosing orbital pseudotumor.

We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our case, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.

Adult↗