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Biomedical subjects

M A Rockoff

Publications and source records attributed to M A Rockoff.

At least 37 records · Page 2Linked to original sources
PubMed1990

Role of stereotactic radiosurgery with a linear accelerator in treatment of intracranial arteriovenous malformations and tumors in children.

Between 1986 and 1988, 16 children were treated for 10 arteriovenous malformations and 6 recurrent intracranial tumors with stereotactic radiation therapy using a modified Clinac 6/100 linear accelerator. The median age of our patients was 10.5 years. For the group with arteriovenous malformation, follow-up ranged from 6 months to 37 months (median was 20 months). No patient bled during the follow-up period. Five of eight patients with follow-up longer than 12 months have achieved complete obliteration of their arteriovenous malformation by angiogram. The four remaining patients who have not achieved a complete obliteration are awaiting their 2-year posttreatment angiogram. The other patient has been treated within the year and have not yet been studied. Five of the six recurrent tumor patients are alive with a median follow-up of 8 months. The remaining patient was controlled locally, but he died of recurrent disease outside the area treated with radiosurgery. The radiographic responses of these patients have included three complete responses, two substantial reductions in tumor volume (greater than 50%) and one stabilization. Despite previous radiotherapy, there have been no significant complications in these patients. We conclude that stereotactic radiation therapy using a standard linear accelerator is an effective and safe technique in the treatment of selected intracranial arteriovenous malformations and tumors in children. In addition, stereotactic radiosurgery may have unique applications in the treatment of localized primary and recurrent pediatric brain tumors.

Adolescent↗
PubMed1987

Surgical division of craniopagi.

The world's surgical experience on the division of craniopagi is reviewed, and a new case is reported. The problems, including ethical considerations, that must be addressed in selecting patients for operation and in preparing for the procedure are discussed in detail. Hemodynamic stability and the problem of intraoperative gravitational distortion of the brain are addressed. The importance of careful planning is stressed. Survival of the 31 craniopagi after operation is discussed in relation to types of junction.

Brain↗
PubMed1986

Cardiac arrest following inhalation induction of anaesthesia in a child with Duchenne's muscular dystrophy.

Cardiac arrest occurred in a 5 1/2-year-old child with suspected Duchenne's muscular dystrophy ten minutes following induction of anaesthesia with halothane, nitrous oxide and oxygen. No muscle relaxants were administered. The cardiac arrest was associated with hyperkalaemia, acidosis, myoglobinuria, elevated serum creatine phosphokinase and a 1.6 degrees C rise in temperature. The child made a complete recovery after receiving 90 minutes of cardiopulmonary resuscitation.

Anesthesia↗
PubMed1985

Subclinical brain swelling in children during treatment of diabetic ketoacidosis.

Clinically apparent cerebral edema is a rare and often fatal complication of diabetic ketoacidosis. To determine whether subclinical brain swelling occurs more commonly, we obtained cranial CT scans in six children with diabetic ketoacidosis treated with fluid resuscitation and continuous low-dose insulin therapy. Control scans were obtained before hospital discharge. Compared with the scans during convalescence, the early scans of all six children showed a narrowing of the brain's ventricular system, compatible with brain swelling. Average changes in diameter were 1.3 +/- 0.1 mm for the third ventricle and 3.7 +/- 0.8 mm for the lateral ventricles (P less than 0.01). In addition, a narrowing of the subarachnoid spaces was subjectively noted during a blind reading of the early scans. Although no single scan was overtly indicative of cerebral edema, the data suggest that subclinical brain swelling may be a common occurrence during treatment of diabetic ketoacidosis in children. Sequential CT scans of the brain may provide a means of evaluating modifications of standard therapy aimed at preventing cerebral edema.

Adolescent↗
PubMed1984

Fatal pulmonary embolism following removal of a central venous catheter.

A 1-year-old child developed fatal septic pulmonary embolism upon removal of a central intravenous catheter. Histologically identical material was found in the pulmonary arteries and in the inferior vena cava at the catheter tip site. The pathophysiology of pulmonary embolism occurring during childhood is reviewed.

Catheters, Indwelling↗
PubMed1984

Apnea testing to confirm brain death in children.

The diagnosis of brain death requires absence of respiratory effort. Various protocols for apnea testing in adults have been reported; however, similar protocols have not been established for children. The technique of apneic oxygenation was used on 10 brain-dead children. PaO2 remained over 200 torr in all patients, and the mean PaCO2 increase was 4 torr/min. Five min of apneic oxygenation is a safe and effective means of evaluating respiratory activity in initially normocapnic children thought to be brain-dead.

Adolescent↗
PubMed1984

Diabetes insipidus accompanying brain death in children.

Diabetes insipidus (DI) developed in 14 of 16 children who satisfied criteria for brain death. The occurrence of DI after an hypoxic/ischemic insult may represent midbrain death and seems to be a clinically useful sign in the diagnosis of brain death in children. In two patients, DI resolved spontaneously; these patients and children without DI may have had small areas of residual cerebral blood flow and brain function. The onset or cessation of DI was temporally associated with the use of dopamine in three patients.

Adolescent↗
PubMed1983

Reye's syndrome.

Although most cases of Reye's syndrome that were initially reported were fatal, the overall mortality is now 20 to 30 per cent, with an even lower rate in some series. Improvement is due to both increased awareness of this disease and advances in care for the critically ill child. A good outcome depends on recognition of the early manifestations of the syndrome and appropriate initial therapy based on the stage of the disease.

Adolescent↗