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Biomedical subjects

M Feinsod

Publications and source records attributed to M Feinsod.

At least 19 recordsLinked to original sources
PubMed1992

[Brain abscess following skull traction].

A case of brain abscess developing after skull traction for fracture of the dens is presented. The abscess was most likely caused by retrograde septic thrombophlebitis via the superficial cortical veins. The abscess was drained and treatment with antibiotics was according to sensitivity on culture. 3 months after surgery there was mild residual paresis of the left hand. The need for close follow-up of patients prone to this complication is emphasized.

Adult↗
PubMed1992

Effect of histamine H2 receptor antagonists on the secretion of cerebrospinal fluid in the cat.

Following a recent report that epithelial cells of the choroid plexus possess histamine H2 receptors, the effect of cimetidine and ranitidine, histamine H2 receptor antagonists, on the secretion and electrolyte content of CSF was examined. Fifty cats were divided into one control (n = 6) and six experimental groups. CSF was collected by puncture of the cisterna magna following pentobarbital anesthesia, and its volume, concentrations of Na+, K+, Cl-, and pH were determined. Cimetidine or ranitidine (50, 20, or 10 mg/kg) was injected intravenously 2 h after the start of the test, and their concentrations were measured in hourly blood samples and in 30-min aliquots of CSF in the 50 mg/kg experimental groups. Whereas the secretion of CSF did not change over 6 h in the control group, it decreased significantly by 30-60 min after injection of cimetidine or ranitidine and remained low for the following 6 1/2 h in all experimental groups except the 10-mg ranitidine group. Peak cimetidine and ranitidine concentrations in CSF in the 50-mg experimental groups were noted 60 and 90 min, respectively, after intravenous injection. CSF electrolyte concentrations and pH did not change during the test in any group. We conclude that intravenous cimetidine or ranitidine can significantly reduce CSF secretion in the cat, possibly by competitive inhibition of the histamine effect on H2 receptors located on the choroid plexus epithelial cell, or by a direct effect on the capillaries of the choroid plexus.

Animals↗
PubMed1991

Development of auditory brainstem evoked potentials in newborn infants: a three-channel Lissajous' trajectory study.

Auditory brainstem evoked potentials (ABEP) were recorded from 50 newborns (35-43 weeks gestational age), using three orthogonal differential electrode pairs, in addition to the widely used vertex-mastoid derivation. Potentials were evoked by alternating polarity, 75 dBnHL clicks presented monaurally at a rate of 10/s. From the records of the three orthogonal electrode pairs (nasion-inion; vertex-spinous cervical process VII; left-right mastoids), Three-channel Lissajous' trajectories (3CLT) were derived and analyzed. 3CLT point-by-point, as well as segmental descriptors were compared with peak latencies of the vertex-mastoid derivation. Point-by-point 3CLT descriptors included apex amplitude, latency and orientation. Segmental descriptors included planar segment beginning latencies, duration and orientation. The interpretation of these results in relation to developmental aspects of the auditory system, as well as to the question of ABEP generators, is enhanced by using 3CLT descriptors of ABEP, which are more comprehensive than their single-channel counterparts. 3CLT apices correlated well with the Vertex-Mastoid defined peaks. Both peak and apex latency changes indicate that at the developmental stages surveyed in this study, development takes place in the more central portions of the pathway, whereas the peripheral portion is already relatively mature. The results also indicate a maturational change in the relative contributions of constituent generators of ABEP components.

Brain Stem↗
PubMed1991

The association between skull fracture, intracranial pathology and outcome in pediatric head injury.

We prospectively studied 653 consecutive head-injured children (less than or equal to 14 years old) treated over a 54-month period (1984-88) at the Department of Neurosurgery of the Rambam Medical Center (Haifa, Israel). Demographic and clinical data were collected, the patients were divided into five age groups (birth to 2 years, 169; 3-5 years, 194; 6-9 years, 164; 10-12 years, 77; and 13-14 years, 49), and the information relative to each was then compared. All patients (except three who died on the operating table) underwent computed tomography (CT) scans; 225 (34.6%) had intracranial pathology, e.g. focal mass lesions, diffuse axonal injury, and subarachnoid haemorrhage. The rate of detected pathology increased with age. Skull fracture was documented in 468 (72%) patients. Craniotomies were done on 114 (17.5%) patients. After 3 months, the patients were classified as having good recovery (84.8%), moderate disability (5.5%), or severe disability (2.3%); 0.9% were in a vegetative state. The mortality was 6.6% (43 patients); of these, 39 (90.7%) had admission Glasgow Coma Scale scores below 8. In our area the annual incidence of neurosurgical hospitalization due to head injury in the pediatric group was 37.6 per 100,000 inhabitants per year. This study substantiates the findings of other series on the effects of prognosis of factors such as associated trauma, admission Glasgow Coma Score, mass lesions with persistent intracranial pressure elevation, or diffuse axonal injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Penetrating craniocerebral injuries in civilians.

During a 6-year period (1984-89), 31 patients were treated at Rambam Medical Center with penetrating craniocerebral injuries (PCCI) not associated with military action. Eighteen (58%) patients died during their initial hospitalization; only two of them had admission Glasgow Coma Scale (GCS) above five. The admission GCS coupled with the mode of injury (type of missile and motivation of shooting) were valuable for early accurate prognosis assessment. Patients with admission GCS of 3 and 4 invariably died despite rapid treatment and attempted haematoma evacuation. The neurological status, CT appearance, as well as the motivation of shooting should be considered in order to assess accurately the possible outcome. Compared with our military series of 113 patients with PCCI, there were more extensive injuries, although the mean period until neurosurgical treatment was the same. Long-term complications connected to dural tears remote from the entrance wound occurred in three of the survivors.

Adolescent↗
PubMed1990

[Head and brain injuries in bicyclists].

44 patients were hospitalized for neurosurgical care after bicycle accidents during a period of 50 months. Ten times as many were injured in other types of road accidents. 42 of the 44 cases had brain injury, with a mean hospitalization of 9.7 days. A third needed operation and a fourth were discharged with residual neurological deficits. The low incidence of 0.95 cases per 100,000 per year led us to examine the factors which limit the use of bicycles in our region. The severity of the injuries in our cases was much greater than in those in other countries, with a mean injury severity score of 14.2. None of our cases had worn a protective helmet, and we join in the world-wide plea for an educational campaign for their use.

Bicycling↗
PubMed1990

Head trauma in northern Israel: incidence and types.

A descriptive epidemiological study of neurotraumatology was undertaken over a 4.5-year period at a regional hospital with a referral base of 1,200,000 residents served by a single neurosurgical department. Neurosurgical evaluations and treatments were given to 1,370 patients in this period. The data base consists of demographic, clinical and radiological features at the time of admission, as well as the hospital course through discharge. The crude incidence rate was 25.2 +/- 3.1 cases per 100,000 person-years (similar to that of three neurosurgical units in Scotland). Age adjustment showed almost twice this rate at the two extremes of age and a smaller elevation in early adulthood. The crude incidence was 36.9 for males and 13.4 for females (p less than 0.01). Age-specific incidence rates in Jews compared to other ethnic groups were reported. Falls had an incidence of 12.8 (51%), road accidents 9.0 (35.7%) and assaults 2.3 (9%) per 100,000 person-years. Other causes were accidents during work or sport and suicide. The rate of brain pathology as revealed by computerized tomography steadily increased from 19% in childhood to 71% in the elderly with a mean of 41.8%. A similar increasing trend with age was found in the rate of intracranial mass lesions (mean 28.3%), impaired consciousness (30.4%) and mortality (13%).

Adolescent↗
PubMed1990

Penetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict, 1982-1985. Analysis of a less aggressive surgical approach.

From June, 1982, through June, 1985, 113 patients were evacuated to Rambam Maimonides Medical Center with penetrating craniocerebral injuries sustained in ongoing military hostilities in Lebanon. Two factors distinguished this group of patients from those presenting in earlier conflicts: 1) this was the first large series in which computerized tomography (CT) was routinely used to initially evaluate combat head injuries; and 2) in an effort to preserve maximum cerebral tissue, intracranial debridement was significantly less vigorous than that advocated during the Korean or Vietnam conflicts. No efforts were made to locate or remove in-driven bone or metal fragments visualized on CT unless they readily presented themselves on gentle irrigation. In fact, it was elected to treat a number of patients without intracranial hematomas nonoperatively. The acute outcome was quite similar to that reported in Vietnam series in respect to both complications and mortality. Of the 83 survivors, 46 were Israeli citizens and thus were available for follow-up review. These 46 patients were reevaluated in late 1988, a mean follow-up period of 5.9 years. None had died in the interim; 10 had developed chronic seizure disorders, and there was one case of delayed meningitis in a patient with no retained fragments. Repeat CT scans were performed on 43 patients; 22 (51%) were found to have retained intracranial bone fragments. No relationship existed between the presence of retained fragments and the development of either a seizure disorder or an infection of the central nervous system. These findings suggest that not only is it unnecessary to reoperate for retained bone fragments, but it may also be possible to temper the initial debridement in an effort to preserve additional cerebral tissue.

Brain Injuries↗
PubMed1990

Diffuse axonal injury: analysis of 100 patients with radiological signs.

One hundred patients with head injuries who showed diffuse axonal injury on computed tomographic scans are reported. Evaluation of the Glasgow Coma Score, pupillary signs, and computed tomographic findings on admission led to an improved ability to forecast outcomes. Our relatively good results as compared with other series, can be explained by the high proportion of children and by the liberal use of computed tomography to evaluate head injuries, thus revealing that concussion may sometimes be regarded as an early form of diffuse axonal injury.

Adult↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. I: Penetrating craniocerebral injuries.

The present report analyzes 116 penetrating wounds of the brain sustained during warfare in Lebanon during 1982-85. Two basic mechanisms of injury were encountered: high-velocity bullets, and shrapnel and stones from explosive devices; and in one case a radio antenna penetrated the head through the orbit. The site of impact was at the convexity in 87% of cases and at the base of the skull in the remaining 13%. Surgery was performed in 83% of the patients: debridement-craniotomy in 73%, burr hole for intracranial pressure monitoring only in 6% and scalp closure only in 4%. The remaining 17% did not require surgery because of transbasal penetration without intracranial mass (10%) or due to moribundity. Indriven bone or foreign body fragments were removed only if readily accessible. The mortality rate was highest among patients with a Glasgow Coma Scale of less than or equal to 4 on arrival, after high-velocity bullet wounds, when the intracranial path was multilobar or transventricular, and when associated lesions were accompanied by shock. A follow-up study of the 49 Israeli survivors for almost 6 years revealed intracerebral-retained bone fragments in 48%, but these did not result in increased immediate or late complications (e.g., infection, epilepsy). These results support our conservative approach. Since all victims of penetrating head injuries were evacuated from Lebanon to Rambam Medical Center, Haifa, our report can serve as an estimation of the incidence of penetrating brain wounds and their burden on a front-line hospital.

Brain↗
PubMed1990

Wartime neurosurgical experience in Lebanon, 1982-85. II: Closed craniocerebral injuries.

This report presents 64 patients who sustained military-related closed craniocerebral injuries during the Lebanon conflict of 1982-85, all of whom underwent CT scanning at the initial assessment. Of these, 59% required surgery for removal of hematomas, depressed fractures and for monitoring intracranial pressure, in addition to intensive care management of elevated intracranial pressure and associated insults. CT scan revealed brain concussion only in 23%, depressed fracture in 9%, brain contusion alone in 17%, extracerebral hematomas in 17%, intracerebral hematomas in 11%, and diffuse axonal injury in 22%. Overall mortality was 19%, and the outcome was good in 69%. Various factors affecting survival are discussed, and our findings are compared with those in the literature concerning closed head injuries among civilians. Attention is drawn to the high proportion of diffuse brain injury due to blasts caused by side mines. Despite continued efforts to hasten evacuation from the field and improve the management of warfare-related head trauma, the outcome is still far from satisfactory.

Blast Injuries↗
PubMed1988

SPECT quantitation of cobalt-57 bleomycin delivery to human brain tumors.

A newly developed and validated noninvasive quantitative SPECT method was used to measure the in vivo uptake of [57Co]bleomycin (Co-bleo) in 13 human brain tumors and the uptake of [99mTc]glucoheptonate (GH) in 23 brain tumors. Significant differences in tumor uptake were found. The tumor concentration over time, the tumor to blood radio at 30 min and the tumor cumulative concentration of radioactivity showed marked differences even between tumors with the same histology. Only a weak correlation was found between tumor concentration of Co-bleo and of GH. Therefore a simple imaging agent such as GH cannot, at the present time, serve as an indicator of individual tumor uptake and further experience with other agents is still necessary. Contrary to the generally held view, no correlation was found between the concentration of drug in the blood and its tumor concentration. It is suggested therefore that the level of a drug in the blood cannot be used as a criterion of the amount that will penetrate the tumor. Direct SPECT measurement of the concentration of the drug in the tumor itself should be performed. The bioavailability of a drug is critical in order for it to exert it tumoricidal effect. The results, showing marked differences in uptake between brain tumors, suggest that before chemotherapy is administered, uptake of the chemotherapeutic drug in the individual tumor to be treated should be assessed and comparisons should be made between the uptake of a series of drugs to determine which drug would be most efficacious on the basis of its uptake as well as its tumor cell killing potential.

Biological Availability↗
PubMed1979

Pseudostereoscopic illusion caused by interhemispheric temporal disparity: clinical and experimental observations.

An extension of Pulfrich's pseudostereoscopic illusion to a situation without interocular disparity, ie, even under purely monocular circumstances, was clinically observed and experimentally produced. The perceived distortion of the movement of a swinging pendulum was found to depend on different combinations of interhemispheric disparity induced by selective prolongation of the conduction time from the nasal or temporal retina to the corresponding hemisphere. In patients, tumor pressure caused the slower conduction time. In normal subjects, neutral density filters covering different visual fields produced similar conduction delays under experimental conditions. Recording the visually evoked response from over each hemisphere provided an objective tool for demonstration and measurement of interhemispheric differences of retinocortical conduction times in various clinical and experimental setups.

Adult↗
PubMed1978

Bilateral transverse sinus obstruction in benign intracranial hypertension due to hypervitaminosis A.

Hypervitaminosis A may be associated with benign intracranial hypertension. So far, the explanation for this phenomenon has remained obscure. A 17-year-old patient with benign intracranial hypertension, following chronic vitamin A intake of 150,000 units daily for acne vulgaris, is presented. Bilateral papilledema was present and bilateral obstruction of the transverse sinuses was demonstrated in the late venous phase of cerebral angiography. Discontinuation of vitamin A and acetazolamide treatment was followed by complete regression of the signs and symptoms of intracranial hypertension. Bilateral sinus obstruction with interference of cerebral sinus outflow is suggested as a critical factor in the pathogenesis of benign intracranial hypertension in vitamin A intoxication. Menstrual dysfunction and tetracycline therapy cannot be completely excluded as possible causative factors.

Acne Vulgaris↗
PubMed1977

Nasopharyngeal tumor initially manifested as myofascial pain dysfunction syndrome.

A patient with facial pain of 1 1/2 years' duration, associated with limitation of opening of the mouth, click, and osteodegenerative changes of the temporomandibular joint, was initially thought to be suffering from a myofascial pain dysfunction syndrome. At first, the patient reacted favorably to muscle exercises and an antidepressive drug, but reduced lacrimation and the development of deafness on the affected side led to re-evaluation and a diagnosis of nasopharyngeal tumor. Biopsy confirmed the presence of an adenocarcinoma of the nasopharynx. The variability of symptoms and the diagnostic problems presented by this tumor are discussed.

Carcinoma, Adenoid Cystic↗
PubMed1976

Midbrain corectopia.

Intermittent corectopia was recently observed in a patient with bilateral, rostral midbrain infarction. Results from neuropathologic examination disclosed isolated but intact Edinger-Westphal nuclei. An explanation of midbrain corectopia centered on segmental innervation of the pupil by the Edinger-Westphal nucleus. In the presence of a paralyzed dilator muscle, select, central inhibition of sphincter tone resulted in an oval and eccentric pupil.

Adult↗