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Biomedical subjects

M Feinsod

Publications and source records attributed to M Feinsod.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1989

Sacrococcygeal extradural ependymoma.

A case of lumbosacral extradural myxopapillary ependymoma is reported. The clinical, embryologic, and therapeutic features of this rare lesion are presented. The unusual entity is discussed in the light of previous experience with extradural ependymoma in the lumbosacral region.

Adult↗
PubMed1989

Neurotraumatological survey in northern Israel. I. Annual and seasonal variations.

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 with a single neurosurgical department. The 1,370 patients included in this study were those who required neurosurgical evaluation and treatment. The data base consists of demographic, clinical and radiological features at the time of admission, as well as the hospital course through to discharge. Higher admission rates were noted in spring and summer, although the mechanisms of injury showed variations. Some of the yearly variations can be explained, such as a change in rates of admission of soldiers and Lebanese population. A change from the expected outcome related to the Glasgow Coma Scale in one of the years deserves another quality control study. The main advantage of such a study, apart from the creation of data base, is an online guide for the decision-making process of health facility planning.

Brain Injuries↗
PubMed1989

Quantitative bone scintigraphy using SPECT.

A quantitative single photon emission computed tomography (SPECT) technique for measuring radiopharmaceutical uptake in humans has been applied to bone scintigraphy. The method was validated by comparing SPECT measured percent of injected [99mTc]MDP in 16 normal skulls with well counter measurements of samples of the same bones obtained at surgery. A very good correlation (r = 0.96) was found. A very good interobserver correlation (r = 0.99) and agreement were also obtained when using quantitative bone scintigraphy (QBS). Control SPECT studies of uptake in the right and left iliac bones and the right and left sacroiliac regions in each patient showed no significant differences between the contralateral sides. Studies done in seven subjects at 2 and 4 hr after the same injection and in nine subjects 4 to 8 mo later in the same subjects showed a very good agreement and no significant differences between the two measurements were found. QBS is suggested as an accurate and reproducible index for assessment of the mass of remodeling bone. Preliminary results showed differences in QBS of normal subjects at different ages. A group of 68 young patients aged 18-26 yr showed a significant higher QBS (p less than 0.001) when compared to an older group of 62 patients aged 50-85 yr. There was, however, a wide range of uptake values for the same bone in the same group, suggesting that the method should best be used for following individual patients over time.

Adult↗
PubMed1988

Cystic meningiomas.

Four cases of cystic meningiomas were found among 194 meningiomas diagnosed by computed tomography (CT) and operated on during a 7 year period, an incidence of 2%. The cysts were in all cases peritumoral. The cyst's wall was the brain itself, and the ependymal ventricular wall was part of their medial boundary. They contained xanthochromic fluid with a high protein content. Three meningiomas were parasagittal and one was adjacent to the pteryon and the external part of the sphenoid ridge. The mural nodules were in 2 cases apparent single nodes although in one it was part of multiple distant and regional growths, in another the tumour was built by the aggregation of 2 nodes, the remaining case was an "en plaque" meningioma. All were definitely attached to the dura. Histological pattern was different in every case. Those parasagittal were: one pure meningotheliomatous, one mixed meningotheliomatous with pseudo psammomatous and lipoblastic sections and one highly vascular angioblastic; the pteryonal case was psammomatous and microcystic. CT diagnosis is difficult because glial, metastatic and other tumours may look cystic and resemble cystic meningiomas. Nevertheless in 3 cases the correct diagnosis was suspected preoperatively because the solid portion of the tumour showed intense and homogeneous contrast enhancement with a sharp edge and was located adjacent to the dura. On the other hand in the remaining case, the parasagittal solid tumour was not readily apparent on CT (the "en plaque", case), and the tentative preoperative diagnosis was of an epidermoid tumour.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Diseases↗
PubMed1988

The incidence of multiple meningiomas--do solitary meningiomas exist?

Since the advent of computed tomography (CT) the recognition of the occurrence of multiple intracranial meningiomas (MIM) in the same individual has been on the increase. In our material the incidence of MIM at first assessment of CT films was 20%, with distant multiplicity prevailing over the regional one. This incidence will probably change in the course of time as MIM develop not only concurrently but also consecutively. On the other hand our surgical macroscopic incidence of regional multiplicity alone was 49%. The discrepancy between the CT and surgical findings prompted us to reevaluate the CT studies of 100 consecutive patients. This reevaluation demonstrated: 1. in two cases, small meningiomas were overlooked at first assessment; 2. nineteen cases of solitary globoid meningiomas seemed to be the consequence of the coalescence of adjacent smaller masses. Thus, the CT incidence of MIM increased to 40%, with regional multiplicity prevailing over the distant one. The authors think that the aforesaid findings question the very existence of solitary meningiomas as a pathological entity. They would be the end product of a coalescence of multiple adjacent smaller growths. Accordingly, a more aggressive surgical approach is suggested to include the resection of a generous fringe of dura mater around the main tumour. As this is not always possible, or too risky, a comprehensive complement to surgery like radiotherapy could be given a reasonable randomized trial.

Dura Mater↗
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↗
PubMed1988

Intraoperative ultrasonography in cystic brain lesions.

Four neurosurgical patients were operated on under real-time ultrasonographic guidance. Two had cystic tumors which were drained through the unincised dura. In one patient a brain abscess was located intraoperatively by ultrasound after a small craniotomy. In a fourth patient with multiple abscesses, one abscess was drained under ultrasonographic guidance through a previous craniotomy. Using intraoperative ultrasonography the length of the operation can be shortened and normal brain tissue spared. Intraoperative ultrasonography is of special value in cystic lesions which can be drained under ultrasonographic guidance.

Adult↗
PubMed1988

[Acute circumferential epidural spinal hematoma. Apropos of a case].

A case of spinal circumferential acute epidural hematoma is presented. The diagnostic procedures are discussed, and particularly the interest of computerized tomography is stressed. Surgical management of this entity and prognostic implication are considered through a pertinent review of the literature.

Acute Disease↗
PubMed1987

Acute spinal extradural haematoma.

Two cases of acute spinal extradural haematoma (ASEH) are presented. Regression of neurological deficit is dependent on early diagnosis and urgent surgical decompression. A review of the literature is included.

Acute Disease↗
PubMed1986

Non-Hodgkin's lymphoma presenting with spinal epidural involvement.

Cord compression was noted at presentation in 10 of 453 (2.2%) previously untreated non-Hodgkin's lymphoma patients seen at the Northern Israel Oncology Center between 1968 and 1983. A prodromal phase of local back pain occurred in eight patients, persisting up to 1 year, followed by a second phase of rapidly progressive signs of cord compression. Five of the ten patients presented with primary spinal epidural involvement (Stage IE), whereas the others had Stage IIE and IIIE (one patient each) and Stage IV, with bone and bone marrow involvement (three patients). All patients had unfavorable histologic diagnoses, mostly of the intermediate grade malignancy types according to the Working Formulation. The patients were treated by radiotherapy (two patients), chemotherapy (three patients), or both modalities (five patients). Seven of the ten patients achieved complete remission, but four of them have subsequently had relapses (two patients in bone, one in central nervous system, and one in mediastinum). The 5-year actuarial survival and 3-year relapse-free survival were 66% and 32%, respectively. Median survival has not been reached after a mean follow-up of 34 months. Non-Hodgkin's lymphoma with spinal epidural involvement at presentation is an aggressive disease. An intensive treatment combining irradiation with chemotherapy, and surgery as needed, is suggested in order to achieve good local response and long-term survival.

Actuarial Analysis↗
PubMed1986

Recurrence of intracranial meningiomas: the role played by regional multicentricity. Part 2: Clinical and radiological aspects.

Globular single meningiomas are generally regarded as benign tumors that can be completely removed. Nevertheless, after a total macroscopic resection including the insertion zone (Grade 1 operation according to Simpson's classification), the incidence of recurrence ranged from 9% to 14% at the 5-year follow-up review. The authors have shown that single meningiomas represent only the visible predominant growth in the midst of a wide neoplastic field in the dura mater. Regional multiplicity in meningiomas would thus seem to be the rule. With this in mind, the authors propose to divide recurrences after Grade 1 operations into true local and false regional. A local recurrence is defined as a regrowth within the limits of the previous dural flap. Regional recurrence is when new growth develops outside the previous craniotomy site; this should not be considered as a recurrence but as a new primary site. These regional recurrences might explain some unexpected late tumor growth occurring after a Grade 1 operation. Five illustrative cases in which regional recurrence was detected by computerized tomography are presented. The authors also propose to add a supplementary grade to Simpson's surgical grading: Grade 0. This operation would entail a wide resection of the dura around the attachment zone of the meningioma. The authors hope that with a Grade 0 operation the incidence of recurrence might be reduced.

Adult↗