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Biomedical subjects

M Feinsod

Publications and source records attributed to M Feinsod.

136 records · Page 8Linked to original sources
PubMedDate not supplied

Severe head injury in children--analyzing the better outcome over a decade and the role of major improvements in intensive care.

We suggest a few possible explanations, including improvement of intensive care, as the main cause, for the improved outcome after severe head injury in children and present the predictors of outcome observed in a contemporary series. From January 1984 to June 1988 we saw 117 children (ages 0-14) with postresuscitation GCS (Glasgow Come Scale) scores of 3-8. The more recent cohort of children seen in 1994-1996 was made up of 152 patients. Apart from standard statistics we used a segmentation method called CHAID (SSPS software). Previously known predictors of outcome are found still to apply in our series. Although in the recent period there was a lower proportion of patients with GCS 3-4 (11% versus 32%), a higher percentage had suffered multiple trauma (56% versus 33%). The rates of craniotomy and of ICP monitoring were similar (66% and 61%). Comparison of the two cohorts for outcome at discharge and through 1 year shows that mortality fell from 33% to 10% and the proportion achieving improvement of neurological status increased from 24% to 56%. CHAID analysis showed that the mortality rates of patients within specific groups declined significantly over the two periods: (1) a significant reduction in mortality was seen in patients with GCS 5-7, especially those with diffuse axonal injury (DAI) (17.3% to 0%); (2) no child admitted in shock survived in the earlier period, whereas 7 with GCS 4-6 survived during the recent period. The best model for mortality prediction includes GCS, and in the GCS 4-7 subgroup, the presence of subdural hematoma. It seems that the trend toward better immediate outcome is continuous, and this is the more striking when the severity of injury is taken into consideration. Our belief is that the modern medical and surgical techniques, although incurring higher costs and necessitating ongoing intensity, are well worth the effort.

Adolescent↗
PubMedDate not supplied

Short latency trigeminal evoked potentials: normative data and clinical correlations.

A very short latency trigeminal evoked potential (STEP) to electrical stimulation of the upper lip has been recorded from over the scalp. This potential consists of 5 distinct peaks within the 12 msec range. Normative data were obtained from 25 healthy volunteers. The impact of the stimulus rate and intensity on the response was studied in each subject. These results were compared to those of 19 patients suffering from lesions involving the trigeminal system in its peripheral aspect or the brain-stem. The STEP was consistently abnormal whenever the involved side was stimulated. Changes in peak latencies and in interpeak latency differences (IPLD) correlated well with clinical and radiological findings and improved with the removal of the offending lesion. The STEP proved to be a reliable method for evaluating the trigeminal system in its peripheral and central pathways; it may thus serve as an additional parameter for studying brain-stem functions.

Adolescent↗
PubMedDate not supplied

Monitoring of brain-stem trigeminal evoked potentials. Clinical applications in posterior fossa surgery.

Brain-stem trigeminal evoked potentials (BTEPs) were monitored intraoperatively in 17 patients during posterior fossa surgery. Satisfactory BTEP recording was performed in all patients without technical problems or interfering with the activity of the operating team. The BTEP was not altered by anesthetic agents or muscle relaxants. Intraoperative monitoring of the BTEP showed wave form alterations or increasing peak latencies in 10 patients. Among these patients, the BTEP demonstrated a dynamic correlation with the surgical process in 8 instances. Two major causative surgical manipulations were identified: cerebellar retraction in 4 cases and tumor dissection from the brain-stem in 6 cases. Withholding the dissection of the tumor, readjusting a cerebellar retractor or further modifying the surgical attitude resulted in partial or complete return of the wave form in 7 patients. The BTEP at the end of surgery proved to correlate with the immediate surgical outcome in most instances. We concluded that the intraoperative monitoring of the BTEP was feasible and suggested, despite the small number of patients, a potential value in the survey of brain-stem functions during posterior fossa surgery.

Adult↗
PubMedDate not supplied

Density spectral array, evoked potentials, and temperature rhythms in the evaluation and prognosis of the comatose patient.

Glasgow Coma Scale (GCS), density spectral array (DSA), EEG, BAEP and circadian temperature rhythm were studied in comatose patients in order to determine level of arousal and appraise the prognostic capability of these combined measures. Subjects were 29 comatose patients in the neurosurgical ICU at the Rambam Medical Center suffering from head trauma, vascular disorders or metastatic growth. Results show that best prognostic capabilities were for DSA, GCS and BAEP, in that order. As a single parameter physiological response to a sound stimulus (increase in EMG, change in EEG frequency and appearance of sharp waves or k-complex) was the single best predictor for outcome, with significant response rates for the good, deficit, vegetative and death outcomes at 83%, 57%, 37% and 18%, respectively. Rectal temperature was analysed for 24 h circadian periodicity. Daily acrophases were found to shift forward or backward on the level of about 2-7 h a day with fluctuations about a stable or unstable mean. The absence of 'free-running rhythms' associated with environmental isolation studies might reflect an ability to respond to environmental Zeitgerbers while unconscious. Temperature oscillations as well as 24 h rhythms were found even in the most severely brain-damaged patients, reflecting the resilience of the circadian oscillators in the brain to trauma.

Adolescent↗
PubMedDate not supplied

Head injuries in the elderly.

Two hundred and sixty-three consecutive head-injured patients aged over 65 years, admitted to a neurosurgical service, are reported. In contrast to younger age group the main cause was falls concomitant with a high rate of cardiovascular pre-existing disorders. The distribution of causes and grim results justify, in our opinion, regarding head injury in the elderly as a distinct entity requiring special surgical, medical, organizational and ethical considerations.

Aged↗
PubMedDate not supplied

Trigeminal and auditory evoked responses in minor head injuries and post-concussion syndrome.

Forty patients who sustained minor head trauma were investigated by brainstem trigeminal and auditory evoked potentials (BTEP, BAEP) and middle-latency auditory evoked potentials (MLAEP). The patients were evaluated within the first 48 h following their admission and at 3 months after the injury. Outcome was scored at the follow-up examination according to six complaints: failure to resume previous professional activity, headache, memory disorders, dizziness and vertigo, behavioural and emotional disturbances, and other symptoms of a neurological nature. Post-concussion syndrome (PCS) was defined by the presence of four or more of the listed features. All three evoked potential modalities showed significantly increased latencies at the initial assessment, disclosing disseminated axonal damage. Unlike the BTEPs and the BAEPs, the MLAEPs proved to correlate to outcome at 3 months, especially in its psychocognitive aspects. These findings suggest that organic diencephalic-paraventricular primary damage may account for the occurrence of PCS.

Adolescent↗
PubMedDate not supplied

Visual evoked response as an aid in diagnosing optic nerve head drusen: case report.

In an 11-year-old girl suffering from decreased vision in he right eye, drusen of the optic nerve head were revealed by ophthalmoscopy and fluorescein angiography in this eye. The fellow eye had good vision and looked normal ophthalmoscopically. An abnormal VER led to further investigation, and asymptomatic buried drusen of the optic nerve head were confirmed by fluorescein angiography.

Child↗