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Biomedical subjects

M H Epstein

Publications and source records attributed to M H Epstein.

At least 55 records · Page 3Linked to original sources
PubMed1989

The management of "asymptomatic" epidural hematomas. A prospective study.

Standard neurosurgical management mandates prompt evacuation of all epidural hematomas to obtain a low incidence of mortality and morbidity. This dogma has recently been challenged. A number of authors have suggested that in selected cases small and moderate epidural hematomas may be managed conservatively with a normal outcome and without risk to the patient. The goal of this study was to define the clinical parameters that may aide in the management of patients with small epidural hematomas who were clinically asymptomatic at initial presentation because there was no clinical evidence of raised intracranial pressure or focal compression. A prospective study was conducted of 22 patients (17 males and five females) aged from 1 to 71 years, who had a small epidural hematoma diagnosed within 24 hours of trauma and were managed expectantly. Of these, 32% subsequently required evacuation of the epidural hematoma 1 to 10 days after the initial trauma. Analysis of the patients revealed that age, sex, Glasgow Coma Scale score, and initial size of the hematoma are not risk factors for deterioration. However, deterioration was seen in 55% of patients with a skull fracture transversing a meningeal artery, vein, or major sinus, and in 43% of those undergoing computerized tomography (CT) within 6 hours of trauma. In contrast, only 13% of patients in whom the diagnosis of a small epidural hematoma was delayed over 6 hours subsequently required evacuation of the epidural collection. Of patients with both risk factors, 71% required evacuation of the epidural hematoma. None of the patients suffered neurological sequelae attributable to this management protocol. It was concluded that patients with a small epidural hematoma, a fracture overlaying a major vessel or major sinus, and/or who are diagnosed less than 6 hours after trauma are at risk of subsequent deterioration and may require evacuation. Conversely, patients without these risk factors may be managed conservatively with repeat CT and careful neurological observation, because of the low risk of delayed deterioration.

Adolescent↗
PubMed1988

Distal anterior choroidal artery aneurysm: intraoperative localization and treatment.

Distal anterior choroidal artery aneurysms with intraventricular hemorrhage are rare and difficult to treat. We report the case of a 46-year-old woman with a left distal anterior choroidal artery aneurysm presenting as a typical subarachnoid hemorrhage from which she had no focal neurological signs. Because the aneurysm was located within the dominant deep temporal lobe, we used intraoperative computed tomography to guide a probe to the aneurysm to allow minimal dissection. This is the first report of a successfully treated distal anterior choroidal artery aneurysm. Reports of this unusual aneurysm and methods of approaching deep temporal lesions are reviewed.

Female↗
PubMed1987

Psychotropic drug treatment among learning-disabled, educable mentally retarded, and seriously emotionally disturbed students.

Psychotropic drug treatment in learning-disabled (LD), educable mentally retarded (EMR), and seriously emotionally disturbed (ED) children and adolescents receiving public school special education services was examined. The findings indicated that while treatment prevalence rates for EMR and ED groups were comparable, the rate for LD students was much lower. In the LD sample, pharmacotherapy was associated with higher ratings of behavioral deviance, longer placement in special education, less social integration, and greater peer rejection, which suggests that symptom severity is an important determiner of pharmacotherapy in this population.

Achievement↗
PubMed1986

Depression in children.

Depression among children has received considerable attention from mental health professionals. A knowledge of the major approaches to conceptualizing, diagnosing, and treating childhood depression can assist school health practitioners in treatment. The purpose of this paper is to review research on the prevalence, classification, etiology, assessment, and treatment of childhood depression.

Adolescent↗
PubMed1986

Patterns of maladjustment among mentally retarded children and youth.

Data from factor analysis of rating scale evaluations of teachers as a basis for classifying the patterns of emotional and behavioral problems found in EMR students in the public schools were presented. These factors permitted a contrast between EMR elementary- and secondary-school-level boys and girls and a comparison group of nonretarded students. Implications for an understanding of the emotional and behavioral characteristics of students identified as EMR and for related programming needs were discussed.

Adaptation, Psychological↗
PubMed1983

Carotid-cavernous fistula. Intravascular treatment with a self-sealing detachable balloon.

Five traumatic carotid-cavernous fistulas were treated using a new self-sealing, detachable, silicone-rubber balloon, as part of a balloon-catheter system, and a modified technique for positioning the balloon. The fistulas were occluded successfully in four patients; in a fifth patient, a small fistula persisted. In each instance, the internal carotid artery flow was preserved. The flexible balloon-catheter system can be guided via the blood flow and still not require a coaxial catheter for detachment. Moreover, the flexibility of the balloon and catheter resulted in easy positioning through a tortuous internal carotid artery.

Adolescent↗
PubMed1983

Long-term outcome of children with severe head trauma and prolonged coma.

Forty-six children with significant head trauma who remained in coma more than 24 hours were the subjects of this long-term outcome study. Twelve (38%) died. The average length of coma in the 34 survivors was 15.5 days. Follow-up ranged from 9 months to 4 years (mean 21 months). Twenty-nine percent of the survivors were normal at follow-up. An additional 53% had mild cognitive or behavioral problems, but 61% of these had evidence of similar problems prior to the injury. Nine percent of survivors had motor residua but normal intellect. Nine percent had severe intellectual and motor problems. Children less than 2 years of age had a worse outcome. Despite severe injury and prolonged coma after head trauma, most children do well. Intensive medical and surgical care increases the rate of survival and does not result in a large number of severely disabled survivors.

Adolescent↗
PubMed1982

Comparison of clinical result between microsurgical and direct visual intracranial aneurysm surgery.

A retrospective study of 119 operative procedures for intracranial aneurysm was performed to compare the clinical result with microsurgical technique vs. that with standard instruments and without magnification; the operative technique was the major variable. The study demonstrated more normal patients, less intraoperative aneurysm rupture, and a greater capacity to isolate the aneurysm definitively with microsurgical technique. Anatomically and pathologically more difficult aneurysms had an even greater percentage of good clinical results when treated microsurgically. Familiarity and experience with microsurgical technique was associated with better clinical results, whereas the results with direct vision remained static.

Adult↗
PubMed1980

The effect of cholera toxin on choroid plexus carbonic anhydrase activity in vitro.

The effects of the adenylate cyclase agonists cholera toxin and prostaglandin E2 on carbonic anhydrase activity in vitro was measured in choroid plexuses isolated from Sprague-Dawley rats. Choroid plexuses were incubated in buffer at 38 degrees C (pH 7.4) with either cholera toxin or prostaglandin E2 (PGE2) at a concentration and for a time period that had been shown in earlier studies to result in maximal stimulation of cyclic AMP production. Cholera toxin (10 micrograms/ml) caused a twofold increase (p < .001) in choroid plexus carbonic anhydrase activity when cholera toxin treated plexuses [20.92 +/- .46 mol CO2/(min)(mg protein X 10(-8)] were compared with plexuses exposed to heat inactivated cholera toxin (10.92 +/- .43). When choroid plexuses were homogenized and separated into a 10,000 g pellet and a supernatant fraction, the supernatant carbonic anhydrase was unresponsive to cholera toxin stimulation. In the pellet fraction, which contained all the cellular adenylate cyclase, challenge with cholera toxin produced a significant increase in carbonic anhydrase activity (p < .01). Control activity was 10.9 +/- 1.2 mol CO2/(min)(mg protein X 10(-8), while carbonic anhydrase activity in fractions exposed to cholera toxin was 28.4 +/- 0.8. PGE2 had no effect, however, upon choroid plexus carbonic anhydrase activity. Since both PGE2 and cholera toxin stimulate cyclic AMP production in vitro, a compartmental model of secretory control is proposed.

Animals↗
PubMed1980

Understanding child with learning disabilities.

A knowledge of the characteristics of learning disabilities in children, the theories behind interventions, and the relevant research can guide child welfare practitioners in treatment.

Attention↗
PubMed1979

Effect of cholera toxin and prostaglandins on the rat choroid plexus in vitro.

The present study was performed to measure the effects of cholera toxin (CT) and prostaglandins (PG) on choroid plexus cyclic AMP accumulation. Choroid plexuses, isolated from Sprague-Dawley rats, were incubated in Krebs-Ringer bicarbonate buffer containing either CT (10 microgram/ml), heat inactivated CT, prostaglandins, or appropriate controls. After a minimum incubation period of 60 min with CT, cyclic AMP accumulation (pmol/mg protein) in treated incubates (58.10 +/- 6.43, n = 6) was 4 times that in controls (14.-5 +/- 1.4, n = 6). This large increase was only seen when theophylline (10 mM) was in the incubation mixture 3--10 min prior to the end of the incubation period. The increase in cyclic AMP accumulation was dose responsive and was irreversible after 5 min of incubation. Of the 5 prostaglandins studied, only PGE2 resulted in an increase in cyclic AMP accumulation. Cyclic AMP levels were 29.64 +/- 2.5 in controls and 57.57 +/- 3.5 in plexus which had been incubated with PGE2 (20 microgram/ml) for 1 min, and this increase was dose responsive.

Adenylyl Cyclases↗
PubMed1979

Dibutyryl cyclic adenosine 3',5'-monophosphate: its role in regulation of cat brain extracellular fluid.

The role of dibutyryl cyclic adenosine 3',5'-monophosphate (db cAMP) in influencing the water content of the cat's gray and white matter was evaluated by intracoritcal injection of 20 micrio L of 2 x 10(-1) to 2 x 10(-6)M solution of db cAMP. Cholera toxin, a stimulator of adenylate cyclase, also was tested. Concentrations of db cAMP less than 10(-3)M failed to produce significant change in brain water content, while concentrations greater than 10(-2)M produced 31.5% +/- 8% and 17.3% +/- 3.6% increases in white matter volume, respectively (P less than .05). Cholera toxin did not increase brain water levels. These results are discussed in relation to the pathophysiology of brain edema.

Animals↗
PubMed1979

Behavior problems of educationally handicapped and normal pupils.

Male pupils identified as behaviorally disordered, learning disabled, and educable mentally retarded, as well as nonidentified normal boys, were rated by their teachers on the Behavior Problem Checklist. Analyses of the ratings indicated significant differences for pupil category, Behavior Problem Checklist dimension, and category by dimension interaction, but no significant differences for age alone or in interaction with other factors. Categories of pupils were best discriminated from one another on the basis of Conduct Disorder and Personality Problem dimensions of the Behavior Problem Checklist. Results were discussed in terms of some implications for special education and further research suggested by the present findings.

Adolescent↗
PubMed1979

Intracranial pressure in the cat during nitroglycerin-induced hypotension.

Intracranial pressure measurements were made during nitroglycerin-induced hypotension in the cat anesthetized with halothane. A total of 48 individual observations were made in eight animals. The administration of sufficient nitroglycerin to decrease mean arterial pressure from a control value of 87 +/- 7 torr by 12 +/- 4 torr resulted in an increase in mean intracranial pressure from a control value of 7 +/- 2 torr to 12 +/- 2 torr. Larger decreases in mean blood pressure were associated with larger increases in intracranial pressure. The increase in intracranial pressure was similar to that previously reported for nitroprusside, and greater as well as more reproducible than that reported for trimethaphan. Thus, nitroglycerin may produce significant increases in intracranial pressure, and this may be a limiting factor in its clinical use.

Anesthesia, Inhalation↗
PubMed1978

Cognitive tempo in educable mentally retarded children.

The present study investigated the relationship of time and errors on the Matching Familiar Figures test to the mental age of 40 Caucasian male, educable mentally retarded (EMR) children. The children, who ranged in age from six to 18 years, had intelligence test scores of less than 80, were exhibiting problems in adaptive behavior, and were all receiving special education services. An ANOVA revealed that with increasing mental age, elapsed time to first response increased and errors decreased, thus indicating a mental age developmental decrease in impulsivity. For all subjects, time was inversely related to errors. The data suggest that the development of cognitive tempo in EMR children parallels that of nonhandicapped children.

Adolescent↗