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Biomedical subjects

M L Apuzzo

Publications and source records attributed to M L Apuzzo.

At least 145 records · Page 8Linked to original sources
PubMed1976

Tumor immunology. A neurosurgical perspective. I. General concepts of tumor immunology.

In the quest for the elusive cure of human neoplasms, considerable effort has been expended over the course of the past 10 years to define the immune system as it relates to the development and evolution of cancer in man. At this time thera is ample evidence for, but incomplete of, the existence of a multifactorial immunosurveillance system that is important in the production and control of neoplasms. The framework for this system has been defined and its modification, with the development and progression of various neoplasms, has been studied with great detail. These studies have been undertaken with the hope of harnessing immune mechanisms and altering their response in favor of the host's defenses related to the evolving tumor. This paper will review the major principles and concepts that have evolved.

Antigens, Neoplasm↗
PubMed1976

Anatomico-physiological considerations in exploration of the fourth ventricle.

The advancement of surgical techniques has enabled the neurosurgeon to undertake a continually more aggressive approach toward lesions within the fourth ventricle. Laboratory and clinical observations have enabled us to conclude that (1) exploration of the fourth ventricle is feasible without anatomical disruption of the vermis, (2) controlled ventilation during such explorations is physiologically most desirable, and (3) irrigation of neural structures must consider acid-base and ionic parameters in order to maintain physiologic stability.

Adolescent↗
PubMed1976

Tumor immunology: a neurosurgical perspective. II. The immunology of glial neoplasms.

The research thus far on the relation of the immune system to gliomas has shown that a glioma associated antigen does exist. Small quantities of glioma associated antibodies probably circulate within the patient's serum but there is definite evidence of depression of the cell-mediated vanguard of the immune response. This depression is caused by a blocking factor that may be present as an antigen, antibody, or antigen-antibody complex. Both active and passive immunotherapeutic techniques have been employed in a small number of patients with little success. Considerable understanding of the alteration of the immune system is necessary before a rational approach toward immunotherapy of gliomas may be undertaken. However, it is apparent that reductive therapy consisting of surgery, radiation, and chemotherapy will be necessary before the immune system will be effective against the tumor burden.

Animals↗
PubMed1975

Penetrating gunshot wounds of the cervical spine in civilians. Review of 38 cases.

The authors present a series of 38 civilian patients with cervical gunshot injuries, and compare neurological recovery in patients with complete lesions and patients with incomplete lesions according to whether therapy was surgical or nonsurgical. In patients with incomplete injury, ultimate recovery was a function of the initial injury more than surgical or nonsurgical therapy; nor did patients with complete lesions show significant change in outcome with either mode of therapy. Cord pathology at laminectomy rarely provided a clue about neurological recovery, and fural decompression did not alter neurological outcome. The authors conclude that the sole indication for routine surgical intervention appears to be progressive neurological deficit.

California↗
PubMed1975

Collagen sponge for surface brain protection. Technical note.

The authors discuss the properties, use, and advantages of collagen sponge as a microneurosurgical adjunct. Experience with the material in over 300 operative cases has demonstrated its value for protecting the surface of the brain during exposure and retraction in neurosurgical procedures.

Brain↗
PubMed1975

Management of cervical spinal cord trauma in Southern California.

Acute cervical spinal cord injuries were reviewed in 356 patients treated by the neurosurgical community in Southern California. Neurological recovery was compared in operated and nonoperated patients with complete and incomplete cervical myelopathies. The complications of nonsurgical and surgical therapy are identified. No neurological improvement was noted in any patient with a complete lesion who underwent early surgical decompression. In those with incomplete sensorimotor paralysis, it was difficult to document any effect of surgical decompression on neurological recovery. Patients with some degree of sensory preservation had a similar incidence of motor recovery in both surgical and nonsurgical groups. With complete sensorimotor paralysis, anterior cervical fusion within the first week of injury was associated with increased pulmonary morbidity.

Adolescent↗
PubMed1975

Ventricular perfusion for ventriculitis.

A system of ventricular perfusion of appropriate antibiotic solutions in the management of neonatal ventriculitis is described. The technique of perfusion as well as considerations in the appropriate selection of antibiotics and perfusates is detailed. The procedure was successfully utilized in a consecutive series of nine children refractory to conventional modes of therapy.

Anti-Bacterial Agents↗
PubMed1975

Anterior decompression of the thoracic and thoraco-lumbar spine.

The authors report their experience with six cases of acute spinal cord compression due to tumor, trauma, and infection in which the thoraco-lumbar spine and cord were most satisfactorily decompressed using an anterior transthoracic approach. Consideration is given to the appropriate pre-operative diagnostic procedures utilized to define those cases that are most amenable to an anterior approach. In addition, a consideration of paravertebral anatomy in the thoraco-lumbar area provides a basis for variance in approaching the ventral aspect of the thoraco-lumbar spine in order to minimize potential vascular complications.

Acute Disease↗
PubMed1975

Ventriculogastrostomy, an alternative means for CSF diversion: a preliminary study.

The feasibility of gastric CSF diversion in the management of hydrocephalus is evaluated in laboratory and clinical settings. A technique for ventriculogastrostomy is described and evaluated initially in 8 mongrel dogs. All distal shunts remained patent to the time of sacrifice. None of the animals exhibited leakage of gastric contents around the tubing. Cultures of the components of the shunting system and gastric mucosa were sterile. Clinical evaluation in a 3 week-old child is discussed. The trial was terminated at 3 weeks postsurgery because of the occurrance of an E. coli ventriculitis which was considered to be secondary to a preoperative conjunctivitis in which the organism was identical. It is concluded that there is good experimental evidence to support the concept of effectiveness of ventriculogastrostomy in the treatment of selected cases of hydrocephalus.

Animals↗
PubMedDate not supplied

Role of stereotactic biopsy in the diagnosis and management of brain tumors.

Stereotactic biopsy has evolved as a powerful and safe tool to provide tissue diagnoses with minimal disruption of normal functioning brain. It plays a significant role in the management of malignant brain tumors, where the benefit of open surgery might not justify the concomitant risks. Stereotactic procedures are closed procedures, and thus direct feedback is not provided to the surgeon during manipulation of brain tissue. This difference from most other neurosurgical procedures necessitates rigor in the preoperative workup, the planning of the procedure, and the conduct of the procedure. The success of the procedure is measured by the ability of the team to make an accurate histopathological diagnosis of the lesion; in experienced hands, the rate of success should exceed 95%. Complications and mortality can be minimized with appropriate attention to detail.

Biopsy↗
PubMedDate not supplied

Economic, ethical, and outcome-based decisions regarding aggressive surgical management in patients with penetrating craniocerebral injury.

Each year fatalities in the United States increase as a result of gunshot wounds to the head. This increase, coupled with the progressive limitation of medical and economic resources available at major trauma centers, has brought into question the concept that everything possible should be done to save the lives of victims, who have only a minimal and nonpredictable chance of having a good outcome. Thus, consideration must be given to the economics of treating cranial gunshot wounds and the relationship of this treatment to outcome. When a good outcome can be predicted, treatment should be aggressive. However, when a good outcome cannot be predicted, surgical intervention will have no effect and the potential costs of aggressive treatment must also be considered. Clearly, there are ethical dilemmas involved in withholding operative treatment from any individual, even if there is only a minimal chance of a reasonable neurologic recovery. A negotiation-based approach should be used in determining the medical and ethical benefits of aggressive management strategies. Unfortunately, the care of critically ill patients is inconsistent with this approach. In order to insure that the best decision is made, guidelines dictating when to surgically intervene must be made an essential part of the patient/health care provider negotiation--even in worst case scenarios. The combination of an extremely poor prognosis for these injuries, and economic constraints faced by government-run facilities today could suggest that some patients should be allowed to die. Thus, the physician must be a source of information for the families, providing support and becoming a decision-making partner regarding potential intervention. In each situation, a strict set of guidelines must be formulated to establish a moral foundation for the ultimate mutual decision.

Adolescent↗
PubMedDate not supplied

MRI of intraventricular cysticercosis: surgical implications.

OBJECTIVE: Our goal was to evaluate the role of Gd-enhanced MR in the diagnosis and surgical planning of intraventricular cysticercosis cysts. MATERIALS AND METHODS: Thirty-three patients with intraventricular cysticercosis were evaluated with Gd-enhanced MRI including follow-up studies ranging over time periods from 6 months to 8 years. The patient age ranged from 17 to 65 years. All had lived in Mexico or Central America. RESULTS: Twenty patients had surgical removal of the cysts. The majority of patients (18 of 20) who had surgical removal of the cyst showed improvement with resolution of hydrocephalus. Two of 20 patients required additional shunting to alleviate hydrocephalus. In these two patients, Gd-enhanced MR showed cyst wall enhancement. Ependymitis with adhesion was found at surgery in these two patients. Nine patients had shunt placement; one of nine patients showed cyst enlargement 2.5 years later that required surgical removal. Of the remaining eight patients, four showed irregular, thick, ring-like enhancement mimicking a neoplasm on follow-up imaging studies. Four patients with cysts in the lateral ventricle did not require treatment. Two of the four patients showed irregular, thick, ring-like enhancement on follow-up imaging studies. CONCLUSION: Gadolinium-enhanced MR is more sensitive than contrast-enhanced CT for detecting ependymitis, which is essential in deciding whether surgical removal of the cyst or shunt placement is indicated. A degenerating intraventricular cysticercosis cyst may present as an irregular, thick, ring-like enhancing lesion or a nodular enhancing lesion with varying degrees of surrounding edema, mimicking a neoplasm.

Adolescent↗
PubMedDate not supplied

Cervical intraextradural hematoma secondary to radicular artery injury: a case report.

A young man presented with a 5-year history of high cervical pain after a blunt blow to the neck and clinical evidence of myelopathy. Preoperative radiographic findings, including metrizamide myelography, CT scan, and vertebral angiography, were consistent with a right C2-3 "dumbell" shaped intradural-extradural tumor. At surgery a firm red-grey mass was found beneath an abnormally thin right C2-3 facet joint. This mass was both intradural and extradural and extended laterally through the root canal to merge with an area of dense adhesions surrounding the vertebral artery. Pathological examination showed no tumor and was consistent with chronic, organized hematoma. Aspects of this unique case of intradural-extradural hematoma in the distribution of a radicular vessel, and possible etiologic considerations are discussed.

Adult↗
PubMedDate not supplied

Long-term follow-up of adrenal medullary transplantation for Parkinson's disease.

Long-term follow-up of eight patients who underwent stereotactic grafting of adrenal medullary tissue into unilateral or bilateral caudate nuclei is presented. We demonstrate that this procedure can be performed with minimal risk. Our results show little benefit when the group as a whole is analyzed. A subgroup of four patients was identified who responded to the procedure, as evidenced by a reduction in motor scores, reduction in medication requirements, and greater "on" time. Three of these patients continue to accrue benefit after 2 years. No characterization of a responder profile was evident. We conclude that a modest benefit is derived from this procedure that may persist for as long as 2 years. Future clinical studies to evaluate grafting procedures are encouraged.

Adrenal Medulla↗
PubMedDate not supplied

Transoral exposure of the atlantoaxial region.

A broad spectrum of disease entities affects the atlantoaxial-clival region. This area is readily accessible through a transoral approach, which offers capabilities for canal decompression and fusion. A case is reported that required transoral odontoidectomy with concurrent excision of an osteophyte from the base of an ununited odontoid fracture. Operative preparation, technique, and postoperative management are described in detail. The advantage and applications of the procedure are discussed.

Axis, Cervical Vertebra↗
PubMedDate not supplied

Malignant glial neoplasms: definition of a humoral host response to tumor-associated antigen(s).

There is increasing evidence that human tumors possess tumor-associated neo-antigens. The host mounts an immunological response to these antigens, as evidenced by the detection of circulating humoral antibodies in a variety of human neoplasia.An indirect immunofluorescent antibody technique was employed to detect antibodies to tumor-associated antigens in the sera of patients with malignant gliomas. Viable single cell suspensions were used to demonstrate antibodies to surface contents of tumor cells and cell preparations were snap-frozen at -160° C to demonstrate antibodies to cytoplasmic components of tumor cells. After incubation with serum, the preparations were treated with polyvalent sheep antihuman globulin conjugated to isomer-1-fluorescein isothiocyanate, washed, and examined with a Leitz incident fluorescent microscope.Of the 17 sera from histologically proven malignant glial neoplasm patients, 2 (11%) were positive for an autologous surface antibody reaction. Five (23%) of 21 were positive for an autologus cytoplasmic antibody, however, 10 (47%) of 21 of the sera gave a positive reaction for cross-reacting cytoplasmic antibodies when tested with a battery of tumor cells obtained from different patients with malignant glial tumors.No reaction was observed with normal brain tissue. Absorption studies indicated the presence of a tumor-associated antigen.This study demonstrated that certain patients with malignant gliomas possess circulating antibodies to cytoplasmic components of their own tumor cells. The fact that a number of sera cross-reacted with tumor cells obtained from different patients suggests that antigenic cross-reactivity exists between malignant glioma cells from different patients. It is suggested that with further refinement, immunofluorescent detection of antibodies could evolve as a useful diagnostic adjunct in malignant glioma.

Antibodies, Neoplasm↗