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Biomedical subjects

R A Hyman

Publications and source records attributed to R A Hyman.

At least 37 records · Page 2Linked to original sources
PubMed1984

Coexisting cervical and lumbar spinal stenosis: diagnosis and management.

An attempt has been made to identify and manage patients symptomatic from both cervical and lumbar spinal stenosis. The order of operative intervention was related to the degree of myelopathy and radiculopathy. Patients requiring cervical surgery first had absolute stenosis with a spinal canal equal to or less than 10 mm in anteroposterior diameter. Those requiring lumbar surgery first presented with stenosis and a canal between 11 and 13 mm in depth. In the latter group, patients presented with radiculopathy in their upper and lower extremities. A significant portion (50%) had intermittent neurogenic claudication (INC). Motor and sensory changes were severe in those with absolute as compared to relative stenosis. After cervical laminectomy, myelopathy improved or stabilized, and the subsequent lumbar decompression could be completed with less risk. Cervical cord decompression often resulted in improvement in lumbar symptoms with resolution of pain, spasticity, and sensory deficits of myelopathic origin. However, latent symptoms of INC caused by lumbar stenosis were not affected by cervial decompression and increased in severity. Electrodiagnostic studies were helpful in that somatosensory evoked potentials showed conduction delays in the cervical cord in patients with significant disease. The identification of motor neuron disease and peripheral neuropathies was essential. The surgical management included extensive, multiple level laminectomy, unroofing of the lateral recesses, and foraminotomy. Neurolysis and untethering of the spinal cord was essential. Significant improvement was shown by 90% of these patients.

Aged↗
PubMed1983

Moderate grade astrocytoma presenting in a 4-month-old child with a family history of von Recklinghausen's neurofibromatosis spanning four generations: a case report.

Intracranial gliomas are found in association with von Recklinghausen's neurofibromatosis. However, few truly neonatal lesions have been identified and studied. This case report concerns a 4-month-old child who was found to have a massive thalamic glioma of moderate grade. Four paternal generations had suffered from different manifestations of this transmissible autosomal-dominant (Ad) phakomatosis.

Adult↗
PubMed1981

Metastasis of intracranial germinoma through a ventriculoperitoneal shunt.

A young man developed a tumor in the pineal region that grew along ventricular surfaces and caused obstructive hydrocephalus. Cytologic examination of cerebrospinal fluid demonstrated malignant cells consistent with germinoma. Following a ventriculoperitoneal shunt and radiotherapy, the tumor and the hydrocephalus regressed. Three years later, an intraperitoneal tumor appeared that was diagnosed by transcutaneous biopsy specimen as a germinoma. The abdominal germinoma also regressed after radiotherapy. While extracranial metastases of intracranial germinomas via shunts are probably rare, their occurrence, as exemplified by this case, argues for including protective filters in the shunts.

Abdominal Neoplasms↗
PubMed1981

Conjoined lumbosacral nerve roots. Management of herniated discs and lateral recess stenosis in patients with this anomaly.

Anomalous L-5 and S-1 nerve roots occur infrequently. If not properly recognized, surgery for entrapment disorders may result in serious neural injury because of an improper surgical approach in exposure and in removing the underlying herniated discs. The diagnosis has been made preoperatively since the introduction of water-soluble myelography because of improved filling of the nerve roots. A herniated disc beneath the bifid root causes extreme pain and disability with marked signs of entrapment because of firm fixation of the conjoined root in the lateral recess between the two pedicles. An underlying herniated disc may not be recognized because of the unique anatomical changes. To properly identify the nature of the lesion, wide exposure by hemilaminectomy is preferred, with unroofing of the lateral recesses and wide foraminal decompression. Eight such patients are reported: seven had herniated discs, and one had lateral recess stenosis with superior facet entrapment. With adequate decompression, all patients made a rapid, uneventful recovery.

Adult↗
PubMed1979

Computed tomography: regression of periventricular enhancing lesions in multiple sclerosis.

A patient with two periventricular enhancing lesions on computed tomography subsequently demonstrated clearing of these abnormalities without treatment and a clinical course compatible with multiple sclerosis. CT scans obtained in disease processes associated with acute demyelination and alteration of the blood-brain barrier can show enhancing lesions. These lesions can initially be confused with primary or secondary neoplasms, enhancing infarcts or arteriovenous malformation. The differential diagnosis of enhancing lesions without significant mass effect should initially include the acute phase of multiple sclerosis and other demyelinating processes.

Adult↗
PubMed1979

The big rib sign: localization of basal pulmonary pathology in lateral projection utilizing differential magnification of the two hemithoraces.

Basal pulmonary pathology which silhouettes the hemidiaphragm in lateral view may not be detectable in routine postero-anterior projection. In such cases, correct lateralization of pathology to the left or right hemithorax depends on accurate identification of the silhouetted left and right hemidiaphragm in lateral view. A prospective analysis of the sensitivity and accuracy of five techniques for identifying the left and right hemidiaphragms in more than 100 patients revealed that the most accurate method for lateralizing juxtadiaphragmatic pathology was the "big rib" sign, a technique based upon the relative difference in magnification between the left and right ribs. Techniques based upon the visceral gas bubble or upon obscuration of the anterior portion of the left hemidiaphragm by the heart proved less useful. Techniques based upon the position and configuration of the major fissures or upon higher and lower position of the two hemidiaphragms were ineffective.

Adult↗
PubMed1979

Cervical myelopathy caused by developmental stenosis of the spinal canal.

The authors present six patients with myelopathy caused by developmental stenosis of the cervical spine. Hyperextension injuries precipitated the onset of symptoms in two patients, aged 19 and 20 years. In four, 41 to 69 years of age, symptoms were gradual in onset, progressing to severe disability. X-ray films revealed narrowing of the dorsoventral diameter of the spinal canal to as little as 1.0 cm. The myelograms showed widening of the cord in the transverse plane strongly suggestive of an intramedullary tumor. A unique finding was maldevelopment with flattening of the neural arch often hidden by the posterior portions of the articular facets when seen in the lateral views. These patients showed no significant evidence of spondylosis, arthrosis, or any of the structural stigmata usually observed in cervical spondylotic myelopathy. When indicated, decompressive laminectomy is the treatment of choice.

Adult↗
PubMed1978

Computed tomographic evaluation of therapeutically induced changes in primary and secondary brain tumors.

A prospective study was initiated to evaluate computed tomography as a method for monitoring therapeutically induced changes in brain tumors. Early postoperative scans may be misleading in the evaluation of residual tumor because of trauma to the blood-brain barrier during operation. The size of the dominant mass (17/25), enhancement (11/25), edema (11/25), and ventricular distortion (14/25) were decreased in many patients after radiation therapy. Occasional tumors increased in size during radiation therapy (3/25). Enlargement of the lateral ventricles developed in 9 of 25 patients. Computed tomography offers definite advantages over nuclide brain scans, angiography and other diagnostic studies for evaluating therapeutically induced changes in brain tumors.

Brain Neoplasms↗
PubMed1978

The origin of the left gastric artery.

Five hundred celiac angiograms were reviewed to evaluate the frequency of clinically significant variations in the origin of the left gastric artery. In 13 of 500 cases, the left gastric artery arose anomalously most often as a direct branch of the aorta; in 14 of 500 cases, the left gastric artery primarily supplied the liver with only minor contributions to the stomach. An aberrant origin of the left gastric artery necessarily influences the angiographic diagnosis and therapy of gastrointestinal hemorrhage.

Angiography↗
PubMed1977

Endocystography in cystic neurilemmoma.

During myelographic evaluation for a suspected herniated disc, a cystic neurilemmoma in the lower lumbar region was inadvertently punctured and a contrast study of the interior of the lesion resulted. The possibility of puncture of a cystic mass should be considered in the differential diagnosis when a complete block is encountered above and below the site of needle puncutre, and particularly when the contrast column demonstrates a relatively smooth biconcave appearance.

Cysts↗
PubMed1977

The widened interspinous distance: a useful sign of anterior cervical dislocation in the supine frontal projection.

Anterior dislocation of the cervical spine may be detected reliably in the supine frontal projection by evaluating the cervical spinous processes. A widened interspinous distance (ISD) which measures more than one and one-half times the ISD above and more than one and one-half times the ISD below indicates the presence of an anterior cervical dislocation at the level of abnormal widening. Measurements of the interspinous distances from the C3-C4 interval through the C7-T1 interval in 500 patients with normal cervical spines and in 14 patients with documented anterior cervical dislocations revealed neither false positive nor false negative diagnoses by these criteria.

Adolescent↗
PubMed1977

Angiographic patterns of posttraumatic renal scarring.

Evaluation of 19 patients with a history of renal trauma revealed three angiographic features helper in the diagnosis of posttraumatic renal scarring: (1) a cup-shaped renal contour defect characterized by smooth margins, infolding of the renal cortex, and extension of the calyces to the edge of the defect; (2) occlusion of an extra- or intrarenal artery associated with a distal avascular zone of infarction; and (3) a grossly heterogeneous nephrogram characterized by scattered islands of renal tissue separated by broad or narrow avascular scars. Limited pathologic correlation suggests that the cup-shaped contour defect reflects subcapsular hemorrhage and that the mottled, heterogeneous nephrogram reflects a shattered kidney.

Adult↗
PubMed1977

Benign pneumoperitoneum after fiberoptic colonoscopy. A prospective study of 100 patients.

A prospective study of 100 consecutive unselected patients undergoing both diagnostic and therapeutic firoptic colonoscopy was undertaken. Our incidence of colonic perforation is 1%, which is similar to the incidence reported in the literature. This study suggests that even when immediate postcolonoscopic supine and erect abdominal radiographs as well as pre- and postcolonoscopic total blood counts and enzyme levels to supplement clinical impressions are obtained, the incidence of perforation of the colon after fiberoptic colonoscopy is low and not any higher than that reported in the literature. Pneumoperitoneum may occur after fiberoptic colonoscopy with minimal or no clinical evidence suggesting perforation. Perforation in some patients may be treated conservatively without the need of emergency laparotomy.

Adult↗
PubMed1976

Parasitic lumbar arterial blood supply in renal angiomyolipoma.

A young woman with azotemia was found to have an angiomyolipoma which had parasitic blood supply from a lumbar artery. Parasitic lumbar arterial blood supply from a lumbar artery. Parasitic lumbar arterial blood supply has previously been considered a strong indication of malignancy. Since this benign lesion had not invaded the adjacent retroperitoneal structures, the phenomenon tends to confirm the postulate that parasitic blood supply to a lesion may occur through hypertrophy of small anastomotic channels normally present between adjacent vessels but not normally seen in angiography.

Adult↗
PubMed1976

Bulbous splenic vein as a cause of renal pseudotumor.

A number renal and suprarenal pseudotumors have been described during the past two decades, paralleling the development of selective visceral angiography. An apparent left upper pole renal mass in a 71-year-old hypertensive man was found to ba a bulbous portion of the splenic vein during angiography. The anatomical basis of this renal pseudotumor is discussed.

Aged↗