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Biomedical subjects

R D Penn

Publications and source records attributed to R D Penn.

At least 109 records · Page 6Linked to original sources

Immunoregulatory cell function in peripheral blood leukocytes of patients with intracranial gliomas.

Levels of indomethacin-sensitive, glass-adherent, preculture-sensitive, and lymphocyte-mediated immunoregulatory activity were measured in peripheral blood mononuclear cells from 12 patients with intracranial astrocytomas. The levels of regulatory cell function were determined in assays of T cell immunocompetence as judged by phytohemagglutinin (PHA)-induced in vitro lymphocyte DNA synthesis. Of 6 patients studied before surgical exploration and diagnosis, 6 exhibited significantly depressed levels of PHA responsiveness in association with significantly increased levels of regulatory cell function by glass-adherent, preculture-sensitive and/or indomethacin-sensitive cells. Six patients were studied after diagnosis and treatment. Of those, 2 in remission had normal levels of immune function in association with normal levels of regulatory cell activity, whereas 2 of 4 patients who had recurrent disease had significantly depressed T cell function in association with increased glass-adherent, preculture-sensitive and/or indomethacin-sensitive regulatory cell activity. Although some alterations in lymphocyte-medicated suppressor cell activity were seen in 2 patients, those changes could not be correlated with impaired T cell function as measured in the PHA stimulation assay. The changes in regulatory cell function could not be correlated with levels of immune complexes in patient sera. These data suggest that increased levels of regulatory cell function by glass-adherent, preculture-sensitive and/or indomethacin-sensitive cells alone or in conjunction with lymphocyte and T cell depletion are a primary determinant of impaired immunocompetence in glioma patients.

Adult↗

Chronic cerebellar stimulation for cerebral palsy: a review.

Chronic cerebellar stimulation for cerebral palsy is a controversial procedure. It is difficult to evaluate objectively because cerebral palsy is not a single disease entity and the clinical syndrome may vary over time. Tests of neurophysiological function, signs of spasticity, and tests of motor function have documented changes, but double-blind evaluations have not. These studies are reviewed, as are the inherent problems in cerebellar stimulation and the physiology of cerebral palsy.

Cerebellum↗

Long-term effects on speech of chronic cerebellar stimulation in cerebral palsy.

Chronic cerebellar stimulation (CCS) of the anterior lobe is undertaken for relief or motor dysfunction in cerebral palsy, but the long-term effect on speech and voice has been uncertain. The present study evaluated speech before cerebellar stimulation and between one year and two years, seven months following stimulation in nine patients with congenital cerebral palsy and one patient with traumatic brain damage. Severity of dysarthria was not significantly altered as assessed by a panel of listeners. No patient demonstrated deteriorations in speech. Only two of the 10 patients showed small positive changes in the majority of parameters evaluated including rate, articulation, and voice.

Adolescent↗

Brain maturation followed by computed tomography.

Computed tomography scans of normal infants were analyzed by computer methods to determine the average brain tissue density during development. A 20% increase was found from term to 20 weeks of age (29 to 35 Hounsfield units); then no further significant change was found over the next 60 weeks. The increase in density parallels the known increase in dry weight of the tissue, but calculations indicate that biochemical changes, such as the accumulation of lipids, are also important.

Age Factors↗

Cerebral edema and neurological function in human beings.

The assumption that cerebral edema necessarily results in neurological deficits was investigated with the computerized scan. Four cases are cited to demonstrate that normal function can be preserved in spite of marked focal edema. Quantitative analysis of the amount of edema showed a large increase in the local water content, while neural activity was apparently not adversely affected.

Adolescent↗

Chronic cerebellar stimulation for cerebral palsy. Prospective and double-blind studies.

The effects of chronic electrical stimulation of the cerebellum in patients with cerebral palsy have been studied using objective tests of joint compliance, and standardized assessments of developmental reflexes and motor skills. Of 14 patients studied prospectively for 1 to 44 months, 11 showed improvement in motor function. A double-blind test of 10 patients off and on stimulation for an average 8-week period showed no significant changes. Thus, we have no proof that the functional improvements seen with long-term stimulation are the result of cerebellar stimulation.

Adolescent↗

Automated scene analysis of CT scans.

Since the advent of computed tomography, there has been an increasing realization that CT scans contain quantitative as well as qualitative information useful in the diagnostic process. Often however, the use of this information is impeded by the tedious manual outlining of the areas of interest in the scan. To alleviate this problem, we have developed a scene segmentation algorithm which will automatically delineate areas of interest in a CT scan. This procedure uses known information about the expected objects in the scan in conjuction with an algorithm to label those objects. The resultant scene segmentation divides the scan into four anatomical areas: skull, normal brain, high density lesions and CSF. After an area of interest is interactively selected by the clinician, volume, density or other quantitative measures may be computed. Limitations of the algorithm and its clinical applications are discussed.

Absorptiometry, Photon↗

Pathophysiological mechanisms in cerebral palsy.

To investigate some of the pathophysiological mechanisms in cerebral palsy, surface electromyograms (EMG) were recorded from pairs of flexor/extensor muscles during both voluntary and passive flexion/extension of upper and lower limbs of 20 patients. Elbow, knee, or ankle joint angles were measured simultaneously, as well as the force required to flex/extend the limbs passively at frequencies of 0.1--1.0 Hz. In addition, single motor units were recorded from the first dorsal interosseous muscles of six of the patients. Almost all patients showed resistance to passive movements (hypertonia). This hypertonia did not necessarily impair voluntary flexion/extension movements if alternating EMG activity was maintained in at least one of the pairs of flexor/extensor muscles involved in the movement. In six severly involved patients, there was a complete breakdown in the reciprocal relationship between reciprocally acting pairs of flexor/extensor motoneurones, which resulted in synchronous activation (co-contractions) of flexor/extensor muscles during both voluntary and passive movements. In these patients the hyperactive segmental reflex added to the disabling effects of co-contractions during voluntary movements. Single motor units recorded from patients with dystonic movements were recruited with variable delays (2--10 s) and usually discharged intermittently at high frequencies (60--120/s). This abnormla motor unit discharge pattern may relate to pathology of the basal ganglia.

Adolescent↗

Ventricular volume in man computed from CAT scans.

A new interactive computers has been developed to measure ventricular volume from CAT scans. Testing this system on phantoms demonstrated an accuracy to within 16%. Then a series of scans of patients with obstructive hydrocephalus was analyzed using both tradional linear measures and the computer method. None of the traditional measures were directly proportional to the calculated volume. The area measure of ventricular volume correlated well with the computer-generated values. Clinical studies which attempt to quantitate ventricular volume should use a computerized or planigraphic measure.

Cerebral Ventricles↗

Evidence for changes in segmental motoneurone pools by chronic cerebellar stimulation and its clinical significance.

Electrophysiological studies in eight patients with severe motor system abnormalities are described both before and after the start of chronic electrical stimulation of the anterior cerebellum. With stimulation, at least one of following changes was found in seven of these eight patients: reversal of abdominal F amplitude ratios (flexor/extensor muscles), decreased prominence of F responses, and loss of H reflexes in at least one muscle other than the soleus. These changes indicate that cerebellar stimulation can affect the excitability of segmental motoneurone pools. Although clinical changes, particularly decrease in tone, were observed in all the patients with stimulation, the complexity of trying to relate the physiological findings to functional improvement is emphasised.

Action Potentials↗

Cerebellar stimulation in man. Quantitative changes in spasticity.

The effects of chronic anterior lobe cerebellar stimulation on patients with cerebral palsy have been investigated using a new method of quanitfying muscle rigidity and stretch reflexes. The ankle is oscillated sinusoidally, compliance is measured at several frequencies, and electromyographic activity of the extensor and flexor muscles is recorded. In some patients stimulation can reduce rigidity and coactivation of muscles immediately or slowly over days or months. In others no change is found.

Adolescent↗

Effects on speech of chronic cerebellar stimulation in cerebral palsy.

Chronic cerebellar stimulation of the anterior lobe is undertaken for relief of motor dysfunction in cerebellar palsy, but the effect on speech and vocal ability has been uncertain. The present study evaluated speech before cerebellar stimulation and during the immediate postoperative period in seven severely spastic/athetoid patients with congenital cerebral palsy and one patient with traumatic brain damage. Structured listening tasks were completed in blind fashion by a trained panel of speech pathologists. Group analysis revealed no significant improvement in speech intelligibility or articulatory accuracy after stimulation. With the exception of strain/strangle vocal quality, which improved considerably, vocal characteristics were not affected by cerebellar stimulation. In three of eight patients, however, improvement in certain speech characteristics was noted.

Adolescent↗

Cerebral edema, mass effects, and regional blood volume in man.

The authors conducted quantitative analysis of computerized tomography (CT) scans to measure tumor size, cerebral edema, and regional blood volume in man. Mass lesions without edema caused a local reduction in blood volume. Cerebral edema also reduced blood volume in proportion to its severity. Consideration of the electrolyte changes and water shifts in white-matter edema suggested that the decrease in absorption coefficient seen in CT scans was due to the increase in water content. Thus, in cerebral edema separation of blood vessels as well as increased interstitial pressure decrease blood volume, and the regional differences in turn reflect pressure gradients within the brain.

Adult↗

Chronic cerebellar stimulation and developmental reflexes.

The changes in motor function in cerebral palsy patients produced by chronic anterior lobe cerebellar stimulation were documented with the Milani-Comparetti developmental scale, which allows comparison betweenfunctional gains and reflex patterns. Two patients with marked motor retardation and primitive reflexes were followed serially over several months of stimulation. Using these measures, the efficiency of chronic stimulation can be assessed, although many years will be needed to evaluate its role in treating motor disabilities.

Adult↗

Computed tomography in the diagnosis of pseudotumor cerebri.

The authors reviewed 17 patients with the clinical diagnosis of benign intracranial hypertension (pseudomotor cerebri). All of these patients underwent CT scans of the head which were interpreted as normal. Comparison of mean ventricular size with that of a group of control subjects showed no significant difference. On the basis of this study and others cited, there would appear to be almost no instances in which invasive neuroradiological procedures would be required to confirm the diagnosis of pseudotumor cerebri.

Adolescent↗

Tumor volume, luxury perfusion, and regional blood volume changes in man visualized by subtraction computerized tomography.

Computer and photographic methods for producing subtractions of computerized axial tomographic (CAT) scans have been developed. By subtracting point for point a normal scan from one taken after intravenous infusion of contrast material, a picture of the contrast in the cerebral vessels is created. By this method, tumor size and degree of vascularity may be assessed. Furthermore, abnormalities in perfusion and changes in blood volume due to mass effects and edema may be detected. Subtracting scans should add to the diagnostic potential of CAT and provide a noninvasive way to study vascular changes in cerebral disease.

Aged↗