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Biomedical subjects

R F Young

Publications and source records attributed to R F Young.

103 records · Page 6Linked to original sources
PubMedDate not supplied

Radiosurgery for the treatment of brain metastases.

Surgical resection and whole brain radiotherapy (WBRT) have been the mainstays of the treatment of cerebral metastases. This approach results in a median survival of about 10 months. Several recent publications and our own experience suggest that a similar median survival can be achieved with stereotactic radiosurgery using either the Leksell Gamma Knife or the linear accelerator radiosurgical techniques. In addition, radiosurgery can effectively treat metastatic tumors in surgically inaccessible sites, e.g., the brainstem. Radiosurgery can also effectively treat multiple intracranial metastases in widely separated areas of the brain. In fact, we have shown that patients with multiple metastases have similar lengths and qualities of survival as do patients with single metastases treated with stereotactic radiosurgery. The most important predictor of success in radiosurgical treatment of cerebral metastases is the neurological status of the patient, usually expressed as the Karnofsky Performance Status (KPS). The histological type of primary cancer is not an outcome predictor. Even so-called "radioresistant" tumors (e.g., melanoma, renal cell) respond favorable to radiosurgery. A great benefit of radiosurgery is the virtual lack of perioperative complications and the minimal interference with quality of life compared either to surgery or to fractionated whole brain radiotherapy. Long-term complications of radiosurgery are infrequent and primarily relate to failure of local tumor control (10%) and radiation-induced edema or necrosis. The later usually can be controlled with corticosteroids, but occasionally, craniotomy may be required to treat life-threatening mass effects. We believe that radiosurgery is the treatment of choice for most cerebral metastases. Only large lesions (> 3.5-4 cm diameter) and those which require immediate decompression to treat life-threatening mass effects require surgical treatment. Radiosurgery also may be used to treat residual disease after surgical resection. We have shown that WBRT does not increase the efficacy of radiosurgery in the treatment of cerebral metastases, and, therefore, we prefer to avoid both the short- and long-term morbidity of that treatment, if possible.

Brain Neoplasms↗
PubMedDate not supplied

Diaphragm pacing as an adjunct in respiratory insufficiency.

Most neurosurgical patients with permanent partial or complete respiratory insufficiency are managed with a mechanical ventilator and tracheostomy. This method presents many medical, technical, emotional, and social problems. A case is presented that illustrates the potential usefulness of electrical stimulation of the phrenic nerve ("diaphragm pacing") as an alternate method of therapy for respiratory insufficiency. This paper outlines the indications for, methods of, and problems with such a system and is intended to make its availability more widely appreciated among neurosurgeons.

Adolescent↗
PubMedDate not supplied

Racial and socioeconomic aspects of myocardial infarction recovery: studying confounds.

Cardiovascular disease rates illustrate the excess morbidity and mortality associated with race and social class. However, while prevalence and deaths from heart disease are greater among black and lower socioeconomic status (SES) populations, researchers rarely consider possible confounds between race and SES. In a longitudinal study of 246 older myocardial infarction (MI) patients, differences appeared in both morbid events and death for black and lower SES patients. Simultaneous comparison of race and SES showed significantly different outcomes among black low SES, black high SES, white low SES, and white high SES patients that confirmed the predicted ranking of these groups. Low SES black subjects ranked last in physical functioning and cardiac symptomatology, whereas high SES white subjects ranked first in preventive health opportunities. We also considered the potential race-SES confound as an interaction term in multiple regression analysis, and three recovery outcomes were significantly predicted by the joint effects of these variables. These findings demonstrate that failure to consider SES of black and white patients jointly, as well as individually, can lead to erroneous conclusions about health.

Black or African American↗