[Importance of dust-mites in the pathophysiology of bronchial asthma].
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Animals↗
Biomedical subjects
S Pomeranz
Publications and source records attributed to S Pomeranz.
Management of tumours involving the cavernous sinus.
The operative experience with 137 tumours of the cavernous sinus at the University of Pittsburgh during the past 7 years is reported. The importance of the normal and tumour-infiltrated cavernous sinus anatomy and imaging is delineated. 63% of the tumours are benign, primarily meningiomas, for which an anatomical grading system is presented. The various operative approaches to the cavernous sinus are described. 88% of the meningiomas were totally resected. There was a 1.5% operative mortality and 1.5% severe morbidity rate. Initial ipsilateral opthalmoplegia progressively improved in the majority of patients. For all patients with at least 6 months of follow up of benign tumours, the intracavernous tumour recurrence rate was 3% and total recurrence rate was 6%.
Brain Neoplasms↗
Extradural petrous bone and petroclival neoplasms.
Extradural petroclival tumours are composed of a spectrum of histological and anatomical configurations dictating a variety of surgical approaches. The experience with 68 such tumours operated at the University of Pittsburgh is presented, emphasizing the basal subfrontal and lateral approaches. 85% of these tumours are benign or low-grade malignancies, with 62% of these totally resected, resulting in a 5.4% recurrence rate. The operative mortality was 1.5% and major morbidity 3%. Well-planned surgery based on precise anatomical knowledge and imaging is the basis of treatment for petroclival tumours.
Combined Modality Therapy↗
Familial intracranial arachnoid cysts.
Three siblings with intracranial arachnoid cysts are described, two males and one female. One of the males has symmetric, bilateral, temporoparietal convexity cysts, and the others have singular, unilateral cysts. Three additional siblings in the family and other known relatives are clinically unaffected. As far as we know, this is the second reported case of familial intracranial arachnoid cysts and the first involving three siblings. The significance of these cysts and a review of the literature are presented.
Arachnoid Cysts↗
Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors.
A retrospective study was designed to evaluate clinical thromboembolic phenomena (TEP) in patients operated upon for brain tumours. Among 492 patients treated surgically in the supratentorial area, the overall incidence of clinical TEP was 7%. There were 5% with deep vein thrombosis (DVT) and 4% with clinical pulmonary embolism (PE). Seven patients (1%) died from massive PE. Among 141 patients treated surgically in the infratentorial area there were no episodes of TEP. Significant risk factors for TEP development were operations in the supratentorial area, malignant gliomas (compared to meningiomas) and para- or hemiparesis. Age, sex and the specific location in the supratentorial area were not found to be statistically significant risk factors. Among 12 patients who presented initially with DVT two developed PE despite full heparinization. 7/19 patients with PE died within minutes to hours of the clinical episode despite full conservative measures. In 2/26 patients who were treated with full heparinization complications occurred. There was one case of diffuse subcutaneous bleeding and one case of tumour bed haematoma. The identification of risk factors for the development of TEP will allow the implementation of prophylactic measures in appropriate patients undergoing elective brain tumour surgery.
Adult↗
The use of fibrin sealant in cerebrospinal fluid leakage.
Cerebrospinal fluid leakage is one of the central problems facing neurosurgeons, both due to its occasional difficulty in management and to the catastrophical significance of ensuing infection. An important tool emerging in the surgical management of CSF leakage is fibrin sealant, the natural coagulation product. Thirteen cases of CSF leakage, due to meningomyelocele, posttraumatic, and secondary to tumor, that were managed surgically with fibrin sealant are presented. Several of the cases were successfully operated upon following failure of conventional surgical techniques. Additional uses of fibrin sealant in neurosurgery are discussed.
Adenoma↗
Gliomas following low-dose irradiation to the head report of three cases.
Three patients developed cerebral gliomas decades after exposure to low-dose x-ray irradiation in childhood for the treatment of tinea capitis. One of the patients had a glioblastoma multiforme concomitant with multiple intracranial meningiomas, a condition highly correlated with previous irradiation. The other tumors were malignant cerebellar astrocytoma and a diffuse cerebral astrocytoma. We review the evidence suggesting that low-dose irradiation is involved in the pathogenesis of gliomas.
Adult↗
"Rubral" tremor following radiation of a pineal region vascular hamartoma.
Tumours of the pineal region have historically been difficult to remove safely. Only recently have large series of successful pineal area operations been reported, and there are many advocates for surgical reticence with these tumours. We report a case of a 20-year-ol women whose pineal region tumour was irradiated, whereupon a unilateral low-frequency resting and intention tremor developed. Following resection of the lesion, a vascular hamartoma, the tremor virtually disappeared. We believe the tremor was secondary to radiation induced tumour shrinkage and distortion of the mesencephalon. This case is demonstration of the importance of exploration and histological verification of pineal region tumours.
Adult↗
Nuclear magnetic resonance and lipids of the plasma from patients with intracranial tumours.
The plasma of fifteen patients with malignant primary intracranial central nervous system (CNS) neoplasms was examined using proton nuclear magnetic resonance (NMR) and lipid level analysis. Twenty-three benign intracranial neoplasms and twelve non-CNS, non-malignancy patients served as control. At 300 MHz the NMR mean line width of plasma with malignant tumours was (+/- 2 SE) 37.2 +/- 3.0 Hz and for benign tumours 33.5 +/- 3.0 Hz (P = 0.09). The mean plasma triglyceride level for the malignancy patients was 100 +/- 25 mg/decilitre and 173 +/- 74 mg/decilitre for the patients with benign tumours (P = 0.07). The mean plasma cholesterol was 182 +/- 42 mg/decilitre for the malignancy patients and for the patients with benign tumours 241 +/- 29 mg/decilitre (P = 0.03). Unfortunately overlaps of the values of the different groups, in spite of statistically significant differences, detracts from the clinical usefulness of these criteria. Attempts to combine these values and correct for tumour volume, as calculated from computerized tomography, did not improve the differentiation between these two groups. Although it has been reported that plasma NMR and lipid levels can differentiate between malignant and benign tumours in general and in the central nervous system, these criteria are not adequately sensitive and specific to replace histology for the definite diagnosis of central nervous system tumours.
Biomarkers, Tumor↗
Penetrating craniocerebral injury caused by a metal rod: an unusual case report.
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Accidental Falls↗
Delayed epidural hematoma without neurologic deficit.
Six patients with delayed epidural hematoma demonstrated by serial computed tomography scan are presented. Three of the patients had no neurologic deficit but suffered from severe headache. We suggest routinely performing repeat CT, before discharge, in patients having sustained head trauma with or without skull fracture, who suffer non-resolving headache, even when there is no neurologic deterioration. Serious symptomatology that may have occurred due to the development of delayed intracranial hematomas is thereby anticipated.
Adult↗
Epidural haematoma and unilateral exophthalmos--a review.
Based on 9 cases in the literature and one of our own a review is made on the occurrence of an association of an intracranial epidural haematoma with unilateral exophthalmos. The possible pathogenesis of this infrequent phenomenon is discussed.
Brain Concussion↗
Hypokalaemia in severe head trauma.
Forty-six consecutive patients with severe isolated head trauma (GCS less than or equal to 7) had significant hypokalaemia averaging 3.1 +/- 0.4 (S.D.) mmol/litre upon admission to the emergency room. This electrolyte imbalance occurred within hours of the trauma and resolved under treatment within the first day. There was no correlation between serum potassium and pH, glucose, urine electrolytes, patient age or sex, admission Glasgow Coma Score or the Glasgow Outcome Score. Sixteen patients with multiple trauma but without head trauma had an average serum potassium of 3.5 +/- 1.1 mmolar. Mechanisms of serum potassium level control and their correlation with brain trauma are addressed in a search for an explanation of this phenomenon. We believe that the most appropriate explanation for this hypokalaemia is the large catecholamine discharge that is known to accompany severe head trauma, with resultant beta 2-adrenergic stimulation of the Na+ -K+ pump. The formation of a prospective on-going study to clarify the basic mechanism of hypokalaemia in severe head trauma is presented.
Adolescent↗
Coexistence of Dandy-Walker syndrome and Down's syndrome.
A newborn with Dandy-Walker syndrome was found to have a trisomy 21 karyotype. This is the first reported case of coexisting Dandy-Walker and Down's syndromes. The pathogenetic alternatives for the development of Dandy-Walker syndrome and the implications of the case are discussed.
Cerebrospinal Fluid Shunts↗
Malignant pseudotumor cerebri. Report of two cases.
Two young Arab women presented with a very rapid loss of vision, ophthalmoplegia, florid papilledema, areflexia of the lower limbs, and normal mentation. Lumbar puncture pressure was above 60 cm H2O, but no intracranial structural lesion was found in either patient. An exhaustive evaluation as to an etiology was negative in both. Under continuous lumbar cerebrospinal fluid drainage and administration of steroids, furosemide, and acetazolamide, both patients had significantly improved vision and ocular movement. In both, lumboperitoneal shunting was considered but only one eventually underwent this procedure. These two patients with pseudotumor cerebri are unique in their fulminant clinical course and severely increased intracranial pressure. Virtually inevitable blindness was prevented by timely intervention.
Acetazolamide↗
Water lily sign in CT of cerebral hydatid disease: a case report.
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Brain Diseases↗
Arachnoid cysts: unusual aspects and management.
Several unusual aspects of primary cerebral arachnoid cysts are presented. The optimal management of these lesions is discussed. Attempts at craniotomy and excision of these cysts is not always effective in eliminating the lesion and may provoke intracranial catastrophies. Huge and bilateral cysts are best treated by cystoperitoneal shunting. In general shunting may be preferable to craniotomy and resection of the cyst. An anti-siphon device is recommended to avoid overdrainage of cerebrospinal fluid.
Adult↗
Technical note: the removal of free peritoneal catheters in the revision of ventriculoperitoneal shunts.
The widespread usage of ventriculoperitoneal shunts has been followed by a plethora of complications. One of these complications, the separation and migration of the distal tubing to be free intraperitoneally, has been relatively disregarded in the literature both as a phenomenon and as to treatment. We present our experience with nine such cases, four involving two peritoneal catheters. Unless contraindicated, we think that such tubing should be removed during shunt revision by single digit blind palpation of the tubing. No complications arose from this procedure, and the postoperative course was uneventful. The indications for this procedure are discussed in relation to the relevant literature.
Cerebrospinal Fluid Shunts↗