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Biomedical subjects

S R Freidberg

Publications and source records attributed to S R Freidberg.

At least 19 recordsLinked to original sources
PubMed2001

Characterization of chemical meningitis after neurological surgery.

We reviewed the records of 70 consecutive adult patients with meningitis after a neurosurgical procedure, to determine the characteristics that might help to distinguish a sterile postoperative chemical meningitis from bacterial infection. The spinal fluid profiles in bacterial and chemical meningitis are similar. The exceptions are that a spinal fluid white blood cell count > 7500/microL (7500 x 10(6)/L) and a glucose level of < 10 mg/dL were not found in any case of chemical meningitis. The clinical setting and clinical manifestations were distinct enough that no antibiotic was administered after lumbar puncture to 30 (43%) of the 70 patients with postoperative meningitis. Chemical meningitis was infrequent after surgery involving the spine and sinuses. Patients with chemical meningitis did not have purulent wound drainage or significant wound erythema or tenderness, coma, new focal neurological findings, or onset of a new seizure disorder. They rarely had temperatures > 39.4 degrees C or cerebrospinal fluid rhinorrhea or otorrhea.

Adult↗
PubMed2001

Intraoperative computerized tomography scanning to assess the adequacy of decompression in anterior cervical spine surgery.

OBJECT: The purpose of this study was to improve the accuracy of bone removal during anterior spinal surgery. Intraoperative computerized tomography (CT) scanning was used to assess the success of bone resection and permit immediate correction in the event of inadequate bone removal. METHODS: The Phillips Tomoscan M was used to obtain preoperative cervical scans before and after cervical bone resection was complete. The completeness of bone removal was assessed by the operating neurosurgeon by reviewing the postresection CT scan. If the bone removal was deemed inadequate, additional bone was removed using a high-speed drill. A CT scan was obtained after each subsequent decompression until adequate bone removal was achieved. In 31 patients undergoing anterior cervical decompression intraoperative CT scanning was performed. Nineteen patients underwent corpectomy and 12 discectomy. Of the 31 patients, assessment of intraoperative CT scans obtained in 17 indicated further bone removal was required. CONCLUSIONS: Intraoperative CT scanning to monitor bone removal during anterior cervical surgery is a valuable tool to ensure the adequacy of surgery.

Adult↗
PubMed1998

Brain tissue response to Holmium:YAG laser irradiation.

OBJECTIVE: To evaluate the usefulness of pulsed infrared solid-state Holmium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in neurosurgery, acute responses of brain tissue to Ho:YAG irradiation and to investigate the healing processes in rats and rabbits. METHODS: Animals were divided into groups according to different survival time and laser irradiation mode. Craniotomy was made and laser energy was delivered to the brain surface by two irradiation modes: 1) contact mode with the fiber in contact with the brain surface; and 2) non-contact mode with the fiber tip 5 mm above the brain surface. Gross observations were made and histological changes were studied. RESULTS: Acute responses were studied on rats' brain. The contact mode produced a crater lined with less than 1 mm thick thermally coagulated layer of brain tissue. The non-contact mode effectively vaporized the brain tissue even with water irrigation. Good homeostatic effect was achieved. The shock waves generated by the pulsed delivery of laser energy, however, impacted on the brain resulting in debris spreading and brain vibration. The healing processes were studied on rabbits' brain one day to six weeks after irradiation. The lesions produced by the contact mode were narrow and sharply defined. With the non-contact mode, the thickness of the coagulated layer at the bottom of the crater varied between 0.8 and 1.1 mm. CONCLUSIONS: Ho:YAG laser should be a clinically useful tool in neurosurgery because of its good ablation effect, shallow penetration and convenient optic fiber transmission system. Meanwhile, a continuously waved Ho:YAG laser is desired to reduce the shock wave impact.

Animals↗
PubMed1995

Hot flushes in men with pituitary adenoma.

BACKGROUND: Hot flushes are common in menopausal women and also in men made acutely hypogonadal after orchiectomy or testicular injury. It is, however, an unusual symptom in patients with hypogonadism secondary to pituitary tumors. METHODS: In evaluating the histories of men with hypogonadal state associated with nonfunctioning pituitary macroadenoma we were struck by the presence of hot flushes in four of them. RESULTS: All four of the patients were hypogonadal with sexual dysfunction preoperatively. All had low gonadotropins and low testosterone levels with varying degrees of panhypopituitarism. All had successful transsphenoidal removal of tumors. None had endocrine improvement following surgery. All patients had improvement in sexual function and the hot flushes with administration of testosterone postoperatively. CONCLUSIONS: Hot flushes are an uncommon presentation in men with pituitary adenoma. Perhaps the symptom will become more prominent if it is specifically questioned. We postulate that the cause of the flushing is related to nonsuppressed pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus.

Adenoma↗
PubMed1994

Repair of injured vertebral artery in anterior cervical procedures.

STUDY DESIGN: A case report of treatment of injury to the vertebral artery in anterior cervical procedures is presented with a review of the literature. OBJECTIVES: The feasibility of direct surgical repair is suggested. SUMMARY OF BACKGROUND DATA: Currently, ligation or tamponade is accepted as the treatment of injury to the vertebral artery in anterior cervical surgery. Significant morbidity can result from this method. Direct repair should eliminate this morbidity. METHODS: A report is presented of a patient who sustained injury to the vertebral artery, and the technique of repair is discussed. The literature was reviewed. RESULTS: The outcome was successful regarding both repair and the primary procedure. CONCLUSIONS: Although it is impossible to make a recommendation based on a single incident, this technique is believed to minimize postoperative sequelae that can be associated with occlusion of the vertebral artery.

Bone Transplantation↗
PubMed1994

Experience with symptomatic spinal epidural cysts.

Epidural cysts, either synovial or ganglion, are an unusual cause of epidural compressive syndromes. We report a series of 26 patients with cysts, including 1 cervical, 2 thoracic, and 23 lumbar. Complaints at the time of admission and findings were similar to those associated with other epidural lesions at the same locations. The surgical technique is similar to that for other spinal lesions, with a wide exposure to enable a clear view of the cyst and surrounding structures, and is governed by imaging studies. Patients with cervical and thoracic lumbar cysts were free of symptoms and signs postoperatively. Of the 23 patients with lumbar cysts, 15 were free of symptoms after an operation, 7 had symptomatic improvement but had some pain and neurological findings, and 1 patient had no improvement. Computed tomography and magnetic resonance imaging permit accurate preoperative evaluation.

Adult↗
PubMed1993

MRI appearances of an ectopic pituitary adenoma: case report and review of the literature.

MR images of an ectopic pituitary adenoma have been published in only a single case, a suprasellar mass. We present a patient with Cushing's disease in whom MRI revealed a pituitary adenoma within the sphenoid sinus. Radiologic characteristics of ectopic pituitary adenomas are reviewed, with emphasis on MRI, which demonstrates a soft tissue mass, isointense with gray matter on T1-weighted images, which enhances in a heterogeneous manner.

ACTH Syndrome, Ectopic↗
PubMed1989

Glucocorticoid dependency as a prognostic factor in radiotherapy for cerebral gliomas.

Records of 76 consecutive patients treated with radiotherapy for cerebral gliomas were reviewed. Eleven patients had no tissue diagnosis, and their outcome was comparable to that of patients with glioblastoma. Patients with other histologic diagnoses had much better results. Among the entire study population, the most important prognostic factors included age and histologic grade. Even with stratification by histologic grade and age, glucocorticoid (steroid) dependency was a reliable prognostic indicator in terms of survival. Fifteen of the 47 patients (32%) who were less steroid dependant are still alive with a median survival time of 29 months. Among the 29 patients who were heavily dependant on steroids during the course of radiotherapy, the median survival time was 5 months with only 2 patients (7%) still alive.

Astrocytoma↗
PubMed1989

Transsphenoidal pituitary surgery in the treatment of patients with Cushing's disease.

Transsphenoidal adenomectomy is the treatment of choice for patients with Cushing's disease. The combination of high serum and urinary cortisol and high plasma ACTH point to a nonadrenal source for Cushing's syndrome. It is important to rule out an ectopic source of ACTH production. Imaging of the sella with MRI and CT and sampling petrosal sinus blood for ACTH measurement should allow differentiation between the two conditions. For younger patients, every effort should be made to preserve the normal gland. If in the younger patient the adenoma cannot be clearly demonstrated, it is appropriate to remove the central portion of the gland, as advocated by Hardy. Should hypercortisolism persist, radiation therapy to the sella should be considered before attempting total hypophysectomy. In the woman past childbearing age, a total hypophysectomy can readily be considered if a sharply demarcated adenoma is not found. In fact, we counsel our older patients before operation that a total hypophysectomy is a possibility. For the patient with an aggressive tumor that is not cured by pituitary operation, radiation therapy must be considered. If it is not possible to wait for the therapeutic effect of radiation, adrenal suppression with aminoglutethimide, metyrapone, or ketoconazole is indicated. Adrenalectomy may be considered.

Adenoma↗
PubMed1987

Lymphocytic hypophysitis in a man.

Fewer than 20 patients with lymphocytic adenohypophysitis have been reported, all of them women, and it usually occurs during pregnancy or the postpartum period. We report the recognition of lymphocytic adenohypophysitis in a man. The patient presented with anterior hypopituitarism and an intrasellar mass on computed tomography. Antipituitary antibodies, found in only one of the previous patients, were not present in this man, although low titer antinuclear antibodies were found. The implications of this latter finding are unclear. The patient's histocompatibility antigen (HLA) types were A2, B8, Bw58, DR1, and DR5. The degree of pituitary failure seemed out of proportion to the size of the mass seen on computed tomographic scan.

Antibodies, Antinuclear↗
PubMed1986

Brain necrosis after radiotherapy for primary intracerebral tumor.

Radiotherapy is a standard postoperative treatment for cerebral glioma. We have observed the onset of symptoms related to brain necrosis, as opposed to recurrent tumor, in surviving patients. This has been manifest as dementia with a computed tomographic pattern of low density in the frontal lobe uninvolved with tumor, but within the field of radiotherapy. Two patients presented with mass lesions also unrelated to recurrent tumor. We question the necessity of full brain irradiation and suggest that radiotherapy techniques be altered to target the tumor and not encompass the entire brain.

Adult↗