Search PubMed⌕ Search

Biomedical subjects

Z H Rappaport

Publications and source records attributed to Z H Rappaport.

At least 55 records · Page 3Linked to original sources
PubMed1990

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↗
PubMed1990

Experimental pathophysiological correlates of clinical symptomatology in peripheral neuropathic pain syndromes.

Recent advances in the study of nerve pathophysiology in experimental models of nerve and spinal root injury indicate a striking parallel between the abnormal electrical behavior of sensory axons and clinical symptomatology. In conjunction with central pain processes, these pathophysiological mechanisms can account for many of the major features of neuropathic pain syndromes.

Animals↗
PubMed1990

Effect of ischemia induced by middle cerebral artery occlusion on superoxide dismutase activity in rat brain.

Acute cerebral ischemia increases the generation of free radicals, causing cell damage, and theoretically may decrease the activity of the scavenging enzyme superoxide dismutase. To investigate the role of superoxide dismutase in cerebral ischemia, we used a model of middle cerebral artery occlusion in rats. In this model an infarct is produced in the pyriform and frontoparietal cortices, extending into the lateral basal ganglia. We measured superoxide dismutase activity by using the xanthine oxidase cytochrome c reduction assay in these areas of rat brains. Tissue samples were analyzed 20 minutes, 2, 6, or 24 hours, or 7 days after middle cerebral artery occlusion and 2 or 24 hours or 7 days after sham operation (n = 8-10 at each time). There was no significant change in superoxide dismutase activity relative to control values in any brain area at any time up to 24 hours after surgery. However, 7 days after middle cerebral artery occlusion a significant decline in superoxide dismutase activity, to 55%-68% (p less than 0.05) of that in unoperated controls, was observed in all brain areas. Our results do not support an important role for changes in the activity of endogenous superoxide dismutase during the acute phase of cerebral ischemia. However, the decrease in superoxide dismutase activity 7 days after ischemia could indicate ongoing additional damage to peri-infarct tissue.

Animals↗
PubMed1989

[Corpus callosotomy in intractable epilepsy].

6 males and 3 females, 2-17 years old, underwent partial or complete corpus callosotomy as treatment for medically intractable epileptic seizures. All benefited from the procedure. Evidence for unilateral cerebral damage on computerized tomography or a nonlocalized focus with secondary contralateral spread were the criteria for patient selection. The best results were obtained in atonic seizures. Long term side effects were minor and were minimized by staging the callosal resection. If partial callosotomy is effective, complete resection is unnecessary.

Adolescent↗
PubMed1989

Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours.

Of 148 patients with infratentorial brain tumours which were operated upon during a 5 year period, 59 patients had associated obstructive hydrocephalus, as evidenced by preoperative CT scan. External ventricular drainage was performed in these cases at time of surgery. CSF drainage was continued in the postoperative period for a mean of 2.3 (+/- 1.6) days. Only 6 of these 59 patients (10%) required a subsequent indwelling shunt. The infection rate was 10% and the total mortality was 8%. Perioperative ventricular drainage during and following the removal of posterior fossa tumours causing hydrocephalus provides an effective alternative to the preoperative placement of an indwelling shunt. Problems of shunt dysfunction, tumour seeding and upward herniation are thereby avoided. Postoperative ICP monitoring and drainage of blood and debris laden CSF is performed, increasing the safety of the postoperative period and possibly reducing the incidence of aseptic meningitis and postoperative shunt requirement.

Astrocytoma↗
PubMed1989

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↗
PubMed1989

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↗
PubMed1989

Aneurysmal bone cyst associated with fibrous dysplasia of the skull.

A 25 year old patient presented with a post-traumatic soft tissue swelling of the occiput, overlying an area of bone expansion and destruction. At operation an aneurysmal bone cyst was found. 11 years previously a similar parietal lesion had been found in conjunction with fibrous dysplasia. The differential diagnosis and treatment of this entity is discussed.

Adult↗
PubMed1988

Corpus callosum section in the treatment of intractable seizures in the Sturge-Weber syndrome.

The Sturge-Weber syndrome includes unilateral cerebral cortical angiomatosis, which often leads to progressive cerebral dysfunction and epileptic seizures that are medically difficult to control. Cerebral resections and hemispherectomy have been successfully performed in the past in intractable epileptic cases. Two children with medically unresponsive generalized seizure activity secondary to the Sturge-Weber syndrome have been surgically treated by dividing their corpus callosum. Cessation of generalized epilepsy was achieved in both cases. Corpus callosotomy is presented as a less destructive and safer procedure in dealing with intractable seizures in the Sturge-Weber syndrome.

Angiomatosis↗
PubMed1988

Corpus callosotomy in the treatment of secondary generalizing intractable epilepsy.

Over the past 5 years 9 patients underwent partial or complete corpus callosotomy for treatment of medically intractable epileptic seizures. A beneficial effect of the procedure was observed in 8 patients. Criteria for performance of the procedure included CT evidence of unilateral cerebral damage and non-localized epileptic foci in that hemisphere with secondary spread to the uninvolved side. The best results were obtained in atonic seizures. Long-term side effects were minor. The procedure is recommended in those patients with medically uncontrolled atonic or secondary generalized motor seizures in whom the corpus callosum is thought to mediate the spread of epileptic activity from a damaged cerebral hemisphere. Side effects are minimized by staging of the callosal section. If a partial callosotomy was beneficial, complete section can then be avoided.

Adolescent↗
PubMed1988

Recurrent trigeminal cistern glycerol injections for tic douloureux.

Fourteen of 60 cases (23%) of trigeminal neuralgia underwent a repeat trigeminal cistern glycerol injection for recurrent pain. The mean time to recurrence was 14 months and the mean follow-up time following the last injection 10 months. Measurement of trigeminal cistern volume at the first and second procedure with metrizamide showed a significant decrease in the cistern volume from 0.38 ml to 0.29 ml. Clumping of nerve roots indicative of arachnoiditis was observed in 4 cases. In 2 further cases difficulty was encountered in emptying the cistern of metrizamide. After the repeat injection 2 patients developed painful dysethesia. Six patients showed either new or increased facial sensory deficits. These findings may indicate trigeminal cistern arachnoiditis. The possibility of deafferentation pain developing after trigeminal glycerol rhizolysis should prompt caution in the use of this technique in the younger patient.

Drug Administration Schedule↗
PubMed1988

Intracranial pressure monitoring after elective intracranial surgery. A retrospective study of 514 consecutive patients.

A retrospective study of 514 consecutive patients whose intracranial pressure (ICP) was monitored after elective supratentorial or infratentorial surgery is reported. Of the 412 patients operated on in the supratentorial region, 76 (18.4%) had a postoperative sustained ICP elevation exceeding 20 torr. Abnormally high ICP occurred after 13 (12.7%) of the 102 infratentorial operations. Risk factors for postoperative ICP elevation were: resection of glioblastoma in 27.2% of cases, repeat surgery in 42.9% of cases, and protracted surgery (greater than 6 hours) in 41.7% of cases. Of the 89 patients with elevated ICP, 47 (52.8%) had an associated clinical deterioration. In 19 of these, the rise in ICP occurred before this deterioration was noticed, leading as a rule to quick diagnostic and management response. In eight patients clinical deterioration was noticed before the rise in ICP, and in 20 it happened simultaneously. The higher the level of ICP elevation, the greater were the chances of associated deterioration. The most common findings on computerized tomography scanning in 35 of 89 patients with elevated ICP were brain edema (19 cases) and bleeding in the tumor bed (15 cases). Mannitol, thiopental, additional hyperventilation, and reintubation (in patients who were previously extubated) were used to reduce ICP, in addition to surgical decompression whenever indicated. Thirteen patients with raised ICP and clinical deterioration underwent reoperation. The postoperative infection rate was 1.2% (six cases). In only one patient could infection be attributed to ICP monitoring. It was concluded that ICP monitoring is advantageous in the immediate postoperative management after elective intracranial surgery and is almost risk-free. It should therefore be used liberally, especially when risk factors for ICP elevation can be identified prior to the end of surgery.

Brain Neoplasms↗
PubMed1987

Intramedullary fibrosarcoma of the cervicomedullary junction: a case report.

A 17-year-old girl presented with signs of increased intracranial pressure. On computed tomography, an enhancing intraaxial lesion in the region of the foramen magnum was demonstrated. Surgical excision was performed. The pathological diagnosis was low grade fibrosarcoma. Her subsequent course was complicated by cerebrospinal fluid seeding, a posterior fossa recurrence, and repeated subarachnoid hemorrhage with cerebral vasospasm. A combination of radiotherapy and intraventricular chemotherapy has left the patient symptom-free 2 years after operation. The intramedullary appearance of fibrosarcoma and the unusual subsequent clinical course are discussed.

Adolescent↗
PubMed1987

Neurosurgical, obstetric and endocrine aspects of meningioma during pregnancy.

A 34-year-old woman presented with symptoms due to a cerebral meningioma during pregnancy. The meningioma tissue was found to be positive for progesterone but not estrogen receptors. The relationship of meningiomas to pregnancy, female sex, and breast cancer is discussed with emphasis on the presence of hormone receptors in the tumor tissue. The high incidence (39 to 100%) of progesterone receptors in meningiomas may explain the increased percentage of its discovery during pregnancy. Neurosurgical intervention during pregnancy should be confined to cases associated with neurological deficit. Cesarean section is indicated only in the presence of a major intracranial mass effect.

Adult↗
PubMed1986

Biopsy of intracranial lesions with computed tomography stereotactic guidance.

Thirteen cases of deep-seated intracranial lesions that were biopsied by the technique of CT (computed tomography) stereotactic guidance are presented. In 11 cases a diagnosis of brain neoplasm was made. One case of a cystic thalamic astrocytoma was treated by stereotactic insertion of a cannula attached to an s.c. reservoir. There was one complication related to a concomitant ventricular catheter placement. The technique is recommended for diagnosis of deep-seated intracranial lesions, where the risk of a conventional open operative approach is considerable.

Adult↗
PubMed1985

A chronically implanted delivery system of drugs to a nerve-end neuroma: effects on a behavioural chronic pain model.

Autotomy has been suggested as an animal model of chronic pain. It starts about a week or two postoperatively and develops until 10 weeks after nerve section. This behaviour is thought to be triggered by activity of sensory fibres ending in a neuroma. Here we suggest to utilize it in combination with a novel drug delivery system which enables a direct and exclusive access of the drug to the neuroma. Alteration in the autotomy behaviour can then be related to the exclusive topical action on the sensory fibres within the neuroma. The sciatic nerve is transsected and its proximal end inserted into a PE tube sealed distally. A second, smaller tube originates in a wound exit in the back of the animal and subcutaneously leads into the large tube, where it is fixed by glue to the inner wall. Thus, the end of the smaller tube is juxtaposed to the nerve end. During the following weeks a neuroma develops within the tube. The resulting autotomy scores are then examined weekly. At various times after the operation, under light anaesthesia, drugs can be injected into the tube and the effect on the autotomy behaviour is monitored. An example is given, describing the autotomy suppressive effects of glycerol and alcohol, injected to different groups of rats immediately after the operation and compared to an injection 14 days postoperatively. This method is suggested as a pharmaco-behavioural assay for the assessment of the analgetic efficacy of drugs for chronic pain.

Amputation Stumps↗