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Biomedical subjects

Z H Rappaport

Publications and source records attributed to Z H Rappaport.

79 records · Page 5Linked to original sources

Computerized axial tomography in the preoperative evaluation of posterior fossa tumors in children.

22 cases of pediatric posterior fossa tumors that underwent preoperative evaluation by computerized tomography are presented. 8 of the cases, in the latter part of the series, were successfully operated upon on the basis of computerized tomography alone. In 14 other cases, additional angiographic investigation was carried out. In only 1 case of multiple hemangioblastoma did angiography provide further significant information. On the basis of this experience, it is suggested that computerized tomography is usually sufficient and further contrast studies are unnecessary in the preoperative evaluation of pediatric posterior fossa tumors.

Adolescent↗

Pediatric brain stem gliomas: an update.

It has become evident that pediatric brain stem gliomas are a heterogeneous pathology and should be classified according to clinical and radiological criteria. This classification has contributed to better treatment and greatly improved prognosis. Based on a review of the literature, we describe the different types of brain stem astrocytomas reported, which are: cervicomedullary, exophytic, cystic, focal and diffuse. Particular attention is paid to therapeutic modalities. For the first three lesions named the treatment is surgical and oncological therapy should be evaluated only for regrowth of the mass. Focal tumors of the medulla and pons are still treated empirically (surgically and/or with radiotherapy), because a definitive therapeutic protocol has not yet been elaborated; on the other hand it is well established that if the focal mass is in the midbrain this should merely be monitored by means of serial MRI, while radiotherapy should be applied in the event of the tumor's growth. Diffuse gliomas are treated with oncological therapy, and surgery (for biopsy or tumor excision) is not indicated. Five illustrative cases from our department are presented.

Adolescent↗

Regional brain sodium, potassium, and water changes in the rat middle cerebral artery occlusion model of ischemia.

Middle cerebral artery occlusions (MCAo) in rats produce infarcts in the pyriform and frontoparietal cortex, extending into the lateral basal ganglia and parasagittal cortex. We estimated tissue H2O concentrations from wet and dry weight measurements and determined Na and K concentrations by atomic absorption spectroscopy in these areas of rat brains. Tissue samples were analyzed at 2, 4, and 24 hours after MCAo and sham MCAo, compared with normal values measured in unoperated rats. In the pyriform and frontoparietal areas, H2O concentrations increased to 34 and 7% greater than normal by 2 hours, and 89 and 94% by 24 hours after MCAo. Na concentrations rose in these areas to 73 and 37% greater than normal by 2 hours, and 281 and 330% by 24 hours. K concentrations did not change until 4 hours, but fell to 62 and 34% of normal in these areas by 24 hours. Such large ion shifts indicate severe tissue destruction. In the parasagittal cortex and basal ganglia areas, the ion and water changes were smaller and did not become significant until 24 hours after MCAo. Rates of Na entry into the infarct site were greatest at 0-2 hours, while the rates of K loss peaked later, between 2 and 4 hours. The difference in Na influx and K efflux resulted in net ion shifts that correlated highly with water entry, yielding a correlation coefficient of 0.992 (p less than 0.001) and a slope indicating that 1 ml of water entered the tissue with each 145 mumoles of ions. These findings strongly suggest that net ion shifts cause the early edema of regional brain ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Regional brain calcium changes in the rat middle cerebral artery occlusion model of ischemia.

Entry of Ca ions into ischemic neurons is believed to cause cell damage. Although several investigators have demonstrated changes in extracellular Ca ionic activity consistent with Ca movement into cells, direct and quantitative evidence for Ca entry into ischemic cells is lacking. We used atomic absorption spectroscopy to measure the regional distribution of tissue Ca contents of rat brains sampled at 2, 4, and 24 hours after middle cerebral artery occlusion (MCAo). At 4 hours after MCAo, Ca concentrations increased significantly (p less than 0.005) in the ischemic middle cerebral artery territory, i.e., the pyriform and frontoparietal cortices, but not in the surrounding brain. At 24 hours, Ca concentrations in the pyriform and frontoparietal cortex were respectively 30.79 (+/- 2.90) and 29.19 (+/- 3.28) mumol/g dry tissue wt compared with 11.9 (+/- 1.7) mumol/g in sham-occluded rats. Tissue Ca concentration changes in the parasagittal cortex and basal ganglia adjacent to the infarct site were much smaller and did not differ significantly from controls until 24 hours. In the ischemic middle cerebral artery territory, greater than 1.0 mumoles of Ca entered per gram of dry tissue weight per hour during the first 4 hours after MCAo. Linear regression analysis revealed a significant correlation (r = 0.9722) between changes in tissue Ca and water, with a slope indicating that 5.88 mumoles of Ca accompanied each milliliter of water entering the lesioned hemisphere. Such massive accumulations of Ca not only confirm Ca entry into injured cells, but indicate the presence of a remarkable Ca sink which sequestered within 24 hours more than 17 times the amount of free Ca present in the tissue before MCAo.

Animals↗

Evaluation of brain death by contrast-enhanced computerized cranial tomography.

Four patients with clinical criteria of cerebral death were evaluated by computerized cranial tomography (CT). Upon intravenous infusion of meglumine diatrizoate, the intracranial vascular structures failed to enhance. Two of the patients also had electroencephalographic evaluation, and one patient underwent cerebral angiography, confirming the absence of cerebral blood flow. Contrast-enhanced CT may provide a contributory method in the establishment of cerebral death, in addition to elucidating the etiology of the ictus.

Adult↗

Transovale trigeminal cistern puncture: modified fluoroscopically guided technique.

A simple, safe, and rapid radiologic technique is described for trigeminal puncture via the foramen ovale. A radiopaque marker is placed 3 cm lateral to the labial commissure. Then, under fluoroscopic guidance, the patient's head is turned until the marker is projected vertically, over the foramen ovale. The needle can be advanced along the anatomically safe line determined by the foramen ovale and the lateral labial puncture site. Needle or patient misalignment is detected readily and can be corrected using fluoroscopic guidance. The technique is learned easily, obviates multiple needle passes, and takes less than 5 min.

Fluoroscopy↗