PubMed Health⌕ Search

Biomedical subjects

A Hirschfeld

Publications and source records attributed to A Hirschfeld.

18 recordsLinked to original sources
PubMed2003

Long-term management of bilateral metastases of renal cell carcinoma to the choroid plexus.

BACKGROUND: Metastatic tumors to the brain presenting exclusively in the choroid plexus are exceedingly rare. These events are frequently associated with renal cell carcinoma (RCC), of which all reported cases have been solitary lesions. METHODS: The authors present the unusual case of a patient with metastatic RCC who developed bilateral tumors of the choroid plexus. These tumors, one of which was confirmed to be metastatic RCC by histologic analysis, were treated over a 5-year period with a combination of interventions, including surgical resection, stereotactic radiosurgery, and chemotherapy, in conjunction with continual radiological monitoring. FINDINGS: Follow-up over a 5-year period demonstrated good control of the patient's intracranial disease and very little neurologic sequelae. INTERPRETATION: This strategy was successful in keeping the patient in good health with minimal neurological symptoms, despite the bilateral nature of the disease and its generally poor prognosis.

Carcinoma, Renal Cell↗
PubMed2002

Hemorrhage within brain tumors in association with long air travel.

Two cases of hemorrhage within brain tumors after air travel are described. The hemorrhages occurred in a meningotheliomatous meningioma and in a melanoma metastasis after the patients had taken transatlantic flights lasting more than seven hours. The literature concerning bleeding associated with brain tumors is reviewed, and possible mechanisms by which air travel may have precipitated these hemorrhages, based on known physiological changes that occur in-flight, are discussed.

Adult↗
PubMed1998

Hypertrophied cauda equina presenting as intradural mass: case report and review of literature.

BACKGROUND: Hereditary motor and sensory neuropathy types I and III usually lead to enlargement of peripheral nerves. Rarely, spinal nerve roots may also be involved, leading to radiculopathy and/or myelopathy. METHODS: This 44-year-old man with back and lower extremity radicular pain and distal lower extremity weakness and numbness was found to have a nonenhancing intradural mass that caused a nearly complete myelographic block from L1-L4. He underwent a decompressive laminectomy with intradural exploration. RESULTS: Hypertrophic but otherwise normal-looking nerve roots were observed. Subsequent electrodiagnostic testing and sural nerve biopsy confirmed that this patient had a previously unsuspected hereditary motor and sensory neuropathy (HMSN). His pain resolved, but at latest follow-up his weakness and numbness persisted. CONCLUSIONS: Nonenhancing spinal intradural mass lesions may represent enlarged nerve roots, which have a number of potential etiologies. Electrodiagnostic studies and peripheral nerve biopsy are instrumental in establishing the diagnosis of HMSN.

Adult↗
PubMed1998

Comparison between 201Tl-chloride and 99Tc(m)-sestamibi SPET brain imaging for differentiating intracranial lymphoma from non-malignant lesions in AIDS patients.

The aim of this study was to compare 201Tl-chloride and 99Tc(m)-sestamibi (MIBI) SPET brain imaging for differentiating brain lymphoma from other intracranial lesions in AIDS patients. Both studies were performed on the same day in 17 AIDS patients with intracranial enhancing lesions on either CT or MRI. Eleven patients underwent brain biopsy and six patients were followed clinically. We calculated the radiopharmaceutical uptake ratio of the lesion to that on the contralateral side with the guidance of CT or MRI findings. Ratios of 1.5 or more were considered to represent malignant lesions and ratios < 1.5 were considered to represent benign lesions. Biopsy revealed four cases of lymphoma, four cases of toxoplasmosis and two cases of progressive multi-focal leukoencephalopathy; one biopsy yielded necrosis. Both the MIBI and 201Tl studies yielded no false-negative cases of lymphoma (sensitivity 100%). Of the 13 non-lymphoma cases, the 201Tl studies showed seven true-negative cases (specificity 54%) and the MIBI studies showed nine true-negative cases (specificity 69%). The biopsies of the false-positive cases (toxoplasmosis) showed a pattern of healing after medical treatment. We conclude that MIBI is more helpful than 201Tl because of higher specificity and equal sensitivity. The medical treatment of toxoplasmosis is a cause of false-positive 201Tl and MIBI studies.

AIDS-Related Opportunistic Infections↗
PubMed1994

Stereotactic brain biopsies in AIDS patients: superior diagnostic yield with side-cutting needle than with cup forceps.

Controversy still exists over the indicators for, and usefulness of, performing brain biopsies in AIDS patients with focal cerebral lesions. One of the sources of doubt is the relatively poor diagnostic yield in biopsying lesions in AIDS patients compared with patients who do not have AIDS. In our institution, we performed 25 CT-guided stereotactic biopsies using the Brown-Roberts-Wells system within a 1-year period. Of these, 11 were performed with a 2-mm-diameter cup forceps, and 14 with a 10-mm-long x 2-mm-diameter side-cutting needle. Abnormal tissue was obtained from all patients, but, in the first group, 5 (45%) biopsies were nondiagnostic, and, in the second group, none (0%) were nondiagnostic. Of the diagnostic biopsies, there was roughly an equal proportion of lymphoma, progressive multifocal leukoencephalopathy, and toxoplasmosis between the two techniques. It is surmised that the deciding factor leading to an enhanced diagnostic yield with the side-cutting needle was the larger amount of tissue obtained with this instrument.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines.

A multidisciplinary Radiation Therapy Oncology Group (RTOG) task force has developed quality assurance guidelines for radiosurgery. The purpose of the guidelines are fourfold: (1) To ensure that participating institutions have the proper equipment and appropriate technique(s) to administer radiosurgery; (2) to outline a standard data set for each treated patient to assess protocol compliance; (3) to define minor and major deviations in protocol treatment; and (4) to set forth clinical data necessary to determine treatment efficacy, including failure patterns, and treatment toxicity. These guidelines are being implemented into active and developing radiosurgery protocols.

Brain Neoplasms↗
PubMed1991

The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions.

In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome--related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.

Bayes Theorem↗
PubMed1989

Spinal epidural lipomatosis: a serious complication of iatrogenic Cushing's syndrome.

Our experience and review of the literature demonstrate that spinal epidural lipomatosis is a rare but serious neurologic complication of iatrogenic Cushing's syndrome. Most patients develop slowly progressive paraparesis over months, but a subgroup exists which presents with acute, irreversible paraplegia. We consider therapeutic options.

Adolescent↗
PubMed1989

Stereotactic techniques in the management of cerebral neoplasms.

Stereotactic devices are being used by neurosurgeons for the diagnosis and treatment of both primary and metastatic brain tumors. Although stereotactic surgery has been performed for over forty years, a resurgence in its use, especially for the management of such anatomically definable lesions as brain tumors, has come about due to the wide availability of computerized imaging of the brain and the almost natural adaptability of stereotaxy to these diagnostic modalities. Stereotactic surgery is now being performed in over 100 centers throughout the United States. The author explains the basic principles of stereotaxy and discusses the broad range of its uses in the management of brain tumors.

Brain Neoplasms↗
PubMed1988

Brain death determination by angiography in the setting of a skull defect.

The absence of cerebral blood flow is presently considered the most reliable ancillary test in diagnosing brain death. A patient with an open skull fracture who met all criteria for brain death, including confirmatory postmortem studies, had a cerebral angiogram that showed unilateral preservation of cerebral circulation with diffuse extravasation of contrast material. We conclude that a skull defect may result in pressure reduction within the cranial cavity and persistent ipsilateral cerebral circulation, even after brain death. In this setting, diffuse extravasation of contrast material on angiography may reflect diffuse autolysis and suggest the diagnosis of brain death.

Adult↗
PubMed1988

Cytomembranous inclusions in the brain of a patient with the acquired immunodeficiency syndrome.

Ultrastructural studies of cells and tissues in the acquired immunodeficiency syndrome (AIDS) have revealed two distinct cytomembranous inclusions referred to as "tubuloreticular inclusions" (TRI) and "confronting cylindrical cisterns" (CCC). TRI are found most often in leukocytes and endothelial cells in conditions with elevated levels of alpha-interferon, such as viral infections, autoimmune diseases and certain neoplasms. On the other hand, CCC are detected almost exclusively in mononuclear inflammatory cells and are limited to a few conditions, of which AIDS is the most common. CCC have been proposed as an ultrastructural marker for human immunodeficiency virus (HIV) infection. We describe CCC in mononuclear inflammatory cells in the brain tissue with no other specific feature such as multinucleated giant cells, nevertheless, should alert the neuropathologist to the possibility that the patient might have AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Spinal epidural compression secondary to osteoblastic metastatic vertebral expansion.

We present two cases in which spinal epidural compression was caused by the expansion of bony elements into the spinal canal as a result of osteoblastic metastases. The precise nature of the compression was appreciated only on computed tomography. One patient had immediate and sustained neurological improvement after laminectomy. The other benefited temporarily, but widespread involvement of his spine ultimately led to paraplegia despite two more decompressive procedures. We think that bony expansion of the spine secondary to osteoblastic metastasis is not reversible with radiation therapy alone and is, therefore, an absolute indication for surgical decompression.

Adult↗
PubMed1987

Effect of sodium butyrate on S-100 protein levels and the cAMP response.

Sodium butyrate (NaB), when added to cell cultures, produces a variety of morphological and biochemical changes. We examined its effects, in nM concentrations, on the expression of two glioma cell-associated proteins, glial fibrillary acidic protein (GFAP) and S-100 protein in human glioma-derived cell line (RF), and of S-100 protein in the C6 rat glioma cell line. GFAP levels decreased by about 50% in the RF cell line, and S-100 protein levels decreased protein levels decreased by about 40% after treatment with 1 mM NaB for 48 h. In the C6 rat glioma cell line, isoproterenol with theophylline was found to increase S-100 levels by two-fold over basal levels. NaB was found to inhibit the induction of S-100 protein but exhibited no effect on the basal levels of the protein. Other short chain fatty acids, including sodium propionate and sodium isobutyrate, exhibited partial inhibitory activity. NaB, at an EC50 of 1 mM, was also found to inhibit both the beta-adrenergic and the forskolin-mediated increase in cAMP levels in these cells. This suggests that NaB may inhibit cells from expressing S-100 protein by attenuating cAMP levels.

Animals↗
PubMed1986

Response variability of human brain tumors to AZQ in tissue culture.

In a series of 28 glioma-derived cell cultures and 6 non-gliomatous CNS tumors, AZQ has been found to have varying degrees of growth inhibiting or cytotoxic activity in nearly all lines tested at doses greater than 100 mcg/ml. At dose levels comparable to the clinically achieved levels (1 mcg/ml), AZQ was found to have a cytotoxic effect in 8 of 28 glioma-derived and 2 of 6 non-gliomatous cell lines tested. These findings suggest that AZQ has activity against certain glioma-derived cells in culture at a response ratio similar to that seen in vivo. There, appear to be significant differences in the degree of responsiveness in different patients' tumor cells which can be detected in vitro prior to clinical treatment.

Antineoplastic Agents↗
PubMed1983

Recent life events and accidents: the role of sex differences.

In order to investigate how gender may moderate the manner in which life change affects behavior, 110 men and 54 women who had had industrial accidents were interviewed to assess what life change events they had experienced during the years before and after their injuries. For both sexes, increases in life events and associated stress had occurred prior to their accidents. Females reported higher levels of work-related events two years pre-accident, whereas men experienced a sharp increase in work events one year pre-accident. Post-accident, both males and females reported the greatest number of live changes with men experiencing more medical sequelae and women more separations from spouses and resumption of school. Results are discussed in terms of the possible effects of changing social and sex role expectations.

Accidents, Occupational↗