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Biomedical subjects

A J Beller

Publications and source records attributed to A J Beller.

At least 19 recordsLinked to original sources

Intracranial meningiomas following low-dose irradiation to the head.

Earlier reports have suggested that low-dose ionizing irradiation might be involved in induction of intracranial meningiomas. One of the problems in evaluating irradiation-induced neoplasms is the belief that these tumors have no distinguishing features to indicate their etiology. In an attempt to identify such features in meningiomas following irradiation, a group of 42 post-irradiation meningiomas (PIM's) has been compared with a group of 84 non-PIM control meningiomas. These 42 PIM's included all the intracranial meningiomas diagnosed at the Hadassah University Hospital during the years 1952 to 1981 in individuals treated in childhood with low-dose x-ray therapy for tinea capitis. Although the individual PIM does not seem to differ from a "spontaneous" meningioma, this study indicates that PIM's as a group have distinct characteristics, namely, their location at the site of maximal irradiation, and features suggesting rapid growth and aggressive biological behavior. There was a significantly higher number of calvarial tumors (p less than 0.001), a high proportion of multiple meningiomas, a higher recurrence rate following apparent complete excision (p less than 0.02), and an increased number of histologically malignant meningiomas (p less than 0.01). The demonstration of features that distinguish PIM's from meningiomas of other etiology supports the suggestion that low-dose ionizing irradiation was involved in the pathogenesis of these tumors.

Female↗

Increased intracranial pressure in post-traumatic rhinorrhoea.

Increased intracranial pressure coexistent with cerebrospinal fluid (CSF) rhinorrhoea was encountered in five out of 46 patients with a persistent CSF leak. In four patients, hypertension was due to malabsorption of CSF. One patient had a post-traumatic intracerebral cyst. The various degrees of intracranial hypertension, their effects on the clinical course and modes of treatment are demonstrated by the cases reported. Many failures in repairing the fistulous tracts may not stem from lack of technique, but could be the result of treatment of only one of the two concomitant conditions.

Adult↗

Somatosensory evoked potential to peroneal nerve stimulation in patients with herniated lumbar discs.

The somatosensory evoked potential (SEP) to peroneal nerve stimulation was recorded from 76 patients with myelographically proven herniated lumbar disc and was compared with normative data obtained from 65 healthy subjects. All patients with disc herniation had an abnormal SEP even when examination failed to disclose sensory deficits. In the patients with distortion of a root sleeve, the SEP abnormality was confined to the involved side. When myelography demonstrated large defects in the dural sac, there was electrophysiological evidence of disturbed conduction from the asymptomatic leg also. SEP changes in postoperative examinations correlated well with improvement or worsening of the patient's condition and enabled objective evaluation of the dynamics of sensory conduction along the involved structures.

Adolescent↗

Choroid plexus papilloma: hydrocephalus and cerebrospinal fluid dynamics.

Dynamics of the cerebrospinal fluid were measured pre- and postoperatively in a patient with a choroid plexus papilloma associated with hydrocephalus. The production rate was 0.35 ml/min, absorption 0.0057 ml/min H2O, and the critical opening pressure 196 mm H2O. Following removal of the tumor, these values were 0.32 ml/min, 0.0053 ml/min/mm H2O, and 105 mm H2O, respectively. It was concluded that no over-production of cerebrospinal fluid was present in this case. The hydrocephalus was due solely to obstruction of the fourth ventricle.

Adult↗

The recurrence of intracranial meningiomas.

A series of 126 patients with meningioma, operated upon 7-17 years ago, is reviewed as to the recurrence of the tumour. The overall rate of recurrence of the histologically benign lesions was 29 per cent. The most important factors influencing the prognosis were the site of the tumour and the degree of radicality of excision. Both factors were illustrated best in the parasagittal meningiomas, which carry the highest rate of recurrence. Infiltration of tumour into adjacent bone does not necessarily carry a higher risk of a clinically relevant recurrence. There seems to be a great variation in the rate of growth of different meningiomas.

Adolescent↗

Bilateral transverse sinus obstruction in benign intracranial hypertension due to hypervitaminosis A.

Hypervitaminosis A may be associated with benign intracranial hypertension. So far, the explanation for this phenomenon has remained obscure. A 17-year-old patient with benign intracranial hypertension, following chronic vitamin A intake of 150,000 units daily for acne vulgaris, is presented. Bilateral papilledema was present and bilateral obstruction of the transverse sinuses was demonstrated in the late venous phase of cerebral angiography. Discontinuation of vitamin A and acetazolamide treatment was followed by complete regression of the signs and symptoms of intracranial hypertension. Bilateral sinus obstruction with interference of cerebral sinus outflow is suggested as a critical factor in the pathogenesis of benign intracranial hypertension in vitamin A intoxication. Menstrual dysfunction and tetracycline therapy cannot be completely excluded as possible causative factors.

Acne Vulgaris↗

Postoperative ventriculitis in infants.

Eight consecutive cases of ventriculitis detected and treated during a four year period are reviewed. This complication represented 7.9% of all cases of spina bifida treated surgically, and 5.4% of all shunt precedures performed during the study period. Prophylactic antibiotic treatment did not reduce the incidence of ventriculitis, and in fact seemed to produce resistant strains, which led to difficulties in treatment and a worse prognosis. The presence of an intraventricular foreign body precludes permanent sterilization of the ventricular fluid. Finally, in those cases in which the antibiotic of choice penetrates poorly into the cerebrospinal fluid; intraventricular as well as systemic administration of the drug is indicated. With Gram negative organisms, Gentamicin is currently the drug of choice.

Cerebrospinal Fluid↗

Brain abscess. Review of 89 cases over a period of 30 years.

Eighty-nine cases of brain abscess, diagnosed over a period of 30 years, are reviewed. The incidence of this disease did not decline throughout the period. Abscesses of ear and nose origin constituted the largest group (38%). Postoperative abscesses seem to have increased in incidence, presumably due to routine postoperative antibiotic treatment. Antibiotics were possibly responsible for the suppression of signs of infection in 45% of the patients, who presented as suffering from a space-occupying lesion. The most accurate diagnostic tool was angiography, which localized the lesion in 90% and suggested its nature in 61%. Brain scan may prove as satisfactory. Staphylococcus was cultured in about two-thirds of the cases. Mortality seemed to decrease concomitantly with the advent of more potent antibiotics. The treatment of choice in terms of both mortality and morbidity seemed to be enucleation after previous sterilization. The hazards of radical surgery should be taken into consideration.

Adolescent↗