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Biomedical subjects

D Goldsher

Publications and source records attributed to D Goldsher.

At least 19 recordsLinked to original sources
PubMed2006

Morphological study of the spinal canal content for subarachnoid endoscopy.

STUDY DESIGN AND OBJECTIVE: This study was designed to examine the morphology of the spinal dural sac and contents, using magnetic resonance imaging in order to define the inner geometrical dimensions that confine the manoeuvre of an endoscope inserted in the lumbar region and along the thoracic and cervical spine. BACKGROUND: The morphology of the spine has been studied since the development of myelography. However, most studies have measured the diameters of the spinal cord only, not the size of the subarachnoid space. In addition, the few studies available on the subarachnoid space have focused on the cervical spine, leaving a near-complete dearth of data on the subarachnoid space dimensions along the thoracic spine. METHODS: Based on MRI images of the spine from 42 patients, the dimensions of the spinal cord, dural sac, and subarachnoid space were measured at mid-vertebral and inter-vertebral disc levels. RESULTS: It was found that at each selected transverse level, the subarachnoid space tends to be symmetrical on the right and left sides of the cord, and measures 2.5 mm on average. However, the posterior and anterior segments, measured on the mid-sagittal plane, are generally asymmetrical and vary widely in size, ranging from 1 to 5 mm. These measurements match those found in previous studies, where these are available. The coefficient of variance for the dimensions of the subarachnoid space is as high as 42.4%, while that for the dimensions of the spinal cord is 10-15%. CONCLUSIONS: The findings presented here expand our knowledge of the spinal canal's morphology, and show that an endoscope designed to travel within the subarachnoid space must be smaller than 2.5 mm in diameter.

Adolescent↗
PubMed2005

Impaired "affective theory of mind" is associated with right ventromedial prefrontal damage.

OBJECTIVE: To examine the hypothesis that patients with ventromedial (VM) frontal lesions are impaired in the affective rather than cognitive facets of theory of mind (ToM). BACKGROUND: Prefrontal brain damage may result in impaired social behavior, especially when the damage involves the orbitofrontal/VM prefrontal cortex (PFC). It has been previously suggested that deficits in ToM may account for such aberrant behavior. However, inconsistent results have been reported, and different regions within the frontal cortex have been associated with ToM impairment. METHOD: The performance of 26 patients with localized lesions in the PFC was compared with responses of 13 patients with posterior lesions and 13 normal control subjects. Three ToM tasks differing in the level of emotional processing involved were used: second-order false belief task, understanding ironic utterances, and identifying social faux pas. RESULTS AND CONCLUSIONS: The results indicated that patients with VM (but not dorsolateral) prefrontal lesions were significantly impaired in irony and faux pas but not in second-order false belief as compared with patients with posterior lesions and normal control subjects. Lesions in the right VM area were associated with the most severe ToM deficit. These results are discussed in terms of the cognitive and affective facets of "mind-reading" processes mediated by the VM cortex.

Adult↗
PubMed2004

Impairment in cognitive and affective empathy in patients with brain lesions: anatomical and cognitive correlates.

The present study was designed to examine the degree of impairment in cognitive and affective empathy among patients with focal brain lesions, and the contribution of specific cognitive abilities (such as cognitive flexibility and processing of emotional information), to empathy. The cognitive and affective empathic response of patients with localized prefrontal lesions (n=36) was compared to responses of patients with parietal lesions (n=15) and healthy control subjects (n=19). Results indicate that patients with prefrontal lesions (especially those with lesions involving the orbitoprefrontal and medial regions) were significantly impaired in both cognitive and affective empathy as compared to parietal patients and healthy controls. When the damage was restricted to the prefrontal cortex, either left- or right-hemisphere lesions resulted in impaired empathy. However, when the lesion involved the right hemisphere, patients with parietal lesions were also impaired. The pattern of relationships between cognitive performance and empathy suggested dissociation between the cognitive correlates of affective and cognitive empathy.

Adult↗
PubMed2003

Hyperbaric oxygen therapy as a treatment for stage-I avascular necrosis of the femoral head.

Avascular necrosis (AVN) of the head of the femur is a potentially crippling disease which mainly affects young adults. Although treatment by exposure to hyperbaric oxygen (HBO) is reported as being beneficial, there has been no study of its use in treated compared with untreated patients. We selected 12 patients who suffered from Steinberg stage-I AVN of the head of the femur (four bilateral) whose lesions were 4 mm or more thick and/or 12.5 mm or more long on MRI. Daily HBO therapy was given for 100 days to each patient. All smaller stage-I lesions and more advanced stages of AVN were excluded. These size criteria were chosen in order to compare outcomes with an identical size of lesion in an untreated group described earlier. Overall, 81% of patients who received HBO therapy showed a return to normal on MRI as compared with 17% in the untreated group. We therefore conclude that hyperbaric oxygen is effective in the treatment of stage-I AVN of the head of the femur.

Adult↗
PubMed2001

CT angiography of the carotid arteries in trauma to the neck.

OBJECTIVES: serious vascular injuries to the neck may be asymptomatic or masked by other life-threatening conditions. Angiography, the "gold standard" vascular imaging modality, is an invasive procedure. Moreover, it is time-consuming and thus may delay a needed vascular intervention. The results of screening angiography are negative in more than 80% of cases. Therefore other less invasive and faster screening tests, such as the Doppler ultrasound and magnetic resonance angiography, have been tested. This retrospective study was done to evaluate the use of CT angiography (CTA) in suspected vascular injuries of the neck. METHODS: from 1995 to 1998, 16 patients with suspected traumatic carotid artery injury underwent CTA. Twelve of these patients had penetrating injuries and four had blunt injuries to the neck. CTAs were obtained by Elscint Twin Flash Spiral Scanner, while MIP reconstructions were carried out on an Omnipro, Elscint (Indy, Silicon Graphics) work station and interpreted by a radiologist. RESULTS: all the CTAs were diagnostic. Positive findings included one complete tear of the right common carotid artery (confirmed by surgery) due to a penetrating injury and one bilateral internal carotid artery thrombosis after blunt injury to the neck. In addition, three patients with multiple trauma were operated on, due to either proximity only or questionable neurological findings. Surgical exploration confirmed the negative findings seen on CTA. CONCLUSION: CT angiography of the carotid arteries in cervical trauma may be used as an accurate decisive tool for a needed surgical intervention. More studies with larger number of patients and comparison with angiography are needed.

Adolescent↗
PubMed2000

Color-coded duplex ultrasound compared to CT angiography for detection and quantification of carotid artery stenosis.

OBJECTIVE: The purpose of this study was to compare findings on color-coded duplex ultrasound and CT angiography for grading internal carotid artery stenosis, and to investigate whether both these imaging modalities are necessary for an accurate diagnosis of carotid stenosis in the pre-surgical assessment of the internal carotid artery. PATIENTS AND METHODS: We examined 92 internal carotid arteries from 46 randomly chosen patients with suspected carotid stenosis by color-coded duplex ultrasound and by three-dimensional CT angiography (CTA). This retrospective study adhered to international guidelines with gradings of mild, moderate, severe, and occlusive carotid disease. RESULTS: The study demonstrated agreement between the degree of stenosis found on color-coded duplex ultrasound and that found on CTA in 78% of cases overall and in 79% of patients requiring surgical intervention. When compared to CTA, color-coded duplex ultrasound yielded a sensitivity of 78.9% and a specificity of 96.3%. Although findings on color-coded duplex ultrasound and CTA were comparable, disagreement affecting treatment decision occurred in 10:92 arteries. CONCLUSION: CTA was not found to be beneficial for patients exhibiting mild stenosis on color-coded duplex ultrasound, as none of the mild groupings found by sonography were interpreted as severe or occluded by CTA. However, CTA may be an important adjunct to color-coded duplex ultrasound regarding the categories of moderate, severe and occluded when carotid endarterectomy is considered.

Adolescent↗
PubMed2000

Hypoplasia of the inferior vena cava with azygous continuation presenting as recurrent leg deep vein thrombosis.

Azygous continuation of the inferior vena cava is a rare congenital malformation. It occurs because of atresia of the retrohepatic segment of the inferior vena cava. The disorder has been described mainly as an incidental finding associated with a number of congenital malformations, including cardiovascular, tracheobronchial, and other visceral malformations. Therapeutic intervention is aimed primarily at accompanying malformations. We report a case of hypoplasia of the inferior vena cava with azygous continuation in a 30-year-old man who presented with recurrent deep venous thrombosis.

Adult↗
PubMed1999

Carboplatin and etoposide for recurrent malignant glioma following surgical and radiotherapy failure: A clinical study conducted at the Northern Israel Oncology Center.

BACKGROUND AND OBJECTIVES: We conducted a phase II study using carboplatin and etoposide on patients with recurrent malignant glioma to investigate tumor response. METHODS: From January 1995 to March 1997, 21 patients with recurrent malignant glioma were treated with a carboplatin (300 mg/m(2), day 1)/etoposide (100 mg/m(2), days 1-3) regimen every 3-4 weeks. The following radiologic parameters were evaluated: tumor size, central lucency, degree of contrast enhancement, and mass effect. No patient had received chemotherapy previously. Dose escalation corresponded to hematologic tolerance and to general and neurologic performance status. Most patients were treated postoperatively with involved field radiotherapy followed by a boost to the tumor area, as defined on the presurgery computed tomography scan or on magnetic resonance imaging. Mean interval to introduction of chemotherapy was 8.8 months (range, 7-36 months). Patients received a mean of four cycles [range, 2-8 cycles]. RESULTS: Only 2 patients showed moderate radiological response, while 12 patients died of progressive disease. Mean time to progression following discontinuation of chemotherapy was 5.8 months (range, 1-11 months). The other patients survived with persistent disease and are being treated palliatively. Toxicity was manageable (1, neutropenic sepsis; 1, thrombocytopenia (45,000/mm(3)); 2, temporarily elevated transaminase level; 2, steroid-induced erosive gastritis). CONCLUSIONS: This phase II regimen proved to be ineffective in recurrent malignant glioma. Further studies incorporating innovative drug regimens and schedules are warranted. J. Surg. Oncol., 1999;71:167-170.

Adolescent↗
PubMed1997

[Temporal hemianopia and diabetes insipidus following head injury].

Bitemporal hemianopia and diabetes insipidus following head injury are caused by a lesion in the center of the optic chiasm, together with injury to the adjacent pituitary stalk or the hypothalamus. This combination was thought to be a rare complication of severe head injury. The case of a 16-year-old male is presented, which together with recent reports suggests that this relatively under-recognized syndrome is not infrequent, that it may follow even minor head injury, and that magnetic resonance imaging can demonstrate the chiasmal lesion.

Adolescent↗
PubMed1996

Melatonin replacement corrects sleep disturbances in a child with pineal tumor.

A child with a germ cell tumor involving the pineal region had marked suppression of melatonin secretion associated with severe insomnia. Exogenous melatonin (3 mg in the evening) for 2 weeks restored sleep continuity, as demonstrated by objective monitoring of rest-activity cycles. This case report provides direct evidence of the essential role of melatonin in normal sleep.

Adolescent↗
PubMed1995

Recurrent retinal artery obstruction as a presenting symptom of ophthalmic artery aneurysm: a case report.

BACKGROUND: Retinal artery obstruction is an ophthalmic emergency requiring immediate treatment. Recurrent episodes are the result of thromboembolic seeding and necessitate diagnostic efforts to find a possible source for this seeding. The most common sources of such seeding are the valves of the heart and the carotid arteries. CASE REPORT: We describe a case of a 25-year-old man who had recurrent episodes of retinal artery obstruction due to embolic spread. DISCUSSION: We suggest the origin of the embolic spread to be a post-traumatic ophthalmic artery aneurysm. The immediate and long-term treatment given to the patient are described, the present case is compared to earlier reports, and the unusual clinical picture and suggested treatment are discussed.

Adult↗
PubMed1993

The management of metastatic spinal cord compression: a radiotherapeutic success ceiling.

PURPOSE: In assessing the effectiveness of the management of metastatic spinal cord or cauda equina compression, we performed a retrospective analysis of 70 patients with this complication whom we treated from 1985 to 1989. METHODS AND MATERIALS: The most frequent primary diagnoses in our series were carcinomas of unknown origin and of the breast, lymphoproliferative disease, lung cancer, and prostatic carcinoma. We used the Findlay classification to group all patients according to their pre-therapeutic functional motor status as Grade I (24 patients or 34%), Grade II (27, or 39%) or Grade III (19 or 27%). Treatment consisted of 30-45 Gy of irradiation (using two different schedules) together with high-dose dexamethasone; in only five cases was there surgical intervention. RESULTS: We found that a powerful predictor of response to radiotherapy was the patient's neurologic status (Findlay grade) at the time of diagnosis: 66% of previously ambulatory patients remained so, whereas 30% of non-ambulatory patients and only 16% of paraplegic patients regained the ability to walk. Another important predictor of response was primary tumor histology, with the most favorable responses to radiation therapy having been observed in lymphoproliferative diseases and in breast cancer, but with some response in other radiosensitive malignancies as well. CONCLUSION: The similarity of our results to those of other centers leads us to conclude that a radiotherapeutic success ceiling of 80% may have been reached for Findlay Grade I patients with metastatic spinal cord compression. In view of this, we suggest that future therapeutic endeavour would be best directed toward early diagnosis of the condition.

Adolescent↗
PubMed1992

Synovial sarcoma associated with osteofibrous dysplasia. A case report and review of the literature.

We report on a 14-year-old boy who demonstrated an unusual association between osteofibrous dysplasia and synovial sarcoma. This case suggests that a patient who presents with osteofibrous dysplasia of the tibia can eventually develop a malignant musculoskeletal tumor in the same anatomical location (same limb). This experience suggests that a patient who presents with osteofibrous dysplasia should be followed up for the possibility of a coexisting synovial sarcoma in the same leg.

Adolescent↗
PubMed1990

Dural "tail" associated with meningiomas on Gd-DTPA-enhanced MR images: characteristics, differential diagnostic value, and possible implications for treatment.

Gadolinium-enhanced magnetic resonance (MR) imaging studies of 30 histologically proved cranial meningiomas revealed a linear enhanced structure or "tail" extending away from the tumor mass along the dural surface in 18 cases (60%). Contrast material-enhanced computed tomographic studies available in 10 of these 18 cases did not depict this structure. Characteristic features of this MR finding were reviewed, and criteria were defined to distinguish this tail from other enhanced structures. To assess the differential diagnostic value of this finding, gadolinium diethylenetriaminepentaacetic acid-enhanced MR studies of a control group of other extraaxial lesions as well as superficial intraaxial tumors that abut the meninges were reviewed. These cases failed to show this MR feature. Pathologic correlation was available in three meningiomas with the finding of a tail, and these demonstrated meningothelial tumor nodules in the samples taken from areas corresponding to the enhanced regions on MR images. This is in agreement with other recent pathologic studies of the dura mater surrounding meningiomas. The authors believe that the linear enhanced structure described may represent tissue containing tumoral nodules. Awareness of this MR sign may be useful in distinguishing meningiomas from other lesions and in planning total resection of the infiltrated dura mater.

Contrast Media↗
PubMed1989

Sacrococcygeal extradural ependymoma.

A case of lumbosacral extradural myxopapillary ependymoma is reported. The clinical, embryologic, and therapeutic features of this rare lesion are presented. The unusual entity is discussed in the light of previous experience with extradural ependymoma in the lumbosacral region.

Adult↗