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Biomedical subjects

E Ganz

Publications and source records attributed to E Ganz.

At least 19 recordsLinked to original sources

Validation of object-induced MR distortion correction for frameless stereotactic neurosurgery.

Spatial fidelity is a paramount issue in image guided neurosurgery. Until recently, three-dimensional computed tomography (3D CT) has been the primary modality because it provides fast volume capture with pixel level (1 mm) accuracy. While three-dimensional magnetic resonance (3D MR) images provide superior anatomic information, published image capture protocols are time consuming and result in scanner- and object-induced magnetic field inhomogeneities which raise inaccuracy above pixel size. Using available scanner calibration software, a volumetric algorithm to correct for object-based geometric distortion, and a Fast Low Angle SHot (FLASH) 3D MR-scan protocol, we were able to reduce mean CT to MR skin-adhesed fiducial marker registration error from 1.36 to 1.09 mm. After dropping the worst one or two of six fiducial markers, mean registration error dropped to 0.62 mm (subpixel accuracy). Three dimensional object-induced error maps present highest 3D MR spatial infidelity at the tissue interfaces (skin/air, scalp/skull) where frameless stereotactic fiducial markers are commonly applied. The algorithm produced similar results in two patient 3D MR-scans.

Algorithms↗

[Myofibroblastoma of the male breast. Apropos of a case].

A case of male breast myofibroblastoma, personally observed, is described. Preoperative examinations have a limited diagnostic value. Only histological study, with immunohistochemical stain, allows to make a right diagnosis and to distinguish this tumor from other, benign or malignant mesenchymal neoplasms.

Aged↗

[Ventrolateral hernias of the abdominal wall. The anatomicopathologic, clinical and therapeutic considerations].

Ventral lateral hernias of the abdominal wall are rare. On the basis of their location we can classify them as follows: hernias of the aponeurosis of the transversus muscle, hernias of the rectal sheath and transmuscular hernias of the iliac region. In a group of 3134 hernias of the abdominal wall observed in a period of 16 years, 11 ventral lateral hernias have been encountered (0.3%). The diagnosis often presents great difficulties as the symptoms and the clinical findings are not typical. They must be differentiated from hematomas of the rectus sheath, abscess or intra-abdominal processes. Echography and Computed Tomography have an important role in their detection. Nevertheless in some patients the true diagnosis is reached only intraoperatively. The treatment generally consists in surgical correction by layer closure of the fascial or muscular defect. In selected cases the use of prosthetic material and video laparoscopic repair are indicated.

Adult↗

[Liposarcoma of the spermatic cord].

A case of well differentiated liposarcoma of the spermatic cord in a 80 year old man is presented. The preoperative diagnosis of spermatic cord liposarcoma is not easy; however, a careful comparison between clinical and ultrasonographic findings can lead to diagnostic suspicion. The treatment of choice is the excision of the liposarcoma associated with orchiectomy and high ligation of the spermatic cord to reduce the risk of recurrence. Postoperative radiotherapy may be indicated for poor differentiated liposarcomas.

Aged↗

Central nervous system complications of cystosarcoma phyllodes.

BACKGROUND: Cystosarcoma phyllodes (CP) is an uncommon fibroepithelial breast neoplasm that rarely involves the central nervous system (CNS). METHODS: The authors encountered two patients with CNS metastases and reviewed the literature to identify reports of CP affecting the nervous system. Patients must have been reported in sufficient detail to characterize clinical course, extent of tumor burden, and histologic type of the primary tumor and metastasis to be included in the study. RESULTS: Eleven cases were identified from the literature, but only six were presented in sufficient detail for analysis. Including the current patients, the mean age of patients with CP metastases was 52 years. The time between initial diagnosis and CNS involvement was 5 years. Parenchymal brain metastases respond poorly to treatment, with a mean survival of 29 days, whereas survival is significantly longer with CNS involvement secondary to epidural extension of tumor from adjacent bony structures. Local recurrence or widespread metastases nearly always were present at the time of CNS involvement. CONCLUSIONS: Brain metastases from CP are refractory to therapy and carry a dismal prognosis. Patients with CP and brain metastases should undergo brain biopsy to exclude metastases from associated epithelial breast tumors, which have significantly better prognoses. Patients with compressive lesions arising from bone have a better prognosis and may benefit from aggressive management.

Adult↗

Functional and morphological effects of defibrotide on renal ischemia.

Defibrotide (Df) has been reported to protect various organs from ischemic damage. The aim of this study was to evaluate the effect of Df on renal function and morphology after warm kidney ischemia. Divided into two groups, 14 pigs underwent bilateral renal clamping for 90 min. One group (7 pigs) was treated with Df (32 mg/kg per h) for 6 h, whereas the control group received 5000 IU of heparin. Serum levels of blood urea nitrogen (BUN) and creatinine measured for 6 days were significantly higher in the control group (peak 26.8 +/- 16.7 vs 11.0 +/- 2.9 mmol/l and 501.2 +/- 351.4 vs 230.2 +/- 68.0 mumol/l P < 0.05). Renal biopsy evidenced a lesser extent of tubular and endothelial damage in Df-treated animals. In conclusion, Df provided relevant protection against renal ischemic injury.

Animals↗

Amyloidoma of the CNS. I. Clinical and pathologic study.

We report a 32-year-old man with a 4-year history of headaches, seizures, and dementia secondary to multifocal amyloidomas in the white matter. Immunohistochemical and electron microscopic analyses suggest that the amyloidomas resulted from processing of plasma-cell-derived amyloidogenic protein by microglial cells.

Adult↗

Spinal epidural abscess: a ten-year perspective.

A retrospective study of spinal epidural abscess spanning 10 years and encompassing 40 patients was done. Epidemiology, clinical features, laboratory findings, radiographic imaging, therapy, and outcome were examined and compared with previous series. An increasing incidence of the disease (up to 1.96 patients per 10,000 admissions per year) and an older, more debilitated population (67% having factors predisposing them to infection) were discovered. Over half of the population was studied with magnetic resonance imaging, which was found to be equally as sensitive (91%) as myelography with computed tomography (92%). Magnetic resonance imaging offers the advantages of being noninvasive and able to delineate other entities, which makes it the imaging modality of choice. Preoperative paralysis and neurological deterioration from normal were identified as poor prognostic features. Of 7 patients with preoperative paralysis, 5 died, and the rest failed to recover neurological function. Eleven patients with initially normal neurological exams deteriorated in the hospital before surgical intervention. Eight of these patients were being treated with appropriate antibiotics; 2 became paralyzed despite more than 3 weeks of antibiotic therapy. Only 3 of these 11 patients recovered fully. Immediate surgical decompression combined with antibiotics remains the treatment of choice.

Abscess↗

Intracranial abscesses secondary to nasal, sinus, and orbital infections in adults and children.

Nineteen cases of intracranial abscesses secondary to infection of the midface are reported. The most common underlying cause was bacterial sinusitis. Other etiologic factors included mucormycosis following steroid therapy, Wegener's granulomatosis, nasal dermoid cyst and sinus tract, tooth abscesses, aspergillosis following chemotherapy for leukemia, squamous cell carcinoma of the frontal sinus, infected methylmethacrylate plate for a prior skull fracture, and a case of gauze packing left in the sinus following surgery. Anaerobic organisms were the predominant cause of the abscesses. The most dangerous intracranial complication was subdural abscess, which occurred in seven patients in this series. Three of them died. Four cases of frontal and parietal lobe abscesses were treated with systemic antibiotics only. This approach has not been well emphasized in our literature. Steroid therapy should not be used for the treatment of sinus and orbital infections. It can result in dreadful complications. The overall mortality rate in this series was 21% (4 of 19), despite aggressive treatment and close cooperation between the neurosurgeon, otolaryngologist, and other specialists. Early diagnosis and adequate treatment are paramount.

Adolescent↗