Biomedical subjects
Publications and source records attributed to E Reichenthal.
The histopathology and clinical course of three patients with schwannomas of the brain and high cervical cord after therapeutic irradiation for intracranial malignancy and for ringworm of the scalp are described. Earlier reports in the literature indicated that radiation of the scalp may induce tumors in the head and neck. It is therefore suggested that therapeutic irradiation in these instances was a causative factor in the genesis of these tumors.
The unique association between carcinoma of the breast and meningioma was previously described. We report herein an additional series of ten instances representing such an association and review the relevant literature. Surgeons should be aware of the possible relationship between these two conditions. Lesions of the central nervous system in patients with carcinoma of the breast should not be labeled as metastases unless benign, resectable, intracranial lesions have been ruled out by proper investigations.
Infratentorial intratumoral hemorrhage is infrequently reported. Owing to crowding of the vital structures in the posterior fossa, a high percentage of bleeding tumors in this region are fatal. Only six such cases of bleeding ependymomas in the posterior fossa have been documented; four of the patients died. We report a seventh case of intratumoral hemorrhage in a 4th-ventricle ependymoma. This patient survived. Reported cases of infratentorially bleeding tumors of various histologic types are reviewed. Their pathogenesis, clinical presentation, and management are discussed.
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More than 10 years have elapsed since the introduction of high dose barbiturate administration in the management of patients with severe head injuries. Barbiturate therapy became an accepted method of treatment for increased intracranial pressure when other measures fail. One of the major limiting factors in the use of high dose barbiturate therapy is its significant hypotensive effect on the systemic arterial blood pressure. In seeking ways and means of minimising this hypotensive effect, we designed a study in which the systemic administration of barbiturates is avoided and replaced by selective perfusion of the concerned hemisphere with the drug utilising the intra-carotid route. Twenty-two rats, divided into two groups, were used in the study. Since monitoring of electroencephalographic (EEG) burst suppression serves as a good indicator of the lowest level of cerebral metabolic activity, we used this as the method for determining the desired endpoint of sodium amytal administration in both groups of animals. Group I, the intravenous group, consisted of eleven animals who received sodium amytal intravenously until burst suppression on the EEG was documented. Group II, the intra-carotid group, comprised eleven animals who received intra-carotid sodium amytal until EEG burst suppression was induced. In the intravenous group, a mean dose of 35 mg/kg of sodium amytal was administered before EEG burst suppression was achieved. This dose, however, was accompanied by an almost 50% reduction in systemic blood pressure compared to the pretreatment level. The intra-carotid group required a mean dose of 3.8 mg/kg sodium amytal and this was accompanied by only minor changes in systemic arterial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Seven cases of aneurysms that ruptured into the subdural space and were treated surgically are reviewed. Six out of the seven presented with signs of uncal herniation, three of them for at least for four hours or more. They all died in spite of urgent decompression and drainage. Three others suffered from uncal herniation for less than four hours and they all did well. The seventh patient had a small subdural haematoma with no signs of compression of the underlying neural structures. This last patient also had a good outcome. The authors point out that the aneurysm causing the haematoma might be overlooked should one utilize CT (computerized tomography) scan alone without contrast. However, in most instances the history gives the aneurysm diagnosis despite the CT scan of haematoma only. Intravenous contrast CT scan may occasionally demonstrate the aneurysm, provided modern CT equipment is adequately utilised. Severe neurological deficit and uncal herniation might still be reversible provided decompression can be carried out in less than four hours. If accessible the aneurysm should also be clipped at the same time.
A series of 74 consecutive cases undergoing craniotomy for single brain metastasis in the Beilinson Medical Center between October 1975 and October 1981 were reviewed. All patients underwent radiation therapy after craniotomy. The most common metastasis was that of unknown origin (35%), followed by lung (24%) and breast (16%). Overall median survival after craniotomy was 6.6 months. Overall 1- and 2-year survival rates were 30 and 15%, respectively. Operative mortality (30 days) was 15%. For the patients with metastases to the lung, median survival was 7.5 months and 1-year survival rate was 33%. It appears from this report that two dominant factors affect the prognosis of these patients. The first is the long latent interval (time between diagnosis of primary tumor and detection of metastasis). The second is the location of the metastasis; those with lesions in the cerebral hemispheres had a far better outcome than those with cerebellar lesions (p less than 0.0001).
The authors retrospectively analyzed the clinical and histopathological findings in 201 patients with intracranial meningiomas operated on in the period 1978 to 1982. Forty-three of the patients (21.4%) had at some previous time received radiation treatment to their scalp, the majority for tinea capitis. The findings in these 43 irradiated patients were compared with those in the 158 non-irradiated patients. Several distinctive clinical and histological features were identified in the irradiated group, which suggest that radiation-induced meningiomas can be defined as a separate nosological subgroup. The use of irradiation in large numbers of children with tinea capitis in the era prior to the availability of griseofulvin may be responsible for a significantly increased incidence of intracranial meningiomas.
Serial narrow-band green-light fundus photographs documented the evolution of descending optic atrophy in a case of rapid bilateral blindness produced by a highly invasive osteogenic sarcoma of the base of the skull. Disappearance of the nerve fiber layer (NFL) was observed to take place between the sixth and 12th week after onset of blindness; thus, it is similar to the evolution of descending atrophy found to occur in clinical cases of blindness caused by traumatic involvement of the optic nerve. Parallel to the disappearance of the NFL there was an increase in optic nerve head excavation and a change in the appearance of the vessels on the disk surfaces.
The clinical and histopathological findings in a child suffering from both cerebral and spinal gliomas of differing histological types are described. There was a family history of von Recklinghausen's neurofibromatosis. The possibility of overlooking the symptoms and signs pointing to a spinal cord lesion in the presence of a known intracranial tumour is stressed.
This paper describes a new method for production of semichronic epileptic foci in the cerebral cortex of cats. Cortical lesions that turned into epileptic foci were induced by extradural application of cobalt oxide powder. These lesions extended through the entire depth of the gray matter, but did not cause gross macroscopic damage. The cobalt oxide powder was removed from the dura mater 7 days after its application, at which time the lesion already showed epileptic activity; this activity did not diminish 7, 14, or 21 days later. Testing of epilepsy was done with a special procedure that allowed work with anesthetized animals. Before treatment with cobalt oxide began, the maximal dose of convulsant drug that would not cause an epileptic electrocorticogram response was determined for each animal (the "trigger dose"). Subsequent testing of potential epileptic foci consisted of monitoring the electrocorticographic responses to rapid intravenous injections of the trigger convulsant dose. The success of the present method in production of epileptic foci is evaluated by several criteria and is compared with other methods.
The present work was undertaken in order to find out whether delicate subpial incisions can be used to stop the epileptic activity of cortical lesions induced by cobalt oxide. Epileptic foci were produced in cats by epidural application of cobalt oxide powder. The presence of epilepsy was demonstrated a week later in anesthetized cats by injections of a "trigger dose" of pentamethylenetetrazole. Performance of subpial incisions through the focus area immediately abolished all ongoing epileptic activity. Such activity could not be evoked again by subsequent injection of pentamethylenetetrazole trigger doses throughout a 2-week period. The practical implications of this result are discussed. Some theoretical consequences of the similarity between the response of penicillin foci and that of cobalt oxide foci to the application of subpial incisions were evaluated. Finally, an attempt is made to explain the differences between our results and those produced by other investigators who also attempted to inactivate cobalt lesions in the cortex.
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A 70-year-old woman presented with a 5-month history of tetraparesis. Her cerebrospinal fluid and roentgenographic examination of the cervical spine were both normal. Myelography showed an extradural type of spinal cord compression at the C7 level. At operation, an extraosseous extradural mass of granulation tissue was removed, which proved on histological and bacteriological examination to be a tuberculous granuloma.
A review is presented of 44 cases of spinal meningioma. Analyses of the data collected indicated that early diagnosis may prevent irreversible neurological deficit and enhances the chance for full recovery after operation. The results obtained in elderly patients were very encouraging. The difficulties involved in making a correct early diagnosis are stressed. The finding of scoliosis in 40 per cent of the patients is noteworthy.
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