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Biomedical subjects

H H Kaufman

Publications and source records attributed to H H Kaufman.

At least 19 recordsLinked to original sources
PubMed1992

Ventriculopleural shunting used as a temporary diversion.

Due to the limited absorptive capacity of the pleural cavity, infants and young children are not generally ideal candidates for ventriculopleural shunts. We report using chest cavities as alternate for temporary diversion of CSF in a young child. Venous access to the cervical region could not be utilized because of scarring from previous procedures, while peritoneal access was contraindicated due to repeated pseudocyst formation. Pleural effusions were removed by thoracentesis when necessary, and the shunt catheter was changed to the opposite side of the chest when the effusions reaccumulated within one week. Utilizing the ventriculopleural shunts allowed us to temporize her non-communicating hydrocephalus for a period of one year, until a definitive CSF procedure by direct intracardiac placement of the distal catheter could be performed.

Cerebrospinal Fluid Shunts↗
PubMed1992

Chronic extradural haematomas: indications for surgery.

Non-invasive neuro-imaging has led to the detection of minimally symptomatic or asymptomatic chronic extradural haematomas. Our experience and review of the literature suggests that, as in the case of chronic subdural haematomas, there is development of membranes and liquifaction of the clot which may permit drainage of such collections through twist drill or burrholes. The time from development and the neuro-imaging chanes on CT and MRI can suggest the age and nature of the clot and thus permit timing of surgery so that drainage may be accomplished with a minor procedure.

Adult↗
PubMed1992

The future. Prospects of innovative treatment of intracerebral hemorrhage.

Aggressive surgical as well as medical management strategies have had limited success with improving outcomes from spontaneous intracerebral hematomas. Future prospects of treatment will undoubtedly focus on less invasive, better tolerated procedures to remove hematomas in select patients. Some success has been achieved with a coupling of stereotactic technology, fibrinolytic agents, and mechanical devices, which can remove solid portions of hematoma through narrow probes. Newer technology also has involved laser endoscopic and small ultrasonic probes to facilitate morcellation and subsequent aspiration without the problems associated with a major intracranial procedure.

Cerebral Hemorrhage↗
PubMed1991

A national survey of neurosurgical care for penetrating head injury.

We report results of a survey on the management patterns of penetrating head injury (PHI). American neurosurgeons (N = 2969) were asked to participate in a mail survey. One thousand one hundred twenty-eight responded, providing detailed information about their practices, their opinions concerning diagnostic testing, nonoperative therapy, and surgical debridement for PHI. Although there was agreement on some areas of management and care, including the use of computed tomography scanning, antibiotics, anticonvulsants, and a few surgical indications/contraindications, there was wide variation on a significant number of points. These included testing for coagulopathy; use of corticosteroids, intracranial pressure monitoring, and barbiturate coma; and surgical indications including debridement of contusions, removal of fragments, location of injury, and Glasgow Coma Score 5-8. Many nonoperative decisions were influenced by the presence of neurosurgical residents, whereas the decision to operate was based primarily on judgment of patient salvageability. This survey uncovered disagreement on several crucial issues in the care of patients with penetrating head injury and the need for continued research in this area of patient care.

Adult↗
PubMed1991

Millipore analysis of valvular fluid in sterile valve malfunctions.

Malfunctions of sterile shunts may result from valvular dysfunction. The cerebrospinal fluid shunt valves of 14 patients were excised during surgery for sterile shunt malfunctions. In 6 patients, the malfunction was due specifically to a valve malfunction. Cerebrospinal fluid from each valve was passed through a millipore filter, which was then stained using either hematoxylin and eosin or periodic acid-Schiff. The stained millipore filters were examined by a neuropathologist who was unaware of the cause of the shunt malfunction. Although inflammatory cells were detected in all cases, the patients with valve malfunctions were found to have numerous macrophages and giant multinucleated reactive cells within their valves, while cerebrospinal fluid from valves that had been removed during shunt revisions for reasons other than a malfunctioning valve contained only rare mononuclear cells or macrophages. No valve contained erythrocytes, fibrinous matter, neural or glial tissue, or choroid plexus. The possible causes of valve malfunction, including infection and allergic reactions, are discussed. All patients did well after simple replacement of the valve.

Adolescent↗
PubMed1991

Ethical and legal responsibilities of the neurosurgeon: selected topics.

There are many ethical and legal implications in a variety of activities in the neurosurgeon's day-to-day practice. Awareness of and proper attention to these issues are a professional responsibility that should be attended to, to ensure that the practice of medicine is carried out efficiently and effectively, to maintain public confidence, and to try to avoid micromanagement by third parties. The authors discuss four such subjects of particular interest to them, namely: 1) reporting of certain diseases and conditions to authorities and third parties; 2) acting without the consent of the patient to prevent harm to him or her and/or others; 3) reporting problems with drugs and devices; and 4) the detection and treatment of colleagues impaired by alcohol, drugs, or mental or physical illness.

Confidentiality↗
PubMed1991

Treatment of civilian gunshot wounds to the head.

Gunshot wounds to the head are a common problem in the United States. A review of the literature and a survey of neurosurgeons suggests some differences of opinion regarding treatment. But the series upon which these opinions are based may be quite different. Disseminated intravascular coagulation can be a major problem. CT scanning is important for surgical decision making. Angiography should be used in cases in which bullets have passed near major vessels. We suggest an aggressive approach, with evacuation of clots and monitoring of intracranial pressure and treatment of elevations, as well as the routine use of anticonvulsants and antibiotics. Vocational rehabilitation is also important.

Cerebral Angiography↗
PubMed1990

Magnetic resonance imaging and posttraumatic Lhermitte's sign.

Two patients developed Lhermitte's sign after cervical spine fractures. The patients were otherwise without evidence of spinal cord dysfunction. Both patients were studied with magnetic resonance scans of the cervical spine. The magnetic resonance scans were normal. The possible etiology of Lhermitte's sign in these patients is discussed. The differential diagnosis including cervical spondylosis, combined systems degeneration, multiple sclerosis, neoplasm, and radiation myelopathy is reviewed. These patients should be carefully evaluated clinically, and flexion/extension lateral cervical spine films as well as a complete blood count and peripheral smear should be obtained. Magnetic resonance scanning may have an important role in evaluating these patients. Magnetic resonance is exquisitely sensitive in detecting demyelination; therefore, we speculate that subarachnoid scarring may be responsible for this symptom. Gadolinium-enhanced magnetic resonance scanning may confirm the presence of such scarring in the future.

Accidents, Traffic↗
PubMed1989

Head injury. Variability of course and presence of confounding factors.

Review of a large data base on 76 patients who had suffered head injuries and whose metabolic changes were being studied demonstrated the variability of their neurological courses and the importance of considering confounding factors in the analysis of such a group. It was apparent that many such patients continue to change neurologically and functionally for long periods of time, and that their ultimate outcome cannot be determined for at least 1 year. The study demonstrates the inherent complexity of a group of patients with head injuries and the need to use sophisticated statistical tools and a computer to demonstrate whether apparent trends are statistically valid in light of confounding factors and variabilities. Failure to take this complexity into account seems to be a major factor in many of the ongoing controversies in research on head injuries. A possible solution to the problem of potential biases introduced by lost patients would be to develop a method to use government records to obtain current addresses for patients involved in federally funded research.

Activities of Daily Living↗
PubMed1989

Detection of brain death in barbiturate coma: the dilemma of an intracranial pulse.

Patients treated with barbiturate coma for elevated intracranial pressure after head injury may suffer brain death. Since such patients have an iatrogenically induced absence of neurological function, brain death cannot be diagnosed clinically. Furthermore, as demonstrated by two of our patients, monitoring of intracranial pressure, even in the face of brain death, may show a low intracranial pressure and an intracranial pulse, suggesting the presence of adequate cerebral perfusion pressure and, therefore, brain viability. Under these circumstances, however, significant intracranial blood flow may be absent. Therefore, we suggest that a patient in barbiturate coma should undergo serial blood flow studies, even when the intracranial pressure is low and an intracranial pulse is present, to determine whether brain death has occurred.

Adult↗
PubMed1989

Mechanical aspiration of hematomas in an in vitro model.

A modified Nucleotome (Surgical Dynamics, San Leandro, California) was used to aspirate blood clot in an in vitro model of intracerebral hematoma. This machine was successful in removing the clot at a reasonably rapid rate. It aspirates normal rat brain far more slowly. It therefore shows promise for being effective and safe in removing intracerebral hematomas in humans.

Adult↗
PubMed1989

The principles of bony spinal fusion.

Bony fusion is frequently required for anatomical reconstruction and stabilization of the spine. This review discusses bone structure, healing after fracture, and bony fusion, including the use of autografts and allografts. Research should be done on preparation of the bed, the nature and quantity of bone to be used, and how best to immobilize the spine.

Bone Transplantation↗
PubMed1989

The incidence and significance of hemostatic abnormalities in patients with head injuries.

Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. Hemostasis in 269 patients with head injuries alone was screened using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT), fibrinogen assay (FIB), level of fibrin-fibrinogen degradation products (FDP), and disseminated intravascular coagulation (DIC) score in the first 24 hours after injury. Test results were compared with the outcome (discharged or dead) in the entire group and in subgroups divided on the basis of the severity of injury as determined by the Glasgow coma score (GCS). Increased consumptive coagulopathy at admission, as reflected in the DIC score, predicts the outcome of head-injured patients with a high degree of accuracy. The degree of increase of the initial FDP level and prolongation of TCT also correlated positively with the outcome. Prolongation of the APTT correlated strongly with unfavorable outcome in a large group of patients, and in a small group, markedly accelerated APTT also predicted death. Stepwise logistic regression analysis demonstrated that GCS, FDP level, and DIC score predicted outcome. Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients.

Adolescent↗
PubMed1988

Cerebrospinal fluid eosinophilia and sterile shunt malfunction.

Cerebrospinal fluid (CSF) eosinophilia is a rare finding most often associated with central nervous system inflammatory processes, including parasitic, bacterial, and mycotic infections. It has also been seen as an allergic phenomenon. We present two cases of CSF eosinophilia occurring concurrently with sterile shunt malfunction. We speculate that CSF eosinophilia in our patients might have resulted from an allergic response to a foreign material such as suture, surgical glove powder, hair, cotton fibers, antibiotics, or silicone rubber. The incidence of sterile CSF eosinophilia after shunting is not known. Information concerning the role of eosinophilia in the development of shunt malfunctions is also lacking. An increased awareness of this possibility and further investigation are warranted.

Eosinophilia↗