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Biomedical subjects

H H Schmidek

Publications and source records attributed to H H Schmidek.

At least 19 recordsLinked to original sources
PubMed1989

Surgical management of spinal epidural disease: an update.

Management of spinal cord compression from metastatic malignant disease remains unsatisfactory. Results of surgical decompression are at best less than those of radiation therapy alone. However, new surgical approaches now focus on removing the anterior-situated tumor tissue which produces neural compression in about 85% of the cases. The results of these procedures that allow removal of the ventrally compressing tumor show significant improvement in the management of patients with spinal epidural disease. We review the surgical strategy of these new approaches and the attendant results.

Aged↗
PubMed1987

The molecular genetics of nervous system tumors.

Major insights have resulted in the last few years from the application of the techniques of molecular genetics to problems of development, differentiation, growth control, and neoplasia. It is now recognized that these problems are often actually different facets of the central question: how are genes regulated under various circumstances? These problems are of particular interest to neurosurgeons insofar as they relate to the mechanisms of development and differentiation of the nervous system and its tumors. This review attempts to provide an introduction to the salient issues and to the current state of knowledge in these various fields in order to promote an understanding of nervous system neoplasia and of areas that bear potential importance for research and therapy.

Humans↗
PubMed1986

Transoral unilateral facetectomy in the management of unilateral anterior rotatory atlantoaxial fracture/dislocation: a case report.

An unusual case of unilateral anterior rotatory atlantoaxial fracture/dislocation with neurological deficit is presented. The injury could not be reduced by skeletal traction, but was successfully reduced by partial facetectomy at C-1, C-2 accomplished through a transoral exposure of the atlantoaxial region combined with labiomandibularglossotomy. To the best of our knowledge, this is the first instance of an injury of this type to be so managed. The details of the operative procedure are described, and the subject of rotatory atlantoaxial dislocation is reviewed.

Adult↗
PubMed1986

Hemorrhage-induced alterations of rabbit basilar artery reactivity and sensitivity to serotonin.

Subarachnoid hemorrhage has a profound effect on cerebrovascular reactivity. The present study noted a progressive change in the sensitivity and reactivity of rabbit basilar artery to serotonin after experimentally induced hemorrhage. The basilar artery exhibited an initial diminished response to serotonin for periods up to 6 hours after hemorrhage, whereafter the vessel gradually became hyperresponsive. The hypersensitivity became maximal 36 hours after hemorrhage and then began to return to normal. Such early onset of serotonin hypersensitivity and reactivity after subarachnoid hemorrhage has not been previously reported. The level of tension developed, however, suggests that serotonin alone is unlikely to cause vasospasm. The strict differentiation of spasm into early and delayed components is questioned.

Animals↗
PubMed1986

Cervical spondylosis.

The "hard" cervical disc, a bony ridge resulting from periosteal activity, usually occurs in the patient with a previous neck injury. The "soft" disc is the bulging or extruded disc itself, often manifested by acute radicular pain in the younger patient. Causes of spondylotic myelopathy include a congenitally narrow spinal canal, disc degeneration and impaired vascularity. Disc syndromes include dysphagia and vertebral artery compression.

Angiography↗
PubMed1985

The cerebral venous system.

The authors discuss the gross and microscopic anatomy and the physiology of the cerebral venous system. Cerebral veins under pathological circumstances (hypercapnia, arterial hypertension, and increased intracranial pressure), pharmacological observations, the venous blood-brain barrier, and traumatic involvement are reviewed. Neoplastic involvement and radiological aspects are included. Surgical reconstruction of venous sinuses (including the Donaghy technique), tumor removal, sinus thrombectomy, and extraanatomical bypass of the transverse sinus are discussed.

Blood-Brain Barrier↗
PubMed1985

Symptomatic intraspinal synovial cyst in a 66-year-old marathon runner.

A 66-year-old marathon runner developed an intraspinal synovial cyst arising from the L5-S1 zygapophyseal joint, clinically characterized by episodic pain, paresthesia and sense of coldness. Symptoms were predictably and completely relieved by running; Valsalva maneuver elicited the pain, paresthesia and cold sensation. A precisely similar episode occurred 3 years previously on the right side and disappeared spontaneously without recurrence. Routine films and myelogram were not diagnostic; a CAT scan showed the lesion. The cyst was successfully resected; the patient has been asymptomatic for 2 year postoperatively.

Aged↗
PubMed1984

Delayed traumatic intracerebral hematoma: report of 15 cases operatively treated.

Fifteen cases of delayed traumatic intracerebral hematoma (DTICH) operatively treated are reported. Patients who are awake or only drowsy on admission (Coma Grades 1 and 2, Grady scale) often undergo dramatic sudden neurological deterioration 48 to 72 hours after admission. Emergency computed tomographic scanning and prompt craniotomy for hematoma evacuation yield excellent clinical results in the majority of cases. Patients presenting in deeper grades of coma (Grades 3 to 5, Grady scale) who develop DTICH do quite poorly, often because the diagnosis is difficult to make and consequently is delayed. The development of DTICH is in our experience highly unpredictable, and often no clear secondary cause (hypercapnia, hypoxia, bleeding diathesis) can be demonstrated.

Adolescent↗
PubMed1984

Compressive myelopathy associated with type VI mucopolysaccharidosis (Maroteaux-Lamy syndrome).

Spinal cord compression with resultant myelopathy is a frequent occurrence in patients with mucopolysaccharidoses. Etiological factors include developmental abnormalities of the cervical spine and infiltration of the dura mater by the accumulated products of mucopolyssacharide metabolism. Compression at the thoracolumbar junction is rare, but was found in a child with the characteristic physical and biochemical stigmata of the Maroteaux-Lamy syndrome (mucopolysaccharidosis VI). An anterolateral approach to remove the compressing bony elements resulted in symptomatic improvement. Careful radiological evaluation is required so that all surgical options can be considered. Patients with metabolic storage diseases and the capacity for normal intellectual function warrant aggressive surgical care to optimize neurological function.

Child↗
PubMed1984

Sacral fractures.

The sacral spine has received relatively little attention in the orthopedic and neurosurgical literature, in part because of the infrequency of developmental, degenerative, or neoplastic conditions of the sacrum requiring surgical intervention. This neglect is unwarranted in trauma, however, because sacral fracture and its associated neural deficit are both common and often complex problems. The sacrum and pelvis behave as a single functional unit; an understanding of the principles of sacropelvic stability has obvious relevance in planning the occasional resection of a sacral tumor and in dealing with the common problem of massive pelvic trauma. A classification of sacral fractures is reviewed along with the usual patterns of neurological involvement. Through analysis of an institutional series of cases, a specific attempt is made to correlate varying types of vertical sacral fractures with differing types of pelvic injury. The radiographic and physiological investigation of sacral fractures is reviewed, as are the various options for achieving the reduction, decompression, and stabilization of sacral fractures.

Biomechanical Phenomena↗
PubMed1983

Epidural morphine for control of pain after spinal surgery: a preliminary report.

Epidural opiates have been used successfully for the control of postoperative pain after obstetrical, abdominal, and orthopedic procedures. The use of these agents for the control of pain after operation on the thoracic and lumbar spine is reported. A catheter is inserted under direct vision into the epidural space after semihemilaminectomy and disc excision, posterior decompressive lumbar laminectomy, and anterolateral thoracolumbar decompression and just before wound closure. Excellent postoperative pain relief is achieved for 8 to 20 hours after single epidural injections of between 2 and 6 mg of morphine. Catheters are left in situ for 2 to 5 days. To date, no complications requiring treatment have been encountered with this approach.

Adult↗
PubMed1983

Carotid body tumors.

A review of seven carotid body tumors less than 5 cm in diameter confirms the thesis of other recent reports that such tumors can be resected with minimal morbidity. In two of our cases, initial exploration and biopsy were performed not suspecting the nature of the neck mass; in one of these, hypoglossal and facial nerve deficits resulted. Angiography was diagnostic in six of our seven cases and should be used to establish the diagnosis preoperatively in any neck mass of doubtful origin where carotid body tumor is a part of the differential diagnosis.

Adolescent↗
PubMed1982

Complications accompanying occipital skull fracture.

One hundred thirty-four cases of occipital skull fracture seen over the past 15 years at the Medical Center Hospital of Vermont have been analyzed with respect to their clinical course and neurologic outcome. Among the cases reviewed, one third of patients had an uncomplicated course, 24% recovered with mild neurologic findings (such as cranial nerve palsy), and 13% died as a result of neurologic insult. This high morbidity results from combinations of traumatic subarachnoid hemorrhage, coup and contrecoup brain lesions, and injury at the skull base. Posterior fossa hematoma, cerebellar contusion, parietal and occipital lobe injury, and cranial nerve injuries associated with this lesion are discussed in detail. CAT scanning is now part of our diagnostic routine in patients with occipital fracture in coma grades 1-5 (Grady scale).

Basal Ganglia↗
PubMed1980

Fractures of the sella turcica.

Five recent cases of sella turcica fracture examined at the Medical Center Hospital of Vermont are reported. These fractures are most commonly associated with frontal or maxillofacial trauma and are complicated by cranial nerve palsies, chiasmatic injury, and cerebrospinal fluid rhinorrhea and otorrhea. The mortality rate with these fractures is high because of the associated brain injury. The importance of a detailed endocrine evaluation to detect developing pituitary abnormalities is also emphasized. The accuracy of radiographic diagnosis of these fractures utilizing plain skull films, tomography, and computed axial tomography is reviewed. the importance of cerebral angiography to evaluate the intracavernous internal carotid arteries and the basilar artery is also emphasized, as is the theoretical basis of the pathological findings associated with these fractures.

Adolescent↗
PubMed1980

Management of acute unstable thoracolumbar (T-11-L-1) fractures with and without neurological deficit.

A one-stage anterilateral decompression of the thoracolumbar spine with Harrington rod alignment and posterior fusion has proven to be an excellent approach to the management of unstable fractures between T-11 and L-1. Twenty-six cases are reported in which this tactic was used to decompress neural structures and stabilize the spine. Preoperative computed tomographic scanning and somatosensory evoked responses (SSERs) are useful adjuncts in the patient's assessment. Intraoperative SSER studies have allowed monitoring to prevent an increase in the patient's neural deficit during operation. Intraoperative myelography is used to provide objective confirmation of the adequacy of the decompression of the spinal subarachnoid space. Satisfactory stability was achieved in all 26 cases reported in this series. Eight of 11 patients with partial neurological deficits returned to essentially normal function within 6 months. None of the patients who were neurologically intact (6 cases) or who had incomplete lesions (11 cases) was made worse by the operation. None of the 9 paraplegic patients regained spinal cord function, although a dramatic improvement in the function of the L-2 and L-3 roots occurred in 1 case. This approach to the management of unstable thoracolumbar fractures is useful, carries with it a low complication rate, and should be a standard part of the neurosurgical and orthopedic armamentarium.

Adult↗
PubMed1980

Contrecoup intracerebellar hemorrhage: report of a case.

A case of contrecoup intracerebellar hematoma is reported. Only one other similar case has been reported in the literature. This complication must be considered in head-injured patients, particularly in the presence of neurological deterioration in association with a cerebellar contusion demonstrated on the initial computed tomographic (CT) scan. Serial CT scanning is particularly important because of delayed intraparenchymal hemorrhage, which in this case occurred in the cerebellum.

Aged↗
PubMed1979

Paget's disease and the nervous system.

Paget's disease usually is found in patients past the age of 40. Early presenting symptoms include headache, deafness, tinnitus, and pain due to radicular compression. The diagnosis is confirmed by radiographic features and elevated levels of serum alkaline phosphatase and urinary hydroxyproline. Bony overgrowth results in pressure on nearby soft tissues such as the brain, spinal cord, and certain peripheral nerves. The abnormally soft quality of the calvarial bone permits distortion by the weight of the brain. Dorsal inclination of the plane of the foramen magnum and the projection of the odontoid process into the posterior fossa lead to stretching of the brain stem over the odontoid process and the ventral margin of the foramen. Obstructive hydrocephalus may result. Sarcoma of the crainial vault may develop in cases of Paget's disease. Once cervicomedullary or spinal compression has occurred, surgical decompression may be necessary. Three drugs--calcitonin, disodium etidronate, and mithramycin--have been used with some benefit in the treatment of Paget's disease.

Adult↗