Biomedical subjects
Harry S Goldsmith
Publications and source records attributed to Harry S Goldsmith.
Spinal cord separation: MRI evidence of healing after omentum-collagen reconstruction.
INTRODUCTION: Animal experimentation has demonstrated that omental-collagen bridge reconstruction of a transected spinal cord in cats can result in the growth of axons crossing the transection site which resulted in the return of motor and sensory activity. This paper raises the possibility that a comparable spinal cord reconstruction model could be possible for human application. METHODS: Cats had their spinal cord transected at the T-9 level. This led to a gap at the transection site that was filled with semi-liquid collagen, followed by omental transposition onto the underlying collagen bridge, which had subsequently hardened. A comparable technique was used on a patient who had, as reported by magnetic resonance imaging (MRI), a complete spinal cord transection at the T-6 level. RESULTS: Reconstruction of a transected spinal cord in cats using an omental-collagen bridge resulted in axons that grew across the transection site at the rate of 1 mm/day. Several animals developed forelimb and hindlimb locomotion. The patient in this paper had omental-collagen reconstruction of her cord and has clinically progressed to the point where she can ambulate with the use of a walker. The patient had a spinal cord defect of 4 cm, which, with multiple MRI studies, has shown the longitudinal development of a spinal cord connection in the area of the omental-collagen bridge that connects the proximal and distal ends of the transected spinal cord. CONCLUSION: This report suggests that a transected spinal cord has the ability to heal when the spinal cord separation is reconstructed using an omental-collagen bridge. This technique has led to neurological improvement.
Protection of an esophageal anastomotic site.
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The evolution of omentum transposition: from lymphedema to spinal cord, stroke and Alzheimer's disease.
It is now well established that the omentum incorporates into its tissues a variety of biological factors that exert a favorable effect on the central nervous system. Physiological characteristics of the omentum include edema absorption, fibrotic inhibition, blood-brain barrier penetration and, of major importance, angiogenic activity. Over several decades, studies have shown increasing clinical uses of the omentum following its placement on various structures within the body. This paper details the evolution of omental transposition (OT) up to the present at which time OT is being applied to the brain of Alzheimer disease (AD) patients. Success in this area raises the possibility that the omentum may prove to be a present-day treatment for patients with AD until future pharmaceutical and/or genetic forms of treatment are developed.
Omental transposition to the brain as a surgical method for treating Alzheimer's disease.
The purpose of this study was to learn the effect of omental transposition to the brain of patients who exhibited the most serious effects of long-standing Alzheimer's disease. Ten patients who had extremely low Mini Mental-State Examination scores of 2-14 underwent placement of their elongated pedicled omentum onto their left parietal-temporal cerebral cortex. Patients underwent pre- and post-operative MRI and SPECT scans in addition to long-term neurological and neuropsychological testing. All were followed up to one year. In spite of the patients' severe cognitive and functional disability, several of the patients demonstrated subjective and objective improvement, especially in terms of their functional status.
Treatment of Alzheimer's disease by transposition of the omentum.
There is increasing evidence that cerebral hypoperfusion plays a key role in the development of Alzheimer's disease (AD). As one ages, cerebral blood flow (CBF) decreases as a direct reflection of a normal aging process. Coupled with this expected drop in CBF are a host of other factors, such as hypertension, stress, smoking, diabetes, cholesterol buildup, etc., which further decrease blood flow to the brain. Maintaining a critical level of CBF is essential if adequate amounts of oxygen and glucose are to be presented to neurons to sustain their cellular energy production (ATP). If CBF drops below a critical flow level, insufficient ATP will be produced and, if this situation is not corrected, neurons will deteriorate and eventually die. When a critical mass of neurons die in areas of the brain involved with cognition and memory, AD will result. Omentum transposition to the brain is a surgical procedure by which a large volume of blood and other biological agents can be delivered to the brain over an indefinite period of time. The omentum gives metabolic support to deteriorating neurons and its presence on the brain has resulted in the reversal of AD symptoms. Additionally, omentum transposition to the brain can markedly reduce senile plaque accumulation, but has no apparent effect on reducing neurofibrillary tangles. Omental transposition may play an important role in the future treatment of AD, especially in early and moderate cases.