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Biomedical subjects

J A Epstein

Publications and source records attributed to J A Epstein.

At least 19 recordsLinked to original sources
PubMed1991

Spinal cord compression complicating subarachnoid infusion of morphine: case report and laboratory experience.

The intraspinal administration of morphine has been employed increasingly in the management of intractable pain of malignant as well as benign origin. We have encountered a previously unreported clinical complication: spinal cord compression by an inflammatory tissue mass surrounding a subarachnoid infusion catheter administering morphine, leading to paraplegia. The patient was referred to our institution after catheter and pump implantation for chronic, intractable pain associated with pre-existing lumbar arachnoid fibrosis, after multiple myelograms and surgeries. The patient may, therefore, have had an underlying propensity to foreign body reactions. We have encountered a similar phenomenon, however, in a canine laboratory model. The pathological features in both our patient and our laboratory preparation, with inflammatory tissue masses around the tip of the catheter but not around proximal subarachnoid segments, suggest an effect related to infusion, as opposed to infection or the presence of the catheter. We review the pathological features in both settings and the pertinent literature.

Adult↗
PubMed1991

Limbus lumbar vertebral fractures in 27 adolescents and adults.

Fractures of the lumbar vertebral limbus involve varying degrees of fragmentation of the peripheral ring apophysis, located at the posterior superior or posterior inferior margins of the mid to lower lumbar vertebrae. Four types, uniquely found in adolescents and young adults, have been described. Type I lesions consist of avulsions of the posterior cortical vertebral rim. Type II fractures are composed of central cortical and cancellous bone fractures. Type III lesions are more lateralized chip fractures. Type IV fractures span the entire length and breadth of the posterior vertebral margin between the end plates. The clinical, neuroradiologic, and surgical management of 27 patients with these four types of lumbar limbus vertebral fractures are reviewed. The data regarding location and type of fracture were critical for planning piecemeal surgical resection with a downbiting curette, tamp, and mallet technique.

Adolescent↗
PubMed1990

Low-grade cerebral astrocytomas. Survival and quality of life after radiation therapy.

Of 77 patients with supratentorial Grades I and II astrocytoma diagnosed from January 1975 to December 1984, 66 were treated with postoperative radiation therapy. The patients received a tumor dose of 5000 to 5500 cGy in 180 cGy fractions, five fractions per week, over 5.5 to 6 weeks. Overall actuarial survival at 2, 5, and 10 years was 71%, 55%, and 43%, respectively. Progression-free survival at 2, 5, and 10 years was 69%, 50%, and 39%, respectively. Survival for patients receiving postoperative radiation therapy in the range of 4500 to 5900 cGy was 78% and 66% at 2 and 5 years, respectively. Quality of life was determined at two points in time: 1 to 2 years postoperatively, and at last follow-up (2-12 years postoperatively). The occurrence of mental retardation was specifically addressed in long-term survivors, and was observed in 50% of children. Overall, however, 80% of short-term survivors and 67% of long-term survivors were intellectually and physically intact, without major neurologic deficit. Specific prognostic factors were assessed by multivariate analysis. Improved survival was observed with young patients, females, normal preoperative mental status, surgical resection (versus biopsy alone), involvement of only one lobe with tumor, and a history of preoperative seizures. A weighted prognostic factor score derived from these observations permits a clinically useful assessment of risk for individual patients.

Adolescent↗
PubMed1990

Far lateral lumbar disc herniations and associated structural abnormalities. An evaluation in 60 patients of the comparative value of CT, MRI, and myelo-CT in diagnosis and management.

The management of 60 patients with far lateral lumbar disc herniations operated on over a 5-year period are presented. These lesions were located superiorly within the neural foramens beneath or distal to the facet joints. The type of surgery performed in 43 of 60 (72%) of these patients was significantly altered by the presence of diffuse and lateral recess stenosis. This was better appreciated on the myelogram and myelo-CT (M-CT) studies than with the noncontrast CT and MRI examinations alone. Myelo-CT findings were particularly valuable in assessing patients who had previous surgical procedures.

Female↗
PubMed1990

Responses of the socially anxious to the prospect of interpersonal evaluation.

We predicted that socially anxious people who are faced with the prospect of an interpersonal evaluation will act in an inhibited and withdrawn way. Subjects who scored low or high on a measure of social anxiety told four stories about themselves to an interviewer. In the anticipated-evaluation condition, the subjects learned that after they had told their stories, the interviewer would tell them her impressions of them. In the control condition, no mention was made of an evaluation. Judges rated transcripts of the stories. As predicted, socially anxious subjects who thought they were going to be evaluated (relative to anxious subjects in the control condition and nonanxious subjects in both conditions) told shorter stories, and the events in their stories were commonplace rather than unique. Their stories were also less revealing about them as individuals, and less vivid. Contrary to a second prediction, socially anxious subjects who expected to be evaluated did not act any less inhibited or withdrawn when their interviewers were described as very trusting than when they were described as very wary. Implications are discussed.

Adult↗
PubMed1990

Intradural disc herniations in the cervical, thoracic, and lumbar spine: report of three cases and review of the literature.

The clinical, neuroradiological, and surgical management of three cases of intradural disc herniations--one each in the cervical, thoracic, and lumbar regions--are presented. Intradural disc herniations comprise only 0.27% of all herniated discs. Three percent occur in the cervical, 5% in the thoracic, and 92% in the lumbar spinal canal. Those with cervical or thoracic lesions frequently exhibit profound myelopathy, whereas those with lumbar lesions demonstrate radicular or cauda equina syndromes. Although varying combinations of the MRI, non-contrast CT, myelogram, and myelo-CT scans may at times fail to accurately establish the diagnosis of an intradural disc herniation prior to surgery, the index of suspicion raised by the lack of clinical correlation with surgical findings justifies an intradural exploration.

Adult↗
PubMed1989

Treatment of fractures of the vertebral limbus and spinal stenosis in five adolescents and five adults.

Fractures of the vertebral limbus occur between the vertebral ring apophyses and the cartilaginous rim of the superior or inferior margins of the vertebral end plates. These fractures are typically seen in adolescents or young adults, since fusion in this area is not complete until the ages of 18 to 25. Of 85 cases reported, 24 occurred in adolescents. The authors present the clinical, neurodiagnostic, and surgical management of fractures of the vertebral limbus and coincident segmental spinal stenosis in a group of 5 adolescents and 5 adults. An additional category for fractures of the vertebral limbus is proposed, namely, a lesion that is not confined to the superior or inferior margins of the vertebral end plates, but that spans the full length of the vertebral body.

Adolescent↗
PubMed1989

Coexisting cervical spondylotic myelopathy and bilateral carpal tunnel syndromes.

In six patients, operations for bilateral carpal tunnel syndromes (CTS) were performed or were about to be performed without the awareness of the presence of underlying cervical spondylo-stenosis. Only later, when symptoms of myeloradiculopathy were recognized, was the diagnosis confirmed and decompressive laminectomy performed. Because the symptoms of CTS may resemble or be masked and accentuated by the cervical disorder, patients with the presumed diagnosis of bilateral CTS should undergo appropriate critical neurologic, electrodiagnostic, and neuroradiologic (magnetic resonance imaging, computed tomography, myelo-computed tomography) assessment. If these guidelines are followed, the radiculopathy caused by cervical pathology will be appropriately recognized and treated, possibly averting the need for carpal tunnel decompression or modifying treatment.

Aged↗
PubMed1988

Ouabain-resistant, amiloride-sensitive Na+-K+ pumping activity and morphological changes are inducible.

The functional expression of a ouabain-resistance gene has been studied in a transfected cell line, OR-6 cells. These cells possess a ouabain-inhibitable, amiloride-resistant Na+-K+ pump under control conditions. They can be induced by brief culture in the presence of low concentrations of ouabain to express a ouabain-resistant, amiloride-sensitive Na+-K+ pumping activity. They revert to the uninduced phenotype shortly after removal of ouabain from the culture medium. When placed in low-potassium, low-serum, or dibutyryl adenosine 3'-5'-cyclic monophosphate-containing media, these cells produce long cellular extensions. Thus a single inducible gene appears to regulate sensitivity of the Na+-K+ pumping activity to cardiac glycosides and to amiloride, and it may be related to important characteristics of cellular morphology.

Amiloride↗
PubMed1979

Cervical myelopathy caused by developmental stenosis of the spinal canal.

The authors present six patients with myelopathy caused by developmental stenosis of the cervical spine. Hyperextension injuries precipitated the onset of symptoms in two patients, aged 19 and 20 years. In four, 41 to 69 years of age, symptoms were gradual in onset, progressing to severe disability. X-ray films revealed narrowing of the dorsoventral diameter of the spinal canal to as little as 1.0 cm. The myelograms showed widening of the cord in the transverse plane strongly suggestive of an intramedullary tumor. A unique finding was maldevelopment with flattening of the neural arch often hidden by the posterior portions of the articular facets when seen in the lateral views. These patients showed no significant evidence of spondylosis, arthrosis, or any of the structural stigmata usually observed in cervical spondylotic myelopathy. When indicated, decompressive laminectomy is the treatment of choice.

Adult↗
PubMed1978

Lap-sash three point seat belt fractures of the cervical spine.

Cervical spine injuries associated with three-point fixation lap-sash seat belts result from impact against the sash. While such injuries are infrequent and often without serious neurologic sequelae, they may produce serious deficits with grave injuries. Flexion-extension fractures of the lower cervical vertebrae, fractures of the transverse and spinous processes of the lower cervical and uppermost thoracic vertebrae, discal disruptions, and brachial plexus avulsions may occur. Of the 3 patients reported here, 2 escaped serious damage.

Accidents, Traffic↗
PubMed1978

Obliterative arachnoiditis complicating lumbar spinal stenosis.

The authors report five patients with spinal stenosis who had a total myelographic block at the level of the obliterated subarachnoid space. Arachnoiditis had not been considered as a primary diagnosis until laminectomy revealed a non-pulsating, thickened dural sac that conformed to the internal configuration of the involved spinal canal. Two patients had stenosis complicated by spondyloarthrosis over multiple lumbar levels, one had a previous spinal fusion, another had degenerative spondylolisthesis, and the fifth had a large midline extruded disc at L2-3 that completely blocked the spinal canal. The dura was opened in two patients, confirming the lesion. Despite obliteration of the subarachnoid space, significant relief for approximately 1 year followed decompressive laminectomy, foraminotomy, and discectomy, with disappearance of neurogenic claudication in three patients. Postoperative erect films showed no caudad passage of contrast. While further observations are required, an awareness of this complication of spinal stenosis is important in the diagnosis and management of such patients and in evaluating their ultimate prognosis.

Aged↗
PubMed1978

Cervical myeloradiculopathy caused by arthrotic hypertrophy of the posterior facets and laminae.

Five patients with typical cervical myeloradiculopathy caused by focal cervical spinal stenosis are presented. Dorsal intrusions into the spinal canal by hypertrophied apophyseal joints and thickened laminae resulted in cord and nerve root compression. Minor spondylotic changes were present in the floor of the spinal canal. Laminar decompression with formainotomy and facetectomy relieved the patients of their symptoms. An anterior approach should not be considered in the management of this disorder. Our findings of severe apophyseal arthrosis with lesser degrees of associated spondylosis are similar to those described in anatomical studies by other authors. While uncommon, myelopathy caused by dorsal compression of the spinal cord and nerve roots deserves specific mention so that therapy can be directed to the proper quadrants of the spinal canal wherein the significant pathology is located.

Aged↗