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Biomedical subjects

L S Fishman

Publications and source records attributed to L S Fishman.

At least 19 recordsLinked to original sources
PubMed1992

Facial growth during adolescence in early, average and late maturers.

The relative stage of maturity of a child may be determined by comparing the child's hand-wrist radiograph to known standards of skeletal development. Hand-wrist radiographs of 70 adolescents were used to categorize the individuals by skeletal maturation into early, average and late maturation groups using the Fishman SMA method of assessment. The rates of mandibular and maxillary growth relative to the last stages of the pubertal growth spurt were measured. Statistical evaluation of the data was performed using an analysis of variance. The magnitude of change in growth increments of the mandible was greater in the late maturers than in the early or average maturers. Incremental differences in growth between the maxilla and mandible during the last stages of puberty were noted, with the mandible growing significantly more than the maxilla.

Adolescent↗
PubMed1991

Stroke as a late sequela of cranial irradiation for childhood brain tumors.

Cerebrovascular disease involving large and medium-size vessels is thought to be an uncommon sequela of treatment of childhood brain tumors. We reviewed 11 children who developed cerebrovascular disease manifested by strokes or transient ischemic attacks 6 months to 4 years after treatment of brain tumors, while their tumors were in remission. All had received radiation therapy, and seven had received chemotherapy. One child died of acute bilateral cerebral infarctions due to carotid occlusion on one side and marked stenosis on the other 2 years after receiving radiation therapy for an incompletely resected craniopharyngioma. Pathologically, there was marked subendothelial fibrosis of the vessels of the circle of Willis, with inflammatory changes surrounding some of the vessels. In addition to the widely recognized small-vessel damage caused by radiation and chemotherapy in children (mineralizing microangiopathy), damage to medium and large intracranial vessels may result in late sequelae, manifested by stroke or transient ischemic attacks.

Adolescent↗
PubMed1988

Very-high-dose phenobarbital for refractory status epilepticus in children.

Status epilepticus refractory to initial anticonvulsant therapy is a serious condition with a high morbidity and mortality. We present 50 cases with refractory status epilepticus (RSE) treated with very-high-dose phenobarbital (VHDPB) without reference to a predetermined maximum level or dose. Maximum serum levels ranged from 70 to 344 micrograms/ml (median, 114 micrograms/ml). VHDPB controlled seizures in all cases where no limits were imposed upon maximum dose (47/50). We found no maximum dose beyond which further doses are likely to be ineffective. Forty patients were intubated prior to VHDPB, but recovered respiratory drive and could be removed from the ventilator despite very high serum levels. This is explained by acute drug tolerance. Hypotension was unusual, related to the highest levels, and easily controlled. VHDPB has many relative advantages over other therapies presently used for RSE.

Blood Pressure↗
PubMed1985

Primary central nervous system lymphoma without intracranial mass in a child. Diagnosis by documentation of monoclonality.

Primary central nervous system lymphoma is a rare presentation of lymphoma and is usually seen in adults, often in association with immunodeficiency. Evaluation of these patients classically shows discrete intracranial lesions, and long-term prognosis despite treatment is poor. The case of a child is presented who had no identifiable predisposing factors, no radiologic evidence of intracranial mass, no evidence of systemic disease, and in whom the diagnosis of primary CNS lymphoma was made based on documentation of a monoclonal population of malignant B-cells in the cerebrospinal fluid. The patient, in whom irreversible blindness developed, was treated with a combination of cranial radiation, and intrathecal and systemic chemotherapy, and is currently alive and disease-free 15 months after diagnosis.

Antibodies, Monoclonal↗
PubMed1985

Combination chemotherapy with cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) in children with brain tumors.

The chemotherapeutic combination of cyclophosphamide, vincristine, procarbazine, and prednisone (COPP) was used to treat 15 children with recurrent central nervous system tumors and seven children with newly diagnosed brainstem tumors. In patients with recurrent tumors, marginal activity was seen in various histologic types. COPP chemotherapy was clearly ineffective in patients with brainstem tumors. Toxicity consisted of mild to moderate myelosuppression and neurotoxicity.

Adolescent↗
PubMed1983

Combined computed tomographic and radionuclide imaging in the long-term follow-up of children with primary intra-axial intracranial neoplasms.

Radionuclide and computed tomographic (CT) scanning was performed for the long-term follow-up of 63 patients who had been treated for primary intracranial central nervous system tumors. This group included 23 children with supratentorial lesions and 40 with infratentorial lesions. The results of imaging were correlated with clinical assessment and the results of cytologic evaluation of the cerebrospinal fluid and, when available, surgical or autopsy findings. The sensitivity, specificity, and positive predictive value of both CT and radionuclide scanning were evaluated for each type of tumor. These two modalities play a complementary role in the long-term follow-up of children with primary intra-axial neoplasms.

Adolescent↗
PubMed1982

Assessment of cerebral perfusion in childhood strokes.

Thirty-three children who had strokes were studied by dynamic and static scintigraphy, 29 by CT scanning, and 10 by cerebral angiography. The accuracy of dynamic scintigraphy in stroke detection during the first week of clinical symptoms was 94% while CT scanning was 60% accurate and static scintigraphy 11% accurate. During the second week the accuracy of CT scanning increased to 100%, but static scintigraphy improved to only 50%. Fifty percent of scintiangiograms performed during the first week showed either luxuriant perfusion or flip-flop patterns. In some patients these two flow patterns changed to that of cerebral hemispheric ischemia after going through a phase during which perfusion appeared to be equal in the two hemispheres. Dynamic scintigraphy is believed to be the test of choice for stroke detection in children during the first week.

Adolescent↗
PubMed1982

The reliability of noninvasive diagnostic procedures in children with brain tumors.

To determine the most reliable method of following the progress of disease in children with primary intracranial neoplasms, the noninvasive diagnostic procedures in 92 children were analyzed. Computerized tomographic (CT) scanning was found to be significantly superior to all other testing procedures in sensitivity, specificity, and overall accuracy. This superiority was seen regardless of tumor location or pathological subtype. When results in follow-up were compared to initial findings at diagnosis, the sensitivity of CT scanning was again significantly more reliable than the other procedures. Cerebrospinal fluid analysis was unreliable and added little information to that obtained from simultaneous CT and Radionuclide (RN) scanning. It is recommended that combined CT and RN scanning be used for management of intracranial neoplasms until a reliable method for detecting microscopic disease is available.

Adolescent↗
PubMed1979

Chronological versus skeletal age, an evaluation of craniofacial growth.

Skeletal and chronologic ages of both female and male populations were compared relative to the degree of concurrence between the two age-indices at the various age levels. Maxillary and mandibular cephalometric measurements were similarly compared for both sex groups. Individual's comparisons of facial changes were made relative to their respective chronologic and skeletal ages. The significance of a skeletal vs. chronologic age discrepancy and its relationship to the timing of facial growth was demonstrated. Clinical implications were discussed.

Adolescent↗
PubMed1978

Scintigraphic detection of congenital intracranial vascular malformations.

Nine children with arteriovenous malformations (AVMs), and a tenth with a cerebral aneurysm, had computer-processed dynamic scintigraphy with static scintigrams, transmission computed tomography (CT) both with and without contrast injection, and radiopaque cerebral angiography. All ten lesions were detected by dynamic scintigraphy and angiography, whereas two AVMs were missed on CT scans and the aneurysm and two AVMs (one missed by CT) were not identified on static scintigrams. Time-activity curves generated from regions of interest placed over the cerebral hemispheres, AVMs and/or various venous structures permitted, respectively, estimation of interhemispheric partition of perfusion, estimation of the fraction of total cerebral hemispheric perfusion preferentially directed into a malformation, and indication of the route of venous drainage from the lesions. While dynamic scintigraphy and CT scanning both identified the aneurysm, scintigraphy was the most effective screening test for detecting AVMs owing to its accuracy, lower cost, and lack of required anesthesia, heavy sedation or iodinated contrast agents.

Adolescent↗
PubMed1977

Acute infantile motor unit disorder. Infantile botulism?

Eight infants with an acute reversible motor unit disorder are described, including two infants from whom Clostridum botulinum type A was isolated from stool specimens. The clinical spectrum includes constipation, cranial nerve deficits, pupillary involvement, and generalized hypotonic weakness. There were no deaths, and all infants have had complete clinical recovery. A characteristic electromyographic (EMG) pattern was present in part until clinical recovery. This distinctive pattern consisted of brief, small, abundant for power exerted motor unit potentials. This EMG pattern in the context of the clinical syndrome may well be diagnostic for acute infantile motor unit disorder.

Acute Disease↗
PubMed1976

Dental and skeletal relationships to attritional occlusion.

Dental attrition has been investigated in depth. Besides alterations in arch length due to attrition, skeletal and intra-arch differences were discovered. It is felt that these findings do have value in helping us realize that present-day concepts of proper occlusion cannot necessarily be applied to dentitions that existed at another time. A more thorough knowledge of occlusions exhibiting dental attrition provides information that is helpful in understanding more fully the nature of tooth eruption and associated dental arch occlusion and the interrelationships of these factors with supporting skeletal structures.

Cephalometry↗