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Biomedical subjects

O H Reichman

Publications and source records attributed to O H Reichman.

At least 19 recordsLinked to original sources
PubMed1992

Neurotologic considerations in the treatment of advanced clival tumors.

Head and neck manifestations of advanced clival tumors result from subtle, yet progressive mass effect or direct involvement of multiple cranial nerves. Misinterpretation of clinical or radiographic findings in these patients may result in inappropriate treatment planning, increased patient morbidity, and probable tumor recurrence. Our combined experience in managing 21 patients with advanced clival tumors has shown that preoperative loss of vision, diplopia, or facial hypesthesia suggests superior parasellar disease. Facial twitching or neurotologic symptoms result from posterior central tumor growth, while inferior extension of disease leads to basal cranial nerve deficits with associated speech, voice, and swallowing dysfunctions. The purpose of this article is to correlate the complex anatomy of the clivus, brainstem, and cranial base and the various neurotologic findings associated with neoplasms in this region. Lateral skull base surgical procedures, based on preoperative clinicoradiographic assessment, will be detailed with particular emphasis on preservation of critical neurovascular structures.

Adolescent↗
PubMed1992

Improved cerebral blood flow and CO2 reactivity after microvascular anastomosis in patients at high risk for recurrent stroke.

The medical community has not yet identified cerebrovascular pathophysiological factors that distinguish patients at high risk for stroke or aid in selecting patients for microvascular cerebral bypass. In this study, we describe the courses of 13 patients, all of whom suffered recurrent episodes of transient cerebral ischemia after previous cerebral infarction. These patients underwent regional cerebral blood flow studies using xenon inhalation with a CO2 challenge before and at various times after extracerebral-to-intracerebral microvascular anastomosis. Collateral circulation was assessed in all patients before surgery using four-vessel cerebral angiography. Patients were followed for a mean of 30 months (range, 1-7 yr) after the anastomosis. Measurements of mean cortical cerebral blood flow, as measured using the initial Slope Index, and CO2 cerebrovascular reactivity of these 13 patients were compared with those in a group of 20 patients designed as controls. Hemispheric cortical blood flow was significantly depressed in these patients before surgery compared with those in the control group (P less than 0.05). After the bypass, the mean resting Initial Slope Index in these patients increased 14% (P = 0.0005). Cerebral blood flow both before and after CO2 inhalation improved significantly in these patients after surgery (P = 0.001). Detectors bordering computed tomographic or magnetic resonance image documented infarctions, identified as peri-infarct regions, and demonstrated significant mean increases in both cerebral blood flow (38.8-43.2 ml/min/100 g, P = 0.05) and CO2 cerebrovascular reactivity in these patients after bypass (1.71 + 1.91% to 4.00 + 2.38% change Initial Slope Index/mm Hg CO2, P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Traumatic intracavernous aneurysm in children: massive epistaxis without ophthalmic signs.

Traumatic intracavernous aneurysms are a distinctly uncommon lesion in children. They usually present with compressive symptoms of the III, IV, V, or VI cranial nerves rather than epistaxis. Epistaxis is rare and usually minor and brief in duration. A child with severe head injury and basal skull fracture, who did not have any preceding symptoms or signs of ophthalmoplegia or exophthalmus, developed massive epistaxis as a leading symptom of the ruptured intracavernous aneurysm. Since there are no reported pediatric cases with fatal epistaxis as a presenting sign, we would like to share our experience.

Adolescent↗
PubMed1990

Sustained increased cerebral blood flow with prophylactic hypertensive hypervolemic hemodilution ("triple-H" therapy) after subarachnoid hemorrhage.

Delayed cerebral ischemia is the major cause of death and disability in patients who initially survive an aneurysmal subarachnoid hemorrhage (SAH). In the present study, a protocol for prophylactic hypertensive hypervolemic hemodilution ("triple-H" therapy) was utilized in the treatment of SAH, and the response of cerebral blood flow (CBF) was evaluated. Serial CBF measurements, f1 and CBF15, were performed using the xenon-133 inhalation technique to maximize therapy. Surgery within 24 hours of subarachnoid hemorrhage was preferred. In 43 patients with SAH, mean hemoglobin and hematocrit were lowered 3.0 +/- 0.3 g/dL and 8.9 +/- 0.5%, respectively, over the first 24 hours. Mean f1 and mean CBF15 over the same period increased 34.2 +/- 5.8% and 21.2 +/- 3.6%, respectively. The maximum mean increase in CBF was 47.2 +/- 4.7% for f1 and 30.1 +/- 3.2% for CBF15. Cerebral blood flow remained elevated during the 21 days after SAH, irrespective of neurological grade on admission, age, sex, or angiographic arterial narrowing. This is the first report of a consistent method for establishing sustained improvement in CBF after SAH. All patients managed in total compliance with the protocol remained neurologically stable or improved. Two patients developed delayed ischemia and infarction because of the inability to sustain protocol requirements. Thirty-six of the 43 patients (84%) were discharged capable of an independent lifestyle. Triple-H therapy is a safe and effective modality for elevating and sustaining CBF after SAH. In combination with early aneurysm surgery, it can minimize delayed cerebral ischemia and lead to an improved overall outcome.

Adult↗
PubMed1990

Meningiomas of the lateral skull base: neurotologic manifestations and patterns of recurrence.

The eradication of basicranial meningiomas by traditional surgical techniques is often hindered by neoplastic entanglement with critical neurovascular structures. Apparent, complete tumor resection is frequently followed by extensive, yet clinically silent, recurrent disease with local infiltration of bone, cranial nerves, and brain. Fifty-five cases of sphenoid wing or parasellar meningioma were analyzed to identify clinical manifestations suggestive of early tumor recurrence. Regrowth patterns were then defined according to preoperative radiographic and intraoperative surgical findings. Medial tumor regrowth, involving the cavernous sinus, caused neurapraxia of cranial nerves III, IV, or VI, with associated diplopia or ophthalmoplegia. Inferior (caudal) regrowth of disease involved the infratemporal fossa, pterygomaxillary space, or paranasal sinuses by bony erosion of the middle cranial fossa floor or through natural anatomic foramina and fissures. Such inferior extension was manifested clinically by facial hypesthesia, trismus, and referred otalgia caused by trigeminal nerve involvement and by autophony or serous otitis media related to eustachian tube obstruction. Posterior tumor regrowth occurred along the petrous bone and horizontal carotid canal, resulting in internal auditory meatus erosion and cerebellopontine angle extension with associated tinnitus, hearing loss, unsteadiness, and occasional facial twitching. While the clinical and radiographic evaluations of any patient with a suspected recurrent basicranial meningioma are critical in planning the method and magnitude of reoperation, an understanding of potential recurrence patterns can be used in devising more extensive, combined approaches that may allow complete tumor extirpation at the initial surgical intervention.

Adult↗
PubMed1989

Indium-111-Photofrin-II scintillation scan.

Photodynamic therapy is under intense investigation as an adjuvant treatment for malignant glial tumors of the central nervous system. Photofrin-II (HpD-II) is currently the most actively investigated photosensitizing agent. A crucial issue regarding the safe and efficacious usage of HpD-II-based photodynamic therapy is the individual in vivo kinetics of tumor uptake and retention, compared with normal brain clearance. The optimal time for photoactivation of sensitized tumor must be known to ensure a high target-to-nontarget ratio, resulting in the maximal tumor destruction while preserving normal brain. Our laboratory developed a radionuclide scan based on 111indium (111In)-labeled HpD-II to evaluate HpD-II localization and clearance noninvasively within a canine model of intracerebral gliosarcoma. Synthesis of the 111In-HpD-II complex in greater than 90% yield is achieved by a simple, rapid labeling method. Radiochemical purity and stability were verified by high-performance liquid chromatography. Using the canine model of intracerebral gliosarcoma, we followed the uptake of 111In-HpD-II in tumors with serial scintillation scanning. Localization of the tumor by 111In-HpD-II has been verified by contrast-enhanced computed tomographic scan followed by gross and histological examination of the enhancing brain region. Total body biodistribution of 111In-HpD-II at various times after injection has been evaluated. The ratio of uptake in tumor compared with surrounding brain peaked at 72 hours after injection. The knowledge of regional distribution and concentration of a photosensitizing agent within a tumor mass and surrounding brain allows for the most efficacious timing and localization of a photoactivating source.

Animals↗
PubMed1988

Endaneurysmal microendarterectomy in the treatment of giant cerebral aneurysms: technical note.

Giant cerebral aneurysms continue to present the surgeon with substantial technical challenges. Operative techniques for managing giant cerebral aneurysms are becoming increasingly sophisticated. We emphasize in this report a technique for direct obliteration of the giant aneurysm with a hard, calcified atheroma at its base that prevents direct clip application without compromise of the parent artery. Temporary trapping of the aneurysm, intramural thrombectomy, and endaneurysmal microendarterectomy allow direct obliteration of the aneurysm neck with preservation of the parent artery.

Endarterectomy↗
PubMed1987

Clinical manifestation of glioma before computed tomographic appearance: the dilemma of a negative scan.

Eight cases are presented to summarize our experience with patients initially evaluated for the new onset of either seizure activity or focal transient neurological deficits. Each was found to have a normal computed tomographic (CT) scan with and without iodinated contrast infusion. All subsequently returned with a CT scan indicative of a glioma 2 weeks to 39 months later. The apparent reasons for the difficulty in early diagnosis of glioma in certain instances are discussed. A review of the literature with an analysis of the conglomerate data is presented. These cases probably represent a subset of gliomas undergoing anaplastic dedifferentiation from relatively benign to more malignant forms. Recommendations for clinical and radiographic follow-up are outlined.

Aged↗
PubMed1987

Monitoring of transient central nervous system postirradiation effects by 133Xe inhalation regional cerebral blood flow measurements.

The early transient postirradiation effects in the central nervous system are well known; however, no specific means of objective follow-up have been devised. The xenon (133Xe) inhalation technique for measurement of regional cerebral blood flow (rCBF) is easily reproducible. Serial rCBF measurements corresponding to the clinical presentation and course of the early postirradiation syndrome have not been previously reported. It is our belief that the global decline in rCBF identified in these patients represents a generalized metabolic derangement induced by whole brain irradiation rather than primary vascular changes. A distinction between tumor recurrence and the early transient postirradiation effects can be made utilizing this technique. It also provides a reproducible monitor of the clinical and metabolic impact of radiotherapy for brain tumors. A series of seven such patients is presented with appropriate case histories and graphic representations of the serial rCBF measurements.

Adult↗
PubMed1987

Reevaluation of an experimental streptococcal canine brain abscess model.

An experimental cerebral abscess model in which alpha-hemolytic Streptococci were inoculated into the brain parenchyma of dogs was evaluated for assessment of antimicrobial therapy. Intracerebral ring-enhancing lesions were visualized by computerized tomography, but they resolved after time without therapeutic intervention. Histopathological study demonstrated evolution of the lesions into sterile granulomas. Quantitative cultures were performed and uniformly became sterile in the early cerebritis stage, approximately 3 days after bacterial inoculation. Therefore, this brain abscess model should not be utilized for the evaluation of new antimicrobial treatment regimens. Rather, other models which document persistent viable organisms within cerebral abscesses need to be developed.

Animals↗
PubMed1985

Bactericidal effects of photoradiation therapy with hematoporphyrin derivative.

Hematoporphyrin derivative (Hpd) localizes selectively in malignant and rapidly metabolizing tissues and undergoes a cytotoxic reaction when exposed to light of a specific wavelength. Hpd has been studied extensively with regard to the diagnosis and treatment of tumors but not with regard to bactericidal activity. This investigation assessed the effect of light-activated Hpd on various microorganisms, on human polymorphonuclear leukocytes, and on the interactions of polymorphonuclear leukocytes and bacteria. Light-activated Hpd was 99.9% bactericidal against Staphylococcus aureus, Streptococcus faecalis, Bacteroides fragilis, Streptococcus M-G intermedius, Streptococcus mutans, Peptostreptococcus anaerobius, Peptococcus magnus, and Clostridium perfringens, but did not affect Escherichia coli, Pseudomonas aeruginosa, or Candida albicans. Photoactivation of Hpd rendered 98% of polymorphonuclear leukocytes inviable. Combinations of light-activated Hpd and polymorphonuclear leukocytes had a 4-log (99.99%) bactericidal effect on both intra- and extracellular S. aureus. The ability of Hpd to localize in inflammatory tissues may have therapeutic applications in the treatment of abscesses.

Bacteria↗
PubMed1979

Angiographic demonstration of recanalization of the basilar artery.

This report details the clinical course and angiographic findings of a patient with intermittent vertebrobasilar insufficiency. Recanalization of the basilar artery was demonstrated during anticoagulant therapy. A review of the literature failed to disclose a previous report of this occurrence.

Basilar Artery↗
PubMed1978

Interhemispheric subdural hematoma.

The clinical presentation and surgical management of an interhemispheric subdural hematoma, a rare entity, is presented and the literature reviewed. Either hemiparesis, worse in the lower than the upper extremity, or lower extremity monoparesis is characteristic of this lesion. Computerized tomography (CT) is the preferred diagnostic procedure. An interhemispheric hematoma, either acute or chronic, is best treated by osteoplastic craniotomy. Specific anatomical considerations, clinical features, and the recommended surgical technique is described.

Adult↗
PubMed1977

Staged intracranial and extracranial revascularization.

Twenty patients with a combination of intracranial and extracranial cerebrovascular lesions were identified in a series comprised of 118 candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Ten patients had internal carotid (ICA) occlusion and contralateral ICA stenosis, seven patients had combinations of ipsilateral lesions, usually ICA occlusion and external carotid (ECA) stenosis, and three patients had multiple lesions. Eighteen patients had a STA-MCA bypass performed; 11 of these had contralateral reconstruction for ICA stenosis, and seven had ECA stenosis corrected. Two additional patients became asymptomatic after ECA endarterectomy only and their proposed STA-MCA bypass has been postponed. There were two deaths, one early and one late. Eleven patients are asymptomatic, five are improved, one is unchanged, and one is neurologically worse.

Adult↗