Bone-marrow depression with cimetidine plus carmustine.
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Biomedical subjects
Publications and source records attributed to R G Selker.
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It has been observed that patients with metastatic brain lesions developed neurologic symptoms when given Corynebacterium parvum. To obtain more information in patients with intracranial mass lesions, intracranial pressures (ICP) were measured or observed in six patients undergoing C. parvum therapy. All patients except two (one previously shunted, one recently operated) demonstrated a profound increase in ICP. It is presumed that either edema is formed within brain and tumor tissue (inasmuch as neurologic deterioration has not been observed in patients without an intracranial lesion) or transient increases in cerebral blood flow adversely alter an already compromised intracranial volume. Surgical decompression of tumor volume or use of Lasix may abort this response to C. parvum infusion.
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A technique of creating localized heating by implanting metallic materials in the brain and inserting the head into a radiofrequency electromagnetic field is described. The heating properties of various materials for implantation were studied, and the two best materials were carbon steel rods and Hysterloy (1000 and 655 cal/g-min, respectively). Heating of these materials was done primarily by eddy current since their heating rates were significantly affected by their shapes and orientation in the field, rods oriented parallel to the field producing the most heat. There is evidence that warmer cells have a greater uptake of chemotherapeutic agents. This suggests a combined therapeutic approach employing localized brain heating in conjunction with systemic or intrathecal chemotherapy. In this way, large doses of chemotherapeutic drugs might be concentrated in a warmed brain tumor while toxicity is prevented by keeping the rest of the brain and body hypothermic.
The technique of preferential cerebral hypothermia is reported in its application to a patient with a "giant" anterior communicating artery aneurysm. The method utilizes elective ventricular fibrillation and differential or "preferential" hypothermia induced by a combination of external skin cooling and perfusion of core organs with 0 degree buffered electrolyte solution. The value of the technique lies in its provision of a period of safe circulatory arrest approaching one hour without the need for anticoagulation, heart-lung bypass, open chest resuscitation or major vessel clamping. Because of the absence of blood flow and because of the clear fluid washout of the cerebral vessels, it was possible to open the aneurysm, evacuate its contents and resect it in several sections. It was not necessary to clip the feeding arteries until all dissection and total removal of the aneurysm were completed. The application of the technique to neurosurgery and cardiovascular surgery is discussed.
15 children with brain abscesses were subjected to continuous catheter drainage as the procedure of choice for a solitary encapsulated abscess. Although many still advocate craniotomy and total excision, this series, coupled with the experience of others in the literature, leaves little doubt that catheter drainage alone is sufficient. The simplicity of creating a burr hole under local anesthesia, the ability to irrigate with antibiotics and then outline the cavity with contrast agents are but a few of the advantages of this method.
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