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Biomedical subjects

R Lesser

Publications and source records attributed to R Lesser.

At least 19 recordsLinked to original sources
PubMed1999

Effect of functional endoscopic sinus surgery on bronchial asthma outcomes.

BACKGROUND: For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationships have been proposed but not proved. To date, limited evidence exists suggesting that asthma improves after surgical correction of rhinosinusitis. OBJECTIVE: To determine whether asthma control improved after first-time functional endoscopic sinus surgery (FESS). PATIENTS AND METHODS: A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medically refractory chronic rhinosinusitis. Patients received comprehensive asthma care before and after FESS (mean, 19.3 and 33.1 months, respectively). Outcomes analyzed included pre- and post-FESS individual and group mean asthma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice affiliated with a medical school. The surgical procedure was performed at a tertiary care teaching hospital by a single ear, nose, and throat surgeon (R.L.). RESULTS: Following FESS, there was no statistically significant change in group mean asthma symptom scores, asthma medication use scores, pulmonary function test results, and the number of emergency department visits or hospital admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). CONCLUSIONS: The data do not support the hypothesis that first-time FESS for medically refractory chronic rhinosinusitis in adult patients with chronic asthma leads to reduced postoperative asthma symptoms or asthma medication use or improved pulmonary function. Based on this limited study, a reexamination of the benefits of sinus surgery to coexisting asthma is in order.

Adolescent↗
PubMed1998

Granular cell tumor of the larynx in a six-year-old child: case report and review of the literature.

Granular cell tumors (granular cell myoblastomas) are uncommon neoplasms in the adult population, occurring predominantly in the head and neck and most frequently in the tongue. Laryngeal presentations are unusual, and granular cell tumors of the larynx in children are extremely rare, with a total of 19 cases reported in the literature in children under the age of 17 years. We report an additional case of a laryngeal granular cell tumor, in a six-year-old boy, and discuss the clinical, histologic, ultrastructural and therapeutic aspects of these neoplasms.

Child↗
PubMed1997

Neuroperceptual differences in consonant and vowel discrimination: as revealed by direct cortical electrical interference.

The effects of direct cortical electrical interference on consonant and vowel discrimination were investigated in five patients with implanted subdural electrode arrays. Without electrical interference, patients performance discriminating consonants and vowels was intact. With electrical interference, consonant discrimination was impaired at one electrode site in each patient on the superior temporal gyrus of the lateral left perisylvian cortex. Conversely, vowel and tone discrimination remained relatively intact when tested with electrical interference at the same site. Analysis of patients' consonant discrimination errors revealed that neither differences in acoustic temporal structure nor syllable position fully account for the consonant-vowel perceptual dissociations elicited. Our data suggest that at the cortical level consonant and vowel perception are intrinsically distinct perceptual phenomena. The selective impairment of consonant, but not vowel, discrimination further suggests that consonant and vowel perception are distinguished by differences in relative dependence on the functional--perhaps integrative--resources of the left lateral superior temporal gyrus.

Adolescent↗
PubMed1994

Electrical stimulation and language.

Electrical stimulation has been used for over half a century in clinical settings to facilitate the surgical treatment of patients with intractable seizures and cortical structural lesions. It should be employed as the final result of a stepwise process in patient management but, when called for, can be very accurate in localizing critical functional areas. We discuss the use of this technique in patient evaluation, with an emphasis on the evaluation of patients with seizure disorders.

Cerebral Cortex↗
PubMed1994

Assessing functional communication in aphasia: clinical utility and time demands of three methods.

A variety of methods has recently been used to assess everyday communication abilities in aphasic adults. This study compares three such methods for their clinical utility and the amount of a therapist's time they use. The three methods employed a standard rating schedule completed by relatives, analysis of speech elicited through role-play and a partial analysis of everyday conversation samples. The utility of these assessments as a clinical tool was measured in terms of the therapist's time needed, and the assessment's ability to show stability or change of communicative effectiveness on test-re-test measures and to illuminate areas for therapeutic intervention. Eight aphasic adults (five acute and three chronic) were tested on all three assessments, then re-tested after a period of 3 months. The results suggested that, although more time-consuming, the partial conversational analysis was a more sensitive measure of stability or change of communicative effectiveness over time than the other two measures, and had the potential advantage for indirect intervention of revealing conversational strategies used by the partner as well as those used by the aphasic individual.

Acute Disease↗
PubMed1993

Felbamate: a double-blind controlled trial in patients undergoing presurgical evaluation of partial seizures.

We studied the efficacy and safety of felbamate, an investigational antiepileptic drug, in a unique, double-blind, placebo-controlled trial. Sixty-four patients with refractory partial-onset seizures who completed a routine evaluation for epilepsy surgery met seizure frequency entry criteria. Each patient received felbamate or placebo in addition to the anticonvulsant regimen present at the conclusion of the presurgical evaluation. The treatment phase consisted of an 8-day inpatient period and a 21-day outpatient period. The efficacy variable was time to fourth seizure. The difference in time to fourth seizure was statistically significant (p = 0.028) in favor of felbamate. Eighty-eight percent of the patients in the placebo group had a fourth seizure during the treatment phase compared with 46% of the patients in the felbamate group (p = 0.001). Adverse experiences with felbamate were generally mild or moderate in severity. This trial demonstrated the ability of felbamate to quickly and safely reduce the occurrence of frequent partial-onset seizures and maintain effective seizure control following reductions in the dosages of standard antiepileptic drugs.

Adolescent↗
PubMed1992

The making of logopedists: an international survey.

An international survey of 43 countries' education and training of logopedists confirms the trend towards an upgrading of qualifications. A heterogeneity of practices remains, however, which makes logopedics further removed from establishing international standards than an allied profession, occupational therapy. Clinical practicum is reported on in detail and shown to be particularly diverse. The situation in the European Community is described in particular, as qualified logopedists are now permitted to work in any of the Community countries, provided that their qualification is not substantially different from that operating in the country of work.

Adult↗
PubMed1992

Motor and sensory cortex in humans: topography studied with chronic subdural stimulation.

Classic neurosurgical teaching holds that once the Rolandic fissure (Rf) has been located, there are distinct differentiated primary motor and sensory functional units confined within a narrow cortical strip: Brodmann's Areas 4 and 6 for primary motor units in front of the Rf and 3, 1, and 2 for sensory units behind the Rf. To test this assumption, we examined in detail the records of cortical mapping done by electrical stimulation of the cerebral cortex via implanted subdural electrode grids in 35 patients with seizure disorders. Of 1381 stimulations of the electrode sites, 346 (25.1%) produced primary motor or motor-arrest and sensory responses in contralateral body parts: 56.8% were primary motor responses; 16.2% were motor-arrest; 22.5% were sensory; and the remaining 4.5% were mixed motor and sensory responses. Two-thirds (65.9%) of the primary motor responses were located within 10 mm of the Rf, and the remaining one-third (34.1%) were more than 10 mm anterior to the Rf or were posterior to the Rf. Furthermore, in the patient group with brain lesions, fewer than one-third (28.1%) of the responses were within the 10-mm narrow anterior strip. Our study reconfirmed that a significant number--at least one-third--of motor responses are distributed outside the classic narrow cortical strip. In patients with brain lesions, the motor representation is further displaced outside the narrow strip. This finding indicates that primary motor cortex may extend beyond the gyrus immediately anterior to the Rf.

Adolescent↗
PubMed1990

Resection of the epileptogenic area in critical cortex with the aid of a subdural electrode grid.

Electrode grids were implanted subdurally in 28 patients with epilepsy. In 16 of the 28 patients, an epileptogenic area was located in the speech-dominant left temporal lobe. Recordings made with the grid revealed that the epileptogenic areas in the patients varied widely in extent: the area was confined within the first 10 mm of the temporal lobe in some patients or it was scattered throughout the entire anterior to posterior 80-mm extend in others. Resection of the epileptogenic area was adjusted accordingly in each case. In 6 of 16 patients who were left-hemisphere-dominant for language, up to 55-80 mm from the tip of the temporal lobe was removed, a measure that exceeds the conventional limit of 50 mm from the tip of the dominant hemisphere. In the remaining 12 of the 28 patients, epileptogenic areas were located in a combination of several lobes. In 7 of these 12 patients, the epileptogenic area encompassed the rolandic area; it was removed without deficit in 4 patients and with expected deficit in 3. Of the latter 3 patients, 1 patient underwent hemispherectomy, and a large portion of the epileptogenic rolandic cortex in the frontal and parietal lobes was removed from the other 2. There were 2 cases of grid-related infection, which cleared with antibiotic treatment; there were no lasting complications of grid implantation in any patient. There was no mortality. Electroencephalographic recording and functional mapping using subdural electrode grids allow a tailored, maximal resection of epileptogenic tissue with minimal injury to critical cortex.

Brain Diseases↗
PubMed1989

Selective preservation of oral spelling without semantics in a case of multi-infarct dementia.

A 70 year old retired van driver, with a diagnosis of multi-infarct dementia, showed features associated with transcortical sensory aphasia, with excellent repetition, a severe anomia, poor semantic comprehension and fluent speech. He was able to spell orally words which he did not understand, as well as nonwords; he wrote to dictation only after first spelling the words orally. Some of his spellings provided evidence for a dissociation between semantics and the graphemic output lexicon, the application of sub-word rules and partial lexical knowledge. These findings are interpreted in terms of a cognitive neuropsychological model.

Aged↗
PubMed1988

Malignant glioma of the optic chiasm eight years after radiotherapy for prolactinoma.

A 41-year-old man had rapidly progressive visual loss caused by a malignant glioma that developed in the optic chiasm eight years after radiation therapy for a recurrent prolactinoma. Radiation-induced glioma should be considered as a cause of progressive visual loss in patients who have received irradiation in the region of the sella turcica.

Adult↗
PubMed1986

Involving relatives in aphasia therapy: an application of language enrichment therapy.

A programme of therapy for aphasia devised in Finland, Language Enrichment Therapy, was tested in an English version, particularly in respect of its co-operative use by speech therapists and the patients' relatives at home. Although a number of changes were recommended, the method was approved of by therapists and relatives. The majority of patients showed improvement, as assessed by the Western Aphasia Battery, over a period of less than three months with a regimen of one hour a week with the therapist supplemented by an average of five hours of help by a relative at home. These results should encourage the development of programmes such as Language Enrichment Therapy as an economic way of enabling speech therapists to use volunteer helpers.

Adult↗
PubMed1984

Recovery functions of spinal cord and subcortical somatosensory evoked potentials to posterior tibial nerve stimulation: intrasurgical recordings.

The recovery function of evoked potentials to posterior tibial nerve stimulation was studied. Intrasurgical recordings were made from interspinous ligaments at lumbar levels and from high thoracic-low cervical level. In addition, surface recordings were obtained from neck-scalp derivations. The recovery function of the potentials recorded from lumbar and from high thoracic-low cervical spinal cord were very similar, showing an early period of supernormality (5-20 ms) followed by a period of subnormality which reached its lowest point at 40-60 ms. Assuming that the potentials recorded at the lumbar level reflect activity in the cauda equina, we conclude that the results support the hypothesis that the potentials recorded from the thoraco-cervical level reflect activity in the dorsal columns. The recovery curve of the amplitude between the far field potentials P27 (which most probably reflects activity of the afferent volley at the level of foramen magnum) and N30 (which, by latency criteria, would reflect lemniscal or thalamic activity) showed a similar shape but with a shorter duration of the periods of super- and subnormality. It is likely that this modification was due to the synapse at the gracilis nucleus. The first cortical component (P32) recorded in the neck-scalp derivation was totally abolished within the recovery period studied (50 ms interval).

Adolescent↗
PubMed1983

Acute monocular visual loss secondary to anterior communicating artery aneurysm in a patient with sickle cell disease.

A patient with sickle cell disease had acute monocular visual loss with no visible vitreal or retinal abnormalities. A large aneurysm of the anterior communicating cerebral artery was found, with direct compression of the optic nerve. This represents a very rare presentation of a relatively common lesion. Consideration should always be given to compressive lesions as the cause of acute monocular visual loss in the absence of visible vitreal, retinal, or optic nerve disease.

Acute Disease↗