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Biomedical subjects

Rob D Dickerman

Publications and source records attributed to Rob D Dickerman.

43 records · Page 3Linked to original sources
PubMed2002

Delayed iliac crest autograft fractures following plated single-level anterior cervical corpectomy with fusion.

Recurrent cervical pain following single-level plated anterior corpectomy with fusion signaled delayed mid-iliac crest autograft fractures in four of 56 patients. Single-level anterior corpectomy with fusion used 15 fixed plates (Sofamor Danek) and 41 dynamic ABC plates (Aesculap). Patients in the fixed-plate and dynamic-plate groups averaged 46 and 48 years of age, respectively. Fusion was confirmed on both dynamic radiograph and two-dimensional CT studies an average of 4.5 months postoperatively. Two (13%) fixed-plated patients developed mid-iliac crest strut fractures 1 and 2 years postoperatively, whereas two (5%) dynamic-plated patients showed similar fractures 6 and 9 months following surgery. Immobilization in CTO orthoses resulted in fusion in one case, whereas three patients required secondary posterior wiring/fusion. Recurrent pain signaled delayed autograft strut fractures in four of 56 patients undergoing plated single-level anterior corpectomy with fusion.

Adult↗
PubMed2002

Basis of persistent and recurrent Cushing disease: an analysis of findings at repeated pituitary surgery.

OBJECT: The goal of this study was to establish the clinical importance of occult dural invasion--invasion of the dura mater or cavernous sinus that is not evident on imaging studies and is not obvious to the surgeon--as the basis of recurrent or persistent tumor and endocrinopathy. METHODS: The authors retrospectively reviewed the case files of patients who underwent repeated transsphenoidal surgery for resection of an adrenocorticotropic hormone (ACTH)-producing pituitary adenoma. Patient selection required the availability of operative and pathology reports from the initial and repeated transsphenoidal surgeries. Because no determination of the cause of persistent or recurrent disease could be made if the tumor could not be localized during the repeated surgery, a pathology report confirming the presence of tumor from the second surgery was also required. Sixty-eight patients met these criteria. In 43 patients (63%) an ACTH-producing tumor was identified at the initial surgery, in 25 patients (37%) no tumor was found, and in three patients (4%) dural invasion was noted at surgery. In 49 (72%) of the 68 patients there was initial resolution of hypercortisolism and recurrent Cushing disease (CD), whereas in 19 patients (28%) there was persistent CD after the initial surgery. At repeated surgery (44 +/- 35 months after the initial surgery) in all 43 patients in whom tumor had been identified at the initial surgery, the tumor was found at the same site or contiguous to the same site. Dural invasion was noted by the surgeon in only three patients at the original surgery, whereas dural invasion by an ACTH-producing tumor was identified during repeated surgery in 42 (62%) of the 68 patients. In addition, 39 (93%) of the 42 invasive adenomas were located laterally and involved the cavernous sinus. Adenomatous invasion of the dura mater was found in 31 (54%) of the 57 microadenomas and in all 11 macroadenomas at repeated surgery. The presence of tumor was not detected in 28 of the 59 patients studied with magnetic resonance (MR) imaging and in none of these 59 patients was dural invasion evident on MR images. CONCLUSIONS: Recurrent and persistent CD consistently results from residual tumor. At repeated surgery the residual tumor can be found at or immediately contiguous to the site at which the tumor was found originally. Unappreciated dural invasion with growth of residual tumor within the cavernous sinus dura, which frequently occurs without residual tumor or dural invasion being evident on MR images or to the surgeon during surgery, is the basis of surgical failure in many patients with CD. Occult lateral dural invasion by tumor may also underlie recurrences of other types of pituitary adenomas.

Adenoma↗
PubMedDate not supplied

Circumferential cervical spine surgery in an 18-month-old female with traumatic disruption of the odontoid and C3 vertebrae. Case report and review of techniques. Case report and review of techniques.

STUDY DESIGN: A case study of an 18-month-old female with craniovertebral instability and spinal cord compression requiring circumferential stabilization. A review of surgical techniques in upper cervical spine and craniovertebral stabilization for young children is provided. OBJECTIVES: To describe an interesting surgical approach in a young pediatric patient requiring circumferential stability at the craniovertebral junction. BACKGROUND DATA: Craniovertebral instability is problematic in the young pediatric population due to the inability to secure hardware for stabilization. We present an interesting case of spinal cord compression with craniovertebral instability in an 18-month-old female requiring circumferential cervical spine and craniovertebral stabilization. METHODS: The patient presented with acute onset quadriparesis after a fall. Radiographs demonstrated C2-C3 disruption with canal compromise. Magnetic resonance imaging revealed signal changes of the spinal cord at C2-C3. Neurological examination revealed normal muscle volume with strength 1/5 in the upper extremities and 0/5 in the lower extremities. Respirations were normal with normal diaphragmatic function. Cranial nerves were intact. RESULTS: Halo-traction attempted at 0.453 kg induced occipital-atlantal dislocation. The patient underwent anterior corpectomy of C3 and the base of C2 with autologous rib grafts placed from C2 to C4 and macropore as an anterior plating system. Posteriorly the patient had occiput-C3 fusion with a titanium rod and autologous rib grafts bilaterally. Postoperatively the patient regained normal neurological function with circumferential fusion after 4 months in a halo vest. CONCLUSIONS: This case demonstrates the ability to achieve circumferential stabilization in the young pediatric patient. Injuries at the odontoid synchondrosis can be difficult to treat and are only complicated by having to achieve a posterior fusion at the craniovertebral junction. We present a successful case of circumferential fusion and offer a surgical technique to achieve spinal cord decompression and fusion of the upper cervical spine and craniovertebral junction in the young pediatric population.

Accidental Falls↗
PubMedDate not supplied

The steroid-responsive hiccup reflex arc: competitive binding to the corticosteroid-receptor?

Hiccups occurring secondary to high-doses of corticosteroids are a well-recognized problem in the field of neurosurgery. Numerous reports of oral, intravenous and intraarticular corticosteroids inducing hiccups exist in the literature. To date, there is only one case of anabolic steroids inducing hiccups. We now present a case of a patient who underwent a suboccipital craniotomy for resection of a cerebellar pontine angle meningioma. Postoperatively the patient was on high doses of Decadron and Oxandrin, an anabolic-anticatabolic agent used to combat the deleterious effects of corticosteroids. The patient suffered intractable hiccups postoperative day one, resistant to Thorazine. Oxandrin was discontinued to assess the possibility of a anabolic steroid-induced singultus. The hiccups resolved within 24 hours. This report validates the previous report on anabolic steroids inducing hiccups and exemplifies the ability for steroids as a class, due to there backbone structural homology, to induce function even as competitive inhibitors.

Adrenal Cortex Hormones↗