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Biomedical subjects

S H Greenblatt

Publications and source records attributed to S H Greenblatt.

At least 19 recordsLinked to original sources
PubMed1996

Incidence of seizures after surgery for supratentorial meningiomas: a modern analysis.

The authors have assessed the incidence of postoperative seizures in 158 patients with supratentorial meningiomas diagnosed by computerized tomography (CT) and/or magnetic resonance (MR) imaging, which theoretically should lead to early diagnosis and treatment and the potential for improved seizure outcome. Univariate chi-square and logistic regression analyses were performed 24 independent variables against the outcome variable of occurrence of a postoperative seizure. The median duration of preoperative seizures was 1 month, considerably shorter than that found in studies conducted prior to the advent of CT and MR imaging. Of 63 patients with a history of preoperative seizures, 40 (63.5%) had complete cessation of seizures after surgery. Twelve (92.3%) of 13 patients with one to three postoperative seizures eventually achieved complete seizure control, whereas only four (40%) of 10 patients with more than three postoperative seizures achieved this result. Overall 88.9% of patients with preoperative seizures achieved complete seizure control postoperatively. Multivariate analysis was used to identify six variables that were predictive of the occurrence of postoperative seizures: preoperative seizure history preoperative language disturbance, extent of tumor removal, parietal location of tumor, postoperative anticonvulsant medication status, and postoperative hydrocephalus. These variables were incorporated into a diagnostic model designed to predict the risk of a postoperative seizure following meningioma surgery. On the basis of their findings, the authors conclude that earlier detection and treatment of supratentorial meningiomas improve seizure outcome in patients with preoperative epilepsy. Furthermore an assessment of the risk of postoperative seizures may help guide decisions concerning weaning patients from anticonvulsant medications postoperatively.

Aged↗
PubMed1995

Phrenology in the science and culture of the 19th century.

In the last decade of the 18th century, Franz Joseph Gall of Vienna invented a combination of physiognomy and brain localization that he originally called "craniology" (the science of the head) and later called "organology" (the science of the organs of the brain). Between 1800 and 1812, he worked with Johann Christoph Spurzheim on a variety of important neuroanatomic studies to support this new science. By 1812, when they parted company in Paris, Spurzheim had become intrigued with the psychosocial potential of the undertaking, which he renamed "phrenology" (the science of the mind). Because a phrenological examination (palpation of skull prominences) could provide an analysis of a person's strengths and weaknesses, Spurzheim thought that his system could lead to personal improvement for everyone, including the laboring classes. He was thus a 19th century reformer, generally on the liberal side of the political and social spectrum. Spurzheim spread his gospel to Britain through several long lecture tours, and phrenology became briefly popular through the efforts of other British reformers, especially George Combe. In 1832, Spurzheim came to the United States. Three months later, he died in Boston, a martyr to his cause. Phrenology then spread widely into American popular culture, encouraged by the entrepreneurial efforts of "the phrenological Fowlers" and others like them. By 1843, the entire Western scientific community rejected organology and phrenology. All forms of cerebral localization were lumped with phrenology and similarly repudiated. Nonetheless, Gall's organology was the first comprehensive, premodern statement of a theory of cerebral localization. The early pioneers of modern localization, especially Paul Broca and David Ferrier, were careful to define how their theories differed from phrenology, even as they provided the clinical and scientific data that confirmed some of its basic tenets.

Culture↗
PubMed1994

Internal carotid artery thrombosis after cervical corpectomy.

SUMMARY OF BACKGROUND DATA: A 74-year-old man suffered an extensive right hemispheric infarct 72 hours after undergoing anterior corpectomies of the C4 and C5 vertebrae for cervical myelopathy resulting from ossification of the posterior longitudinal ligament. RESULTS: Angiography revealed proximal right internal carotid artery thrombosis with atherosclerosis and a normal left internal carotid artery. The thrombosis may have been due to stasis during lengthy retraction of an atherosclerotic carotid artery. CONCLUSIONS: Preoperative screening of internal carotid artery blood flow with Doppler ultrasonography is recommended before contemplating extensive anterior cervical surgery in middle-aged and elderly patients at significant risk for atherosclerotic disease.

Aged↗
PubMed1991

Clinical clerkships in neurosurgery and neurology at United States medical schools.

The neurology and neurosurgery clinical clerkship experience (excluding lectures and conferences) of the students in U.S. allopathic medical schools during one of the academic years 1986 to 1987 or 1987 to 1988 was surveyed. Almost all schools have at least some students taking these clerkships. The majority of students (78%) have clinical exposure to neurology, but only a minority (28%) take a neurosurgical clerkship; however, far more schools require their students to take neurology clerkships (54%) than neurosurgical clerkships (12%). A few require that either be taken. Overall, 81% of schools require all students to take at least one of these clerkships. For the most part, students taking a clerkship in either specialty do not do so again. The initial and usually unique exposure averages 3.5 weeks in neurology and 2.4 weeks in neurosurgery. For each specialty, required clerkships tended to be shorter than selective clerkships, which in turn were shorter than elective ones. Furthermore, first clerkships offered in the fourth year, whether they were required, selective, or elective, tended to be longer than the corresponding third-year first clerkships at other schools. Whereas the average length of a first clinical clerkship in neurology is almost as long for schools requiring it (3.4 wk) as for those that offer it as an elective or selective (4.0 wk), required neurosurgical clerkships are much shorter (1.5 wk) than elective or selective rotations (3.1 wk). Schools with residency training programs more frequently required students to a clerkship and, consequently, had greater numbers of students taking a clerkship in the corresponding specialty.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Clerkship↗
PubMed1991

The image of the "brain surgeon" in American culture: the influence of Harvey Cushing.

In contemporary American culture, the term "brain surgeon" conjures up the image of an intensely single-minded professional, who deals with terribly complex matters of life and death. These descriptors find their personification in Harvey Cushing, because they are derived directly from him. This hypothesis was tested by a complete search of the New York Times Index and the Reader's Guide to Periodical Literature for the years 1919 to 1942. All entries for Harvey Cushing were reviewed in the original sources. In the New York Times, Cushing's first significant exposure was in response to his winning a Pulitzer Prize in 1925. Major editorial coverage began in 1934, and was especially prominent with the publication of From a Surgeon's Journal in 1936. The process of lionizing Cushing by creating an overdrawn caricature reached its apotheosis in Time magazine in 1939. The Time article was actually a report of Cushing's 70th birthday party. It expounded all of the descriptors that are now associated with "brain surgeon". Thus, it was Cushing's literary skills that initially brought him recognition from editors who were arbiters of public opinion. This attention seems to have been the conduit to his mythologization by the larger public. Although unnamed, it is really Cushing's image that still persists as the prototypical "brain surgeon" in the collective American consciousness.

History, 20th Century↗
PubMed1990

Left occipital lobectomy and the preangular anatomy of reading.

Two patients had alexias after left occipital lobectomies. Case 1 was a 55-year-old man with a glioblastoma. At 4 months after surgery he could read slowly, but reading was neither efficient nor pleasant. Case 2 was a 19-year-old male who had a more restricted, medial occipital lobectomy for an encapsulated mesenchymal chondrosarcoma. The tumor did not invade brain initially, and the patient recovered efficient reading after 15 months. It is postulated that Case 2 was able to recover efficient reading because he still had a field of left ventrolateral occipitotemporal cortex connected to homologous cortex on the right.

Adult↗
PubMed1988

Anatomy of the human lumbar epidural space: new insights using CT-epidurography.

The anatomy of the lumbar epidural space was demonstrated in 40 patients by computed tomography (CT) examinations performed after epidural injection of noninonic radiographic contrast material into the sacral caudal canal via percutaneous catheter. Radiologic evaluation of the epidural space was performed to evaluate possible disc herniation or other pathologic encroachments on the epidural space. In all 40 patients, the examinations showed the posterior epidural space to be divided by the plica mediana dorsalis and an additional transverse connective tissue plane not previously described. The compartmentalized nature of the space may be, at times, responsible for entrapment and coiling of epidural catheters, despite satisfactory technical performance of catheterization for epidural anesthesia. Thirty-one of 40 patients demonstrated a greater amount of fatty tissue within the junctions of the posterior midline epidural connective tissue structures, producing a bulky triangular-shaped structure which might be an impediment to catheterization. The divisions of the anterior and posterior epidural spaces are seen to be more complex than previously described.

Epidural Space↗
PubMed1988

Cervical stabilization by plate and bone fusion.

Anterior stabilization with combined plate and bone fusion was performed after neural decompression on ten patients for spondylotic cervical myelopathy, and for radiculopathy or trauma in three patients. Medial corpectomy was performed at one to four levels. Iliac crest or fibular bone grafts were secured by plates anchored to the graft and adjacent vertebral bodies. All patients were placed in Minerva braces postoperatively. There was successful fusion in all cases, and no graft dislodgement or kyphosis. Early initiation of rehabilitation was achieved. Morbidity occurred in patients with severe spondylotic cervical myelopathy. This include respiratory depression requiring reintubation in 2/13 procedures, dysphagia (2/13) from loosening of the screws or prominent hardware and graft, and screw loosening (2/13). Neurological improvement was present in 85% (11/13) of patients. There was no deterioration of neurological function in any case. We conclude from this early follow-up that anterior bone fusion with supplemental plates provides effective stabilization for the unstable cervical spine. Greater morbidity risk exists in patients with severe spondylotic cervical myelopathy and spastic quadriparesis who required multilevel medial corpectomies and fusion.

Adult↗
PubMed1987

Computed tomography application to lumbar epidurography.

The application of current-generation computed tomography scanning to lumbar epidurography has resulted in a better appreciation of epidural anatomy and improved ease of interpretation of non-ionic contrast material within the epidural space. The development of extended window width has greatly improved imaging of the more variable levels of attenuation encountered in contrast material within the epidural space. The procedure of distribution of contrast material by catheter technique via the sacral canal approach is described. The experience obtained on examination of 24 patients is discussed, along with the possible adjunctive and primary roles of this type of imaging in evaluation of the lumbar spine.

Catheterization↗
PubMed1987

Computed tomography-guided intracranial biopsy and cyst aspiration: accumulated experience in 60 patients.

We have reviewed our continued experience with computed tomography guided freehand percutaneous brain biopsy using a needle guide sheath of our own devising. The guide sheath is equipped with small metallic marker beads and throws no artifacts. It is useful in demonstrating the exact tip of the guide biopsy sheath in relation to the wall of the intracerebral lesion. The deforming response of the target lesion wall to the guide sheath and the biopsy needle is easily seen using our technique and is highly correlated to obtaining a satisfactory pathologic specimen. Combination of this guide sheath with a suitable computed tomography compatible head frame may represent a highly accurate and reliable but relatively simple guidance system.

Biopsy, Needle↗
PubMed1984

The multiple roles of Broca's discovery in the development of the modern neurosciences.

Using the classical clinico-anatomical correlation method of the French clinical school, Paul Broca confirmed the localization of "language" in the frontal lobe. He actually discovered the lateralization of language in the left hemisphere. These contributions eventually led to the demise of the older concept of the "sensorium commune," because Broca's ideas implied the presence of motor functions in the hemispheres. Although Broca worked within the theoretical motif of the "faculty" psychology, the reflex-oriented "associationist" psychology soon became the predominant theoretical framework of localization, because it accommodated the motor aspect of hemispheric function. Since Broca's time, the study of the biology of language has proceeded along two parallel but sometimes separate lines in the experimental and clinical traditions.

Dominance, Cerebral↗
PubMed1984

Foster Kennedy syndrome and an optociliary vein in a patient with a falx meningioma.

We describe a 51-year-old woman with a falx meningioma causing Foster Kennedy syndrome accompanied by optociliary shunt vessels on the atrophic optic nerve. The tumor did not directly involve optic nerves or chiasm. The optociliary vessels disappeared after successful tumor removal. The patient's arteriograms, surgical findings, and postoperative course support the theory that optic atrophy in Foster Kennedy syndrome may be caused by compression of the optic nerve by adjacent brain tissue displaced by a distant intracranial mass lesion.

Ciliary Body↗